Abstract
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).
Highlights
Prognostic factors of intracranial purulent-septic complications of combat-related gunshot penetrating skull and brain wounds
All patients had gunshot penetrating skull and brain wounds sustained in combat conditions during a local armed conflict in the Eastern Ukraine
Isolated meningocephalitis was detected in 8 patients, meningoencephalitis combined with ventriculitis – in 3 patients, meningoencephalitis combined with ventriculitis and subdural empyema – in 2 patients
Summary
Prognostic factors of intracranial purulent-septic complications of combat-related gunshot penetrating skull and brain wounds. Летальність серед пацієнтів з внутрішньочерепними ГСУ становила 50%, а сприятливий результат за ШВГ через рік мали тільки 14,3% поранених з внутрішньочерепними ГСУ. B. Aarabi [3], after examining surgical outcomes in 435 patients with craniocerebral wounds during the Iran-Iraq war, concluded that the two main factors of mortality in the group were low Glasgow Coma Scale (GCS) score and presence of infection. Aarabi [3], after examining surgical outcomes in 435 patients with craniocerebral wounds during the Iran-Iraq war, concluded that the two main factors of mortality in the group were low Glasgow Coma Scale (GCS) score and presence of infection “Aggressive” surgical tactics was associated with high postoperative mortality, development of persistent neurologic impairment and post-traumatic epilepsy in a significant number of patients [20]
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