Civilian and military gunshot wounds to the head

Authors: N. Svoboda 1;  V. Beneš 1;  D. Netuka 1;  M. Sokol 1,2;  K. Langová 3;  M. Májovský 1
Authors‘ workplace: Neurochirurgická a neuroonkologická klinika 1. LF UK a ÚVN Praha 1;  Vojenský ú stav soudní ho lé kař ství , Ú VN – VFN Praha 2;  Ústav lékařské biofyziky a Ústav molekulární a translační medicíny, LF UP, Olomouc 3
Published in: Cesk Slov Neurol N 2019; 82(6): 670-676
Category: Original Paper
doi: 10.14735/amcsnn2019670


Aim: Gunshot wound to the head is one of the most severe injuries with high morbidity and mortality. Appropriately indicated extensive surgical treatment leads to improved patient prognosis. Thus, the evaluation of preoperative factors that would predict patients` prognosis is of high importance at the time of admission to the hospital.

Methods: A retrospective analysis of the results of patients with gunshot head wounds hospitalized in the Military University Hospital in Prague during the period 2000–2018 was performed. Epidemiological data; Injury cause, type, and motive; Glasgow Coma Scale (GCS) on admission; CT scan findings; therapeutic approach; and clinical outcome according to the Glasgow Outcome Score Extended (GOSE) were evaluated and statistically analyzed.

Results: 81 patients were enrolled in the study. Out of these 81 patients, 71 (88%) were injured in a civilian and 10 (12%) in a military setting. Mean GCS on admission was 5.8 (3–15). We operated on 18 patients. Mean GOSE after surgery was 2.8 (1–8). Patients with an overpenetration type of injury, with low GCS value on admission, with a higher number of injured brain lobes and with a bullet trajectory crossing the midsagittal and/or midcoronal plane had statistically significantly worse outcome (P ≤ 0.0001).

Conclusion: GCS on admission, injury cause and motive, and CT findings proved to be significantly important predictive factors. Chosen therapeutic approach should reflect these factors as they correlate with patient’s prognosis.

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


traumatic brain injury – suicide – wounds – gunshot – military medicine


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