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Related Experiment Videos

Transcranial gunshot wounds: cost and consequences

D G Jacobs1, C P Brandt, J J Piotrowski

  • 1Department of Surgery, Saint Luke's Medical Center, Cleveland, Ohio, USA.

The American Surgeon
|August 1, 1995
PubMed
Summary

Outcomes for transcranial gunshot wounds (TC-GSW) are poor, but treatment is justified. Despite high mortality, TC-GSW patients can be significant organ donors, and treating facilities do not incur financial losses.

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Area of Science:

  • Trauma Surgery
  • Neurosurgery
  • Critical Care Medicine

Background:

  • Transcranial gunshot wounds (TC-GSW) often lead to a fatalistic approach due to poor outcomes and perceived financial burdens.
  • Institutions may hesitate to provide aggressive care for TC-GSW patients.

Purpose of the Study:

  • To identify factors predicting mortality in TC-GSW patients.
  • To evaluate the financial costs and benefits of treating TC-GSW patients.
  • To assess the potential for organ and tissue donation from TC-GSW non-survivors.

Main Methods:

  • Retrospective review of medical records for 57 TC-GSW patients at a Level I Trauma Center (1990-1992).
  • Analysis of mortality predictors including Glasgow Coma Score and respiratory rate.
  • Financial data analysis for 37 patients.

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  • Evaluation of organ and tissue donation success rates among non-survivors.

    • Main Results:

    • Overall mortality was 75%.
    • Predictors of mortality included admission Glasgow Coma Score <= 4, respiratory rate < 10, and self-inflicted wounds.
    • Financial reimbursements ($306,156) exceeded costs ($243,899) by $62,257.
    • Organ donation was successful in 44.2% of non-survivors (19/43), yielding 60 organs and 29 tissues.
    • Organ donors were not clinically or demographically different from non-donors.

    Conclusions:

    • Despite high mortality, aggressive resuscitation and stabilization for TC-GSW patients are warranted.
    • TC-GSW patients represent a significant source of organ and tissue donors.
    • Concerns about financial losses for treating facilities are unfounded.