Am J Surg. 2018 Nov 27;Epub ahead of print

# Trends in civilian penetrating brain injury: A review of 26,871 patients.

Skarupa D, Khan M, Hsu A, Madbak F, Ebler D, Yorkgitis B, Rahmathulla G, Alcindor D, Joseph B

INTRODUCTION: The aim of our study is to analyze the 5 years' trends, mortality rate, and factors that influence mortality after civilian penetrating traumatic brain injury (pTBI).

METHODS: We performed a 5-year-analysis of all trauma patients diagnosed with pTBI in the TQIP. Our outcome measures were trends of pTBI.

RESULTS: A total of 26,871 had penetrating brain injury over the 5-year period. Mean age was 36.2 ± 18 years. Overall 55% of the patients had severe TBI and mortality rate was 43.8%. There was an increase in the rate of pTBI from 3042/100,000 (2010) to 7578/100,000 trauma admissions (2014) (p < 0.001). The mortality rate has increased from 35% (2010) to 48% (2011) (p < 0.001) followed by a linear decrease in mortality to 40% (2014). Independent predictors of mortality were age, pre-hospital intubation, suicide attempt, and craniotomy/craniectomy.

CONCLUSIONS: Incidence and mortality for patients who are brought to hospitals following pTBI have gradually increased over the five-year period. Self-inflicted injury and prehospital intubation were the two most significant predictors of mortality.