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Cases were included meeting the criteria age 16 years or older, nonpenetrating trauma, and experiencing neurologic deterioration during prehospital or emergency department (<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>) care prior to definitive management (e.g., discharge, spinal clearance by computed tomography, admission to an inpatient service, or surgical intervention). Results were qualitatively analyzed for characteristics and themes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty\u2010one qualifying cases were identified from 12 papers. In 30 cases, the new deficits were apparently spontaneous and were not detected until routine reassessment. In 12 cases the authors did attribute deterioration to temporally associated precipitants, seven of which were possibly iatrogenic; these included removal of a cervical collar, placement of a halo device, patient agitation, performance of flexion\/extension films, \u201cunintentional manipulation,\u201d falling in or near the <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>, and forced collar application in patients with ankylosing spondylitis. Thirteen cases occurred during prehospital care, none of them sudden and movement\u2010provoked, and all reported by a single study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Published reports of early secondary neurologic deterioration after blunt spinal trauma are exceptionally rare and generally poorly documented. High\u2010risk features may include altered mental status and ankylosing spondylitis. It is unclear how often events are linked with spontaneous patient movement and whether such events are preventable.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.12765","type":"journal-article","created":{"date-parts":[[2015,9,23]],"date-time":"2015-09-23T02:04:11Z","timestamp":1442973851000},"page":"1200-1212","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Early Secondary Neurologic Deterioration After Blunt Spinal Trauma: A Review of the Literature"],"prefix":"10.1111","volume":"22","author":[{"given":"Brandon","family":"Oto","sequence":"first","affiliation":[{"name":"University of New England Portland ME"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"II","given":"Domenic John","family":"Corey","sequence":"additional","affiliation":[{"name":"Northeastern University Boston MA"},{"name":"Cataldo Ambulance Service, Inc. 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