Similarities between civilian gunshot wounds to the head and nongunshot head injuries

Background: This investigation compared the cerebral pathophysiologic statu s of gunshot wounds to the head (GSWH) with that of severe head injury of o ther causes (non-GSWH). Methods: Data were collected prospectively from 71 GSWH and 541 non-GSWH pa tients. The two groups had similar demographic characteristics and injury s everities. Cerebral metabolic parameters for each patient were averaged for the entire period of monitoring. These per-patient averages were compared between GSWH and non-GSWH groups. Results: Median intracranial pressure was 21.4 mm Hg in GSWH patients vs. 1 6.7 mm Hg in non-GSWH patients (p < 0.001). Mean arterial pressures were si milar, but the higher intracranial pressure in GSWH patients produced a low er median cerebral perfusion pressure. Cerebral blood flow, cerebrovascular resistance, cerebral metabolic rate of oxygen, average jugular venous oxyg en saturation, and number of jugular venous desaturations did not differ si gnificantly between the groups. Three-month outcome was death in 43% of GSW H patients and 32% of non-GSWH patients, persistent vegetative state or sev ere disability in 33% and 32%, respectively, and moderate disability or goa d recovery in 24% and 36%, respectively, These outcomes were not significan tly different (p = 0.11). Conclusion: GSWH patients suffer global cerebral metabolic disturbances tha t are at least as severe as those seen in non-GSWH patients with injuries o f comparable severity. This selected population of GSWH patients may enjoy outcomes comparable to those of non-GSWK patients if they are treated by th e same aggressive protocols.