A Nationwide Analysis of Gunshot Wounds of the Head and Neck: Morbidity, Mortality, and Cost

Menezes, John M.; Batra, Kavita; Zhitny, Vlasdislav

doi:10.1097/scs.0000000000009268

Cited by 5 publications

(1 citation statement)

References 29 publications

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“…These traumas include a wide range of etiologies. 7 Among these etiologies, we can mention accidents on public roads, accidents at work, sports, traumas caused by bullets, traumas caused by arrows, etc.…”

Section: Discussionmentioning

confidence: 99%

A hunting arrow traumatism to the head: A case report from Niger

Ibrahim

Murhega

Sanoussi

2023

Clinical Case Reports

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Key Clinical MessageArrow injuries have not disappeared in our environment despite the advances in the development of warfare tools in the world. All regions of the body can be the target of these arrows and in particular the cephalic region whose gravity will depend on the structures reached.AbstractWith the development of modern weapons of war, arrow wounds have become rare in developed countries, but they are still common in developing countries, including Niger. These injuries are often serious and life‐threatening when they are in the head and neck region, due to the presence of major vessels and vital organs in these areas of the body. Extraction of these arrows is usually difficult due to the proximity of major vital structures. Unskilled extraction can aggravate the injury or result in unintentional damage to vital structures with imminent risk of death. We present the case of a patient with a homemade arrow to the head in the left periorbital region that we successfully extracted at the National Hospital in Niamey. Our objective is to highlight the experience with this patient and review some reports in the literature.

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Section: Discussionmentioning

confidence: 99%

A hunting arrow traumatism to the head: A case report from Niger

Ibrahim

Murhega

Sanoussi

2023

Clinical Case Reports

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Unusual trajectory of a bullet from the shoulder to the brain: an emergency department perspective on finding a missing bullet

Anwar,

Shakeel,

Waheed

et al. 2024

BMJ Case Rep

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Terminal ballistics continues to struggle with bullet trajectory reconstruction and interpretation. This is a case of a young man presented with a very unusual trajectory of a bullet from the left shoulder to the brain parenchyma. The single wound and altered mentation prompted a CT head and neck scan, which revealed a retained bullet in the brain parenchyma, traversing from the left shoulder, across the neck and into the brain without causing significant damage to vital organs. We managed the patient conservatively. Emergency physicians dealing with gunshot injuries should thoroughly search for the bullet in cases where only a single wound is present and the bullet is missing, and they should have a basic understanding of the ballistics to understand the mechanism and injury pattern sustained by the bullet. This atypical ballistic trajectory scenario emphasises the need to exercise vigilance in accurately predicting the trajectory when the ballistic route is unknown.

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Coagulopathy in Penetrating Ballistic Cranial Trauma: A 7-Year Experience

Alhourani,

Stephenson,

Bridwell

et al. 2024

Neurosurgery

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BACKGROUND AND OBJECTIVES: Penetrating ballistic cranial trauma (PBCT) carries significant mortality when compared with blunt trauma. The development of coagulopathy in PBCT is a strong predictor of mortality. The goal of the study was to describe the incidence and risk factors of coagulopathy in PBCT and to report the value of tranexamic acid administration in PBCT. METHODS: We retrospectively analyzed 270 patients who presented with PBCT to a single, Level 1 trauma center between 2016 and 2023. RESULTS: A total of 47% (127/270) of patients with PBCT developed coagulopathy at presentation. Fifty-seven patients received tranexamic acid at presentation, which did not affect the development of coagulopathy. Coagulopathic patients were more likely to have more serious injury patterns (bihemispheric [adjusted odds ratio, aOR: 2.6 CI: 1.4-4.9, P = .004] or transventricular trajectories [aOR: 4.9 CI: 1.9-19.6, P = .03]). In addition, they presented with a larger base deficit (aOR: 0.9 CI: 1.002-1.2 per mEq/L, P = .006) which negatively correlated with the international normalized ratio (ρ: −0.46, P < .0001, Spearman correlation). Using thromboelastography helped to identify an additional 20% of patients who presented with normal coagulation on conventional testing. CONCLUSION: Coagulopathy is prevalent in approximately 50% of patients with PBCT and is persistent despite treatment in a substantial subset of patients. The addition of thromboelastography with its increased coagulopathy sensitivity can potentially guide treatment more efficiently than traditional coagulopathy laboratory tests and fibrinogen alone. Patients with a significant base deficit on arterial blood gas are at higher risk for coagulopathy.

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A Nationwide Analysis of Gunshot Wounds of the Head and Neck: Morbidity, Mortality, and Cost

Cited by 5 publications

References 29 publications

A hunting arrow traumatism to the head: A case report from Niger

A hunting arrow traumatism to the head: A case report from Niger

Unusual trajectory of a bullet from the shoulder to the brain: an emergency department perspective on finding a missing bullet

Coagulopathy in Penetrating Ballistic Cranial Trauma: A 7-Year Experience

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