PENETRATING CRANIOCEREBRAL INJURIES - AN ESCALATING PROBLEM IN PAKISTAN

We carried out a prospective study on patients admitted to busy neuros urgical units in Karachi and Quetta with penetrating craniocerebral in juries. Of the 100 patients, 52 died and 48 survived in spite of aggre ssive surgical management. Maximum mortality was in patients with Glas gow Coma Score (GCS) below 5. A delay of 6 h, delay in interhospital t ransfers, and limited post operative aggressive management led to furt her secondary insults to the brain contributing to a poorer outcome. A review of current literature on pathophysiology and management is inc luded and the importance of prehospital optimum care, and early transf er to the neurosurgical centre are emphasized. Since only two of the 3 5 patients with a GCS of less than five survived, with severe disabili ties, utilizing resources in third world countries on the management o f craniocerebral penetrating injuries in patients with a GCS less than 5 is questioned especially when organ donation is not possible.