Rolle Myron L, McLellan Rachel M, Nanda Pranav, Patel Aman B, Sacks Chana A, Masiakos Peter T, Stapleton Christopher J
Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Division of General Internal Medicine and Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Neurohospitalist. 2022 Jul;12(3):444-452. doi: 10.1177/19418744221077552. Epub 2022 Mar 28.
To assess the clinical, racial, and social characteristics of victims of Gunshot wounds (GSWs) to the head and assess for associations between these factors and outcomes.
Previous literature has not focused on the association of race and socioeconomic factors with these specific injuries.
We identified patients with GSWs to the head who presented to 2 urban academic medical centers between 1998 and 2020, and extracted patient-level demographic data, information about the clinical and surgical course, and outcomes at discharge and follow-up.
The cohort included 250 patients, 90% (n = 226) of whom were male, with a mean age of 28 years. Forty-five percent were white (n = 112), 19% Black (n = 48), 18% Latinx (n = 45), with 6% "other" (n = 16), and 12% "unknown" (n = 29). The majority of patients presented with assault-related trauma (n = 153, 61%) as compared to self-inflicted injuries (n = 97, 39%). Across the entire cohort, sex, age, race, and median income by ZIP code were not significant predictors of outcome. Victims of assault by GSW to the head were more likely to be age 18 or younger (OR 5.26, P = 0.01), between the ages of 19 and 33 years (OR 4.7, P = 0.001), Black (OR 6.66, P < .001), and Latinx (OR 2.65, P = 0.03). Most patients (n = 155, 63%) had a poor functional outcome (modified Rankin Score 3-6) at discharge.
Age, race, and income status were not independent predictors of mortality or functional outcome at discharge in our population. Assault-related GSWs to the head mostly involved young Black or Latinx men of lower socioeconomic status, while self-inflicted injuries were largely seen in older white men.
评估头部枪伤（GSW）受害者的临床、种族和社会特征，并评估这些因素与预后之间的关联。
既往文献尚未关注种族和社会经济因素与这些特定损伤之间的关联。
我们确定了1998年至2020年间前往两家城市学术医疗中心就诊的头部枪伤患者，并提取了患者层面的人口统计学数据、有关临床和手术过程的信息以及出院时和随访时的预后情况。
该队列包括250名患者，其中90%（n = 226）为男性，平均年龄28岁。45%为白人（n = 112），19%为黑人（n = 48），18%为拉丁裔（n = 45），6%为“其他”（n = 16），12%为“未知”（n = 29）。与自伤（n = 97，39%）相比，大多数患者（n = 153，61%）呈现与袭击相关的创伤。在整个队列中，性别、年龄、种族和邮政编码对应的收入中位数并非预后的显著预测因素。头部枪伤袭击受害者更有可能年龄在18岁及以下（比值比5.26，P = 0.01）、19至33岁之间（比值比4.7，P = 0.001）、为黑人（比值比6.66，P < 0.001）以及为拉丁裔（比值比2.65，P = 0.03）。大多数患者（n = 155，63%）出院时功能预后较差（改良Rankin评分3 - 6）。
在我们的研究人群中，年龄、种族和收入状况并非出院时死亡率或功能预后的独立预测因素。与袭击相关的头部枪伤大多涉及社会经济地位较低的年轻黑人或拉丁裔男性，而自伤在老年白人男性中更为常见。
