Penetrating civilian craniocerebral gunshot wounds: A protocol of delayed surgery

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dc.contributor.authorLiebenberg W.A.
dc.contributor.authorDemetriades A.K.
dc.contributor.authorHankins M.
dc.contributor.authorHardwidge C.
dc.contributor.authorHartzenberg B.H.
dc.date.accessioned2011-05-15T16:17:30Z
dc.date.available2011-05-15T16:17:30Z
dc.date.issued2005
dc.description.abstractOBJECTIVE: Several factors have led to our unique approach of delayed definitive debridement. We wanted to evaluate the effectiveness of our management and compare it with the existing data in the literature. METHODS: We retrospectively reviewed the records of 194 patients presenting between January 1996 and October 2003 with penetrating craniocerebral gunshot wounds. After exclusion criteria, 125 patients qualified. RESULTS: Of the patients, 88.8% were male. The mean age was 24.9 ± 10.9 years. In 70.4% of patients, the presenting Glasgow Coma Scale (GCS) score was 3 to 8. Only 38 (30.4%) of the 125 patients survived, with poor outcome in 2 and good outcome in 36. Bilaterally fixed and dilated pupils and bihemispheric tract on computed tomographic scan were significantly related to poor outcome. There were 49 surgical procedures performed on 27 of the patients, with a mortality rate of 7.4%. Of the 38 survivors, 13 underwent no surgery. Average time to surgery was 11.04 days. Total rate of infection was 8%, and it did not influence outcome. No patient presenting with a GCS score of 3 or 4 survived. Seventeen patients attended follow-up, for a total of 3609 days (average, 212 d) and very few late complications. CONCLUSION: Our supportive care of patients is not optimal. We should have saved more of our patients who presented with GCS scores of 14 and 15 who subsequently died. We have been able to report unconventionally late surgical management of two-thirds of survivors, with no surgery in one-third of survivors. Despite a high rate of infectious complications, infection did not lead to death or disability. Our protocol rarely leads to patients surviving in a permanently vegetative state. In the future, we would perform early surgery for patients who present awake and continue our current management for poor-grade patients. In this way, we will improve the number of good outcomes without increasing the population of severely damaged and dependent survivors.
dc.description.versionReview
dc.identifier.citationNeurosurgery
dc.identifier.citation57
dc.identifier.citation2
dc.identifier.issn0148396X
dc.identifier.other10.1227/01.NEU.0000166662.77797.EC
dc.identifier.urihttp://hdl.handle.net/10019.1/14246
dc.subjectadult
dc.subjectautonomic dysfunction
dc.subjectbrain injury
dc.subjectclinical protocol
dc.subjectcomputer assisted tomography
dc.subjectdeath
dc.subjectdebridement
dc.subjectdisability
dc.subjectfemale
dc.subjectfollow up
dc.subjectGlasgow coma scale
dc.subjectgunshot injury
dc.subjecthemisphere
dc.subjecthuman
dc.subjectinfection
dc.subjectinjury scale
dc.subjectmajor clinical study
dc.subjectmale
dc.subjectmortality
dc.subjectmydriasis
dc.subjectoperation duration
dc.subjectpenetrating trauma
dc.subjectpostoperative complication
dc.subjectpriority journal
dc.subjectretrospective study
dc.subjectreview
dc.subjectsurgical approach
dc.subjectsurvival
dc.subjecttreatment outcome
dc.subjectAdolescent
dc.subjectAdult
dc.subjectCraniocerebral Trauma
dc.subjectFemale
dc.subjectGlasgow Coma Scale
dc.subjectHead Injuries, Penetrating
dc.subjectHumans
dc.subjectMale
dc.subjectOutcome and Process Assessment (Health Care)
dc.subjectRetrospective Studies
dc.subjectTime Factors
dc.subjectWounds, Gunshot
dc.titlePenetrating civilian craniocerebral gunshot wounds: A protocol of delayed surgery
dc.typeReview
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