"Time is brain" the Gifford factor - or: Why do some civilian gunshot wounds to the head do unexpectedly well? A case series with outcomes analysis and a management guide

Lin, David J.; Lam, Fred C.; Siracuse, Jeffrey J.; Thomas, Ajith J.; Kasper, Ekkehard M.

doi:10.4103/2152-7806.100187

Cited by 36 publications

(10 citation statements)

References 14 publications

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“…These should all be considered when deciding to pursue aggressive management and surgery on the individual patient [ 6 ]. The current management of penetrating injury to CNS is based mainly on retrospective observational studies [ 17 ]. Clinical practice guidelines for the management of civilian and military penetrating brain injury have been published [ 18 , 19 ].…”

Section: Craniocerebral Gswmentioning

confidence: 99%

“…Broad-spectrum antibiotic cover is also recommended in the penetrating brain injury guidelines [ 23 ]. Lin et al [ 17 ] recommended broad-spectrum prophylactic antibiotic cover with vancomycin, gentamycin and metronidazole for 48–72 h.…”

Section: Craniocerebral Gswmentioning

confidence: 99%

“…Lin et al [ 17 ] have presented useful practical technical advice to enable rapid and successful surgery. Their mantra for treating GSW to the brain is “time is brain”.…”

Section: Craniocerebral Gswmentioning

confidence: 99%

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Current Concepts in Penetrating and Blast Injury to the Central Nervous System

2014

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AimTo review the current management, prognostic factors and outcomes of penetrating and blast injuries to the central nervous system and highlight the differences between gunshot wound, blast injury and stabbing.MethodsA review of the current literature was performed.ResultsOf patients with craniocerebral GSW, 66–90 % die before reaching hospital. Of those who are admitted to hospital, up to 51 % survive. The patient age, GCS, pupil size and reaction, ballistics and CT features are important factors in the decision to operate and in prognostication. Blast injury to the brain is a component of multisystem polytrauma and has become a common injury encountered in war zones and following urban terrorist events. GSW to the spine account for 13–17 % of all gunshot injuries.ConclusionsUrgent resuscitation, correction of coagulopathy and early surgery with wide cranial decompression may improve the outcome in selected patients with severe craniocerebral GSW. More limited surgery is undertaken for focal brain injury due to GSW. A non-operative approach may be taken if the clinical status is very poor (GCS 3, fixed dilated pupils) or GCS 4–5 with adverse CT findings or where there is a high likelihood of death or poor outcome. Civilian spinal GSWs are usually stable neurologically and biomechanically and do not require exploration. The indications for exploration are as follows: (1) compressive lesions with partial spinal cord or cauda equina injury, (2) mechanical instability and (3) complications. The principles of management of blast injury to the head and spine are the same as for GSW. Multidisciplinary specialist management is required for these complex injuries.

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Section: Craniocerebral Gswmentioning

confidence: 99%

Section: Craniocerebral Gswmentioning

confidence: 99%

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Current Concepts in Penetrating and Blast Injury to the Central Nervous System

2014

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“…The need for intracranial pressure (ICP) monitoring is not as well de ned in postoperative management of patients with civilian GWH in the management and prognosis of penetrating brain injury. 1,32,33 Commonly used methods for ICP correction are the infusion of hypertonic saline and mannitol, short-term hyperventilation, CSF drainage, barbiturates and paralytics, and nally decompressive craniectomy. Correction of ICP should be started at ICP values higher than the threshold of 20 mmHg registered for 5 min and longer.…”

Section: Clinical Managementmentioning

confidence: 99%

Civilian Gunshot Wounds to The Head: A Case Report, Clinical Management, and Literature Review.

2020

Preprint

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Background: Civilian Gunshot wounds to the head refers to the brain injury caused by projectiles such as gun projectiles and various fragments generated by explosives, gunpowder, etc. as a power launch or explosion. Gunshot wounds to the head is the deadliest of all gun injuries, according to literature statistics, the survival rate is only 9%.1 Due to the strict management of various types of firearms, they rarely occur, so the injury mechanism, injury and trauma analysis, clinical management, and surgical standards are almost based on military experience, and there are few related reports especially the head suffered a fatal blow more than once in a short time. We report a case with a return to almost complete recovery despite the patient suffered shots on the head twice in a short period of time.Case Presentations: We present a case of a 53-year old male who suffered twice gunshot injuries to the head under unknown circumstances. On initial presentation the patient had a Glasgow Coma Score of 6, unable to communicate, loss of consciousness. The first bullet penetrated from the right frontal area and finally reached the right occipital lobe. When the patient subconsciously covers his head with his hand, the second bullet through the patient's right palm bone, entered from the right frontotemporal, and stayed deep in the lateral sulcus. The patient had a cerebral hernia when he was admitted to the hospital, and immediately entered the operating room for rescue after a compute tomography scan. After two foreign body removals and one skull repair, the patient recovered completely.Conclusions: Gunshot wounds to the head have a high mortality rate and usually require aggressive management. Evaluation of most gunshot injuries requires extremely fast imaging examination upon arrival at the hospital followed by proactive treatment against infection, seizure and increased intracranial pressure. Surgical intervention is usually necessary, and its key point usually includes the timing of the operation, the method of operation, and the scope of the operation.

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“…Nonmissile penetrating head injuries (NPHIs), on the other hand, are relatively rare; and theories about their management are mostly controversial. They are defined to have an impact velocity of less than 100 meters per second [1][2][3][4][5]. Although less destructive than missile PHIs, significant damage can occur when vital structures are impacted.…”

Section: Introductionmentioning

confidence: 99%