Road traffic accidents are the second most common cause of admission for trauma to the University Hospital of the West Indies (9). The 2017 annual traffic crash report of Jamaica found 321 persons were killed as a result of 292 motor vehicle crashes (10). Victims of motorcycle collision and motorbike collision sustain serious injuries (9). A study done by Ward et al. examined the cost of violence-related injuries in Jamaica (11). The total cost of violence related injuries in 2014 was JMD $3.6 billion which represents 22% of the health budget of Jamaica. Trauma plays an important role in the financial burden of the health system (11).
This study showed that the majority of patients (46.4%) presenting with potential cervical spine injury was caused by motor vehicle collisions. The second most common presenting cause was motorbike collisions representing 23.8% of patients. In total 76.7% of the potential injuries were as a result of road traffic accidents. When males were compared to females, males presented more frequently with a ratio of 3:1. This study’s findings is in keeping with other studies done within Jamaica and worldwide.
We found the NEXUS Low-Risk Criteria was used more often than the CCR in deciding the need for radiograph in the emergency department of the University Hospital of the West Indies.
In a study done by Elseton et al., and another done by Poonnoose et al., the overutilization of cervical spine imaging by emergency physicians despite the recommended use of the NEXUS Low-Risk criteria and CCR was found (12). Overutilization was also shown in this study with the performance of 243 (55%) cervical spine X-Rays in patients without the application of a clinical decision rule.
Of the 806 patients who were studied, 20 (2.48%) of these had a cervical spine injury. The average age of a patient with injury was 36.8 years with a male to female ratio of 6:1. The NEXUS Low-Risk criteria were applied to 11 of these patients, and nine patients had pathologies which were diagnosed without the application of criteria. Motor collisions (motorbike collisions and motor car collisions) were the most common mechanism of injury 14 patients (70%) were the most common mechanism of injury found.
In a study done by Dickinson et al. (n = 8,924), cervical spine injuries were found in 14 (0.16%) patients; this percentage was significantly smaller than 2.48% found in this study. The average age of patient with injury was 56.57 years with a male to female ratio of (2:1), this study had an average age of 36.8 years representing a younger population. Fall from height was the most common mechanism to cause injury to the cervical spine; it represented 71.41% in comparison to this study which was represented by motor collision 70.0%. The other two mechanisms of injury in the study by Dickinson et al. were motor vehicle collisions and trampled by horse 21.48% and 7.14% respectively (13).
The cervical spine injuries which resulted from motor collision occurred at C2-7. The injuries caused by motor collisions were, displacements, teardrop fracture, spinous process fracture, facet and laminar fracture, open transverse process fracture, compression fracture, and comminuted fracture. Other injuries associated with motor collision were a frontal bone fracture, subgleal hematoma, fracture of the 5th proximal phalanx, left femur fracture, left forearm fracture, left fibula fracture, multiple vertebral fractures, and right femoral fracture.
The two methods of cervical spine treatment used in this study were internal fixation and the application of a rigid collar. Internal fixation was applied in four (20%) of patients, and treatment with a rigid collar was documented in only four (20%) of the patients. The majority of these patients 60% had no treatment used documented. All patients presenting to the University Hospital of the West Indies with head or neck injuries will have stabilization of their cervical spine. This is mostly done with the application of a rigid (hard) cervical collar. Lack of documentation may account for most patients having had no treatment recorded for their cervical spine injury. When compared to the study done by Dickinson et al., their methods of treatment were a hard collar, halo, internal fixation and soft collar representing 57.14%, 21.43%, 14.29% and 7.14% respectively (13).
The most common types of injuries to the cervical spine were fractures and dislocations to the C3-7 region (3). Injuries to the cervical spine occur most commonly at two points. One half are found at C5-7 region and one third at C-2 (14). The most common cervical spine vertebrae fracture in this study were C5 and C-6 (45%). A study on spinal injuries done by Bruce et al., at the University Hospital of the West Indies showed C-6 to be the cervical vertebra most commonly fractured, (15). Other common injuries found in the study by Bruce et al., were to the lumbar spine and the thoracic region (15).
In this retrospective study, a limitation was that some of the dockets could not be found. Of 1,380 medical record numbers collected from the Emergency Department logbooks, only 887 dockets were recovered from the library.