Spinal Injury Associated With Firearm Use

Abstract

Injuries associated with firearms are a significant health burden. However, there is no comprehensive study of firearm spinal injuries over a large population. It was the purpose of this study to analyze the demographics of spinal firearm injuries across the entire United States for all ages using a national database. Methods A retrospective review of prospectively collected data using the Inter-University Consortium for Political and Social Research Firearm Injury Surveillance Study 1993-2015 (ICPSR 37276) was performed. The demographic variables of patients with spinal injuries due to firearms were analyzed with statistical analyses accounting for the weighted, stratified nature of the data, using SUDAAN 11.0.01™ software (RTI International, Research Triangle Park, North Carolina, 2013). A p-value of < 0.05 was considered statistically significant. Results For the years 1993 through 2015, there were an estimated 2,667,896 emergency department (ED) visits for injuries due to firearms; 10,296 of these injuries (0.4%) involved the spine. The vast majority (98.2%) were due to powder firearm gunshot wounds. Those with a spine injury were more likely to have been injured in an assault (83.7% vs. 60.2%), involved a handgun (83.5% vs. 60.2%), were male (90.8% vs. 86.4%), were admitted to the hospital (86.8% vs. 30.9%), and were seen in urban hospitals (86.7 vs. 64.6%). The average age was 28 years with very few on those < 14 years of age. Illicit drug involvement was over four times as frequent in those with a spine injury (34.7% vs. 8.0%). The cervical spine was involved in 30%, thoracic in 32%, lumbar in 32%, and sacrum in 6%. A fracture occurred in 91.8% and neurologic injury in 33%. Injuries to the thoracic spine had the highest percentage of neurologic involvement (50.4%). There was an annual percentage decrease for patients with and without spine involvement in the 1990s, followed by increases through 2015. The average percentage increase for patients with a spine injury was 10.3% per year from 1997 onwards (p < 10-6), significantly greater than the 1.5% for those without spinal involvement (p = 0.0001) from 1999 onwards. Conclusions This nationwide study of spinal injuries associated with firearms covering all ages can be used as baseline data for future firearm studies. A reduction in the incidence of such injuries can be guided by our findings but may be difficult due to sociopolitical barriers (e.g. socioeconomic status of the injured patients, differences in political opinion regarding gun control in the US, and geospatial patterns of firearm injury).

Meningitis due to intra-abdominal cerebrospinal fluid fistula following gunshot wound successfully treated with antibiotics and blood patch: A case report and literature review

“…[3] Among PSCI in the United States, the described incidence of firearm-associated injuries is high, with 92-98% of cases attributed to firearms. [15,16] e most commonly affected regions of the spine are the thoracic and lumbar spine, which have similar injury incidence, followed less commonly by the cervical and sacrococcygeal spine. [3,15,22] Due to the abdomen and pelvis being common regions of firearm injuries, the incidence of concomitant abdominal or pelvic organ injury is high, with studies estimating abdominal viscus injury occurring in 57-69% of cases.…”

“…[15,16] e most commonly affected regions of the spine are the thoracic and lumbar spine, which have similar injury incidence, followed less commonly by the cervical and sacrococcygeal spine. [3,15,22] Due to the abdomen and pelvis being common regions of firearm injuries, the incidence of concomitant abdominal or pelvic organ injury is high, with studies estimating abdominal viscus injury occurring in 57-69% of cases. [18,22] In the case of PSCI associated with abdominal viscus injury, the risk of CNS infection has been variably reported.…”

“…[ 3 ] Among PSCI in the United States, the described incidence of firearm-associated injuries is high, with 92–98% of cases attributed to firearms. [ 15 , 16 ] The most commonly affected regions of the spine are the thoracic and lumbar spine, which have similar injury incidence, followed less commonly by the cervical and sacrococcygeal spine. [ 3 , 15 , 22 ]…”

Impact of Firearm Surveillance on Gun Control Policy: Regression Discontinuity Analysis

“…Mass shooting fatalities, as a particular type of gun injury event, account for <1% of all gun deaths [3] and have largely been ignored until recently [4,5]; yet, mass shooting events occur multiple times per year [6]. This information is based on insights from firearm surveillance performed by a variety of researchers, and state and federal agencies on incidence, prevalence, risk factors, injuries, deaths, and precipitating events, similar to the surveillance of infectious diseases such as COVID-19 [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. Teutch and Thacker [22] defined public health surveillance as the ongoing systematic collection, analysis, and interpretation of health data, essential to the planning, implementation, and evaluation of public health practice, closely integrated to the dissemination of these data to those who need to know and linked to prevention and control.…”

Impact of Firearm Surveillance on Gun Control Policy: Regression Discontinuity Analysis (Preprint)

“…Mass shooting fatalities, as a particular type of gun injury event, account for <1% of all gun deaths [3] and have largely been ignored until recently [4,5]; yet, mass shooting events occur multiple times per year [6]. This information is based on insights from firearm surveillance performed by a variety of researchers, and state and federal agencies on incidence, prevalence, risk factors, injuries, deaths, and precipitating events, similar to the surveillance of infectious diseases such as COVID-19 [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. Teutch and Thacker [22] defined public health surveillance as the ongoing systematic collection, analysis, and interpretation of health data, essential to the planning, implementation, and evaluation of public health practice, closely integrated to the dissemination of these data to those who need to know and linked to prevention and control.…”