Traumatic brain injury (TBI) is a leading cause of injury death and long-term disability. A traumatic brain injury can either be penetrating, in which an external object enters the brain, or closed, in which external forces damage the brain without penetration by an object.
Certain factors have been associated with increased risk of mortality in patients with closed brain injuries. For instance, subdural hematoma, subarachnoid hemorrhage, intraventricular hemorrhage, and cisternal effacement have been shown to substantially increase the risk of early death. Other factors are more predictive of mortality in patients with penetrating brain injuries, including missile tracks involving both hemispheres, multiple lobes, or the ventricular system.
Closed brain injuries have been studied in much more detail than penetrating brain injuries. Because closed head injuries are better understood, penetrating brain injuries are usually treated with the same clinical guidelines used for closed brain injuries. Given the differences between mortality risks, however, it is likely that penetrating brain injuries require a different type of treatment than closed head injuries. Future research needs to focus on treatment specifically for penetrating brain injuries, as well as the prevention of complications and death.
Santiago LA, Oh BC, Dash PK, Holcomb JB, and CE Wade. A clinical comparison of penetrating and blunt traumatic brain injuries. Brain Injury (February 2012).