{"id":"bd898e7b-b7fb-4ef2-a848-993f233410d0","slug":"time-is-brain-the-gifford-factor-or-why-do-some-civilian-gunshot-wounds-to-the-head-do-unexpectedly-well-a-case-series-with-outcomes-analysis-and-a-management-guide","title":"“Time is brain” the Gifford factor – or: Why do some civilian gunshot wounds to the head do unexpectedly well? A case series with outcomes analysis and a management guide","authors":["David J. Lin","Fred C. Lam","Jeffrey J. Siracuse","Ajith Thomas","Ekkehard M. Kasper"],"abstract":"Background: Intracranial gunshot wound (GSW) injuries are among the most lethal traumas, with significant morbidity and mortality rates. The management of GSWs has evolved, yet postoperative mortality rates remain above 20%. This study presents a case series of patients with GSWs, analyzing their surgical management and outcomes to identify factors contributing to unexpected recovery. Methods: A retrospective chart review was conducted on adult patients admitted to a trauma center over five years with GSWs to the head. A total of 28 patients were identified, with 17 requiring emergent surgical intervention. The analysis focused on patients with poor Glasgow Coma Scale (GCS) scores to understand their recovery outcomes. Results: The case series highlighted three patients with varying GSWs who demonstrated unexpected recovery despite initially poor GCS scores. Factors such as the trajectory of the bullet, the presence of intact anatomical structures, and timely surgical intervention contributed to positive outcomes. All patients showed significant functional recovery post-surgery. Conclusion: This study underscores the importance of specific anatomical and clinical factors in the management of GSWs, suggesting that even patients with poor initial GCS scores can achieve favorable outcomes with appropriate surgical intervention. Further research is needed to establish comprehensive treatment algorithms for GSW management. Keywords: gunshot wound, intracranial injury, surgical management, outcomes analysis, traumatic brain injury, Glasgow Coma Scale, case series","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/bd898e7b-b7fb-4ef2-a848-993f233410d0/featured/hero-1782421016840.png","publishDate":"2012-08-27T00:00:00.000Z","doi":"10.4103/2152-7806.100187","categories":["Original Article"],"fullTextUrl":"http://sni.wpengine.com/wp-content/uploads/2015/05/3437/SNI-3-98.pdf"}