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Blunt Versus Penetrating Violent Traumatic Brain Injury: Frequency and Factors Associated with Secondary Conditions and Complications

Black, Kertia L. MD*; Hanks, Robin A. PhD**; Wood, Deborah L. MS; Zafonte, Ross D. DO; Cullen, Nora MD§; Cifu, David X. MD; Englander, Jeffrey MD$; Francisco, Gerard E. MD%

The Journal of Head Trauma Rehabilitation: December 2002 - Volume 17 - Issue 6 - p 489–496
Clinical Research and Practice, Part 2

Objective: To compare types and frequency of medical complications and comorbidities associated with violence-related penetrating traumatic brain injury (TBI) as compared to violence-related blunt TBI.

Method: Data were collected prospectively at four medical centers participating in the TBI Model Systems (TBIMS) of Care project. A total of 317 individuals met the inclusion criteria for the TBIMS (i.e., showed evidence of a TBI, were age 16 or older, presented to the TBIMS emergency department within 24 hours of injury, and received acute and rehabilitation services within the model system).

Main Outcome Measures: Frequency of medical complications and comorbid diseases.

Results: Patients with penetrating injuries suffered significantly higher rates of respiratory failure (P = .004), pneumonitis/pneumonia, (P = .002), skull fracture (P = .001), cerebrospinal fluid leak (P = .0005), and hypotonia (P = .001) than did patients with blunt injuries. Prediction of complications and comorbidities via multiple regression revealed that a penetrating violent injury and the severity of injury were independent predictors of a higher rate of medical complications, whereas age and gender did not account for unique variance in the equation.

Conclusions: Penetrating injuries are associated with higher rates of certain medical complications, especially to the pulmonary and central nervous systems. Acute care physicians and physiatrists must be prepared to treat these complications more often in patients with penetrating injuries.

*Interim Associate Chairperson, Physical Medicine and Rehabilitation, Rehabilitation Institute of Michigan, Detroit.

**Assistant Professor and Chief of Psychology, Physical Medicine and Rehabilitation, Rehabilitation Institute of Michigan, Detroit.

Neurotrauma Research Manager, Physical Medicine and Rehabilitation, Rehabilitation Institute of Michigan, Detroit.

Professor and Chairman, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania.

§Physiatrist and Assistant Professor, Toronto Rehabilitation Institute, Toronto, Canada.

Professor and Chairman, Physical Medicine and Rehabilitation, Medical College of Virginia, Richmond, Virginia.

$Vice Chairperson, Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, California.

%Associate Director, Brain Injury Program, The Institute for Rehabilitation and Research, Houston, Texas.

Address correspondence and requests for reprints to Kertia Black, MD, Interim Associate Chairperson, Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Michigan, 261 Mack Boulevard, Detroit, MI 48201; Telephone: 313-966-0444; Fax: 313-745-1063; E-mail:

This research was supported, in part, by the National Institute on Disability and Rehabilitation Research, U.S. Department of Education (Grant number: H133A970021).

© 2002 Lippincott Williams & Wilkins, Inc.