title: C-spine injury associated with gunshot wounds to the head: retrospective study and literature review.
abstract: OBJECTIVE
  To determine the incidence of C-spine injury (CSI) associated with gunshot wounds (GSWs) to the head.
  
  
  METHODS
  A retrospective chart review including patients with GSWs to the head and excluding those with penetrating facial/neck trauma was performed. Cervical clearance was by clinical/radiologic criteria in survivors, and autopsy in nonsurvivors. A MEDLINE literature search was performed and relevant articles reviewed.
  
  
  RESULTS
  One hundred seventy-four charts were available for review; 90 had C-spine radiographs (complete series [49], lateral [33], and computed tomographic scan [8]). Of 84 with no radiographs, 29 were clinically cleared, and 55 died (32 cleared at autopsy). Twenty-three died without evaluation. None of the remaining 151 (87%) had CSI. Literature search yielded only three relevant articles. Combining the data from these articles yielded 534 patients, and CSI was excluded in 507 (95%).
  
  
  CONCLUSIONS
  C-spine immobilization and diagnostic radiography are probably not necessary in patients with isolated GSWs to the head and may complicate and delay emergency airway management.
authors.affiliation: Department of Emergency Medicine, Lincoln Medical and Mental Health Center, Bronx, New York 10451, USA. richlanoix@aol.com
authors.forename: R
authors.initials: R
authors.lastname: Lanoix
authors.forename: R
authors.initials: R
authors.lastname: Gupta
authors.forename: L
authors.initials: L
authors.lastname: Leak
authors.forename: J
authors.initials: J
authors.lastname: Pierre
mesh_terms: D002574:Cervical Vertebrae / Q000293:injuries*; D006259:Craniocerebral Trauma / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy; D004638:Emergency Treatment / Q000379:methods; D006801:Humans; D015994:Incidence; D009518:New York / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D014948:Wounds, Gunshot / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy