alexa Abstract | Comparative outcome of non-metallic and metallic craniocerebral missile injuries

Current Neurobiology
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We ought to sought the comparative outcome related to 694 non-metallic and metallic cra-niocerebral missile injuries who lived at 2 hours and beyond the time of injury in a retro-spective and prospective analysis in the Department of Neurosurgery at Sher-I-Kashmir In-stitute of Medical Sciences (SKIMS) Kashmir, India, over a period of 21 years from Sep-tember 1988 to March, 2010. The study revealed an overall mortality of 32.70% (227 out of 694). A total of 664 adults and 30 children (mostly teenagers) were studied. The 79.1% (549 out of 694) patients were metallic missile (metal bullets, grenade, bomb and improvised ex-plosive device (IED) blasts, shrapnels, bolts, splinters and pellets used by shotgun etc) inju-ries whereas 20.8% (145 out of 694) patients were non-metallic missile injuries. The non-metallic missile injury group mostly (72.4% i.e.; 105 out of 145) had low GCS (Glasgow Coma Scale) score and overall worse prognosis with zero good-recovery, 47.5% disabilities and 52.4% mortality as compared to the metallic missile injury group. The non-metallic group comprised of 60% (18 out of 30) children which resulted in only one death. The me-tallic missile injury deaths amounted to 21.75% (151 out of 694 patients) and non-metallic missile injuries accounted for 10.95% (76 out of 694 patients) of total deaths. Predictors of poor outcome were low admission GCS score, non-metallic penetrating injury due to tear-gas cartridges, rubber bullets and stone-bullets, perforating metallic missile injuries and de-layed and maltransportation. Most complications i.e. 287 complications in only 145 patients, mostly infective were found in non-metallic missile injuries with worst outcome. The com-mon non-metallic missiles used were stone balls (stone-bullets) and spherical glass balls (lo-cally Buanta) fired by Gulail (modified catapult) or slingshot, red rubber bullets, plastic tear gas shells and cartridges, wooden (pulped mulberry stem) and card-board wads used in shotguns (pellet-guns). The stone pelting, throwing stone projectiles (stone-bullets and glass-bullets) by Gulail and manually has become a common way to inflict head and eye injuries in Kashmir. The non-metallic missiles are not less-lethal and have high disabling, killing and infective

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Author(s): Bhat Abdul Rashid Muhammed Afzal Wani AR Kirmani TH Raina Imtiyaz Naqash Altaf U R Shafiq Alam Sajad Arif Ashish Kumar Basharat


Craniocerebral, missile injuries, metallic, non-metallic, outcome

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