Civilian penetrating gunshot injury to the neurocranium in Enugu

Abstract

Introduction:Civilian penetrating gunshot injuries to the neurocranium are no longer uncommon in Nigeria. Such injuries are however poorly reported. They are associated with poor outcome and, at close range, are frequently fatal, especially when inflicted by high-velocity weapons. Prompt transfer to neurosurgical service and urgent intervention may improve outcome in those that are not mortally wounded.Materials and Methods:Fifty-two patients with civilian penetrating gunshot wounds seen over a 10-year period (2004–2014) at the University of Nigeria Teaching Hospital and Memfys Hospital for Neurosurgery Enugu were reviewed retrospectively, and their data were analyzed to evaluate factors that impacted on outcome. Only patients with clinical and imaging evidence of cranial gunshot injuries who reached hospital alive were included in the study. The overall mortality and Glasgow outcome score were analyzed.Results:Fifty-two patients with isolated civilian penetrating gunshot wounds were identified (M:F = 7.7:1); mean (standard deviation) age was 32.8 (11.9) years. There was a high correlation (0.983) between the sex of the patients and the outcome. The overall mortality was 30.8%, whereas the mortality for patients with postresuscitation Glasgow coma scale (GCS) score ≤8 was 57%, as against 12.9% in those in whom postresuscitation GCS was >8; meaning that 87.1% of patients in whom postresuscitation GCS was >8 survived. Thirty-one patients (59.6%) had papillary abnormalities. Majority of patients with monohemispheric lesions survived while all those with diencephalic, transventricular, and posterior fossa involvement had 100% mortality.Conclusions:Admitting GCS and bullet trajectory were predictive of outcome.

Gunshot Injuries: Patterns, Presentations, and Outcomes of Civilian Hospital Experiences in a Developing Country Setting

“…Interestingly, our numbers, with regard to gunshot injuries in pediatric patients, are similar to a report from South Africa [14]. Like other previous studies [6,9,13,[15][16][17], our data revealed that males were disproportionately affected, and this could be explained by their outdoor presence most of the time because of societal gender roles.…”

Gunshot injuries: experience in a tertiary health facility in the Niger Delta Region of Nigeria

“…This was made up of 37 males and 4 females giving a male: female ratio of 9.25: 1. The finding of a large male preponderance in this study has been the general trend in the literature over the years [ 2 , 6 , 13 , 15 , 16 , 18 , 22 , 24 , 27 - 29 ]. The reasons for this trend have been attributed by many authors to the fact that males are usually the bread winners, take more risks, are more outgoing and thus more involved in the activities that predispose to GSI including wars, armed robbery, communal clashes, political thuggery etc.…”