Evaluation of Prognostic Factors in Patients with Cranial Gunshot Wounds.

IF 0.7 4区 医学 Q3 MEDICINE, GENERAL & INTERNAL
Nigerian Journal of Clinical Practice Pub Date : 2025-07-01 Epub Date: 2025-07-28 DOI:10.4103/njcp.njcp_863_24
K Oktay, M Mammadov, A Alnageeb, H E Alcan, U Pektaş, K M Ozsoy, N E Cetinalp, T Erman
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引用次数: 0

Abstract

Background: In recent years, cranial gunshot wounds become a growing concern for neurosurgeons due to factors such as the increase in civil wars, terrorist activities, and the global rise in civilian gun ownership.

Aim: To evaluate the prognostic factors in patients with cranial gunshot wounds.

Methods: The current study included 124 patients who received either conservative or surgical treatment for cranial gunshot wounds between October 2014 and April 2024. The data including age, gender, clinical parameters (Glasgow coma scale (GCS), pupillary examination, admission time, high or low-velocity gunshot injuries), radiological parameters (pattern of injury, presence of midline cross of the projectiles, affected brain lobes, presence of foreign body in the cranium, accompanying pathologies), and treatment parameters (treatment modalities, complications, and Glasgow outcome scale) were retrospectively collected.

Results: The mean age of the patients was 26.29 ± 10.76 years (2-76 years). Sixteen patients (12.9%) were female, and 108 patients (87.1%) were male. Ninety-four patients (75.8%) had gunshot wounds related to Syrian civil war, 18 patients (14.5%) had accidental injuries, and 12 patients (9.7%) had suicide injuries. Higher initial GCS scores, isochoric pupils, low-velocity injuries, tangential injuries, the absence of midline cross of the projectiles, unihemispheric unilobar injuries, the absence of accompanying hematomas, and the lack of complications were statistically significantly correlated with favorable outcomes (P = 0.001). The overall mortality rate in the study cohort was 41.1% (51 patients). Fifty-five patients (44.4%) had favorable outcome, while 69 patients (55.6%) had poor outcome. Fifty-six complications were determined in 38 patients. Neurodeficits (32.1%), cerebrospinal fluid fistula and wound dehishence (21.4%), and systemic infections (21.4%) were primary complications.

Conclusion: In the present study, low initial GCS scores, fixed pupils, high-velocity injuries, perforating injuries, the presence of the midline cross of the projectiles, bihemispheric injuries, the presence of IVH, the presence of the complications, and the lack of surgical treatment showed statistically significant influence on mortality. Among these predictors, lower initial GCS scores, fixed pupils, midline cross of the projectiles, and complications were found to be the primary risk factors for mortality. Additionally, surgical treatment was found to reduce mortality rates.

颅脑枪伤患者预后因素的评价。
背景:近年来,由于内战、恐怖活动的增加以及全球民用枪支拥有量的增加等因素,颅脑枪伤成为神经外科医生日益关注的问题。目的:探讨影响颅脑枪伤患者预后的因素。方法:本研究纳入2014年10月至2024年4月期间接受保守或手术治疗的124例颅脑枪伤患者。回顾性收集患者的年龄、性别、临床参数(格拉斯哥昏迷量表(GCS)、瞳孔检查、入院时间、高速或低速枪伤)、放射学参数(损伤类型、弹片中线交叉、受影响的脑叶、头盖骨内是否存在异物、伴随病理)和治疗参数(治疗方式、并发症和格拉斯哥结局量表)。结果:患者平均年龄26.29±10.76岁(2 ~ 76岁)。女性16例(12.9%),男性108例(87.1%)。叙利亚内战相关枪伤94例(75.8%),意外伤害18例(14.5%),自杀伤害12例(9.7%)。较高的初始GCS评分、等线瞳孔、低速损伤、切向损伤、无弹丸中线交叉、单半球单叶损伤、无伴血肿和无并发症与良好结果有统计学显著相关(P = 0.001)。研究队列的总死亡率为41.1%(51例)。55例(44.4%)患者预后良好,69例(55.6%)患者预后不良。38例患者共发现56例并发症。主要并发症为神经功能缺损(32.1%)、脑脊液瘘和创面粘连(21.4%)和全身性感染(21.4%)。结论:在本研究中,初始GCS评分低、瞳孔固定、高速损伤、穿孔损伤、弹丸中线交叉、双半球损伤、IVH的存在、并发症的存在以及缺乏手术治疗对死亡率的影响具有统计学意义。在这些预测因素中,较低的初始GCS评分、固定瞳孔、射体中线交叉和并发症被发现是死亡的主要危险因素。此外,发现手术治疗可降低死亡率。
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来源期刊
Nigerian Journal of Clinical Practice
Nigerian Journal of Clinical Practice MEDICINE, GENERAL & INTERNAL-
CiteScore
1.40
自引率
0.00%
发文量
275
审稿时长
4-8 weeks
期刊介绍: The Nigerian Journal of Clinical Practice is a Monthly peer-reviewed international journal published by the Medical and Dental Consultants’ Association of Nigeria. The journal’s full text is available online at www.njcponline.com. The journal allows free access (Open Access) to its contents and permits authors to self-archive final accepted version of the articles on any OAI-compliant institutional / subject-based repository. The journal makes a token charge for submission, processing and publication of manuscripts including color reproduction of photographs.
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