Gunshot wounds to the head: 29 cases of monocenter children's trauma hospital experience and predictor scales in pediatric population.

Background and objectives: GSWTH in children remain an underexplored area and all clinical guidelines extrapolated from adult experiences. A key challenge in treating these patients is age stratification, as pediatric survival rates are notably higher than in adults. The objective of the study is to compare two groups of patients based on the severity of their condition and to analyze the impact of various factors on the outcomes of these conditions.

Methods: A single-center retrospective cohort study was conducted. Patient records of individuals (from birth to 18 years old) with cranio-cerebral injuries caused by GSWTH and treated at Morozov Children's City Hospital between 1992 and 2015 were comprehensively reviewed. Data analysis included clinical presentation, CT scan findings, injury site and trajectory, GCS and GOS scores, and the St. Louis Scale.

Results: A total of 29 pediatric patients (79% male, 21% female, median age 8 years) with GSWTH were analyzed. The mortality rate was 17%. A transventricular wound trajectory was found in 17% of patients and was associated with a poor prognosis (p<0.001). The GCS showed insufficient specificity in injury severity assessment. A MLR model predicting injury severity based on bullet type, gender, and time to admission had an accuracy of 80%, while a DT model improved accuracy to 96.6%. A stacking model combining MLR and DT increased sensitivity to 87.5% and explained 65.5% of the variance.

Conclusion: The findings emphasize the importance of a multifactorial approach in children with GSWTH, highlighting its effectiveness for precise outcome prediction.