Intracranial Hemorrhage as a Predictor of Occult Cervical-Spine Fracture

Study objective: To determine whether intracranial hemorrhage is a predictor of occult cervical-spine fracture. Design: A prospective, cross-sectional study. Setting: University-affiliated Level I trauma center. Participants: Ninety-three blunt trauma victims with a Glasgow Coma Scale score of 12 or less. Exclusion criteria were incomplete radiographic evaluation caused by hemodynamic instability, death, or other reasons. Interventions: The study protocol required that all patients undergo a five-view cervical-spine trauma series, head computed tomography (CT), and upper cervical-spine CT. Cervical-spine radiographs and CT scans were read by two radiologists blinded to each other's interpretations. The results were compared with each patient's head CT diagnosis. Medical records were reviewed for demographic information and mechanism of injury. Results: Of the 93 patients, 54 had intracranial hemorrhage noted on CT scan; two of these patients had an upper cervical-spine fracture, but only one was an occult cervical-spine fracture. Thirty-nine patients had no intracranial hemorrhage; two patients had an upper cervical-spine fracture, but only one had an occult cervical-spine fracture. Fisher's exact test showed no significant difference between the rate of occult cervical-spine fracture between patients with and without hemorrhage. Conclusion: Despite a high percentage of patients with traumatic intracranial hemorrhage, our study failed to demonstrate that intracranial hemorrhage is predictor of occult cervical-spine fracture. [Frye G, Wolfe T, Knopp R, Lesperance R, Williams J: Intracranial hemorrhage as a predictor of occult cervical-spine fracture. Ann Emerg Med April 1994;23:797-801.]