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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