Management of War-Related Ballistic Craniocerebral Injuries in a French Role 3 Hospital During the Afghan Campaign

• Published in: World neurosurgery Vol. 102; pp. 6 - 12
• Main Authors: Dagain, Arnaud, Aoun, Olivier, Bordes, Julien, Roqueplo, Cédric, Joubert, Christophe, Esnault, Pierre, Sellier, Aurore, Delmas, Jean-Marc, Desse, Nicolas, Fouet, Mathilde, Pernot, Philippe, Dulou, Renaud
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2017
• Subjects: Adolescent; Adult; Afghan Campaign 2001; Afghanistan; Ballistic craniocerebral injuries; Child; Child, Preschool; Craniocerebral Trauma - diagnostic imaging; Craniocerebral Trauma - etiology; Craniocerebral Trauma - therapy; Damage control; Disease Management; Female; France; Glasgow Coma Scale; Hospitals, Military; Humans; Infant; Male; Middle Aged; Military Medicine; Neurosurgery; Neurosurgical Procedures - methods; Orthopedic Procedures; Retrospective Studies; Tomography Scanners, X-Ray Computed; Treatment Outcome; War injury; Young Adult; RTS; Afghanistan; War injury; GCS; ISS; Ballistic craniocerebral injuries; ISAF; KaIA; TRISS; Damage control; AUC; International Security and Assistance Force; Trauma Injury Severity Score; Revised Trauma Score; Injury Severity Score; Area under the receiver operating characteristic curve; Kabul International Airport; Glasgow Coma Scale
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.02.097

France deployed to Afghanistan from 2001 to 2014 within the International Security and Assistance Force. A French role 3 hospital was built in 2009 in the vicinity of Kabul International Airport (KaIA). The objectives of this study were to describe the epidemiology, management, and outcome of war-related craniocerebral injuries during the Afghan campaign in a French role 3 hospital. From March 1, 2010 to September 30, 2012, we conducted a retrospective descriptive study in Kabul, Afghanistan. All patients presenting with a ballistic craniocerebral injury to the KaIA role 3 hospital were included. We analyzed 48 records. Mean age was 21.9 years (1–46 years) with a 37:11 (male:female) sex ratio and a majority Afghan population (n = 41). Civilians represented 64.6% (n = 31) of casualties. On the battlefield, mean Glasgow Coma Scale score was 9.4 [3–15]. On arrival at the KaIA field hospital, 20 of the 48 patients were hemodynamically unstable. All patients underwent a full-body computed tomography scan. The majority of our casualties had associated injuries. Neurosurgery was indicated for 42 (87.5%) patients. The surgery consisted of wound debridement plane by plane associated with decompressive craniectomy (n = 11), debridement craniectomy (n = 19), and craniotomy (n = 12). A total of 32.4% wounded died at the point of injury, 8.4% at the emergency department, and 16.9% after surgery. War casualties with ballistic head injuries were predominantly multitraumatized patients with hemodynamic compromise requiring neurosurgical damage control management and multidisciplinary care. The neurosurgeon has thus an essential role to play.