Outcome of cranial firearm injuries in civilian population based on a novel classification system

Abstract

Background: Cranial firearm injuries (CFAIs) are expected to be frequent during warfare; however, it is becoming increasingly common among civilian population in our part of the world. These injuries are associated with significant morbidity and mortality in addition to financial loss. The objective of our study is to evaluate the pattern of gunshot injuries to cranium and their outcome. Methods: The study was conducted on 114 patients presenting with CFAIs to Jinnah Postgraduate Medical Centre, Karachi, Pakistan, between June 2015 and January 2019. Patients were evaluated with respect to age, gender, pattern of injury, Glasgow coma scale on arrival, radiological and clinical assessment, surgical intervention, and Glasgow outcome score measured at 6 months follow-up. Results: Among patients with cranial gunshot, injuries most were males (76.3%). More than 50% patients aged between 18 and 35 years. About 46.5% of patients presented with moderate traumatic brain injury commonly involving the temporal lobe (36.8%). Of total 114 patients, 84.2% were managed conservatively but wound debridement was done in all patients. At 6 months, the overall mortality in our patients was 33.3%. Patients with good outcome (GOS 4 and 5) were 30.7% and 35.9% patients had bad outcome (GOS 2 and 3). Complication rate was 14.9% and the most common complication was disseminated intravascular coagulation in 5.2%. Conclusion: Surgical intervention has no significant benefit over conservative management on long-term mortality and should be limited to patients with large intracranial hematomas and intraventricular hematomas causing hydrocephalus.

Evaluate the Pattern of Firearm Injuries Based on Gender in Hyderabad, Sindh, Pakistan

“…The rate of violent deaths and related to firearm injuries in the developing societies are the twice as compared to high income countries 4 . A study conducted in the Northern Italy showed the mortality rates approximately 0.84 per every 100000 residents in year 2006, however the average of 12.6 cases yearly 5,6 .…”

Firearm-Related Traumatic Brain Injury Homicides in the United States, 2000-2019

“…8,20 Currently, there are very limited large-scale, national published studies on firearm-related TBIs and even fewer on firearm-related TBI homicides. 21 When available, recently published studies on firearm-related TBIs generally focus on firearm-related suicide, suicidality, and self-harm [22][23][24][25][26] ; contain small sample sizes or present clinical case studies 7,[27][28][29][30][31] ; and/or examine a specific population (eg, patients seen in trauma centers). 8,20 Given the unique characteristics of firearm-related TBI homicides, greater understanding of the burden of this injury is warranted.…”