In the past few decades, there has been an increase in the number of head injuries caused by gunshot wounds. According to the American Association of Neurological Surgeons, gunshot wounds have become one of the leading causes of traumatic brain injury in the United States, and one of the most lethal of all firearm injuries.
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Healthcare costs for firearm-related injuries are also high. In 2010, the total firearm assault injury cost U.S. hospitals just under $630 million.
However, researchers at the University of Massachusetts Medical School in Worcester have developed a new scientific tool – the SPIN-Score – that might improve decision-making regarding treatment for gunshot wounds to the head.
The SPIN-Score stands for “Surviving Penetrating Injury to the Brain” and is designed to help predict an individual’s chances of survival after a gunshot wound to the head, or other penetrating brain injuries.
In January 2013, President Barack Obama issued 23 executive orders directing the Centers for Disease Control and Prevention (CDC) and other relevant institutions to research the causes of firearm violence, strategies for prevention, and plans to minimize its public health burden.
One of these executive orders noted that “in addition to being a law enforcement challenge, firearm violence is also a serious public health issue that affects thousands of individuals, families, and communities across the nation.”
In 2015, almost 12,000 people died from a firearm, and just under 25,000 were injured.
In 2010, more than 105,000 individuals were injured or killed in a firearm-related incident.
Although the over number of violent crimes has declined over the past 5 years, the U.S. still has the highest rate of firearm-related deaths in industrialized countries.
According to the report on hospital costs of firearm assaults published by the Urban Institute in 2013, firearm assault injuries accounted for 36,341 visits to the emergency department and more than 25,000 hospitalizations.
The total cost for U.S. hospitals in 2010 was just under $630 million. This is more than the entire state of Wyoming spent on Medicaid in 2011, which is $534 million.
According to a new study published in the journal Neurology, researchers have now developed SPIN, an innovative tool that predicts a patient’s chances of survival after a gunshot wound to the head or other penetrating injury.
Gunshot wounds are among the leading causes of traumatic brain injury (TBI) deaths, accounting for about 35 percent. They are also “the number one cause of penetrating traumatic brain injuries,” according to lead study author Dr. Susanne Muehlschlegel, of the University of Massachusetts Medical School.
A “penetrating injury” is a form of TBI, where the projectile penetrates the cranium, but does not exit.
To come up with the SPIN tool, researchers carried out a comprehensive study of patient data spanning over 10 years in two trauma centers – one in Massachusetts and one in Maryland.
The analysis examined 413 people who had been treated for penetrating injuries to the head, most of which were gunshots. The average age of the patients was 33.
Researchers looked at the factors that influenced a person’s chance of survival, both immediately after the trauma and 6 months later.
The overall survival rate in the study was 42 percent, with no participants dying in the6 months after leaving the hospital. Women had a 76 percent higher chance of survival, but the reasons for this are unknown.
The SPIN-Score predicted whether people would survive with an accuracy of 96 percent.
The SPIN-Score for those in the study ranged from 4 to 52, with higher scores indicating a higher chance of survival.
Those with a SPIN-Score of 16 or less did not survive.
Self-inflicted gunshot wounds presented an 80 percent increased chance of dying. Generally, suicide-related gunshot wounds have the highest rate of mortality, compared with accidental wounds or those caused by an assault.
Of all the factors that helped predict survival in the study, two were the most indicative: how well a person’s pupils responded to light, and how well the person could move in response to stimuli.
Stimuli included obeying commands or withdrawing from pain, which is also part of the motor tests in the Glasgow Coma Scale (GCS). The GCS is currently the most common scoring system for assessing the level of consciousness in a patient following TBI.
The American Association of Neurological Surgeons (AANS) report that gunshot wound head trauma is fatal about 90 percent of the time, with many victims dying before even arriving at the hospital.
For victims who do survive the initial wound, arouns 50 percent die in the emergency room, and around 50 percent of surviving patients will suffer from seizures and require anti-epilepsy medication.
In terms of treatment, patients with gunshot wound head trauma are aggressively resuscitated when they arrive at the hospital. The medical staff will then perform an urgent CT brain scan.
At the moment, the decision whether to proceed with surgical treatment of the gunshot wound must consider three factors: the level of consciousness – decided using the GCS – the degree of brainstem neurological function, and the CT scan findings.
If the SPIN-Score becomes sufficiently reliable, it might become the fourth factor that determines whether to operate on a patient with a gunshot wound.
“Much of our knowledge about surviving such injuries comes from the battlefield, not from shootings among civilians. Being better able to determine the average person’s chance of survival could help doctors and families make important decisions about medical treatment.”
Dr. Susanne Muehlschlegel
“More research is needed to validate the SPIN-Score so for now, it remains a preliminary prediction tool,” adds Dr. Muehlschlegel. “Still, developing this tool is an important step toward improving overall outcomes.”
Read about how three laws could cut gun deaths by 90 percent.