1115 Predictors of Neurological Outcome in Gunshot Wounds to the Head: A Paired Statistical Analysis

INTRODUCTION: Gunshot wounds to the head (GSWH) confer high lethality and uncertain recovery. It is unclear which patients benefit from aggressive medical and surgical intervention, particularly in those with a low Glasgow coma scale (GCS) upon admission. METHODS: Our institutional medical records database was screened to identify GSWH patients over the last 5 years. Demographic, clinical, radiographic, and therapeutic data were obtained. Multiple paired t-test analyses were conducted to identify predictors of survival and good neurological outcome in GSWH (defined as GCS>9 on follow-up). RESULTS: Fifteen patients were identified. Mean age was 26.2±14 years. Ten were males. Two were self-inflicted. Mean initial GCS was 6.2±3.9. Two patients underwent placement of intracranial-pressure monitoring devices, 2 had external ventricular drains, and 5 underwent decompressive craniectomies. Mean length of stay was 25.3±17 days. Two mortalities were reported. For patients who survived, mean GCS upon discharge was 11.5±5.7. Mean follow-up time was 10.4±6.3 months, and mean GCS at last follow-up was 13.1±4.3. Factors associated with increased mortality/worse neurological outcome included INR >1.4 (p=0.038) and GCS<6 on arrival (p=0.023), re-hemorrhage during hospitalization (p=0.024), radiographic herniation on arrival (p=0.018), transventricular trajectory of the bullet (p=0.027) with multilobar (p=0.043) and bihemispheric (p=0.032) involvement, and retained intraparenchymal fragments (p=0.027). Factors associated with neurological recovery (GCS>9 on last follow-up) included presence of pupillary response upon arrival (p=0.017), tangential trajectory of the bullet without dural penetration (p=0.015), and no intracranial vascular injury (p=0.026). CONCLUSIONS: Several factors should be considered when assessing the severity of GSWH. This subpopulation of neurosurgical patients tends to be young, and, in adequately selected cases, maximal medical/surgical management leads to significant neurological recovery. An ongoing GSWH multicenter study, of which our institution is a participant site, will provide more robust evidence on this topic soon.