title: Transcranial gunshot wounds: cost and consequences.
abstract: Poor outcomes following transcranial gunshot wounds (TC-GSW) and the perception of significant financial loss have led some institutions to adopt a fatalistic attitude towards these patients. This study was undertaken to define those factors predictive of mortality following TC-GSW as well as to determine the costs and benefits associated with providing care to these individuals. We reviewed the medical records of 57 TC-GSW patients seen at our Level I Trauma Center between January 1990 and December 1992. Overall mortality was 75 percent, and was statistically associated with an admission Glasgow Coma Score of 4 or less, a respiratory rate of less than 10, and self-inflicted wounds. Complete financial information was available for 37 of the 57 patients. Reimbursements for this group were $306,156 and exceeded costs by $62,257. Organ donation efforts were successful in 44.2 per cent of the nonsurvivors (19/43), yielding 60 organs and 29 tissues for transplantation. Nonsurvivors who became organ donors were clinically and demographically indistinguishable from those in whom organs/tissues could not be retrieved. Despite the poor outcome following TC-GSW, vigorous resuscitation and stabilization is justified in all patients, in that nearly one half of nonsurvivors will become organ and/or tissue donors. Concerns regarding excessive monetary looses by treating facilities are unfounded.
authors.affiliation: Department of Surgery, Saint Luke's Medical Center, Cleveland, Ohio, USA.
authors.forename: D G
authors.initials: DG
authors.lastname: Jacobs
authors.forename: C P
authors.initials: CP
authors.lastname: Brandt
authors.forename: J J
authors.initials: JJ
authors.lastname: Piotrowski
authors.forename: C R
authors.initials: CR
authors.lastname: McHenry
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D005544:Forecasting; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D012051:Reimbursement Mechanisms; D012119:Respiration; D012151:Resuscitation; D012189:Retrospective Studies; D013405:Suicide; D015996:Survival Rate; D014019:Tissue Donors; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000191:economics* / Q000401:mortality / Q000628:therapy*