title: Patients with gunshot wounds to the head do not require cervical spine immobilization and evaluation.
abstract: OBJECTIVE
  The purpose of this study was to determine the incidence of indirect spinal column injury in patients sustaining gunshot wounds to the head.
  
  
  METHODS
  A retrospective review of patient records and autopsy reports was conducted of patients admitted with gunshot wounds to the head between July of 1990 and September of 1995 were included. Those with gunshot wounds to the neck and those who were dead on arrival were excluded.
  
  
  RESULTS
  A total of 215 patients were included in the study. Cervical spine clearance in 202 patients (93%) was determined either clinically, radiographically, or by review of postmortem results. No patients sustained indirect (blast or fall-related) spinal column injury. Three patients had direct spinal injury from bullet passage that were apparent from bullet trajectory. More intubation attempts occurred in patients with cervical spine immobilization (49 attempts in 34 patients with immobilization versus five attempts in four patients without cervical spine immobilization, p = 0.008).
  
  
  CONCLUSIONS
  Indirect spinal injury does not occur in patients with gunshot wounds to the head. Airway management was compromised by cervical spine immobilization. Protocols mandating cervical spine immobilization after a gunshot wound to the head are unnecessary and may complicate airway management.
authors.affiliation: Department of Surgery, UCSF/Fresno, University Medical Center, California 93702, USA.
authors.forename: K L
authors.initials: KL
authors.lastname: Kaups
authors.forename: J W
authors.initials: JW
authors.lastname: Davis
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000293:injuries; D006259:Craniocerebral Trauma / Q000628:therapy*; D005260:Female; D006801:Humans; D007103:Immobilization; D008297:Male; D012189:Retrospective Studies; D014948:Wounds, Gunshot / Q000628:therapy*