Imaging Factors Inform Treatment of Penetrating Gunshot Wounds in Children and Adolescents

Researchers examining Intracranial Gunshot Wounds (GSWs) in children and adolescents have identified several factors predictive of patient outcomes.

The researchers found nine clinical, laboratory, and Computed Tomography (CT) imaging factors that were statistically associated with mortality. Several of these factors included bilateral fixed and dilated pupils, intravascular volume depletion, systolic blood pressure lower than 100 mmHg anemia, a Glasgow Coma Scale score of 5 or lower, and injuries to various brain injuries involving various parts of the brain or blood vessels.

The results of the study were published in the January 5, 2016, issue of the Journal of Neurosurgery. The researchers from the Department of Neurosurgery at the University of Tennessee (Knoxville, TN, USA), and a number of other institutions, looked at the medical records of pediatric patients aged 18 years or younger who received treatment for penetrating GSWs to the head. The study included records of 71 patients with a mean age at presentation of 14 years, suffering only from a single trauma. Thirty-nine (55%) of the patients underwent Surgery.

The primary outcome in the study was the Glasgow Outcome Scale score, and the overall mortality rate was 48%, or 34 of the 71 patients. Thirty of the 37 surviving (81%) achieved a favorable outcome (Glasgow Outcome Scale Score 4 or 5).

The results demonstrated the importance of collecting clinical, laboratory, and radiological factors associated with mortality, to help guide treatment plans and predict in children and adolescents with GSW. The researchers found that only bilateral fixed and dilated pupils are a reliable indicator for predicting mortality. The other predictive factors collected in the study were only useful to help inform decision-making for treatment and care the pediatric patients. The authors found that children have a good ability to overcome severe neurological injuries.

The authors, said, “When presented with a child who has sustained an intracranial GSW, the neurosurgeon must quickly decide whether the child has a fatal injury, an injury that is potentially nonfatal but very likely to have a devastating neurological outcome, or a survivable injury with a reasonable chance of maintaining or regaining meaningful neurological function.”

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