2025 Proffered Presentations
S072: EFFECTS OF INJURY LOCATION AND SKULL BASE FRACTURES ON OUTCOMES OF PENETRATING TRAUMATIC BRAIN INJURY
Alexa R Lauinger1; Wael Hassaneen, MD, PhD2; 1Carle Illinois College of Medicine; 2Carle Neuroscience Institute
Background: Traumatic brain injury (TBI) annually affects around 69 million individuals worldwide. Of these, penetrating traumatic brain injury (pTBI) have a high morbidity and mortality rate. Civilian pTBIs are most commonly caused by gunshot injuries. Recently in the US, there has been an increase in incidence of pTBI and an increase in the rate of operative intervention for these injuries. The treatment options for pTBI include antibiotic prophylaxis and surgical intervention. However, there’s still limited data on how injury details and treatment can impact patient outcomes. This project will explore the factors associated with poor outcomes following pTBI using the United States National Trauma Data Bank (NTDB). We specifically included information about skull fracture diagnoses to estimate the location of the entry wound.
Methods: Data from the NTDB between the years 2017 and 2021 was collected, and patients with a pTBI were selected for further analysis. Diagnoses were collected based on ICD10 codes. Logistic regression was completed on 80% of the data from 2017 and 2018 to develop a multivariable model that predicted in-hospital mortality. This model was tested internally using the 20% testing cohort and externally using the data from 2020 and 2021.
Results: Univariable analysis for mortality, complications, and hospital length of stay all significantly correlated with skull base and vault fractures; however, none of these diagnoses were included in the final multivariable models. The final multivariable regression model for in-hospital complication included emergency department (ED) Glasgow coma scale (GCS), penetration greater than 2cm, drain placement, injury severity scale (ISS), and transfusion. This model had an accuracy of 89.5% and 87.1% for internal and external testing cohorts, respectively. The median hospital length of stay was 6 days. The model for length of stay included ISS, transfusion, and drain placement. For complications, the model included drain placement, transfusion, and ISS. Accuracy for the length of stay model was 71.5% internally and 71.8% externally while they were 92.0% internally and 93.6% externally for the complication model.
Conclusion: As prevalence of pTBI remains high in the US, it is important to understand the factors associated with poor prognosis. Severity of overall injury, patient age, and procedures were the most predictive parameters. Interesting, the location of fractures and associated complications, such as cerebral edema, were not included in the outcome models. Nonetheless, it was noted that injuries associated with skull base and vault fractures had worse mortality rates and longer hospital stays compared to fractures in other skull bones.