Global Outcome and Late Seizures After Penetrating Versus Closed Traumatic Brain Injury: A NIDRR TBI Model Systems Study.
BACKGROUND
If and how much dural penetration influences long-term outcome after traumatic brain injury (TBI) is understudied, especially within the civilian population.


OBJECTIVE
Using the large TBI Model Systems cohort, this study assessed and compared penetrating TBI (PTBI) and closed TBI with respect to global outcome and late seizures 2 years after injury.


METHODS
After performing unadjusted PTBI versus closed TBI comparisons, multivariate regression models were built and analyzed for both outcomes by including the following additional predictors: length of unconsciousness, posttraumatic amnesia duration, hospital length of stay, age, gender, race, marital status, education level, problem substance abuse, and preinjury employment status.


RESULTS
The collapsed Glasgow Outcome Scale model (n = 6111) showed significant secondary effects of PTBI with employment status. When employed before injury, individuals with PTBI were 2.62 times more likely (95% confidence interval, 1.92-3.57) to have a lower Glasgow Outcome Scale category. The final model for late seizures (n = 6737) showed a significant main effect for PTBI. Adjusting for other predictors, individuals with PTBI were 2.78 times more likely (95% confidence interval, 1.93-3.99) than those with closed TBI to be rehospitalized for a seizure.


CONCLUSIONS
This study empirically demonstrates that penetrating injury mechanism has important prognostic implications.
Department of Physical Medicine and Rehabilitation (Dr Walker and Ms Marwitz) and Department of Biostatistics (Mr Ketchum and Dr McClish), Virginia Commonwealth University, Richmond, Virginia; Santa Clara Valley Medical Center, Rehabilitation Research Center, San Jose, California (Dr Kolakowsky-Hayner); and Rusk Rehabilitation, New York University Langone School of Medicine, New York (Dr Bushnik).
William C
WC
Walker
James S
JS
Ketchum
Jennifer H
JH
Marwitz
Stephanie A
SA
Kolakowsky-Hayner
Donna K
DK
McClish
Tamara
T
Bushnik
D000328:Adult; D001930:Brain Injuries / Q000150:complications*; D015331:Cohort Studies; D005260:Female; D023261:Glasgow Outcome Scale; D016489:Head Injuries, Closed / Q000150:complications*; D020197:Head Injuries, Penetrating / Q000150:complications*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012640:Seizures / Q000453:epidemiology*; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult