Table 3.
Association of clinical presentation with the radiological presentation and outcome. Of the 64 patients admitted alive with GSWB, 55 underwent a head CT scan. For the remaining 9 patients, prognosis was deemed so poor based on the clinical status and examination that only palliative treatment was administered after admission and no head CT scan was performed. The extent of injury visible in the head CT scans was stratified according to whether only lobar injury was observed, or whether deeper brain structure were affected or the mesencephalon and brain stem were affected as well. The affected lobes, presence of parenchymal (ICH) or subdural (SDH) hematoma, as well as the presence of edema were assessed from the CT scan. In addition, the presence of any midline shift was scored (yes or no) as an indicator of the expansive nature of concomitant hematoma or edema. Somewhat surprisingly most patients did not present with midline shift despite most of them presenting with hematoma or edema, suggesting that most of the hematomas were not very expansive. Due to the retrospective nature of our study, we were not able to determine all the study variables accurately for all the patients. Because of this, the results are reported so that both the number of index cases and the number of patients from whom we were able to gather the information are given
| 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 |