Prognostic factors in civilian gunshot wounds to the head: a series of 110 surgical patients and brief literature review

Abstract

This study was carried out to evaluate the early results and the prognostic factors affecting the outcome during the in-hospital stay of 110 patients with civilian gunshot wounds to the head admitted at the Hospital of Restauração, Recife, Brazil. Penetrating injury (66%) was the most prevalent type of wound encountered in the present series. Twelve of the 110 (10.9%) patients presented a unilateral dilated pupil at the admission. Motor impairment was present in 24/110 (21.8%) patients. Intracerebral hematoma was present in 36/110 (32.7%) and there were 15/110 (13%) patients with cerebrospinal fluid fistula. Eleven of 110 patients developed meningitis and in 9/110 intracranial abscesses occurred. Nine of 110 patients developed deep venous thrombosis, 11/110 had urinary infection, and coagulopathy was detected in 8/110. Following the surgical procedure, 27/110 (24.5%) patients died during their hospital stay. When the two groups, survivors and non-survivors, were compared, there were significant statistical differences and the univariate analysis identified five preoperative predictors of a poor outcome following surgery: age over 40 years (odds ratios (OR) 5.4, 95% CI 1.73-16.82); presence of unilateral pupil dilatation (OR 5.5, 95% CI 1.641-18.13); low (≤8) Glasgow coma score on admission (OR 6.50, 95% CI 2.27-18.60), presence of intracranial hematoma (OR 3.0, 95% CI 1.21-7.34), and respiratory infection (OR 4.8, 95% CI 1.75-13.47). Thus, (a) age of the patient (juvenile/young age), (b) high preoperative Glasgow coma score, (c) lack of pupil abnormalities, and (d) absence of intracerebral hematoma are predictors of a good prognosis.

Surgical management of civilian gunshot wounds to the head

“…Prognostic factors that help at the scene of accident include hypotension, respiratory distress, abnormal pupillary response to light, and GCS score (Kaufman et al, 1983;Murano et al, 2005;Glapa et al, 2009;Hofbauer et al, 2010;Ambrosi et al, 2012). Despite a timely resuscitation of patients with GSWH at the scene of accident, a large number of patients are dead on arrival (Zafonte et al, 2001a).…”

“…After secondary survey and resuscitation, the patients should have a computed tomography (CT) scan of the head (Kaufman et al, 1983;Murano et al, 2005;Glapa et al, 2009;Hofbauer et al, 2010;Ambrosi et al, 2012). Although not so fully studied in patients with GSWH as in those with blunt head trauma, it should be assumed that these patients will suffer cerebral oligemic ischemia.…”

“…In the Iran-Iraq War, operated and unoperated patients were received at the emergency department of a tertiary hospital after a mean of 49 hours (Aarabi, 1990). The second clinical predictor of outcome is the status of the pupillary size and reaction to light (Aarabi, 1990;Brandvold et al, 1990;Grahm et al, 1990;Murano et al, 2005;Glapa et al, 2009;Hofbauer et al, 2010;Petridis et al, 2011;Ambrosi et al, 2012). In the literature on civilians with GSWH, the percentage of patients with a GCS of 3-8 ranges from 48% to 94% (Kaufman et al, 1983;Clark et al, 1986;Mancuso et al, 1988;Grahm et al, 1990;Shaffrey et al, 1992;Kennedy et al, 1993).…”

Craniocerebral gunshot injury in newborn

“…A series from our institution published in 2005 (3) reports that the youngest patient among 110 cases of gunshot wounds to the head admitted to the emergency ward was two years of age. In two larger series of pediatric gunshot injuries (4,5), the youngest patients were aged two and six months, respectively.…”

Factors affecting dural penetration and prognosis in patients admitted to emergency department with cranial gunshot wound

“…Once prevalent in regions of military conflict, cranial gunshot wounds (CGWs) are now increasingly common even in the absence of military clashes, especially affecting civilians living in developing countries [1,2]. Penetrating brain injuries differ from blunt brain injuries primarily by the presence of dural perforation [3].…”