49 Organ Donation Potential in Cases of Fatal Gunshot Wounds to the Head: Tools for Timely Screening in the Emergency Department

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Gunshot wounds to the head (GSWH) have a high mortality rate and account for over a third of deaths due to head injury. Here we hypothesize that out-of-hospital vital signs may be useful tools in preliminary identification of organ donation potential when a patient presents to the ED with a fatal GSWH. Retrospective analysis was performed on data from an urban level 1 trauma center’s trauma database. All adult patients with out-of-hospital vital signs on-scene who presented to the ED before expiring due to a fatal GSWH between 1/1/2012 and 12/31/2018 were included. Characteristics of organ donors vs non-donors were analyzed, including injury severity score/abbreviated injury scale-head (ISS/AIS), on-scene Glasgow Coma Score (GCS), on-scene systolic blood pressure (SBP), on-scene respiratory rate (RR), and location of death. For non-normally distributed data, differences between groups were assessed with Wilcoxon Rank Sum Test. Differences for categorical variables were assessed using either Pearson's chi-squared test or Fisher's Exact Test. Significance noted when p < 0.05. Of 208 subjects meeting inclusion criteria, organ donation requests were made in 36 (17.3%) cases and 22 (10.6%) patients donated organs. Neither mean ISS nor AIS-head differed significantly between donors and non-donors (ISS: 4.5 vs 4.7 p=0.3761. AIS-head: 33.7 vs 27.3 p=0.0647) (Table 1). Donors had significantly higher mean on-scene GCS (5.1 vs 3.9 p=0.0016), SBP (129.3 vs 82.1 p=0.0028) and RR (20.5 vs 10.7 p=0.0001) than non-donors (Fig. 1A, B, C). While there was no significant difference in mean GCS at the ED (3.6 vs 3.5 p=0.4093), donors had a significantly larger decrease in mean GCS vs non-donors (-1.4 vs -0.6 p=0.0018) between on-scene and hospital assessment (Fig 1A). At the ED, donors had significantly higher mean SBP than non-donors (114.1 vs 82.7 p=0.0323) (Fig 1B). More donors than non-donors died in the ICU (90.9% vs 45.7%); 9.1% of donors and 45.7% of non-donors died in the OR; no donor died in the ED compared to 52.2% of non-donors; one non-donor (0.5%) died on the floor. Differences in location of death were significant (p < 0.0001) (Table 1). Out-of-hospital GCS, SBP, and RR values were all significantly higher in donors than non-donors. Donors also had significantly higher mean SBP at the ED and a larger decline in GCS between on-scene and the ED compared to non-donors. Nearly half of the study group, all non-donors, died in the ED. Out-of-hospital vitals and status changes en route to the ED may be of use in early identification of potential donors, allowing timely referral to organ procurement agencies, increasing donor opportunity and organ donation. No extra time or resources would be required to collect these metrics, as they are already assessed during emergent resuscitation and management of patients. Timely identification of donor potential may allow fatally wounded patients who expire in the ED the chance to become donors.View Large Image Figure ViewerDownload Hi-res image Download (PPT)