Introduction: Civilian gunshot wounds to the head (GSWH) are deadly. Predictors of clinical outcome due to GSWH were analyzed over a 24-month period.
Methods: We posited two questions: 1) What percentage of subjects with GSWH died across the state of Maryland; and 2) What were the predictors of good outcome (GOS) following GSWH? Demographics, clinical, imaging and acute care data of 786 civilians who sustained GSWH were analyzed. Univariate and regression analyses were used to analyze the data.
Results: Of this cohort (N= 786 patients), 594 died at the scene and 122 died following admission to 8 Level I-III Trauma Centers. Seventy patients made it to TBI rehabilitation of which 30 (3.8%) had surgery.
From the 69 patients who were admitted to this Level I Trauma Center, 78.6% were male, mean age was 34.8, injury severity score 26.7, GCS 7.1, and abnormal pupillary response to light (APR) was present in 47.4% of patients. CT scan indicated midline shift in 17.5%, obliteration of basal cisterns in 42.5%, intracranial hematomas in 35% and intraventricular hemorrhage in 55% of cases. Two subsets of admissions were studied: (1) 27 patients who died during acute care and (2) 15 patients who had a good outcome when followed a mean of 39 months.
Missile trajectory (p< 0.001), admission GCS (p< 0.001), APR (p=0.002), patency of basal cisterns (p= 0.01), age (p= 0.02) and intraventricular bleed (p= 0.03) had significant relationship with outcome. Stepwise multivariable logistic regression analysis indicated that GCS and patency of basal cistern were significant determinants of outcome. Exclusion of GCS from the regression models indicated missile trajectory and APR were significant players in determining outcome.
Conclusions: GCS at admission, APR to light, patency of basal cisterns and the trajectory of the missile were significant determinants of outcome in civilian GSWH.
Patient Care: Better selection of patients for conservative or surgical intervention in order to have the best clinical outcome
Learning Objectives: This investigation will empower neurosurgeons to better select victims of GSWH for the best possible outcome
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