Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
Neurosurgery. 2024 Oct 1;95(4):825-833. doi: 10.1227/neu.0000000000002937. Epub 2024 Apr 16.
Patients with intracranial gunshot wounds (IC-GSWs) often present with severe neurological injuries requiring prompt neurological evaluation. Neurosurgical intervention is reserved for those with reasonable chances of survival. Handguns and long guns, such as shotguns and rifles, have differing mechanisms of injury which may influence surgical candidacy and outcomes. This study aims to compare rates and types of neurosurgical intervention and inpatient outcomes in patients with IC-GSWs handguns and long guns.
The National Trauma Data Bank was retrospectively queried for patients with IC-GSWs from 2017 to 2019. Patients with long gun IC-GSWs were propensity score matched with those with handgun IC-GSWs based on patient demographics, comorbidities, insurance status, injury extent and severity, and hospital trauma level. Group differences were compared using Student's t-tests and Pearson's χ2 tests, and multivariable logistic regression was used to identify predictors of in-hospital mortality.
Overall, patients in the long gun group were more likely to undergo neurosurgical intervention (21% vs 17%, P = .02). Following propensity score matching, the long gun group had lower rates of in-hospital mortality (35% vs 43%, P < .01), lower rates of cardiac arrest (5% vs 8%, P = .02), and lower rates of reoperation (0% vs 2%, P = .02) than the handgun group. In multivariable regression, independent predictors of survival included long gun IC-GSWs (odds ratio [OR] 0.65, CI 0.52-0.83), neurosurgical foreign body removal (OR 0.44, CI 0.33-0.58), intracranial debridement (OR 0.47, 0.33-0.67), and craniectomy (OR 0.46, CI 0.34-0.63).
Patients with IC-GSWs present to the hospital with severe neurological injury. Neurosurgical intervention was independently associated with decreased mortality. After matching, patients with long gun IC-GSWs experienced lower in-hospital mortality rates compared with those from handguns. This study suggests that patients suffering from long gun IC-GSW may respond particularly well to neurosurgical intervention and firearm type should be considered when determining neurosurgical candidacy.
颅内枪弹伤（IC-GSWs）患者常伴有严重的神经损伤，需要及时进行神经学评估。神经外科干预适用于有合理生存机会的患者。手枪和长枪（如猎枪和步枪）的致伤机制不同，这可能会影响手术适应证和结果。本研究旨在比较手枪和长枪致颅内枪弹伤患者的神经外科干预率和住院结局。
本研究通过回顾性分析 2017 年至 2019 年全国创伤数据库，筛选出颅内枪弹伤患者。根据患者的人口统计学、合并症、保险状况、损伤程度和严重程度以及医院创伤级别，对手枪致颅内枪弹伤患者进行倾向评分匹配，以匹配长枪致颅内枪弹伤患者。采用 Student's t 检验和 Pearson's χ2 检验比较组间差异，采用多变量逻辑回归分析确定住院死亡率的预测因素。
总体而言，长枪组患者更有可能接受神经外科干预（21% vs. 17%，P =.02）。在倾向评分匹配后，长枪组的住院死亡率（35% vs. 43%，P <.01）、心脏骤停率（5% vs. 8%，P =.02）和再次手术率（0% vs. 2%，P =.02）均低于手枪组。多变量回归分析表明，生存的独立预测因素包括长枪致颅内枪弹伤（比值比[OR] 0.65，95%置信区间[CI] 0.52-0.83）、神经外科异物取出术（OR 0.44，CI 0.33-0.58）、颅内清创术（OR 0.47，0.33-0.67）和颅骨切除术（OR 0.46，CI 0.34-0.63）。
颅内枪弹伤患者就诊时伴有严重的神经损伤。神经外科干预与死亡率降低独立相关。在匹配后，与手枪致颅内枪弹伤患者相比，长枪致颅内枪弹伤患者的住院死亡率较低。本研究表明，长枪致颅内枪弹伤患者可能对神经外科干预反应良好，在确定神经外科适应证时应考虑火器类型。
