title: Spine injuries are common among asymptomatic patients after gunshot wounds.
abstract: BACKGROUND
  Spine injuries after gunshot wounds are thought to be rare among asymptomatic patients. The occurrence of spine injuries among asymptomatic patients with gunshot wounds was studied to determine the necessity for mandatory spine immobilization and radiographic imaging.
  
  
  METHODS
  In this retrospective cohort study, initial physical examination, radiographic findings, and final diagnosis and treatment were reviewed. Patients were included if they were admitted to the authors' level 1 trauma center with gunshot wounds to the head, neck, or trunk during a 10-year period. Spine injuries were considered "significant" if the injury was associated with spinal cord injury or required spine-related surgical procedures or prolonged spine immobilization. Spine injuries were defined as "unsuspected" if there were no neurologic findings at admission.
  
  
  RESULTS
  During the study period, 2,450 patients who survived more than 24 hours were admitted with gunshot wounds to the trunk, neck, or head. Of these patients, 244 (approximately 10%) had spine injuries, and 228 of them had complete records. Two thirds of the spine injuries were found to be significant, requiring surgery or prolonged immobilization, and 13% were unsuspected.
  
  
  CONCLUSIONS
  Spine injuries without neurologic signs are not uncommon among patients with gunshot wounds. Complete radiographic spine imaging is therefore recommended to ensure that spine injuries are not missed in this population.
authors.affiliation: Divisions of Trauma and Surgical Critical Care, University of Miami School of Medicine, Miami, Florida, USA. yoramkl@clalit.org.il
authors.forename: Yoram
authors.initials: Y
authors.lastname: Klein
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Cohn
authors.forename: Dror
authors.initials: D
authors.lastname: Soffer
authors.forename: Mauricio
authors.initials: M
authors.lastname: Lynn
authors.forename: Christiana Marie
authors.initials: CM
authors.lastname: Shaw
authors.forename: Amir
authors.initials: A
authors.lastname: Hasharoni
mesh_terms: D000007:Abdominal Injuries / Q000150:complications; D005151:Facial Injuries / Q000150:complications; D006801:Humans; D019838:Neck Injuries / Q000150:complications; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000209:etiology*; D014948:Wounds, Gunshot / Q000150:complications*