Risk Factors of Aldrich et al for Penetrating Civilian Gunshot Wounds to the Head

 

Patient selection: Glasgow Coma Scale <= 8 after nonsurgical resuscitation or to deteriorate to <= 8 within 48 hours of injury

Glasgow Coma Score at Crime Scene	Outcome
3, 4 or 5	94% died, 5% severely impaired, 1% moderately impaired
6, 7 or 8	70% died; 20% severely impaired, 10% moderately impaired
initially > 8, then drop to < 8	37.5% died; 37.5% severely impaired; 12.5% moderately impaired; 12.5% good recovery

 

Other predictors of a poor outcome (mortality rate 79-88%):

(1) midline shift > 3 mm

(2) volume of hyperdense and mixed-density lesions > 15 mL

(3) compression or obliteration of the mesencephalic cisterns

(4) subarachnoid blood present

(5) intraventricular hemorrhage

(6) maximum intracranial pressure in the first 72 hours > 56 mm Hg