Management of Pediatric Intracranial Gunshot Wounds: Predictors of Favorable Outcome and a Proposed Treatment Paradigm

Katie Bandt, MD1, Chester Yarbrough, MD1, Jacob Greenberg, BS1, Jeffrey Leonard, MD1

1Saint Louis, MO United States

Keywords: gunshot wound, outcome, traumatic brain injury, children, penetrating trauma

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Abstract

     There has been an increase in civilian gun violence since the 1980s with the highest proportional increase occurring in the pediatric population.
     To date, no paradigm exists for management of these patients nor do we fully understand predictors of favorable outcome in this population.
     Retrospective review of all victims of intracranial GSW age birth-18 years at a major metropolitan Level 1 trauma center from 2002-2011. N=48.
     The predictive values of accepted adult clinical and radiographic factors for poor prognosis were investigated.
     Statistically significant (p/= 1 reactive pupil on arrival, SBP 100 on arrival, no deep nuclei &/or 3rd ventricular involvement, ICP /= 1 reactive pupil, no deep nuclei &/or 3rd ventricular involvement and ICP /= 3. This finding prompted a proposed treatment paradigm termed The St. Louis Scale for Pediatric Gunshot Wounds to the Head in which these initial findings are allotted points according to their strength of predictiveness for outcome.
     This is a retrospective study.
     The pediatric population tends to demonstrate more favorable outcomes following intracranial gunshot injury, therefore, some patients may benefit from more aggressive treatment than is considered for adults.
     Utilizing the St. Louis Scale for Pediatric Gunshot Wounds to the Head may provide an evidence-based tool for decision making.


Acknowledgements

Project Roles:

K. Bandt (), C. Yarbrough (), J. Greenberg (), J. Leonard ()