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Pediatric Gunshot Head Injury: Prevalence of Prognostic Factors in Surgical Patients: An Institutional Experience in
Luiz Severo Bem Junior1,2, Otávio da Cunha Ferreira Neto3, Artêmio José Araruna Dias2
1Departament of Neurosurgery, Hospital da Restauração, Recife, Brazil.
Insights
Pediatric head gunshot wounds predict poor outcomes with low initial Glasgow Coma Scale (GCS) scores and midline-crossing injuries. These factors indicate higher mortality and morbidity in young patients with head trauma.
Area of Science:
- Neurosurgery
- Pediatric Traumatology
- Forensic Pathology
Background:
- Pediatric head gunshot wounds are a critical public health issue with significant morbidity and mortality.
- Understanding predictive factors for outcomes is essential for effective clinical management and resource allocation.
Purpose of the Study:
- To identify predictors of morbidity and mortality in pediatric patients with head gunshot wounds.
- To analyze the association between initial clinical and radiological findings and patient outcomes.
Main Methods:
- Retrospective review of 43 pediatric patients treated for head gunshot wounds between 2010-2019.
- Analysis of demographic data, injury characteristics (entry site, trajectory), initial Glasgow Coma Scale (GCS), CT findings, and Glasgow Outcome Scale (GOS) at discharge.
- Statistical analysis to determine significant associations between variables and patient outcomes.
Main Results:
- The majority of patients were male (90.7%) and aged 16-17 years (60.5%).
- Frontal region was the most common entry site (41.9%); penetrating trajectory occurred in 48.8% of cases.
- Low GCS scores on admission (p=0.001) and midline-crossing wounds (p=0.014) were significantly associated with unfavorable outcomes (GOS 1-3).
Conclusions:
- Low initial Glasgow Coma Scale scores are a significant predictor of poor outcomes in pediatric head gunshot wound patients.
- Head gunshot wounds that cross the midline are associated with increased mortality and morbidity.
- Early identification of these predictive factors can guide treatment strategies and improve patient prognosis.
Abstract:
This article aims to evaluate the predictive factors of morbidity and mortality in pediatric patients who suffered gunshot wounds to the head. We reviewed a series of 43 patients who were admitted to a referential neurosurgical hospital between 2010 and 2019. Data from 43 patients who underwent a surgical treatment in our institution were collected, and the following parameters were considered in the analysis: the initial Glasgow Coma Scale (GCS), age, sex, bullet entry site, and bullet trajectory. Computed tomography (CT) scans at admission, complications, midline crossing, and Glasgow score scale at the time of discharge (Glasgow Outcome Scale; GOS) were also factored in. Male sex corresponded to 90.7% of cases (N = 39), and 16-17 years of age was the most common age (60.5%). The frontal region was the most common entry site (41.9%), followed by the parietal wall and occipital entry. Penetrating trajectory was shown in 48.8% of cases, perforation/transfixing in 39.5%, and tangential in 11.6%. CT showed that sinking is the most common alteration (74.4%), followed by cerebral contusion (44.2%). According to the GOS, 23.3% died, 23.3% were classified by an unfavorable outcome (GOS, 2-3), and 53.5% a favorable outcome (GOS, 4 and 5). In our study, there was a significant association between the low GCS scores on admission and low GOS (1-3; p = 0.001) at time of discharge. Patients with wounds that crossed the midline also had a significant association with low GOS (p = 0.014) in our clinical experience. We concluded that low GCS scores at admission and children with a wound that crosses the midline are predictive factors of high mortality and morbidity, in our clinical experience.
