• Roni Mai, Viktor Umerenkov, Dmitriy Reshchikov, Elena Sсhepkina, and Vladimir Popov.
• Department of Pediatric Surgery, Moscow Regional Scientific Research Clinical Institute M.F. Vladimirsky, Moscow, Russia; Department of Pediatric Neurosurgery, Russian Children's Clinical Hospital, Pirogov Russian National Research Medical University, Moscow, Russia. Electronic address: doctor.ronimai@gmail.com.
• World Neurosurg. 2024 Sep 13.

ObjectivesGunshot wounds to the head (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 2 groups of patients based on the severity of their condition and to analyze the impact of various factors on the outcomes of these conditions.MethodsA single-center retrospective cohort study was conducted. Patient records of individuals (from birth to 18 years old) with craniocerebral injuries caused by GSWTH and treated at Morozov Children's City Hospital between 1992 and 2015 were comprehensively reviewed. Data analysis included clinical presentation, computed tomography scan findings, injury site and trajectory, Glasgow Coma Scale and Glasgow Outcome Scale scores, and the St. Louis Scale.ResultsA 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 Glasgow Coma Scale showed insufficient specificity in injury severity assessment. A multiple logistic regression model predicting injury severity based on bullet type, gender, and time to admission had an accuracy of 80%, while a Decision Tree model improved accuracy to 96.6%. A stacking model combining multiple logistic regression and Decision Tree increased sensitivity to 87.5% and explained 65.5% of the variance.ConclusionsThe findings emphasize the importance of a multifactorial approach in children with GSWTH, highlighting its effectiveness for precise outcome prediction.Copyright © 2024 Elsevier Inc. All rights reserved.

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