Management of War-related Ballistic Craniocerebral Injuries in a French Role 3 Hospital During the Afghan Campaign.

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Management of War-related Ballistic Craniocerebral Injuries in a French Role 3 Hospital During the Afghan Campaign.

World Neurosurg. 2017 Feb 27;:

Authors: Dagain A, Aoun O, Bordes J, Roqueplo C, Joubert C, Esnault P, Sellier A, Delmas JM, Desse N, Fouet M, Pernot P, Dulou R

Abstract
INTRODUCTION: France deployed to Afghanistan from 2001 to 2014 within the International Security and Assistance Force. A French role 3 hospital was built in 2009 in the vicinity of Kabul International Airport (KaIA). The objectives of this study were to describe the epidemiology, management and outcome of war-related craniocerebral injuries during the Afghan campaign in a French role 3 hospital.
METHODS: From March 1, 2010 to September 30, 2012, we conducted a retrospective descriptive study in Kabul, Afghanistan. All patients presenting with a ballistic craniocerebral injury to the KaIA role 3 hospital were included.
RESULTS: We analyzed 48 records. Mean age was 21.9 years (1-46) with a 37/11 sex ratio and a majority of Afghans (n=41). Civilians represented 64.6% (n=31) of casualties. On the battlefield, mean GCS was 9.4 [3-15]. Upon arrival at the KaIA field hospital, 20 out of the 48 patients were hemodynamically unstable. All patients underwent a full-body computed tomography scan. The majority of our casualties had associated injuries. Neurosurgery was indicated for 42 (87.5%) patients. The surgery consisted of wound debridement plane by plane associated with decompressive craniectomy (N=11), debridement craniectomy (N=19), and craniotomy (N=12). 32.4% wounded died on the point of injury, 8.4% at the emergency department, and 16.9% after surgery.
CONCLUSION: War casualties with ballistic head injuries were predominantly multitraumatized patients with hemodynamic compromise requiring neurosurgical damage control management and multidisciplinary care. The neurosurgeon has thus an essential role to play.

PMID: 28254598 [PubMed - as supplied by publisher]

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