1111 Aggressive Surgical Intervention for Penetrating Gunshot Wounds to the Head: The Experience of a High-Volume Trauma Center

• DOI: 10.1227/neu.0000000000003360_1111
• Publication Date: 2025-03-14T13:15:15Z
• Authors: Barrett Schwartz; Christopher Troy; John Edwards Dugan; Mark Nicholas Pernik; David Alexander W...; Garrett Thomas Ve...; William Mangham; Paul Klimo; Nickalus Khan; Raul Jose Cardenas; Michael S. Muhlbauer; Stephanie L. Einhaus; Jeffrey M. Sorenson

INTRODUCTION: Civilian gunshot wounds to the head (GSWH) account for 35% of all deaths related to traumatic brain injury (TBI), and there remains a lack of consensus regarding best neurosurgical care in these complex cases.

METHODS: A retrospective cohort study was conducted utilizing a single-center, prospective database of GSWH patients. Patients were divided by injury type, and surgical and non-surgical groups. The primary outcome was last known Glasgow Outcome Score (GOS). Furthermore, GOS=4 was termed a favorable outcome and GOS=3 a poor outcome.

RESULTS: Of 185 patients (mean age=32.8±15.1, 83.2% male), 79 (42.7%) underwent surgery and 106 (57.3%) did not. There were no differences in initial GCS between the surgery and non-surgery group (7.0 [3.0-14.0] vs. 8.0 [3.0-14.0]; U=1,637.00,p=.492). The surgery group had significantly higher most recent GOS (4.0 [3.0-5.0] vs. 1.0 [1.0-1.0]; U=1,100.00,p<.001) as well as a greater proportion of patients with favorable outcomes (52.2% vs. 8.7%; X2=40.82,p<.001) compared to the non-surgical group. In multivariable analysis, receiving surgery was associated with higher GOS (β=0.51, 95%CI% 1.22, 2.34;p<.001) and favorable outcomes (OR=12.01, 95%CI: 2.97, 50.30;p<.001).

CONCLUSIONS: Penetrating ballistic injuries are complex and injury patterns vary widely. No two patients are the same and determining the appropriate treatment for each requires a tailored approach. Currently, surgeon experience and gestalt are our best determinants for predicting favorable outcomes. In our series, surgical intervention was significantly associated with higher last known GOS and favorable outcomes (GOS=4). These findings suggest that an aggressive approach, when applied to carefully chosen patients, may lead to better clinical outcomes.