Bandt et al reported favorable prognostic factors for a pediatric patient with an intracranial gunshot wound. The authors are from Washington University and St. Louis Children's Hospital in St. Louis.
Patient selection: pediatric patient with an intracranial gunshot wound
Most important prognostic factors for a favorable outcome:
(1) absence of a transventricular trajectory
(2) less than 3 lobes involved
(3) >= 1 reactive pupils on arrival
(4) absence of deep nuclei and/or third ventricular involvement
(5) initial intracranial pressure (ICP) < 30 mm Hg
Additional factors:
(6) single hemisphere involvement
(7) systolic blood pressure > 100 mm Hg
(8) absence of midline shift
(9) Glasgow coma scale 14 or 15
|
Parameter
|
Finding
|
Points
|
|
fixed pupils on arrival
|
bilateral
|
3
|
|
|
none or unilateral
|
0
|
|
involvement of deep nuclei and/or third ventricle
|
no
|
0
|
|
|
yes
|
3
|
|
ICP
|
<= 30 mm Hg
|
0
|
|
|
> 30 mm Hg
|
3
|
|
mixed supra/infratentorial involvement
|
no
|
0
|
|
|
yes
|
2
|
|
number of lobes involved
|
< 3
|
0
|
|
|
>= 3
|
2
|
|
transventricular trajectory
|
no
|
0
|
|
|
yes
|
2
|
|
bihemispheric involvement
|
no
|
0
|
|
|
yes
|
1
|
|
systolic blood pressure
|
< 100 mm Hg
|
1
|
|
|
>= 100 mm Hg
|
0
|
|
midline shift
|
no
|
0
|
|
|
yes
|
1
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 18
• A score <= 4 was associated with survival (positive predictive value 89%).
