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A National Trauma Data Bank Analysis of Patient Demographics and Outcomes in Patients with Gunshot Wounds to the Head based on Intent of Injury: Self-Inflicted, Assault, or Unintentional

Friday, May 3, 2024

    Presenting Author(s)

  • Courtney Deaver, BS

    Medical Student
    University of Arizona College of Medicine, Neurosurgery Department, Phoenix AZ
    Gilbert, AZ, US

    • Co-Author(s)

  • RB

    Robert W. Bina, MD

    Assistant Professor of Neurosurgery
    University of Arizona College of Medicine, Neurosurgery Department, Phoenix AZ
    Phoenix, Arizona, United States

  • WC

    W. Ethan Coleman, BS

    Clinical Research Specialist
    Barrow Neurological Institute, United States

  • SF

    Sofia Fabrega, B.S.

    Medical Student
    The University of Arizona College of Medicine - Phoenix, United States

  • PN

    Peter Nakaji, MD

    Chair, Department of Neurosurgery
    University of Arizona College of Medicine, Neurosurgery Department, Phoenix AZ
    Phoenix, Arizona, United States

  • Annie Pico, BA

    Medical Student
    University of Arizona College of Medicine, Neurosurgery Department, Phoenix AZ
    Chandler, AZ, US

  • DP

    Daniel Pietz, MS

    Data Analyst
    University of Arizona College of Medicine - Phoenix, Department of Neurosurgery, United States

  • KZ

    Kevin Zhao, MD

    Clinical Fellow
    University of Arizona College of Medicine – Phoenix, Banner University Medical Center
    Phoenix, Arizona, United States

Introduction: Firearm violence is rising in the US and understanding the incidence and outcomes associated with intent can inform healthcare preparedness and injury prevention.

Methods: The National Trauma Data Bank was queried for adult patients who suffered gunshot wounds to the head (GSWH) from 2010-2021 (excluding 2016). Patient demographics and outcomes in relation to intent of injury were analyzed.

Results: 312,308 patients were identified with a GSWH. Self-inflicted GSWH had increased likelihood of mortality (OR: 5.89, p< 0.001), being White (OR: 3.13, p< 0.001), Asian (OR: 2.59, p< 0.001), Native American (NA) (OR: 3.14, p< 0.001), or Pacific Islander (OR: 3.15, p< 0.001). Assault-related (AR) GSWH were more likely to be black (OR: 1.45, p< 0.001), have deep (OR: 1.33, p< 0.001), superficial (OR: 1.99, p< 0.001), or organ space infection (OR: 2.12, p< 0.001), sepsis (OR: 2.10, p< 0.001), unplanned ICU stay (OR: 1.78, p< 0.001), unplanned intubation (OR: 1.36, p< 0.001), and unplanned OR visits (OR: 1.55, p< 0.001). Unintentional GSWH were less likely to have infections (sepsis OR: 0.40, organ space OR: 0.32, superficial OR: 0.84, deep OR: 0.89; p< 0.001) or unplanned ICU stay (OR: 0.56, p< 0.001), OR visit (OR: 0.715, p< 0.001), or intubation (OR: 0.83, p< 0.001). Unintentional (OR: 0.34, p< 0.001) and AR (OR: 0.39, p< 0.001) GSWH had decreased mortality likelihood.

Conclusion : Significant disparities in outcomes based on intent exist. These disparities underpin the importance of addressing underlying cultural beliefs that influence GSWH treatment.