A study of the pattern of cervical spine injuries in head injured patients as seen at the Kenyatta National Hospital.



The study is a cross sectional prospective study was carried out on the pattern of cervical spine injury in head injured patients as seen at Kenyatta National Hospital (KNH).

The aims and objectives of the study were to determine the relative frequency of cervical injury in head injured patients, the age and sex distribution, the pattern of cervical spine injuries as related to the cause and severity of head injury and the pre hospital care given to protect the cervical spine before arrival at KNH.

All patients with head injury admitted to KNH, who qualified for the study, and consented to participate, were recruited. Demographic  information (age, sex) and clinical information( cause of head injury, evidence of intoxication, pre-hospital care given, level of consciousness, neurological deficit, Neck pain or tenderness, Type and area of scalp injury, and all other relevant parameters) were then obtained.

Investigations done were mainly plain radiography (three views for the skull and a lateral, antero-posterior and odontoid view for the cervical spine). CT scan was obtained where possible.

Three hundred and sixty one cases were recruited over a period of 10 weeks. Of this number 19, (5.3%) were found to have cervical spine injury. Most of the head injuries were secondary to assault (51%), followed by road traffic accidents (41%) while fall from height was 7.8%. Road traffic accidents contributed 57% of all the cervical spine injuries seen.

Most of those having heads injuries were male (90%) and 10% were female, however 26% of the cervical spine injuries seen were female while 74% were male. The peak age range for cervical spine injury was 21 to 35 years. The youngest was 4.5 years and the oldest 65 years. KNH was the primary hospital for 94% of all head injuries seen. None had any form of cervical spine protection on arrival. Only 18%of those referred from other hospitals had cervical collars on arrival at the Accident & Emergency department of KNH.

The majority (78%) of the cervical spine injuries were in the lower cervical spine (C3 to C7) with 22% in the upper cervical region (C1 to C2).Only one patient had spinal cord injury- which was mild.

The incidence of cervical spine injury in head injured patients at KNH is 5.3%. For most of these patients (94%)  KNH is the primary hospital; none of these patients at presentation have any cervical spine protection. Females with head injury were found to be significantly more at risk of having cervical spine injury compared to the males.

There is very poor pre-hospital care of the cervical spine. A lot of emphasis on teaching the basic care of the injured and cervical spine immobilization, to the public, police and first aid providers is recommended.

A post mortem study of fatal head injuries would reveal the incidence and severity of cervical spine injury in this group.