INCIDENCE OF CERVICAL-SPINE INJURY IN PATIENTS WITH GUNSHOT WOUNDS TOTHE HEAD

Cervical spine immobilization is standard during the early stages of p rehospital and hospital care of patients with blunt head injury. Howev er, the need for cervical spine immobilization in patients with gunsho t wounds to the head has not been addressed. To determine the incidenc e and types of cervical spine injury in this group, we retrospectively examined the records of 308 consecutive patients who had computed tom ographic (CT) scans of the head to evaluate brain injury after gunshot wounds. Of the 266 patients with data adequate for review, 157 (59%) had a complete lateral x-ray film of the cervical spine. Of these 157, 105 had wounds limited to the calvaria, and none had cervical spine i njury. Of 52 patients with complete lateral x-ray films and wounds not limited to the calvaria, 5 (10%) had cervical spine or spinal cord in jury. Of the 192 patients who had CT-proven intracranial injury, 86 (4 5%) required immediate intubation before x-ray films were obtained, an d 67 (35%) died. We conclude that cervical spine immobilization may no t be required during endotracheal intubation of brain-injured gunshot victims with wounds limited to the calvaria.