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Imaging Factors Inform Treatment of Penetrating Gunshot Wounds in Children and Adolescents

By MedImaging International staff writers
Posted on 13 Jan 2016

Researchers examining Intracranial Gunshot Wounds (GSWs) in children and adolescents have identified several factors predictive of patient outcomes.

The researchers found nine clinical, laboratory, and Computed Tomography (CT) imaging factors that were statistically associated with mortality. Several of these factors included bilateral fixed and dilated pupils, intravascular volume depletion, systolic blood pressure lower than 100 mmHg anemia, a Glasgow Coma Scale score of 5 or lower, and injuries to various brain injuries involving various parts of the brain or blood vessels.

The results of the study were published in the January 5, 2016, issue of the Journal of Neurosurgery. The researchers from the Department of Neurosurgery at the University of Tennessee (Knoxville, TN, USA), and a number of other institutions, looked at the medical records of pediatric patients aged 18 years or younger who received treatment for penetrating GSWs to the head. The study included records of 71 patients with a mean age at presentation of 14 years, suffering only from a single trauma. Thirty-nine (55%) of the patients underwent Surgery.

The primary outcome in the study was the Glasgow Outcome Scale score, and the overall mortality rate was 48%, or 34 of the 71 patients. Thirty of the 37 surviving (81%) achieved a favorable outcome (Glasgow Outcome Scale Score 4 or 5).

The results demonstrated the importance of collecting clinical, laboratory, and radiological factors associated with mortality, to help guide treatment plans and predict in children and adolescents with GSW. The researchers found that only bilateral fixed and dilated pupils are a reliable indicator for predicting mortality. The other predictive factors collected in the study were only useful to help inform decision-making for treatment and care the pediatric patients. The authors found that children have a good ability to overcome severe neurological injuries.

The authors, said, “When presented with a child who has sustained an intracranial GSW, the neurosurgeon must quickly decide whether the child has a fatal injury, an injury that is potentially nonfatal but very likely to have a devastating neurological outcome, or a survivable injury with a reasonable chance of maintaining or regaining meaningful neurological function.”

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66 (33.855438232422): select jos_google_plus.link from jos_google_plus where cat=10

67 (34.093856811523): select jos_linkedin.link from jos_linkedin where cat=10

68 (171.89979553223): SELECT fid FROM jos_deeppockets WHERE id=294762235 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294762235 AND published='1' LIMIT 1

69 (253.20053100586): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

70 (702.85797119141): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294762235 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (563.14468383789): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294762235 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (92.983245849609): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (56.028366088867): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (559.80682373047): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (!!!!! 1244.068145752): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294762235 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (53.882598876953): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294762235 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (72.956085205078): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (!!!!! 1456.9759368896): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (142.09747314453): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (349.99847412109): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (761.03210449219): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (47.922134399414): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (57.93571472168): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (243.18695068359): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (389.81437683105): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (43.869018554688): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (212.19253540039): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 1334.1903686523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294762235 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294762235 AND published='1' LIMIT 1

105 (334.9781036377): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294762235 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294762235 AND published='1' LIMIT 1

106 (437.97492980957): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294762235 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (963.92631530762): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294762235 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 2516.0312652588): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294762235 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294762235 AND published='1' LIMIT 1

109 (309.94415283203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294762235 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294762235 AND published='1' LIMIT 1

110 (385.04600524902): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294762235 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (869.0357208252): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294762235 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (!!!!! 4792.9286956787): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (!!!!! 8992.1951293945): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (!!!!! 5191.0877227783): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294762235 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294762235 AND published='1' LIMIT 1

115 (!!!!! 2123.1174468994): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294762235 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294762235 AND published='1' LIMIT 1

116 (446.08116149902): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294762235 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294762235 AND published='1' LIMIT 1

117 (54.836273193359): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294762235 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294762235 AND published='1' LIMIT 1

118 (702.85797119141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294762235 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294762235 AND published='1' LIMIT 1

119 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294762235 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294762235 AND published='1' LIMIT 1

120 (384.09233093262): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294762235 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294762235 AND published='1' LIMIT 1

121 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294762235 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294762235 AND published='1' LIMIT 1

122 (298.02322387695): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 41707.992553711): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (!!!!! 2014.8754119873): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294762235 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294762235 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (56.982040405273): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (37.193298339844): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (205.99365234375): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (44.107437133789): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (304.22210693359): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (39.100646972656): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (33.140182495117): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (201.94053649902): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (36.001205444336): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (34.809112548828): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (!!!!! 1279.1156768799): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294762235 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (!!!!! 1410.0074768066): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294762235 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (!!!!! 1050.9490966797): SELECT name FROM jos_deeppockets WHERE id=211

138 (55.074691772461): SELECT name FROM jos_deeppockets WHERE id=211

139 (!!!!! 1008.0337524414): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (!!!!! 1415.0142669678): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (!!!!! 2556.0855865479): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294762235 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294762235 AND published='1' LIMIT 1

142 (!!!!! 4307.0316314697): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294762235 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294762235 AND published='1' LIMIT 1

143 (!!!!! 29123.067855835): TRUNCATE TABLE jos_trademed_module

144 (89.883804321289): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294762235 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (48.87580871582): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294762235 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 1080.9898376465): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294762235 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (246.04797363281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294762235 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (766.03889465332): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294762235 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294762235 AND published='1' LIMIT 1

149 (49.829483032227): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294762235 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294762235 AND published='1' LIMIT 1

150 (!!!!! 2715.8260345459): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (440.12069702148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294762235 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294762235 AND published='1' LIMIT 1

152 (197.17216491699): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294762235 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294762235 AND published='1' LIMIT 1

153 (!!!!! 1920.9384918213): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294762235 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294762235 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (333.07075500488): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

155 (36.001205444336): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

156 (531.91184997559): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (!!!!! 2262.1154785156): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294762235 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294762235 AND published='1' LIMIT 1

158 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294762235 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294762235 AND published='1' LIMIT 1

159 (!!!!! 1229.0477752686): select jos_twitters.link from jos_twitters where cat=10

160 (232.93495178223): select jos_facebook.link from jos_facebook where cat=10

161 (35.04753112793): select jos_google_plus.link from jos_google_plus where cat=10

162 (62.942504882812): select jos_linkedin.link from jos_linkedin where cat=10

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