A review of civilian gunshot wounds to the head in northeast Slovenia: 1992 to 2002.
BACKGROUND
Surgical management of gunshot wounds to the head has remained a controversial issue. There are considerable regional differences in the causes of civilian gunshot wounds (GSW) to the head and various devices are used in different countries. The aim of our study was to review the demographic factors, treatment and outcome of patients with GSW to the head over the past 10 years at Maribor Teaching Hospital.


METHODS
Thirty-seven patients with GSW to the head (35 male and 2 female; mean age 43.3 +/- 15.5 years) were included in the study. Clinical and radiological findings are described. Statistical analysis was used to find the effects of all independent variables on mortality and prognostic factors.


RESULTS
The great majority (86.5%) of our patients suffered self-inflicted wounds. The weapon used was a stunning device in 54% of cases and a handgun in 46%. Alcohol consumption was documented in 40% patients. Nearly half (48.9%) of our patients were either industrial workers or farmers. Postresuscitation Glasgow Coma Scale (GCS) scores of 3-8 were recorded in 54%. The pupils were fixed and dilated in 32.4% of our patients; hypotension was documented in 8.1% and apnea in 27%. These parameters were significantly correlated with poor outcome. A bihemispheric lesion was found in 37.8%, a transventricular lesion in 54% and a multilobar lesion in 70.3% of patients. Those factors were also associated with poor outcome. The majority of patients (56.8%) underwent operation immediately, in 13.5% the operation was delayed and 29.7% of patients had no surgery. The overall mortality was 51.4%, a poor outcome was noted in 24.3% and a good one was achieved in 24.3%.


CONCLUSIONS
The results of our study support previous ones stating that patients with GSW to the head can benefit from aggressive treatment and still make satisfactory recoveries. Clearly, there are ethical dilemmas involved in withholding operative treatment from any individual. Guidelines dictating when to surgically intervene must be made.
Strojnik
Tadej
T
Department of Neurosurgery, Maribor Teaching Hospital, Maribor, Slovenia. t.strojnik@siol.net
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking; D002648:Child; D006259:Craniocerebral Trauma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D003627:Data Interpretation, Statistical; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011859:Radiography; D012737:Sex Factors; D017524:Slovenia; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*