Fatal gunshot wound to the head: The impact of aggressive management

Bellal A Joseph, Hassan Aziz, Moutamn Sadoun, Narong Kulvatunyou, Viraj Pandit, Andrew - Tang, Julie Wynne, Terence O. Keeffe, Randall S Friese, Rainer W G Gruessner, Peter M Rhee

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background Patients with fatal gunshot wounds (GSWs) to the head often have poor outcomes but are ideal candidates for organ donation. The purpose of this study was to evaluate the effects of aggressive management on organ donation in patient with fatal GSWs to the head. Methods A 5-year review of all patients at a trauma center with GSWs to the head was performed. The primary outcome was organ donation after fatal GSW to the head. Results A total of 98 patients with fatal GSWs to the head were identified. The rate of potential organ donation was 70%, of whom 49% eventually donated 72 solid organs. Twenty-five percent of patients were not considered eligible for donation as a result of disseminated intravascular coagulopathy. The T4 protocol lead to significant organ procurement rates (odds ratio, 3.6; 95% confidence interval, 1.3 to 9.6; P =.01). Failures to organ donation in eligible patients were due to lack of family consent and cardiac arrest. Conclusions Organ donation after fatal GSW to the head is a legitimate goal. Management goals should focus on early aggressive resuscitation and correction of coagulopathy.

Original languageEnglish (US)
Pages (from-to)89-94
Number of pages6
JournalAmerican Journal of Surgery
Volume207
Issue number1
DOIs
StatePublished - Jan 2014

Fingerprint

Gunshot Wounds
Tissue and Organ Procurement
Head
Trauma Centers
Heart Arrest
Resuscitation
Odds Ratio
Confidence Intervals

Keywords

  • Aggressive management
  • GSW to the head
  • Organ donation
  • T4 protocol

ASJC Scopus subject areas

  • Surgery

Cite this

Fatal gunshot wound to the head : The impact of aggressive management. / Joseph, Bellal A; Aziz, Hassan; Sadoun, Moutamn; Kulvatunyou, Narong; Pandit, Viraj; Tang, Andrew -; Wynne, Julie; Keeffe, Terence O.; Friese, Randall S; Gruessner, Rainer W G; Rhee, Peter M.

In: American Journal of Surgery, Vol. 207, No. 1, 01.2014, p. 89-94.

Research output: Contribution to journalArticle

Joseph, Bellal A ; Aziz, Hassan ; Sadoun, Moutamn ; Kulvatunyou, Narong ; Pandit, Viraj ; Tang, Andrew - ; Wynne, Julie ; Keeffe, Terence O. ; Friese, Randall S ; Gruessner, Rainer W G ; Rhee, Peter M. / Fatal gunshot wound to the head : The impact of aggressive management. In: American Journal of Surgery. 2014 ; Vol. 207, No. 1. pp. 89-94.
@article{b34bbc0f6e444a0f957b1f0701fcbd81,
title = "Fatal gunshot wound to the head: The impact of aggressive management",
abstract = "Background Patients with fatal gunshot wounds (GSWs) to the head often have poor outcomes but are ideal candidates for organ donation. The purpose of this study was to evaluate the effects of aggressive management on organ donation in patient with fatal GSWs to the head. Methods A 5-year review of all patients at a trauma center with GSWs to the head was performed. The primary outcome was organ donation after fatal GSW to the head. Results A total of 98 patients with fatal GSWs to the head were identified. The rate of potential organ donation was 70{\%}, of whom 49{\%} eventually donated 72 solid organs. Twenty-five percent of patients were not considered eligible for donation as a result of disseminated intravascular coagulopathy. The T4 protocol lead to significant organ procurement rates (odds ratio, 3.6; 95{\%} confidence interval, 1.3 to 9.6; P =.01). Failures to organ donation in eligible patients were due to lack of family consent and cardiac arrest. Conclusions Organ donation after fatal GSW to the head is a legitimate goal. Management goals should focus on early aggressive resuscitation and correction of coagulopathy.",
keywords = "Aggressive management, GSW to the head, Organ donation, T4 protocol",
author = "Joseph, {Bellal A} and Hassan Aziz and Moutamn Sadoun and Narong Kulvatunyou and Viraj Pandit and Tang, {Andrew -} and Julie Wynne and Keeffe, {Terence O.} and Friese, {Randall S} and Gruessner, {Rainer W G} and Rhee, {Peter M}",
year = "2014",
month = "1",
doi = "10.1016/j.amjsurg.2013.06.014",
language = "English (US)",
volume = "207",
pages = "89--94",
journal = "American Journal of Surgery",
issn = "0002-9610",
publisher = "Elsevier Inc.",
number = "1",

}

TY - JOUR

T1 - Fatal gunshot wound to the head

T2 - The impact of aggressive management

AU - Joseph, Bellal A

AU - Aziz, Hassan

AU - Sadoun, Moutamn

AU - Kulvatunyou, Narong

AU - Pandit, Viraj

AU - Tang, Andrew -

AU - Wynne, Julie

AU - Keeffe, Terence O.

AU - Friese, Randall S

AU - Gruessner, Rainer W G

AU - Rhee, Peter M

PY - 2014/1

Y1 - 2014/1

N2 - Background Patients with fatal gunshot wounds (GSWs) to the head often have poor outcomes but are ideal candidates for organ donation. The purpose of this study was to evaluate the effects of aggressive management on organ donation in patient with fatal GSWs to the head. Methods A 5-year review of all patients at a trauma center with GSWs to the head was performed. The primary outcome was organ donation after fatal GSW to the head. Results A total of 98 patients with fatal GSWs to the head were identified. The rate of potential organ donation was 70%, of whom 49% eventually donated 72 solid organs. Twenty-five percent of patients were not considered eligible for donation as a result of disseminated intravascular coagulopathy. The T4 protocol lead to significant organ procurement rates (odds ratio, 3.6; 95% confidence interval, 1.3 to 9.6; P =.01). Failures to organ donation in eligible patients were due to lack of family consent and cardiac arrest. Conclusions Organ donation after fatal GSW to the head is a legitimate goal. Management goals should focus on early aggressive resuscitation and correction of coagulopathy.

AB - Background Patients with fatal gunshot wounds (GSWs) to the head often have poor outcomes but are ideal candidates for organ donation. The purpose of this study was to evaluate the effects of aggressive management on organ donation in patient with fatal GSWs to the head. Methods A 5-year review of all patients at a trauma center with GSWs to the head was performed. The primary outcome was organ donation after fatal GSW to the head. Results A total of 98 patients with fatal GSWs to the head were identified. The rate of potential organ donation was 70%, of whom 49% eventually donated 72 solid organs. Twenty-five percent of patients were not considered eligible for donation as a result of disseminated intravascular coagulopathy. The T4 protocol lead to significant organ procurement rates (odds ratio, 3.6; 95% confidence interval, 1.3 to 9.6; P =.01). Failures to organ donation in eligible patients were due to lack of family consent and cardiac arrest. Conclusions Organ donation after fatal GSW to the head is a legitimate goal. Management goals should focus on early aggressive resuscitation and correction of coagulopathy.

KW - Aggressive management

KW - GSW to the head

KW - Organ donation

KW - T4 protocol

UR - http://www.scopus.com/inward/record.url?scp=84890429909&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84890429909&partnerID=8YFLogxK

U2 - 10.1016/j.amjsurg.2013.06.014

DO - 10.1016/j.amjsurg.2013.06.014

M3 - Article

C2 - 24119889

AN - SCOPUS:84890429909

VL - 207

SP - 89

EP - 94

JO - American Journal of Surgery

JF - American Journal of Surgery

SN - 0002-9610

IS - 1

ER -