Krueger Evan M, Moll Joshua, Kumar Rahul, Lu Victor M, Benveniste Ronald, Cordeiro Joacir G, Jagid Jonathan
Neurosurgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, USA.
Neurosurgery, University of Miami Miller School of Medicine, Miami, USA.
Cureus. 2022 May 21;14(5):e25187. doi: 10.7759/cureus.25187. eCollection 2022 May.
Civilian cranial gunshot wounds are common injuries associated with significant morbidity and mortality. Simple wound closure has been previously proposed as an alternative treatment option for a small subset of patients, but the exact outcomes of this strategy are not well-defined. The objective of this paper was to describe the scientific literature reporting simple wound closure of civilian cranial gunshot wounds, its effect on short-term and long-term neurologic outcomes, and rates of seizures and infections. A systematic literature review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The strength of evidence was assessed using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria. Seventeen studies were found that met inclusion criteria. There was very low strength of evidence that patients treated with simple wound closure can achieve good short and long-term neurologic outcomes. There was very low strength of evidence that simple wound closure has a higher incidence of mortality compared to operative intervention, especially in patients with initial low Glasgow Coma Scale (GCS) scores. There was very low strength of evidence that patients treated with simple wound closure have a small risk of subsequently developing infections or seizures. In conclusion, under most circumstances, neurosurgical operative intervention should be viewed as the optimal treatment for salvageable civilian cranial gunshot wound patients. However, our literature review showed that simple wound closure is safe and viable. More data are needed to determine the appropriate clinical scenario for using this alternative option.
平民颅脑枪伤是常见的损伤，常伴有较高的发病率和死亡率。此前曾有人提出，对于一小部分患者，单纯伤口缝合可作为一种替代治疗方案，但该策略的确切效果尚不明确。本文的目的是描述报告平民颅脑枪伤单纯伤口缝合的科学文献，其对短期和长期神经学结果的影响，以及癫痫发作和感染率。根据系统评价和荟萃分析的首选报告项目（PRISMA）指南进行了系统的文献综述。使用推荐分级、评估、制定和评价（GRADE）标准评估证据的强度。共发现17项符合纳入标准的研究。证据强度非常低，表明接受单纯伤口缝合治疗的患者可实现良好的短期和长期神经学结果。证据强度非常低，表明与手术干预相比，单纯伤口缝合的死亡率更高，尤其是初始格拉斯哥昏迷量表（GCS）评分较低的患者。证据强度非常低，表明接受单纯伤口缝合治疗的患者随后发生感染或癫痫发作的风险较小。总之，在大多数情况下，神经外科手术干预应被视为可挽救的平民颅脑枪伤患者的最佳治疗方法。然而，我们的文献综述表明，单纯伤口缝合是安全可行的。需要更多数据来确定使用这种替代方案的合适临床情况。
