Outcomes in patients with gunshot wounds to the brain

Leigh Anna Robinson, Lauren M. Turco, Bryce Robinson, Joshua G. Corsa, Michael Mount, Amy V. Hamrick, John Berne, Dalier R. Mederos, Allison G. McNickle, Paul J. Chestovich, Jason Weinberger, Areg Grigorian, Jeffry Nahmias, Jane K. Lee, Kevin L. Chow, Erik J. Olson, Jose L. Pascual, Rachele Solomon, Danielle A. Pigneri, Husayn A. LadhaniJoanne Fraifogl, Jeffrey Claridge, Terry Curry, Todd W. Costantini, Manasnun Kongwibulwut, Haytham Kaafarani, Janika San Roman, Craig Schreiber, Anna Goldenberg-Sandau, Parker Hu, Patrick Bosarge, Rindi Uhlich, Nicole Lunardi, Farooq Usmani, Joseph Victor Sakran, Jessica M. Babcock, Juan Carlos Quispe, Lawrence Lottenberg, Donna Cabral, Grace Chang, Jhoanna Gulmatico, Jonathan J. Parks, Rishi Rattan, Jennifer Massetti, Onaona Gurney, Brandon Bruns, Alison A. Smith, Chrissy Guidry, Matthew E. Kutcher, Melissa S. Logan, Michelle Y. Kincaid, Chance Spalding, Matthew Noorbaksh, Frances H. Philp, Benjamin Cragun, Robert D. Winfield

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Article numbere000351
JournalTrauma Surgery and Acute Care Open
Volume4
Issue number1
DOIs
StatePublished - Nov 1 2019

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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    Robinson, L. A., Turco, L. M., Robinson, B., Corsa, J. G., Mount, M., Hamrick, A. V., Berne, J., Mederos, D. R., McNickle, A. G., Chestovich, P. J., Weinberger, J., Grigorian, A., Nahmias, J., Lee, J. K., Chow, K. L., Olson, E. J., Pascual, J. L., Solomon, R., Pigneri, D. A., ... Winfield, R. D. (2019). Outcomes in patients with gunshot wounds to the brain. Trauma Surgery and Acute Care Open, 4(1), [e000351]. https://doi.org/10.1136/tsaco-2019-000351