251 A Comparison of Neurosurgical Intervention and In-hospital Mortality in Patients With Intracranial Gunshot Wounds From Long Guns Versus Handguns: A Propensity-matched National Database Analysis

Abstract

INTRODUCTION: Intracranial gunshot wounds (IC-GSW) are an understudied cause of mortality with indications for neurosurgical intervention. Historically, handguns have accounted for the majority of IC-GSW, but incidents involving long guns (rifles/shotguns) are rising. A comparison of neurosurgical intervention and in-hospital mortality by firearm type has yet to be fully explored. METHODS: The National Trauma Data Bank was queried from 2017-2019 for patients with IC-GSW presenting to a hospital with signs of life. Propensity score matching was performed between LG and HG groups based on demographics, comorbidities, Glasgow Coma Scale (GCS), and insurance type. Group differences were compared using paired Student’s t-tests and Pearson’s chi-square tests. A logistic regression model was developed to identify predictors of mortality. RESULTS: A total of 6,585 patients met inclusion criteria. Following one-to-one propensity score matching, 510 patients were identified and compared in each group. Seventy percent of patients with IC-GSW arrived with a GCS < 8 (68.43% LG vs. 72.16% HG, p=0.19). Rates of neurosurgical intervention were similar between the LG and HG groups (20.49% vs. 23.53%, p = 0.26), however LG patients had a lower rate of in-hospital mortality (34.51% vs. 42.55%, p < 0.01). Neurosurgical wound debridement (OR = 0.46, p<0.001), foreign body removal (OR = 0.44, p < 0.001), craniectomy (OR = 0.48, p < 0.001), and ventriculostomy (OR = 0.58, p < 0.01) were associated with lower odds of mortality. CONCLUSIONS: Patients with IC-GSW often present to the hospital in critical neurologic condition. Neurosurgical intervention is associated with lower odds of in-hospital mortality. Though both groups undergo neurosurgery at similar rates, patients with LG IC-GSW have a lower mortality rate. This study identifies a subset of patients who may particularly benefit from neurosurgery. Further research is needed to quantify the rationale behind these findings.