Craniocerebral gunshot injuries in South Africa - A suggested management strategy

Objective. To determine the outcome of craniocerebral gunshot injuries, ana lyse factors that affect prognosis and Suggest a management protocol. Design. A retrospective analysis of civilian craniocerebral gunshot injurie s treated over a 7-year period. Setting. Groote Schuur Hospital's neurosurg ery and trauma unit service. Patients. One hundred and eighty-one patients with craniocerebral gunshot i njuries were admitted to the Department of Neurosurgery, Groote Schuur Hosp ital, University of Cape Town, over a 7-year period and a retrospective ana lysis of these patient records with regard to outcome and prognostic factor s was carried out. Results. Seventy-Six patients sustained non-penetrating injuries, 8 (11%) o f whom had underlying cerebral injury on computed tomography (CT) scan. The prognosis Was good in the case of non-penetrating injuries. One hundred an d five patients sustained penetrating injuries and 57% (62) had a poor outc ome; A Glasgow Coma Score (GCS) of 5 or less following resuscitation was as sociated with a 98% mortality rate. CT scan evidence of transventricular in jury was associated with 100% mortality bihemispheric injury with 90% morta lity, and diffuse cerebral swelling with 81% mortality. Conclusion. Patients with non-penetrating craniocerebral gunshot injuries s hould 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 treatmen t is indicated.