Mortality and Functional Outcome Predictors in Combat-Related Penetrating Brain Injury Treatment in a Specialty Civilian Medical Facility

Abstract

Introduction The combined use of new types of weapons and new types of personal protective equipment has led to changes in the occurrence, nature, and severity of penetrating brain wounds. The availability of modern equipment, methods of treatment, and trained medical personnel in a civilian hospital, as well as advanced specialty medical care, has improved treatment outcomes. There have been a limited number of publications regarding analysis and predictors of treatment outcomes in patients with combat-related penetrating brain injury in contemporary armed conflicts. The purpose of this study was to analyze the results of surgical treatment of patients with penetrating brain injury and to identify significant outcome predictors in these patients. Materials and Methods This was a prospective analysis of penetrating brain injury in patients who were admitted to Mechnikov Dnipropetrovsk Regional Clinical Hospital, Ukraine, from May 9, 2014, to December 31, 2017. All wounds were sustained during local armed conflict in Eastern Ukraine. The primary outcomes of interest were mortality rate at 1 month and Glasgow Outcome Scale score at 12 months after the injury. Results In total, 184 patients were identified with combat-related brain injury; of those, 121 patients with penetrating brain injury were included in our study. All patients were male soldiers with a mean age of 34.1 years (standard deviation [SD], 9.1 years). Mean admission Glasgow Coma Scale score was 10 (SD, 4), and mean admission Injury Severity Score was 27.7 (SD, 7.6). Mortality within 1 month was 20.7%, and intracranial purulent-septic complications were diagnosed in 11.6% of the patients. Overall, 65.3% of the patients had favorable outcome (good recovery or moderate disability) based on Glasgow Outcome Scale score at 12 months after the injury. The following were predictors of mortality or poor functional outcome at 1 year after the injury: low Glasgow Coma Scale score on admission, gunshot wound to the head, dural venous sinuses wound, presence of intracerebral hematomas, intraventricular and subarachnoid hemorrhage accompanied by lateral or axial dislocation, and presence of intracranial purulent-septic complications. Conclusions Generally, combat-related penetrating brain injuries had satisfactory treatment outcomes. Treatment outcomes in this study were comparable to those previously reported by other authors in military populations and significantly better than outcomes of peacetime penetrating brain injury treatment.

Patterns and Outcomes of Patients with Penetrating Head Injury

“…In the current study, the GCS on admission was statistically significant lower in the non-survivor group as compared to the survivor group (p < 0.001). Our results come in agreement with Sirko et al (23) who showed that GCS score on admission is a predictor. Mortality was 44.7% in patients with GCS score of ≤ 8 on admission, whereas it was 5.4% in patients with GCS score of ≥ 9 on admission (P < 0.001).…”

“…This agrees with El-Shanawany et al (12) who reported that missile injuries carry a worse prognosis than non-missile injuries as demonstrated by high mortality 45.8% to 16.6% respectively and that missile injuries carries a high incidence of morbidity to non-missile injuries. Sirko et al (23) also confirmed that patients with penetrating brain injury secondary to gunshot wound in our cohort had worse functional outcomes at all-time points than those who had blast penetrating brain injury.…”

Case of gunshot injury to the liver by a hand-made modified sniper bullet: organ-preserving surgical management with damage control tactics and transpapillary biliary decompression

“…This case report is an example of the effective application of damage control surgery as well as transpapillary biliary decompression in the patient with multisystem causality in hybrid warfare. Furthermore, this case report provides new evidence of specific features of combat trauma and its management in the combat area of JFO in East Ukraine, which is consistent with previous publications [1,2,4,22]. In our opinion, this case report presents the evolution of the pathomorphosis of combat injury to the liver, which is associated with the improvement of high-energy weapons.…”

Cognitive evoked potentials in the diagnosis of post-concussion syndrome due to blast mild traumatic brain injury

“…The military conflict in the East of Ukraine is characterized by the simultaneous use of modern personal protective equipment and new types of weapons, in particular rocket artillery, rocketpropelled grenades and landmines. This has led to an increase in the number of victims with blast injury and the need to provide them with effective assistance and rehabilitation [6].…”