Management of Pediatric Intracranial Gunshot Wounds-Management of Pediatric Intracranial Gunshot Wounds

Management of Pediatric Intracranial Gunshot Wounds

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This document discusses the management of pediatric intracranial gunshot wounds and factors associated with survival. Intracranial gunshot wounds due to firearms are not uncommon at major trauma centers, and they can lead to significant morbidity and mortality. The mortality rate for pediatric gunshot wounds ranges from 20-60%. In a case series of 71 pediatric patients with intracranial gunshot wounds, the overall mortality rate was 47.9%. Factors predictive of mortality included bilateral fixed pupils, deep nuclear injury, transventricular trajectory, bihemispheric injury, injury to 3 or more lobes, systolic blood pressure below 100 mm Hg, anemia, and Glasgow Coma Scale score below 5. Survival was associated with factors such as reactive pupils, absence of deep nuclear injury, midline shift, and involvement of fewer lobes. <br /><br />Surgery is performed in patients who are adequately resuscitated and have a chance of survival. The type of surgery ranges from wound debridement and small craniotomy to decompressive craniectomy with duraplasty. Intraoperative monitoring of intracranial pressure (ICP) is important, and the goal is to maintain ICP below 20 cm H2O or mm Hg. Nursing management includes continuous ICP monitoring and neurochecks, elevation of the head of the bed, and accurate recording of drain output. Excessive postoperative imaging is avoided, and the ICP monitor is removed after stability is achieved. Rehabilitation placement can be challenging due to various factors. <br /><br />In conclusion, a multidimensional approach is necessary for the management of pediatric intracranial gunshot wounds. Factors such as clinical and radiological findings should be considered collectively rather than individually in determining prognosis and treatment.

Keywords

pediatric intracranial gunshot wounds

management

survival

morbidity

mortality

factors

surgery

ICP monitoring

neurochecks

rehabilitation placement