Introduction: Traumatic Brain injury (TBI) due to civil gunshot-wounds is a critical situation. In Colombia, there are few reports that describe the population, and it is important to be able to offer a good quality medical attention and early assessment.
Methods: An observational, descriptive cross-sectional study was conducted by retrospectively collecting clinical data related to pediatric patients, ages between 1 and 18 years-old, that presented TBI due to gunshot-wounds, who consulted to the ER in Fundación-Valle-del-Lili, Cali, Colombia between January-2003 and December-2015. A descriptive statistical analysis was performed for all considered variables, and Kaplan-Meier analysis was used to estimate the survival function for the study population. STATA-12.0-software was used to perform the statistical analysis.
Results: A total of 34 patients were included for the analysis. Mean age was 13.3 years-old (SD±5.2), were 76.5% accounted for male patients. Most of injuries took place in the streets 47.06%. TBI was associated to other types types of trauma in 20.59% of cases, the most prevalent was extremity injury 11.76% (n=4) followed by thoracic injury 8.82% (n=3). Injury Severity Score (ISS) of the patients in the ER had a mean of 41.79 (SD±26.12). GCS at admission was 3-8: 61.76%, 3-15: 32.35% and 5.88% for those who had 9-12. Initial CT-scan was preformed, and Marshall-score showed that 52.88% of the patients had a score of III or more, that was associated with poor prognosis. Mortality was 47.06%, all of them associated directly to TBI, with 50% (n=8) of the deaths occurring during the first 24-hour period; Age group with most mortality was 11-18 years-old with 53% (n=14).
Conclusions: An alarming number of children were treated for TBI due to gunshot wounds due to violence. Most of patients admitted to the ER had severe injuries with poor prognosis, and emphasize the importance of prevention and early assessment.
Patient Care: knowledge of epidemiological data and prognostic factors, in the pediatric population that presents TBI secondary to gunshot-wounds, will help us to develop rapid response strategies for patients with this type of trauma and to develop prevention and promotion programs.
Learning Objectives: • Severe TBI secondary to gunshot-wounds in pediatric population is an uncommon situation.
• The majority of pediatric patients with severe TBI secondary to gunshot-wounds had poor prognosis.
• Early assessment and appropriate care are critical for a better outcome in severe TBI due to gunshot-wounds, however prevention should be the main strategy in this catastrophic event.
References: • Cleves, Daniela, Catalina Gómez, Diana María Dávalos, Ximena García, and Raul Ernesto Astudillo. “Pediatric Trauma at a General Hospital in Cali, Colombia.” Journal of Pediatric Surgery, February 3, 2016.
• Barlow, B., M. Niemirska, and R. P. Gandhi. “Ten Years’ Experience with Pediatric Gunshot Wounds.” Journal of Pediatric Surgery 17, no. 6 (December 1982): 927–32.
• Wani, Abrar A., Altaf U. Ramzan, Nayil K. Malik, Abdul Qayoom, Furqan A. Nizami, Altaf R. Kirmani, and M. Afzal Wani. “Missile Injury to the Pediatric Brain in Conflict Zones.” Journal of Neurosurgery. Pediatrics 7, no. 3 (March 2011): 276–81.
• Coughlan, Marc D., A. Graham Fieggen, Patrick L. Semple, and Jonathan C. Peter. “Craniocerebral Gunshot Injuries in Children.” Child’s Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery 19, no. 5–6 (June 2003): 348–52.
• Alexiou, George A., George Sfakianos, and Neofytos Prodromou. “Pediatric Head Trauma.” Journal of Emergencies, Trauma, and Shock 4, no. 3 (July 2011): 403–8.
• Rubiano, Andrés M., Nancy Carney, Randall Chesnut, and Juan Carlos Puyana. “Global Neurotrauma Research Challenges and Opportunities.” Nature 527, no. 7578 (November 19, 2015): S193–97.