More than neurosurgeons: combatting firearm-related traumatic brain injury

Firearm-related deaths in children and adolescents have reached a tipping point in the United States. In 2020, firearm-related injuries became the leading cause of death among people 1-19 years of age, overtaking motor vehicle crashes. In particular, firearm-related traumatic brain injury (frTBI) is the most morbid and lethal aftereffect of both firearm injuries and TBIs, despite robust neurosurgical involvement and engagement in the American trauma system.

The tragedy and hopelessness felt with each young life lost to senseless and preventable causes such as frTBI cannot be understated and should not be accepted.

In seeking to understand this issue, I turned to the literature, something that I have been trained to do as a medical student aspiring to pursue neurosurgery. It quickly became clear to me that the topic of frTBI is woefully understudied despite its disproportionate role in morbidity and mortality associated with the epidemic of firearm-related violence.

To jumpstart the conversation regarding this in our own academic community, my mentors and I undertook a structured scoping review of the topic of pediatric frTBI. Our goals were to better characterize the epidemiology of pediatric frTBI as well as any literature that has discussed potential mechanisms to reduce its burden on American society

Unsurprisingly, the trends and gaps we saw in the literature are worrisome. In the limited number of studies found and assessed, the majority of firearm fatalities (75-84%) were caused by head and neck trauma. Trends from the national trauma data bank (NTDB) showed that assault and suicide were the first and second most common methods of injury or death overall, and while accident-related gunshot wounds to the head have decreased by half, self-inflicted gunshot wounds to the head have doubled.

There was an increased risk for both injury and death from frTBI in males, pre-teenage and teenage youths, minorities and individuals in firearm-owning households. Furthermore, very few structured studies have been published regarding potential mitigating interventions. Targeted patient screening, firearm-injury prevention counseling, and advocacy of safety-oriented policy are at present the most commonly proposed action areas, though whether these approaches tangibly affect pediatric frTBI outcomes is largely yet to be determined.

Our work underscores the urgent need for further research in this space. As providers working through tertiary prevention when these severe and morbid cases arrive at the hospital, neurosurgeons are uniquely posed to understand and communicate the toll that frTBI places on individuals, families and communities.

With this in mind, physicians, and specifically neurosurgeons, are not often trained experts in policy. As an initial step, the neurosurgical community can strive to understand the impact of public health problems like this through data. Then, with concerted research efforts, the neurosurgical community can help further define areas for advocacy to change the tide and combat this issue both in their role as surgeons and patient advocates.

By Ron Gadot, fourth-year medical student at Baylor College of Medicine.

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