Arvo building, Lecture room F025, address: Arvo Ylpön katu 34.
Doctoral defence of Lic.Med. Tuomo Thesleff
The field of science of the dissertation is Neurosurgery.
The opponent is professor Iver Arne Langmoen (University of Oslo, Norway). Professor Juha Öhman acts as the custos.
The language of the dissertation defence is English.
Simple falls lead to fatal cervical spine injuries
Cervical spine injury (CSI) is a serious condition which may cause permanent disability or even death. In countries with similar population demographics to Finland, the annual incidence of CSI is approximately 9-17/100,000 inhabitants. The most common injury mechanisms leading to CSIs are traffic accidents and falls. CSI diagnostics are based on a prompt clinical assessment and the utilization of radiological imaging.
This study showed that in Finland, the incidence of fatal CSI increased between 1987 and 2010 to approximately 20/million/year. The mean age of patients with fatal CSIs increased dramatically from approximately 50 to 70 years. Falls exceeded traffic accidents as the predominant cause of CSIs in 1998. Moreover, alcohol contributed to one third of CSIs. The other major finding was that the frequency of diagnostic errors and other adverse events increased slightly during the study period despite improvements in radiological services and advancements in medical care in general. Diagnostic errors were most commonly associated with high patient age and ground-level falls. In the emergency department setting (among patients with head injury), those with traumatic brain injury visible in a computed tomography scan, high-energy injury mechanism, high age, and facial fractures, had an increased risk of concurrent cervical spine fractures. The second cervical vertebra, the axis, was the most commonly injured vertebra.
Epidemiological data, and data on diagnostic errors and other adverse events were obtained from the death certificates of cervical spine-injured patients (n=2,041), that were issued in Finland between 1987 and 2010. Risk factors for cervical spine fractures in head-injured patients were evaluated from patients treated at the Tampere University Hospital´s emergency department between 2010 and 2012. The original emergency department sample included 3,023 consecutive patients who underwent head computed tomography due to an acute head injury.
This thesis confirms the changing demographics in cervical spine trauma. The incidence of fatal CSI is not decreasing despite improved traffic safety and general health of people. Low-energy falls by elderly men have contributed most to the number of fatal CSIs in recent years. Alcohol is a major risk factor for fatal CSI especially among young men. CSI diagnostics continue to be challenging despite the wide availability of computed tomography and magnetic resonance imaging. It is expected that the incidence of CSIs will increases in Finland due to the growing number of elderly people. Fall prevention measures should be actively implemented to prevent some of these injuries. Furthermore, it should be emphasized that the diagnostics of geriatric CSI is challenging and prone to errors.
The dissertation is published in the publication series of Acta Universitatis Tamperensis; 2333, Tampere University Press, Tampere 2017. The dissertation is also published in the e-series Acta Electronica Universitatis Tamperensis; 1838, Tampere University Press 2017.