Prognostic factors of intracranial purulent-septic complications of combat-related gunshot penetrating skull and brain wounds

• Published in: Medychni perspektyvy 2019-01, Vol.24 (3), p.58-66
• Main Authors: Sirko, A G, Dzyak, L A, Pylypenko, G S, Yovenko, I O, Skrypnik, A A
• Format: Article
• Language: English
• Subjects: antibacterial therapy; combat-related gunshot wounds; craniocerebral wounds; Epilepsy; Infections; intracranial complications; Meningitis; Mortality; Neurosurgery; outcomes; prognostic factors; purulent-septic complications; Trauma; Traumatic brain injury; Vietnam War; Wound healing
• ISSN: 2307-0404
• DOI: 10.26641/2307-0404.2019.3.181881

Purpose – to ana­lyze the structure of intracranial purulent-septic complications (IPSC), determine the factors influencing development of purulent-septic complications in patients with combat-related gunshot penetrating skull and brain wounds (CRPSBW), determine the effect of intracranial PSC on patients’ outcomes. A prospective analysis of results of exa­mination and treatment of 121 patients was performed. All patients had gunshot penetrating skull and brain wounds sustained in combat conditions during a local armed conflict in the Eastern Ukraine. Evaluation of treatment outcome included analysis of mortality in 1 month (survived/died) and dichotomous Glasgow Outcome Scale (GOS) score in 12 months (favorable/unfavorable outcome). 121 wounded men aged 18 to 56 (average, 34.1±9.1) were included in the study. Intracranial purulent-septic complications (IPSC) were diagnosed in 14 (11.6%) gunshot CRPSBW patients. The following prognostic factors had statistically significantly correlation with the risk of intracranial purulent-septic complications development: wound liquorrhea on admission (p = 0.043), intraventricular hemorrhage (p = 0.007), bone fragments left in the wound (p = 0.0152), and duration of inflow-outflow wound drainage for more than 3 days (p= 0.0123). Intracranial PSC patients had mortality rate of 50%, and only 14.3% of those patients had a favorable outcome according to GOS score in one year. Presence of intracranial PSC had statistically significant association with mortality rate (p=0.0091) and GOS score in one year (p=0.0001).