Bandt S Kathleen, Greenberg Jacob K, Yarbrough Chester K, Schechtman Kenneth B, Limbrick David D, Leonard Jeffrey R
Department of Neurological Surgery, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, Missouri 63110, USA.
J Neurosurg Pediatr. 2012 Dec;10(6):511-7. doi: 10.3171/2012.8.PEDS123. Epub 2012 Sep 28.
There has been an increase in civilian gun violence since the late 1980s, with a disproportionately high increase occurring within the pediatric population. To date, no definite treatment paradigm exists for the management of these patients, nor is there a full understanding of the predictors of favorable clinical outcome in this population.
The authors completed a retrospective review of all victims of intracranial gunshot injury from birth to age 18 years at a major metropolitan Level 1 trauma center (n = 48) from 2002 to 2011. The predictive values of widely accepted adult clinical and radiographic factors for poor prognosis were investigated.
Eight statistically significant factors (p < 0.05) for favorable outcome were identified. These factors include single hemispheric involvement, absence of a transventricular trajectory, < 3 lobes involved, ≥ 1 reactive pupil on arrival, systolic blood pressure > 100 mm Hg on arrival, absence of deep nuclei and/or third ventricular involvement, initial ICP < 30 mm Hg when monitored, and absence of midline shift. Of these 8 factors, 5 were strong predictors of favorable clinical outcome as defined by Glasgow Outcome Scale score of 4 or 5. These predictive factors included absence of a transventricular trajectory, < 3 lobes involved, ≥ 1 reactive pupil on arrival, absence of deep nuclei and/or third ventricular involvement, and initial ICP < 30 mm Hg. These findings form the basis of the St. Louis Scale for Pediatric Gunshot Wounds to the Head, a novel metric to inform treatment decisions for pediatric patients who sustain these devastating injuries.
The pediatric population tends to demonstrate more favorable outcomes following intracranial gunshot injury when compared with the adult population; therefore some patients may benefit from more aggressive treatment than is considered for adults. The St. Louis Scale for Pediatric Gunshot Wounds to the Head may provide critical data toward evidence-based guidelines for clinical decision making.
自20世纪80年代末以来，平民枪支暴力事件有所增加，儿科人群中的增长比例尤其高。迄今为止，对于这些患者的管理尚无明确的治疗模式，对该人群良好临床结局的预测因素也未完全了解。
作者对2002年至2011年期间在一家大型都市一级创伤中心收治的所有出生至18岁的颅内枪伤受害者（n = 48）进行了回顾性研究。研究了广泛接受的成人临床和影像学因素对预后不良的预测价值。
确定了8个对良好结局有统计学意义的因素（p < 0.05）。这些因素包括单半球受累、无经脑室弹道、累及脑叶< 3个、入院时≥ 1个反应性瞳孔、入院时收缩压> 100 mmHg、无深部核团和/或第三脑室受累、监测时初始颅内压< 30 mmHg以及无中线移位。在这8个因素中，有5个是良好临床结局的强预测因素，定义为格拉斯哥结局量表评分为4或5。这些预测因素包括无经脑室弹道、累及脑叶< 3个、入院时≥ 1个反应性瞳孔、无深部核团和/或第三脑室受累以及初始颅内压< 30 mmHg。这些发现构成了圣路易斯小儿头部枪伤量表的基础，这是一种新的指标，可为遭受这些严重损伤的儿科患者的治疗决策提供参考。
与成人相比，儿科人群在颅内枪伤后往往表现出更有利的结局；因此，一些患者可能比成人更能从积极治疗中获益。圣路易斯小儿头部枪伤量表可能为基于证据的临床决策指南提供关键数据。
