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Abstract
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BACKGROUND: We aimed to determine the outcomes and prognostic factors in pediatric craniocerebral gunshot injury (CGI) patients. Pediatric patients may have significantly different physiology, neuroplasticity, and clinical outcomes in CGI than adults. There is limited literature on this topic, mainly case reports and small case series.
METHODS: We queried the National Trauma Data Bank (NTDB) for all pediatric CGI between 2014-2017. Patients were identified using International Classification of Diseases, ninth edition (ICD-9) codes. Demographic, emergency department, and clinical data were analyzed. Subgroup analysis was attempted for groups with Glasgow Coma Scale (GCS) of 9-15 and age 0-8 years.
RESULTS: In a three-year period, there were 209 pediatric patients (aged 0-18) presenting to American hospitals with signs of life. The overall mortality rate was 53.11%. A linear relationship was demonstrated showing a mortality rate by initial GCS of 79% in GCS 3, 56% in GCS 4-8, 22% in GCS 9-12, and 5% in GCS 13-15. The youngest patients, aged 0-8 years, had dramatically better initial GCS and subsequently lower mortality rates. Regression analysis showed mortality benefit in the total population for intracranial pressure monitoring (OR 0.267) and craniotomy (OR 0.232).
CONCLUSIONS: This study utilizes the NTDB to quantify the prevalence of pediatric intracranial gunshot wounds, with the goal to determine risk factors for prognosis in this patient population. Significant effects on mortality for invasive interventions including ICP monitoring and craniotomy for all patients suggests low threshold for use of these procedures if there is any clinical concern. The presence of a 79% mortality rate in patients with GCS on presentation of 3 suggests that as long as there is not a declared neurologic death, ICP monitoring and treatment measures including craniotomy should be considered by the consulting clinician. LEVEL OF EVIDENCE: Level III EvidenceRetrospective cohort study; Prognostic and Epidemiological.
Language: en |