title: Management of War-Related Ballistic Craniocerebral Injuries in a French Role 3 Hospital During the Afghan Campaign.
abstract: BACKGROUND
  France deployed to Afghanistan from 2001 to 2014 within the International Security and Assistance Force. A French role 3 hospital was built in 2009 in the vicinity of Kabul International Airport (KaIA). The objectives of this study were to describe the epidemiology, management, and outcome of war-related craniocerebral injuries during the Afghan campaign in a French role 3 hospital.
  
  
  METHODS
  From March 1, 2010 to September 30, 2012, we conducted a retrospective descriptive study in Kabul, Afghanistan. All patients presenting with a ballistic craniocerebral injury to the KaIA role 3 hospital were included.
  
  
  RESULTS
  We analyzed 48 records. Mean age was 21.9 years (1-46 years) with a 37:11 (male:female) sex ratio and a majority Afghan population (n = 41). Civilians represented 64.6% (n = 31) of casualties. On the battlefield, mean Glasgow Coma Scale score was 9.4 [3-15]. On arrival at the KaIA field hospital, 20 of the 48 patients were hemodynamically unstable. All patients underwent a full-body computed tomography scan. The majority of our casualties had associated injuries. Neurosurgery was indicated for 42 (87.5%) patients. The surgery consisted of wound debridement plane by plane associated with decompressive craniectomy (n = 11), debridement craniectomy (n = 19), and craniotomy (n = 12). A total of 32.4% wounded died at the point of injury, 8.4% at the emergency department, and 16.9% after surgery.
  
  
  CONCLUSIONS
  War casualties with ballistic head injuries were predominantly multitraumatized patients with hemodynamic compromise requiring neurosurgical damage control management and multidisciplinary care. The neurosurgeon has thus an essential role to play.
authors.affiliation: Neurosurgery Department, Sainte-Anne Military Hospital, Toulon, France; Val de Grâce Military Medical Corps Academy, Paris, France. Electronic address: dr.adagain@gmail.com.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Dagain
authors.affiliation: Strasbourg Armed Forces Medical Center, Strasbourg, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Aoun
authors.affiliation: Intensive Care Department, Sainte-Anne Military Hospital, Toulon, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Bordes
authors.affiliation: Strasbourg Armed Forces Medical Center, Strasbourg, France.
authors.forename: Cédric
authors.initials: C
authors.lastname: Roqueplo
authors.affiliation: Neurosurgery Department, Sainte-Anne Military Hospital, Toulon, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Joubert
authors.affiliation: Intensive Care Department, Sainte-Anne Military Hospital, Toulon, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Esnault
authors.affiliation: Neurosurgery Department, Sainte-Anne Military Hospital, Toulon, France.
authors.forename: Aurore
authors.initials: A
authors.lastname: Sellier
authors.affiliation: Neurosurgery Department, Percy Military Hospital, Clamart, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Delmas
authors.affiliation: Neurosurgery Department, Sainte-Anne Military Hospital, Toulon, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Desse
authors.affiliation: Neurosurgery Department, Percy Military Hospital, Clamart, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Fouet
authors.affiliation: Val de Grâce Military Medical Corps Academy, Paris, France; Neurosurgery Department, Percy Military Hospital, Clamart, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Pernot
authors.affiliation: Val de Grâce Military Medical Corps Academy, Paris, France; Neurosurgery Department, Percy Military Hospital, Clamart, France.
authors.forename: Renaud
authors.initials: R
authors.lastname: Dulou
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D019468:Disease Management; D005260:Female; D005602:France; D015600:Glasgow Coma Scale; D006772:Hospitals, Military; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D008887:Military Medicine; D019635:Neurosurgical Procedures / Q000379:methods; D019637:Orthopedic Procedures; D012189:Retrospective Studies; D015898:Tomography Scanners, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: Afghanistan; Ballistic craniocerebral injuries; Damage control; War injury