title: Factors affecting dural penetration and prognosis in patients admitted to emergency department with cranial gunshot wound.
abstract: OBJECTIVE
  To explore the effect of admission physical examination findings, anamnesis, and computed tomography on dural penetration and prognosis in patients with cranial gunshot wound (CGW).
  
  
  METHODS
  In this study, the medical data of 56 subjects who were admitted to the Emergency Department of Dicle University Hospital with CGWs between January 2011 and December 2013 were retrospectively reviewed. The effects of type of incident (suicidal vs non-suicidal), pupil diameter and light reflex, hemodynamic status, type (bullet or pellet), velocity, trajectory of foreign material, trauma scores, and imaging findings on dural penetration and mortality were explored.
  
  
  RESULTS
  The mean age of the study population was 24.8 ± 13.50 years. Thirty (53.6 %) patients had penetrating injuries and 26 (46.4 %) had non-penetrating injuries; 9 (16.1 %) patients died and 47 (83.9 %) survived. Suicidal injury, pupil diameter and light reflex, bullet as foreign material, and high velocity and lateral trajectory of foreign material significantly affected dural penetration and mortality (p < 0.05). In addition, dural penetration, bilobar, multilobar, or bihemispheric involvement of brain parenchyma, presence of intracranial hemorrhage, subarachnoid hemorrhage, ventricular hemorrhage, fracture, shift, edema, and trauma scores significantly affected mortality (p < 0.05).
  
  
  CONCLUSIONS
  In CGWs, dural penetration and prognosis can be predicted by physical examination findings and patient characteristics on initial admission.
authors: Department of Emergency Medicine, Faculty of Medicine, Dicle University, 21280, Diyarbakır, Turkey. drmicer@gmail.com.
authors: M
authors: M
authors: İçer
authors: Department of Emergency Medicine, Faculty of Medicine, Dicle University, 21280, Diyarbakır, Turkey.
authors: Y
authors: Y
authors: Zengin
authors: Department of Emergency Medicine, Faculty of Medicine, Dicle University, 21280, Diyarbakır, Turkey.
authors: R
authors: R
authors: Dursun
authors: Department of Emergency Medicine, Faculty of Medicine, Dicle University, 21280, Diyarbakır, Turkey.
authors: H M
authors: HM
authors: Durgun
authors: Department of Radiology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey.
authors: C
authors: C
authors: Göya
authors: Department of Biostatistics, Faculty of Medicine, Dicle University, Diyarbakır, Turkey.
authors: I
authors: I
authors: Yıldız
authors: Department of Emergency Medicine, Faculty of Medicine, Dicle University, 21280, Diyarbakır, Turkey.
authors: C
authors: C
authors: Güloğlu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D020300:Intracranial Hemorrhages / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011379:Prognosis; D012189:Retrospective Studies; D014421:Turkey / Q000453:epidemiology; D014948:Wounds, Gunshot / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology; D014950:Wounds, Penetrating / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology; D055815:Young Adult
keywords: Cranial gunshot wound; Dural penetration; Emergency service; Mortality; Prognosis