Kim et al identified factors affecting outcome for patients with gunshot wounds involving the brain. These can help identify patients who may benefit from early, aggressive management. The authors are from Chonnam National University in Korea.
Outcome was measured using the Glasgow Outcome Scale (4 or 5 favorable; 1 to 3 unfavorable)
Parameters:
(1) Glasgow coma score (GCS) on admission
(2) trajectory of the bullet
Parameter
Finding
Points
Glasgow coma score
9 to 15
0
3 to 8
1
trajectory
single lobe
0
2 or more lobes
1
transventricular and/or bihemispheric trajectory
1
where:
• The lower the GCS the worse the prognosis.
• About two thirds of patients with a non-single lobe injury had an unfavorable outcome (page 1450, second column).
number of risk factors =
= SUM(points for both parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 2
• A score of 0 was compatible with a favorable outcome. The patient is likely to benefit from early and aggressive management.
• The presence of either risk factor was associated with a poor outcome.
• The presence of retained bullet fragments after initial debridement did not increase the risk for either infection or later seizures. The presence of any clothing or organic material may be more important.
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