C-Spine Injury Associated with Gunshot Wounds to the Head: Retrospective Study and Literature Review

Lanoix, Richard; Gupta, Rajesh; Leak, Lee; Pierre, Jean Lookens

doi:10.1097/00005373-200011000-00011

Cited by 29 publications

(21 citation statements)

References 15 publications

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“…12 This is despite reports in literature that emphasizes the need to address life threatening injuries before the concern for immobilizing the neck as instability from the initial missile injury is rare. [13][14][15][16] For example, in patients with isolated GSW to the head, although there are reports that immobilization and diagnostic radiography is of minimal use, [17][18][19] Kaups et al, demonstrated that airway management was compromised by cervical immobilization as more intubation attempts occurred with cervical spine immobilization than without. 20 The emphasis of the mechanism of injury and its association with cervical spinal injuries would also be beneficial to the military where penetrating injury is the predominant mechanism.…”

Section: Discussionmentioning

confidence: 99%

Cervical Spine Injury is Highly Dependent on the Mechanism of Injury Following Blunt and Penetrating Assault

Rhee

Kuncir

Johnson

et al. 2006

The Journal of Trauma: Injury, Infection, and Critical Care

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Section: Discussionmentioning

confidence: 99%

Cervical Spine Injury is Highly Dependent on the Mechanism of Injury Following Blunt and Penetrating Assault

Rhee

Kuncir

Johnson

et al. 2006

The Journal of Trauma: Injury, Infection, and Critical Care

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“…In fact, in those studies that included all penetrating injuries (GSW and stab wounds), the majority indicated that most, if not all, of the spine injuries occurred in patients sustaining a GSW rather than stab wounds. 14,26,28,31 However, a subset analysis could not be performed on spinal injury in patients sustaining stab wounds because this group was not separated in most of the studies that reported both GSWs and stab wounds. Based on the studies in our analysis, the incidence of spinal injury in patients with isolated stab wounds is very low, and it is unlikely that PHSI in stab wound patients is of any benefit from a clinical and an economic standpoint.…”

Section: Discussionmentioning

confidence: 99%

Cost-utility analysis of prehospital spine immobilization recommendations for penetrating trauma

Garcia

Liu

Victorino

2014

Journal of Trauma and Acute Care Surgery

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BACKGROUND:The American College of Surgeons' Committee on Trauma's recent prehospital trauma life support recommendations against prehospital spine immobilization (PHSI) after penetrating trauma are based on a low incidence of unstable spine injuries after penetrating injuries. However, given the chronic and costly nature of devastating spine injuries, the cost-utility of PHSI is unclear. Our hypothesis was that the cost-utility of PHSI in penetrating trauma precludes routine use of this prevention strategy. METHODS:A Markov model based cost-utility analysis was performed from a society perspective of a hypothetical cohort of 20-year-old males presenting with penetrating trauma and transported to a US hospital. The analysis compared PHSI with observation alone. The probabilities of spine injuries, costs (US 2010 dollars), and utility of the two groups were derived from published studies and public data. Incremental effectiveness was measured in quality-adjusted life-years. Subset analyses of isolated head and neck injuries as well as sensitivity analyses were performed to assess the strength of the recommendations. RESULTS:Only 0.2% of penetrating trauma produced unstable spine injury, and only 7.4% of the patients with unstable spine injury who underwent spine stabilization had neurologic improvement. The total lifetime per-patient cost was $930,446 for the PHSI group versus $929,883 for the nonimmobilization group, with no difference in overall quality-adjusted life-years. Subset analysis demonstrated that PHSI for patients with isolated head or neck injuries provided equivocal benefit over nonimmobilization. CONCLUSION:PHSI was not cost-effective for patients with torso or extremity penetrating trauma. Despite increased incidence of unstable spine injures produced by penetrating head or neck injuries, the cost-benefit of PHSI in these patients is equivocal, and further studies may be needed before omitting PHSI in patients with penetrating head and neck injuries. (J Trauma Acute Care Surg. 2014;76: 534Y541.

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“…These findings are similar to those of previous reports. 6,7 In cases of solitary gunshot wound to the head, there appears to be no need for radiographic clearance of the spine, and cervical spine protection is therefore not necessary. A high index of suspicion and careful radiographic evaluation of the spine is however recommended after gunshot wound to the face because asymptomatic injuries were common when significant spine injury was present.…”

Section: Discussionmentioning

confidence: 99%

Spine Injuries Are Common Among Asymptomatic Patients After Gunshot Wounds

Klein

Cohn

Soffer³

et al. 2005

The Journal of Trauma: Injury, Infection, and Critical Care

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C-Spine Injury Associated with Gunshot Wounds to the Head: Retrospective Study and Literature Review

Abstract: C-spine immobilization and diagnostic radiography are probably not necessary in patients with isolated GSWs to the head and may complicate and delay emergency airway management.

Cited by 29 publications

References 15 publications

Cervical Spine Injury is Highly Dependent on the Mechanism of Injury Following Blunt and Penetrating Assault

Cervical Spine Injury is Highly Dependent on the Mechanism of Injury Following Blunt and Penetrating Assault

Cost-utility analysis of prehospital spine immobilization recommendations for penetrating trauma

Spine Injuries Are Common Among Asymptomatic Patients After Gunshot Wounds

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