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Association between cranial surgery and mortality among patients with firearm-related traumatic brain injury

Kathleen R Ran1, Jiaqi Liu2, Vikas N Vattipally1

  • 11Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland.

Journal of Neurosurgery
|June 27, 2025
PubMed

Insights

Cranial surgery significantly reduces in-hospital mortality for patients with penetrating traumatic brain injury (pTBI) and subdural hematoma (SDH). This survival benefit is more pronounced in patients with significant midline shift, indicating surgery

Area of Science:

  • Neurosurgery
  • Trauma Surgery
  • Neurocritical Care

Background:

  • Firearm-related penetrating traumatic brain injury (pTBI) presents heterogeneous injury patterns.
  • Subdural hematoma (SDH) is a common consequence of pTBI.
  • Tailored analysis of homogeneous pTBI cohorts is crucial for refining surgical management guidelines.

Purpose of the Study:

  • To evaluate the association between cranial surgery and survival in patients with pTBI and SDH.
  • To determine if cranial surgery impacts in-hospital mortality in this specific patient population.

Main Methods:

  • Retrospective analysis of the American College of Surgeons Trauma Quality Program dataset (2017-2019).
  • Inclusion of patients with firearm-related pTBI and resultant SDH.
  • Hierarchical regression models to assess the association between cranial surgery and in-hospital mortality, with subgroup analysis for significant midline shift (> 5 mm).

Main Results:

  • Cranial surgery was independently associated with a significant reduction in in-hospital mortality (OR 0.49).
  • This protective effect persisted after risk adjustment for injury characteristics and interventions like ICP monitoring.
  • In patients with SDH and midline shift > 5 mm, cranial surgery showed an even greater survival benefit (OR 0.40).

Conclusions:

  • Cranial surgery is independently linked to lower in-hospital mortality in firearm-related pTBI with SDH.
  • The survival benefit of cranial surgery is amplified in cases with significant midline shift.
  • Further research is warranted to explore long-term functional outcomes following surgical intervention.
Abstract

Keywords:
acute subdural hematomacraniotomydecompressive craniectomyfirearmspenetrating head injurytraumatraumatic brain injury

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