Traumatic Brain Injury Caused by Missile Wounds in the North of Palestine: A Single Institution's Experience with 520 Consecutive Civilian Patients

• Published in: World neurosurgery 2018-08, Vol.116, p.e329-e339
• Main Authors: Darwazeh, Rami, Darwazeh, Mazhar, Sbeih, Ibrahim, Yan, Yi, Wang, Jianmin, Sun, Xiaochuan
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Arabs; Brain Injuries, Traumatic - diagnostic imaging; Brain Injuries, Traumatic - epidemiology; Brain Injuries, Traumatic - surgery; Child; Child, Preschool; Civilian; Craniocerebral injury; Emergency Service, Hospital - trends; Female; Head Injuries, Penetrating - diagnostic imaging; Head Injuries, Penetrating - epidemiology; Head Injuries, Penetrating - surgery; Humans; Infant; Male; Middle Aged; Missile wounds; Palestine; Palestinian intifada; Retrospective Studies; Time-to-Treatment - trends; Traumatic brain injury; Young Adult
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.04.202

Literature about traumatic brain injury caused by missile wounds is scanty. We shed some light on this field. This retrospective study was carried out, between September 2000 and September 2010, on 520 civilian patients who sustained traumatic brain injury from missiles in the north of Palestine. Thorough detailed analyses were made of patients' admission Glasgow Coma Scale (GCS) scores, pupillary reactivity to light, site and mode of injuries, type of injurious agents, missile trajectory, method of treatment, radiologic manifestations, complications, and outcome. The GCS score was used to assess the level of consciousness, whereas the Glasgow Outcome Scale score was used to evaluate the outcome. Patients' age ranged from 6 months to 75 years. Only 50 (9.6%) patients were female. Patients injured by metallic bullets, rubber bullets, and shrapnel from bomb explosions numbered 351, 139, and 30, respectively. Of 384 patients who were treated conservatively, no mortality was detected, whereas of 136 surgically treated patients, 66 (48.5%) died of their injuries. Although our management of patients was not optimal because of many factors, the overall mortality was 12.7% (n = 66). The promptness of transport to hospital was a decisive factor with a major bearing on decreasing mortality. Brain computed tomography was invaluable in the diagnosis and follow-up of our patients. In addition, age, pupillary reactivity, admission GCS score, missile trajectory, ventricular involvement, and site and mode of injury were important prognostic factors. •The promptness of transport to the hospital leads to a major decrease in mortality.•Brain computed tomography is invaluable in the diagnosis and follow-up.•Age, pupillary reactivity, and admission GCS score are important prognostic factors.•Missile trajectory and ventricular involvement are significant for prognosis.•Site and mode of injury play an important role in the outcome.