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Neurosurg Focus. 2018 Dec 1;45(6):E4. doi: 10.3171/2018.9.FOCUS18359.

Two-year mortality and functional outcomes in combat-related penetrating brain injury: battlefield through rehabilitation.

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1F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland.
2Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
3Department of Neurosurgery, Temple University, Philadelphia, Pennsylvania.
4Walter Reed National Military Medical Center, Bethesda, Maryland.
5Division of Neurosurgery, University of Washington, Seattle, Washington; and.
6Division of Neurosurgery, Department of Surgery, Uniformed Services University, Bethesda, Maryland.


OBJECTIVEThere are limited data concerning the long-term functional outcomes of patients with penetrating brain injury. Reports from civilian cohorts are small because of the high reported mortality rates (as high as 90%). Data from military populations suggest a better prognosis for penetrating brain injury, but previous reports are hampered by analyses that exclude the point of injury. The purpose of this study was to provide a description of the long-term functional outcomes of those who sustain a combat-related penetrating brain injury (from the initial point of injury to 24 months afterward).METHODSThis study is a retrospective review of cases of penetrating brain injury in patients who presented to the Role 3 Multinational Medical Unit at Kandahar Airfield, Afghanistan, from January 2010 to March 2013. The primary outcome of interest was Glasgow Outcome Scale (GOS) score at 6, 12, and 24 months from date of injury.RESULTSA total of 908 cases required neurosurgical consultation during the study period, and 80 of these cases involved US service members with penetrating brain injury. The mean admission Glasgow Coma Scale (GCS) score was 8.5 (SD 5.56), and the mean admission Injury Severity Score (ISS) was 26.6 (SD 10.2). The GOS score for the cohort trended toward improvement at each time point (3.6 at 6 months, 3.96 at 24 months, p > 0.05). In subgroup analysis, admission GCS score ≤ 5, gunshot wound as the injury mechanism, admission ISS ≥ 26, and brain herniation on admission CT head were all associated with worse GOS scores at all time points. Excluding those who died, functional improvement occurred regardless of admission GCS score (p < 0.05). The overall mortality rate for the cohort was 21%.CONCLUSIONSGood functional outcomes were achieved in this population of severe penetrating brain injury in those who survived their initial resuscitation. The mortality rate was lower than observed in civilian cohorts.


EVD = external ventricular drain; GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale; GSWH = gunshot wound to the head; Glasgow Outcome Scale; ICP = intracranial pressure; ISS = Injury Severity Score; KAF = Kandahar Airfield; PBI = penetrating brain injury; WRNMMC = Walter Reed National Military Medical Center; ballistics; combat; functional outcomes; military; neurosurgery; penetrating brain injury


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