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  • A Meta-Analysis of Factors Predicting Mortality in Civilian Craniocerebral Gunshot Injuries

    Final Number:

    Georgios Maragkos MD; Efstathios Papavassiliou MD; Martina Stippler MD; Aristotelis Filippidis MD, PhD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: There is currently no consensus regarding prognosis and management for civilian craniocerebral gunshot injuries (cCGI). To the authors’ knowledge, this is the first meta-analysis to study mortality prognostic factors in cCGI.

    Methods: Five online databases and the reference lists of relevant articles were queried for cohort studies of cCGI reporting factors associated with mortality. PRISMA guidelines were followed. Study quality was assessed using the Newcastle-Ottawa scale. Pooled estimates of odds ratios and 95% confidence intervals were derived using random-effects models. Heterogeneity was assessed with I-square and meta-regression. Funnel-plots were utilized to assess publication bias.

    Results: We identified 17 retrospective cohort studies encompassing 1774 cCGI patients. Out of the factors assessed, the ones significantly associated with mortality were: older age (Odds Ratio 3.44, 95% Confidence Interval [1.71-6.91]), suicide attempt (5.78 [3.07-10.87]), post-resuscitation Glasgow Coma Scale (GCS) 3-8 (38.02 [21.98-65.77]), bilateral fixed and dilated pupils (67.12 [16.67-270.22]), penetration of the dura (29.07 [4.30-196.53]), bullet trajectory through both hemispheres (4.23 [2.32-7.68]), and through multiple lobes (6.53 [1.99-21.42]).

    Conclusions: This is the first attempt to systematically assess prognostic factors for civilians with gunshot injuries to the brain. Older patients, those attempting suicide, those arriving in a comatose state, with pupillary defects, and trajectories through the dura and through both hemispheres or multiple lobes are the strongest predictors of in-hospital mortality. Further research is needed to utilize these results into management guidelines.

    Patient Care: Identification of admission factors that can accurately predict patient mortality after a gunshot wound to the head may assist in patient selection for operative treatment, resource allocation, quicker patient transfer as well as setting the correct outcome expectations in discussions with the family.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the factors predicting mortality after craniocerebral gunshot wounds in civilians; 2) Discuss, in small groups which of these patients are most likely to survive; 3) Identify an effective management plan for cCGI based on clinical and radiologic findings on presentation.


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