• S A Ansari and A M Panezai.
• Department of Neurosurgery, Dow Medical College, Karachi, Pakistan.
• Br J Neurosurg. 1998 Aug 1;12(4):340-3.

AbstractWe carried out a prospective study on patients admitted to busy neurosurgical units in Karachi and Quetta with penetrating craniocerebral injuries. Of the 100 patients, 52 died and 48 survived in spite of aggressive surgical management. Maximum mortality was in patients with Glasgow Coma Score (GCS) below 5. A delay of 6 h, delay in interhospital transfers, and limited post operative aggressive management led to further secondary insults to the brain contributing to a poorer outcome. A review of current literature on pathophysiology and management is included and the importance of prehospital optimum care, and early transfer to the neurosurgical centre are emphasized. Since only two of the 35 patients with a GCS of less than five survived, with severe disabilities, utilizing resources in third world countries on the management of craniocerebral penetrating injuries in patients with a GCS less than 5 is questioned especially when organ donation is not possible.

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