Pediatric Intracranial Gunshot Wounds: Lessons From the Newark Experience

Pediatric gunshot wounds to the head (GSWH) are among the most devastating injuries, with mortality rates ranging from 20% to 65%. Prognostic tools such as the St. Louis Score (SLS) and Rotterdam computed tomography (CT) Score have been studied, but data specific to pediatric populations are limited. This study aimed to identify factors predictive of mortality and functional outcomes in pediatric GSWH and evaluate the predictive accuracy of existing scoring systems.

We retrospectively reviewed all 14 pediatric patients (≤18 y old) with GSWH at an urban, level 1 trauma center between 2010 and 2023. Patient demographics, injury characteristics, imaging findings, and outcomes were analyzed. Predictive tools were evaluated using receiver operator curve analysis, and statistical comparisons were conducted between survivors and nonsurvivors and between favorable (Glasgow Outcome Score ≥ 4) and unfavorable outcomes.

The overall mortality rate was 65%. Survivors had significantly higher admission Glasgow Coma Scale (11 versus 4, P = 0.008), lower international normalized ratio (1.1 versus 1.7, P = 0.015), lower serum glucose (138 versus 225, P = 0.021), and lower Rotterdam CT Scores (3 versus 5, P = 0.038). SLS and Rotterdam CT Score demonstrated poor predictive accuracy for mortality.

Survivors of pediatric GSWH exhibited distinct clinical and laboratory profiles on admission, including higher Glasgow Coma Scale and lower international normalized ratio and glucose levels. While the Rotterdam CT Score performed better than the SLS, both prognostic tools were suboptimal to predict favorable outcomes for this cohort. Larger studies are needed to refine predictive models and improve management strategies in pediatric GSWH.