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Pediatric Intracranial Gunshot Wounds: Lessons From the Newark Experience
Antonia M Sames1, Arman Sawhney1, Tannishtha Som1
1Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.
Insights
Pediatric gunshot wounds to the head have a high mortality rate. Survivors show better Glasgow Coma Scale scores and lower lab values on admission, but current scoring systems poorly predict outcomes.
Area of Science:
- Pediatric Traumatology
- Neurosurgery
- Medical Imaging Analysis
Background:
- Pediatric gunshot wounds to the head (GSWH) are critical injuries with high mortality (20-65%).
- Existing prognostic tools like the St. Louis Score (SLS) and Rotterdam CT Score lack specific validation in pediatric GSWH.
- Limited data exists on predictive factors for mortality and functional outcomes in this vulnerable population.
Purpose of the Study:
- To identify key factors predicting mortality and functional outcomes in pediatric GSWH.
- To evaluate the predictive accuracy of the St. Louis Score (SLS) and Rotterdam CT Score in pediatric GSWH.
Main Methods:
- Retrospective review of 14 pediatric patients (≤18 years) with GSWH.
- Analysis of demographics, injury characteristics, imaging findings, and outcomes.
- Receiver operator curve analysis for prognostic tools; comparison between survivors/nonsurvivors and favorable/unfavorable outcomes.
Main Results:
- Overall mortality rate was 65%.
- Survivors had higher Glasgow Coma Scale (GCS), lower international normalized ratio (INR), lower serum glucose, and lower Rotterdam CT Scores.
- Both SLS and Rotterdam CT Score showed poor predictive accuracy for mortality.
Conclusions:
- Survivors of pediatric GSWH present with distinct admission profiles (higher GCS, lower INR, lower glucose).
- The Rotterdam CT Score showed slightly better performance than SLS but both were suboptimal predictors.
- Further research with larger cohorts is essential to develop improved prognostic models for pediatric GSWH.
Introduction:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
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