A novel predictor of mortality for penetrating brain injury in paediatric patients

Abstract

Objective: Penetrating brain injury (PBI) is a severe form of traumatic brain injury associated with high mortality, particularly in children. However, mortality predictors in children with PBI remain unclear. This study aimed to evaluate the association among the number of intracranial foreign bodies (FBs), brain computed tomography (CT) findings, and mortality outcomes in paediatric patients with PBI who presented to the emergency department (ED).

Methodology: This prospective observational study was conducted in the ED of Kilis State Hospital from December 2015 to December 2022. Paediatric patients with isolated penetrating head injuries from sniper gunshot wounds or barrel bomb explosions were included. Demographic data, pre-hospital interventions, Glasgow Coma Scale scores, brain CT findings, and mortality outcomes were collected and analysed.

Results: This study included 126 paediatric patients with PBI. The presence of ≥2 intracranial FBs was significantly associated with increased mortality (odds ratio 37.4; p<0.001). Other mortality predictors included Glasgow Coma Scale score ≤9, epidural haematoma, midline shift, and pre-hospital endotracheal intubation. Mortality was not significantly different between injuries from shrapnel and those from sniper gunshots.

Conclusion: In paediatric patients with PBI, having ≥2 intracranial FBs was associated with increased mortality. Therefore, FB count may be a novel and accessible prognostic factor. Further research is required to validate these findings and support their integration into clinical decision-making.