Skull and brain gunshot wound during the armed conflict in eastern Ukraine. Report 3. Optimization of medical care
Keywords:skull and brain gunshot wounds, penetrating craniocerebral wounds, initial surgical debridement, surgical treatment, qualified medical aid, specialized medical aid
Objective. To improve the quality of the first aid delivery in cases of skull and brain gunshot wounds.
Materials and methods. Analysis of results of treatment of 790 patients who suffered injuries to various systems and anatomic regions of a body has been performed. Both extent and quality of the medical care at all stages of evacuation of 64 patients with skull and brain gunshot wounds has been analyzed in detail. Qualified medical aid to the patients with head injuries was administered at military medical hospital, municipal and district hospitals of Donetsk and Luhansk regions.
Results. Absence of any surgical debridement of a gunshot wound was discovered in 26.5% of patients, low-quality initial surgical debridement, in 52.2% of patients, the need of re-operation, in 33.3% of patients operated during qualified aid delivery; craniocerebral complications were found in 31.3% of patients. Following treatment indicators were obtained during specialized medical aid delivery: postoperative complications were found in 15.6% of patients; re-operations were performed for 15% of initially operated patients; postoperative mortality made 5%. Combined wounds, found in 65.6% of cases, require involvement of a large number of allied specialists, which is only possible within a multi-field hospital. In the conditions of today’s military conflicts, which are characterized by wide capabilities of air transportation of patients to the hospitals, it would be more effective to minimize remedial measures at all intermediary stages and transfer such measures to the stage of specialized aid delivery.
Summary. Evacuation to the nearest neurosurgeon, avoidance of diagnostic delays, and initiation of cerebral resuscitation increase the chance of full patient recovery. Optimal results of treatment of patients with head or brain wound are only achieved when early surgical debridement of skull and brain wounds is performed by a neurosurgeon at the stage of specialized medical aid delivery in the in-patient neurosurgery department of a multi-field hospital after CT of the brain.
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