Craniocerebral gunshot injuries in South Africa--a suggested management strategy.
OBJECTIVE
To determine the outcome of craniocerebral gunshot injuries, analyse factors that affect prognosis and suggest a management protocol.


METHODS
A retrospective analysis of civilian craniocerebral gunshot injuries treated over a 7-year period.


METHODS
Groote Schuur Hospital's neurosurgery and trauma unit service.


METHODS
One hundred and eighty-one patients with craniocerebral gunshot injuries were admitted to the Department of Neurosurgery, Groote Schuur Hospital, University of Cape Town, over a 7-year period and a retrospective analysis of these patient records with regard to outcome and prognostic factors was carried out.


RESULTS
Seventy-six patients sustained non-penetrating injuries, 8 (11%) of whom had underlying cerebral injury on computed tomography (CT) scan. The prognosis was good in the case of non-penetrating injuries. One hundred and five patients sustained penetrating injuries and 57% (62) had a poor outcome. A Glasgow Coma Score (GCS) of 5 or less following resuscitation was associated with a 98% mortality rate. CT scan evidence of transventricular injury was associated with 100% mortality, bihemispheric injury with 90% mortality, and diffuse cerebral swelling with 81% mortality.


CONCLUSIONS
Patients with non-penetrating craniocerebral gunshot injuries should all undergo a CT scan as 10% will have cerebral injury. The prognosis is normally good. In penetrating craniocerebral gunshot injuries a GCS of 5 or less, or a GCS of 8 or less with CT scan findings of transventricular or bihemispheric injury have such a poor outcome that conservative treatment is indicated.
Semple
P L
PL
Department of Neurosurgery, Groote Schuur Hospital and University of Cape Town.
Domingo
Z
Z
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D017678:Sex Distribution; D013019:South Africa / Q000453:epidemiology; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*