Outcomes of surgical treatment of combat gunshot craniocerebral injuries

A.G. Sirko

Abstract


Background. In combat operations during local conflicts, the incidence of head injuries has increased significantly and makes about 24–27 %. Penetrating head and neck injuries come second in terms of incidence after limb da­mage. Purpose: to analyze the outcomes of surgical treatment for combat craniocerebral gunshot injuries. Materials and me­thods. The study is based on comprehensive examination and treatment of 132 patients with craniocerebral gunshot injuries (CGIs) in I.I. Mechnikov Dnipropetrovsk Regional Clinical Hospital in 2014–2015. The average age of patients was 33.2 ± 8.8 years. 93 (70.45 %) patients were diagnosed with penetrating craniocerebral gunshot injury, 39 (29.55 %) had non-penetrating CGIs. In 115 (87.12 %) CGI patients, the injury was caused by fragments of mine explosive devices; in 17 (12.88 %) patients — by firearm bullets. Two (1.52 %) patients were in satisfactory condition at admission, 32 (24.24 %) had moderate injury, 63 (47.73 %) — severe injury, 28 (21.21 %) — extremely severe injury, and 7 (5.3 %) patients were in terminal condition. Patients’ mortality analysis was performed and treatment outcomes were assessed using Glasgow Coma Scale (GCS) 1 and 6 months after the injury. Results. Based on the results of the study, 16 patients with combat CGI died. Posto­perative mortality was 12.1 %. All persons with non-penetra­ting CGI (n = 39) survived. 16 (17.2 %) of 93 patients with penetrating CGI died. Seven (41.2 %) out of 17 patients with bullet injury and 5 (4.3 %) out of 115 patients with mine-blast injury died. Mortality in penetrating ricochet CGIs was 7.4 %; with non-perforating CGIs — 14.8 %; perforating CGIs — 33.3 %; tangential CGIs — 100 %. All patients who were hospitalized fully conscious or with a moderate clouding of consciousness survived. Mortality of patients with penetrating CGI who were hospitalized with a severe clouding of consciousness was 7.1 %; semicoma (GCS 9–10) — 11.1 %; grade I coma (GCS 6–8) — 10.5 %; grade II coma (GCS 4–5) — 62.5 %; grade III coma (GCS 3) — 100 %. Primary severe brain injuries caused death of 14 (87.5 %) patients; 2 (12.5 %) patients died because of septic complications. In a study conducted 1 month after the combat craniocerebral injury, there was not a single patient in the vegetative state. A favorable result of treatment 1 month after the injury was noted in 38 (97.4 %) patients with non-penetrating craniocerebral wounds, adverse — in 1 (2.6 %). Favorable treatment outcomes were noted in 64 (68.8 %) of wounded persons with penetrating craniocerebral wounds, adverse — in 29 (31.2 %). According to the results of the study, it was found that the higher the kinetic energy of the shell, the more severe the damage to the brain. Gunshot craniocerebral wounds had a higher degree of severity of injury, the mortality rate at them was quite high. The best treatment outcomes were obtained with non-penetrating craniocerebral wounds, in which, according to the results of the study, there were no lethal outcomes. On the contrary, in penetrating craniocerebral wounds, mortality was 17.2 %. Conclusions. Bullet CGIs appeared heavier than missile injuries. Bullet CGIs caused death almost 10 times more often than mine-blast injuries. Morta­lity also depended on the type of CGI, being higher in case of ricochet or perforating skull or brain injuries. Critical brain structure damage was the main cause of death of CGI patients. Evacuation to the nearest hospital, where a neurosurgeon is available, in order to avoid diagnostic delays and to initiate cerebral resuscitation increase the chances of complete recovery of the victim. Best results of treatment in wounds of the skull and brain are achieved when the early surgical treatment for skull and brain injuries is performed by a neurosurgeon at the stage of specialized medical care in neurosurgical department of the hospital.

Keywords


combat gunshot injuries; craniocerebral injuries; surgical treatment; treatment outcomes; mortality; bullet injuries; missile mine-blast injuries

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DOI: https://doi.org/10.22141/2224-0586.8.87.2017.121328

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