Evidence map›Paper›PMID 42599524›Full record

SynthesisNeurosurgical review2026

The optimal timing of surgical intervention for peripheral nerve injuries from gunshot wounds: A case series and systematic review.

Adham M Khalafallah, Bhavjeet S Sanghera, Joseph Yunga Tigre, Samuel Nodal, Danny L John, Taylor Smartz, S Shelby Burks, Allan D Levi

Abstract readComparative StudyMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Neurosurgical review, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Adham M KhalafallahDepartment of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA. adham.khalafallah@jhsmiami.org.ORCID http://orcid.org/0000-0002-3249-9657
Bhavjeet S SangheraDepartment of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Joseph Yunga TigreDepartment of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Samuel NodalDepartment of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Danny L JohnDepartment of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Taylor SmartzDepartment of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
S Shelby BurksDepartment of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Allan D LeviDepartment of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The optimal timing of surgical intervention for peripheral nerve injuries (PNIs) after gunshot wounds (GSWs) is controversial. Although delayed intervention has traditionally been preferred, recent reports suggest earlier intervention may improve outcomes. This study compares early (≤ 3 months) versus delayed (> 3 months) surgical management of PNIs following GSWs. We retrospectively reviewed patients treated at a tertiary academic center between 2000 and 2023 who underwent surgical intervention for PNIs secondary to GSWs. A systematic review was conducted following PRISMA guidelines. PubMed, Embase, and Web of Science databases were searched for clinical studies reporting outcomes of PNIs after GSWs. A proportional meta-analysis was performed using a random-effects model. Fifteen patients (mean age of 38.3 years) underwent surgical intervention at a mean of 4.6 months post-injury. Seven patients were treated early, and 7 underwent delayed intervention. At follow-up, improvement in motor and/or sensory function was observed in 5 out of 7 early cases and 6 out of 7 delayed cases (p = 1.000). Eleven studies published between 1995 and 2023, involving 271 nerves, were included in the meta-analysis. Functional improvement occurred in 58.7% (n = 63) of patients in the early group and 70.7% (n = 208) in the delayed group. Pain relief was achieved in 100% of early and 74.4% of delayed cases. Both our institutional case series and proportional meta-analysis demonstrated similar rates of successful function and pain outcomes between early and delayed surgical intervention groups. Importantly, no additional harm was observed with early intervention, suggesting it is a safe and reasonable option in appropriately selected patients.

Indexed as

Neurosurgical ProceduresPeripheral Nerve InjuriesWounds, GunshotAdultFemaleHumansMaleMiddle AgedRetrospective StudiesTime FactorsTime-to-TreatmentTreatment OutcomeCase seriesGunshot woundsMeta-analysisNerve repairOptimal timingPeripheral nerve injuriesSurgical intervention

Identifiers

PMID42599524

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.