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

• Published in: The American journal of emergency medicine 2016-04, Vol.34 (4), p.726-729
• Main Authors: Schubl, Sebastian D., MD, Robitsek, R. Jonathan, PhD, Sommerhalder, Christian, MD, Wilkins, Kimberly J., MD, Klein, Taylor R., BS, Trepeta, Scott, MD, Ho, Vanessa P., MD, MPH
• Format: Article
• Language: English
• Subjects: Adult; Cervical Vertebrae - injuries; Confidence intervals; Craniocerebral Trauma - complications; Emergency; Emergency medical care; Female; Hospitals; Humans; Immobilization; Injuries; Injury Severity Score; Intensive care; Intubation; Male; Mortality; Neck; Neck injuries; Neck Injuries - complications; Palliative care; Radiography; Retrospective Studies; Spinal cord; Spinal Fractures - complications; Spinal Fractures - diagnostic imaging; Spine; Stabbings; Transportation of Patients - methods; Trauma; Variables; Wounds, Gunshot - complications; Wounds, Stab - complications
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2016.01.014

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.