Cervical spine immobilization may be of value following firearm injury to the head and neck

Sebastian D. Schubl, R. Jonathan Robitsek, Christian Sommerhalder, Kimberly J. Wilkins, Taylor R. Klein, Scott Trepeta, Vanessa P. Ho

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background Penetrating injuries to the head and neck may not be able to cause unstable fractures without concomitant spinal cord injury, rendering prehospital spinal immobilization (PHSI) ineffectual, and possibly harmful. However, this premise is based on reports including predominantly chest and abdominal injuries, which are unlikely to cause cervical spine (CS) injuries. Methods We performed a retrospective review of all patients presenting with a penetrating wound to the head or neck over a 4-year period at an urban, level 1 trauma center to determine if there was a benefit of PHSI. Results One hundred seventy-two patients were identified, of which 16 (9.3%) died prior to CS evaluation. Of 156 surviving patients, mechanism was gunshot wound (GSW) in 36 (28%) and stab wound (SW) in 120 (72%). Fifty-eight patients had PHSI placed (37%), and GSW patients' odds of having PHSI were greater than SW patients (OR 2.3; CI 1.08-4.9). Eight of 156 surviving patients eventually died (5.1%), and the odds of mortality were greater among those that had PHSI than those without (OR 5.54; CI 1.08-28.4). Six (3.8%; 5 GSW, 1 SW) patients had a CS fracture. Two GSW patients (5.6%) had unstable CS fractures with a normal neurological exam at initial evaluation. Conclusions Of patients with a GSW to the head or neck that survived to be evaluated, 5.6% had unstable fractures without an initial neurologic deficit. PHSI may be appropriate in this population. Further studies are warranted prior to a determination that PHSI is unnecessary in penetrating head and neck injuries.

Original languageEnglish (US)
Pages (from-to)726-729
Number of pages4
JournalAmerican Journal of Emergency Medicine
Volume34
Issue number4
DOIs
StatePublished - Apr 1 2016
Externally publishedYes

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Neck Injuries
Firearms
Craniocerebral Trauma
Immobilization
Spine
Gunshot Wounds
Stab Wounds
Penetrating Head Injuries
Neck
Head
Penetrating Wounds
Abdominal Injuries
Thoracic Injuries
Trauma Centers
Neurologic Manifestations
Spinal Cord Injuries

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Schubl, S. D., Robitsek, R. J., Sommerhalder, C., Wilkins, K. J., Klein, T. R., Trepeta, S., & Ho, V. P. (2016). Cervical spine immobilization may be of value following firearm injury to the head and neck. American Journal of Emergency Medicine, 34(4), 726-729. https://doi.org/10.1016/j.ajem.2016.01.014

Cervical spine immobilization may be of value following firearm injury to the head and neck. / Schubl, Sebastian D.; Robitsek, R. Jonathan; Sommerhalder, Christian; Wilkins, Kimberly J.; Klein, Taylor R.; Trepeta, Scott; Ho, Vanessa P.

In: American Journal of Emergency Medicine, Vol. 34, No. 4, 01.04.2016, p. 726-729.

Research output: Contribution to journalArticle

Schubl, SD, Robitsek, RJ, Sommerhalder, C, Wilkins, KJ, Klein, TR, Trepeta, S & Ho, VP 2016, 'Cervical spine immobilization may be of value following firearm injury to the head and neck', American Journal of Emergency Medicine, vol. 34, no. 4, pp. 726-729. https://doi.org/10.1016/j.ajem.2016.01.014
Schubl, Sebastian D. ; Robitsek, R. Jonathan ; Sommerhalder, Christian ; Wilkins, Kimberly J. ; Klein, Taylor R. ; Trepeta, Scott ; Ho, Vanessa P. / Cervical spine immobilization may be of value following firearm injury to the head and neck. In: American Journal of Emergency Medicine. 2016 ; Vol. 34, No. 4. pp. 726-729.
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abstract = "Background Penetrating injuries to the head and neck may not be able to cause unstable fractures without concomitant spinal cord injury, rendering prehospital spinal immobilization (PHSI) ineffectual, and possibly harmful. However, this premise is based on reports including predominantly chest and abdominal injuries, which are unlikely to cause cervical spine (CS) injuries. Methods We performed a retrospective review of all patients presenting with a penetrating wound to the head or neck over a 4-year period at an urban, level 1 trauma center to determine if there was a benefit of PHSI. Results One hundred seventy-two patients were identified, of which 16 (9.3{\%}) died prior to CS evaluation. Of 156 surviving patients, mechanism was gunshot wound (GSW) in 36 (28{\%}) and stab wound (SW) in 120 (72{\%}). Fifty-eight patients had PHSI placed (37{\%}), and GSW patients' odds of having PHSI were greater than SW patients (OR 2.3; CI 1.08-4.9). Eight of 156 surviving patients eventually died (5.1{\%}), and the odds of mortality were greater among those that had PHSI than those without (OR 5.54; CI 1.08-28.4). Six (3.8{\%}; 5 GSW, 1 SW) patients had a CS fracture. Two GSW patients (5.6{\%}) had unstable CS fractures with a normal neurological exam at initial evaluation. Conclusions Of patients with a GSW to the head or neck that survived to be evaluated, 5.6{\%} had unstable fractures without an initial neurologic deficit. PHSI may be appropriate in this population. Further studies are warranted prior to a determination that PHSI is unnecessary in penetrating head and neck injuries.",
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