Civilian Craniocerebral Gunshot Injuries in a Developing Country: Presentation, Injury Characteristics, Prognostic Indicators, and Complications

Khan, Muhammad Babar; Kumar, Rajesh; Irfan, Furqan B.; Irfan, Affan; Bari, Muhammad Ehsan

doi:10.1016/j.wneu.2013.01.026

Cited by 26 publications

(19 citation statements)

References 22 publications

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“…6,7,[9][10][11][12]14,16,18,21,22 Martins et al reported a 96.2% mortality rate for bihemispheric injuries and a 100% mortality rate for posterior fossa injuries.…”

Section: Bullet Trajectorymentioning

confidence: 99%

Predictors of outcome in civilians with gunshot wounds to the head upon presentation

Gressot

Chamoun

Patel

et al. 2014

JNS

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Object Prediction of outcome from initial presentation after a gunshot wound to the head (GSWH) is essential to further clinical decision making. The authors' goals are to report the survival and functional outcomes of these patients, to identify prognostic factors, and to propose a scoring system that can predict their outcome. Methods The records of 199 patients admitted with a GSWH with dural penetration between 1990 and 2008 were retrospectively reviewed. The inclusion criterion was a CT scan available for review. Patients declared brain dead on presentation were excluded, which yielded a series of 119 patients. Statistical analysis was performed using a logistic regression model. Results Fifty-eight (49%) of the 119 patients died. Twenty-three patients (19%) had a favorable outcome defined as a 6-month Glasgow Outcome Scale (GOS) score of moderate disability or good recovery, 35 (29%) had a poor outcome (GOS of persistent vegetative state or severe disability), and 3 (3%) were lost to follow-up. Significant prognostic factors for mortality were age older than 35 years, nonreactive pupils, bullet trajectory of bihemispheric (excluding bifrontal), and posterior fossa involvement compared with unihemispheric and bifrontal. Factors that were moderately associated with higher mortality included intracranial pressure (ICP) above 20 mm Hg and Glasgow Coma Scale (GCS) score at presentation of 3 or 4. Upon multivariate analysis, the significant factors for mortality were bullet trajectory and pupillary response. Variables found to be significant for good functional outcome were admission GCS score greater than or equal to 5, pupillary reactivity, and bullet trajectory of unihemispheric or bifrontal. Factors moderately associated with good outcome included age of 35 years or younger, initial ICP 20 mm Hg or lower, and lack of transventricular trajectory. In the multivariate analysis, significant factors for good functional outcome were bullet trajectory and pupillary response, with age moderately associated with improved functional outcomes. The authors also propose a scoring system to estimate survival and functional outcome. Conclusions Age, pupils, GCS score, and bullet trajectory on CT scan can be used to determine likelihood of survival and good functional outcome. The authors advocate assessing patients based on these parameters rather than pronouncing a poor prognosis and withholding aggressive resuscitation based upon low GCS score alone.

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“…6,7,[9][10][11][12]14,16,18,21,22 Martins et al reported a 96.2% mortality rate for bihemispheric injuries and a 100% mortality rate for posterior fossa injuries.…”

Section: Bullet Trajectorymentioning

confidence: 99%

Predictors of outcome in civilians with gunshot wounds to the head upon presentation

Gressot

Chamoun

Patel

et al. 2014

JNS

View full text Add to dashboard Cite

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“…As mentioned previously, one of the first challenges in managing patients with CGI is determining whether any intervention will result in an outcome that is acceptable to the patient, family, and society, 16) in this circumstance, the postresuscitation GCS is the most reliable and significant clinical predictor of outcome to date. 3 28 40 51 55) The series reported by Khan et al 36) confirmed the strong correlation between postresuscitation GCS score and outcome. Interestingly, they found no difference in outcome between penetrating (no exit) and perforating (entrance and exit) wounds.…”

Section: Mortality and Prognosismentioning

confidence: 62%

Management of Craniocerebral Gunshot Injuries: A Review

Alvis-Miranda

Villafañe

Rojas

et al. 2015

Korean J Neurotrauma

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Craniocerebral gunshot injuries (CGI) are increasingly encountered by neurosurgeons in civilian and urban settings. Unfortunately this is a prevalent condition in developing countries, with major armed conflicts which is not very likely to achieve a high rate of prevention. Management goals should focus on early aggressive, vigorous resuscitation and correction of coagulopathy; those with stable vital signs undergo brain computed tomography scan. Neuroimaging is vital for surgical purposes, especially for determine type surgery, size and location of the approach, route of extraction of the foreign body; however not always surgical management is indicated, there is also the not uncommon decision to choose non-surgical management. The treatment consist of immediate life salvage, through control of persistent bleeding and cerebral decompression; prevention of infection, through extensive debridement of all contaminated, macerated or ischemic tissues; preservation of nervous tissue, through preventing meningocerebral scars; and restoration of anatomic structures through the hermetic seal of dura and scalp. There have been few recent studies involving penetrating craniocerebral injuries, and most studies have been restricted to small numbers of patients; classic studies in military and civil environment have identified that this is a highly lethal or devastating violent condition, able to leave marked consequences for the affected individual, the family and the health system itself. Various measures have been aimed to lower the incidence of CGI, especially in civilians. It is necessarily urgent to promote research in a neurocritical topic such as CGI, looking impact positively the quality of life for those who survive.

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“…The major cause of TBI in youth is road traffic accidents (40,41); while in children, it is falls from a certain height (50,51). Another rapidly increasing cause of TBI in Pakistan is the penetrating brain injuries (PBIs) occurring due to gunshots or other firearms (38,(52)(53)(54). The increase in such injuries is attributed mainly with the increase in level of violence and terrorism due to bomb blasts and suicidal bomb attacks (54) (Note: We expect this rate of PBI occurrence to have slowed following much improved security condition since 2016, however, no recent formal study has been published to provide such statistics), These injuries are broadly divided into three categories (52); (1) Tangential with gunshots glancing off the skull without entering, (2) Penetrating with gunshots entering the skull, and (3) Perforating with gunshot entering and exiting the skull.…”

Section: Incidence Of Brain Injury and Management In Pakistanmentioning

confidence: 99%

Brain Injury and Dementia in Pakistan: Current Perspectives

et al. 2020

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Alzheimer's disease (AD) is the most common form of dementia, accounting for 50-75% of all cases, with a greater proportion of individuals affected at older age range. A single moderate or severe traumatic brain injury (TBI) is associated with accelerated aging and increased risk for dementia. The fastest growth in the elderly population is taking place in China, Pakistan, and their south Asian neighbors. Current clinical assessments are based on data collected from Caucasian populations from wealthy backgrounds giving rise to a "diversity" crisis in brain research. Pakistan is a lower-middle income country (LMIC) with an estimated one million people living with dementia. Pakistan also has an amalgamation of risk factors that lead to brain injuries such as lack of road legislations, terrorism, political instability, and domestic and sexual violence. Here, we provide an initial and current assessment of the incidence and management of dementia and TBI in Pakistan. Our review demonstrates the lack of resources in terms of speciality trained clinician staff, medical equipment, research capabilities, educational endeavors, and general awareness in the fields of dementia and TBI. Pakistan also lacks state-of-the-art assessment of dementia and its risk factors, such as neuroimaging of brain injury and aging. We provide recommendations for improvement in this arena that include the recent creation of Pakistan Brain Injury Consortium (PBIC). This consortium will enhance international collaborative efforts leading to capacity building for innovative research, clinician and research training and developing databases to bring Pakistan into the international platform for dementia and TBI research.

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Civilian Craniocerebral Gunshot Injuries in a Developing Country: Presentation, Injury Characteristics, Prognostic Indicators, and Complications

Cited by 26 publications

References 22 publications

Predictors of outcome in civilians with gunshot wounds to the head upon presentation

Predictors of outcome in civilians with gunshot wounds to the head upon presentation

Management of Craniocerebral Gunshot Injuries: A Review

Brain Injury and Dementia in Pakistan: Current Perspectives

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