title: Fatal gunshot wound to the head: the impact of aggressive management.
abstract: BACKGROUND
  Patients with fatal gunshot wounds (GSWs) to the head often have poor outcomes but are ideal candidates for organ donation. The purpose of this study was to evaluate the effects of aggressive management on organ donation in patient with fatal GSWs to the head.
  
  
  METHODS
  A 5-year review of all patients at a trauma center with GSWs to the head was performed. The primary outcome was organ donation after fatal GSW to the head.
  
  
  RESULTS
  A total of 98 patients with fatal GSWs to the head were identified. The rate of potential organ donation was 70%, of whom 49% eventually donated 72 solid organs. Twenty-five percent of patients were not considered eligible for donation as a result of disseminated intravascular coagulopathy. The T4 protocol lead to significant organ procurement rates (odds ratio, 3.6; 95% confidence interval, 1.3 to 9.6; P = .01). Failures to organ donation in eligible patients were due to lack of family consent and cardiac arrest.
  
  
  CONCLUSIONS
  Organ donation after fatal GSW to the head is a legitimate goal. Management goals should focus on early aggressive resuscitation and correction of coagulopathy.
authors.affiliation: Department of Surgery, Division of Trauma, Critical Care, Emergency Surgery, and Burns, University of Arizona, 1501 N Campbell Avenue, Room No 5411, PO Box 245063, Tucson, AZ 85727, USA. Electronic address: bjoseph@surgery.arizona.edu.
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
authors.affiliation: Department of Surgery, Division of Trauma, Critical Care, Emergency Surgery, and Burns, University of Arizona, 1501 N Campbell Avenue, Room No 5411, PO Box 245063, Tucson, AZ 85727, USA.
authors.forename: Hassan
authors.initials: H
authors.lastname: Aziz
authors.affiliation: Department of Surgery, Division of Trauma, Critical Care, Emergency Surgery, and Burns, University of Arizona, 1501 N Campbell Avenue, Room No 5411, PO Box 245063, Tucson, AZ 85727, USA.
authors.forename: Moutamn
authors.initials: M
authors.lastname: Sadoun
authors.affiliation: Department of Surgery, Division of Trauma, Critical Care, Emergency Surgery, and Burns, University of Arizona, 1501 N Campbell Avenue, Room No 5411, PO Box 245063, Tucson, AZ 85727, USA.
authors.forename: Narong
authors.initials: N
authors.lastname: Kulvatunyou
authors.affiliation: Department of Surgery, Division of Trauma, Critical Care, Emergency Surgery, and Burns, University of Arizona, 1501 N Campbell Avenue, Room No 5411, PO Box 245063, Tucson, AZ 85727, USA.
authors.forename: Viraj
authors.initials: V
authors.lastname: Pandit
authors.affiliation: Department of Surgery, Division of Trauma, Critical Care, Emergency Surgery, and Burns, University of Arizona, 1501 N Campbell Avenue, Room No 5411, PO Box 245063, Tucson, AZ 85727, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Tang
authors.affiliation: Department of Surgery, Division of Trauma, Critical Care, Emergency Surgery, and Burns, University of Arizona, 1501 N Campbell Avenue, Room No 5411, PO Box 245063, Tucson, AZ 85727, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Wynne
authors.affiliation: Department of Surgery, Division of Trauma, Critical Care, Emergency Surgery, and Burns, University of Arizona, 1501 N Campbell Avenue, Room No 5411, PO Box 245063, Tucson, AZ 85727, USA.
authors.forename: Terence
authors.initials: T
authors.lastname: O' Keeffe
authors.affiliation: Department of Surgery, Division of Trauma, Critical Care, Emergency Surgery, and Burns, University of Arizona, 1501 N Campbell Avenue, Room No 5411, PO Box 245063, Tucson, AZ 85727, USA.
authors.forename: Randall S
authors.initials: RS
authors.lastname: Friese
authors.affiliation: Department of Surgery, Division of Trauma, Critical Care, Emergency Surgery, and Burns, University of Arizona, 1501 N Campbell Avenue, Room No 5411, PO Box 245063, Tucson, AZ 85727, USA.
authors.forename: Rainer W G
authors.initials: RW
authors.lastname: Gruessner
authors.affiliation: Department of Surgery, Division of Trauma, Critical Care, Emergency Surgery, and Burns, University of Arizona, 1501 N Campbell Avenue, Room No 5411, PO Box 245063, Tucson, AZ 85727, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001130:Arizona / Q000453:epidemiology; D006259:Craniocerebral Trauma / Q000401:mortality*; D004211:Disseminated Intravascular Coagulation / Q000628:therapy; D005190:Family; D005260:Female; D006323:Heart Arrest; D006801:Humans; D007258:Informed Consent; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012151:Resuscitation; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting; D009927:Tissue and Organ Procurement / Q000379:methods / Q000706:statistics & numerical data; D014948:Wounds, Gunshot / Q000401:mortality*
keywords: Aggressive management; GSW to the head; Organ donation; T4 protocol