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Citation
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Meister MR, Boulter JH, Yabes JM, Sercy E, Shaikh F, Yokoi H, Stewart L, Scanlon MM, Shields MM, Kim A, Tribble DR, Bartanusz V, Dengler B. J. Trauma Acute Care Surg. 2023; ePub(ePub): ePub. |
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Abstract
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BACKGROUND: Penetrating brain injuries are a potentially lethal injury associated with substantial morbidity and mortality. We examined characteristics and outcomes among military personnel who sustained battlefield-related open and penetrating cranial injuries during military conflicts in Iraq and Afghanistan.
METHODS: Military personnel wounded during deployment (2009-2014) were included if they sustained an open or penetrating cranial injury and were admitted to participating hospitals in the United States. Injury characteristics, treatment course, neurosurgical interventions, antibiotic use and infection profiles were examined.
RESULTS: The study population included 106 wounded personnel, of whom 12 (11.3%) had an intracranial infection. Post-trauma prophylactic antibiotics were prescribed in over 98% of patients. Patients who developed CNS infections were more likely to have undergone a ventriculostomy (p = 0.003), had a ventriculostomy in place for a longer period (17 vs 11 days; p = 0.007), had more neurosurgical procedures (p < 0.001), and have lower presenting Glasgow Coma Scale (GCS, p = 0.01), and higher Sequential Organ Failure Assessment (SOFA) scores (p = 0.018). Time to diagnosis of CNS infection was a median of 12 days post-injury (interquartile range [IQR]: 7-22 days) with differences in timing by injury severity (critical head injury had median of 6 days while maximal (currently untreatable) head injury had median of 13.5 days), presence of other injury profiles in addition to head/face/neck (median of 22 days), and the presence of other infections in addition to CNS infections (median of 13.5 days). The overall length of hospitalization was a median of 50 days and two patients died.
CONCLUSIONS: Approximately 11% of wounded military personnel with open and penetrating cranial injuries developed CNS infections. These patients were more critically injured (e.g., lower GCS and higher SOFA scores) and required more invasive neurosurgical procedures. LEVEL OF EVIDENCE: Level III; Prognostic/Epidemiological.
Language: en |