title: Anatomic distribution of bullet head injuries in combat fatalities.
abstract: BACKGROUND
  Gun-shot wound head injury comprises a substantial fraction of combat injuries and a major cause of death in the battlefield. Current shielding gear is totally ineffective against bullets, because bullet-proof materials are too heavy to be worn on the head. The aim of this work was to describe the anatomic distribution of bullet entry wounds to the head in combat fatalities and to discern whether distribution is random (null hypothesis) or not.
  
  
  METHODS
  We retrospectively examined the forensic external examination reports of all Israeli Defense Forces combat fatalities during the years 2000 to 2004, the Second Lebanon War (2006), and Operation Cast Lead (2009) and mapped the exact anatomic location of all bullet entry wounds to the calvaria.
  
  
  RESULTS
  We found 76 gun-shot entry wounds to the heads of 49 fatalities. Among these wounds, the occipital and anterior-temporal regions were found to be hit significantly more often than expected compared with their relative surface area (p < 0.001 and p < 0.001, respectively). Fifty-five percent of all injuries occurred within 15% of the surface area of skull.
  
  
  CONCLUSIONS
  These findings imply that gun-shot entry wounds to the head are unevenly distributed. A partially bullet-proof protective helmet may prevent a substantial fraction of injuries (and fatalities) without a significant weight addition to the helmet.
authors.affiliation: Israel Defense Forces, Medical Corp., Israel. ranyuval@gmail.com
authors.forename: Yuval
authors.initials: Y
authors.lastname: Ran
authors.forename: Michael
authors.initials: M
authors.lastname: Yagudaev
authors.forename: Yona
authors.initials: Y
authors.lastname: Kosashvili
authors.forename: Yana
authors.initials: Y
authors.lastname: Yegorov
authors.forename: Ori
authors.initials: O
authors.lastname: Ganor
authors.forename: Nachman
authors.initials: N
authors.lastname: Ash
authors.forename: Gil
authors.initials: G
authors.lastname: Hirschhorn
mesh_terms: D020197:Head Injuries, Penetrating / Q000401:mortality* / Q000473:pathology / Q000517:prevention & control; D006260:Head Protective Devices; D006801:Humans; D007557:Israel; D007861:Lebanon; D012189:Retrospective Studies; D014857:Warfare; D014948:Wounds, Gunshot / Q000401:mortality* / Q000473:pathology / Q000517:prevention & control