Brain Wounds and Their Treatment in VII Corps during Operation Desert Storm, February 20 to April 15, 1991

Carey, Michael E.; Joseph, Allen S.; Morris, William; McDonnell, Dennis E.; Rengachary, Setti S.; Smythies, Christopher; Williams, Joseph P.; Zimba, Frank A.

doi:10.1093/milmed/163.9.581

Cited by 28 publications

(21 citation statements)

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“…Cushing advocated watertight closure of all lining tissues following World War I, with subsequent schools of thought debating the necessity for full surgical debridement or limited closure. 51,52 The majority of penetrating cranial injuries from nails are low-velocity, single wounds. Despite their long projection, often crossing the midline, the associated parenchymal damage is frequently minimal.…”

Section: Surgerymentioning

confidence: 99%

“…This concurs with evidence from gunshot series reporting that outcomes were not measurably worse when aggressive debridement was not undertaken. [51][52][53] Dural closure from a single penetration site was not considered necessary in any of the cases; however this is clearly dependent on the size of the defect. 13 The timing of surgery is important as the majority of nailgun injuries are not associated with mass lesions which need urgent surgical removal.…”

Section: Surgerymentioning

confidence: 99%

“…This is in stark contrast to cranial gunshot injuries where 30-50% of patients suffer some form of seizure disorder. 38,41,[51][52][53] The current evidence for anti-seizure medication following head trauma, suggests institution of prophylactic antiepileptic drugs (AEDs) for approximately 7-10 days, commencing within the first 24 hours of a moderate to severe head injury. 61,62 Risk factors for early seizures have been shown to include GCS <10, supratentorial injury, dural penetration, skull fracture and subdural haematoma.…”

Section: Seizure Disordermentioning

confidence: 99%

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Penetrating head injury from nailguns: A case series from New Zealand

Winder

Monteith

Lightfoot

et al. 2008

Journal of Clinical Neuroscience

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Section: Surgerymentioning

confidence: 99%

Section: Surgerymentioning

confidence: 99%

Section: Seizure Disordermentioning

confidence: 99%

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Penetrating head injury from nailguns: A case series from New Zealand

Winder

Monteith

Lightfoot

et al. 2008

Journal of Clinical Neuroscience

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“…Only 356 Army personnel received injuries of any type from combat during Operation Desert Storm [39] and 62 were injured in combat in Somalia [40] . There were few TBI cases among those injured in combat in these operations [40,41] and they did not appear to have had an impact on TBI-related hospitalization rates in the Army in FY1991 or FY 1993. Ironically, Operation Desert Storm may be the reason why the Army's TBI-related hospitalization rates were lower in FY1991 than they were in FY1992 ( fig.…”

Section: Discussionmentioning

confidence: 94%

Hospital Admissions Associated with Traumatic Brain Injury in the US Army during Peacetime: 1990s Trends

Ivins¹,

Schwab²,

Baker³

et al. 2006

Neuroepidemiology

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Introduction: This paper examines 10-year trends in traumatic brain injury (TBI)-related hospitalization rates for active duty US Army personnel in the 1990s. It does this within the context of various factors, including enhanced injury prevention policies and changed hospital admission practices, that may have affected TBI hospitalization rates. It also compares TBI hospitalization rates in the Army to those from an age-comparable segment of the US civilian population over this time period. Methods: Crude (unadjusted) incidence rates for all active duty US Army personnel hospitalized with a TBI diagnosis from fiscal years (FY) 1990 to 1999 were calculated. Once the trends were identified, the percentage change in the overall rate, as well as the rates for different TBI severity levels, and in-hospital deaths from FY1990 and FY1999 were analyzed. Changes in age- and gender-specific rates as well as crude rates for cases with and without other injuries and cases treated in military and civilian hospitals were also analyzed. Rate ratios were used to compare aggregated 5-year TBI hospitalization rates in the Army to rates for civilians 17–49 years of age during the following time periods: 1990–1994 and 1995–1999. The rates used in the comparison were adjusted to control for differences in age and gender. Results: The overall incidence of TBI-related hospitalization in the Army decreased 75% from FY1990 to FY1999. The rates for all TBI severity levels decreased, but the rate for mild TBI decreased more than the rates for moderate and severe TBI. The rate of in-hospital deaths from TBI also decreased. Rates decreased similarly for males and females, across all age groups, as well as for cases with and without other injuries. TBI rates decreased for Army personnel treated in military hospitals but changed minimally for Army personnel treated in civilian hospitals. The Army’s TBI hospitalization rates were generally higher than civilian rates in the early 1990s but by the late 1990s, most of the Army’s rates were lower than or equal to the civilian rates. Conclusions: The incidence of TBI-related hospitalization in the active duty US Army decreased markedly (75%) during the 1990s. As a result, most of the Army’s TBI hospitalization rates were lower than civilian rates by the late 1990s. Effective injury prevention and changes in the Army population were two of the factors that likely contributed to the decrease in rates for all TBI severity levels, while changes in hospital admission practices likely contributed to the disproportionate decrease in the Army’s rates for mild TBI.

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“…At Walter Reed Army Medical Center, a state-of-the-art facility has been developed where computergenerated cranial flaps are made from methyl methacrylate. This approach has improved cosmetic results, shortened operation times, and reduced the need for subcutaneous placement of the bone flap with its attendant risks (22,(25)(26)(27)(28).…”

Section: Traumatic Brain Injurymentioning

confidence: 99%

Surgical Innovations Arising from the Iraq and Afghanistan Wars

2010

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The delivery of combat casualty care poses numerous challenges including austere conditions, limited supplies and medical personnel, and multiple simultaneous patients. However, the exigent circumstances of the battlefield compel the development of research and the advancement of adaptive, practical medical technologies to support and sustain military health. In Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), modern changes in medical management, coupled with improved protective gear and evacuation capabilities, have facilitated the highest survival rate in combat history.

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Brain Wounds and Their Treatment in VII Corps during Operation Desert Storm, February 20 to April 15, 1991

Abstract: (1) Although computed tomography is a useful diagnostic adjunct, its availability should not be a sine qua non for forward neurosurgery. (2) The current Kevlar helmet design appears successful.

Cited by 28 publications

References 0 publications

Penetrating head injury from nailguns: A case series from New Zealand

Penetrating head injury from nailguns: A case series from New Zealand

Hospital Admissions Associated with Traumatic Brain Injury in the US Army during Peacetime: 1990s Trends

Surgical Innovations Arising from the Iraq and Afghanistan Wars

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