@article{ref1,
title="Management of civilians with penetrating brain injury: a systematic review",
journal="Journal of critical care",
year="2020",
author="Loggini, Andrea and Vasenina, Valentina I. and Mansour, Ali and Das, Paramita and Horowitz, Peleg M. and Goldenberg, Fernando D. and Kramer, Christopher and Lazaridis, Christos",
volume="56",
number="",
pages="159-166",
abstract="PURPOSE: 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. <br><br>METHODS: 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). <br><br>RESULTS: 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. <br><br>CONCLUSIONS: Limited amount of published work is clinically meaningful; this systematic review identified key knowledge gaps.<br><br>Copyright © 2019. Published by Elsevier Inc.<p /> <p>Language: en</p>",
language="en",
issn="0883-9441",
doi="10.1016/j.jcrc.2019.12.026",
url="http://dx.doi.org/10.1016/j.jcrc.2019.12.026"
}