{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T09:21:52Z","timestamp":1770888112355,"version":"3.50.1"},"reference-count":23,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,7,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Firearm injuries are now the leading cause of death in children and young adults younger than 25 years of age in the US. Current management of these injuries is extrapolated from adult blunt and penetrating traumatic brain injury guidelines. The objectives of this study were to investigate and analyze the clinical, radiological, and laboratory factors associated with mortality and functional outcomes in pediatric patients presenting with intracranial gunshot wounds (GSWs).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>Medical records were screened for all patients younger than 21 years of age with an intracranial GSW who presented to the University Medical Center in New Orleans, Louisiana, from 2012 to 2022. Demographics and radiological, clinical, and laboratory data were extracted, and chi-square and Fisher\u2019s exact tests were used to evaluate individual association with mortality and functional outcome. Odds ratios were calculated from the cross tabulations for categorical variables and univariate binary logistic regression models for continuous variables. Multivariate binary logistic regression was used to adjust for effects of covariates and isolate the contributions of predictor variables for mortality and functional outcome.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Ninety-six patients (82 male, 14 female) had a median age of 18 (interquartile range [IQR] 15\u201320) years. The 30-day inpatient, 60-day, and 6-month mortality rates among these patients were 53.1%, 0%, and 2.4%, respectively. Those who died were more likely to have an initial Glasgow Coma Scale score \u2264 8 (p &lt; 0.001), bilateral fixed pupils (p &lt; 0.001), transventricular trajectory (p &lt; 0.001), deep nuclear\/third ventricle involvement (p = 0.004), bihemispheric trajectory (p = 0.025), injury to \u2265 3 lobes (p = 0.015), parietal lobe involvement (p = 0.023), base deficit &lt; \u22125 mEq\/L (p = 0.013), international normalized ratio (INR) &gt; 1.5 (p = 0.007), and a St. Louis Scale (SLS) score \u2265 5 (p &lt; 0.001). The survivors with favorable functional outcome were more likely to have lower median SLS scores (p = 0.016) and injury to &lt; 3 lobes (p &lt; 0.001). In a multivariate analysis, bilaterally fixed nonreactive pupils were positively associated with mortality and negatively associated with favorable functional outcome, whereas the Injury Severity Score (ISS) and injury to \u2265 3 lobes were negatively associated with favorable functional outcome only.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>This is one of the largest series of pediatric intracranial GSWs to date. The authors identified certain clinical (bilateral fixed pupils, SLS score \u2265 5, ISS &gt; 16), laboratory (INR &gt; 1.5, base deficit &lt; \u22125 mEq\/L), and radiological (transventricular trajectory, deep nuclear\/third ventricle involvement, parietal lobe involvement) factors that were associated with death and poor functional outcome in this pediatric cohort.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.2.peds23375","type":"journal-article","created":{"date-parts":[[2024,4,27]],"date-time":"2024-04-27T02:19:20Z","timestamp":1714184360000},"page":"9-18","source":"Crossref","is-referenced-by-count":3,"title":["Clinical, radiological, and laboratory factors associated with mortality and functional outcomes in pediatric patients presenting with intracranial gunshot wounds"],"prefix":"10.3171","volume":"34","author":[{"given":"Roboan","family":"Guillen Arguello","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center;"},{"name":"Children\u2019s Hospital of New Orleans; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick J.","family":"McCarty","sequence":"additional","affiliation":[{"name":"Tulane University School of Medicine, New Orleans, Louisiana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jerome","family":"Volk","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center;"},{"name":"Children\u2019s Hospital of New Orleans; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oritsejolomi","family":"Roberts","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center;"},{"name":"Children\u2019s Hospital of New Orleans; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary O.","family":"Haastrup","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Culicchia","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"20","key":"b1","series-title":"N Engl J Med","first-page":"1955","article-title":"Current causes of death in children and adolescents in the United States","volume":"386","author":"Goldstick JE","year":"2022","unstructured":"Goldstick JE, Cunningham RM, Carter PM. 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