Anatomic Distribution of Bullet Head Injuries in Combat Fatalities

Ran, Yuval; Yagudaev, Michael; Kosashvili, Yona; Yegorov, Yana; Ganor, Ori; Ash, Nachman; Hirschhorn, Gil

doi:10.1097/ta.0b013e3181e4ec69

Cited by 10 publications

(7 citation statements)

References 5 publications

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“…The mortality was significantly lower in the military DoDTR population (23% vs 41%, P < 0.001). Military patients who survived had a discharge mean GCS of 14 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). However, 32 (32.7%) of them had a discharge GCS < 9.…”

Section: Resultsmentioning

confidence: 99%

“…Pannell et al2 in an analysis of Canadian soldiers killed in Afghanistan, reported GSW were the second leading mechanisms of injury causing death and neurological injury after hemorrhage. Analysis of Israeli Defense Forces combat fatalities during the years 2000 to 2004, the Second Lebanon War (2006), and Operation Cast Lead (2009) reported that GSW to the head comprised a substantial fraction of combat injuries and a major cause of death in the battlefield 3. In a review of 369 United States Special Operations Command battle-injured fatalities, GSW accounted for 39.8% and brain injuries in 31.6% of deaths 4.…”

Section: Discussionmentioning

confidence: 99%

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Therapeutic Interventions and Outcomes in Civilian and Military Isolated Gunshot Wounds to the Head

et al. 2022

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Objective: The purpose of this study was to compare therapeutic strategies and outcomes, following isolated gunshot wounds of the head, between military and civilian populations. Background: Recent military conflicts introduced new concepts in trauma care, including aggressive surgical intervention in severe head trauma. Methods: This was a cohort-matched study, using the civilian Trauma Quality Improvement Program (TQIP) database of the American College of Surgeons (ACS) and the Department of Defense Trauma Registry (DoDTR), during the period 2013 to 2016. Included in the study were patients with isolated gunshots to the head. Exclusion criteria were dead on arrival, civilians transferred from other hospitals, and patients with major extracranial associated injuries (body area Abbreviated Injury Scale >3). Patients in the military database were propensity score–matched 1:3 with patients in the civilian database. Results: A total of 136 patients in the DoDTR database were matched for age, sex, year of injury, and head Abbreviated Injury Scale with 408 patients from TQIP. Utilization of blood products was significantly higher in the military population (P<0.001). In the military group, patients were significantly more likely to have intracranial pressure monitoring (17% vs 6%, P<0.001) and more likely to undergo craniotomy or craniectomy (34% vs 13%, P<0.001) than in the civilian group. Mortality in the military population was significantly lower (27% vs 38%, P=0.013). Conclusions: Military patients are more likely to receive blood products, have intracranial pressure monitoring and undergo craniectomy or craniotomy than their civilian counterparts after isolated head gunshot wounds. Mortality is significantly lower in the military population. Level of Evidence: Level III—therapeutic.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Therapeutic Interventions and Outcomes in Civilian and Military Isolated Gunshot Wounds to the Head

et al. 2022

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“…Four papers were identified that required translation (French and Russian). Following screening, 10 papers1 2 5 7 11 14 – 18 and two books had pertinent information when analysed 6 8. An internet search identified 24 additional publications, only two of which had pertinent information to those three questions,9 19 and that had not been found in the database searching.…”

Section: Resultsmentioning

confidence: 99%

Defining combat helmet coverage for protection against explosively propelled fragments

et al. 2013

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We recommend relating the margins of the brain to three identifiable anatomical landmarks (nasion, external auditory meatus and superior nuchal line), which can in turn be related to the coverage provided by the helmet. Early assessments using an anatomical mannequin indicate that the current helmet covers the majority of the brain and brainstem from projectiles with a horizontal trajectory but not from ones that originate from the ground. Protection from projectiles with ground-originating trajectories is reduced by helmets with increased stand-off from the skin. Future helmet coverage assessments should use a finite element numerical modelling approach with representative material properties assigned to intracranial anatomical structures to enable differences in projectile trajectory and helmet coverage to be objectively compared.

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“…2 In the combat zone, penetrating missile wounds to the head are usually deliberate, not accidental, and can lead to increased mortality and morbidity. 3,4 In this particular case, the event had little to do with war and more to do with competitive sports, civic pride, and subsequent celebration. The local soccer team happened to be the Iraqi national team, playing in Baghdad.…”

mentioning

confidence: 91%

Image of the Month—Diagnosis

2012

Arch Surg

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Anatomic Distribution of Bullet Head Injuries in Combat Fatalities

Abstract: These findings imply that gun-shot entry wounds to the head are unevenly distributed. A partially bullet-proof protective helmet may prevent a substantial fraction of injuries (and fatalities) without a significant weight addition to the helmet.

Cited by 10 publications

References 5 publications

Therapeutic Interventions and Outcomes in Civilian and Military Isolated Gunshot Wounds to the Head

Therapeutic Interventions and Outcomes in Civilian and Military Isolated Gunshot Wounds to the Head

Defining combat helmet coverage for protection against explosively propelled fragments

Image of the Month—Diagnosis

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