CAUSES OF DEATH FOR PATIENTS WITH CERVICAL  SPINE INJURIES (CSI)

Chung, Ho Sung; Kim, Sang Eun; Lee, Jun Hyung; Park, Cheol Wan; Lee, Keun

J Korean Soc Emerg Med > Volume 7(1); 1996 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 1996;7(1): 90-97.

CAUSES OF DEATH FOR PATIENTS WITH CERVICAL SPINE INJURIES (CSI)

Ho Sung Chung, Sang Eun Kim, Jun Hyung Lee, Cheol Wan Park, Keun Lee

Department of Emergency Medicine. Chung Ang Gil Hospital, Inchon, Korea

Published online: March 31, 1996.

ABSTRACT

Mortality after cervical spine injury(CSI) is reported as high as 10~30%, and it is intimately related to the initial management and cardiopulmonary function. We analyzed the cause of death for 29 patients who expired at Chung Ang Gil Hospital after CSI between 1900 and 1994. Of 198 patients with CSI, 43 patients(21.7%) died. Except 14 cases with concomitant fatal head injury and/or multiple systemic injuries, the mortality rate of CSI was 14.6%. Male to female ratio was over 6:1. Fourth to sixth decades constituted 69.0%. Common causes of CSI were traffic accidents(58.6%) and fall/slip(34.5%). The level of CSI was above C5(upper cervical group : UCG) in 65.5%, and below C4(lower cervical group : LCG) in 34.5%. Most of them(86.2%) died within four weeks after CSI. Early death(within 7 days) was more common in the UCG(57.9%) than the LCG(20.0%). Associated injuries were found in 72.4%, and the head injury was the most common one. The higher the Injury Severity Score(ISS), the earlier the patients expired(Fisher's test, P<0.05). On arrival, hypotension(systolic blood pressure below 90 mmHg), bradycardia(less than 60/min), and respiratory arrest was found in 31.0%, 34.5% and 17.2%, respectively. The episode of bradycardia was found in 58.6%. It was more common in cases of early death(69.2%) than those of the late death(50%). Hypoxia, hypercarbia, and acidosis was observed in 20.7%, 17.2%, and 51.7%, respectively. Respiratory failure was responsible for the majority(89.7%) of death. In UCG and the cases of the early death, primary respiratory dysfunction was the main cause of death, while in LCG and the cases of the late death, pulmonary complication was the major reason(Fisher's test P<0.01, P<0.01, respectively).

Key words: Cervical spine injury, Mortality, Cause of death