Is Cervical Spine Imaging Indicated in Gunshot Wounds to the Cranium

ObjectiveThe Canadian C-Spine Rule (CCR) and the National Emergency X-Radiography Utilization Study (NEXUS) criteria are two commonly used clinical decision rules which use midline cervical spine (c-spine) tenderness on palpation as an indication for c-spine imaging post-trauma. This study was undertaken to determine the prevalence and location of midline c-spine tenderness in the non-trauma population.MethodsWe prospectively evaluated consenting adult patients presenting to an urban ED or university sport medicine clinic in Montreal, Canada between 2018 and 2020 for atraumatic non-head and neck-related reports over a 20-month period. The presence and location of pain during midline c-spine palpation as assessed by two examiners during separate evaluations was recorded. Patient information such as age, neck length and circumference, gender, body mass index (BMI) and scaphoid tenderness was also collected.ResultsOf 478 patients enrolled, 286 (59.8%) had midline c-spine tenderness on palpation with both examiners. The majority of those with tenderness were female (70.6%). When examining all patients, tenderness was present in the upper third of the c-spine in 128 (26.8%) patients, middle third in 270 (56.5%) patients and lower third in 6 (1.3%) patients. Factors associated with having increased odds of midline c-spine tenderness on palpation included a lower BMI and the presence of scaphoid tenderness on palpation.ConclusionsThere is a high prevalence of c-spine tenderness on palpation in patients who have not undergone head or neck trauma. This finding may help explain the low specificity in some of the validation studies examining the CCR and the NEXUS criteria.

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Cervical Spine Injury is Rare in Self-Inflicted Craniofacial Gunshot Wounds: An Institutional Review and Comparison to the US National Trauma Data Bank (NTDB)

Prehospital and Disaster Medicine ◽

10.1017/s1049023x20000771 ◽

2020 ◽

Vol 35 (5) ◽

pp. 524-527

Author(s):

Allison G. McNickle ◽

Paul J. Chestovich ◽

Douglas R. Fraser

Keyword(s):

Cervical Spine ◽

Spinal Surgery ◽

Gunshot Wounds ◽

Data Bank ◽

Spine Injury ◽

Spine Fractures ◽

National Trauma ◽

National Trauma Data Bank ◽

The Us ◽

Cervical Spine Fractures

AbstractBackground:Cadaveric and older radiographic studies suggest that concurrent cervical spine fractures are rare in gunshot wounds (GSWs) to the head. Despite this knowledge, patients with craniofacial GSWs often arrive with spinal motion restriction (SMR) in place. This study quantifies the incidence of cervical spine injuries in GSWs to the head, identified using computerized tomography (CT). Fracture frequency is hypothesized to be lower in self-inflicted (SI) injuries.Methods:Isolated craniofacial GSWs were queried from this Level I trauma center registry from 2013-2017 and the US National Trauma Data Bank (NTDB) from 2012–2016 (head or face abbreviated injury scale [AIS] >2). Datasets included age, gender, SI versus not, cervical spine injury, spinal surgery, and mortality. For this hospital’s data, prehospital factors, SMR, and CTs performed were assessed. Statistical evaluation was done with Stata software, with P <.05 significant.Results:Two-hundred forty-one patients from this hospital (mean age 39; 85% male; 66% SI) and 5,849 from the NTDB (mean age 38; 84% male; 53% SI) were included. For both cohorts, SI patients were older (P < .01) and had increased mortality (P < .01). Overall, cervical spine fractures occurred in 3.7%, with 5.4% requiring spinal surgery (0.2% of all patients). The frequency of fracture was five-fold greater in non-SI (P < .05). Locally, SMR was present in 121 (50.2%) prior to arrival with six collars (2.5%) placed in the trauma bay. Frequency of SMR was similar regardless of SI status (49.0% versus 51.0%; P = not significant) but less frequent in hypotensive patients and those receiving cardiopulmonary resuscitation (CPR). The presence of SMR was associated with an increased use of CT of the cervical spine (80.0% versus 33.0%; P < .01).Conclusion:Cervical spine fractures were identified in less than four percent of isolated GSWs to the head and face, more frequently in non-SI cases. Prehospital SMR should be avoided in cases consistent with SI injury, and for all others, SMR should be discontinued once CT imaging is completed with negative results.

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Variation in pediatric cervical spine imaging across trauma centers – A cause for concern?

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000003344 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Roxanne Massoumi ◽

Joseph Wertz ◽

Tuyen Duong ◽

Chi-hon Tseng ◽

Howard Chung-Hao Jen

Keyword(s):

Cervical Spine ◽

Trauma Centers ◽

Spine Imaging

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Evaluation of clinical criteria to determine the need for cervical spine imaging in victims of blunt assault

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2019.10.011 ◽

2020 ◽

Vol 71 ◽

pp. 84-88

Author(s):

Joseph Chaudry ◽

Nisha Swaminathan ◽

Ruth K. Gershon ◽

David P. Gordy ◽

Lindsey Allred ◽

...

Keyword(s):

Cervical Spine ◽

Clinical Criteria ◽

Spine Imaging

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Controversies in cervical spine imaging in trauma patients

Emergency Radiology ◽

10.1007/s10140-004-0360-5 ◽

2004 ◽

Vol 11 (1) ◽

Cited By ~ 13

Author(s):

RichardH. Daffner

Keyword(s):

Cervical Spine ◽

Trauma Patients ◽

Spine Imaging

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Cervical Spine Injury in Patients with Civilian Gunshot Wounds to the Head

Neurosurgery ◽

10.1097/00006123-199709000-00137 ◽

1997 ◽

Vol 41 (3) ◽

pp. 741-741

Author(s):

Paul J. Apostolides ◽

Karl A. Greene ◽

John G. Golfinos ◽

A. Giancarlo Vishteh ◽

Jonathan J. Baskin ◽

...

Keyword(s):

Cervical Spine ◽

Cervical Spine Injury ◽

Gunshot Wounds ◽

Spine Injury

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Calcification of the alar ligament of the cervical spine: imaging findings and clinical course

Skeletal Radiology ◽

10.1007/s002560100325 ◽

2001 ◽

Vol 30 (5) ◽

pp. 295-297 ◽

Cited By ~ 15

Author(s):

Yuka Kobayashi ◽

J. Mochida ◽

Ikuo Saito ◽

Sizuka Matui ◽

Eiren Toh

Keyword(s):

Cervical Spine ◽

Clinical Course ◽

Imaging Findings ◽

Alar Ligament ◽

Spine Imaging

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Cervical spine imaging for young children with inflicted trauma: Expanding the injury pattern

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2017.01.049 ◽

2017 ◽

Vol 52 (5) ◽

pp. 816-821 ◽

Cited By ~ 7

Author(s):

Joanne Baerg ◽

Arul Thirumoorthi ◽

Rosemary Vannix ◽

Asma Taha ◽

Amy Young ◽

...

Keyword(s):

Cervical Spine ◽

Young Children ◽

Injury Pattern ◽

Spine Imaging

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Cervical Spine Imaging in Blunt Trauma Patients

10.1093/med/9780190223700.003.0010 ◽

2016 ◽

Author(s):

Christoph I. Lee

Keyword(s):

Cervical Spine ◽

Blunt Trauma ◽

Trauma Patients ◽

Clinical Context ◽

Cervical Spine Injuries ◽

Additional Information ◽

Spine Imaging ◽

Spine Injuries ◽

Study Methodology ◽

Spine Radiographs

This chapter, found in the back pain section of the book, provides a succinct synopsis of a key study examining the use of cervical spine imaging in blunt trauma patients. This summary outlines the study methodology and design, major results, limitations and criticisms, related studies and additional information, and clinical implications. The study presents a set of five diagnostic criteria that approach 100% sensitivity for identifying clinically important cervical spine injuries and could eliminate one-eighth of all cervical spine radiographs ordered for these patients. In addition to outlining the most salient features of the study, a clinical vignette and imaging example are included in order to provide relevant clinical context.

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