116.18 Determinant of Non-Survivability Following Gunshot Wounds to the Head

Posted on September 9, 2020

A. P. Ekeh1, B. Wainblat1, H. Jeanty1, A. P. Ekeh1  1Wright State University,Surgery,Dayton, OH, USA

Introduction: Gunshot wounds (GSWs) to the head with resultant brain injury are a leading cause of mortality following traumatic brain injuries, with known dismal survival rates. Providers are often faced with the challenge of determining the aggressiveness of initial and subsequent resuscitative efforts. We sought to assess features that may indicate decreased probability of survival following gunshot wounds to the head. 

Methods: All patients admitted to an American College of Surgeons verified Level I Trauma Center between January 2006 and December 2016 with GSWs to the head were identified from the trauma registry. Demographic data as well as the intent (self- inflicted or otherwise), cerebral hemisphere involvement (unilateral or bilateral), brain stem involvement and frontal lobe involvement were abstracted from the patient records.Patients who were dead on arrival were not included. The primary outcome was in-hospital mortality. Binomial logistic regression was performed to determine specific factors associated with mortality following GSWs.

Results:In the 11 year period, there were 201 patients identified (80.1% male) with a mean age of 38. Over half of the patients (54.2%, n=109) had self-inflicted injuries. Only 35.5% (71 patients) survived to discharge. Logistic regression of five predictor variables assessed demonstrated statistical significance for increased mortality in self-inflicted GSW and bilateral hemispheric involvement.

Conclusion:GSWs to the head have high mortality rate and commonly self -inflicted (suicide or suicide attempts). Involvement of both hemispheres and self- inflicted intent are factors significantly associated with non-survivability. Identification of these factors may be helpful in prognostication in conjunction with other clinical features. The prevalence of self-inflicted GSWs to the head highlights the need for public health advocacy and preventive mental health intervention and awareness.