Neurobehavioural outcomes of penetrating and tangential gunshot wounds to the head

Objective: The objective of this study was to compare penetrating and tangential gunshot wounds to the head with regards to demographic, neurobehavioural and clinical outcome measures. Methods: Twenty-nine patients with penetrating gunshot wounds (P-GSW) and 11 patients with tangenital gunshot wound (T-GSW) to the head admitted to an acute neurotrauma service were compared using standardized neurobehavioural and clinical outcome measures. Results: The mean GCS was 10.5 +/- 0.79 for the P-GSW group and 13.4 +/- 0.72 for the T-GSW group. The mean AIS-CNS for the P-GSW group was 5.00 +/- 0 and for the T-GSW group was 3.7 +/- 0.27. Significance was found on Digit Span (p < 0.05) and Block Design (p < 0.009) subtests. Outcomes between the two groups were similar, except for significant differences were found for acute length of stay (LOS) (P-GSW was 47.72 +/- 13.2 and T-GSW group was 13.0 +/- 1.3, p = 0.005) and for acute care charges (P-GSW group was $150533+/-23834 and T-GSW group was $70712+/-16587, p = 0.05). Conclusions: Initially, a penetrating gunshot wound is a more severe and costly injury than a tangential gunshort wound to the head, however T-GSW possess significant deficits and, if the patient survives past the acute phase of recovery, the two groups have similar functional outcomes. Future prospective trials should be conducted utilizing standard classification, neuropsychological, and clinical outcome measures.