1110 Risk Factors for In-Hospital Mortality Following Penetrating Traumatic Brain Injury

INTRODUCTION: 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, but there has also been an increase in the rate of operative intervention for these injuries. However, there’s still limited data on how treatment options at a single level 1 trauma center can impact patient outcomes. METHODS: Data from the NTDB between the years 2017 and 2021 was collected and queried for pTBI. Univariable and Multivariable logistic regression was completed on 80% of the data from 2017. A model was created based on the 5 most important parameters for in-hospital mortality outcomes. The model was tested on 20% of that data and all the data from a level 1 trauma center. RESULTS: 25,865 patients were included for pTBI from 2017-2021. Of these, in-hospital mortality was reported in 10,774 or 41.7% of cases. The five most predictive variables were emergency department GCS, the depth of penetration, injury severity score, age, and whether extirpation was completed. The AUCs for internal and external validation were 0.921 and 0.913. CONCLUSIONS: 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 as important in this model.