Penetrating craniocerebral injuries in a civilian population in mid-Europe

Our current neurosurgical understanding of civilian penetrating craniocereb ral injuries is based on VS metropolitan series. It is unknown whether all principles applied to these patients are relevant in the Mid-European setti ng with its distinct epidemiology. The objective of this study was to chara cterize our patients with penetrating craniocerebral injuries, to analyze t heir outcome, and to identify relevant prognostic factors. Thirty-two patie nts with penetrating craniocerebral injuries were entered into the study. P atient evaluation comprised neurological, laboratory and radiographic analy ses. Motivating factors were suicide (75%), assault (13%), and accident (9% ). Initial GCS score, coagulopathy on admission, and radiographic extent of injury could be identified as outcome predictors (P < 0.001). An aggressiv e therapeutic approach to patients with GCS 3-7 reduced mortality when comp ared to a conservative management (67 vs. 91%). Due to major differences in epidemiology and outcome of our penetrating craniocerebral injury patients when compared to major US metropolitan series, current therapeutic strateg ies applied to this patient population in mid-Europe should be reconsidered . The results of our study justify an aggressive neurosurgical approach eve n in those patients that are thought to have a deleterious prognosis. Predi ctive variables identified in this study and a novel CT-grading algorithm m ay help in decision making. (C) 1999 Elsevier Science B.V. All rights reser ved.