title: Civilian cerebral gunshot wounds: a South African experience.
abstract: BACKGROUND
  Cerebral gunshot wounds represent one of the most lethal forms of traumatic brain injury, but there is a paucity of literature on the topic, especially from the developing world. We reviewed our experience and describe the spectrum and outcome of civilian cerebral gunshot wounds in a major metropolitan trauma centre in South Africa.
  
  
  METHODS
  This was a retrospective study of all patients with isolated cerebral gunshot wounds managed by the Pietermaritzburg Metropolitan Trauma Service over a 5-year period from 2010 to 2014.
  
  
  RESULTS
  One hundred and two patients were included, 92% (94/102) were male and the mean age was 29 years. Fifty-four per cent (55/102) of all patients were from urban areas. The mean time from injury to arrival was 6 h (standard deviation: 5) for urban patients and 15 h (standard deviation: 5.2) for rural patients (P < 0.001). Ninety-four per cent (94/102) of all injuries were related to interpersonal violence and involved low velocity firearms. Twenty per cent of all patients (20/102) had a Glasgow Coma Scale 3-8, 20% (20/102) 9-12 and 61% (61/102) 12-15. All 102 patients underwent computed tomography scans. Thirty per cent (31/102) required neurosurgical interventions. The overall mortality rate was 22% (22/102). There was a significant difference in mortality between urban and rural patients (9% versus 36%, P < 0.001).
  
  
  CONCLUSIONS
  Cerebral gunshot wounds are associated with significant mortality and protracted delay to definitive care is common in our setting. Those who survive the delayed transfer to definitive care generally do well and have reasonably good clinical outcomes.
authors.affiliation: Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Victor
authors.initials: V
authors.lastname: Kong
authors.affiliation: Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Jocinta
authors.initials: J
authors.lastname: Odendaal
authors.affiliation: Department of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Benn
authors.initials: B
authors.lastname: Sartorius
authors.affiliation: Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.|Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Damian
authors.initials: D
authors.lastname: Clarke
authors.affiliation: Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Petra
authors.initials: P
authors.lastname: Brysiewicz
authors.affiliation: Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Ellen
authors.initials: E
authors.lastname: Jerome
authors.affiliation: Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: John
authors.initials: J
authors.lastname: Bruce
authors.affiliation: Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Grant
authors.initials: G
authors.lastname: Laing
mesh_terms: D000328:Adult; D006259:Craniocerebral Trauma / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009026:Mortality; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D014948:Wounds, Gunshot / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery
keywords: cerebral; civilian; gunshot wounds; mortality; outcome disparity