Skip to main content

Advertisement

SpringerLink
Log in

Pediatric cranial injuries: the Syrian civil war

  • Original Article
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Objective

Kilis, Turkey, a city near Aleppo, Afrin and Azez, Syria, where conflicts are intense, is one of the cities that provides initial emergency treatment. The aim in this study was to analyze the clinical and radiological characteristics of and treatment methods and results in pediatric patients admitted to Kilis State Hospital with cranial gunshot wounds obtained during the Syrian war.

Materials and methods

In this study, 62 pediatric patients treated for cranial gunshot wounds obtained during the civil war in Syria between December 2011 and May 2017 at the Neurosurgery Clinic of Kilis State Hospital on the Turkish side of the Turkey-Syria border were retrospectively analyzed.

Results

A total of 62 patients were evaluated. Forty-six (74.2%) patients were male and 16 (25.8%) were female. The mean age of the patients was 11.4 ± 6.3 (range: 1 month to 18 years) years. The mean Glasgow coma scale (GCS) score was 7.2 ± 3.8. Surgical treatment was performed in 36 patients (58.1%). Six (16.7%) of the surgically treated patients and 15 (57.7%) of the conservatively treated patients died (p < 0.001). While good clinical results (GOS4-5) were obtained in 24 (66.7%) patients who underwent surgical treatment, only 8 (30.8%) patients who underwent conservative treatment had good clinical results (GOS 4–5). The treatment results in patients with a GCS score of between 9 and 15 who were treated with both methods were significantly better (GOS score of 4–5) (p < 0.05) than those in patients with a GCS score of 8 or lower. The treatment results of the patients aged 10–18 years were significantly better than those of patients aged 0–9 years (GOS 4–5) (p < 0.05).

Conclusion

In this study, the GCS score on admission was a significant predictive factor for survival in pediatric patients with cranial gunshot wounds. The outcomes of patients aged 0–9 years with severe neurological damage were worse than those in patients aged 10–18 years. On the basis of the analyses of the treatment methods and GCS and GOS scores of the patients in our study, we conclude that surgical treatment should be performed immediately in all patients with radiological indications and a GCS score higher than 3. Additionally, we conclude that child soldiers exist in Syria.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. UNHCr R (2019) Syria regional refugee response. http://data.unhcr.org/syrianrefugees/regional.php. Accessed 2019 

  2. Celikel A, Karbeyaz K, Kararslan B, Arslan MM, Zeren C (2015) Childhood casualties during civil war: Syrian experience. J Forensic Leg Med 34:1–4

    Article  Google Scholar 

  3. Doganay M, Demiraslan H (2016) Refugees of the Syrian civil war: impact on reemerging infections, health services, and biosecurity in Turkey. Health Secur 14:220–225

    Article  Google Scholar 

  4. Devakumar D, Birch M, Rubenstein LS, Osrin D, Sondorp E, Wells JC (2015) Child health in Syria: recognising the lasting effects of warfare on health. Confl Health 9:34

    Article  Google Scholar 

  5. Hazama A, Ripa V, Kwon CS, Abouelleil M, Hall W, Chin L (2018) Full recovery after a bihemispheric gunshot wound to the head: case report, clinical management, and literature review. World Neurosurg 117:309–314

    Article  Google Scholar 

  6. Miller JD, Butterworth JF, Gudeman SK, Faulkner JE, Choi SC, Selhorst JB, Harbison JW, Lutz HA, Young HF, Becker DP (1981) Further experience in the management of severe head-injury. J Neurosurg 54:289–299

    Article  CAS  Google Scholar 

  7. Raul JS, Deck C, Meyer F, Geraut A, Willinger R, Ludes B (2007) A finite element model investigation of gunshot injury. Int J Legal Med 121:143–146

    Article  Google Scholar 

  8. DeCuypere M, Muhlbauer MS, Boop FA, Klimo P (2016) Pediatric intracranial gunshot wounds: the Memphis experience. J Neurosurg-Pediatr 17:595–601

    Article  Google Scholar 

  9. Liu R, Liu Y, Liu W, Liu X, Gong J, Li C, Tian Y (2018) Gunshot penetrating brain injury in children: report of three cases with review of the literature. Childs Nerv Syst 34:1459–1463

    Article  Google Scholar 

  10. Aras M, Altas M, Yilmaz A, Serarslan Y, Yilmaz N, Yengil E, Urfali B (2014) Being a neighbor to Syria: a retrospective analysis of patients brought to our clinic for cranial gunshot wounds in the Syrian civil war. Clin Neurol Neurosur 125:222–228

    Article  CAS  Google Scholar 

  11. Alvis-Miranda HR, A MR, Agrawal A, Rojas A, Moscote-Salazar LR, Satyarthee GD, Calderon-Miranda WG, Hernandez NE, Zabaleta-Churio N, (2016) Craniocerebral gunshot injuries; a review of the current literature. Bull Emerg Trauma 4:65–74

    PubMed  PubMed Central  Google Scholar 

  12. Borgialli DA, Mahajan P, Hoyle JD, Jr., Powell EC, Nadel FM, Tunik MG, Foerster A, Dong L, Miskin M, Dayan PS, Holmes JF, Kuppermann N, Pediatric Emergency Care Applied Research N (2016) Performance of the pediatric Glasgow coma scale score in the evaluation of children with blunt head trauma. Acad Emerg Med 23:878–884

    Article  Google Scholar 

  13. Jr PB (2001) Surgical management of penetrating brain injury. J Trauma 51:S16–S25

  14. Guha-Sapir D, Schluter B, Rodriguez-Llanes JM, Lillywhite L, Hicks MHR (2018) Patterns of civilian and child deaths due to war-related violence in Syria: a comparative analysis from the Violation Documentation Center dataset, 2011–16. Lancet Glob Health 6:E103–E110

    Article  Google Scholar 

  15. Secretariat GD (2008) Global burden of armed violence. Introduction and Methology, The Journal of Trauma: Injury, Infection, and Critical Care: August 2001 51(2):S44–S49

  16. Patton GC, Coffey C, Sawyer SM, Viner RM, Haller DM, Bose K, Vos T, Ferguson J, Mathers CD (2009) Global patterns of mortality in young people: a systematic analysis of population health data. Lancet (London, England) 374:881–892

    Article  Google Scholar 

  17. Er E, Çorbacıoğlu ŞK, Güler S, Aslan Ş, Seviner M, Aksel G, Bekgöz B (2017) Analyses of demographical and injury characteristics of adult and pediatric patients injured in Syrian civil war. Am J Emerg Med 35:82–86

    Article  Google Scholar 

  18. Levy BS, Sidel VW (2013) Adverse health consequences of the Iraq War. Lancet (London, England) 381:949–958

    Article  Google Scholar 

  19. Hicks MH, Dardagan H, Bagnall PM, Spagat M, Sloboda JA (2011) Casualties in civilians and coalition soldiers from suicide bombings in Iraq, 2003–10: a descriptive study. Lancet (London, England) 378:906–914

    Article  Google Scholar 

  20. Liker MAB, Levy ML (1999) Missile wounds to the head: ballistics and forensics. In: Aarabi BKH, Dagi F, George ED, Levy ML (eds) Neurosurgical topics: missile wounds of the head and neck. AANS Publications, IL, pp 35–55

    Google Scholar 

  21. Coughlan MD, Fieggen AG, Semple PL, Peter JC (2003) Craniocerebral gunshot injuries in children. Childs Nerv Syst 19:348–352

    Article  Google Scholar 

  22. Stone JL, Lichtor T, Fitzgerald LF (1995) Gunshot wounds to the head in civilian practice. Neurosurgery 37:1104–1110. discussion 1110–1102

  23. Kaufman HH, Makela ME, Lee KF, Haid RW, Gildenberg PL (1986) Gunshot Wounds to the Head - a Perspective. Neurosurgery 18:689–695

    Article  CAS  Google Scholar 

  24. Ragel BT, Klimo P, Martin JE, Teff RJ, Bakken HE, Armonda RA (2010) Wartime decompressive craniectomy: technique and lessons learned. Neurosurg Focus 28

  25. Bandt SK, Greenberg JK, Yarbrough CK, Schechtman KB, Limbrick DD, Leonard JR (2012) Management of pediatric intracranial gunshot wounds: predictors of favorable clinical outcome and a new proposed treatment paradigm. J Neurosurg Pediatr 10:511–517

    Article  Google Scholar 

  26. Irfan FB, Hassan RU, Kumar R, Bhutta ZA, Bari E (2010) Craniocerebral gunshot injuries in preschoolers. Childs Nerv Syst 26:61–66

    Article  Google Scholar 

  27. Nagib MG, Rockswold GL, Sherman RS, Lagaard MW (1986) Civilian gunshot wounds to the brain: prognosis and management. Neurosurgery 18:533–537

    Article  CAS  Google Scholar 

  28. Geneva Declaration Secretariat (2008) Global burden of armed violence. Paper

  29. Ewing-Cobbs L, Thompson NM, Miner ME, Fletcher JM (1994) Gunshot wounds to the brain in children and adolescents: age and neurobehavioral development. Neurosurgery 35:225–233. discussion 233

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Faculty of Medicine, Usak University, Usak, Turkey

    Ilker Deniz Cingoz & Ismail Kaya

  2. Kutahya Health Sciences University, Training and Research Center, Kutahya, Turkey

    Meryem Cansu Şahin

  3. Department of Neurosurgery, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey

    Murat Vural

Authors
  1. Ilker Deniz Cingoz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ismail Kaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Meryem Cansu Şahin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Murat Vural
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Concept and design: Murat Vural, Ismail Kaya. Acquisition of data: İlker Deniz Cingoz, Ismail Kaya. Analysis and interpretation of data: Ilker Deniz Cingoz, Murat Vural. Drafting of the article: Meryem Cansu Sahin, Ilker Deniz Cingoz. Critical revision of the article: Murat Vural, Ismail Kaya.

Corresponding author

Correspondence to Ilker Deniz Cingoz.

Ethics declarations

Ethics approval

This study was approved by the ethics committee of İzmir Katip Çelebi University (720 no decree dated 18.06.2020). The authors declare that the study complies with the Declaration of Helsinki.

Consent for publication

All the authors approve the submission of the present article.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cingoz, I.D., Kaya, I., Şahin, M.C. et al. Pediatric cranial injuries: the Syrian civil war. Childs Nerv Syst 38, 1743–1749 (2022). https://doi.org/10.1007/s00381-022-05556-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-022-05556-x

Keywords

Search

Navigation