Education & Training

A better way to predict survival after gunshot head injuries

Pediatric Critical Care Fellow Kayla Duvall, MD

Kayla Duvall, MD, couldn’t stop thinking about her patient, a 16-year-old girl who had been shot in the head. After undergoing surgery and a month-long stay in the pediatric intensive care unit, the girl died of her devastating head injury. “Her family went through so much anguish just waiting, and they couldn’t even spend any quality time with her,” said Duvall, a third-year pediatric critical care fellow. “Instead of critical-care physicians doing everything we can until there is nothing left to do, I think we can better serve families by counseling them on the likely mortality outcome to help them make informed decisions about their child’s care.”

Currently, however, there are few objective data to predict mortality in children with penetrating brain injuries. Such biomarkers exist for adults with gunshot wounds to the head, but not for kids. “Right now, we use data on traumatic brain injury to make treatment decisions,” said Duvall. “But children shot in the head have a very different kind of injury, so we need more specific data.”

Duvall found only two studies on prognostic mortality markers for children with brain injuries caused by bullets. The St. Louis Scale for Pediatric Gunshot Wounds to the Head found that international normalized ratio (INR), a marker of coagulopathy, and hemoglobin were predictive of survival. The other study, however, failed to validate the St. Louis Scale findings.

The high incidence of pediatric penetrating head injury at the University of Chicago Medicine Comer Children’s Hospital provided a large patient population for Duvall to study to determine if the St. Louis criteria for predicting mortality were valid. In a chart review of 67 Comer Children’s patients with penetrating brain injury, Duvall found that an INR above 1.5, which is abnormal, is associated with a statistically significant likelihood of increased mortality. Her next step is to test whether coagulopathy is indicative of mortality in patients presenting with gunshot wounds to the head at Comer Children’s. “My goal is to continue to do studies to gather as much objective data as possible to help physicians and families make joint decisions about the care of traumatically wounded children,” she said.

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