Radiographic Predictors of Spinal Column Instability after Gunshot Wounds: A Pragmatic Score

Radiographic Predictors of Spinal Column Instability after Gunshot Wounds: A Pragmatic Score | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Radiographic Predictors of Spinal Column Instability after Gunshot Wounds: A Pragmatic Score Nicholas Derrico, Tyler Giles, Katherine Baker, Thomas Hemphill, and 10 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9013986/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Firearm injuries to the spinal column remain a major United States public health concern and present an uncertain challenge in assessing spinal stability. No scoring system currently exists to evaluate ballistic injuries to the spinal column. We propose the BaLlistic Assessment in Spine Trauma (BLAST) score to differentiate stable and unstable ballistic spine fractures for the purposes of operative stabilization. Methods Over approximately 14 years, the University of Mississippi Medical Center neurosurgical service evaluated 353 gunshot wounds (GSW) to the spine. Patients who presented with radiographic injury to the spinal column were included and then evaluated with the BLAST score in this retrospective chart review study. Results Our results indicate that a score of 6 or more correlates with operative management. As a test, the BLAST score ultimately performed commensurate with the accuracy reported in validation studies of the Subaxial Cervical Spine Injury Classification System (SLICS), Thoracolumbar Injury Classification and Severity Scale (TLICS), and Spinal Instability Neoplastic Scale (SINS) scoring systems, achieving a receiver-operating characteristic (ROC) area under the curve (AUC) of 0.965 and 0.812 for cervical and thoracolumbar injuries, respectively. The BLAST scoring system achieved kappa statistics of 0.39 and 0.40 and intraclass correlation coefficients (ICC) of 0.82 and 0.79 for the cervical and thoracolumbar spine, respectively. Conclusion The BLAST score offers an efficient, accurate, and pragmatic composite score than can differentiate stable and unstable injuries in GSW to the spine. spine trauma ballistics gunshot wounds severity scoring Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9013986","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":617877130,"identity":"6b66e529-1312-4939-820e-396333a16d3f","order_by":0,"name":"Nicholas Derrico","email":"","orcid":"","institution":"University of Mississippi Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Nicholas","middleName":"","lastName":"Derrico","suffix":""},{"id":617877131,"identity":"320f6ab0-f0fa-47fa-9cdd-b365af759a07","order_by":1,"name":"Tyler Giles","email":"","orcid":"","institution":"University of Mississippi Medical 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scoring","lastPublishedDoi":"10.21203/rs.3.rs-9013986/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9013986/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eFirearm injuries to the spinal column remain a major United States public health concern and present an uncertain challenge in assessing spinal stability. No scoring system currently exists to evaluate ballistic injuries to the spinal column. We propose the BaLlistic Assessment in Spine Trauma (BLAST) score to differentiate stable and unstable ballistic spine fractures for the purposes of operative stabilization.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eOver approximately 14 years, the University of Mississippi Medical Center neurosurgical service evaluated 353 gunshot wounds (GSW) to the spine. Patients who presented with radiographic injury to the spinal column were included and then evaluated with the BLAST score in this retrospective chart review study.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOur results indicate that a score of 6 or more correlates with operative management. 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