Open Access
Outcomes in patients with gunshot wounds to the brain
Leigh Anna Robinson, Lauren M Turco, Bryce Robinson, Joshua G Corsa, Michael Mount, Amy V Hamrick, John Berne, Dalier R Mederos, Allison G McNickle, Paul J Chestovich, Jason Weinberger, Areg Grigorian, Jeffry Nahmias, Jane K Lee, Kevin L Chow, Erik J Olson, Jose L Pascual, Rachele Solomon, Danielle A Pigneri, Husayn A Ladhani, Joanne Fraifogl, Jeffrey Claridge, Terry Curry, Todd W Costantini, Manasnun Kongwibulwut, Haytham Kaafarani, Janika San Roman, Craig Schreiber, Anna Goldenberg-Sandau, Parker Hu, Patrick Bosarge, Rindi Uhlich, Nicole Lunardi, Farooq Usmani, Joseph Victor Sakran, Jessica M Babcock, Juan Carlos Quispe, Lawrence Lottenberg, Donna Cabral, Grace Chang, Jhoanna Gulmatico, Jonathan J Parks, Rishi Rattan, Jennifer Massetti, Onaona Gurney, Brandon Bruns, Alison A Smith, Chrissy Guidry, Matthew E Kutcher, Melissa S Logan, Michelle Y Kincaid, Chance Spalding, Matthew Noorbaksh, Frances H Philp, Benjamin Cragun, Robert D Winfield
DOI: 10.1136/tsaco-2019-000351 Published 17 November 2019
Leigh Anna Robinson
1
Department of Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
Lauren M Turco
2
Emergency Medicine, Spectrum Health Butterworth Hospital, Grand Rapids, Michigan, USA
Bryce Robinson
3
Department of Surgery, Harborview Medical Center, Seattle, Washington, USA
Joshua G Corsa
3
Department of Surgery, Harborview Medical Center, Seattle, Washington, USA
Michael Mount
4
Division of Surgery, Spartanburg Regional Healthcare System, Spartanburg, South Carolina, USA
Amy V Hamrick
4
Division of Surgery, Spartanburg Regional Healthcare System, Spartanburg, South Carolina, USA
John Berne
5
Division of Trauma and Critical Care, Broward Health, Fort Lauderdale, Florida, USA
Dalier R Mederos
5
Division of Trauma and Critical Care, Broward Health, Fort Lauderdale, Florida, USA
Allison G McNickle
6
Department of Surgery, UNLV School of Medicine, Las Vegas, Nevada, USA
Paul J Chestovich
6
Department of Surgery, UNLV School of Medicine, Las Vegas, Nevada, USA
Jason Weinberger
7
Christiana Care Health System, Wilmington, Delaware, USA
Areg Grigorian
8
Department of Surgery, University of California Irvine School of Medicine, Irvine, California, USA
Jeffry Nahmias
8
Department of Surgery, University of California Irvine School of Medicine, Irvine, California, USA
Jane K Lee
9
Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
Kevin L Chow
9
Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
Erik J Olson
10
Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
Jose L Pascual
10
Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
Rachele Solomon
11
Memorial Regional Hospital, Hollywood, Florida, USA
Danielle A Pigneri
11
Memorial Regional Hospital, Hollywood, Florida, USA
Husayn A Ladhani
12
Department of Surgery, Case Western Reserve University Hospital, Cleveland, Ohio, USA
Joanne Fraifogl
12
Department of Surgery, Case Western Reserve University Hospital, Cleveland, Ohio, USA
Jeffrey Claridge
12
Department of Surgery, Case Western Reserve University Hospital, Cleveland, Ohio, USA
Terry Curry
13
Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, UC San Diego Health, San Diego, California, USA
Todd W Costantini
13
Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, UC San Diego Health, San Diego, California, USA
Manasnun Kongwibulwut
14
Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
Haytham Kaafarani
14
Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
Janika San Roman
15
Division of Trauma, Surgical Critical Care & Acute Care Surgery, Cooper University Hospital, Camden, New Jersey, USA
Craig Schreiber
15
Division of Trauma, Surgical Critical Care & Acute Care Surgery, Cooper University Hospital, Camden, New Jersey, USA
Anna Goldenberg-Sandau
15
Division of Trauma, Surgical Critical Care & Acute Care Surgery, Cooper University Hospital, Camden, New Jersey, USA
Parker Hu
16
Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
Patrick Bosarge
16
Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
Rindi Uhlich
16
Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
Nicole Lunardi
17
Department of Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
Farooq Usmani
17
Department of Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
Joseph Victor Sakran
17
Department of Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
Jessica M Babcock
18
Department of Surgery, Loma Linda University, Loma Linda, California, USA
Juan Carlos Quispe
18
Department of Surgery, Loma Linda University, Loma Linda, California, USA
Lawrence Lottenberg
19
St. Mary's Medical Center, Boca Raton, Florida, USA
Donna Cabral
19
St. Mary's Medical Center, Boca Raton, Florida, USA
Grace Chang
20
Department of Surgery, Mount Sinai Hospital, Chicago, Illinois, USA
Jhoanna Gulmatico
20
Department of Surgery, Mount Sinai Hospital, Chicago, Illinois, USA
Jonathan J Parks
21
Department of Surgery, University of Miami School of Medicine, Miami, Florida, USA
Rishi Rattan
21
Department of Surgery, University of Miami School of Medicine, Miami, Florida, USA
Jennifer Massetti
22
Department of Surgery, University of Maryland Medical System, Baltimore, Maryland, USA
Onaona Gurney
22
Department of Surgery, University of Maryland Medical System, Baltimore, Maryland, USA
Brandon Bruns
22
Department of Surgery, University of Maryland Medical System, Baltimore, Maryland, USA
Alison A Smith
23
Department of Surgery, Tulane Medical Center, New Orleans, Louisiana, USA
Chrissy Guidry
23
Department of Surgery, Tulane Medical Center, New Orleans, Louisiana, USA
Matthew E Kutcher
24
Department of Surgery, University of Mississippi, University Park, Mississippi, USA
Melissa S Logan
24
Department of Surgery, University of Mississippi, University Park, Mississippi, USA
Michelle Y Kincaid
25
Trauma and Acute Care Surgery, Grant Medical Center, Columbus, Ohio, USA
Chance Spalding
25
Trauma and Acute Care Surgery, Grant Medical Center, Columbus, Ohio, USA
Matthew Noorbaksh
26
Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
Frances H Philp
26
Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
Benjamin Cragun
26
Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
Robert D Winfield
1
Department of Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA

Article Figures & Data
Tables
- Table 1
Patients contributed by participating institutions
Trauma center Eligible patients University of Maryland 100 University Medical Center Las Vegas 76 University of Alabama 72 Johns Hopkins University 60 Tulane Medical Center 60 Harborview Medical Center 52 University of California-Irvine 50 St Mary’s Medical Center 35 MetroHealth 35 Cooper Health 32 University of Illinois-Chicago 32 Allegheny Health 26 Mount Sinai Hospital-Chicago 24 Jackson Memorial Hospital-Miami 22 University of Mississippi 19 Grant Medical Center 18 Christiana Healthcare System 17 Memorial Regional Hospital 16 Broward Health 14 University of Kansas 14 University of Pennsylvania 13 Loma Linda University 11 Mass General Hospital 10 University of California-San Diego 10 Spartanburg Medical Center 7 - Table 2
Patient demographics
Total Survivors Non-survivors Age 31 (23–46) 32 (23–44) 31 (23–46) Male gender 723 (88) 14/17 (82) 709/808 (88) Race Black 362 (44) 9 (56) 353 (47) White 340 (41) 5 (31) 335 (45) Other 123 (15) 2 (13) 57 (8) Injury Severity Score 26 (25–41) 25 (17–26) 26 (25–75) Abbreviated Injury Scale-Head 5 (5–6) 5 (4–5) 5 (5–6) Injury intent Assault 355 (50) 11 (65) 344 (50) Suicide 294 (41) 6 (35) 288 (42) Accident 54 (8) 0 54 (8) Legal intervention 6 (1) 0 6 (1) - Table 3
Predictors of survival to hospital discharge
Predictor Sample size OR 95% CI P value Signs of life at trauma center 824 8.30 2.32 to 52.91 0.001 Receipt of tranexamic acid (TXA) 793 7.90 1.71 to 27.15 0.0001 Transfer to level I/II trauma center 793 6.61 2.02 to 18.94 0.000 Replacement of ≥1 hormone(s) 819 3.82 1.32 to 10.79 0.01 Units of platelets 801 1.66 1.16 to 2.21 0.001 Units of packed red blood cells 803 1.14 1.05 to 1.22 0.000 Systolic blood pressure 745 1.02 1.01 to 1.03 0.000 Injury Severity Score 769 0.55 0.23 to 0.76 0.01 Abbreviated Injury Scale 609 0.48 0.28 to 0.87 0.01 - Table 4
Predictors of successful organ donation
Predictor Sample size OR 95% CI P value Volume (L) of crystalloid 453 1.15 1.06 to 1.26 0.001 Replacement of ≥1 hormone(s) 453 10.03 5.19 to 20.13 0.000
Outcomes in patients with gunshot wounds to the brain
Leigh Anna Robinson, Lauren M Turco, Bryce Robinson, Joshua G Corsa, Michael Mount, Amy V Hamrick, John Berne, Dalier R Mederos, Allison G McNickle, Paul J Chestovich, Jason Weinberger, Areg Grigorian, Jeffry Nahmias, Jane K Lee, Kevin L Chow, Erik J Olson, Jose L Pascual, Rachele Solomon, Danielle A Pigneri, Husayn A Ladhani, Joanne Fraifogl, Jeffrey Claridge, Terry Curry, Todd W Costantini, Manasnun Kongwibulwut, Haytham Kaafarani, Janika San Roman, Craig Schreiber, Anna Goldenberg-Sandau, Parker Hu, Patrick Bosarge, Rindi Uhlich, Nicole Lunardi, Farooq Usmani, Joseph Victor Sakran, Jessica M Babcock, Juan Carlos Quispe, Lawrence Lottenberg, Donna Cabral, Grace Chang, Jhoanna Gulmatico, Jonathan J Parks, Rishi Rattan, Jennifer Massetti, Onaona Gurney, Brandon Bruns, Alison A Smith, Chrissy Guidry, Matthew E Kutcher, Melissa S Logan, Michelle Y Kincaid, Chance Spalding, Matthew Noorbaksh, Frances H Philp, Benjamin Cragun, Robert D Winfield
Trauma Surg Acute Care Open Nov 2019, 4 (1) e000351; DOI: 10.1136/tsaco-2019-000351

Outcomes in patients with gunshot wounds to the brain
Leigh Anna Robinson, Lauren M Turco, Bryce Robinson, Joshua G Corsa, Michael Mount, Amy V Hamrick, John Berne, Dalier R Mederos, Allison G McNickle, Paul J Chestovich, Jason Weinberger, Areg Grigorian, Jeffry Nahmias, Jane K Lee, Kevin L Chow, Erik J Olson, Jose L Pascual, Rachele Solomon, Danielle A Pigneri, Husayn A Ladhani, Joanne Fraifogl, Jeffrey Claridge, Terry Curry, Todd W Costantini, Manasnun Kongwibulwut, Haytham Kaafarani, Janika San Roman, Craig Schreiber, Anna Goldenberg-Sandau, Parker Hu, Patrick Bosarge, Rindi Uhlich, Nicole Lunardi, Farooq Usmani, Joseph Victor Sakran, Jessica M Babcock, Juan Carlos Quispe, Lawrence Lottenberg, Donna Cabral, Grace Chang, Jhoanna Gulmatico, Jonathan J Parks, Rishi Rattan, Jennifer Massetti, Onaona Gurney, Brandon Bruns, Alison A Smith, Chrissy Guidry, Matthew E Kutcher, Melissa S Logan, Michelle Y Kincaid, Chance Spalding, Matthew Noorbaksh, Frances H Philp, Benjamin Cragun, Robert D Winfield
Trauma Surg Acute Care Open Nov 2019, 4 (1) e000351; DOI: 10.1136/tsaco-2019-000351
Outcomes in patients with gunshot wounds to the brain
Leigh Anna Robinson, Lauren M Turco, Bryce Robinson, Joshua G Corsa, Michael Mount, Amy V Hamrick, John Berne, Dalier R Mederos, Allison G McNickle, Paul J Chestovich, Jason Weinberger, Areg Grigorian, Jeffry Nahmias, Jane K Lee, Kevin L Chow, Erik J Olson, Jose L Pascual, Rachele Solomon, Danielle A Pigneri, Husayn A Ladhani, Joanne Fraifogl, Jeffrey Claridge, Terry Curry, Todd W Costantini, Manasnun Kongwibulwut, Haytham Kaafarani, Janika San Roman, Craig Schreiber, Anna Goldenberg-Sandau, Parker Hu, Patrick Bosarge, Rindi Uhlich, Nicole Lunardi, Farooq Usmani, Joseph Victor Sakran, Jessica M Babcock, Juan Carlos Quispe, Lawrence Lottenberg, Donna Cabral, Grace Chang, Jhoanna Gulmatico, Jonathan J Parks, Rishi Rattan, Jennifer Massetti, Onaona Gurney, Brandon Bruns, Alison A Smith, Chrissy Guidry, Matthew E Kutcher, Melissa S Logan, Michelle Y Kincaid, Chance Spalding, Matthew Noorbaksh, Frances H Philp, Benjamin Cragun, Robert D Winfield
Trauma Surgery & Acute Care Open Nov 2019, 4 (1) e000351; DOI: 10.1136/tsaco-2019-000351
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