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Original research
Outcomes in patients with gunshot wounds to the brain
  1. Leigh Anna Robinson1,
  2. Lauren M Turco2,
  3. Bryce Robinson3,
  4. Joshua G Corsa3,
  5. Michael Mount4,
  6. Amy V Hamrick4,
  7. John Berne5,
  8. Dalier R Mederos5,
  9. Allison G McNickle6,
  10. Paul J Chestovich6,
  11. Jason Weinberger7,
  12. Areg Grigorian8,
  13. Jeffry Nahmias8,
  14. Jane K Lee9,
  15. Kevin L Chow9,
  16. Erik J Olson10,
  17. Jose L Pascual10,
  18. Rachele Solomon11,
  19. Danielle A Pigneri11,
  20. Husayn A Ladhani12,
  21. Joanne Fraifogl12,
  22. Jeffrey Claridge12,
  23. Terry Curry13,
  24. Todd W Costantini13,
  25. Manasnun Kongwibulwut14,
  26. Haytham Kaafarani14,
  27. Janika San Roman15,
  28. Craig Schreiber15,
  29. Anna Goldenberg-Sandau15,
  30. Parker Hu16,
  31. Patrick Bosarge16,
  32. Rindi Uhlich16,
  33. Nicole Lunardi17,
  34. Farooq Usmani17,
  35. Joseph Victor Sakran17,
  36. Jessica M Babcock18,
  37. Juan Carlos Quispe18,
  38. Lawrence Lottenberg19,
  39. Donna Cabral19,
  40. Grace Chang20,
  41. Jhoanna Gulmatico20,
  42. Jonathan J Parks21,
  43. Rishi Rattan21,
  44. Jennifer Massetti22,
  45. Onaona Gurney22,
  46. Brandon Bruns22,
  47. Alison A Smith23,
  48. Chrissy Guidry23,
  49. Matthew E Kutcher24,
  50. Melissa S Logan24,
  51. Michelle Y Kincaid25,
  52. Chance Spalding25,
  53. Matthew Noorbaksh26,
  54. Frances H Philp26,
  55. Benjamin Cragun26,
  56. Robert D Winfield1
  1. 1 Department of Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
  2. 2 Emergency Medicine, Spectrum Health Butterworth Hospital, Grand Rapids, Michigan, USA
  3. 3 Department of Surgery, Harborview Medical Center, Seattle, Washington, USA
  4. 4 Division of Surgery, Spartanburg Regional Healthcare System, Spartanburg, South Carolina, USA
  5. 5 Division of Trauma and Critical Care, Broward Health, Fort Lauderdale, Florida, USA
  6. 6 Department of Surgery, UNLV School of Medicine, Las Vegas, Nevada, USA
  7. 7 Christiana Care Health System, Wilmington, Delaware, USA
  8. 8 Department of Surgery, University of California Irvine School of Medicine, Irvine, California, USA
  9. 9 Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
  10. 10 Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
  11. 11 Memorial Regional Hospital, Hollywood, Florida, USA
  12. 12 Department of Surgery, Case Western Reserve University Hospital, Cleveland, Ohio, USA
  13. 13 Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, UC San Diego Health, San Diego, California, USA
  14. 14 Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
  15. 15 Division of Trauma, Surgical Critical Care & Acute Care Surgery, Cooper University Hospital, Camden, New Jersey, USA
  16. 16 Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
  17. 17 Department of Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
  18. 18 Department of Surgery, Loma Linda University, Loma Linda, California, USA
  19. 19 St. Mary's Medical Center, Boca Raton, Florida, USA
  20. 20 Department of Surgery, Mount Sinai Hospital, Chicago, Illinois, USA
  21. 21 Department of Surgery, University of Miami School of Medicine, Miami, Florida, USA
  22. 22 Department of Surgery, University of Maryland Medical System, Baltimore, Maryland, USA
  23. 23 Department of Surgery, Tulane Medical Center, New Orleans, Louisiana, USA
  24. 24 Department of Surgery, University of Mississippi, University Park, Mississippi, USA
  25. 25 Trauma and Acute Care Surgery, Grant Medical Center, Columbus, Ohio, USA
  26. 26 Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr Lauren M Turco, Emergency Medicine, Spectrum Health Butterworth Hospital, Grand Rapids, MI 49503, USA; turco.lauren{at}gmail.com

Abstract

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.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/tsaco-2019-000351

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    Footnotes

    • Presented at This research will be presented as a Quickshot at the 32nd Annual Scientific Assembly of the Eastern Association for the Surgery of Trauma on January 18, 2019 in Austin, Texas.

    • Contributors LAR and RDW were involved in study design. LAR, RDW, and LMT wrote the original content. All authors contributed to critical review and major revisions.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are available.