{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T22:34:30Z","timestamp":1792794870363,"version":"4.5.0"},"reference-count":31,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Penetrating brain injury in civilians is much less common than blunt brain injury but is more severe overall. Gunshot wounds (GSWs) cause high morbidity and mortality related to penetrating brain injury; however, there are few reports on the management and outcome of intracranial GSWs in children. The goals of this study were to identify clinical and radiological factors predictive for death in children and to externally validate a recently proposed pediatric prognostic scale.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The authors conducted a retrospective review of penetrating, isolated GSWs sustained in children whose ages ranged from birth to 18 years and who were treated at 2 major metropolitan Level 1 trauma centers from 1996 through 2013. Several standard clinical, laboratory, and radiological factors were analyzed for their ability to predict death in these patients. The authors then applied the St. Louis Scale for Pediatric Gunshot Wounds to the Head, a scoring algorithm that was designed to provide rapid prognostic information for emergency management decisions. The scale's sensitivity, specificity, and positive and negative predictability were determined, with death as the primary outcome.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Seventy-one children (57 male, 14 female) had a mean age of 14 years (range 19 months to 18 years). Overall mortality among these children was 47.9%, with 81% of survivors attaining a favorable clinical outcome (Glasgow Outcome Scale score \u2265 4). A number of predictors of mortality were identified (all p &lt; 0.05): 1) bilateral fixed pupils; 2) deep nuclear injury; 3) transventricular projectile trajectory; 4) bihemispheric injury; 5) injury to \u2265 3 lobes; 6) systolic blood pressure &lt; 100 mm Hg; 7) anemia (hematocrit &lt; 30%); 8) Glasgow Coma Scale score \u2264 5; and 9) a blood base deficit &lt; \u22125 mEq\/L. Patient age, when converted to a categorical variable (0\u20139 or 10\u201318 years), was not predictive. Based on data from the 71 patients in this study, the positive predictive value of the St. Louis scale in predicting death (score \u2265 5) was 78%.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>This series of pediatric cranial GSWs underscores the importance of the initial clinical exam and CT studies along with adequate resuscitation to make the appropriate management decision(s). Based on our population, the St. Louis Scale seems to be more useful as a predictor of who will survive than who will succumb to their injury.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2015.7.peds15285","type":"journal-article","created":{"date-parts":[[2016,1,5]],"date-time":"2016-01-05T09:08:15Z","timestamp":1451984895000},"page":"595-601","source":"Crossref","is-referenced-by-count":40,"title":["Pediatric intracranial gunshot wounds: the Memphis experience"],"prefix":"10.3171","volume":"17","author":[{"given":"Michael","family":"DeCuypere","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Tennessee Health Science Center;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S.","family":"Muhlbauer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Tennessee Health Science Center;"},{"name":"Semmes-Murphey Neurologic and Spine Institute, and"},{"name":"Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederick A.","family":"Boop","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Tennessee Health Science Center;"},{"name":"Semmes-Murphey Neurologic and Spine Institute, and"},{"name":"Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Klimo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Tennessee Health Science Center;"},{"name":"Semmes-Murphey Neurologic and Spine Institute, and"},{"name":"Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-peds15285","series-title":"J 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