Pediatric intracranial arterial injuries by penetrating gunshot wounds: an institutional experience
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ORIGINAL ARTICLE
Pediatric intracranial arterial injuries by penetrating gunshot wounds: an institutional experience Joshua S. Catapano 1 & Danielle M. Hutchens 1 & Megan S. Cadigan 1 & Visish M. Srinivasan 1 & Felipe C. Albuquerque 1 & Ruth E. Bristol 1 Received: 16 June 2020 / Accepted: 12 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Pediatric intracranial injuries due to penetrating gunshot wounds are a rare entity that is often fatal. A subset of patients may experience an intracerebral arterial injury; however, literature on the pediatric population is limited. This study analyzes a large institution’s experience with pediatric head gunshot wounds and intracranial arterial injuries. Methods All pediatric patients ≤ 18 years of age who presented to our institution with a penetrating gunshot wound from 2008 to 2018 were retrospectively analyzed. Results Thirty-seven patients presented with an intracerebral penetrating gunshot injury. There were 18 deaths (49%) in the cohort. A total of 20 patients (54%) had vascular imaging. Of the remaining 17 patients with no vascular imaging, 13 (35%) died before any vascular studies were obtained. Four (20%) of the 20 patients with vascular imaging experienced an intracerebral arterial injury. Three of these 4 patients died before treatment could be administered. One patient with a firearm injury underwent embolization of a distal middle cerebral artery pseudoaneurysm and was discharged home with a Glasgow Outcome Scale score of 5 on follow-up. Conclusion Pediatric patients with penetrating intracranial gunshot wounds often die before vascular imaging can be obtained. Keywords Head gunshot wounds . Pediatric . Intracranial arterial injury . Intraventricular hemorrhage
Abbreviations GSW Gunshot wound
Introduction Firearm injuries are the third-leading cause of death and the second-leading cause of injury-related death among the pediatric population 1–18 years of age in the United States [1]. These injuries can be classified into two groups on the basis of the type of weapon: powder and nonpowder. The former group includes firearms in which the ignition of gunpowder produces energy to fire a projectile; the latter group uses compressed air or gas (e.g., BB guns, pellet guns, and air rifles) [2–4]. The vast majority of individuals with intracranial * Ruth E. Bristol [email protected] 1
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, 350 W. Thomas Rd, Phoenix, AZ 85013, USA
powder gunshot injury die at the scene; however, aggressive, appropriate measures can reduce the mortality rate among survivors who reach a hospital [5]. The majority of injuries caused by nonpowder firearms are minor, yet studies have demonstrated the potential of such injuries to cause longterm functional insufficiency [2–4]. The Centers for Disease Control and Prevention has estimated that almost half of all self-inflicted firearm injuries and approximately 14% of assault-related firearm injurie
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