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The effect of brain tomography findings on mortality in sniper shot head injuries
  1. Çağdaş Can1,
  2. M Bolatkale2,
  3. A Sarıhan1,
  4. Y Savran3,
  5. A Ç Acara4 and
  6. M Bulut2
  1. 1Department of Emergency Medicine, Merkezefendi State Hospital, Manisa, Turkey
  2. 2Department of Emergency Medicine, Medipol University Hospital, Istanbul, Turkey
  3. 3Department of Internal Medicine, Dokuz Eylul University Hospital, Izmir, Turkey
  4. 4Department of Emergency Medicine, Dokuz Eylul University Hospital, Izmir, Turkey
  1. Correspondence to Çağdaş Can, Department of Emergency Medicine, Merkezefendi State Hospital, Manisa, Turkey; drcagdascan{at}


Objectives Penetrating gunshot head injuries have a poor prognosis and require prompt care. Brain CT is a routine component of the standard evaluation of head wounds and suspected brain injury. We aimed to investigate the effect of brain CT findings on mortality in gunshot head injury patients who were admitted to our emergency department (ED) from the Syrian Civil War.

Methods The study group comprised patients who were admitted to the ED with gunshot brain injury. Patients' GCS scores, prehospital intubations and brain CT findings were examined.

Results 104 patients were included (92% male, mean age 25 years). Pneumocephalus, midline shift, penetrating head injury, patients with GCS scores ≤6 and patients who had to be intubated in the prehospital period were associated with higher mortality (p<0.05).

Discussion The results of this study demonstrated that pneumocephalus, midline shift, a penetrating head injury, GCS scores ≤6 and prehospital intubation are associated with high mortality, whereas patients with temporal bone fracture, perforating or single cerebral lobe head injury had a higher survival rates. The temporal bone has a relatively thin and smooth shape compared with the other skull bones so a bullet is less fragmented when it has penetrated the temporal bone, which could be a reason for the reduced cavitation effect. In perforating head injury, the bullet makes a second hole and so will have deposited less energy than a retained bullet with a consequent reduction in intracranial injury and mortality. Further studies are required to reach definitive conclusions.

  • penetrating gunshot
  • brain computed tomography
  • emergency department
  • prehospital intubation
  • glasgow coma scale
  • perforating head injury

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  • Contributors Planning: ÇC, MB, AS; conduct: ÇC, MB; reporting: ÇC, MB, AS, YS, AÇA, MB.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Clinical Research Ethics Committee (Medipol University Hospital/14.05.2015/13-10).

  • Provenance and peer review Not commissioned; externally peer reviewed.