Management of war penetrating craniocerebral injuries during the war in Croatia

From September 1991 to December 1992, during the war in Croatia, the General Hospital in Slavonski Brod served as an evacuation centre. During that period 197 patients with war-related penetrating craniocerebral injuries were admitted. They were analyzed according to wound characteristics, operability, mortality, operative and post-operative complications, and their condition after hospital discharge and follow-up. A less aggressive surgical approach was accepted in our surgical strategy, recommended in recent studies, followed by an aggressive intensive management. All patients received antibiotics ("war scheme") and anticonvulsants. Early results of treatment do not differ significantly from other recent studies (Vietnam, Israel) in respect to both mortality and complications. Follow-up was difficult. Most of the patients were Bosnia and Herzegovina citizens who were refugees and banished to foreign countries; thus their addresses were unknown. They are consequently lost to follow-up. A less aggressive surgical approach proved to be justified. Routine use of antibiotics and anticonvulsants lowered the infection rate and early seizure incidence to an acceptable level. Late seizure incidence is similar to those previously reported.