Brain Imaging Features in Patients with Gunshot Wounds to the Head

Area of Science:

• Neurosurgery
• Radiology
• Trauma Surgery

Background:

• Gunshot wounds to the head (GSWH) causing penetrating brain injury (PBI) have high mortality rates.
• Accurate prognostication is crucial for guiding treatment decisions in PBI patients.
• Existing scoring systems may not fully capture the unique imaging characteristics of PBI.

Purpose of the Study:

• Introduce the UChicago PBI Imaging score, a novel tool for characterizing HCT features in GSWH.
• Quantify the association between specific imaging features and mortality in PBI patients.
• Evaluate the predictive performance of the UChicago PBI Imaging score against established scores.

Main Methods:

• Retrospective analysis of 230 GSWH patients admitted to a Level 1 trauma center.
• Evaluation of HCT images for predefined features by blinded readers.
• Development of a SuperLearner ensemble model to assess feature contribution to mortality.

Main Results:

• The UChicago PBI Imaging score achieved an AUC of 0.86, outperforming the Rotterdam (0.8) and Marshall (0.66) scores.
• Key predictors of mortality included transhemispheric projectile location, ventricular blood, and brainstem involvement.
• The score demonstrated robust performance in patients with Glasgow Coma Scale scores of 5-9.

Conclusions:

• The UChicago PBI Imaging score offers improved mortality prediction for PBI patients compared to existing methods.
• Specific imaging features in GSWH HCT are strongly associated with mortality.
• This score enhances prognostication, particularly in the intermediate GCS range, aiding targeted treatment strategies.