Aldrich et al identified prognostic factors for civilians with gunshot wounds to the head. This can help identify patients who are likely to have a poor outcome. The authors are from the University of Texas at Galveston, the National Institute of Neurologic Disorders and Stroke, the University of Virginia, the University of California San Diego and the Medical College of Virginia.


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


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


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