Citation

Chen JW. Neurosurgery 2019; ePub(ePub): ePub.

Affiliation

Department of Neurological Surgery, University of California-Irvine, Irvine, California.

Copyright

(Copyright © 2019, Congress of Neurological Surgeons)

DOI

10.1093/neuros/nyz223

PMID

31232430

Abstract

In this paper the authors have done a nice job extending their prior study to validate the SPIN (Survival after Acute Civilian Penetrating Brain Injuries) score. They have extended their study to retrospectively review their cases of penetrating civilian gunshot wounds to the head at three level 1 trauma centers spanning a time period dating back as far as 1987 for trauma center. The original SPIN study was derived from the experience of two trauma centers, thus they have added an additional trauma center and have extended the review back many years. In the current paper, hospital 2 understandably has a low number of cases because this was the originating center for the original paper and thus their cases prior to 2015 were excluded. The finding that the authors are able to apply the SPIN score derived from the original paper with cases that go back 30 yr supports the robust nature of their model. The top three predictors of mortality were mGCS, pupillary reactivity, and INR which is very consistent with what most operating neurosurgeons find clinically.

The authors1 appropriately point out in their limitations section that their data spans many years, over which there were changes in technology and surgical adjuncts. However, despite innovations in imaging, surgery, and critical care the mortality has been consistently high in civilian gunshot wounds to the head. In addition, the ability to find much of the data extracted speaks to the importance of comprehensive databases. In recent years, such programs as the TQUIP (Trauma Quality Improvement Program) of the American College of Surgeons (ACS) have provided large amounts of standardized data about trauma patients ...

It is interesting that the SPIN model does not rely on any radiographic predictors although it is noted that it was examined in the original paper

Language: en