Cervical spinal cord injury after blunt assault: Just a pain in the neck?

Trine G Eskesen; Josefine S Baekgaard; Thomas Peponis; Jae Moo Lee; Noelle Saillant; Haytham M A Kaafarani; Peter J Fagenholz; David R King; Marc de Moya; George C Velmahos; D Dante Yeh

doi:10.1016/j.amjsurg.2018.06.022

Cervical spinal cord injury after blunt assault: Just a pain in the neck?

Am J Surg. 2019 Apr;217(4):648-652. doi: 10.1016/j.amjsurg.2018.06.022. Epub 2018 Jun 23.

Authors

Affiliations

¹ Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge Street Suite 810, Boston, MA, 02114, USA. Electronic address: trinegeskesen@live.dk.
² Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge Street Suite 810, Boston, MA, 02114, USA. Electronic address: josefinebaekgaard@me.com.
³ Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge Street Suite 810, Boston, MA, 02114, USA. Electronic address: tpeponis@partners.org.
⁴ Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge Street Suite 810, Boston, MA, 02114, USA. Electronic address: jlee187@partners.org.
⁵ Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge Street Suite 810, Boston, MA, 02114, USA. Electronic address: nsaillant@partners.org.
⁶ Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge Street Suite 810, Boston, MA, 02114, USA. Electronic address: hkaafarani@mgh.harvard.edu.
⁷ Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge Street Suite 810, Boston, MA, 02114, USA. Electronic address: pfagenholz@mgh.harvard.edu.
⁸ Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge Street Suite 810, Boston, MA, 02114, USA. Electronic address: dking3@mgh.harvard.org.
⁹ Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge Street Suite 810, Boston, MA, 02114, USA. Electronic address: mdemoya@mcw.edu.
¹⁰ Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge Street Suite 810, Boston, MA, 02114, USA. Electronic address: gvelmahos@mgh.harvard.edu.
¹¹ Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge Street Suite 810, Boston, MA, 02114, USA. Electronic address: dxy154@med.miami.edu.

PMID: 30665737
DOI: 10.1016/j.amjsurg.2018.06.022

Abstract

Background: We aimed to determine the incidence, risk factors, and outcomes of cervical spinal cord injury (CSCI) after blunt assault.

Methods: The ACS National Trauma Data Bank (NTDB) 2012 Research Data Set was used to identify victims of blunt assault using the ICD-9 E-codes 960.0, 968.2, 973. ICD-9 codes 805.00, 839.00, 806.00, 952.00 identified cervical vertebral fractures/dislocations and CSCI. Multivariable analyses were performed to identify independent predictors of CSCI.

Results: 14,835 (2%) out of 833,311 NTDB cases were blunt assault victims and thus included. 217 (1%) had cervical vertebral fracture/dislocation without CSCI; 57 (0.4%) had CSCI. Age ≥55 years was independently predictive of CSCI; assault by striking/thrown object, facial fracture, and intracranial injury predicted the absence of CSCI. 25 (0.02%) patients with CSCI underwent cervical spinal fusion.

Conclusions: CSCI is rare after blunt assault. While the odds of CSCI increase with age, facial fracture or intracranial injury predicts the absence of CSCI.

Summary: The incidence, risk factors, and outcomes of cervical spinal cord injury (CSCI) after blunt assault was investigated. 14,835 blunt assault victims were identified; 217 had cervical vertebral fracture/dislocation without CSCI; 57 had CSCI. Age ≥55 years was found to independently predict CSCI, while assault by striking/thrown object, facial fracture, and intracranial injury predicted the absence of CSCI.

Keywords: Blunt assault; Cervical spinal cord injury; Cervical spine injury.

MeSH terms

Adult
Cervical Vertebrae / injuries*
Databases, Factual
Female
Fracture Dislocation / complications*
Fracture Dislocation / epidemiology
Humans
Incidence
Male
Middle Aged
Neck Injuries / complications*
Neck Injuries / epidemiology
Risk Factors
Spinal Cord Injuries / epidemiology
Spinal Cord Injuries / etiology*
Spinal Fractures / complications*
Spinal Fractures / epidemiology
United States / epidemiology
Violence*
Wounds, Nonpenetrating / complications*
Wounds, Nonpenetrating / epidemiology