CRANIAL GUNSHOT WOUNDS IN ADOLESCENTS AND ADULTS: A COMPARATIVE STUDY OF MANAGEMENT AND OUTCOMES AT A LEVEL I TRAUMA CENTER anhann2@emory.edu

PW05-07

CRANIAL GUNSHOT WOUNDS IN ADOLESCENTS AND ADULTS: A COMPARATIVE STUDY OF MANAGEMENT AND OUTCOMES AT A LEVEL I TRAUMA CENTER

4

United States

Oral or Poster

Of the 40,000 adolescents affected by firearm injury since 2018, approximately 15% sustained intracranial gunshot wounds (GSWH), with mortality exceeding 50%. Despite this burden, data on adolescent GSWH remain limited, and direct comparisons with adult populations are lacking. This study aims to compare the clinical management and outcomes of GSWH in adolescent and adults with the goal of identifying age-related differences that may inform tailored approaches to care.

We conducted a retrospective cohort study of GSWH from 2017–2022, stratifying patients into adolescents (11–21) and adults (>21). We compared demographics, injury intent, characteristics, management (operative vs. non-operative), and outcomes (mortality, hospital length of stay). T-tests, Chi-squared, and Mann-Whitney tests assessed differences. Logistic regression evaluated associations with mortality and surgical intervention.

Of 531 GSWH patients, 121 (23%) were adolescents (mean age 18). Adolescents were more often Black (80% vs. 68%, p=0.009) and had more bihemispheric injuries (48% vs. 33%, p=0.008). Overall mortality was 59%, significantly higher in adolescents (67% vs. 52%, p=0.005). Glasgow Outcome Scores were worse in adolescents, with more scoring <3 (p=0.007). Surgical rates, length of stay, and injury severity scores were similar between groups.

Extent of injury, particularly bihemispheric involvement, was the strongest predictor of mortality after GSWH rather than age. While national data suggest surgery reduces mortality, this effect was not seen in our cohort. These findings underscore the need for adolescent-focused prevention strategies and interventions targeting the social determinants driving GSWH injuries.