Management of War-related Ballistic Craniocerebral Injuries in a French Role 3 Hospital During the Afghan Campaign

• Published in: World neurosurgery 2017-06, Vol.102, p.6-12
• Main Authors: Dagain, Arnaud, Aoun, Olivier, Bordes, Julien, Roqueplo, Cédric, Joubert, Christophe, Esnault, Pierre, Sellier, Aurore, Delmas, Jean-Marc, Desse, Nicolas, Fouet, Mathilde, Pernot, Philippe, Dulou, Renaud
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Afghan Campaign 2001; Afghanistan; Ballistic craniocerebral injuries; Child; Child, Preschool; Craniocerebral Trauma - diagnostic imaging; Craniocerebral Trauma - etiology; Craniocerebral Trauma - therapy; Damage control; Disease Management; Female; France; Glasgow Coma Scale; Hospitals, Military; Humans; Infant; Male; Middle Aged; Military Medicine; Neurosurgery; Neurosurgical Procedures - methods; Orthopedic Procedures; Retrospective Studies; Tomography Scanners, X-Ray Computed; Treatment Outcome; War injury; Young Adult
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.02.097

Abstract Introduction France deployed to Afghanistan from 2001 to 2014 within the International Security and Assistance Force. A French role 3 hospital was built in 2009 in the vicinity of Kabul International Airport (KaIA). The objectives of this study were to describe the epidemiology, management and outcome of war-related craniocerebral injuries during the Afghan campaign in a French role 3 hospital. Methods From March 1, 2010 to September 30, 2012, we conducted a retrospective descriptive study in Kabul, Afghanistan. All patients presenting with a ballistic craniocerebral injury to the KaIA role 3 hospital were included. Results We analyzed 48 records. Mean age was 21.9 years (1-46) with a 37/11 sex ratio and a majority of Afghans (n=41). Civilians represented 64.6% (n=31) of casualties. On the battlefield, mean GCS was 9.4 [3-15]. Upon arrival at the KaIA field hospital, 20 out of the 48 patients were hemodynamically unstable. All patients underwent a full-body computed tomography scan. The majority of our casualties had associated injuries. Neurosurgery was indicated for 42 (87.5%) patients. The surgery consisted of wound debridement plane by plane associated with decompressive craniectomy (N=11), debridement craniectomy (N=19), and craniotomy (N=12). 32.4% wounded died on the point of injury, 8.4% at the emergency department, and 16.9% after surgery. Conclusion War casualties with ballistic head injuries were predominantly multitraumatized patients with hemodynamic compromise requiring neurosurgical damage control management and multidisciplinary care. The neurosurgeon has thus an essential role to play.