Prehospital stabilization of the cervical spine for penetrating injuries of the neck — is it necessary?

Barkana, Yaniv; Stein, Michael D.; Scope, Alon; Maor, Ron; Abramovich, Y; Friedman, Zeev; Knoller, Nachshon

doi:10.1016/s0020-1383(99)00298-3

Cited by 78 publications

(62 citation statements)

References 15 publications

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“…Appeared a likely source of this increased risk of indirect central neurologic injury. CSI iatrogenia may have facilitated indirect neurologic injury by negatively impacting the "ischemic penumbra" [2][3][4][5][6]15,[22][23][24]27,29,30].…”

Section: Discussionmentioning

confidence: 99%

“…CSI has been shown to cause treatment delay, obscure injury, impair care delivery, respiration, increase intracranial pressure, effect negative outcomes and exacerbate and impede control of hemorrhage in penetrating cervical trauma [2][3][4][5][6]15,[22][23][24]27,29,30]. Both patients with indirect central neurologic injuries secondary to carotid arterial disruption received CSI.…”

Section: Discussionmentioning

confidence: 99%

“…Respiratory physiology and obtainment of a definitive airway had both been previously shown to be impaired by CSI [2,6,15,16]. Consideration was then given to examining the relationship between respiratory tract injuries and indirect neurologic injury in this study.…”

Section: Discussionmentioning

confidence: 99%

“…Current recommendations for CSI were developed for blunt trauma patients and empirically extended to include patients with penetrating injury [1][2][3][4]. CSI was designed to prevent progression of direct neurologic injury from cervical spine instability caused by CSFx and/or ligamentous injury.…”

Section: Introductionmentioning

confidence: 99%

“…Unstable CSFx resulting from penetrating cervical trauma has been repeatedly associated with complete neurologic devastation in the surveyed literature. CSI has no demonstrated benefit in neurologically devastated patients [2].…”

Section: Introductionmentioning

confidence: 99%

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Cervical spine immobilization in penetrating cervical trauma is associated with an increased risk of indirect central neurological injury

Turnock¹,

Carney²,

Fleischer³

et al. 2016

Trauma Emerg Care

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This study hypothesized that cervical spine immobilization (CSI) in penetrating cervical trauma is associated with increased central neurologic injury rather than prevention. Data abstraction proceeded from a previously constructed patient database formed via retrospective chart analysis of the trauma registries of two independent American College of Surgeons verified Level 1 Trauma centers. Neurologic injuries were categorized as peripheral or central. Central neurologic injuries were further subdivided into spinal cord and brain injuries. Patients were grouped according to the presence and type of neurologic injury, the presence and type of cervical spine fracture, death, and the presence or absence of respiratory and vascular injury. Vascular injury was further subdivided into major and minor categories. Groups were compared statistically. Significance was accepted for p<0.05. Cervical spine fracture (CSFx) was a significant risk factor for cervical spinal cord injury (CSCI) (p<0.00001; RR 20.56; 95% CI 8.44-26.47) but all patients with unstable CSFx presented with complete spinal neurologic devastation. Major vascular injury was associated with brain injury (p=0.01; RR 10.21; 95% CI 6.67-15.65) but was not associated with CSCI (p=0.99) or CSFx (p=0.67). Hypoperfusion was a strong independent risk cervical cord and brain injury (p<0.00001; RR 38.4; 95% CI 16.17-91.2). CSI was a significant risk factor for indirect central neurologic injury (p<0.001; RR 1.63; 95% CI 1.23-1.95). Brain injury was not associated with CSFx (p=0.35) or CSCI (p=0.08). No benefit of CSI in penetrating cervical trauma could be determined from this study. CSI entailed an absolute risk increase for central neurologic injury of 18.69% with a 5.3 number needed to harm (NNH).

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