Introduction
Materials and methods
Patients, data collection, and methods
Variable | Self-inflicted (80%, 51/64) | Not self-inflicted/unkown (20%, 13/64) | P value |
---|---|---|---|
Age: median (min–max) | 51 (18–86) | 33 (20–74) | 0.102 |
Gender (% males) | 96.1% (49/51) | 76.9% (10/13) | 0.053 |
Weapon used | |||
Handgun | 68.6% (35/51) | 76.9% (10/13) | 0.501 |
Shotgun | 2.0% (1/51) | 0% (0/13) | 0.501 |
Rifle | 11.8% (6/51) | 0% (0/13) | 0.501 |
Shot distance | |||
Contact | 96.1% (49/51) | 23.1% (3/13) | < 0.001 |
< 5-m distance | 3.9% (2/51) | 53.8% (7/13) | < 0.001 |
> 5-m distance | – | – | – |
Outcome | |||
Death | 77.6% (38/49) | 61.5%(8/13) | 0.291 |
GOS: median (min–max) | 1 (1–5) | 1 (1–5) | 0.051 |
Statistical analyses
Literature search
Results
Type of injury and patient outcome
Clinical presentation and patient outcome
Variable | Status at hospital admission | p value | |
---|---|---|---|
GCS > 8 | GCS ≤ 8 | ||
Documented on-site loss of consciousness | 0.0% (0/9) | 94.9% (37/39) | < 0.001 |
GCS on site: median (min–max) | 15 (12–15), n = 9 | 3 (3–10), n = 39 | < 0.001 |
GCS on admission: median (min–max) | 15 (11–15), n = 9 | 3 (3–7), n = 39 | < 0.001 |
Thoracoabdominal injuries | 0% (0/9) | 2.6% (1/39) | < 0.001 |
Hypotension (during transport) | 14.3% (1/7) | 35.5% (11/31) | 0.395 |
Edema | 33.3% (3/9) | 93.8% (30/32) | < 0.001 |
Presence of any midline shift | 33.3% (3/9) | 40.6% (13/32) | 1.000 |
SDH | 55.6% (5/9) | 68.8% (22/32) | 0.692 |
ICH | 55.6% (5/9) | 87.5% (28/32) | 0.054 |
Wound tract through the ventricles in CT | 0.0% (0/9) | 61.5% (24/39) | < 0.001 |
Wound tract through the basal ganglia in CT | 22.2% (2/9) | 71.9% (23/32) | 0.023 |
Wound tract through the thalamus in CT | 0.0% (0/9) | 43.8% (14/32) | 0.049 |
Wound tract in CT through the brain stem/medulla oblongata | 0.0% (0/5) | 23.1% (3/13) | 0.383 |
Surgical intervention | 77.8% (7/9) | 20.5% (8/39) | 0.002 |
GOS: median (min–max) | 5 (3–5), n = 6 | 1 (1–5), n = 38 | < 0.001 |
Death | 0,0% (0/9) | 92.3% (36/38) | < 0.001 |
Variable | Extent of injury | p value | ||
---|---|---|---|---|
Lobar | Through ventricles or basal ganglia or thalamus | Midbrain and/or brain stem affected | ||
GCS on admission: median (min–max) | 12 (3–15), n = 13 | 3 (3–15), n = 25 | 3 (3–6), n = 3 | 0.014 |
GCS ≤ 8 | 40.0% (6/15) | 69.7% (23/33) | 100% (3/3) | 0.010 |
Multiple lobes affected | 88.2% (15/17) | 94.3% (33/35) | 100% (3/3) | 0.674 |
Frontal | 88.2% (15/17) | 88.6% (31/35) | 100% (3/3) | 1.000 |
Parietal | 29.4% (5/17) | 34.3% (12/35) | 66.7% (2/3) | 0.523 |
Occipital | 5.9% (1/17) | 5.7% (2/35) | 0% (0/3) | 1.000 |
Temporal | 76.5% (13/17) | 71.4% (25/35) | 100% (3/3) | 0.884 |
Cerebellar | 11.8% (2/17) | 0% (0/35) | 33.3% (1/3) | 0.022 |
Bullet exit wound | 33.3% (5/15) | 58.6% (17/29) | 33.3% (1/3) | 0.324 |
Secondary missiles | 93.8% (15/16) | 97.1% (34/35) | 100% (3/3) | 0.584 |
ICH | 41.2% (7/17) | 97.1% (34/35) | 66.7% (2/3) | < 0.001 |
SDH | 47.1% (8/17) | 65.7% (23/35) | 33.3% (1/3) | 0.304 |
Edema | 41.2% (7/17) | 85.7% (30/35) | 100% (3/3) | 0.003 |
Presence of any midline shift | 29.4% (5/17) | 45.7% (16/35) | 33.3% (1/3) | 0.588 |
Surgical intervention | 64.7% (11/17) | 28.6% (10/35) | 33.3% (1/3) | 0.004 |
GOS: median (min–max) | 3 (1–5), n = 13 | 1 (1–5), n = 33 | 1 (1–1), n = 2 | 0.003 |
Death | 37.5% (6/16) | 84.8% (28/33) | 66.7% (2/3) | 0.001 |
Radiological presentation and patient outcome
Effect of interventions on outcome
Variable | Treatment intensity | p value | |
---|---|---|---|
Surgery (n = 22) | No surgery (n = 42) | ||
GCS on admission: median (min–max) | 7 (3–15) n = 15 | 3 (3–15) n = 33 | < 0.001 |
Wound tract through the ventricles, the basal ganglia, or the thalamus in CT | 40.9% (9/22) | 72.7% (24/33) | 0.026 |
Craniotomy and evacuation of hematoma or contusion and hematoma | 16/22 | – | NA |
Bullet removal | 11/22 | – | NA |
Superficial wound revision* | 3/22 | – | – |
Death | 32% (7/22) | 98% (39/40)** | < 0.001 |
GOS: median (min–max) | 3 (1–5), n = 17 | 1 (1–5), n = 40 | < 0.001 |
Return to prior occupation | 27% (3/11) | 0% (0/38) | 0.002 |