Predictive factors influencing the outcome after gunshot injuries to the head-a retrospective cohort study

Abstract

Background: Civilian gunshot injuries to the head are relatively rare in the irenical European Union, and studies of treatment and outcomes are seldom for this region in the current literature.

Methods: A cohort of 85 patients with civilian head gunshot injuries, who were admitted to our University hospital over a period of 16 years, was reviewed retrospectively. Clinical manifestation, computed tomography scan findings, and surgical treatment were described, with special regard to prognostic factors and outcome.

Results: The mean age was 48 years (range, 17.8-98.4 years), and 87% were men. Sixty patients sustained penetrating craniocerebral injuries (P-group) and 25, nonpenetrating gunshot wounds (NP-group). The overall mortality was 87% in the P-group and 4% in the NP-group. The Glasgow Coma Scale (GCS) score at admission was recorded to be 3 to 5 in 58 patients (96%) and 7 patients (28%) in the P-group and NP-group, respectively. Only 8 patients (13%) survived in the P-group compared with 24 patients (96%) in the NP-group. Excluding wound debridement, there were 16 surgical procedures in the P-group and 8 in the NP-group, with a mortality rate of 63% and 13%, respectively.

Conclusions: Glasgow Coma Score at admission and the status of pupils and hemodynamic situation seem to be the most significant predictors of outcome in penetrating craniocerebral gunshot wounds. Computed tomography scans, bi- or multilobar injury, and intraventricular hemorrhage were correlated with poor outcome. Patients with a GCS score >8, normal pupil reaction, and single lobe of brain injury may benefit from early aggressive management.