TRANSCRANIAL GUNSHOT WOUNDS - COST AND CONSEQUENCES

Poor outcomes following transcranial gunshot wounds (TC-GSW) and the p erception of significant financial loss have led some institutions to adopt a fatalistic attitude towards these patients. This study was und ertaken to define those factors predictive of mortality following TC-G SW as well as to determine the costs and benefits associated with prov iding care to these individuals. We reviewed the medical records of 57 TC-GSW patients seen at our Level I Trauma Center between January 199 0 and December 1992. Overall mortality was 75 per cent, and was statis tically associated with an admission Glasgow Coma Score of 4 or less, a respiratory rate of less than 10, and self-inflicted wounds. Complet e financial information was available for 37 of the 57 patients. Reimb ursements for this group were $306,156 and exceeded costs by $62,257. Organ donation efforts were successful in 44.2 per cent of the nonsurv ivors (19/43), yielding 60 organs and 29 tissues for transplantation. Nonsurvivors who became organ donors were clinically and demographical ly indistinguishable from those in whom organs/tissues could not be re trieved. Despite the poor outcome following TC-GSW, vigorous resuscita tion and stabilization is justified in all patients, in that nearly on e half of nonsurvivors will become organ and/or tissue donors. Concern s regarding excessive monetary losses by treating facilities are unfou nded.