Improving survival rates after civilian gunshot wounds to the brain

Bellal Joseph, Hassan Aziz, Viraj Pandit, Narong Kulvatunyou, Terence OKeeffe, Julie Wynne, Andrew Tang, Randall S. Friese, Peter Rhee

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Background Gunshot wounds to the brain are the most lethal of all firearm injuries, with reported survival rates of 10% to 15%. The aim of this study was to determine outcomes in patients with gunshot wounds to the brain, presenting to our institution over time. We hypothesized that aggressive management can increase survival and the rate of organ donation in patients with gunshot wounds to the brain. Study Design We analyzed all patients with gunshot wounds to the brain presenting to our level 1 trauma center over a 5-year period. Aggressive management was defined as resuscitation with blood products, hyperosmolar therapy, and/or prothrombin complex concentrate (PCC). The primary outcome was survival and the secondary outcome was organ donation. Results There were 132 patients with gunshot wounds to the brain, and the survival rates increased incrementally every year, from 10% in 2008 to 46% in 2011, with the adoption of aggressive management. Among survivors, 40% (16 of 40) of the patients had bi-hemispheric injuries. Aggressive management with blood products (p = 0.02) and hyperosmolar therapy (p = 0.01) was independently associated with survival. Of the survivors, 20% had a Glasgow Coma Scale score ≥ 13 at hospital discharge. In patients who died (n = 92), 56% patients were eligible for organ donation, and they donated 60 organs. Conclusions Aggressive management is associated with significant improvement in survival and organ procurement in patients with gunshot wounds to the brain. The bias of resource use can no longer be used to preclude trauma surgeons from abandoning aggressive attempts to save patients with gunshot wound to the brain.

Original languageEnglish (US)
Pages (from-to)58-65
Number of pages8
JournalJournal of the American College of Surgeons
Volume218
Issue number1
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Gunshot Wounds
Survival Rate
Brain
Tissue and Organ Procurement
Survival
Survivors
Wounds and Injuries
Glasgow Coma Scale
Trauma Centers
Firearms
Resuscitation

ASJC Scopus subject areas

  • Surgery

Cite this

Improving survival rates after civilian gunshot wounds to the brain. / Joseph, Bellal; Aziz, Hassan; Pandit, Viraj; Kulvatunyou, Narong; OKeeffe, Terence; Wynne, Julie; Tang, Andrew; Friese, Randall S.; Rhee, Peter.

In: Journal of the American College of Surgeons, Vol. 218, No. 1, 01.01.2014, p. 58-65.

Research output: Contribution to journalArticle

Joseph, B, Aziz, H, Pandit, V, Kulvatunyou, N, OKeeffe, T, Wynne, J, Tang, A, Friese, RS & Rhee, P 2014, 'Improving survival rates after civilian gunshot wounds to the brain', Journal of the American College of Surgeons, vol. 218, no. 1, pp. 58-65. https://doi.org/10.1016/j.jamcollsurg.2013.08.018
Joseph, Bellal ; Aziz, Hassan ; Pandit, Viraj ; Kulvatunyou, Narong ; OKeeffe, Terence ; Wynne, Julie ; Tang, Andrew ; Friese, Randall S. ; Rhee, Peter. / Improving survival rates after civilian gunshot wounds to the brain. In: Journal of the American College of Surgeons. 2014 ; Vol. 218, No. 1. pp. 58-65.
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N2 - Background Gunshot wounds to the brain are the most lethal of all firearm injuries, with reported survival rates of 10% to 15%. The aim of this study was to determine outcomes in patients with gunshot wounds to the brain, presenting to our institution over time. We hypothesized that aggressive management can increase survival and the rate of organ donation in patients with gunshot wounds to the brain. Study Design We analyzed all patients with gunshot wounds to the brain presenting to our level 1 trauma center over a 5-year period. Aggressive management was defined as resuscitation with blood products, hyperosmolar therapy, and/or prothrombin complex concentrate (PCC). The primary outcome was survival and the secondary outcome was organ donation. Results There were 132 patients with gunshot wounds to the brain, and the survival rates increased incrementally every year, from 10% in 2008 to 46% in 2011, with the adoption of aggressive management. Among survivors, 40% (16 of 40) of the patients had bi-hemispheric injuries. Aggressive management with blood products (p = 0.02) and hyperosmolar therapy (p = 0.01) was independently associated with survival. Of the survivors, 20% had a Glasgow Coma Scale score ≥ 13 at hospital discharge. In patients who died (n = 92), 56% patients were eligible for organ donation, and they donated 60 organs. Conclusions Aggressive management is associated with significant improvement in survival and organ procurement in patients with gunshot wounds to the brain. The bias of resource use can no longer be used to preclude trauma surgeons from abandoning aggressive attempts to save patients with gunshot wound to the brain.

AB - Background Gunshot wounds to the brain are the most lethal of all firearm injuries, with reported survival rates of 10% to 15%. The aim of this study was to determine outcomes in patients with gunshot wounds to the brain, presenting to our institution over time. We hypothesized that aggressive management can increase survival and the rate of organ donation in patients with gunshot wounds to the brain. Study Design We analyzed all patients with gunshot wounds to the brain presenting to our level 1 trauma center over a 5-year period. Aggressive management was defined as resuscitation with blood products, hyperosmolar therapy, and/or prothrombin complex concentrate (PCC). The primary outcome was survival and the secondary outcome was organ donation. Results There were 132 patients with gunshot wounds to the brain, and the survival rates increased incrementally every year, from 10% in 2008 to 46% in 2011, with the adoption of aggressive management. Among survivors, 40% (16 of 40) of the patients had bi-hemispheric injuries. Aggressive management with blood products (p = 0.02) and hyperosmolar therapy (p = 0.01) was independently associated with survival. Of the survivors, 20% had a Glasgow Coma Scale score ≥ 13 at hospital discharge. In patients who died (n = 92), 56% patients were eligible for organ donation, and they donated 60 organs. Conclusions Aggressive management is associated with significant improvement in survival and organ procurement in patients with gunshot wounds to the brain. The bias of resource use can no longer be used to preclude trauma surgeons from abandoning aggressive attempts to save patients with gunshot wound to the brain.

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