Introduction: South-western Colombia is a region with high prevalence of trauma related to violence, including Traumatic Brain Injuries (TBI) due to gunshot-wounds. It is important to characterize and define predictors in the initial treatment of this patients in order to provide a better care with better outcomes.

Methods: An observational, descriptive cross-sectional study was conducted by retrospectively collecting clinical data related to adult patients, ages above 18-years-old, that presented TBI due to gunshot-wounds and that consulted to the Emergency Room at Fundación Valle del Lili Hospital between January 2003 and December of 2015. A descriptive statistical analysis was performed for all considered variables, and the 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 80 patients older than 18-years-old were included. Most (93.5%) were male; Mean age was 29.7 (SD +/-11.1). Trauma context was civilian in 96% of cases, 47.5% of them representing assault and the most common location of trauma was in the streets (58.8). In 45% of cases multiple trauma occurred, where the most prevalent was associated chest injury (72.2%). Glasgow-Coma-Score at admission was: 3-8=67.5%; 9-12=5%; 13-15=27,5%. Admission brain-CT-scan sshowed VI and VI Marshall-classification in 59.5% of patients. A total of 41 (48.75%) patients died, of these, 66.7% died at first 24-hours. Of those who died, 72.2% had a Marshall-classification of IV or higher, 71.1% had subarachnoid hemorrhage, 47.4% midline deviation, and 42.1% had the basal cisterns completely closed.

Conclusions: Major compromise in general status on admission determines an overall poorer prognosis and a high likelihood of death in the first 24-hours. Prevention is important for this deadly condition, much more when most of victims are young adults (economically productive population).

Patient Care: knowledge of epidemiological data and prognostic factors, in the adult 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 remains a challenge for neurosurgery, emergency medicine and neurocritical care. • Almost half of the adult patients with severe TBI secondary to gunshot-wounds had poor prognosis and died in the first 24 hours. • 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. • Neurotrauma Outside the High-Income Setting remains to be highly inflicted by violence and assault.

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