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

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

Research output: Contribution to journalArticle

10 Scopus citations

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 1 2014

Keywords

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

ASJC Scopus subject areas

  • Surgery

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