PATIENTS WITH GUNSHOT WOUNDS TO THE HEAD DO NOT REQUIRE CERVICAL-SPINE IMMOBILIZATION AND EVALUATION

Objective: The purpose of this study was to determine the incidence of indirect spinal column injury in patients sustaining gunshot wounds t o the head. Methods: A retrospective review of patient records and aut opsy reports was conducted of patients admitted with gunshot wounds to the head between July of 1990 and September of 1995 were included. Th ose 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 e ither 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 t hat were apparent from bullet trajectory. More intubation attempts occ urred in patients with cervical spine immobilization (49 attempts in 3 4 patients with immobilization versus five attempts in four patients w ithout cervical spine immobilization, p = 0.008). Conclusions: Indirec t spinal injury does not occur in patients with gunshot wounds to the head. Airway management was compromised by cervical spine immobilizati on. Protocols mandating cervical spine immobilization after a gunshot wound to the head are unnecessary and may complicate airway management .