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. 2021 Oct 2;21(1):109.
doi: 10.1186/s12873-021-00504-5.

Factors associated with hospital outcomes of patients with penetrating craniocerebral injuries in armed conflict areas of the Democratic Republic of the Congo: a retrospective series

Paterne Safari Mudekereza  1   2   3 , Gauthier Bahizire Murhula  1 , Charles Kachungunu  3 , Amani Mudekereza  2 , Fabrice Cikomola  1   2 , Leon-Emmanuel Mukengeshai Mubenga  1   2 , Patrick Birindwa Balungwe  1   2 , Paul Munguakonkwa Budema  1   2 , Christian Molima  4 , Erick Namegabe Mugabo  2 , Hervé Monka Lekuya  5   6
Affiliations

Factors associated with hospital outcomes of patients with penetrating craniocerebral injuries in armed conflict areas of the Democratic Republic of the Congo: a retrospective series

Paterne Safari Mudekereza et al. BMC Emerg Med. .

Abstract

Introduction: Penetrating craniocerebral injuries (PCCI) are types of open head injuries caused by sharp objects or missiles, resulting in communication between the cranial cavity and the external environment. This condition is deemed to be more prevalent in armed conflict regions where both civilians and military are frequently assaulted on the head, but paradoxically their hospital outcomes are under-reported. We aimed to identify factors associated with poor hospital outcomes of patients with PCCI.

Methods: This was a retrospective series of patients admitted at the Regional Hospital of Bukavu, DRC, from 2010 to 2020. We retrieved medical records of patients with PCCI operated in the surgical departments. A multivariate logistic regression model was performed to find associations between patients' admission clinico-radiological parameters and hospital outcomes. Poor outcome was defined as a Glasgow Outcomes Score below 4.

Results: The prevalence of PCCI was 9.1% (91/858 cases) among admitted TBI patients. More than one-third (36.2%) of patients were admitted with GCS < 13, and 40.6% of them were unstable hemodynamic. Hemiplegia was found in 23.1% on admission. Eight patients had an intracerebral hemorrhage. Among the 69 operated patients, complications, mainly infectious, occurred in half (50.7%) of patients. Poor hospital outcomes were observed in 30.4% and associated with an admission GCS < 13, hemodynamic instability, intracerebral hemorrhage, and hemiplegia (p < 0.05).

Conclusion: The hospital poor outcomes are observed when patients present with hemodynamic instability, an admission GCS < 13, intracerebral hemorrhage, and hemiplegia. There is a need for optimizing the initial care of patients with PCCI in armed conflict regions.

Keywords: Glasgow outcome score; Hemodynamic instability; Hospital outcomes; Intracerebral hemorrhage; Penetrating craniocerebral injury.

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Conflict of interest statement

Authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Brain Window CT of a patient with PCCI showing a comminuted right frontal fracture with an underlying frontal burst lobe with severe brain edema
Fig. 2
Fig. 2
Bone window CT of a patient with PCCI showing a retained bullet in the cranium
Fig. 3
Fig. 3
A, B and C illustrates imaging and intraoperative findings of a case of a 46-year old male with PCCI
See this image and copyright information in PMC

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