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<h4>Background</h4>Cerebral gunshot wounds (CGSWs) represent a highly lethal form of traumatic brain injury, and triaging these patients is difficult. The prognostic significance of the serum lactate level in the setting of CGSWs is largely unknown.<h4>Objectives</h4>To examine the relationship between elevated serum lactate levels and mortality in patients with isolated CGSWs.<h4>Methods</h4>A retrospective review of the regional trauma registry was undertaken at the Pietermaritzburg Metropolitan Trauma Service, South Africa, over a 5-year period from 1 January 2010 to 31 December 2014. All patients with an isolated CGSW were included.<h4>Results</h4>A total of 102 patients with isolated CGSWs were identified. Of these, 92.2% (94/102) were male. The mean age (standard deviation) was 29 (8) years, and the in-hospital mortality rate was 21.6% (22/102). The mean serum lactate level was significantly higher among non-survivors than among survivors (6.1 mmol/L v. 1.3 mmol/L; p&lt;0.001). Lactate levels among non-survivors were &lt;2 mmol/L in 4.5%, 2 - 3.99 mmol/L in 9.1%, 4 - 5.99 mmol/L in 36.4% and ≥6 mmol/L in 50.0%. The odds ratio for mortality with a lactate level of 4 - 5.99 mmol/L was 67 (95% confidence interval (CI) 1.7 - 2 674.2), while for a lactate level of ≥6 mmol/L it was 1 787 (95% CI 9.0 - 354 116.1). The serum lactate level accurately predicted mortality even after adjustment for other variables. Based on a receiver operating curve analysis, an optimal cut-off of 3.3 mmol/L for serum lactate as a predictor for mortality was identified (area under the curve = 0.957).<h4>Conclusions</h4>CGSWs are associated with significant mortality, and a raised serum lactate level appears to be an independent predictor of in-hospital mortality. It is a potentially useful adjunct in the resuscitation room for identifying patients with a very poor prognosis.

Original publication

DOI

10.7196/samj.2018.v108i5.12837

Type

Journal

South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde

Publication Date

25/04/2018

Volume

108

Pages

413 - 417

Addresses

Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa. victorywkong@yahoo.com.

Keywords

Humans, Brain Injuries, Wounds, Gunshot, Lactic Acid, Prognosis, Registries, Hospital Mortality, Retrospective Studies, Predictive Value of Tests, Adult, Emergency Service, Hospital, Triage, South Africa, Female, Male