Factores asociados con la mortalidad y desenlaces funcionales de los pacientes pediátricos con traumatismo craneoencefálico por arma de fuego en el Hospital Francisco Icaza Bustamante durante el período 2023-2025.

Abstract

INTRODUCTION: Head gunshot wounds in children represent a catastrophe at the cerebral and functional levels. Several factors have been described as being associated with mortality and functional outcome following such injuries; these variables were the subject of study in this work. KEYWORDS: trauma, traumatic brain injury, firearms, mortality, outcome, pediatric. METHODS: Twenty-eight patients, aged 0 to 14 years, 11 months, and 29 days, were diagnosed with head gunshot wounds and admitted to the emergency department of Francisco Icaza Bustamante Hospital, which were included in the study. Clinical, radiological, and laboratory factors were analyzed to determine their association with mortality and functional outcome, which was stratified using the Glasgow Outcome Score. Categorical variables were compared using the chi-square test or Fisher's exact test when necessary, while numerical variables were analyzed using the non-parametric Mann-Whitney U test. RESULTS: A mortality rate of 21.4% (6 of 28 patients) was obtained, with a predominance of males and a mean age of 10 years. All were collateral victims and came mostly from the provinces of Guayas and Los Ríos. Five factors associated with mortality were identified: mydriasis and anisocoria (p = 0.002), intracranial hypertension (p = 0.041), cardiac arrest (p < 0.001), greater base deficit on admission (p = 0.041), and hospital stay in other areas (p = 0.047). Functional outcome was categorized using the GOS score. Six variables were associated with a worse outcome: red blood cell transfusion (p=0.024), intraparenchymal hemorrhage (p=0.021), cerebral edema (p=0.013), intracranial hypertension (p=0.019), cardiac arrest (p=0.009), and days of mechanical ventilation (p=0.044). CONCLUSIONS: There are factors associated with mortality and functional outcome in pediatric patients with gunshot wounds, findings consistent with those of several authors worldwide.