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 Robinson, Leigh Anna
A1 Turco, Lauren M
A1 Robinson, Bryce
A1 Corsa, Joshua G
A1 Mount, Michael
A1 Hamrick, Amy V
A1 Berne, John
A1 Mederos, Dalier R
A1 McNickle, Allison G
A1 Chestovich, Paul J
A1 Weinberger, Jason
A1 Grigorian, Areg
A1 Nahmias, Jeffry
A1 Lee, Jane K
A1 Chow, Kevin L
A1 Olson, Erik J
A1 Pascual, Jose L
A1 Solomon, Rachele
A1 Pigneri, Danielle A
A1 Ladhani, Husayn A
A1 Fraifogl, Joanne
A1 Claridge, Jeffrey
A1 Curry, Terry
A1 Costantini, Todd W
A1 Kongwibulwut, Manasnun
A1 Kaafarani, Haytham
A1 San Roman, Janika
A1 Schreiber, Craig
A1 Goldenberg-Sandau, Anna
A1 Hu, Parker
A1 Bosarge, Patrick
A1 Uhlich, Rindi
A1 Lunardi, Nicole
A1 Usmani, Farooq
A1 Sakran, Joseph Victor
A1 Babcock, Jessica M
A1 Quispe, Juan Carlos
A1 Lottenberg, Lawrence
A1 Cabral, Donna
A1 Chang, Grace
A1 Gulmatico, Jhoanna
A1 Parks, Jonathan J
A1 Rattan, Rishi
A1 Massetti, Jennifer
A1 Gurney, Onaona
A1 Bruns, Brandon
A1 Smith, Alison A
A1 Guidry, Chrissy
A1 Kutcher, Matthew E
A1 Logan, Melissa S
A1 Kincaid, Michelle Y
A1 Spalding, Chance
A1 Noorbaksh, Matthew
A1 Philp, Frances H
A1 Cragun, Benjamin
A1 Winfield, Robert D
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.