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.

To read more or access our algorithms and calculators, please log in or register.