• R Lanoix, R Gupta, L Leak, and J Pierre.
• Department of Emergency Medicine, Lincoln Medical and Mental Health Center, Bronx, New York 10451, USA. richlanoix@aol.com
• J Trauma. 2000 Nov 1; 49 (5): 860-3.

ObjectiveTo determine the incidence of C-spine injury (CSI) associated with gunshot wounds (GSWs) to the head.MethodsA 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.ResultsOne 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%).ConclusionC-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.

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