Predictive Survival Factors in Pediatric Intracranial Gunshot Wounds

Researchers examined a variety of clinical, laboratory, and CT findings to see if they were predictive of death, and identified 9 factors statistically associated with mortality.

Researchers have identified 9 clinical, laboratory, and radiological factors that were predictive of either survival or death after pediatric intracranial gunshot wounds, according to research published in the Journal of Neurosurgery: Pediatrics.

“When presented with a child who has sustained an intracranial gunshot wound, the neurosurgeon must quickly decide whether the child has a fatal injury, an injury that is potentially nonfatal but very likely to have a devastating neurological outcome, or a survivable injury with a reasonable chance of maintaining or regaining meaningful neurological function,” the authors wrote.

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Based on the neurosurgeon’s evaluation and the wishes of the family, a decision must be made after an intracranial gunshot wound on how to proceed with treatment. This process is more challenging in children than adults due to the limited amount of published material about this topic and because of the differences between children and adults: children and adolescents generally have a lower mortality rate and a greater chance of recovery.

When making the decision with how to proceed with treatment, the amount of information shared with a patient’s family can also differ and can vary “from physician to physician,” Paul Klimo Jr, MD, MPH, from the Department of Neurosurgery at the University of Tennessee Health Science Center, told Clinical Pain Advisor. “You need to quickly get a feel of the family. Will they be able to comprehend the details I provide to them, or do I summarize my opinion without getting into the various details? If we feel someone would benefit from surgery, then we rapidly move in that direction and there isn’t much discussion to be had.”

The authors also sought to determine the effectiveness of the 2012 St. Louis Scale for Pediatric Gunshot Wounds to the Head in predicting death or survival.

To determine what factors can predict either death or a favorable outcome, and to evaluate the accuracy of the predictions made by the St. Louis Scale, the researchers evaluated the medical records of all pediatric patients (18 years or younger) who were treated for a single intracranial gunshot wound between 1996 and 2013 at Le Bonheur Children’s Hospital or the Elvis Presley Memorial Trauma Center in Memphis.