Mortality Caused by War Wounds to the Head and Neck Encountered at the Slavonski Brod Hospital during the 1991–1992 War in Croatia

Abstract

From July 1, 1991, until January 1, 1993, a total of 7,720 patients (soldiers and civilians) with war wounds were treated at Dr. Josip Bencević General Hospital in Slavonski Brod, Croatia. Treatment was provided for 7,043 patients, whereas 677 individuals (8.8%) killed in action (KIA) were examined at the Forensic Department. There were 1,456 patients (18.9%) with head and neck wounds: 1,176 soldiers and 280 civilians. The mortality rate was significantly greater in patients with head and neck wounds (N = 271, 40.0%) than in those with injuries to the thorax (N = 163, 24.1%) and abdomen (N = 62, 9.2%; p < 0.01 for both). During treatment, 188 patients (2.4%) died of wounds (DOW). The DOW mortality was 5.2% (61 of 1,185), 4.0% (41 of 1,026), and 2.9% (25 of 867) for wounds of the head and neck, thorax, and abdomen, respectively. There was no significant difference in the mortality rate between head and neck and thorax wounds: however, the former exceeded the mortality rate recorded for abdominal wounds (p < 0.05). No significant differences were observed between soldiers and civilians with head and neck injuries either in the KIA (205 of 1,176, 17.4% vs. 66 of 280, 23.5%, respectively) or the DOW group (51 of 971, 5.3% vs. 10 of 214, 4.7%, respectively. According to the mechanism of head and neck wounding, there were 1,046 explosive (71.9%), 226 gunshot (15.5%), and 184 other (12.6%) wounds. Lethal outcome was significantly more common in gushot than in explosive wounds (79 of 226, 35% vs. 243 of 1,046, 23.2%; p < 0.01). The proportion of head and neck injuries did not differ significantly from literature reports on recent conventional wars. The site of wounding, i.e., at the battlefield or elsewhere, had no effect on the prognosis of wounds to the head and neck. Gunshot head and neck injuries showed a significantly higher mortality rate.

Neurologic Recovery after Penetrating Craniocerebral War Injury

“…Inferior protective equipment (helmets and bullet-proof jackets) resulted in injuries inflicted by explosive projectiles and devices in more than two thirds of Croatian civilians and soldiers [7,8,18,19]. However, there was relatively rapid and effective management of Puntarić /Soldo-Butković/Vladetić/ Prgomet the wounded as almost 5 out of every 6 wounded soldiers survived [18,19].…”

“…Traumatic craniocerebral injuries account for about 20-30% of all war-related head injuries (3-13% of all war injuries) [4][5][6][7][8]. Closed craniocerebral injuries usually caused by traffic accidents are commoner in peacetime [9].…”

“…Closed craniocerebral injuries usually caused by traffic accidents are commoner in peacetime [9]. Penetrating craniocerebral explosive and gunshot injuries are commoner in wartime [4,7,8,10].…”