196 Meta-Analysis of the Effect of Intracranial Infections on Morbidity and Mortality of Civilian Craniocerebral Gunshot Injuries

Abstract

Abstract INTRODUCTION Civilian gunshot wounds to the head (GSWH) are a significant cause of traumatic brain injury-related mortality in the US. Intracranial infections are feared delayed complications in civilian GSWH and the benefit of prophylactic antibiotics has not been thoroughly studied. METHODS We conducted a meta-analysis of retrospective studies. A database search was conducted in PubMed, EMBASE, Scopus, Web of Science and Cochrane Library for articles after 2000 for intracranial infections (meningitis, cerebritis, ventriculitis and cerebral abscess) after civilian GSWH. We compared the intracranial infection rate in patients who received antibiotic prophylaxis with those who did not. We also compared the mortality of postoperative patients developing intracranial infections with the rest, and their morbidity, as evidenced by their Glasgow Outcome Scale (GOS), and grouped as favorable (GOS 4–5) or unfavorable (GOS 2–3). RESULTS >We identified 64 relevant articles, 7 of which had extractable information. Two articles compared intracranial infection rates with and without antibiotic prophylaxis in 219 GSWH patients. Prophylactic antibiotics did not decrease the risk of developing intracranial infections (OR 1.84; 95% CI 0.93–3.62; P = 0.08). Five articles reported 509 patients admitted with GSWH, 91.9% male, mean age 26.6 years old. 224 patients survived resuscitation and surgery. Postoperative intracranial infections did not significantly increase mortality (OR 0.67; CI 0.19–2.43; P = 0.55), but led to more unfavorable outcomes (OR 4.86; CI 1.19–19.79; P = 0.03). Of note, 160 out of the 224 initial survivors (71.4%) were reported to have received prophylactic antibiotics. CONCLUSION Prophylactic antibiotics are routinely given to GSWH patients to prevent infections. This meta-analysis of retrospective studies suggests that 1. prophylactic antibiotics did not decrease the risk of intracranial infections; 2. the presence of intracranial infections in a GSWH setting did not affect mortality and 3. patients developing intracranial infections had worse neurological outcomes.