Document Detail


Civilian craniocerebral gunshot wounds: an update in predicting outcomes.
MedLine Citation:
PMID:  16447469     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Given the high mortality in patients sustaining intracranial injury secondary to gunshot wounds (GSWs), predictors to identify patients at increased risk of death are needed to assist clinicians early in determining optimal treatment. There have been few recent studies involving penetrating craniocerebral injuries, and most studies have been restricted to small numbers of patients, which do not allow for adequate prediction of mortality. A retrospective chart review of 298 patients who sustained GSWs to the head between 1992 and 2003 was conducted at a level 1 trauma center. Demographics, bullet trajectory, admitting Glasgow Coma Scale (GCS), head Abbreviated Injury Score (AIS), as well as admission blood pressure and respiratory rate were evaluated. Univariate testing followed by multivariate logistic regression was performed to identify independent predictors of death. In-hospital mortality for patients with intracranial injury secondary to GSW was 51 per cent. A GCS <5 on admission and a high Injury Severity Score (ISS >25) was associated with mortality as compared with survivors (P < 0.05). Of those patients presenting with a GCS of 3, there were seven survivors to discharge. Logistic regression identified the following variables as predictors of death: respiratory arrest on admission, hypotension on admission, transhemispheric and transventricular GSW. Identification of those patients at the highest risk of death secondary to a craniocerebral GSW allows clinicians to better predict outcome and prognosis. This is not only important in determining treatment algorithms for physicians but also for appropriate counseling of family members to educate them with regard to patients' outcomes.
Authors:
Tiffany Murano; Alicia M Mohr; Robert F Lavery; Catherine Lynch; Adena T Homnick; David H Livingston
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The American surgeon     Volume:  71     ISSN:  0003-1348     ISO Abbreviation:  Am Surg     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2006-02-01     Completed Date:  2006-02-22     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370522     Medline TA:  Am Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1009-14     Citation Subset:  IM    
Affiliation:
Department of Surgery, Division of Emergency Medicine, UMDNJ-New Jersey Medical School, Newark, New Jersey 07103, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Age Distribution
Aged
Analysis of Variance
Cause of Death*
Cohort Studies
Critical Illness
Emergency Service, Hospital
Female
Follow-Up Studies
Glasgow Coma Scale
Head Injuries, Penetrating / epidemiology*,  etiology,  surgery*
Humans
Incidence
Injury Severity Score
Logistic Models
Male
Middle Aged
Neurosurgical Procedures / methods*,  mortality
New Jersey / epidemiology
Predictive Value of Tests
Probability
Retrospective Studies
Risk Assessment
Sex Distribution
Statistics, Nonparametric
Survival Analysis
Violence
Wounds, Gunshot / complications*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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