Rami Darwazeh1, Mazhar Darwazeh2, Ibrahim Sbeih3, Yi Yan4, Jianmin Wang5, Xiaochuan Sun6. 1. Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China; Department of Neurosurgery, Specialized Arab Hospital, Nablus, Palestine. 2. Department of Neurosurgery, Specialized Arab Hospital, Nablus, Palestine. 3. Department of Neurosurgery, Ibn Al-Haytham Hospital, Amman, Jordan. 4. Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China. 5. Institute of Surgery Research, Daping Hospital-Third Military Medical University, Chongqing, People's Republic of China. 6. Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China. Electronic address: 779203374@qq.com.
Abstract
BACKGROUND: Literature about traumatic brain injury caused by missile wounds is scanty. We shed some light on this field. METHODS: This retrospective study was carried out, between September 2000 and September 2010, on 520 civilian patients who sustained traumatic brain injury from missiles in the north of Palestine. Thorough detailed analyses were made 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, radiologic manifestations, complications, and outcome. The GCS score was used to assess the level of consciousness, whereas the Glasgow Outcome Scale score was used to evaluate the outcome. RESULTS: Patients' age ranged from 6 months to 75 years. Only 50 (9.6%) patients were female. Patients injured by metallic bullets, rubber bullets, and shrapnel from bomb explosions numbered 351, 139, and 30, respectively. Of 384 patients who were treated conservatively, no mortality was detected, whereas of 136 surgically treated patients, 66 (48.5%) died of their injuries. Although our management of patients was not optimal because of many factors, the overall mortality was 12.7% (n = 66). CONCLUSIONS: The promptness of transport to hospital was a decisive factor with a major bearing on decreasing mortality. Brain computed tomography was invaluable in the diagnosis and follow-up of our patients. In addition, age, pupillary reactivity, admission GCS score, missile trajectory, ventricular involvement, and site and mode of injury were important prognostic factors.
BACKGROUND: Literature about traumatic brain injury caused by missile wounds is scanty. We shed some light on this field. METHODS: This retrospective study was carried out, between September 2000 and September 2010, on 520 civilian patients who sustained traumatic brain injury from missiles in the north of Palestine. Thorough detailed analyses were made 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, radiologic manifestations, complications, and outcome. The GCS score was used to assess the level of consciousness, whereas the Glasgow Outcome Scale score was used to evaluate the outcome. RESULTS:Patients' age ranged from 6 months to 75 years. Only 50 (9.6%) patients were female. Patients injured by metallic bullets, rubber bullets, and shrapnel from bomb explosions numbered 351, 139, and 30, respectively. Of 384 patients who were treated conservatively, no mortality was detected, whereas of 136 surgically treated patients, 66 (48.5%) died of their injuries. Although our management of patients was not optimal because of many factors, the overall mortality was 12.7% (n = 66). CONCLUSIONS: The promptness of transport to hospital was a decisive factor with a major bearing on decreasing mortality. Brain computed tomography was invaluable in the diagnosis and follow-up of our patients. In addition, age, pupillary reactivity, admission GCS score, missile trajectory, ventricular involvement, and site and mode of injury were important prognostic factors.