Predictors of outcome in civilian gunshot wounds to the head

Aarabi, Bizhan; Tofighi, Babak; Kufera, Joseph A.; Hadley, Jeffrey A.; Ahn, Edward S.; Cooper, Carnell; Malik, Jacek M.; Naff, Neal J.; Chang, Louis W.; Radley, Michael G.; Kheder, Ashker; Uscinski, Ronald H.

doi:10.3171/2014.1.jns131869

Cited by 103 publications

(125 citation statements)

References 67 publications

Supporting

Mentioning

115

Contrasting

Order By: Relevance

“…[3,16] Previous studies have reported that the patients admitted for FAI were usually 20-35 years old and predominantly male. [4,8,10,16,18] In agreement with the literature, our study found that predominantly young males were the victims of FAIs.…”

Section: Discussionsupporting

confidence: 92%

“…[35] Former studies have reported that GCS was inversely proportional to mortality. [4,10,12,16,18,30,3335,36] Complying with the literature data, an inverse relationship between GCS and mortality was also detected.…”

Section: Discussion Concerning Emergency Procedures Applied For Faissupporting

confidence: 60%

“…[3,10] Williams et al, and Raul et al have reported that the ballistic trajectory and the extent of injury affect the rates of morbidity and mortality. [40,41] Various studies have particularly stressed that intraventricular hemorrhages are associated with poor prognosis.…”

Section: Discussion Concerning Emergency Procedures Applied For Faismentioning

confidence: 99%

“…[8,9] No consensus has been reached yet regarding an appropriate CFAI classification and the indications for operation. [10] Some authors have recommended aggressive surgery and rapid treatment. [11][12][13][14][15] although some others have advocated a conservative treatment in the case of multilobular injury and a GCS less than 5.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Outcomes and Demostration of Cranial Firearm Injuries: A Multicenter Retrospective Study

Çınar¹,

Seçer

Alagöz

et al. 2015

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Discussion Concerning Emergency Procedures Applied For Faissupporting

confidence: 60%

Section: Discussion Concerning Emergency Procedures Applied For Faismentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Outcomes and Demostration of Cranial Firearm Injuries: A Multicenter Retrospective Study

Çınar¹,

Seçer

Alagöz

et al. 2015

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

show abstract

“…Penetrating brain injury from a high-velocity projectile creates a complex pattern of permanent tissue damage. The bullet track left in the wake of the missile creates a potential nidus for foreign body migration, local brain necrosis, and external contamination of devitalized wound tissues (15).…”

Section: Discussionmentioning

confidence: 99%

A Migrating Retained Intracranial Bullet Presenting with Hydrocephalus and Alterations of Consciousness: A Case Report and Literature Review

2017

View full text Add to dashboard Cite

Migrating intracranial bullets are a dilemma to neurosurgeons, as their management is challenging, and the removal process is associated with high mortality and morbidity rates. They are also associated with alterations in consciousness and focal neurological defects. We herein report a 40-year-old man with a retained intracranial AK-47 bullet for 22 years, admitted to our emergency department with decreased level of consciousness. He was diagnosed with meningitis and obstructive hydrocephalus, given the pressure effect of the bullet over the aqueduct of Sylvius. He underwent placement of external ventricular drainage (EVD) and received broad-spectrum antibiotics. However, he passed away due to complications of meningitis. Postmortem examination revealed that the bullet had entered the anterior perforated substance from ethmoidal air cells and migrated to the brain ventricular system in 22 years. Accordingly, conservative management of intracranial retained bullets is recommended.

show abstract

Comparative Effectiveness of Intracranial Pressure Monitoring vs No Monitoring in Severe Penetrating Brain Injury Management

et al. 2023

View full text Add to dashboard Cite

ImportanceCivilian penetrating brain injury (PBI) is associated with high mortality. However, scant literature is available to guide neurocritical care monitoring and management of PBI.ObjectiveTo examine the association of intracranial pressure (ICP) monitoring with mortality, intensive care unit (ICU) length of stay (LOS), and dispositional outcomes in patients with severe PBI.Design, Setting, and ParticipantsThis comparative effectiveness research study analyzed data from the Trauma Quality Improvement Program of the National Trauma Data Bank in the US from January 1, 2017, to December 31, 2019. Patients with PBI were identified, and those aged 16 and 60 years who met these inclusion criteria were included: ICU LOS of more than 2 days, Glasgow Coma Scale (GCS) score lower than 9 on arrival and at 24 hours, and Abbreviated Injury Scale score of 3 to 5 for the head region and lower than 3 for other body regions. Patients with bilaterally fixed pupils or incomplete data were excluded. A 1:1 propensity score (PS) matching was used to create a subgroup of patients. Patients were divided into 2 groups: with vs without ICP monitoring. Data analysis was conducted between September and December 2022.ExposuresIntracranial pressure monitoring vs no monitoring.Main Outcomes and MeasuresOutcomes were mortality, rate of withdrawal, ICU LOS, and dispositional outcome. Measures were age, initial systolic blood pressure, initial oxygen saturation level on a pulse oximeter, first-recorded GCS score, GCS score at 24 hours, Abbreviated Injury Scale score, midline shift, and pupillary reactivity.ResultsA total of 596 patients (505 males [84.7%]; mean [SD] age, 32.2 [12.3] years) were included, among whom 220 (36.9%) died and 288 (48.3%) had ICP monitoring. The PS matching yielded 466 patients (233 in each group with vs without ICP monitoring). Overall mortality was 35.8%; 72 patients with ICP monitoring (30.9%) died compared with 95 patients (40.8%) without ICP monitoring . Patients with ICP monitoring were more likely to survive (odds ratio [OR], 1.54; 95% CI, 1.05-2.25; P = .03; number needed to treat, 10). No difference in favorable discharge disposition was observed. The PS-weighted analysis included all 596 patients and found that patients with ICP monitoring were more likely to survive than those without (OR, 1.40; 95% CI, 1.10-1.78; P = .005). The E-value for the OR calculated from the PS-matched data set was 1.79. In addition, ICP monitoring vs no monitoring was associated with an increase in median (IQR) ICU LOS (15.0 [8.0-21.0] days vs 7.0 [4.0-12.0] days; P &lt; .001).Conclusions and RelevanceIn this comparative effectiveness research study, PBI management guided by ICP monitoring was associated with decreased mortality and increased ICU LOS, challenging the notion of universally poor outcomes after civilian PBI. Randomized clinical trials that evaluate the efficacy of ICP monitoring in PBI are warranted.

show abstract

Predictors of outcome in civilian gunshot wounds to the head

Cited by 103 publications

References 67 publications

Outcomes and Demostration of Cranial Firearm Injuries: A Multicenter Retrospective Study

Outcomes and Demostration of Cranial Firearm Injuries: A Multicenter Retrospective Study

A Migrating Retained Intracranial Bullet Presenting with Hydrocephalus and Alterations of Consciousness: A Case Report and Literature Review

Comparative Effectiveness of Intracranial Pressure Monitoring vs No Monitoring in Severe Penetrating Brain Injury Management

Contact Info

Product

Resources

About