Validation of the Baragwanath mortality prediction score for cerebral gunshot wounds: the Pietermaritzburg experience

Cerebral gunshot wounds (GSW) are highly lethal injuries. To date, only one clinical scoring system to predict mortality in a developing world setting has been described. This is the Baragwanath mortality prediction score ("ABC": admission blood pressure, brain matter spillage and consciousness level). We performed a retrospective review of prospectively entered data for a cohort of patients with isolated cerebral GSWs over a 5-year period (January 2010-December 2014) in our institution. We aimed to validate the Baragwanath ABC mortality prediction score in our population. During the 5-year study period, 102 patients with isolated cerebral GSWs were reviewed, 22% (22/102) of which died. Based on the total ABC score (1-5), the mortality was 0% for 1, 21% for 2, 67% for 3, 92% for 4, and 100% for 5. The ABC score has a sensitivity of 82% (95% CI 60-95%), specificity of 96% (95% CI 89-99%), PPV of 86% (95% CI 66-96%) and NPV of 95% (95% CI 86-99%). The Baragwanath mortality prediction score accurately predicts non survival of patients with a cerebral GSW in our patient cohort. Further validation studies in other populations are required before this system can be widely adopted.