@article{ref1,
title="Safe management of paediatric penetrating head injury without a CT scanner: a strategy for humanitarian surgeons based on experience in southern Afghanistan",
journal="Annals of the Royal College of Surgeons of England",
year="2016",
author="Mathew, P. and Nott, D. M. and Gentleman, D.",
volume="98",
number="3",
pages="198-205",
abstract="Introduction In many parts of the world, access to a CT scanner remains almost non-existent, and patients with a head injury are managed expectantly, often with poor results. Recent military medical experience in southern Afghanistan using a well-equipped surgical facility with a CT scanner has provided new insights into safe surgical practice in resource-poor environments. <br><br>METHODS All cases of children aged under 16 years with penetrating head injury who were treated in a trauma unit in southern Afghanistan by a single neurosurgeon between 2008 and 2010 were reviewed. Based on a previously published retrospective review, a clinical strategy aimed specifically at generalist surgeons is proposed for selecting children who can benefit from surgical intervention in environments with no access to CT scanners. <br><br>RESULTS Fourteen patients were reviewed, of whom three had a tangential wound, 10 had a penetrating wound with retained fragments and one had a perforating injury. Two operations for generalist surgeons are described in detail: limited wound excision; and simple decompression of the intra-cranial compartment without brain resection or dural repair. <br><br>CONCLUSIONS In resource-poor environments, clinically-based criteria may be used as a safe and appropriate strategy for selecting children who may benefit from relatively straightforward surgery after penetrating brain injury.<p /> <p>Language: en</p>",
language="en",
issn="0035-8843",
doi="10.1308/rcsann.2016.0058",
url="http://dx.doi.org/10.1308/rcsann.2016.0058"
}