Nearly half of all patients who are hospitalized alive after a traumatic brain injury (TBI) survive. This is one of the most surprising findings in a study conducted by the Karl Landsteiner University of Health Sciences in Krems (KL Krems), the first in Austria to assess the nature, causes and prospects of recovery from this type of injury. According to the study, it is important for treatment decisions to properly assess how quickly the bodies penetrate. Lower speeds cause injuries with significantly better recovery prospects. In Austria, the frequency of injuries caused by bolt-action pistols also stands out.
Objects such as bullets, nails, and screws that pierce the bones of the skull cause many different injuries to the brain, with the prospects for recovery dependent on many variables. However, there is little data so far on these types of injuries in the civilian sector. In Austria, a team from KL Krems has now collected this data for the first time and has published their findings internationally.
life and death
“In general, it must be said that penetrating brain injuries are fatal in many cases,” explains Dr. Franz Marhold, Department of Clinical Neurosurgery at St. Polten University Hospital, one of the teaching and research sites on the Kuala Lumpur Krems. “Three-quarters of those affected die while they are still at the scene; at least this is true in the civilian sector.” But even for those still alive in the hospital, the chances of survival were previously considered low. But it is precisely this group that provides the now-published study with surprising insights.
“Our results show a much more mixed picture of these patients’ chances of survival,” Dr. Marhold explains. “According to the study, the critical factor, among other things, is the velocity of entry into the body causing the damage. If these were low, then 70% of those affected in our study had the probability of a good prognosis. For things but at a high velocity it was less than 20%.”
Meanwhile, Dr. Marhold said, what counts as a “low” speed and what counts as a “high” speed has not been clearly defined. But as the study results showed, the distinction is important in determining further treatment steps. And this, he points out, includes very critical situations in which the lives of those affected are on a knife edge.
Data were collected over a 13-year period at St. Polten University Hospital. During this time, a total of 24 affected patients were admitted alive and received further neurosurgical treatment.
More than half of the infected patients (58%) were self-infected. The method of choice was to use a firearm. In most cases, this resulted in high-speed injuries with a poor prognosis. “In these cases, brain damage also occurs outside the actual channel of entry to the projectile,” Dr. Marhold explains.
“On the other hand, low-velocity objects are more likely to cause localized injuries, which explains the better prognosis for these victims.”
Injuries with low entry velocity were more often accidents or attempted suicides. Here, the high ratio (5/13) generated by bolt pistols, which is widely used in Austrian slaughterhouses, was striking. It is a very high number in the international comparison.
In addition to assessment via entry velocity, the study shows that above all, pupil status of affected subjects provides important information about the likely success of treatment. If the pupils presented themselves as normally as possible, the study team was able to score an adequate course of treatment in more than 60%.
However, if the the pupils Showing satisfactory reactions, this percentage decreased to less than 20%. awareness assessment and Brain weakness According to the so-called Glasgow Coma Scale, it is also identified as an important decision criterion.
Overall, this study was published in Frontiers in surgery, provides a first detailed view of brain injury with brain-infiltrating objects in Austria. It reveals essential features for assessing the potential success of treatment in this acute emergency situation, and is thus fully in line with KL Krems’ research focus, which incorporates scientific findings with clinical added value for patients.
Franz Marhold et al, Surviving the scene in civilian penetrating brain injury: injury type and cause and effect in a consecutive patient series in Austria, Frontiers in surgery (2022). DOI: 10.3389 / fsurg.2022.923949
Presented by Karl Landsteiner University of Health Sciences
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