Blast-induced Traumatic Brain Injuries: Experience from the Deadliest Suicide Double-Car Bomb Attack in Iraq.

INTRODUCTION: Blast-induced traumatic brain injuries (bTBIs) are increasingly frequent in civilian settings. The authors present the first study of bTBI victims in Iraq. The paper focuses on one of the deadliest suicide-car bomb attacks in Iraq, and uses. it as an example to illustrate the devastating nature of bTBIs METHODS: This study was conducted at the Neurosurgery Teaching Hospital (NTH) in Baghdad, Iraq. A retrospective chart analysis of bTBI victims admitted to the NTH was performed. Measured parameters included victims' demographics, initial presentation, injury patterns, hospital course, surgical management, and outcomes.

RESULTS: A total of 75 bTBI victims were included in this study, 19 of whom died in the emergency room. The remaining 56 victims were admitted to the hospital. Of those, 68.6% (n=39) underwent surgery, and 30.4% were managed conservatively. A modified, tailored triaging system was implemented. All surgeries were guided by the principles of Damage control neurosurgery (DCNS). In addition, 76.9%, and 46.2% of victims underwent corticectomy and decompressive craniectomy, respectively. Dural venous sinus repair was done in 17.9% of cases, and 30.7% of the surgeries entailed additional steps to control major (arterial) cerebrovascular bleeding. The net bTBI-related complication rate was 76%. The total mortality rate was 48%. Amongst survivors, 10.7% (n=8) were discharged with a severe disability. Overall, good outcomes were achieved in 41.3% of the victims.

CONCLUSION: This study sheds light on the devastating nature of bTBIs. Neurosurgeons around the world need to be mindful of the unique triaging, diagnostic, and management requirements of these injuries.