Early predictors of mortality in penetrating compared with closed brain injury.

Introduction: Although brain injury incidence rates have been decreasing, the proportion of these injuries which are penetrating has been increasing. This study compares mortality amongst persons with penetrating and closed brain injuries and explores the relationship of early predictors of mortality.

Methods: The study included 795 moderately or severely brain injured individuals identified through the UCLA Brain Injury Research Centre. Logistic regression was used to predict mortality by GCS level and brain injury type, controlling for age, gender, and presence of multiple trauma.

Results: Of the 795 individuals, 110 had penetrating and 685 had closed brain injury. Case fatality rates were higher for penetrating than closed injuries for all GCS, gender, age, and cause of injury categories. When controlling for GCS level at admission, age, gender, and multiple trauma, those with penetrating injuries were 6.6 (95% CI = 3.9-11.1) times more likely to die.

Conclusions: As the pool of information about survival and recovery from penetrating injuries grows, decisions regarding clinical care and prevention activities can be more appropriately focused.