Combat Gunshot Head Injury
Iraqi Postgraduate Medical Journal,
2017, Volume 16, Issue 1, Pages 72-78
Combat Gunshot Head Injury is an increasingly important issue with all its drawbacks on the health care system .
This study presents an evaluation of traumatic brain injury caused by gunshots and discusses possible predictive factors for the outcome of surgical intervention.
PATIENTS AND METHOD:
A prospective study performed at Al Shaheed Mohammed Al Majed hospital, Samarra, Saladin, Iraq consisted of 60 patients who underwent surgery for penetrating TBI over a 1 year period (2015 – 2016). All injuries were caused by gunshot.
Mean patients’ age was 31.5 years. The Glasgow Coma Scale (GCS) score on admission was > 8 in 43 patients (71.7%) and ≤ 8 in 17 patients (28.3%). Commonest site of brain injury is the frontal lobe (28%). Ballistic trajectory through brain affects the post operative outcome with good outcome (50%) in the anteroposterior bullet trajectory plane. 5 patients (8.3%) died despite surgical management.
Admission GCS score, bullet trajectory and ventricular involvement are the most powerful prognostic indicator with a score of more than 8, no ventricular hemorrhage, anteroposterior trajectory of bullet and lesions limited to a single lobe of the brain, have improved surgical outcomes. Early and less invasive surgery in conjunction with short transportation time to the hospital could decrease mortality rates.
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