Managing military penetrating brain injuries in the war zone: lessons learned

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Managing penetrating military brain injuries in a war zone setting is different than managing common civilian penetrating brain injuries. Triage, i.e., deciding on which patients to treat or not treat, and which to be flown back home, is essential to avoid wasting valuable limited resources. In this study the authors aim to identify reliable predictors of mortality and poor outcome to help develop a protocol for treating their patients in the battlefield. They also demonstrate all the lessons learned from their collective experience regarding some of the controversial management issues.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>This study was a retrospective review of 102 patients with penetrating military missile head injuries treated by the authors in various facilities in northern Sinai between 2011 and 2018. Patient demographics, clinical characteristics, imaging characteristics, postoperative complications, and Glasgow Outcome Scale (GOS) scores were recorded for each patient. Several variables associated with mortality and poor outcome that were derived from the literature were analyzed, in addition to variables obtained by direct observation by the authors over time.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>There were 50 patients (49%) with GOS score of 1 (death), 12 patients (11.8%) with GOS score of 2 (survivors in persistent vegetative state), and 40 survivors (39.2%) with varying degrees of disability on the last follow-up evaluation. The authors identified an anatomical danger zone that was found to predict mortality when traversed. Bilateral dilated fixed pupils and low Glasgow Coma Scale score on admission were also found to be independent predictors of mortality and poor outcome. Based on these findings, a protocol was developed for managing these patients in the war zone.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Managing military penetrating head injuries in the war zone is different than civilian gunshot head injuries encountered by most neurosurgeons in urban cities. The authors developed a simple protocol for managing military penetrating injuries in the war zone. They also describe important lessons learned from this experience.</jats:p></jats:sec>

Survival status and predictors of mortality among traumatic brain injury patients in an Ethiopian hospital: A retrospective cohort study

“…This finding is compatible with the pathophysiology and severity of this type of injury. Among the different TBIs, penetrating brain injury has a worse prognosis [36] . Among 169 (50.0%) TBI patients diagnosed with severe TBI (GCS ≤ 8) based on their GCS score at admission, the cumulative survival was 36.92%, and those for patients diagnosed with moderate and mild TBI patients were 46.6% and 75.03%, respectively.…”

“Mosaic Pattern” Foreign Bodies in Computed Tomography of the Head: A Specific Sign to Detect Tempered Glass-Related Head Injury

“…Craniocerebral perforating injuries have been reported by a variety of objects such as nails, metal, keys, pencil, gunshot injuries, chopstick, stone, pellet, wood, and power drill, but most commonly they are caused by knife injury. 1,2,[5][6][7] As per the literature, intracranial penetration by foreign bodies occur most commonly through the orbit, nose, or frontal sinus. 4,8,9 Rarely, penetrating injuries can occur due to glass of an automobile window.…”

Letter: Neurosurgical Triage in the Pandemic Era

“…Among the general predictors of poor prognosis are increased age, abnormal pupillary responses, low Glasgow Outcome Score, intracranial hemorrhage, subarachnoid hemorrhage (SAH), 8 and penetrating cranial injury. 6,9 Under normal circumstances, the highest quality of evidence is provided by data from carefully controlled studies. The objective of these studies is to remove confounds, such as comorbid infections, scarce resources, and nonideal treatment environments.…”