Prevalence, and computed tomographic findings of cervical spine injury among adult head trauma patients at tertiary hospitals in Kampala.

Abstract

Trauma are one of the neglected key areas in the healthcare management system yet they account for 9% of global death which is equivalent to almost twice the burden of HIV, and T.B combined. Cervical spine injuries of variable severity are common among patients with an acutetraumatic brain injury (TBI) and studies reported 18 to 40 % of individuals with cervical spine injuries will have moderate to severe head injuries. Objectives: To determine the prevalence of Cervical Spine Injuries, CT scan findings and risk factors to occurrence among adult head trauma patients. Methods: This was a cross sectional study. Structured questionnaire was administered to collect sociodemographic, clinical presentations, mechanism of injury, and others. Volumetric axial CT scan images were used to identify cervical spine injury. Data was collected using Epidata and exported to STATA 16 for analysis. Result: Of the whole cranio-cervically CT-imaged sample (n=376), In terms of head trauma severity nearly half of cases are classified as mild TBI (49.7%), followed by moderate TBI (27.4%) and severe TBI (22.9%). The leading mechanisms of trauma were road traffic accidents (65.2%), falls from height (12.5%), and violence/assault (19%), with a small percentage attributed to other/nonspecific causes (3.3%). the prevalence of Cervical Spine Injury among patients with head trauma was 10.37% (95% CI: 0.0760-0.1314). The patients with Severe TBI (low GCS), neck pain, intraparenchymal hemorrhage had significantly increased likelihood of cervical spine injury. Cervical spine fractures were observed at various levels, C1 was the most common involved axial cervical spine(C1 and C2). C4 was the most common involved subaxial cervical spine (C3-C7). Eight patients had more than one level of CSI, with C1 and C2, C4 and C5, and C5 and C6 representing the more common combination of injury. Conclusion: Adult Head trauma patients with low GCS, Intraparenchymal hemorrhage and neck pain have a high risk for cervical spinal injury. Based on the study findings physicians should ask for head and cervical spine CT or better still the imaging personnel should always include the cervical spine if the indication is head trauma.