Trauma Surgery & Acute Care Open (Nov 2019)
Outcomes in patients with gunshot wounds to the brain
- Rishi Rattan,
- Jeffry Nahmias,
- Areg Grigorian,
- Brandon Bruns,
- Paul J Chestovich,
- Jose L Pascual,
- Patrick Bosarge,
- Rindi Uhlich,
- Parker Hu,
- Allison G McNickle,
- Grace Chang,
- Todd W Costantini,
- Lawrence Lottenberg,
- John Berne,
- Chance Spalding,
- Leigh Anna Robinson,
- Lauren M Turco,
- Bryce Robinson,
- Joshua G Corsa,
- Michael Mount,
- Amy V Hamrick,
- Dalier R Mederos,
- Jason Weinberger,
- Jane K Lee,
- Kevin L Chow,
- Erik J Olson,
- Rachele Solomon,
- Danielle A Pigneri,
- Husayn A Ladhani,
- Joanne Fraifogl,
- Jeffrey Claridge,
- Terry Curry,
- Manasnun Kongwibulwut,
- Haytham Kaafarani,
- Janika San Roman,
- Craig Schreiber,
- Anna Goldenberg-Sandau,
- Nicole Lunardi,
- Farooq Usmani,
- Joseph Victor Sakran,
- Jessica M Babcock,
- Juan Carlos Quispe,
- Donna Cabral,
- Jhoanna Gulmatico,
- Jonathan J Parks,
- Jennifer Massetti,
- Onaona Gurney,
- Alison A Smith,
- Chrissy Guidry,
- Matthew E Kutcher,
- Melissa S Logan,
- Michelle Y Kincaid,
- Matthew Noorbaksh,
- Frances H Philp,
- Benjamin Cragun,
- Robert D Winfield
Affiliations
- Rishi Rattan
- 21 Department of Surgery, University of Miami School of Medicine, Miami, Florida, USA
- Jeffry Nahmias
- Department of Surgery, University of California Irvine, Irvine, California, USA
- Areg Grigorian
- University of California Irvine College of Medicine, Irvine, California, USA
- Brandon Bruns
- Department of Surgery, UT Southwestern Medical School, Dallas, Texas, USA
- Paul J Chestovich
- 6 Department of Surgery, UNLV School of Medicine, Las Vegas, Nevada, USA
- Jose L Pascual
- 10 Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
- Patrick Bosarge
- 16 Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Rindi Uhlich
- Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Parker Hu
- The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Allison G McNickle
- 6 Department of Surgery, UNLV School of Medicine, Las Vegas, Nevada, USA
- Grace Chang
- 20 Department of Surgery, Mount Sinai Hospital, Chicago, Illinois, USA
- Todd W Costantini
- Surgery, University of California San Diego, San Diego, California, USA
- Lawrence Lottenberg
- 19 St. Mary`s Medical Center, Boca Raton, Florida, USA
- John Berne
- Department of Surgery, Broward Health, Fort Lauderdale, Florida, USA
- Chance Spalding
- Trauma and Acute Care Surgery, Grant Medical Center, Columbus, Ohio, USA
- Leigh Anna Robinson
- 1 Department of Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
- Lauren M Turco
- 2 Emergency Medicine, Spectrum Health Butterworth Hospital, Grand Rapids, Michigan, USA
- Bryce Robinson
- Surgery, Harborview Medical Center, Seattle, Washington, USA
- Joshua G Corsa
- 3 Department of Surgery, Harborview Medical Center, Seattle, Washington, USA
- Michael Mount
- 4 Division of Surgery, Spartanburg Regional Healthcare System, Spartanburg, South Carolina, USA
- Amy V Hamrick
- 4 Division of Surgery, Spartanburg Regional Healthcare System, Spartanburg, South Carolina, USA
- Dalier R Mederos
- 5 Division of Trauma and Critical Care, Broward Health, Fort Lauderdale, Florida, USA
- Jason Weinberger
- 7 Christiana Care Health System, Wilmington, Delaware, USA
- Jane K Lee
- 9 Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
- Kevin L Chow
- 9 Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
- Erik J Olson
- 10 Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
- Rachele Solomon
- 11 Memorial Regional Hospital, Hollywood, Florida, USA
- Danielle A Pigneri
- 11 Memorial Regional Hospital, Hollywood, Florida, USA
- Husayn A Ladhani
- 12 Department of Surgery, Case Western Reserve University Hospital, Cleveland, Ohio, USA
- Joanne Fraifogl
- 12 Department of Surgery, Case Western Reserve University Hospital, Cleveland, Ohio, USA
- Jeffrey Claridge
- 12 Department of Surgery, Case Western Reserve University Hospital, Cleveland, Ohio, USA
- Terry Curry
- 13 Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, UC San Diego Health, San Diego, California, USA
- Manasnun Kongwibulwut
- 14 Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Haytham Kaafarani
- 14 Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Janika San Roman
- 15 Division of Trauma, Surgical Critical Care & Acute Care Surgery, Cooper University Hospital, Camden, New Jersey, USA
- Craig Schreiber
- 15 Division of Trauma, Surgical Critical Care & Acute Care Surgery, Cooper University Hospital, Camden, New Jersey, USA
- Anna Goldenberg-Sandau
- 15 Division of Trauma, Surgical Critical Care & Acute Care Surgery, Cooper University Hospital, Camden, New Jersey, USA
- Nicole Lunardi
- 17 Department of Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
- Farooq Usmani
- 17 Department of Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
- Joseph Victor Sakran
- 17 Department of Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
- Jessica M Babcock
- 18 Department of Surgery, Loma Linda University, Loma Linda, California, USA
- Juan Carlos Quispe
- 18 Department of Surgery, Loma Linda University, Loma Linda, California, USA
- Donna Cabral
- 19 St. Mary`s Medical Center, Boca Raton, Florida, USA
- Jhoanna Gulmatico
- 20 Department of Surgery, Mount Sinai Hospital, Chicago, Illinois, USA
- Jonathan J Parks
- 21 Department of Surgery, University of Miami School of Medicine, Miami, Florida, USA
- Jennifer Massetti
- 22 Department of Surgery, University of Maryland Medical System, Baltimore, Maryland, USA
- Onaona Gurney
- 22 Department of Surgery, University of Maryland Medical System, Baltimore, Maryland, USA
- Alison A Smith
- 23 Department of Surgery, Tulane Medical Center, New Orleans, Louisiana, USA
- Chrissy Guidry
- 23 Department of Surgery, Tulane Medical Center, New Orleans, Louisiana, USA
- Matthew E Kutcher
- 24 Department of Surgery, University of Mississippi, University Park, Mississippi, USA
- Melissa S Logan
- 24 Department of Surgery, University of Mississippi, University Park, Mississippi, USA
- Michelle Y Kincaid
- 25 Trauma and Acute Care Surgery, Grant Medical Center, Columbus, Ohio, USA
- Matthew Noorbaksh
- Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
- Frances H Philp
- 26 Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
- Benjamin Cragun
- 26 Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
- Robert D Winfield
- Department of Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
- DOI
- https://doi.org/10.1136/tsaco-2019-000351
- Journal volume & issue
-
Vol. 4,
no. 1
Abstract
Introduction Gunshot wounds to the brain (GSWB) confer high lethality and uncertain recovery. It is unclear which patients benefit from aggressive resuscitation, and furthermore whether patients with GSWB undergoing cardiopulmonary resuscitation (CPR) have potential for survival or organ donation. Therefore, we sought to determine the rates of survival and organ donation, as well as identify factors associated with both outcomes in patients with GSWB undergoing CPR.Methods We performed a retrospective, multicenter study at 25 US trauma centers including dates between June 1, 2011 and December 31, 2017. Patients were included if they suffered isolated GSWB and required CPR at a referring hospital, in the field, or in the trauma resuscitation room. Patients were excluded for significant torso or extremity injuries, or if pregnant. Binomial regression models were used to determine predictors of survival/organ donation.Results 825 patients met study criteria; the majority were male (87.6%) with a mean age of 36.5 years. Most (67%) underwent CPR in the field and 2.1% (n=17) survived to discharge. Of the non-survivors, 17.5% (n=141) were considered eligible donors, with a donation rate of 58.9% (n=83) in this group. Regression models found several predictors of survival. Hormone replacement was predictive of both survival and organ donation.Conclusion We found that GSWB requiring CPR during trauma resuscitation was associated with a 2.1% survival rate and overall organ donation rate of 10.3%. Several factors appear to be favorably associated with survival, although predictions are uncertain due to the low number of survivors in this patient population. Hormone replacement was predictive of both survival and organ donation. These results are a starting point for determining appropriate treatment algorithms for this devastating clinical condition.Level of evidence Level II.
