Original ContributionNeck collar used in treatment of victims of urban motorcycle accidents: over- or underprotection?☆
Introduction
Cervical spine protection is of vital importance in patients who have sustained trauma. Patients with traumatic spinal cord injuries have worse outcomes and increased overall mortality compared with the general population [1]. According to previous studies, most cervical spine injuries come from falls, violence, sports, or motor vehicle crashes [2], [3], [4], [5], [6]. The epidemiology may differ from region to region [7], [8]. Different trauma mechanisms may cause varying severity of injuries and result in different treatment. Although a neck collar applied at the scene is the first priority for proper management, there is no solid evidence of the benefit of this when applied in blunt cervical spine injury in asymptomatic patients with a significant mechanism of injury. Therefore, the role of neck collar application in asymptomatic patients with different mechanisms still remains controversial [9].
Lightweight motorcycles (engine size <150 mL) are the major form of urban transportation in many cities of Asia and Europe. Unlike the United States, where the speed limit may be up to 75 mile/h (120 km/h) on the highway for road motorcycles, the speed limit in Taiwan is 50 km/h and is seldom exceeded owing to heavy traffic. The different speeds may result in different injuries and outcome. According to the official records of the Ministry of Transportation and Communication of Taiwan, in August 2009, there were 14 421 784 motorcycles in Taiwan. This density was the highest in the world, with 1 motorcycle for almost every adult. Consequently, more than 40% of motor vehicle accidents are motorcycle based. With motorcycles being the main transportation tool, lightweight motorcycle accidents are one of the major causes of blunt cervical spine injury. Incidence of this injury is variable in the previous literature [4], [8], [10]; however, a few studies have dealt with the epidemiology and management of this injury in lightweight motorcycle accidents [11]. Moreover, although immobilization of the cervical spine remains the first priority as suggested by some previous studies, the efficiency of the cervical collar when applied in such cases remains unknown in trauma patients.
In this study, we analyzed the epidemiology and management of cervical spine injuries of lightweight motorcyclists in an expansive urban area and discuss the efficiency and results of neck collar application in these patients. We hypothesize that people sustaining lightweight motorcycle accidents in urban areas are less susceptible to cervical spine injury and that injuries to the cervical spine are less severe because of lower speed impact. Thus, the protocol of neck collar application might also be reevaluated.
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Patients and methods
All patients in this study were retrospectively collected from a 1200-bed hospital in southern Taiwan from January 1, 2008, to December 31, 2009. The study hospital provides medical center–level health care and serves approximately 1.5 million people within the Kaohsiung City metropolitan area in southern Taiwan. All trauma registry data from the hospital, where all patients were evaluated according to the National Emergency X-Radiography Utilization Study (NEXUS) for cervical spine images,
Results
During the study period, 30 835 trauma patients visited our ED. Of the 8633 motorcycle crash victims, 26 patients had traumatic cardiac arrest, 1239 patients were transferred to or from other facilities, 831 patients had incomplete data, and 1398 patients who did not follow-up were excluded. A total of 2319 female patients and 2820 male patients had complete data and were included in our study. Mean age was 38 years (age range, 10-96 years). The average time from scene to ED was 14.11 ± 7.16
Discussion
For the lightweight motorcyclists in an urban area, our study demonstrated that when a traffic accident happened, cervical spine injury was not common. However, a neck collar had been applied to half of these patients by our EMTs according to either their immobilization protocols or uncertainty of the injuries. In addition, our study showed that most of the cervical spine injuries involved more than 2 vertebrae; but three quarters of these particular cases had stable injuries and could be
Limitations
Our study has several limitations. First, it is a single-institution experience and may reflect the characteristics only of local patients. However, the hospital is located in the central area of the city; and most patients were brought to the hospital directly without diversion. The average time of patients being brought by EMTs from scene to hospital was short; therefore, our patients may represent the population of motorcyclists in the urban area. In addition, our study is retrospective; and
Conclusion
The incidence of cervical spine injuries in urban area lightweight motorcycle accidents is very low. Although the injuries often involve more than 2 vertebrae, most cervical spine injuries present as stable. Patients who remain clearly conscious without neurologic deficiency, neck pain, or supraclavicular lesion may not need the cervical collar brace or restraint at the scene. Our study also suggested that prehospital protocol for cervical collar brace application in people sustaining
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This study was supported by a grant from the Kaohsiung Medical University Hospital (KMUH98-8G26).
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The first 2 authors have equal contribution in this work and are both equally considered as first author.