William C Walker1, James S Ketchum, Jennifer H Marwitz, Stephanie A Kolakowsky-Hayner, Donna K McClish, Tamara Bushnik. 1. Department of Physical Medicine and Rehabilitation (Dr Walker and Ms Marwitz) and Department of Biostatistics (Mr Ketchum and Dr McClish), Virginia Commonwealth University, Richmond, Virginia; Santa Clara Valley Medical Center, Rehabilitation Research Center, San Jose, California (Dr Kolakowsky-Hayner); and Rusk Rehabilitation, New York University Langone School of Medicine, New York (Dr Bushnik).
Abstract
BACKGROUND: If and how much dural penetration influences long-term outcome after traumatic brain injury (TBI) is understudied, especially within the civilian population. OBJECTIVES: Using the large TBI Model Systems cohort, this study assessed and compared penetrating TBI (PTBI) and closed TBI with respect to global outcome and late seizures 2 years after injury. METHODS: After performing unadjusted PTBI versus closed TBI comparisons, multivariate regression models were built and analyzed for both outcomes by including the following additional predictors: length of unconsciousness, posttraumatic amnesia duration, hospital length of stay, age, gender, race, marital status, education level, problem substance abuse, and preinjury employment status. RESULTS: The collapsed Glasgow Outcome Scale model (n = 6111) showed significant secondary effects of PTBI with employment status. When employed before injury, individuals with PTBI were 2.62 times more likely (95% confidence interval, 1.92-3.57) to have a lower Glasgow Outcome Scale category. The final model for late seizures (n = 6737) showed a significant main effect for PTBI. Adjusting for other predictors, individuals with PTBI were 2.78 times more likely (95% confidence interval, 1.93-3.99) than those with closed TBI to be rehospitalized for a seizure. CONCLUSION: This study empirically demonstrates that penetrating injury mechanism has important prognostic implications.
BACKGROUND: If and how much dural penetration influences long-term outcome after traumatic brain injury (TBI) is understudied, especially within the civilian population. OBJECTIVES: Using the large TBI Model Systems cohort, this study assessed and compared penetrating TBI (PTBI) and closed TBI with respect to global outcome and late seizures 2 years after injury. METHODS: After performing unadjusted PTBI versus closed TBI comparisons, multivariate regression models were built and analyzed for both outcomes by including the following additional predictors: length of unconsciousness, posttraumatic amnesia duration, hospital length of stay, age, gender, race, marital status, education level, problem substance abuse, and preinjury employment status. RESULTS: The collapsed Glasgow Outcome Scale model (n = 6111) showed significant secondary effects of PTBI with employment status. When employed before injury, individuals with PTBI were 2.62 times more likely (95% confidence interval, 1.92-3.57) to have a lower Glasgow Outcome Scale category. The final model for late seizures (n = 6737) showed a significant main effect for PTBI. Adjusting for other predictors, individuals with PTBI were 2.78 times more likely (95% confidence interval, 1.93-3.99) than those with closed TBI to be rehospitalized for a seizure. CONCLUSION: This study empirically demonstrates that penetrating injury mechanism has important prognostic implications.
Authors: William C Walker; Katharine A Stromberg; Jennifer H Marwitz; Adam P Sima; Amma A Agyemang; Kristin M Graham; Cynthia Harrison-Felix; Jeanne M Hoffman; Allen W Brown; Jeffrey S Kreutzer; Randall Merchant Journal: J Neurotrauma Date: 2018-05-16 Impact factor: 5.269
Authors: John Burke; James Gugger; Kan Ding; Jennifer A Kim; Brandon Foreman; John K Yue; Ava M Puccio; Esther L Yuh; Xiaoying Sun; Miri Rabinowitz; Mary J Vassar; Sabrina R Taylor; Ethan A Winkler; Hansen Deng; Michael McCrea; Murray B Stein; Claudia S Robertson; Harvey S Levin; Sureyya Dikmen; Nancy R Temkin; Jason Barber; Joseph T Giacino; Pratik Mukherjee; Kevin K W Wang; David O Okonkwo; Amy J Markowitz; Sonia Jain; Daniel Lowenstein; Geoffrey T Manley; Ramon Diaz-Arrastia; Neeraj Badjatia; Ann-Christine Duhaime; V Ramana Feeser; Etienne Gaudette; Shankar Gopinath; C Dirk Keene; Frederick K Korley; Christopher Madden; Randall Merchant; David Schnyer; Ross Zafonte Journal: JAMA Netw Open Date: 2021-12-01