From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital; the Department of Surgery, the Division of Plastic and Reconstructive Surgery, and the Department of Neurosurgery, University of Maryland School of Medicine; and the Division of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center.
Plast Reconstr Surg. 2019 Aug;144(2):415-422. doi: 10.1097/PRS.0000000000005842.
Self-inflicted gunshot wounds involving the face are highly morbid. However, there is a paucity of objective estimates of mortality. This study aims to provide prognostic guidance to clinicians that encounter this uncommon injury.
A retrospective review of patients presenting to R Adams Cowley Shock Trauma Center (a Level I trauma center) with self-inflicted gunshot wounds to the face from 2007 to 2016. Isolated gunshot wounds to the calvaria or neck were excluded. The data were analyzed to determine predictors of survival.
Of the 69 patients that met inclusion criteria, 90 percent were male and 80 percent were Caucasian, with an age range of 21 to 85 years. The most frequently seen injury patterns showed submental (57 percent), intraoral (22 percent), and temporal (12 percent) entry sites. Fewer than half (41 percent) of the cohort sustained penetrative brain injury. Overall, there were 18 deaths (overall mortality, 26 percent), 17 of which were secondary to brain injury. Independent predictors of death included penetrative brain injury (OR, 17; p < 0.0001) and age. Mortality was 17 percent among patients younger than 65 years, compared with 73 percent for those aged 65 years or older (p = 0.0001). Gastrostomy placement was independently associated with 25 percent reduction in length of hospitalization (p = 0.0003).
Despite tremendous morbidity, the overwhelming majority of patients who present with facial self-inflicted gunshot wounds will survive, especially if they are young and have no penetrative brain injury. These findings should help guide clinical decisions for this devastating injury.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
面部自伤性枪伤的病死率极高。然而，目前对于此类损伤的病死率仍缺乏客观评估。本研究旨在为遇到这种罕见损伤的临床医生提供预后指导。
回顾性分析 2007 年至 2016 年期间因面部自伤性枪伤就诊于 R Adams Cowley 休克创伤中心（一级创伤中心）的患者。排除单纯颅顶或颈部枪伤。对数据进行分析，以确定生存的预测因素。
在符合纳入标准的 69 例患者中，90%为男性，80%为白人，年龄范围为 21 岁至 85 岁。最常见的损伤模式为颏下（57%）、口腔内（22%）和颞部（12%）入口。不到一半（41%）的患者发生穿透性脑损伤。总的来说，有 18 例死亡（总死亡率为 26%），其中 17 例死于脑损伤。死亡的独立预测因素包括穿透性脑损伤（OR，17；p < 0.0001）和年龄。年龄小于 65 岁的患者死亡率为 17%，而年龄为 65 岁或以上的患者死亡率为 73%（p = 0.0001）。胃造口术的应用与住院时间缩短 25%独立相关（p = 0.0003）。
尽管存在巨大的发病率，但绝大多数因面部自伤性枪伤就诊的患者能够存活，尤其是年轻且无穿透性脑损伤的患者。这些发现有助于指导此类破坏性损伤的临床决策。
临床问题/证据水平：风险，III 级。
