A game day plan can reduce consequences of catastrophic spine injuries

Having an on-field plan for the treatment of a traumatic spinal injury saves time and may keep the athlete’s condition stable.

PHILADELPHIA — Although catastrophic injuries to the spine are rare in youth who participate in sports, having a game day, pre-hospital treatment plan in place is still essential when covering these sports, according to a physician who spoke on the topic at the American Academy of Neurology Annual Meeting, here.

“It is imperative to have standard guidelines and communication. This is key. But, game day on the field is not the place to decide who is in charge. I have seen unorganized approaches in the past and it is not pretty. This is something that needs to be practiced. There needs to be a plan in place for these injuries,” Tad D. Seifert, MD, director of the Sports Concussion Program at Norton Healthcare, in Louisville, Ky., said.

Tad D. Seifert

During his presentation, Seifert discussed a study by the National Center for Catastrophic Sports Injury Research that detailed the number of catastrophic spinal injuries in nonprofessional football from 1982 to 2009. Pop Warner youth football had two reported incidents, high school football had 60 reported incidents, and college football had one reported incident of a catastrophic spine injury during that period.

According to Seifert, 104 direct fatalities have occurred due to catastrophic spine injuries in nonprofessional football during the same time period.

Cervical fractures, one type of catastrophic spine injury, have multiple presentations. These include paralysis, neck pain/rigidity, paresthesia, loss of consciousness, respiratory compromise and neurogenic shock, he said.

At risk players

However, quadriplegia incidents in nonprofessional football have been on the decline since 1975, Seifert said. Thirty-two such incidents occurred that year, but only four incidents occurred in 1995. The vast majority of the quadriplegia incidents — 80% — occurred when an athlete attempted to make a tackle. Being tackled was the second greatest cause of quadriplegia, which occurred in 10% of quadriplegia cases in athletes, he noted.

Seifert explained that the vast majority of quadriplegia incidents in football affect defensive backs, with more than 44% of these injuries occurring in those defensemen. The position played that has the second greatest risk for an injury that results in quadriplegia is an athlete who plays on special teams. More than 18% of those athletes sustained such an injury, according to the statistics Seifert cited.

Organization is key

Seifert said it is important for medical officials at each game to practice their routine for on-field and pre-hospital treatment of an athlete who may have suffered a catastrophic spine injury, such as a cervical fracture.

“Injuries to the cervical spine in sport are uncommon, but can result in devastating consequences,” Seifert said.

The primary survey the physicians should use for emergency care on the field is the ABC protocol — airway, breathing and circulation, Seifert said. Transportation to a hospital should already be in place, and the physician must have the ability to remove the facemask of the injured athlete, if necessary, for the primary survey. – by Robert Linnehan

Reference:

Seifert TD. Session #C82. Presented at: American Academy of Neurology Annual Meeting; April 26-May 3, 2014; Philadelphia.

For more information:

Tad D. Seifert, MD, can be reached at Norton Neurology Services, 3991 Dutchmans Lane, Louisville, KY 40207; email: tad.seifert@nortonhealthcare.org.
Disclosure: Seifert has no relevant financial disclosures.