Surgical mortality in 913 who sustained missile head wounds during the Iran-Iraq war

ABSTRACT

Surgical mortality was studied in 913 patients with missile head wounds evacuated to Nemazee Hospital over a 95-month period. One hundred and twenty six patients died in this series [13.8%]. Thirty-five of 412 patients [8.5%] with primary exploration [Group A] and 57 of 277 patients [20.5%] with secondary exploration [Group B] in Shiraz expired post-operatively. Mortality in 224 patients with a primary exploration at a base hospital was 15% [Group C]. The type of projectile, the site of injury over the skull, and intracranial hematomas were not statistically determinant on mortality. Penetrating projectiles crossing into a second dural compartment or having a perforating mode of injury had a significant bearing on mortality. In patients with a Glasgow Coma Scale score of 13-15, 9-12, 4-8 and 3, the mortality was 3.3, 14, 44.3 and 100 percent. Of the patients who died in this series, 71.4% had a Glasgow Coma Scale score of 3-8. Eighteen patients in Group A [4.4%], 43 in Groups B [15.5%], and 30 in Group C [13.4%] developed CNS infection. Forty of 91 patients [44%] with CNS infection died