Penetrating brain injury caused by tired bullet: First report from Somalia

Background: Brain injuries caused by a tired bullet can range from headaches to severe brain injury and death. The question which poses a dilemma is whether extraction of retained bullets could decrease the late complications. This study aims to investigate the radiological findings, the neurological status of the patients, and different modalities of management for craniocerebral tired bullet injury. Method: This study retrospectively reviewed 21 patients with a tired bullet injury to the brain who were admitted into our hospital over five years. All patients were assessed for the Glasgow outcome scale as outpatients. Result: Of the 21 patients in the study, 11 (52.3%) were males, and 10 (47.6%) were females. The most common entry point of the bullet was frontal in 8 (38.0%) patients, followed by parietal in 7 (33.3%), and orbital in 5 (23.8%). The mortality rate was 23.8% (n = 5 patients). Bad outcomes were documented in patients with low GCS, with all patients who died having a GCS of (3-8). Bullet retrieval was performed for 7 of 21 patients, while all patients who were not candidates for emergency operation underwent local wound debridement. The GOS score was good [4 and 5] in 71.4% (15 of 21 patients). Conclusion: This study revealed that two-thirds of patients with tired bullet injury underwent conservative treatment with an excellent long-term outcome, particularly for patients with high GCS on admission. The mortality rate was high among children under 15 years and those with a GCS of 3-8.