An overview of penetrating traumatic brain injuries at a major civilian trauma centre in South Africa

  • Johannes JP Buitendag Stellenbosch University
  • Abraham Ras Stellenbosch University
  • Victor Kong University of the Witwatersrand
  • John Bruce University of KwaZulu-Natal
  • Grant Laing University of KwaZulu-Natal
  • Damian Clarke University of KwaZulu-Natal
  • Petra Brysiewicz University of KwaZulu-Natal
Keywords: Traumatic Brain Injury, Penetrating, Motor Score, Simplified Motor Score

Abstract

Background: This study reviews our experience with penetrating Traumatic Brain Injury (TBI) in order to define and describe the injury pattern and the outcome. A secondary aim of this study was to review the use of the Motor Score (M Score) and the Simplified Motor Score (SMS) to assess and triage patients with penetrating TBI.

Methods: All patients with a TBI secondary to a penetrating mechanism were identified from the Hybrid Electronic Medical Registry at Pietermaritzburg Metropolitan Trauma Service (PMTS) from January 2012 to December 2014. Standard demographic data, need for neuro-surgical intervention, location of external wounds, CT findings and mortality where analysed. The Glasgow Coma Scale (GCS) M score and SMS score were specifically evaluated to determine the relationship between the individual motor component and patient outcome.

Results: Over the two-year period January 2012–December 2014, a total of 384 patients were admitted following a penetrating TBI. There were 350 males and 34 females and of this total 7 (1.82%) died. The mechanism of injury was axe (30), bottle (34), gunshot wound (GSW) (22) and stab wound (298). The average age for axe injuries was 27 and bottle injuries was 30. The average age for firearms and knives was 29 and 30 respectively.  Surgery was not required for 76.67% of patients. The need for surgery varied according to mechanism of injury. Axe injuries were treated non-operatively in 47.83%, bottle injuries in 87.50%, firearms 70% and knife injuries were treated nonoperatively in 86.84% of cases. The overall survival rate for a penetrating head injury in this population is 98.16%. There were a total of 368 patients with a motor score of 6 of which one died. The survival rate was 99.7% and the mortality rate 0.3%. There were only 6 patients with a motor score of 5 and only 2 with a motor score of 4. The survival rate for both these groups was 100%. There was a total of 6 patients with a motor score of 1. There was a 100% mortality rate is this group.

Conclusion: Penetrating TBI has a good prognosis. The vast majority of cases do not require neuro-surgical intervention. Poor motor score is associated with a poor outcome.

Author Biographies

Johannes JP Buitendag, Stellenbosch University

Department of Surgery, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa

Abraham Ras, Stellenbosch University

Department of Surgery, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa

Victor Kong, University of the Witwatersrand

Department of Surgery, University of the Witwatersrand, Johannesburg; and Department of Surgery, University of KwaZulu Natal, Durban, South Africa

John Bruce, University of KwaZulu-Natal

Department of Surgery, University of KwaZulu Natal, Durban, South Africa

Grant Laing, University of KwaZulu-Natal

Department of Surgery, University of KwaZulu-Natal, Durban, South Africa

Damian Clarke, University of KwaZulu-Natal

Department of Surgery, University of the Witwatersrand, Johannesburg; and Department of Surgery, University of KwaZulu-Natal, Durban, South Africa

Petra Brysiewicz, University of KwaZulu-Natal

School of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa

Published
2019-02-13
How to Cite
Buitendag, J., Ras, A., Kong, V., Bruce, J., Laing, G., Clarke, D., & Brysiewicz, P. (2019). An overview of penetrating traumatic brain injuries at a major civilian trauma centre in South Africa. South African Journal of Surgery, 57(1), 37-42. Retrieved from http://sajs.redbricklibrary.com/index.php/sajs/article/view/2711
Section
Trauma