Table 4.
Treatment and overall outcome. Of the 64 patients admitted alive with GSWB, 27 were admitted to the ICU and 22 underwent surgery (ICP monitor placement, ventriculostomy, craniotomy and hematoma evacuation, wound debridement). Those patients who underwent surgery had a significantly better level of consciousness on admission, as determined by the Glasgow Coma Scale (GCS). GCS could not be accurately retrospectively determined from those patients that were intubated and sedated in the field prior to hospital admission, and therefore, GCS on admission is given for 48 patients. Those 37 patients not admitted to the ICU were deemed unsalvageable based on clinical status and examination and 9 of these patients did not undergo a head CT scan. Thus, the course of the wound tract could be evaluated in the CT scans of 55 patients. Moreover, data on the clinical outcome could not be determined retrospectively from the patient records of all patients, and thus, outcome data is presented for only 49 patients. 1/22 of the surgically treated patients underwent only placement of an ICP monitoring probe, and 1/22 underwent only reconstruction of the anterior skull base. Superficial wound revision only (*) was performed for 3 patients admitted with GCS 15. In 2 of these patients, the bullet remained in the bone, but there was a contusion hemorrhage in the adjacent temporal lobe that did not require operative treatment. The 1 patient that did not die despite not undergoing surgery (**) had right-sided frontotemporal contusions that were treated conservatively, and in this case, the bullet had not penetrated the skull bone
| 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 |