Neurologic sequelae of penetrating cervical trauma.
METHODS
Multicenter, retrospective chart analysis was performed using data housed in the trauma registries of 2 independent American College of Surgeons verified, Level I Trauma centers. The trauma registries were queried for all cases of penetrating cervical trauma. Abstracted data included age, sex, race, mechanism of injury, Glasgow Coma Scale (GCS) level on arrival, neurologic findings on arrival, zone of injury, associated injuries, imaging studies and results, operations performed, neurologic sequelae, disposition from the hospital and the presence or absence of neurologic injury, cervical spine fracture, and cervical spine immobilization.


OBJECTIVE
The purpose of this study was to determine the relationship between cervical spine immobilization and neurologic sequelae in penetrating cervical trauma.


BACKGROUND
Current recommendations for cervical spine immobilization in penetrating cervical trauma developed by empiric extension of blunt trauma protocols without evidentiary support. No evidence exists to support cervical spine immobilization as a means of preventing neurologic injury progression in cases of penetrating cervical injury.


METHODS
Abstracted data were organized, entered into a database, and compared statistically. Significance was accepted for P<0.05.


RESULTS
A total of 196 patient charts formed the study cohort. Neurologic injuries either improved or remained static. No patient could be determined to have benefited from cervical spine immobilization in this study as the only 2 patients presenting with unstable cervical spine fractures were completely neurologically devastated at the time of injury. Prehospital cervical spine immobilization may have negatively affected patients with vascular and airway injuries. Decreased cervical spine immobilization rates at one institution did not affect neurologic outcome.


CONCLUSIONS
Cervical spine immobilization does not appear to prevent progression of neurologic injury in cases of penetrating cervical trauma. Comorbid penetrating injuries may be negatively impacted by prehospital cervical spine immobilization.
Vanderlan
Wesley B
WB
Department of Surgery, Tulane University, New Orleans, LA, USA. blakevanderlan@yahoo.com
Tew
Beverly E
BE
Seguin
Cara Y
CY
Mata
Melanie M
MM
Yang
James J
JJ
Horst
H Mathilda
HM
Obeid
Farouck N
FN
McSwain
Norman E
NE
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001915:Braces / Q000009:adverse effects / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D007223:Infant; D008297:Male; D008875:Middle Aged; D019838:Neck Injuries / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D012149:Restraint, Physical / Q000009:adverse effects / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000453:epidemiology / Q000517:prevention & control*; D013124:Spinal Injuries / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D014193:Trauma Centers / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014950:Wounds, Penetrating / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D055815:Young Adult