Civilian and military gunshot wounds to the head

Česká verzia

Authors: N. Svoboda ¹; V. Beneš ¹; D. Netuka ¹; M. Sokol ^1,2; K. Langová ³ ; M. Májovský ¹
Authors place of work: Neurochirurgická a neuroonkologická klinika 1. LF UK a ÚVN Praha ¹; Vojenský ú stav soudní ho lé kař ství , Ú VN – VFN Praha ²; Ústav lékařské biofyziky a Ústav molekulární a translační medicíny, LF UP, Olomouc ³
Published in the journal: Cesk Slov Neurol N 2019; 82(6): 670-676
Category: Original Paper
doi: https://doi.org/10.14735/amcsnn2019670

Summary

Aim: Gunshot wound to the head is one of the most severe injuries with high morbidity and mortality. Appropriately indicated extensive surgical treatment leads to improved patient prognosis. Thus, the evaluation of preoperative factors that would predict patients` prognosis is of high importance at the time of admission to the hospital.

Methods: A retrospective analysis of the results of patients with gunshot head wounds hospitalized in the Military University Hospital in Prague during the period 2000–2018 was performed. Epidemiological data; Injury cause, type, and motive; Glasgow Coma Scale (GCS) on admission; CT scan findings; therapeutic approach; and clinical outcome according to the Glasgow Outcome Score Extended (GOSE) were evaluated and statistically analyzed.

Results: 81 patients were enrolled in the study. Out of these 81 patients, 71 (88%) were injured in a civilian and 10 (12%) in a military setting. Mean GCS on admission was 5.8 (3–15). We operated on 18 patients. Mean GOSE after surgery was 2.8 (1–8). Patients with an overpenetration type of injury, with low GCS value on admission, with a higher number of injured brain lobes and with a bullet trajectory crossing the midsagittal and/or midcoronal plane had statistically significantly worse outcome (P ≤ 0.0001).

Conclusion: GCS on admission, injury cause and motive, and CT findings proved to be significantly important predictive factors. Chosen therapeutic approach should reflect these factors as they correlate with patient’s prognosis.

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

平民和军人头部的枪伤

目的：头部枪伤是发病率和死亡率最高的严重伤害之一。恰当的研究指出，广泛的外科治疗可改善患者的预后。因此，在入院时评估能够预测患者预后的术前因素非常重要。

方法：对2000-2018年在布拉格军事大学医院住院的枪击性颅脑伤口患者的结果进行回顾性分析。流行病学数据；伤害原因，类型和动机；入院时的格拉斯哥昏迷量表（GCS）； CT扫描结果；治疗方法；根据格拉斯哥成果评分扩展（GOSE）对临床结果进行评估并进行统计学分析。

结果：81名患者被纳入研究。在这81名患者中，71名(88%)平民受伤，10名(12%)军人受伤。入院时的平均GCS为5.8（3-15）。我们对18例患者进行了手术。术后平均GOSE为2.8（1–8）。具有穿透性损伤类型，入院时GCS值低，受伤的脑叶数量更多，子弹轨迹越过矢状中和/或冠状中平面的患者在统计学上有较差的预后，结果显著（P≤0.0001）。
结论：GCS在入院，损伤原因和动机以及CT表现方面被证明是重要的预测因素。选择的治疗方法应反映这些因素，因为它们与患者的预后相关。

关键词：颅脑外伤–自杀–伤口–枪击–军事医学

Keywords:

suicide – traumatic brain injury – wounds – gunshot – Military medicine

Zdroje

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