Civilian gunshot wounds to the brain

Civilian gunshot wounds to the brain are relatively rare, and a much-neglected subject in Taiwan. We present our experience with 16 patients who sustained gunshot wounds to the brain, and then identify factors determining the respective outcomes.

From 1988-2002, data from 16 patients with civilian gunshot wounds to the brain, who were treated at Taichung Veterans General Hospital, were retrospectively reviewed. Historical information, clinical manifestations, and imaging findings were described. Based on Glasgow Outcome Score (GOS), patients were divided into a poor-outcome group (GOS, 1-2) and satisfactory-outcome group (GOS, 3-5) for further analysis.

The overall mortality rate was 31.3% (5 of 16 patients). Thirteen patients underwent surgery, and the surgical mortality rate was 15.4% (2 of 13 patients). Of the 7 patients with a Glasgow Coma Scale (GCS) score of more than 8, all survived with satisfactory outcomes; of the 9 patients with a GCS score of less than 8, 8 had poor outcomes (5 died, and 3 were in a persistent vegetative state); p < 0.005 between the 2 GCS groups. In addition, the rate of satisfactory outcome was significantly higher in 7 patients with limited brain injury, as determined by computed tomography (CT) scan, than in 8 patients with extensive brain injury (86% vs 25%; p < 0.05).

GCS score on admission, and the extent of brain injury as visualized by CT scan, seem to be the 2 most significant predictors of outcome in cranio-cerebral gunshot wounds. Patients with a GCS score of more than 8, or brain lesions limited to a single lobe of the brain, may benefit from aggressive management.