Craniocerebral gunshot injuries in South Africa – a suggested management strategy

Objective. To determine the outcome of craniocerebral gunshot injuries, analyse factors that affect prognosis and suggest a management protocol.Design. A retrospective analysis of civilian craniocerebral gunshot injuries treated over a 7-year period.Setting. Groote Schuur Hospital's neurosurgery and trauma unit service.Patients. One hundred and eighty-one patients with craniocerebral gunshot injuries were admitted to the Department of Neurosurgery, Groote Schuur Hospital, University of Cape Town, over a 7-year period and a retrospective analysis of these patient records with regard to outcome and prognostic factors was carried out.Results. Seventy-six patients sustained non-penetrating injuries, 8 (11 %) of whom had underlying cerebral injury on computed tomography (CT) scan. The prognosis was good in the case of non-penetrating injuries. One hundred and five patients sustained penetrating injuries and 57% (62) had a poor outcome. A Glasgow Coma Score (GCS) of 5 or less following resuscitation was associated with a 98% mortality rate. CT scan evidence of transventricular injury was associated with 100% mortality, bihernispheric injury with 90% mortality, and diffuse cerebral swelling with 81% mortality.Conclusion. Patients with non-penetrating craniocerebral gunshot injuries should 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 bihernispheric injury have such a poor outcome that conservative treatment is indicated