ABSTRACT

Purpose:

To assess the need for repeated x-ray and computed tomography (CT) of the thoracic spine for routine clearance of multi-trauma cases in Intensive Care Unit (ICU).

Methods:

Six cases were consulted by aut-hor at mean 3 days (range 2- 6 days) after ad-mission to the ICU. The median age was 37 years (range 23-54). The charts and first chest radiographies of cases were reviewed. The ne-urological assessment was done using the Frankel scale and fractures were classified ac-cording to Magerl.

Results:

Thoracic spine fractures were not shown on first chest radiographs. Repeated x-rays and CT of the thoracic spine showed fractures of the vertebrae. The average Injury Se-verity Score was 32,16 ± 4,30. Other injuries noted at the time of presentation included: Lung contusion(2), lung laceration(1), haemotho-rax6), multiple rib fractures(5), maxillofacial tra-uma(1) and extremity trauma.

The mean duration of artificial ventilation was 7,5 days (range 2-18 days) and of ICU tre-atment was 13 days (range 4-24 days). Missed thoracic fractures were consisted of type A3 in two cases (T6 and T7), type B1 and B2 in two cases (T4 and T9), type C1 in one case (T9) and gunshot injury in one (T9). Neurological le-sions were Frankel A in 5 cases and Frankel E in 1 case at first evaluation. Five of 6 cases we-re operated, 4 presenting complete paraplegia and one neurologically intact, only two of 4 complete paraplegic cases made a neurological improvement from Frankel A to E and one case’s status in whom neurologically intact re-mained normal. One case that had complete paraplegia was treated conservatively and the-re was no difference his neurological status at follow up. One case died at follow-up due to pulmonary emboli.

Conclusion:

The radiological signs may be minimal or absent during the first assessment of thoracic spinal fractures. Most importantly, a full neurological examination may not feasible at the time of injury in multi-traumatized pati-ents. This fact has implications for the nursing care of such cases in the ICU. CT is warranted in these cases.