title: Blunt versus penetrating violent traumatic brain injury: frequency and factors associated with secondary conditions and complications.
abstract: OBJECTIVE
  To compare types and frequency of medical complications and comorbidities associated with violence-related penetrating traumatic brain injury (TBI) as compared to violence-related blunt TBI.
  
  
  METHODS
  Data were collected prospectively at four medical centers participating in the TBI Model Systems (TBIMS) of Care project. A total of 317 individuals met the inclusion criteria for the TBIMS (i.e., showed evidence of a TBI, were age 16 or older, presented to the TBIMS emergency department within 24 hours of injury, and received acute and rehabilitation services within the model system).
  
  
  METHODS
  Frequency of medical complications and comorbid diseases.
  
  
  RESULTS
  Patients with penetrating injuries suffered significantly higher rates of respiratory failure (P =.004), pneumonitis/pneumonia, (P =.002), skull fracture (P =.001), cerebrospinal fluid leak (P =.0005), and hypotonia (P =.001) than did patients with blunt injuries. Prediction of complications and comorbidities via multiple regression revealed that a penetrating violent injury and the severity of injury were independent predictors of a higher rate of medical complications, whereas age and gender did not account for unique variance in the equation.
  
  
  CONCLUSIONS
  Penetrating injuries are associated with higher rates of certain medical complications, especially to the pulmonary and central nervous systems. Acute care physicians and physiatrists must be prepared to treat these complications more often in patients with penetrating injuries.
authors.affiliation: Physical Medicine and Rehabilitation, Rehabilitation Institute of Michigan, Detroit 48201, USA. KBlack@dmc.org
authors.forename: Kertia L
authors.initials: KL
authors.lastname: Black
authors.forename: Robin A
authors.initials: RA
authors.lastname: Hanks
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Wood
authors.forename: Ross D
authors.initials: RD
authors.lastname: Zafonte
authors.forename: Nora
authors.initials: N
authors.lastname: Cullen
authors.forename: David X
authors.initials: DX
authors.lastname: Cifu
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Englander
authors.forename: Gerard E
authors.initials: GE
authors.lastname: Francisco
mesh_terms: D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000150:complications* / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D015599:Trauma Severity Indices; D014754:Violence; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000534:rehabilitation*; D014950:Wounds, Penetrating / Q000150:complications* / Q000534:rehabilitation*