Citation

Yue J, Deng H, Winkler E, Dhall S, Manley G, Tarapore P. J. Neurotrauma 2017; 34(13): A23.

Copyright

(Copyright © 2017, Mary Ann Liebert Publishers)

DOI

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PMID

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Abstract

Firearm injuries cause an estimated 33,000 deaths annually in the United States. Management algorithms following gunshot wounds to the head (GSWH) have been static for two decades and outcomes remain in need of systematic characterization. Adult GSWH patients in the National Sample Program (NSP) of the National Trauma Data Bank (NTDB), years 2003-2012, were extracted. Multivariable regression identified predictors for hospital length of stay (HLOS), intensive care unit length of stay (ICU LOS), medical complications, mortality, and discharge disposition. Odds ratios (OR) and 95% confidence intervals (CI) were reported. Statistical significance was assessed at p < 0.001. In total, 8,148 patients were included extrapolating to 32,439 national incidents. Age was 36.6 ± 16.4 years. Mean HLOS was 13.9 ± 17.9 days and ICU LOS was 8.6 ± 17.4 days. The mortality was 54.6%. Age, injury intent, Glasgow Coma Scale (GCS) score, Injury Severity Score (ISS), and hypotension were significant predictors as previously reported (p < 0.001). Compared to privately insured patients, Medicare/Medicaid patients had longer HLOS (mean increase 4.4 days, 95% CI [2.6-6.3 days], p < 0.001). Compared to the Midwest, the South had longer HLOS (mean increase 3.7 days [2.0-5.4 days], p < 0.001) and more complications (OR 1.7 [1.4-2.0], p < 0.001); the West had less complications (OR 0.6 [0.5-0.7], p < 0.001). Compared to handgun, injury from shotgun and hunting rifle had lower odds of death (OR 0.3 [0.2-0.4], p < 0.001; OR 0.5 [0.4-0.8], p < 0.001). Suicide had lower odds of discharge to home compared to accident (OR 0.5 [0.3-0.7], p < 0.001). Relative to Level I trauma centers, Level II trauma centers had lower odds of discharge to home (OR 0.7 [0.5-0.8], p < 0.001). In conclusion, firearm type, injury intent, insurance type, and geographic region are important prognosticators for acute recovery and outcome following GSWH, in addition to older age, hypotension, and injury severity. Improved understanding of civilian GSWH is critical to increasing awareness and reducing injury burden from firearm injuries.

Keywords: firearm injury, mortality, penetrating brain injury, traumatic brain injury, epidemiology

Abstract from: The 35th Annual National Neurotrauma Symposium, July 7-12, 2017, Snowbird, Utah

Language: en

Keywords

epidemiology; firearm injury; mortality; penetrating brain injury; traumatic brain injury