Details

Autor(en) / Beteiligte

• Loggini, Andrea
• Vasenina, Valentina I.
• Mansour, Ali
• Das, Paramita
• Horowitz, Peleg M.
• Goldenberg, Fernando D.
• Kramer, Christopher
• Lazaridis, Christos

Titel

Management of civilians with penetrating brain injury: A systematic review

Ist Teil von

• Journal of critical care, 2020-04, Vol.56, p.159-166

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2020

Quelle

MEDLINE

Beschreibungen/Notizen

• There has been a dramatic increase in penetrating gunshot-inflicted civilian penetrating brain injuries (cvPBI). We undertook a systematic review with exclusive focus on the management of cvPBI. We explored: (1) cervical spine immobilization, (2) seizure incidence and prophylaxis, (3) infection incidence and antibiotic prophylaxis, (4) coagulopathy (5) vascular complications, and (6) surgical management. We searched PubMed, EMBASE, and Cochrane (1985–2019). The PRISMA guidelines were followed. The Newcastle-Ottawa Scale was employed for qualitative assessment; risk of bias was evaluated based upon the RTI item bank. The full protocol was registered to PROSPERO (CRD42019118877). The literature is scant, and of overall low quality and high risk of bias. Incidence of c-spine injury with no direct trauma is low; incidence of seizures does not appear to be different from non-penetrating mechanisms; there is no robust data for prophylactic antibiotics; coagulopathy is prevalent and has been independently associated with outcome; there is a high incidence of vascular injuries with traumatic intracranial aneurysms the most common sequelae; neurosurgical decision-making appears largely influenced by operator's assessment of salvageability. Surgery has been associated with decreased mortality. Limited amount of published work is clinically meaningful; this systematic review identified key knowledge gaps. •The literature on civilian populations is of low quality and high risk of bias.•Coagulopathy is prevalent and has been independently associated with outcome.•No robust data on the use, duration or type of prophylactic antibiotics.•High incidence of vascular injuries; intracranial aneurysm formation the most common.•No pre-defined criteria for neurosurgical intervention; decreased mortality.