Cerebral gunshot wounds: a score based on three clinical parameters to predict the risk of early mortality

Background: To provide a score to predict the risk of early mortality after single craniocerebral gunshot wound (GSW) based on three clinical parameters.

Methods: All patients admitted to Baragwanath Hospital, Johannesburg, South Africa, between October 2000 and May 2005 for an isolated single craniocerebral GSW were retrospectively evaluated for the documentation of (i) blood pressure (BP) on admission; (ii) inspection of the bullet entry and exit site; and (iii) initial consciousness (n= 214).

Results: Conscious GSW victims had an early mortality risk of 8.3%, unconscious patients a more than fourfold higher risk (39.2%). Patients with a systolic BP between 100 and 199 mm Hg had an 18.2% risk of mortality. Hypotension (<100 mm Hg) doubled this risk (37.7%) and severe hypertension (≥200 mm Hg) was associated with an even higher mortality rate of 57.1%. Patients without brain spilling out of the wound (‘non-oozer’) exhibited a mortality of 19.7%, whereas it was twice as high (43.3%) in patients with brain spill (‘oozer’). By logistic regression, a prognostic index for each variant of the evaluated parameters could be established: non-oozer:0, oozer:1, conscious:0, unconscious:2, 100 ≤RR_sys < 200 mm Hg:0, RR_sys < 100 mm Hg:1, RR_sys≥ 200 mm Hg:2. This resulted in a score (0–5) by which the individual risk of early mortality after GSW can be anticipated.

Conclusions: Three immediately obtainable clinical parameters were evaluated and a score for predicting the risk of early mortality after a single craniocerebral GSW was established.