Management of pediatric intracranial gunshot wounds: Predictors of favorable clinical outcome and a new proposed treatment paradigm: Clinical article

S. Kathleen Bandt*, Jacob K. Greenberg, Chester K. Yarbrough, Kenneth B. Schechtman, David D. Limbrick, Jeffrey R. Leonard

*Corresponding author for this work

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

Object. There has been an increase in civilian gun violence since the late 1980s, with a disproportionately high increase occurring within the pediatric population. To date, no definite treatment paradigm exists for the management of these patients, nor is there a full understanding of the predictors of favorable clinical outcome in this population. Methods. The authors completed a retrospective review of all victims of intracranial gunshot injury from birth to age 18 years at a major metropolitan Level 1 trauma center (n = 48) from 2002 to 2011. The predictive values of widely accepted adult clinical and radiographic factors for poor prognosis were investigated. Results. Eight statistically significant factors (p < 0.05) for favorable outcome were identified. These factors include single hemispheric involvement, absence of a transventricular trajectory, < 3 lobes involved, ≥ 1 reactive pupil on arrival, systolic blood pressure > 100 mm Hg on arrival, absence of deep nuclei and/or third ventricular involvement, initial ICP < 30 mm Hg when monitored, and absence of midline shift. Of these 8 factors, 5 were strong predictors of favorable clinical outcome as defined by Glasgow Outcome Scale score of 4 or 5. These predictive factors included absence of a transventricular trajectory, < 3 lobes involved, ≥ 1 reactive pupil on arrival, absence of deep nuclei and/or third ventricular involvement, and initial ICP < 30 mm Hg. These findings form the basis of the St. Louis Scale for Pediatric Gunshot Wounds to the Head, a novel metric to inform treatment decisions for pediatric patients who sustain these devastating injuries. Conclusions. The pediatric population tends to demonstrate more favorable outcomes following intracranial gunshot injury when compared with the adult population; therefore some patients may benefit from more aggressive treatment than is considered for adults. The St. Louis Scale for Pediatric Gunshot Wounds to the Head may provide critical data toward evidence-based guidelines for clinical decision making.

Original languageEnglish (US)
Pages (from-to)511-517
Number of pages7
JournalJournal of Neurosurgery: Pediatrics
Volume10
Issue number6
DOIs
StatePublished - Dec 1 2012

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Keywords

  • Clinical outcome
  • Gunshot wound
  • Head injury
  • Patient management
  • Trauma
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

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