title: Prognostic factors in civilian gunshot wounds to the head: a series of 110 surgical patients and brief literature review.
abstract: This study was carried out to evaluate the early results and the prognostic factors affecting the outcome during the in-hospital stay of 110 patients with civilian gunshot wounds to the head admitted at the Hospital of Restauração, Recife, Brazil. Penetrating injury (66%) was the most prevalent type of wound encountered in the present series. Twelve of the 110 (10.9%) patients presented a unilateral dilated pupil at the admission. Motor impairment was present in 24/110 (21.8%) patients. Intracerebral hematoma was present in 36/110 (32.7%) and there were 15/110 (13%) patients with cerebrospinal fluid fistula. Eleven of 110 patients developed meningitis and in 9/110 intracranial abscesses occurred. Nine of 110 patients developed deep venous thrombosis, 11/110 had urinary infection, and coagulopathy was detected in 8/110. Following the surgical procedure, 27/110 (24.5%) patients died during their hospital stay. When the two groups, survivors and non-survivors, were compared, there were significant statistical differences and the univariate analysis identified five preoperative predictors of a poor outcome following surgery: age over 40 years (odds ratios (OR) 5.4, 95% CI 1.73-16.82); presence of unilateral pupil dilatation (OR 5.5, 95% CI 1.641-18.13); low (≤8) Glasgow coma score on admission (OR 6.50, 95% CI 2.27-18.60), presence of intracranial hematoma (OR 3.0, 95% CI 1.21-7.34), and respiratory infection (OR 4.8, 95% CI 1.75-13.47). Thus, (a) age of the patient (juvenile/young age), (b) high preoperative Glasgow coma score, (c) lack of pupil abnormalities, and (d) absence of intracerebral hematoma are predictors of a good prognosis.
authors.affiliation: Department of Neurological Surgery, Hospital of Restauração, University of Pernambuco, Rua Apipucos, 317/601, Recife, 52071-000, Brazil.
authors.forename: Patricia B
authors.initials: PB
authors.lastname: Ambrosi
authors.forename: Marcelo M
authors.initials: MM
authors.lastname: Valença
authors.forename: Hildo
authors.initials: H
authors.lastname: Azevedo-Filho
mesh_terms: D001938:Brazil / Q000453:epidemiology; D006259:Craniocerebral Trauma / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000401:mortality* / Q000601:surgery*; D055815:Young Adult