Research Reports - Outcome and seizures after penetrating versus closed traumatic brain injury

J Head Trauma Rehabil. 2015 Apr 29

Walker WC(1), Ketchum JS 3rd, Marwitz JH, Kolakowsky-Hayner SA, McClish DK,
Bushnik T.

BACKGROUND: If and how much dural penetration influences long-term outcome after
traumatic brain injury (TBI) is understudied, especially within the civilian
population.
OBJECTIVES: 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.
CONCLUSION: This study empirically demonstrates that penetrating injury mechanism
has important prognostic implications.

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