COMMENTARY COMMENTARY
Commentary: Severe Pediatric Head Injury During the Iraq and Afghanistan Conflicts Ryan P. Morton, MD Richard G. Ellenbogen, MD Department of Neurological Surgery, University of Washington, Seattle, Washington Correspondence: Richard G. Ellenbogen, MD, Department of Neurological Surgery, Box 359766, Harborview Medical Center, 325 9th Avenue, Seattle, WA. E-mail: [email protected]
Copyright © 2015 by the Congress of Neurological Surgeons.
8 | VOLUME 77 | NUMBER 1 | JULY 2015
K
limo et al are to be congratulated for reporting the largest study of severe combat-related isolated head injuries in children. Their article highlights the incredible work being done overseas by our active-duty military neurosurgeons, who not only are tasked with the care of soldiers, sailors, and airmen—but also with the care of local nationals, including innocent children. The pathology encountered abroad was remarkably different than what we are accustomed to in the continental United States, with 60% of this pediatric trauma series suffering penetrating head injuries. Our military colleagues were clearly ready to meet this wartime challenge, as they aggressively treated this severely injured patient population: 50% of the children received a craniotomy/ craniectomy and another 35% received an intracranial pressure monitor. Sadly, despite such aggressive efforts, the in-hospital mortality rate was still 25%. Admission Glasgow Coma score was, not surprisingly, the most predictive variable and, while impossible to account for in this retrospective database review, we think geography and time to transport to a level III MTF
undoubtedly played a role in many cases of poor outcome. Other definitive conclusions that we all would enjoy knowing (ie, specifics on pre- and postoperative computed tomographic radiography, operative techniques, operative outcomes of infection and subsequent cranioplasty, long-term clinical outcomes, etc.) are impossible draw from this JTTR dataset due to the significant inherent limitations that the authors dutifully highlight. Once again, we congratulate this group on their contribution to the literature. We’ve enjoyed their previous publications about the neurosurgical diseases encountered during wartime and look forward to future reports from them and the other military neurosurgeons. Their work will not only improve care in future military conflicts, but also care state-side as we look forward to applying wartime lessons learned to our current civilian trauma practices. Disclosure The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
www.neurosurgery-online.com
Copyright © Congress of Neurological Surgeons. Unauthorized reproduction of this article is prohibited
Commentary: Severe Pediatric Head Injury During the Iraq and Afghanistan Conflicts Ryan P. Morton, MD Richard G. Ellenbogen, MD Department of Neurological Surgery, University of Washington, Seattle, Washington Correspondence: Richard G. Ellenbogen, MD, Department of Neurological Surgery, Box 359766, Harborview Medical Center, 325 9th Avenue, Seattle, WA. E-mail: [email protected]
Copyright © 2015 by the Congress of Neurological Surgeons.
8 | VOLUME 77 | NUMBER 1 | JULY 2015
K
limo et al are to be congratulated for reporting the largest study of severe combat-related isolated head injuries in children. Their article highlights the incredible work being done overseas by our active-duty military neurosurgeons, who not only are tasked with the care of soldiers, sailors, and airmen—but also with the care of local nationals, including innocent children. The pathology encountered abroad was remarkably different than what we are accustomed to in the continental United States, with 60% of this pediatric trauma series suffering penetrating head injuries. Our military colleagues were clearly ready to meet this wartime challenge, as they aggressively treated this severely injured patient population: 50% of the children received a craniotomy/ craniectomy and another 35% received an intracranial pressure monitor. Sadly, despite such aggressive efforts, the in-hospital mortality rate was still 25%. Admission Glasgow Coma score was, not surprisingly, the most predictive variable and, while impossible to account for in this retrospective database review, we think geography and time to transport to a level III MTF
undoubtedly played a role in many cases of poor outcome. Other definitive conclusions that we all would enjoy knowing (ie, specifics on pre- and postoperative computed tomographic radiography, operative techniques, operative outcomes of infection and subsequent cranioplasty, long-term clinical outcomes, etc.) are impossible draw from this JTTR dataset due to the significant inherent limitations that the authors dutifully highlight. Once again, we congratulate this group on their contribution to the literature. We’ve enjoyed their previous publications about the neurosurgical diseases encountered during wartime and look forward to future reports from them and the other military neurosurgeons. Their work will not only improve care in future military conflicts, but also care state-side as we look forward to applying wartime lessons learned to our current civilian trauma practices. Disclosure The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
www.neurosurgery-online.com
Copyright © Congress of Neurological Surgeons. Unauthorized reproduction of this article is prohibited
