Safe management of paediatric penetrating head injury without a CT scanner: A strategy for humanitarian surgeons based on experience in southern Afghanistan

Abstract

INTRODUCTION In many parts of the world, access to a CT scanner remains almost non-existent, and patients with a head injury are managed expectantly, often with poor results. Recent military medical experience in southern Afghanistan using a well-equipped surgical facility with a CT scanner has provided new insights into safe surgical practice in resource-poor environments. METHODS All cases of children aged under 16 years with penetrating head injury who were treated in a trauma unit in southern Afghanistan by a single neurosurgeon between 2008 and 2010 were reviewed. Based on a previously published retrospective review, a clinical strategy aimed specifically at generalist surgeons is proposed for selecting children who can benefit from surgical intervention in environments with no access to CT scanners. RESULTS Fourteen patients were reviewed, of whom three had a tangential wound, 10 had a penetrating wound with retained fragments and one had a perforating injury. Two operations for generalist surgeons are described in detail: limited wound excision; and simple decompression of the intra-cranial compartment without brain resection or dural repair. CONCLUSIONS In resource-poor environments, clinically-based criteria may be used as a safe and appropriate strategy for selecting children who may benefit from relatively straightforward surgery after penetrating brain injury.

Management and Prognostic Factors of Penetrating Craniocerebral Wounds at One Teaching Hospital in Benin

“…Antibiotic therapy should be initiated on admission [25] [40] [41]. Antibiotic therapy is the best barrier to pre-or post-operative infection, which can be a cause of mortality [9] [44]. In our study our attitude was identical to that reported in the publications literature.…”

“…Location The location of PCCWs varied from study to study independently of the circumstances in which they occurred [23] [25] [31] [32]. However, the main loca-tions were frontal [13] [19] [33], parietal [9] [25] or frontaloparieto-temporal [7]. The position of the victims at the time of contact and the virulence of the aggression seem to be determining factors in the predominance of localizations.…”

“…Although little or not recommended in the published literature, standard radiography retains indications and contributes to the identification of metallic objects [10] [37] [38]. This imaging examination is still widely used in under-medical healthcare centers [9] [25] [26] [39].  Treatment…”