Citation

Deng H, Yue JK, Winkler EA, Dhall SS, Manley G, Tarapore PE. J. Neurotrauma 2019; 36(2): 322-337.

Affiliation

San Francisco General Hospital, Brain and Spinal Injury Center, San Francisco, California, United States ; phiroz.tarapore@ucsf.edu.

Copyright

(Copyright © 2019, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2017.5591

PMID

29855212

Abstract

Civilian firearm injury is an important public health concern in the United States. Gunshot wounds to the head (GSWH) remain in need of update and systematic characterization. We identify predictors of prolonged hospital length of stay (HLOS), ICU LOS, medical complications, mortality, and discharge disposition from a population-based sample using the National Sample Program (NSP) of the National Trauma Data Bank (NTDB), years 2003-2012. Statistical significance was assessed at α < 0.001 to correct for multiple comparisons. In total, 8,148 adult GSWH patients were included extrapolating to 32,439 national incidents. Age was 36.6±16.4 years and 64.4% were severe TBI (GCS score 3-8). Assault (49.2%), handgun (50.3%), and residential injury (43.2%) were of highest incidence. HLOS and ICU LOS were 7.7±14.2 and 5.7±13.4 days, respectively. Overall mortality was 54.6%; suicide/self-injury associated with the highest mortality rate (71.6%). GCS, ISS, and hypotension were significant predictors for outcomes overall. Medicare/Medicaid patients had longer HLOS compared to private/commercial insured (mean increase 4.4 days, 95% CI[2.6-6.3 days]). Compared to the Midwest, the South had longer HLOS (mean increase 3.7 days,[2.0-5.4 days]) and higher odds of complications (OR 1.7[1.4-2.0]); the West had lower odds of complications (OR 0.6[0.5-0.7]). Versus handgun, shotgun (OR 0.3[0.2-0.4]) and hunting rifle (OR 0.5 [0.4-0.8]) resulted in lower mortality. Patients with government/other insurance had higher odds of discharging home compared to private/commercially insured (OR 1.7[1.3-2.3]). In comparison to level I trauma centers, level II trauma centers had lower odds of discharge to home (OR 0.7[0.5-0.8]). Our results support hypotension, injury severity, injury intent, firearm type, and U.S. geographic location as important prognostic variables in firearm-related TBI. Improved understanding of civilian GSWH is critical to promoting increased awareness of firearm injuries as a public health concern, and reducing its debilitating injury burden to patients, families, and healthcare systems.

Language: en

Keywords

EPIDEMIOLOGY; OUTCOME MEASURES; Penetrating Ballistic-like Brain Injury; TRAUMATIC BRAIN INJURY