Acute and Long-Term Complications of Gunshot Wounds to the Head
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BRAIN INJURY MEDICINE AND REHABILITATION (G GALANG, SECTION EDITOR)
Acute and Long-Term Complications of Gunshot Wounds to the Head Kristen A. Harris 1 & Peter Yonclas 2 Accepted: 8 October 2020 / Published online: 16 November 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Traumatic brain injury (TBI) secondary to gunshot wounds is a common problem in the USA and presents with a unique set of acute and chronic complications. Recent Findings Recent publications in trauma and critical care literature have sought to better understand incidence, demographics, and acute complications of gunshot wounds to the head. These findings, coupled with literature on rehabilitation of TBI patients secondary to gun violence, may help brain injury physiatrists better understand issues which may arise during rehabilitation. Clinical commonalities among TBI patients with gunshot wounds to the head provide a foundation for suggested management paradigms. Summary Patients with gunshot wounds to the head represent a unique subset of the TBI population associated with the pathophysiology of a penetrating brain injury, including intracranial infection, early seizures, and CSF leak. Mood and substance use disorders may further complicate rehabilitation and require attention to maximize patients’ benefit from rehabilitation. Keywords Traumatic brain injury . Gunshot wounds . Penetrating brain injury . Head trauma . Rehabilitation . Prognosis . Outcome
Introduction Patients with gunshot wounds to the head (GSWH) represent a unique subset of the traumatic brain injury (TBI) population. Traumatic brain injury (TBI) secondary to firearm injury is an increasing problem in the USA. Overall TBI-related emergency department visits increased by over 50% from 2007 to 2014, from approximately 1.6 million to nearly 2.5 million [1]. While falls remain the most common cause of TBI injury overall, TBI secondary to intentional self-harm increased by more than 75% over the same period from 0.4 to 0.7 per 100,000 cases. TBI secondary to assault likewise saw a 20% increase over the same time period. Assault and self-harm
cases of TBI often involve firearms, and penetrating TBI (pTBI) cases are frequently differentiated from blunt causes of injury. Of approximately 67,000 gunshot wound injuries requiring hospitalization from 2010 to 2012, over 20% were to the head and neck [2]. GSWH patients present with unique pathology, due to dural penetration and ballistic nature of the injury, as well as frequent underlying mood and substance abuse disorders often present in this population that create varied challenges to the rehabilitation team in the acute and post-acute period. We review the demographics, predictors of outcome, acute and long-term complications, and challenges in care for this patient population.
This article is part of the Topical Collection on Brain Injury Medicine and Rehabilitation
Demographics
* Peter Yonclas [email protected]
Demographics
1
Department of Physical Medicine and R
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