Lynn Yamane1, Sarah Hinds1, Seong Kyu Yang2, Elena Moreno2, kaitlin simmons2, atzhiry paz2, Ryan Kitagawa2, bindi naik-mathuria2, Huimahn Choi2
1Neurosurgery, The University of Texas Health Science Center At Houston, 2The University of Texas Health Science Center At Houston
Objective:
To characterize penetrating traumatic brain injuries (pTBI) to the head and identify risk factors for mortality.
Background:
In 2022, there were 48,204 firearm-related deaths in the US, averaging 1 death every 11 minutes. In children, it is a leading cause of death. pTBI is the deadliest form of firearm injury. We aimed to identify demographic factors, medical/criminal history, injury severity, and shooting context relating to death.
Design/Methods:
This is a retrospective study of patients admitted to a Level 1 Trauma Center from 2018-2020 with pTBI from a firearm. Univariate analyses were performed using Wilcoxon rank-sum tests and Fisher's exact tests. Adjusted analyses, using multiple logistic regression, were performed to identify risk factors for death.
Results:
203 patients over 18 years (mean 37.3) were identified, 80.8% being men. In adults, causes of pTBI were: 46.8% suicide-attempts, 41.4% intentional, 5.9% accidental, 2% stray bullet, 1% police action, and 3% undetermined. Injuries occurred most in patients’ homes (46.1%) followed by in a vehicle (18%). Overall mortality was 54.2%. Suicide-attempt was the only factor associated with mortality (84.3% vs 31.4%; p<0.001). Suicide was associated with white race and less drug abuse history (p<0.001). Blacks were younger than whites (p=0.016), less likely to have mental illness (p<0.001), and more likely to have drug abuse history (p=0.003).
40 children, ages 2 to 17 (mean 13.8), were identified. Causes include 42.5% intentional, 22.5% accidental, 25.0% suicides, 5.0% stray bullet, and 5.0% undetermined. Mortality was 52.5%. Unintentional pTBI was most commonly caused by the patient (68%) or family (18%). Excluding suicides, children living in apartments were more likely to have intentional pTBI compared to those in houses.
Conclusions:
Adult pTBI was most commonly caused by suicide, the only predictor of death. Children were more likely to have pTBI from intentional discharge followed by accidental discharge. Mortality was similar in adults and children.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.