Improving survival rates after civilian gunshot wounds to the brain

Bellal Joseph; Hassan Aziz; Viraj Pandit; Narong Kulvatunyou; Terence O'Keeffe; Julie Wynne; Andrew Tang; Randall S Friese; Peter Rhee

doi:10.1016/j.jamcollsurg.2013.08.018

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Improving survival rates after civilian gunshot wounds to the brain

Journal article

Peer reviewed

Improving survival rates after civilian gunshot wounds to the brain

Bellal Joseph, Hassan Aziz, Viraj Pandit, Narong Kulvatunyou, Terence O'Keeffe, Julie Wynne, Andrew Tang, Randall S Friese and Peter Rhee

Journal of the American College of Surgeons, Vol.218(1), pp.58-65

01/2014

DOI: 10.1016/j.jamcollsurg.2013.08.018

PMID: 24055384

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Abstract

Gunshot wounds to the brain are the most lethal of all firearm injuries, with reported survival rates of 10% to 15%. The aim of this study was to determine outcomes in patients with gunshot wounds to the brain, presenting to our institution over time. We hypothesized that aggressive management can increase survival and the rate of organ donation in patients with gunshot wounds to the brain. We analyzed all patients with gunshot wounds to the brain presenting to our level 1 trauma center over a 5-year period. Aggressive management was defined as resuscitation with blood products, hyperosmolar therapy, and/or prothrombin complex concentrate (PCC). The primary outcome was survival and the secondary outcome was organ donation. There were 132 patients with gunshot wounds to the brain, and the survival rates increased incrementally every year, from 10% in 2008 to 46% in 2011, with the adoption of aggressive management. Among survivors, 40% (16 of 40) of the patients had bi-hemispheric injuries. Aggressive management with blood products (p = 0.02) and hyperosmolar therapy (p = 0.01) was independently associated with survival. Of the survivors, 20% had a Glasgow Coma Scale score ≥ 13 at hospital discharge. In patients who died (n = 92), 56% patients were eligible for organ donation, and they donated 60 organs. Aggressive management is associated with significant improvement in survival and organ procurement in patients with gunshot wounds to the brain. The bias of resource use can no longer be used to preclude trauma surgeons from abandoning aggressive attempts to save patients with gunshot wound to the brain.

Adolescent

Adult

Blood Coagulation Factors - therapeutic use

Blood Component Transfusion

Combined Modality Therapy

Female

Fluid Therapy

Head Injuries, Penetrating - mortality

Head Injuries, Penetrating - therapy

Hematologic Agents - therapeutic use

Humans

Logistic Models

Male

Middle Aged

Multivariate Analysis

Resuscitation - methods

Retrospective Studies

Survival Rate

Tissue and Organ Procurement - statistics & numerical data

Trauma Centers

Treatment Outcome

Wounds, Gunshot - mortality

Wounds, Gunshot - therapy

Young Adult

Details

Title: Subtitle: Improving survival rates after civilian gunshot wounds to the brain
Creators: Bellal Joseph - University of Arizona
Hassan Aziz - University of Arizona
Viraj Pandit - University of Arizona
Narong Kulvatunyou - University of Arizona
Terence O'Keeffe - University of Arizona
Julie Wynne - University of Arizona
Andrew Tang - University of Arizona
Randall S Friese - University of Arizona
Peter Rhee - University of Arizona
Resource Type: Journal article
Publication Details: Journal of the American College of Surgeons, Vol.218(1), pp.58-65
DOI: 10.1016/j.jamcollsurg.2013.08.018
PMID: 24055384
ISSN: 1072-7515
eISSN: 1879-1190
Language: English
Date published: 01/2014
Academic Unit: Surgery
Record Identifier: 9984701542902771

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86 Times Cited - Web of Science

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