Surgical Treatment of Penetrating Wounds After Resuscitation study: a new classification system for penetrating injuries to the posterior fossa

In the largest reported series of patients with posterior fossa pTBI, 1-month mortality was lower than that in other published series, suggesting that patients with military pTBI, which is caused primarily by shrapnel, may have a better outcome than those with civilian pTBI, most of whom have gunshot wounds. The STOPWAR classification system performed well. A major advantage of the STOPWAR scale is that it is based only on imaging findings and may be used when clinical examination is impossible or potentially inaccurate. The slightly worse performance of the STOPWAR scheme for GOS outcome than for mortality may reflect the inadequacy of using the GOS as an outcome metric at the early postinjury time point of 1 month. Unfortunately, more detailed outcome assessments at longer postinjury time intervals are currently not possible in Ukraine. These and other improvements in study design can be explored in future investigations, which may also evaluate the role of the STOPWAR scale in civilian pTBI patients and in casualties from other armed conflicts.