title: Damage control of civilian penetrating brain injuries in environments of low neuro-monitoring resources.
abstract: BACKGROUND
  Gunshot wounds to the head are more common in military settings. Recently, a damage control (DC) approach for the management of these lesions has been used in combat areas. The aim of this study was to evaluate the results of civilian patients with penetrating gunshot wounds to the head, managed with a strategy of early cranial decompression (ECD) as a DC procedure in a university hospital with few resources for intensive care unit (ICU) neuro-monitoring in Colombia.
  
  
  METHODS
  Fifty-four patients were operated according to the DC strategy (<12 h after injury), over a 4-year period. Variables were analysed and results were evaluated according to the Glasgow Outcome Scale (GOS) at 12 months post injury; a dichotomous variable was established as 'favourable' (GOS 4-5) or 'unfavourable' (GOS 1-3). A univariate analysis was performed using a χ(2) test.
  
  
  RESULTS
  Forty (74.1%) of the patients survived and 36 (90%) of them had favourable GOS. Factors associated with adverse outcomes were: Injury Severity Score (ISS) greater than 25, bi-hemispheric involvement, intra-cerebral haematoma on the first CT, closed basal cisterns and non-reactive pupils in the emergency room.
  
  
  CONCLUSIONS
  DC for neurotrauma with ECD is an option to improve survival and favourable neurological outcomes 12 months after injury in patients with penetrating traumatic brain injury treated in a university hospital with few resources for ICU neuro-monitoring.
authors.affiliation: a Facultad de Salud - Universidad Surcolombiana/Hospital Universitario , Neiva , Colombia.
authors.forename: José D
authors.initials: JD
authors.lastname: Charry
authors.affiliation: a Facultad de Salud - Universidad Surcolombiana/Hospital Universitario , Neiva , Colombia.|b Fundación MEDITECH , Neiva , Colombia.
authors.forename: Andrés M
authors.initials: AM
authors.lastname: Rubiano
authors.affiliation: c Department of Surgery , University of Pittsburgh Medical Center , Pittsburgh , PA , USA.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Puyana
authors.affiliation: d Department of Medical Informatics and Clinical Epidemiology , Oregon Health Sciences University , Portland , OR , USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Carney
authors.affiliation: e Barrow Neurological Institute at Phoenix Children's Hospital , Phoenix , AZ , USA.
authors.forename: P
authors.initials: P
authors.lastname: David Adelson
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D020197:Head Injuries, Penetrating / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D064926:Neurophysiological Monitoring; D019635:Neurosurgical Procedures; D014948:Wounds, Gunshot / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D055815:Young Adult
keywords: cranial decompression; damage control; gunshot injuries; neurotrauma