Ateşli Silah Yaralanmasına Bağlı Kafa Travması Geçiren Hastaların Radyolojik Değerlendirilmesi
Yıl 2023,
Cilt: 20 Sayı: 1, 1 - 6, 27.04.2023
Bahadır Duman
,
Saime Shermatova
,
Hasan Büyükaslan
,
Ferit Doğan
,
Mehmet Zeki Yılmaztekin
Öz
Amaç: Suriye’de 2011 tarihinde başlayan iç savaş, çok sayıda insanın ölümüne ve yaralanmasına neden olmuştur. Kafa yaralanmaları savaşta ve savaş dışı zamanlarda cerrahi acillerin en önemlilerindendir.
Materyal ve method: 2014-2015 yılları arasında Suriye savaşında kurşun ve şarapnel gibi ateşli silah yaralanmalarına bağlı kafa travması nedeniyle başvuran toplam 75 hasta (58 erkek 17 kadin) retrospektif olarak değerlendirildi. İncelemeye nörolojik ve radyolojik incelemeleri yapılmış hastalar dahil edildi.
Bulgular: Penetran ateşli silahla yaralı kafa travması nedeniyle hastanemize başvuran 75 hastadan 20’si (%26.67) ölmüştür. Beyin parankimal kanaması olanların ölüm oranı olmayanlara göre anlamlı düzeylerde bulunmuştur (p<0.001). Beyin ödemi olan hastaların ölüm oranı olmayanlara göre anlamlı düzeylerde bulunmuştur (p=0.003). Ayrıca ventriküler kanama ve subaraknoid kanaması olan hastalarda da ölüm oranı olmayanlara göre anlamlıya yakın düzeylerde yüksek bulunmuştur (ventriküler kanama için p=0.081, subaraknoid kanama için p=0.056).
Sonuç: İleriye yönelik olarak ateşli silahla yaralı kafa travmalı hastalarda ilk müdahalede, gereklilik halinde cerrahi acil girişime karar verilmesi aşamasında ve komplikasyonların yönetiminde gerekli verileri oluşturmaktır.
Kaynakça
- 1. Tintinali JE, Stapczynski JS, Ma OJ, Cline DM, Cydulka RK, Meckler GD. Tintinalli’s Emergency Medicine, McGraw-Hill, Ninth edition. 2020; 1683.
- 2. Menon DK, Schwab K, Wright DW, Maas AI; Demographics and Clinical Assessment Working Group of the International and Interagency Initiative toward Common Data Elements for Research on Traumatic Brain Injury and Psychological Health. Position statement: definition of traumatic brain injury. Arch Phys Med Rehabil. 2010; 91(11):1637-40.
- 3. Anderson T, Heitger M, Macleod AD. Concussion and mild head injury. Practical Neurology 2006;6(6):342-57.
- 4. McCaig LF, Ly N. National Hospital Ambulatory Medical Care Survey: 2000 emergency department summary. Adv Data. 2002(326):1-32.
- 5. Cassidy JD, Carroll LJ, Peloso PM, Borg J, von Holst H, Holm L, et al. Incidence, risk factors and prevention of mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med. 2004(43 Suppl):28-60.
- 6. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974; 2(7872):81-4.
- 7. Harad FT, Kerstein MD. Inadequacy of bedside clinical indica-tors in identifying significant intracranial injury in trauma pati-ents. J Trauma. 1992;32(3):359-61; discussion 61-3.
- 8. Stein SC, Ross SE. The value of computed tomographic scans in patients with low-risk head injuries. Neurosurgery. 1990;26(4):638-40.
- 9. Servadei F, Teasdale G, Merry G. Defining acute mild head injury in adults: a proposal based on prognostic factors, diag-nosis, and management. J Neurotrauma. 2001;18(7):657-64.
- 10. Heegaard W, Biros M. Traumatic brain injury. Emerg Med Clin North Am. 2007;25(3):655-78.
- 11. Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, DeB-lieux PM. Indications for computed tomography in patients with minor head injury. N Engl J Med. 2000;343(2):100-5.
- 12. Stiell IG, Wells GA, Vandemheen K, Clement C, Lesiuk H, Laupacis A, et al. The Canadian CT Head Rule for patients with minor head injury. Lancet. 2001;357(9266):1391-6.
- 13. Rosengren D, Rothwell S, Brown AF, Chu K. The application of North American CT scan criteria to an Australian population with minor head injury. Emerg Med Australas. 2004;16(3):195-200.
- 14. Stiell IG, Clement CM, Rowe BH, Schull MJ, Brison R, Cass D, et al. Comparison of the Canadian CT Head Rule and the New Orleans Criteria in patients with minor head injury. JAMA. 2005;294(12):1511-8.
- 15. Kaufman, H.H. Civilians gunshot wounds to the head. Neuro-surgery, 1993; 32, 962-4.
- 16. Peden M, McGee K, Sharma G. The injury chart book: a graphical overview of the global burden of injuries. Geneva, World Health Organization, 2002.
- 17. McNett M. A review of the predictive ability of Glasgow Coma Scale scores in head- injured patients. J Neurosci Nurs. 2007;39:68-75.
- 18. Ziyal İM, Kılınçoğlu BF, Şahin Y, Aydın Y Penetrating cranice-rebral gunshot wounds. Ulus Travma Acil Cerrahi Derg. 1999; 5: 238-41
- 19. Jinkins J, Dadsefan M, Sener R Value of acute phase angiog-raphy in the detection of vascular injuries caused by gunshot wounds to the head. Analysis of 12 cases. AJR. 1992; 159: 365-6.
- 20. Tsai, F.Y., Huprich, J.E., Gardner, F.C., Segall, H.D. & Teal, J.S. Diagnostic and prognostic implications of computed tomog-raphy of head trauma. J. Comput. Assist. Tomogr. 1978; 2: 323-31.
- 21. Erdogan E, Izci Y, Gonul E, Timurkaynak E: Ventricular injury following cranial gunshot wounds: Clinical study. Mil Med. 2004; 169: 691-5.
- 22. Izci Y, Kayali H, Daneyemez M, Koksel T, Cerrahoglu K: The clinical, radiological and surgical characteristics of supratento-rial penetrating craniocerebral injuries: A retrospective clinical study. Tohoku J Exp Med. 2003; 201:39-46.
- 23. Izci Y, Kayali H, Daneyemez M, Koksel T: Comparison of clinical outcomes between anteroposterior and lateral penetrating craniocerebral wounds. Emerg Med J. 2005; 22: 409-10.
- 24. Kapp JP, Grielchinsky I Management of combat wounds of the dural venous sinuses. Surgery. 1972; 71: 913-4.
- 25. Erdogan, E., Gonul, E. & Seber, N. Craniocerebral gunshot wounds. Neurosurgery Quarterly, 2002; 12: 1-18.
- 26. Cooper, P.R., Maravilla, K. & Cone, J. Computerized tomog-raphic scan and gunshot wound to the head: Indications and radiographic findings. Neurosurgery, 1979; 4: 373- 80.
- 27. Carey, M.E., Young, H.F., Marthis, J.L. & Forsyte, J.A. A bacte-riological study of craniocerebral missile wounds. J. Neuro-surg. 1971; 34: 145-54.
- 28. Brandvold, B., Levi, L., Feinsod, M. & George, E.D. Penetra-ting craniocerebral injuries in the Israeli involvement in the Lebanese conflict 1982-1985. J. Neurosurg. 1990; 72: 15-21.
- 29. Pitlyk, P.J., Tolchin, S. & Stewart, W. The exsperimental significance of retained intracranial bone fragments. J.Neurosurg. 1970; 33, 19-24.
- 30. Walker, A.E. & Erculei, F. Head Injured Men Fifteen Years Later. Sprinfield: Charles C Thomas, 1969; 10-1.
- 31. Weiss, G.H., Cavaness, W.F. & Einsiedel-Lecktape, H. Life expentancy and causes of death in a group of head injured veterans of World War I. Arch. Neurol.1982; 39, 741-3.
- 32. Rish, B.L., Dillon, J.D. & Weiss, G.H. Mortality following penet-rating craniocerebral injuries. J. Neurosurg. 1983; 59: 775-80.
Radiologic Evaluation of Patients With Head Trauma Due to Gunshot Injuries
Yıl 2023,
Cilt: 20 Sayı: 1, 1 - 6, 27.04.2023
Bahadır Duman
,
Saime Shermatova
,
Hasan Büyükaslan
,
Ferit Doğan
,
Mehmet Zeki Yılmaztekin
Öz
Background: Civil war in Syria that started in 2011 has caused death and injuries of thousands of people. Head trauma is one of the most important surgical emergencies both in wartimes and out of wartimes.
Materials and methods: A total of 75 patients (58 males and 17 females) who presented with head trauma due to gunshot injuries such as bullet and shrapnel during the Syrian war between 2014 and 2015 were evaluated retrospectively. Patients who had neurological and radiological examinations were included in the study.
Results: Twenty (26.67%) of 75 patients admitted to our hospital due to head trauma with penetrating gunshot died. The mortality rate of patients with brain parenchymal hemorrhage was found to be significantly higher than those without (p<0.001). The mortality rate of patients with brain edema was found to be significantly higher than those without (p=0.003). In addition, the mortality rate in patients with ventricular hemorrhage and subarachnoid hemorrhage were found to be significantly higher than those without (p=0.081 for ventricular hemorrhage, p=0.056 for subarachnoid hemorrhage).
Conclusion: To create the necessary data for the first intervention in patients with gunshot injuries in the future, at the stage of deciding on surgical emergency intervention if necessary, and in the management of complications.
Kaynakça
- 1. Tintinali JE, Stapczynski JS, Ma OJ, Cline DM, Cydulka RK, Meckler GD. Tintinalli’s Emergency Medicine, McGraw-Hill, Ninth edition. 2020; 1683.
- 2. Menon DK, Schwab K, Wright DW, Maas AI; Demographics and Clinical Assessment Working Group of the International and Interagency Initiative toward Common Data Elements for Research on Traumatic Brain Injury and Psychological Health. Position statement: definition of traumatic brain injury. Arch Phys Med Rehabil. 2010; 91(11):1637-40.
- 3. Anderson T, Heitger M, Macleod AD. Concussion and mild head injury. Practical Neurology 2006;6(6):342-57.
- 4. McCaig LF, Ly N. National Hospital Ambulatory Medical Care Survey: 2000 emergency department summary. Adv Data. 2002(326):1-32.
- 5. Cassidy JD, Carroll LJ, Peloso PM, Borg J, von Holst H, Holm L, et al. Incidence, risk factors and prevention of mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med. 2004(43 Suppl):28-60.
- 6. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974; 2(7872):81-4.
- 7. Harad FT, Kerstein MD. Inadequacy of bedside clinical indica-tors in identifying significant intracranial injury in trauma pati-ents. J Trauma. 1992;32(3):359-61; discussion 61-3.
- 8. Stein SC, Ross SE. The value of computed tomographic scans in patients with low-risk head injuries. Neurosurgery. 1990;26(4):638-40.
- 9. Servadei F, Teasdale G, Merry G. Defining acute mild head injury in adults: a proposal based on prognostic factors, diag-nosis, and management. J Neurotrauma. 2001;18(7):657-64.
- 10. Heegaard W, Biros M. Traumatic brain injury. Emerg Med Clin North Am. 2007;25(3):655-78.
- 11. Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, DeB-lieux PM. Indications for computed tomography in patients with minor head injury. N Engl J Med. 2000;343(2):100-5.
- 12. Stiell IG, Wells GA, Vandemheen K, Clement C, Lesiuk H, Laupacis A, et al. The Canadian CT Head Rule for patients with minor head injury. Lancet. 2001;357(9266):1391-6.
- 13. Rosengren D, Rothwell S, Brown AF, Chu K. The application of North American CT scan criteria to an Australian population with minor head injury. Emerg Med Australas. 2004;16(3):195-200.
- 14. Stiell IG, Clement CM, Rowe BH, Schull MJ, Brison R, Cass D, et al. Comparison of the Canadian CT Head Rule and the New Orleans Criteria in patients with minor head injury. JAMA. 2005;294(12):1511-8.
- 15. Kaufman, H.H. Civilians gunshot wounds to the head. Neuro-surgery, 1993; 32, 962-4.
- 16. Peden M, McGee K, Sharma G. The injury chart book: a graphical overview of the global burden of injuries. Geneva, World Health Organization, 2002.
- 17. McNett M. A review of the predictive ability of Glasgow Coma Scale scores in head- injured patients. J Neurosci Nurs. 2007;39:68-75.
- 18. Ziyal İM, Kılınçoğlu BF, Şahin Y, Aydın Y Penetrating cranice-rebral gunshot wounds. Ulus Travma Acil Cerrahi Derg. 1999; 5: 238-41
- 19. Jinkins J, Dadsefan M, Sener R Value of acute phase angiog-raphy in the detection of vascular injuries caused by gunshot wounds to the head. Analysis of 12 cases. AJR. 1992; 159: 365-6.
- 20. Tsai, F.Y., Huprich, J.E., Gardner, F.C., Segall, H.D. & Teal, J.S. Diagnostic and prognostic implications of computed tomog-raphy of head trauma. J. Comput. Assist. Tomogr. 1978; 2: 323-31.
- 21. Erdogan E, Izci Y, Gonul E, Timurkaynak E: Ventricular injury following cranial gunshot wounds: Clinical study. Mil Med. 2004; 169: 691-5.
- 22. Izci Y, Kayali H, Daneyemez M, Koksel T, Cerrahoglu K: The clinical, radiological and surgical characteristics of supratento-rial penetrating craniocerebral injuries: A retrospective clinical study. Tohoku J Exp Med. 2003; 201:39-46.
- 23. Izci Y, Kayali H, Daneyemez M, Koksel T: Comparison of clinical outcomes between anteroposterior and lateral penetrating craniocerebral wounds. Emerg Med J. 2005; 22: 409-10.
- 24. Kapp JP, Grielchinsky I Management of combat wounds of the dural venous sinuses. Surgery. 1972; 71: 913-4.
- 25. Erdogan, E., Gonul, E. & Seber, N. Craniocerebral gunshot wounds. Neurosurgery Quarterly, 2002; 12: 1-18.
- 26. Cooper, P.R., Maravilla, K. & Cone, J. Computerized tomog-raphic scan and gunshot wound to the head: Indications and radiographic findings. Neurosurgery, 1979; 4: 373- 80.
- 27. Carey, M.E., Young, H.F., Marthis, J.L. & Forsyte, J.A. A bacte-riological study of craniocerebral missile wounds. J. Neuro-surg. 1971; 34: 145-54.
- 28. Brandvold, B., Levi, L., Feinsod, M. & George, E.D. Penetra-ting craniocerebral injuries in the Israeli involvement in the Lebanese conflict 1982-1985. J. Neurosurg. 1990; 72: 15-21.
- 29. Pitlyk, P.J., Tolchin, S. & Stewart, W. The exsperimental significance of retained intracranial bone fragments. J.Neurosurg. 1970; 33, 19-24.
- 30. Walker, A.E. & Erculei, F. Head Injured Men Fifteen Years Later. Sprinfield: Charles C Thomas, 1969; 10-1.
- 31. Weiss, G.H., Cavaness, W.F. & Einsiedel-Lecktape, H. Life expentancy and causes of death in a group of head injured veterans of World War I. Arch. Neurol.1982; 39, 741-3.
- 32. Rish, B.L., Dillon, J.D. & Weiss, G.H. Mortality following penet-rating craniocerebral injuries. J. Neurosurg. 1983; 59: 775-80.