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Craniocerebral gunshot injuries in preschoolers
Furqan B Irfan1, Rameez Ul Hassan, Rajesh Kumar
1Department of Neurosurgery, Aga Khan University, Karachi, 74800, Sindh, Pakistan. furqan.irfan@gmail.com
Insights
Pediatric craniocerebral gunshot wounds (GSW) are increasingly common and lethal. Aggressive surgical intervention, even in children with severe head injuries (Glasgow Coma Scale <5), can be life-saving.
Area of Science:
- Pediatric Neurosurgery
- Trauma Surgery
- Emergency Medicine
Background:
- Craniocerebral gunshot wounds (GSW) represent a highly lethal form of trauma.
- There is a concerning global increase in pediatric GSW incidents.
- This study details the management of four young children (2-3 years old) with head GSW.
Observation:
- Four pediatric patients with craniocerebral GSW were admitted to a tertiary care neurosurgery service.
- Three patients presented with severe neurological impairment (Glasgow Coma Scale [GCS] 3-5), while one had a GCS >10.
- Bullet entry wounds were primarily in the parietal region, with three cases involving bihemispheric injury.
Findings:
- Despite the severity of injuries, three out of four pediatric patients survived.
- Rapid transport to the emergency department (within 2 hours) was observed in most cases.
- Aggressive surgical management was employed for all patients.
Implications:
- Early, aggressive surgical intervention can significantly improve survival rates in pediatric craniocerebral GSW.
- This approach offers a life-saving measure even for children presenting with critically low GCS scores.
- Highlights the importance of specialized neurosurgical care for pediatric trauma patients.
Introduction:
Gunshot wounds (GSW) to the head are the most lethal form of trauma; unfortunately, the frequency of children being involved in such form of trauma is increasing at an alarming rate worldwide. We present our experience with four children from 2 to 3 years of age with craniocerebral GSW admitted to the neurosurgery service at a tertiary care hospital.
Methods:
For this study, four children, 2 to 3 years old, injured solely from bullet injuries to the head were selected. Their history, arrival Glasgow Coma Scale (GCS), clinical presentation at the time of arrival in ER, radiological findings, management, and follow-up reviewed.
Results:
Out of four children, only one did not survive. The bullet entrance wound was in the parietal region in robbery-related incidences, and, in three cases, the injury was bihemispheric. The time taken to reach the emergency department was less than 2 h for all patients except one. Of four patients, three presented with GCS between 3 and 5 while 1 presented with GCS well above ten.
Conclusion:
Our results show that even in children presenting with low GCS<5, an early act of aggressive surgical intervention can prove to be a life-saving measure.
