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Intentional Traumatic Brain Injury: Epidemiology, Risk Factors, and Associations with Injury Severity and Mortality

Wagner, Amy Kathleen MD; Sasser, Howell Crawford PhD; Hammond, Flora McConnell MD; Wiercisiewski, David MD; Alexander, James MD

The Journal of Trauma: Injury, Infection, and Critical Care: September 2000 - Volume 49 - Issue 3 - p 404-410

Background Intentional injury is associated with significant morbidity and mortality and has been associated with certain demographic and socioeconomic groups. Less is known about the relationship of intentional traumatic brain injury (TBI) to injury severity, mortality, and demographic and socioeconomic profile. The objective of this study was to delineate demographic and event-related factors associated with intentional TBI and to evaluate the predictive value of intentional TBI on injury severity and mortality.

Methods Prospective data were obtained for 2,637 adults sustaining TBIs between January 1994 and September 1998. Descriptive, univariate, and multivariate analyses were conducted to determine the predictive value of intentional TBI on injury severity and mortality.

Results Gender, minority status, age, substance abuse, and residence in a zip code with low average income were associated with intentional TBI. Multivariate analysis found minority status and substance abuse to be predictive of intentional injury after adjusting for other demographic variables studied. Intentional TBI was predictive of mortality and anatomic severity of injury to the head. Penetrating intentional TBI was predictive of injury severity with all injury severity markers studied.

Conclusion Many demographic variables are risk factors for intentional TBI, and such injury is a risk factor for both injury severity and mortality. Future studies are needed to definitively link intentional TBI to disability and functional outcome.

From the Carolinas Health Care System (H.C.S., J.A.), and the Charlotte Institute of Rehabilitation (A.K.W., F.M.H., D.W.), Charlotte, North Carolina.

Submitted for publication January 11, 2000.

Accepted for publication May 4, 2000.

Address for reprints: Amy Wagner, MD, Department of Physical Medicine and Rehabilitation, University of Pittsburgh, 3471 Fifth Avenue, Kaufmann Building Suite 901, Pittsburgh, PA 15213.

© 2000 Lippincott Williams & Wilkins, Inc.