On 22 May 2017, the Manchester Arena bombing caused 22 lives and over 160 casualties requiring medical attention. Given the threat of modern-era terrorist attacks in civilian environments, everyone must be able to anticipate and appropriately manage neurological injuries associated with these events. This article describes our experience of working pediatric neurosurgical blast injuries, from initial triage and operative management to longer-term considerations. The researchers have made the study entirely based on old literature reviews and case studies.
Pediatric traumatic and penetrating brain injury patients often make an excellent neurological recovery despite low GCS at the time of injury; this should be accounted for during triage and operative decision making, little trauma, mass casualty events. Conservative management of retained shrapnel is advocated because of low long-term infection rates with retained shrapnel and worsened neurological outcomes with shrapnel retrieval. All penetrating brain injuries should receive a prolonged course of broad-spectrum antibiotics and undergo long-term follow-up imaging to monitor cerebral abscesses’ development. MRI should never be utilized in penetrating brain injury cases, even in the absence of macroscopically visible fragments, due to the effect of MRI ferromagnetic field torque on shrapnel fragments. Anti-epileptic drugs should only be prescribed for the initial seven days after injury, as continuing beyond this does not benefit the reduction of long-term post-traumatic epilepsy.