Racial Disparities in Cranial Gunshot Wounds: Intent and Survival

Gunshot wounds (GSW) to the head are associated with the highest mortality of all gun-related injuries, with assault reported as the leading cause of penetrating GSW. Several studies have explored factors and trends related to assault and self-inflicted GSW separately. The aim of this study was to investigate epidemiological characteristics and racial differences collectively in patients with GSW to the head by examining associations to injury intent and survival.

A retrospective study was performed by accessing the hospital trauma registry at our regional Level 1 Trauma Center. A query of neurosurgery consults with penetrating trauma was completed from January 2008 to October 2013. Patients with penetrating intracranial GSW were included in the study. A chi-square test was used to evaluate association between patients' characteristics and intent of injury. Logistic regression analyses predicting intent of injury and survival were also conducted.

Of 111 patients, the majority were male (87.4 %). Most were African American (57.7 %) and Caucasian (35.1 %). Compared to African Americans, Caucasian patients were more likely to inflict self-harm (odds ratio (OR) 16.369 (95 % confidence interval (CI) 5.633-47.571), p < 0.0001), while African Americans (OR 26.413 (95 % CI 8.957-77.890), p < 0.0001) were more likely to be victims of assault. Race and other demographic variables did not predict survival nor did intent of injury (p = 0.368).

This study reports that there are racial disparities between assault GSW and self-inflicted GSW. However, neither race nor intent is a predictor of survival outcome. Targeted efforts are needed to reduce occurrence of cranial GSW events in order to decrease associated morbidity and mortality.