Bodanapally et al reported factors predictive for arterial injury in a civilian with a penetrating brain injury. This can help to identify a patient who may benefit from early brain CT and more aggressive management. The authors are from the University of Maryland and Mahidol University in Bangkok.

Patient selection: civilian with penetrating brain injury


Outcome: arterial injury


Predictors for arterial injury on multivariate analysis:

(1) wound trajectory in close proximity (< 2 cm) to the Circle of Willis (odds ratio 6.8)

(2) subarachnoid hemorrhage (SAH)

(3) increased SAH severity by a modified Hijdra score (from 0 to 18, with risk associated with score >=3)

(4) intraventricular hemorrhage (IVH)

(5) increased intraventricular hemorrhage score by a modified Graeb score (from 0 to 12, with risk associated with score (>= 3)


Predictors from univariate analysis:

(1) entry over the frontobasal-temporal region (frontobasal = maxillary, zygomatic, frontal)

(2) bihemispheric wound trajectory

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