Spine Injuries Are Common Among Asymptomatic Patients After Gunshot Wounds

Klein, Yoram; Cohn, Stephen M.; Soffer, Dror; Lynn, Mauricio; Shaw, Christiana; Hasharoni, Amir

doi:10.1097/01.ta.0000152549.63584.29

Cited by 27 publications

(15 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…6 – 11 Data from the Vietnam conflict were retrospectively analysed and it was concluded that, in a hostile environment, only 1.4% of all casualties who were candidates for immobilisation may have benefited from this care and that, in this population, all penetrating cervical cord injury was universally fatal 7. In addition, Barkana et al 8 performed a retrospective chart review and evaluated autopsy reports of military casualties in Israel and concluded that life-threatening complications due to PNI (such as expanding haematomas) may be overlooked with a rigid cervical collar in place.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Management of penetrating neck injury in the emergency department: a structured literature review

Brywczynski

Barrett

Lyon

et al. 2008

Emergency Medicine Journal

View full text Add to dashboard Cite

The current literature suggests that prehospital cervical immobilisation may not be necessary unless the patient has focal neurological deficits. Studies show that patients with penetrating neck trauma who are haemodynamically stable and exhibit no "hard signs" of vascular injury may be evaluated initially by MDCT imaging even when platysma violation is present. Airway management is evolving, but traditional laryngoscopy continues to be the mainstay of airway stabilisation.

show abstract

Section: Resultsmentioning

confidence: 99%

“…A 10-year retrospective cohort study by Klein et al 6 reported that 33/183 patients (18%) with gun shot wounds to the neck had cervical spine injuries. The authors concluded that spine immobilisation is essential for patients with gunshot wounds to the neck until radiographic imaging is complete.…”

Section: Resultsmentioning

confidence: 99%

Management of penetrating neck injury in the emergency department: a structured literature review

Brywczynski

Barrett

Lyon

et al. 2008

Emergency Medicine Journal

View full text Add to dashboard Cite

show abstract

“…Upon further analysis, we found that the subset analyses of isolated head and isolated neck injuries may have been skewed by the findings of Klein et al, 24 which reviewed 2,450 patients with head, neck, and torso gunshot wounds (GSWs). This single-center study reported a higher incidence of spinal cord injuries (n = 244, 10%), and specifically unstable spine injuries (151 patients, 6.2%), than rates reported in other studies.…”

Section: Discussionmentioning

confidence: 94%

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

Garcia

Liu

Victorino

2014

Journal of Trauma and Acute Care Surgery

View full text Add to dashboard Cite

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.

show abstract

“…Two-thirds of the spine injuries are significant, and about 13% are unsuspected. 28 Plain radiographs and CT scans are helpful. The 3-column theory of Denis, 6 which meant for blunt trauma only, does not apply to penetrating trauma.…”

Section: Treatment Of Victims With No Neurologic Deficitmentioning

confidence: 98%

Treatment of Civilian Gunshot Wounds of the Spine

Heary¹,

Kumar

2006

Techniques in Orthopaedics

View full text Add to dashboard Cite

Gunshot wounds (GSWs) commonly result from low-velocity weapons in civilians but there is an increasing trend for high velocity GSWs. The initial focus of the gunshot victims must address all life threatening injuries. Maintenance of airway, breathing and circulation (ABC) are the most important. Tetanus prophylaxis is routinely indicated for all gunshot injuries. Steroids have no proven role in the treatment of GSWs and should be avoided. Surgery also plays very little role in the treatment of low velocity GSWs. It is very unlikely to improve the neurologic status of the patient. Surgery for spinal cord injuries resulting from low velocity GSWs are reserved for patients with progressive neurologic deterioration, persistent cerebrospinal fluid (CSF) fistulae, and sometimes for incomplete spinal cord injuries. Surgery for spinal cord injury victims may also be indicated to relieve active neural compression from a bullet, bone, intervertebral disk, or a hematoma within the spinal canal. Spinal instability rarely results from a civilian GSW. Cauda equina injuries from low velocity GSWs have better overall improvement when compared with spinal cord injuries. As such, spine surgery in these cases, which are actually peripheral nerve injuries rather than spinal cord injuries, may have a favorable result on the long-term neurologic outcome. The decision to perform surgery should be made on individualized basis.

show abstract

Spine Injuries Are Common Among Asymptomatic Patients After Gunshot Wounds

Abstract: Spine injuries without neurologic signs are not uncommon among patients with gunshot wounds. Complete radiographic spine imaging is therefore recommended to ensure that spine injuries are not missed in this population.

Cited by 27 publications

References 9 publications

Management of penetrating neck injury in the emergency department: a structured literature review

Management of penetrating neck injury in the emergency department: a structured literature review

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

Treatment of Civilian Gunshot Wounds of the Spine

Contact Info

Product

Resources

About