Early predictors of mortality in penetrating compared with closed brain injury.
BACKGROUND
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.
Peek-Asa
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Southern California Injury Prevention Research Center, UCLA Department of Epidemiology, School of Public Health, Los Angeles, CA, USA. cpeekasa@ucla.edu
McArthur
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Hovda
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Kraus
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D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D016489:Head Injuries, Closed / Q000401:mortality* / Q000473:pathology; D020197:Head Injuries, Penetrating / Q000401:mortality* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis