The effect of brain tomography findings on mortality in sniper shot head injuries

Can, Çağdaş; Bolatkale, Mustafa; Sarihan, Aydın; Savran, Yusuf; Acara, Ahmet Çağdaş; Bulut, Mehtap

doi:10.1136/jramc-2016-000632

Cited by 7 publications

(5 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Surprisingly, the frequency of gunshot injuries in the parietal lobes of our sample was higher compared with those in the existing literature in armed personnel. 8,17 This tendency aligns with the study by Can et al, 23 who indicated that 65% of sniper head injuries during the Syrian war treated in Turkey were parietal. At the same time, both these studies on the SAC deviate from the repetitively reported dominance of frontal lobe injuries by gunshots in military personnel.…”

Section: Discussionsupporting

confidence: 86%

“…This is in line with previous studies that showed higher mortality from injuries to the brain stem and parietal lobes and injuries that pass the ventricles. 8,16,22,35 In contrast, Can et al 23 reported higher mortality in temporal injuries, which might be more specific for his sample that included only sniper head injuries. Finally, the site of injury in our sample could solely explain about 14% of the variability in mortality.…”

Section: Discussionmentioning

confidence: 79%

See 1 more Smart Citation

Patterns of War-Related Traumatic Brain Injuries and Predictors of Mortality Among Civilians During the Syrian Armed Conflict

Alsalkini,

Hanafi,

Omarain

et al. 2023

Neurosurgery

View full text Add to dashboard Cite

BACKGROUND AND OBJECTIVES: High-velocity weapons were used against unshielded civilians during the Syrian armed conflict, leading to a variety of combat-related traumatic brain injuries with high fatality and morbidity. Because of the lack of data in the literature about the management and outcomes of similar injuries, we aimed in this study to characterize shrapnel and gunshot injuries in this vulnerable group and to describe the association between the mechanisms, site, and type of injury and the outcomes. METHODS: This was a single-center retrospective cohort study on new traumatic brain injuries in civilians who presented alive to the neurosurgery department at Damascus Hospital between 2014 and 2017. The analyzed data included the mechanism of injury and its type and site based on computed tomography scans. We also studied the neurological status at admission, the major interventions applied, and outcomes including mortality and neurological deficits at discharge. RESULTS: Shrapnel and gunshot injuries more likely affected the frontal and parietal lobes, respectively. While shrapnel led to injuries in multiple body parts, gunshots led to localized but more severe injuries. Despite that, mortality rates were comparable between the two mechanisms. Injuries to the right parietal and right frontal lobes were more fatal with odds ratios of 2.61 (1.23-5.52) and 2.12 (1.00-4.50), respectively. Moreover, mortality was also linked to the radiological findings of loss of brain material with an odds ratio of 3.73 (1.42-9.81), intracerebral hemorrhage with an odds ratio of 3.60 (1.67-7.80), intraventricular hemorrhage with an odds ratio of 5.49 (1.68-17.95), and subdural hemorrhage with an odds ratio of 6.35 (2.29-17.66). CONCLUSION: The unfortunate nature of the Syrian armed conflict, wherein civilians were targeted during their daily routine, seems to manifest a heightened propensity to affect the parietal lobes, potentially resulting in higher morbidity. Although shrapnel and gunshot injuries showed no significant difference in mortality rates, injuries involving loss of brain tissue and intracranial hemorrhage emerged as independent predictors of mortality.

show abstract

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 79%

Patterns of War-Related Traumatic Brain Injuries and Predictors of Mortality Among Civilians During the Syrian Armed Conflict

Alsalkini,

Hanafi,

Omarain

et al. 2023

Neurosurgery

View full text Add to dashboard Cite

show abstract

“…Although the mortality rate in our analysis (33.3%) excluded patients who arrived dead or died before admission, it was still signi cantly higher than in similar studies in Jordanian and Israeli centres (34,38). Meanwhile, even it is comparable to the mortality rate in the two Turkish studies, it is worth mentioning that one of them had many more patients in the severe GCS category (24), and the other recruited only gunshot injuries (21), also suggesting a worse outcome in our sample (Table 7). A possible reason for that might be the short distances and rapid transportation of victims in Damascus.…”

Section: Discussionsupporting

confidence: 61%

“…Several reports on war-related injuries in the SAC have been published in neighboring countries (20)(21)(22)(23)(24), and a systematic review found that injuries to the head, face, and neck were the most common (37%) (25). Brain damage and hemorrhage were also the most common causes of death in Syrians who presented to Turkish and Jordanian trauma centers (26, 27).…”

Section: Introductionmentioning

confidence: 99%

War-related traumatic brain injuries during the Syrian armed conflict in Damascus 2014-2017: a cohort study and a literature review

Hanafi

Munder

AHMAD

et al. 2022

Preprint

View full text Add to dashboard Cite

Background: The decade-long Syrian armed conflict killed or injured more than 11% of the Syrian population. Head and neck injuries are the most frequent cause of war-related trauma, about half of which are brain injuries. Reports about Syrian brain trauma victims were published from neighboring countries; However, none are available from Syrian hospitals. This study aims to report war-related traumatic brain injuries from the Syrian capital.Methods: We conducted a retrospective cohort study between 2014 and 2017 at Damascus Hospital, the largest public hospital in Damascus, Syria. Target patients were the victims of combat-related traumatic brain injuries who arrived alive and were admitted to the neurosurgery department or to another department but followed by the neurosurgery team. The collected data included the mechanism, type, and site of injury based on imaging findings; types of invasive interventions; intensive-care unit (ICU) admissions; as well as neurological status at admission and discharge including several severity scales.Results: Our sample consisted of 195 patients; Ninety-six of them were male young adults, in addition to 40 females and 61 children. Injuries were caused by shrapnel in 127 (65%) cases, and by gunshots in the rest, and most of them (91%) were penetrating. Sixty-eight patients (35%) were admitted to the ICU, and 56 (29%) underwent surgery. Neurological impairment was reported in 49 patients (25%) at discharge, and the mortality rate during hospitalization was 33%. Mortality and neurological impairment associated significantly with higher values on clinical and imaging severity scores.Conclusions: This study captured the full spectrum of war-related brain injuries of civilians and armed personnel in Syria without the delay required to transport patients to neighboring countries. Although the clinical presentation of injuries at admission was not as severe as that in previous reports, the inadequate resources (i.e., ventilators and operation rooms) and the lack of previous experience with similar injuries might have resulted in the higher mortality rate. Clinical and imaging severity scales can provide a handy tool in identifying cases with low probability of survival especially with the shortage of personal and physical resources.

show abstract

“…Although the mortality rate in our analysis (33.3%) excluded patients who arrived dead or died before admission, it was still significantly higher than in similar studies in Jordanian and Israeli centres [ 21 , 22 ]. Meanwhile, although it was comparable to the mortality rate in the two Turkish studies, it is worth mentioning that one of them had many more patients in the severe GCS category [ 23 ], and the other recruited only gunshot injuries [ 20 ], also suggesting a worse outcome in our sample (Table 7 ). A possible reason for that might be the short distances and rapid transportation of victims in Damascus.…”

Section: Discussionsupporting

confidence: 61%

War-related traumatic brain injuries during the Syrian armed conflict in Damascus 2014–2017: a cohort study and a literature review

et al. 2023

View full text Add to dashboard Cite

Background The decade-long Syrian armed conflict killed or injured more than 11% of the Syrian population. Head and neck injuries are the most frequent cause of war-related trauma, about half of which are brain injuries. Reports about Syrian brain trauma victims were published from neighboring countries; However, none are available from Syrian hospitals. This study aims to report war-related traumatic brain injuries from the Syrian capital. Methods We conducted a retrospective cohort study between 2014 and 2017 at Damascus Hospital, the largest public hospital in Damascus, Syria. Target patients were the victims of combat-related traumatic brain injuries who arrived alive and were admitted to the neurosurgery department or to another department but followed by the neurosurgery team. The collected data included the mechanism, type, and site of injury based on imaging findings; types of invasive interventions; intensive-care unit (ICU) admissions; as well as neurological status at admission and discharge including several severity scales. Results Our sample consisted of 195 patients; Ninety-six of them were male young adults, in addition to 40 females and 61 children. Injuries were caused by shrapnel in 127 (65%) cases, and by gunshots in the rest, and most of them (91%) were penetrating. Sixty-eight patients (35%) were admitted to the ICU, and 56 (29%) underwent surgery. Neurological impairment was reported in 49 patients (25%) at discharge, and the mortality rate during hospitalization was 33%. Mortality and neurological impairment associated significantly with higher values on clinical and imaging severity scores. Conclusions This study captured the full spectrum of war-related brain injuries of civilians and armed personnel in Syria without the delay required to transport patients to neighboring countries. Although the clinical presentation of injuries at admission was not as severe as that in previous reports, the inadequate resources (i.e., ventilators and operation rooms) and the lack of previous experience with similar injuries might have resulted in the higher mortality rate. Clinical and imaging severity scales can provide a handy tool in identifying cases with low probability of survival especially with the shortage of personal and physical resources.

show abstract

The effect of brain tomography findings on mortality in sniper shot head injuries

Cited by 7 publications

References 19 publications

Patterns of War-Related Traumatic Brain Injuries and Predictors of Mortality Among Civilians During the Syrian Armed Conflict

Patterns of War-Related Traumatic Brain Injuries and Predictors of Mortality Among Civilians During the Syrian Armed Conflict

War-related traumatic brain injuries during the Syrian armed conflict in Damascus 2014-2017: a cohort study and a literature review

War-related traumatic brain injuries during the Syrian armed conflict in Damascus 2014–2017: a cohort study and a literature review

Contact Info

Product

Resources

About