Penetrating Firearm-Inflicted Injury—The Neglected Traumatic Brain Injury

Lazaridis, Christos; Das, Paramita

doi:10.1001/jamaneurol.2023.3030

Cited by 1 publication

(3 citation statements)

References 7 publications

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“… a Median (interquartile range [IQR]); n (%) b Wilcoxon rank sum test; Pearson's χ 2 test GCS, Glasgow Coma Scale; WOLST withdrawal of life-sustaining therapies, ICU, intensive care unit; ICP, intracranial pressure; ISS, Injury Severity Score. …”

Section: Resultsmentioning

confidence: 99%

“…The data set was divided into two groups based on the mechanism of injury (blunt vs. penetrating). Statistical analyses were conducted using parametric testing (unpaired t test) for continuous variables and Pearson χ 2 test for categorical variables. P value of <0.05 was considered statistically significant.…”

Section: Methodsmentioning

confidence: 99%

“…This is particularly striking given the considerable public health implications associated with PBI, mainly firearm-inflicted brain injuries. Almost half of all TBI-related deaths from recent years resulted from suicide and homicide, 2 , 3 with specific demographic groups, such as young men in metropolitan areas and non-Hispanic black individuals, bearing a disproportionately higher burden. Despite the dire epidemiological data, there is a significant deficit of good quality literature on PBI.…”

Section: Introductionmentioning

confidence: 99%

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Comparative Analysis of Clinical Severity and Outcomes in Penetrating Versus Blunt Traumatic Brain Injury Propensity Matched Cohorts

Mansour,

Powla,

Alvarado-Dyer

et al. 2024

Neurotrauma Reports

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Traumatic brain injury (TBI) is a global health challenge; however, penetrating brain injury (PBI) remains under-represented in evidence-based knowledge and research efforts. This study utilized data from the Trauma Quality Improvement Program (TQIP) of the National Trauma Data Bank (NTDB) to investigate outcomes of PBI as compared with clinical-severity-matched non-penetrating or blunt TBI. A total of 1765 patients with PBI were 1:1 propensity score-matched for clinical severity with blunt TBI patients. The intent of PBI was self-inflicted in 34.1% of the cases, and the mechanism was firearm-inflicted in 89.1%. Mortality was found to be significantly more common in PBI than in the severity- matched TBI cohort (33.9% vs. 14.3 %, p < 0.001) as was unfavorable outcome. Mortality was mediated by withdrawal of life-sustaining therapies (WOLST) 30% of the time, and WOLST occurred earlier (median 3 days vs. 6 days, p < 0.001) in PBI. Increased rate of mortality was observed with a Glasgow Coma Scale (GCS) of <11 in PBI as compared with <7 in blunt TBI. In conclusion, PBI patients exhibited higher mortality rates and unfavorable outcomes; one third of excess mortality was mediated by WOLST. The study also brings into question the applicability of the conventional TBI classification, based on GCS, in PBI. We emphasize the need to address the observed disparities and better understand the distinctive characteristics and mechanisms underlying PBI outcomes to improve patient care and reduce mortality.

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