Article Text

  1. T. R. Smith1,
  2. D. H. Duong1,
  3. H. M. Valdez1
  1. 1University of California, Los Angeles, Los Angeles, CA.


Object Since the introduction of the Guidelines for Management and Prognosis of Penetrating Brain Injury (PBI) in 2001, published data investigating its impact on the patients' outcome have been limited. This study reports the outcome of PBI patients managed by these guidelines.

Methods Retrospective medical record reviewing of PBI patients between 2001 and 2003 was performed. The following information was tabulated: patient demographic factors, injury types, postresuscitation GCS score, admitting blood pressure, oxygenation status, associating injuries, hospital course, incidence of infection, and seizure. Glasgow Outcome Scale (GOS) score was used to determine the outcome. One hundred six patients were available for the study. The average length of follow-up was 25 months (10-41 months). Ninety-seven were male and 9 were female. The average age was 26 (8-52 years). Forty-four patients had Glasgow Coma Score (GCS) of 3 to -5, 6 of 6 to 8, 16 of 9 to 11, and 40 of 12 to 15. Four patients had blood pressure below 90 mm Hg and four had PaO2 below 60 mm Hg. Thirty-one had other systemic penetrating injuries. Patients were treated with antibiotics and Dilantin when indicated by the guidelines. There was no related infection to the head wound and no seizure was reported. The overall mortality was 42% (GOS of 5) and 45% with GOS of 1 and 2.

Conclusions The outcome for PBI patients with GCS of 3 to 5 remains to be poor with only 7% survival. However, with aggressive management of intracranial pressure, systemic blood pressure, and oxygenation, a better outcome was seen in patients with GCS of 6 to 12, with 86% alive and 47% independent.

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