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Vol. 29. Num. 5.September - October 2018
Pages 217-266
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Vol. 29. Num. 5.September - October 2018
Pages 217-266
Clinical Research
DOI: 10.1016/j.neucie.2018.07.002
Characterization of 95 patients with traumatic brain injury due to gunshot wounds at a referral centre in Cali, Colombia
Caracterización de 95 pacientes adultos con trauma craneoencefálico debido a herida por proyectil de arma de fuego en un centro de referencia en Cali, Colombia
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Daniel Ospina-Delgadoa, Laura Marcela Mosquera Salasa, Alejandro Enríquez-Marulandaa, Jaime Hernández-Moralesa, Robinson Pachecob, Javier Lobato-Poloc,
Corresponding author
jmlobatop@yahoo.com

Corresponding author.
a Facultad de Medicina, Universidad Icesi, Cali, Colombia
b Centro de Investigaciones Clínicas, Cali, Colombia
c Departamento de Neurocirugía, Fundación Valle del Lili, Cali, Colombia
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Figures (1)
Tables (5)
Table 1. Demographic and clinical profile of the population studied.
Table 2. General mortality and condition at discharge.
Table 3. Comparison of variables in survivors versus deceased.
Table 4. Factors associated with death linked to length of hospital stay and complications.
Table 5. Comparison of surviving patients based on adverse clinical outcome at discharge.
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Abstract
Objective

This study aims to describe cases of traumatic brain injury due to gunshot wounds in civilian population over 18 years of age, treated at a referral hospital in Cali, Colombia and compare the clinical outcomes at discharge.

Methods

An observational, descriptive cross-sectional study was conducted by retrospectively collecting clinical data related to adult patients that presented traumatic brain injury due to civil gunshot-wounds and that consulted to the emergency room at Fundación Valle del Lili Hospital in Cali, Colombia between January 2010 and February of 2016. A univariate analysis was performed to determine factors associated with death and adverse clinical outcomes.

Results

A total of 95 patients older than 18 years, with traumatic brain injury by gunshot were included in the civil context. The 91.6% were male. The main context was interpersonal violence with 54.7%. The most common method of transportation was by ambulance (79%). The Glasgow score at admission was 3–8 in 64.2% of cases; 9–12 in 6.32% and 13–15 in 28.4%. On admission, head CT scan was performed in 82 (86.3%) patients within the first hour, finding a Marshall-Score between I–III in 60.9%, of IV in 17.8% of cases and a score between V–VI and in 4.1%. The trajectory was non-transfixing penetrating in 43.2%, transfixing in 27.3% and tangential in 9.5%. Mortality was 45.3% in total, 39% died within the first 24h.

Conclusions

A major compromise on admission determines an overall poorer prognosis and a high likelihood of death in the first 24-h.

Keywords:
Traumatic brain injury
Gunshot
Penetrating brain injury
Adult
Resumen
Objetivo

Este estudio busca describir casos de trauma craneoencefálico debido a heridas por proyectil de arma de fuego, en población civil mayor de 18 años, atendidos en un hospital de referencia y realizar una comparación de los pacientes de acuerdo a los resultados clínicos al egreso.

Métodos

Se trata de un estudio descriptivo, observacional, retrospectivo a través de la revisión de historias clínicas de los pacientes mayores de 18 años que ingresaron en la sala de urgencias de la Fundación Valle del Lili en Cali, Colombia con trauma craneoencefálico secundario a heridas por proyectil de arma de fuego, en contexto civil, entre enero del 2010 y febrero del 2016. Se realizó un análisis univariado para determinar factores asociados a muerte y resultados clínicos adversos.

Resultados

Se incluyó un total de 95 pacientes con trauma craneoencefálico por heridas por proyectil de arma de fuego en el contexto civil. El 91,6% fue de sexo masculino, el principal contexto fue violencia interpersonal en un 54,7%, el método de transporte más común fue ambulancia terrestre en un 79%, el puntaje de Glasgow (GCS) al ingreso fue 3-8=64,2%; 9-12=6,3%; 13-15=28,4%. Al ingreso se le tomó TAC simple a 82 (86,3%) pacientes dentro de la primera hora, encontrando una clasificación de Marshall entre I-III en 60,9%, un valor de IV en el 17,8% y entre V-VI en un 4,1%. La trayectoria era penetrante no transfixiante en el 43,2%, transfixiante en el 27,4% y tangencial en el 9,5%. La mortalidad fue del 45,3%, de esta 39% ocurrió en las primeras 24h.

Conclusiones

Un mayor compromiso en el estado general del paciente al ingreso determina un pobre pronóstico y mayor probabilidad de muerte en las primeras 24h.

Palabras clave:
Trauma craneoencefálico
Herida por proyectil de arma de fuego
Trauma craneano penetrante
Adultos

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