Prognostic factors and SPIN score validation in civilian self-inflicted gunshot penetrating brain injuries

This retrospective study evaluates prognostic factors in patients with penetrating traumatic brain injuries (pTBI) caused by gunshot wounds to the head, with a focus on a civilian cohort predominantly composed of self-inflicted injuries. The primary goal was to externally validate the SPIN score, a prognostic model developed for predicting survival after acute penetrating brain trauma. The analysis included 57 patients admitted over a 10-year period in a tertiary neurosurgical center. Most were middle-aged males, and over 90% of injuries were self-inflicted. Results confirmed that the full SPIN score had good predictive value for survival, with an AUC of 0.895 (CI: 0.817 – 0.974, p<0.001). Among all variables, the Glasgow Coma Scale (GCS) at admission remained the most consistent independent predictor of unfavorable outcome. Neither midline shift nor chronic alcohol use reached statistical significance in multivariate analysis. Seasonal variation showed a higher number of self-inflicted injuries during winter, though this was not statistically significant. The study confirms the utility of the SPIN score in civilian settings and emphasizes the need for individualized triage tools that account for the high lethality and unique clinical features of self-inflicted pTBI. Additionally, it advocates for caution in decision-making and highlights the limitations of relying solely on simplified scoring systems or outdated military-derived guidelines. Overall, the results support the SPIN score as a valuable framework for early prognostic assessment in neurotrauma, with potential implications for surgical planning, resource allocation, and family counseling.