Differences in brain injury caused by blast fragmentation versus gunshot wound.


penetrating intracranialPenetrating intracranial injuries are a type on injury in which a foreign object penetrates the brain. In the military, penetrating intracranial injury typically occurs from physical fragments of a blast or from a gunshot wound. However, there are differences between these two common types of military-related injury. For instance, blast fragmentation occurs at a much lower velocity (speed) than gunshot wounds.

Although the rate of survival after either type of injury is poor, researchers recently found specific differences in the outcomes of each. Looking at military hospital records from over 800 military patients with penetrating intracranial injury, researchers found that:

  • Overall, more than 40% did not survive
  • Of those who survived, about 40% were injured from gunshot wound and about 60% from blast fragmentation
  • The Glasgow Coma Scale (GCS) in gunshot wound patients was significantly lower and injury severity significantly higher in gunshot wound patients than in blast injured patients
  • Any patient with a penetrating intracranial injury who had a GCS of over 5 upon arrival was much more likely to survive to discharge.

The results of this study found that patients with a gunshot wound were less likely to survive, and more likely to have a low GCS score than those with a blast-related penetrating injury. The speed of the penetrating object may be one factor involved in the different outcomes.

Smith JE, Harrisson SE, Russell R, & Midwinter M. Outcome of penetrating intracranial injuries in a military setting. Injury. (May 2014).