Civilian gunshot wounds: The limits of salvageability

Abstract

Patients who have suffered gunshot wounds in civilian settings, who present with posturing and in whom the bullet has passed through the geographical centre of the brain have generally not been felt to be salvageable. However, surprisingly favourable outcomes in two such patients have led us to believe that some such patients may deserve aggressive treatment.

Factors affecting dural penetration and prognosis in patients admitted to emergency department with cranial gunshot wound

“…where E is the kinetic energy, m the bullet's mass, and v the bullet's velocity [21,22]. This formula can explain the significant impact of high bullet velocity on dural penetration and mortality in our study.…”

“…CGWs are said to be of "low velocity" when the bullet velocity was lower than 1200 ft/s and of "high velocity" when it exceeded 1200 ft/s; high-velocity weapons cause more severe damage [21,22]. Injury severity depends on a bullet's kinetic energy, which is directly proportional to a bullet's mass and square of its velocity.…”

Surgical management of civilian gunshot wounds to the head

“…Only one-third of patients with GSWH have a chance for a functional recovery after a devastating injury to the brain (Grahm et al, 1990;Kaufman et al, 1995;Zafonte et al, 2001aZafonte et al, , 2012Aarabi, 2013). In the literature on civilians with GSWH, the percentage of patients with a GCS of 3-8 ranges from 48% to 94% (Kaufman et al, 1983;Clark et al, 1986;Mancuso et al, 1988;Grahm et al, 1990;Shaffrey et al, 1992;Kennedy et al, 1993). The Israeli experience in Lebanon indicated that up to 48% of the patients transferred to a military hospital within 30 minutes of injury were comatose (GCS < 10) (Brandvold et al, 1990;Levi et al, 1990).…”

“…In this group of patients the proportion of patients with a GCS of 3-8 was 24%. Abnormal pupillary response to light is present in 50-60% of the patients with GSWH (Byrnes et al, 1974;Kaufman et al, 1983;Suddaby et al, 1987;Aarabi et al, 2001). Among 69 patients who were admitted to the shock trauma center in a 2 year period, 21 (30%) were dead on arrival and 30 (44%) were in the GCS 3-8 group ( Fig.…”

High-Velocity Gunshot Wounds to the Head: Analysis of 135 Patients

“…26) In such cases, early and deep debridement of devitalized brain tissue and removal of all accessible foreign bodies and bony fragments is also advocated. 5,9,17,21,27,30,38) The present study suggests that deep and maximal debridement of devitalized brain tissue and removal of all accessible foreign bodies and bony fragments must be performed as aggressively and early as possible to prevent the resultant edema associated with devitalized brain tissue. An indriven foreign body or large amounts of necrotic brain tissue is generally considered to be an important source for epileptic seizures and increased infection rate.…”