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Master Thesis

Prise en charge des traumatismes cervicaux à la phase initiale en Guadeloupe, bénéfices et risques d’une immobilisation cervicale systématique

Abstract : Background : Cervical immobilization with a rigid collar is a key point in the management of traumatized patients from pre-hospital care. However, vertebral and spinal cord injuries are rare and studies questioning this method’s effectiveness are increasing. The principal objective of our study was to measure the prevalence of cervical lesions justifying the wearing of a rigid collar at the emergency unit in Guadeloupe in 2019. Methods : This prospective, multicentric, descriptive study was conducted from September 15 2018 to January 15, 2019 at the Pointe-à-Pitre Hospital Center (CHU) and at the Eaux-Claires Clinic. All the adults over 18 years old who were admitted with a rigid collar at the emergency department and who were not presenting vigilance disorders were included. We first conducted a prevalence survey of cervical lesions. Then, uni and multivariate logistic regression analyzes were used to determine the risk factors for cervical lesions. Finally, a survival analysis was used to determine the risk of side effects depending on the time of application of the collar adjusted on the other factors. Results: Among the 99 patients included, we measured a prevalence of cervical lesions of 4.09%. Three fourth of our patients presented side effects of their cervical collar (73 said they were embarrassed and 23 had skin damages). The side effects of the collar increased with the duration of application. Finally, 66% of the imaging examinations performed were not justified, of which 24% were non-recommended X-rays. Conclusion: Although spinal injuries can have devastating consequences, these are rare in the injured population. Our datas confirm a low prevalence of injuries among traumatized patients. Thus, the higher number of road accidents in Guadeloupe and particularly violent accidents probably explain the higher prevalence of injuries compared to the datas of the literature. The benefits of the cervical collar are debatable especially since it has many side effects. It is necessary to carry out additional studies in order to improve pre-hospital care protocol in Guadeloupe and to optimize requests for additional imaging examinations.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02874161
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Submitted on : Thursday, June 18, 2020 - 6:43:33 PM
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Camille Lorzil. Prise en charge des traumatismes cervicaux à la phase initiale en Guadeloupe, bénéfices et risques d’une immobilisation cervicale systématique. Médecine humaine et pathologie. 2019. ⟨dumas-02874161⟩

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