RT Journal Article
SR Electronic
T1 Outcomes in patients with gunshot wounds to the brain
JF Trauma Surgery & Acute Care Open
JO Trauma Surg Acute Care Open
FD BMJ Publishing Group Ltd
SP e000351
DO 10.1136/tsaco-2019-000351
VO 4
IS 1
A1 Leigh Anna Robinson
A1 Lauren M Turco
A1 Bryce Robinson
A1 Joshua G Corsa
A1 Michael Mount
A1 Amy V Hamrick
A1 John Berne
A1 Dalier R Mederos
A1 Allison G McNickle
A1 Paul J Chestovich
A1 Jason Weinberger
A1 Areg Grigorian
A1 Jeffry Nahmias
A1 Jane K Lee
A1 Kevin L Chow
A1 Erik J Olson
A1 Jose L Pascual
A1 Rachele Solomon
A1 Danielle A Pigneri
A1 Husayn A Ladhani
A1 Joanne Fraifogl
A1 Jeffrey Claridge
A1 Terry Curry
A1 Todd W Costantini
A1 Manasnun Kongwibulwut
A1 Haytham Kaafarani
A1 Janika San Roman
A1 Craig Schreiber
A1 Anna Goldenberg-Sandau
A1 Parker Hu
A1 Patrick Bosarge
A1 Rindi Uhlich
A1 Nicole Lunardi
A1 Farooq Usmani
A1 Joseph Victor Sakran
A1 Jessica M Babcock
A1 Juan Carlos Quispe
A1 Lawrence Lottenberg
A1 Donna Cabral
A1 Grace Chang
A1 Jhoanna Gulmatico
A1 Jonathan J Parks
A1 Rishi Rattan
A1 Jennifer Massetti
A1 Onaona Gurney
A1 Brandon Bruns
A1 Alison A Smith
A1 Chrissy Guidry
A1 Matthew E Kutcher
A1 Melissa S Logan
A1 Michelle Y Kincaid
A1 Chance Spalding
A1 Matthew Noorbaksh
A1 Frances H Philp
A1 Benjamin Cragun
A1 Robert D Winfield
YR 2019
UL http://tsaco.bmj.com/content/4/1/e000351.abstract
AB Introduction Gunshot wounds to the brain (GSWB) confer high lethality and uncertain recovery. It is unclear which patients benefit from aggressive resuscitation, and furthermore whether patients with GSWB undergoing cardiopulmonary resuscitation (CPR) have potential for survival or organ donation. Therefore, we sought to determine the rates of survival and organ donation, as well as identify factors associated with both outcomes in patients with GSWB undergoing CPR.Methods We performed a retrospective, multicenter study at 25 US trauma centers including dates between June 1, 2011 and December 31, 2017. Patients were included if they suffered isolated GSWB and required CPR at a referring hospital, in the field, or in the trauma resuscitation room. Patients were excluded for significant torso or extremity injuries, or if pregnant. Binomial regression models were used to determine predictors of survival/organ donation.Results 825 patients met study criteria; the majority were male (87.6%) with a mean age of 36.5 years. Most (67%) underwent CPR in the field and 2.1% (n=17) survived to discharge. Of the non-survivors, 17.5% (n=141) were considered eligible donors, with a donation rate of 58.9% (n=83) in this group. Regression models found several predictors of survival. Hormone replacement was predictive of both survival and organ donation.Conclusion We found that GSWB requiring CPR during trauma resuscitation was associated with a 2.1% survival rate and overall organ donation rate of 10.3%. Several factors appear to be favorably associated with survival, although predictions are uncertain due to the low number of survivors in this patient population. Hormone replacement was predictive of both survival and organ donation. These results are a starting point for determining appropriate treatment algorithms for this devastating clinical condition.Level of evidence Level II.