McNickle Allison G, Chestovich Paul J, Fraser Douglas R
Department of Surgery, UNLV School of Medicine, Las Vegas, NevadaUSA.
Prehosp Disaster Med. 2020 Oct;35(5):524-527. doi: 10.1017/S1049023X20000771. Epub 2020 Jun 30.
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.
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.
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).
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.
尸体研究和既往影像学研究表明，头部枪伤（GSW）合并颈椎骨折的情况罕见。尽管有此认识，但颅面部枪伤患者就诊时通常已实施脊柱活动限制（SMR）。本研究旨在量化头部枪伤患者颈椎损伤的发生率，通过计算机断层扫描（CT）进行识别。推测自伤（SI）患者的骨折发生率较低。
从该一级创伤中心2013 - 2017年的登记资料以及美国国家创伤数据库（NTDB）2012 - 2016年的数据中查询孤立的颅面部枪伤病例（头部或面部简明损伤定级标准[AIS] >2）。数据集包括年龄、性别、是否为自伤、颈椎损伤、脊柱手术及死亡率。对于该医院的数据，评估院前因素、SMR及所进行的CT检查情况。使用Stata软件进行统计评估，P <.05为有统计学意义。
纳入该医院的241例患者（平均年龄39岁；85%为男性；66%为自伤）及NTDB的5849例患者（平均年龄38岁；84%为男性；53%为自伤）。对于两个队列，自伤患者年龄更大（P <.01）且死亡率更高（P <.01）。总体而言，颈椎骨折发生率为3.7%，5.4%的患者需要进行脊柱手术（占所有患者的0.2%）。非自伤患者的骨折发生率高5倍（P <.05）。在当地，121例（50.2%）患者到达前已实施SMR，6例（2.5%）在创伤室放置了颈托。无论自伤状态如何，SMR的发生率相似（49.0%对51.0%；P =无统计学意义），但在低血压患者和接受心肺复苏（CPR）的患者中发生率较低。实施SMR与颈椎CT检查的使用增加相关（80.0%对33.0%；P <.01）。
头部和面部孤立枪伤患者中，颈椎骨折的发生率不到4%，非自伤病例中更常见。对于符合自伤损伤的病例，应避免院前SMR；对于所有其他病例，一旦CT成像结果为阴性，应停止SMR。
