Description

Petridis et al reported prognostic factors for a civilian with a craniocerebral gunshot injury. This can help to identify a patient who may or may not benefit from surgery. The authors are from the University Kiel in Germany.


Patient selection: civilian with craniocerebral gunshot wound

 

Poor prognostic factors:

(1) Glasgow coma scale from 3 to 8

(2) 2 fixed pupils

(3) > 2 bone fragments

(4) bilobar, transventricular, posterior fossa or brainstem lesions

(5) ICP > 45 mm Hg

(6) midline shift > 10 mm

 

Surgery should not be performed if:

(1) the Glasgow coma scale <= 8 and there are 2 non-reactive pupils

(2) one or both pupils are reactive and if there is a translobar/transventricular wound

Otherwise surgery can be performed

 

If surgery is performed, then the wound and the missile or bone track should be debrided meticulously.


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