Traumatic Brain Injury due to Missile Wounds in the North of Palestine: A Single Institution's Experience with 520 Consecutive Civilian Patients.

Traumatic Brain Injury due to Missile Wounds in the North of Palestine: A Single Institution's Experience with 520 Consecutive Civilian Patients.

World Neurosurg. 2018 May 05;:

Authors: Darwazeh R, Darwazeh M, Sbeih I, Yan Y, Wang J, Sun X

Abstract
BACKGROUND: Literature about traumatic brain injury (TBI) due to missile wounds is rather scanty. Therefore, we availed ourselves the opportunity to shed some light on this dark field.
METHODS: This retrospective study was carried out, between September-2000 to September-2010, on 520 civilian patients who sustained TBI due to missiles in the north of Palestine. Thorough detailed analyses of patients' admission Glasgow coma scale (GCS) scores, pupillary reactivity to light, site and mode of injuries, type of injurious agents, missile trajectory, method of treatment, radiological manifestations, complications and outcome were made. The GCS score was employed to assess the level of consciousness, whereas the Glasgow outcome scale (GOS) score was used to evaluate the outcome.
RESULTS: Patients' age ranged from 6 months to 75 years. Only 50 (9.6%) patients were females. Patients hurt by metallic bullets, rubber bullets and shrapnel from bomb explosions were 351, 139 and 30, respectively. Out of 384 patients who were treated conservatively, no mortality was detected, while out of 136 surgically treated patients, 66 (48.5%) patients succumbed to their injuries. Although our management of patients was not optimal due to many factors, the overall mortality rate was 12.7% (n=66).
CONCLUSIONS: The promptness of transport to the hospital was a decisive factor with a major bearing on decreasing mortality rates. Brain computed tomography (CT) scan was invaluable in the diagnosis and follow-up of our patients. Additionally, age, pupillary reactivity, admission GCS score, missile trajectory, ventricular involvement, site and mode of injury were important prognostic factors.

PMID: 29738860 [PubMed - as supplied by publisher]

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