title: Cervical spine injury is highly dependent on the mechanism of injury following blunt and penetrating assault.
abstract: BACKGROUND
  The mechanism of injury has not been highly regarded as an important variable when evaluating cervical spine injuries. The aim of this study was to determine the incidence of cervical spine fracture (CSF) and cervical spinal cord injury (CSCI) based on mechanism following blunt and penetrating assault to better aid prioritization of management.
  
  
  METHODS
  Retrospective analysis from two large urban Level I trauma centers over 87 and 144 months caused by gunshot wounds (GSW), stab wounds (SW) or blunt assault (BA).
  
  
  RESULTS
  During the study period, there were 57,532 trauma patients evaluated at the two trauma centers, of which 42.3% were following blunt or penetrating assault. The rates of CSF and CSCI for the various mechanisms were similar between the two centers. The rates for having CSF were significantly different (p < 0.05) for the various mechanisms. GSW (1.35%) was the highest followed by BA (0.41%) and then SW (0.12%). The rates of CSCI for GSW (0.94%) were significantly (p < 0.05) higher than BA (0.14%) and SW (0.11%). For GSW patients, all patients with CSF or CSCI had a point of entry between the ears and the nipple. For SW patients, the wound was directly in the neck below the mandible and above the trapezius muscle. Although many of the SW patients also suffered blunt assault, none of the CSF or CSCI injuries were from blunt forces. In addition, all patients, both blunt and penetrating who had CSCI had neurologic deficit at the time of presentation. Surgical stabilization or tongs were applied in 15.5% (26 of 168) of the GSWs, 27.8% (3 of 11) of the SWs and 31.6% (6 of 19) of the BA patients. There was a BA patient (1 of 4,390) patient with CSF that was neurologically intact that required surgical stabilization and this patient had neck pain on admission. No penetrating injury patients with CSCI regained significant neurologic recovery during the hospitalization.
  
  
  CONCLUSIONS
  The rate of CSF or CSCI is low following assault and dependent on mechanism of injury. Thus the concern and extent of evaluation should also be dependent on the mechanism of injury. Neurologic deficits from penetrating assault were established and final at the time of presentation. Concern for protecting the neck should not hinder the evaluation process or life saving procedures.
authors.affiliation: Department of Surgery, Los Angeles County Medical Center + University of Southern California, Los Angeles, California 90033, USA. peterhee@hotmail.com
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Kuncir
authors.forename: Laura
authors.initials: L
authors.lastname: Johnson
authors.forename: Carlos
authors.initials: C
authors.lastname: Brown
authors.forename: George
authors.initials: G
authors.lastname: Velmahos
authors.forename: Matthew
authors.initials: M
authors.lastname: Martin
authors.forename: Dennis
authors.initials: D
authors.lastname: Wang
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
authors.forename: Jay
authors.initials: J
authors.lastname: Doucet
authors.forename: Susan
authors.initials: S
authors.lastname: Kennedy
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000293:injuries; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000453:epidemiology / Q000209:etiology*; D014949:Wounds, Nonpenetrating / Q000150:complications*; D014950:Wounds, Penetrating / Q000150:complications*