Incidence of cervical spine injury in victims of dismounted blast: a systematic review.

Abstract

Introduction: Dismounted blast has the potential to cause life-threatening injuries to multiple simultaneous casualties, including injury to the cervical spine (c-spine). Spinal immobilisation can be costly in terms of time and personnel required to apply and sustain it. C-spine 'clearing' tools frequently do not apply to the blast-injured casualty, so clinical judgement must be used to determine those requiring c-spine immobilisation. This will be strongly influenced by the likelihood of such an injury, but currently, the incidence of c-spine injury in dismounted blasts is not known.

Methods: We searched PubMed, EMBASE and the Cumulative Index to Nursing and Allied Health for original research reporting the number of patients suffering c-spine injury as a result of the dismounted blast, as well as indices of injury severity such as incidence of limb amputation. Rates were combined to give an overall incidence. The systematic review was preregistered with PROSPERO (CRD42024527592).

Results: 2775 unique studies were identified, 13 of which were analysed. Reported incidences of c-spine injuries ranged from 0% to 5.85% across all 13 studies, and unstable injuries ranged from 0% to 1.23% in the nine studies in which this could be calculated. After excluding one study due to an overlapping population, in 7889 patients the rate of c-spine injury was 0.89%. In the 4618 patients for which the incidence of unstable c-spine injury could be calculated, the rate was 0.30%. There was no correlation between the rate of amputation and the rate of c-spine injury (Spearman's ρ=0.226, p=0.667).

Conclusion: Dismounted blasts result in a very low rate of c-spine injury. The populations sampled included a number of seriously injured casualties with potentially life-threatening wounds, such as limb amputation. We recommend deprioritising c-spine control in dismounted victims of the blast in favour of focusing the limited time and resources on addressing potentially life-threatening injuries.