Les plaies crâniocérébrales d’origine balistique : recherche d’arguments pronostiques

Abstract Background and purpose A retrospective study about craniocerebral gunshot wounds was done to better identify outcome predictors. Methods We reported and analyzed the clinical and radiological data of 18 patients admitted to Le Kremlin-Bicetre institute for a craniocerebral gunshot wound between January 2000 and December 2005. The Glasgow Outcome Scale (GOS) was used to analyze patient outcome. Results There were 17 men and one woman, mean age 43 years (range 17–84). Fifteen patients died, two had a GOS equal to 2 and one GOS equal to 3. There were 16 suicides and two murders. All patients with areactive bilateral mydriasis and all patients with Glasgow Coma Scale (GCS) less than seven died except one. The 10 patients with intraventricular hemorrhage died. The bullet crossed the midline for 13 patients and all of them died. None of the patients underwent emergency surgery for the treatment of craniocerebral gunshot wounds because of low Glasgow Coma Scale. Conclusions This study shows some interesting prognosis patterns: bilateral areactive mydriasis, GCS less or equal to 7 and bullet trajectory (if crossing the midline) are the most important factors predicting a fatal outcome.