Abstract

Background: Cranial gunshot injuries (CGIs) are a leading cause of severe morbidity and mortality, particularly in regions marred by political unrest and violence. During the July Revolution 2024 in Bangladesh, a mass uprising against governmental repression, thousands of innocent civilians were targeted in brutal crackdowns, resulting in widespread gunshot injuries, many of which involving head. Dhaka Medical College Hospital became a frontline facility for managing these critical injuries. This study aims to evaluate the clinical characteristics and prognostic indicators of cranial gunshot injury patients admitted during this period.

Methodology: This retrospective study analysed ICU registry data from Dhaka Medical College Hospital between July 18 and August 8, 2024, focusing on cranial gunshot injury patients with confirmed CT scans. Multiple logistic regression identified predictors of GOS scores, and a risk model was developed and validated using the Hosmer-Lemeshow test with data analysis conducted in SPSS 26.

Results: The patients had a mean age of 26.5 ± 11.83 years, with a predominant male population (97.9%). Initial GCS was 7.9 ± 2.49, and 85.4% required mechanical ventilation. Baseline vital parameters included a mean MAP of 61 ± 19.5 mmHg, SpO2 of 92 ± 22.5%, and blood sugar of 6.6 ± 2.8 mmol/L. Logistic regression revealed that initial GCS (p = 0.003) and SpO2 (p = 0.015) were significant predictors of favourable outcomes.Model adequacy was confirmed by a Nagelkerke’s R² of 0.48. During ICU treatment, the most common complications were septic shock (22.9%), followed by hospital-acquired or ventilator-associated pneumonia (20.8%).CT scan findings showed SAH had the strongest negative association (OR = 0.11, p = 0.010), followed by ASDH (OR = 0.14, p = 0.025).

Conclusion: Initial Glasgow Coma Scale (GCS) scores and SpO2 levels are significant predictors of positive outcomes in patients with cranial gunshot injuries, while SAH, ASDH, and spinal cord injuries are critical indicators of adverse outcomes. These findings emphasize the need for early detection and targeted management to enhance patient survival and recovery.