Severe penetrating head injury: A study of outcomes

Objective: To determine and describe the demographics and functional outcomes of persons who require inpatient rehabilitation for severe penetrating head injury resulting from a gunshot wound to the head. Design: Data were collected prospectively from the time of admission to acute care through discharge from inpatient rehabilitation. Setting: Two sites: an urban, level I, acute care, trauma center and an inpatient rehabilitation hospital with a specialized brain injury unit. Participants: Twenty-seven persons with severe penetrating head injury. Main Outcome Measures: The FIM(TM) instrument, the Disability Rating Scale (DRS), and the length of stay (LOS). Results: Demographic data showed our population to be similar to other groups of persons at high risk for violent injury. Eighty-five percent of the subjects were men with a mean age of 34 years. The majority were African American (93%), reflective of our general patient population. Average acute care LOS was 31 days and average rehabilitation LOS was 44 days. Average FIM gain was 40.2 and, on average, DRS scores improved 7.6 points from rehabilitation admission to discharge. All study participants made enough progress to be discharged to private residences. Conclusion: Although the mortality rate is high among patients with penetrating head injury, those who survive to receive inpatient rehabilitation can achieve functional improvement.