Analysis of the results of treatment of patients with gunshotwound to the head in acute and early postoperative period

Abstract

Objective ‒ to evaluate the results of treatment of gunshot wounds to the head in the conditions of a specialized neurosurgical center and to determine the factors that negatively affected the results of treatment.Materials and methods. The study is retrospective. 109 cases with open and closed craniocerebral injuries, which came to the military medical center during the hostilities in the East of Ukraine in the period from March 2014 to the end of December 2017 were analyzed. All patients were treated at the National Military Medical Clinical Center «Main Military Clinical Hospital». Collected information on demographic indicators, features of assistance provided at the stages of evacuation, type of injury. The Glasgow outcome scale (GOS) was used to evaluate the results. Results. Shrapnel injuries prevailed in 82 (75.23 %) cases, bullet wounds were diagnosed less frequently in 17 (15.6 %) cases, and 10 (9.17 %) servicemen were injured as a result of the blast wave. The vast majority of the wounded were admitted to the military medical center in good condition – 81 (74.32 %) patients, in moderate condition – 15 (13.75 %), in coma I – 5 (4.59 %), in coma II – 3 (2.75 %), in coma III – 3 (2.75 %). Computed tomography was performed in all patients upon admission. The frequency of infectious complications was 31.19 %. 45 patients underwent repeated surgeries, 26 were operated on three times for gunshot wounds in different medical institutions at different stages, 5 patients were operated on more than three times. 52 (47.7 %) of the wounded had a good recovery result (GOS 4, 5). 44 (40.36 %) of the wounded were discharged with the result of GOS 3, 3 patients were in a vegetative state (GOS 2), 10 (9.17 %) patients died (GOS 1). Statistically significant (p<0.05) factors that had a negative impact on the treatment results are GCS <12 at admission, Injury severity score >25, CSF leak, infectious complications, repeated operations.Conclusions. All patients with gunshot wounds to the head should have a CT scan of the head immediately upon admission to a medical facility. Patients should be hospitalized in specialized centers where there is a full examination, CT and the possibility of providing specialized neurosurgical care. This reduces the number of repeated surgical interventions and, accordingly, complications.