{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T04:33:47Z","timestamp":1784176427965,"version":"3.55.0"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"5-6","funder":[{"name":"Infectious Disease Clinical Research Program"},{"name":"Department of War"},{"name":"Uniformed Services University of the Health Sciences, Department of Preventive Medicine and Biostatistics"},{"DOI":"10.13039\/100003896","name":"The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100003896","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Institute of Health","award":["Y1-AI-5072"],"award-info":[{"award-number":["Y1-AI-5072"]}]},{"name":"Defense Health Program"},{"DOI":"10.13039\/100000005","name":"U.S. Department of Defense","doi-asserted-by":"publisher","award":["HU0001190002"],"award-info":[{"award-number":["HU0001190002"]}],"id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009896","name":"Department of the Navy","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009896","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Wounded, Ill, and Injured Program"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Traumatic brain injuries (TBIs) are associated with substantial morbidity and mortality. We examined characteristics and outcomes among military personnel with battlefield-related penetrating TBI (pTBI) compared to closed TBI (cTBI) and non-head injuries (without cranial injuries).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>Military personnel admitted to participating U.S. military hospitals (2009-2014) were classified based on injury patterns: pTBI, cTBI (head Abbreviated Injury Scale [AIS] \u22653), and non-head (\u22651 non-head injury AIS \u22653). Propensity score and inverse probability of treatment weighting (IPTW) were used to assess associations with mortality, hospital stay, and infection burden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study population included 106 pTBI patients, 259 cTBI patients, and 715 patients with non-head injuries. Patients with pTBIs were more severely injured with differing injury mechanisms compared to the other 2 groups. Patients with pTBIs had more critical care requirements versus both cTBI and non-head injury patients (P\u2009&amp;lt;\u2009.05) and longer hospitalization (median 27 days vs. 22; P\u2009=\u2009.041) compared to cTBI patients. More central nervous system (CNS) infections were diagnosed among patients with pTBIs (11.3%) versus cTBIs (1.2%) and non-head injuries (0.7%; P\u2009&amp;lt;\u2009.001). Although the overall proportion of patients who developed non-CNS infections was not significantly different between the TBI groups, there was a higher proportion among pTBI versus non-head injury patients (53.8% vs. 40.8%; P\u2009=\u2009.012). Patients with pTBIs also had less skin and soft-tissue infections and more pneumonia compared to non-head injury patients (P\u2009&amp;lt;\u2009.05). There was no significant difference in the proportion of mortality between the pTBI and cTBI patients (7.6% vs. 3.1%); however, it was higher compared to patients with non-head injuries (1.0%; P\u2009&amp;lt;\u2009.001). Sustaining any TBI (penetrating or closed) was associated with greater risk of mortality compared to non-head injuries (risk ratio: 3.71; 95% CI, 1.83-7.55).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patients with pTBIs are critically injured with substantial critical care requirements and morbidity. Between patients with pTBIs and cTBIs, there was not a significant difference in non-CNS infection burden or mortality, but pTBI patients did have longer hospitalization. When compared to severely injured military personnel with non-head injuries using propensity scores and IPTW analysis, sustaining a TBI (penetrating or closed) was not associated with having more non-CNS infections or a longer hospital stay. This may be a result of the high injury severity (median of 26) and relative occurrence of polytrauma in the total population. Patients with TBIs (penetrating or closed) did have a greater risk of mortality compared to patients with non-head injuries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usaf546","type":"journal-article","created":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T17:26:27Z","timestamp":1762968387000},"page":"e1052-e1060","source":"Crossref","is-referenced-by-count":1,"title":["Epidemiology and Outcomes of Battlefield-Related Penetrating and Closed Traumatic Brain Injuries Compared to Non-Head Injuries: A Retrospective Cohort Study"],"prefix":"10.1093","volume":"191","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7833-9927","authenticated-orcid":false,"given":"Melissa R","family":"Meister","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Walter Reed National Military Medical Center , Bethesda, MD 20889,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason H","family":"Boulter","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Piedmont Atlanta Hospital , Atlanta, GA 30309,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1313-9816","authenticated-orcid":false,"given":"Callum D","family":"Dewar","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Walter Reed National Military Medical Center , Bethesda, MD 20889,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caren","family":"Stuebe","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Inova Fairfax Medical Campus , Falls Church, VA 22042,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7975-8601","authenticated-orcid":false,"given":"Erica","family":"Sercy","sequence":"additional","affiliation":[{"name":"Infectious Disease Clinical Research Program, Preventive Medicine & Biostatistics Department, Uniformed Services University of the Health Sciences , Bethesda, MD 20814,","place":["United States"]},{"name":"The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc , Bethesda, MD 20817,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M Leigh","family":"Carson","sequence":"additional","affiliation":[{"name":"Infectious Disease Clinical Research Program, Preventive Medicine & Biostatistics Department, Uniformed Services University of the Health Sciences , Bethesda, MD 20814,","place":["United States"]},{"name":"The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc , Bethesda, MD 20817,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faraz","family":"Shaikh","sequence":"additional","affiliation":[{"name":"Infectious Disease Clinical Research Program, Preventive Medicine & Biostatistics Department, Uniformed Services University of the Health Sciences , Bethesda, MD 20814,","place":["United States"]},{"name":"The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc , Bethesda, MD 20817,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph M","family":"Yabes","sequence":"additional","affiliation":[{"name":"Infectious Disease Service, Brooke Army Medical Center , Fort Sam Houston, TX 78234,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laveta","family":"Stewart","sequence":"additional","affiliation":[{"name":"Infectious Disease Clinical Research Program, Preventive Medicine & Biostatistics Department, Uniformed Services University of the Health Sciences , Bethesda, MD 20814,","place":["United States"]},{"name":"The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc , Bethesda, MD 20817,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R","family":"Tribble","sequence":"additional","affiliation":[{"name":"Infectious Disease Clinical Research Program, Preventive Medicine & Biostatistics Department, Uniformed Services University of the Health Sciences , Bethesda, MD 20814,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viktor","family":"Bartanusz","sequence":"additional","affiliation":[{"name":"The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc , Bethesda, MD 20817,","place":["United States"]},{"name":"Military Traumatic Brain Injury Initiative (MTBI2), Uniformed Services University of the Health Sciences , Bethesda, MD 20814,","place":["United States"]},{"name":"Now with Surgery Service, Bay Pines VA Health Care System , 10000 Bay Pines Boulevard , Bay Pines, FL 33744,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley","family":"Dengler","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Walter Reed National Military Medical Center , Bethesda, MD 20889,","place":["United States"]},{"name":"Military Traumatic Brain Injury Initiative (MTBI2), Uniformed Services University of the Health Sciences , Bethesda, MD 20814,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,4,17]]},"reference":[{"key":"2026050517473551600_usaf546-B1","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1089\/sur.2017.240","article-title":"Early infections complicating the care of combat casualties from Iraq and Afghanistan","volume":"19","author":"Weintrob","year":"2018","journal-title":"Surg Infect (Larchmt)"},{"key":"2026050517473551600_usaf546-B2","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1093\/milmed\/usz027","article-title":"After the battlefield: infectious complications among wounded warriors in the trauma infectious disease outcomes study","volume":"184","author":"Tribble","year":"2019","journal-title":"Mil Med"},{"key":"2026050517473551600_usaf546-B3","doi-asserted-by":"publisher","first-page":"S33","DOI":"10.1097\/TA.0b013e318221162e","article-title":"Infection-associated clinical outcomes in hospitalized medical evacuees after traumatic injury: trauma infectious disease outcome study","volume":"71","author":"Tribble","year":"2011","journal-title":"J Trauma"},{"key":"2026050517473551600_usaf546-B4","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1176\/appi.neuropsych.16050100","article-title":"Traumatic brain injury in Iraq and Afghanistan veterans: new results from a national random sample study","volume":"29","author":"Lindquist","year":"2017","journal-title":"J Neuropsychiatry Clin Neurosci"},{"key":"2026050517473551600_usaf546-B5","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1186\/cc2828","article-title":"Nosocomial infections and immunity: lesson from brain-injured patients","volume":"8","author":"Dziedzic","year":"2004","journal-title":"Crit Care"},{"key":"2026050517473551600_usaf546-B6","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1053\/srin.2000.20935","article-title":"Trauma, head injury, and neurosurgery infections","volume":"15","author":"Boque","year":"2000","journal-title":"Semin Respir Infect"},{"key":"2026050517473551600_usaf546-B7","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1111\/j.1469-0691.2011.03625.x","article-title":"Infections in traumatic brain injury patients","volume":"18","author":"Kourbeti","year":"2012","journal-title":"Clin Microbiol Infect"},{"key":"2026050517473551600_usaf546-B8","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/j.bbi.2019.04.034","article-title":"Infections after a traumatic brain injury: the complex interplay between the immune and neurological systems","volume":"79","author":"Sharma","year":"2019","journal-title":"Brain Behav Immun"},{"key":"2026050517473551600_usaf546-B9","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1097\/TA.0000000000002327","article-title":"Infection after penetrating brain injury-An Eastern association for the surgery of trauma multicenter study oral presentation at the 32nd annual meeting of the Eastern association for the surgery of trauma, January 15-19, 2019, in Austin, Texas","volume":"87","author":"Harmon","year":"2019","journal-title":"J Trauma Acute Care Surg"},{"key":"2026050517473551600_usaf546-B10","doi-asserted-by":"publisher","first-page":"S72","DOI":"10.1097\/ta.0000000000004018","article-title":"Epidemiology of cranial infections in battlefield-related penetrating and open cranial injuries","volume":"95","author":"Meister","year":"2023","journal-title":"J Trauma Acute Care Surg"},{"key":"2026050517473551600_usaf546-B11","doi-asserted-by":"publisher","first-page":"1525","DOI":"10.1097\/TA.0b013e318270e179","article-title":"Long-term outcomes of combat casualties sustaining penetrating traumatic brain injury","volume":"73","author":"Weisbrod","year":"2012","journal-title":"J Trauma Acute Care Surg"},{"key":"2026050517473551600_usaf546-B12","doi-asserted-by":"publisher","first-page":"1366","DOI":"10.1097\/01.ta.0000245894.78941.90","article-title":"Trauma system development in a theater of war: experiences from Operation Iraqi Freedom and Operation Enduring Freedom","volume":"61","author":"Eastridge","year":"2006","journal-title":"J Trauma"},{"key":"2026050517473551600_usaf546-B13","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1093\/milmed\/usac050","article-title":"Department of Defense trauma registry infectious disease module impact on clinical practice","volume":"187","author":"Tribble","year":"2022","journal-title":"Mil Med"},{"key":"2026050517473551600_usaf546-B14","author":"Centers for Disease Control and Prevention","year":"2025"},{"key":"2026050517473551600_usaf546-B15","author":"Centers for Disease Control and Prevention","year":"2018"},{"key":"2026050517473551600_usaf546-B16","doi-asserted-by":"publisher","first-page":"1080","DOI":"10.3171\/2017.10.Jns17352","article-title":"Estimating the global incidence of traumatic brain injury","volume":"130","author":"Dewan","year":"2019","journal-title":"J Neurosurg"},{"key":"2026050517473551600_usaf546-B17","author":"Centers for Disease Control and Prevention","year":"2024"},{"key":"2026050517473551600_usaf546-B18","doi-asserted-by":"publisher","first-page":"56","DOI":"10.17116\/neiro20238702156","article-title":"Infectious complications in acute period after traumatic brain injury","volume":"87","author":"Sychev","year":"2023","journal-title":"Zh Vopr Neirokhir Im N N Burdenko"},{"key":"2026050517473551600_usaf546-B19","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1007\/s12028-017-0397-4","article-title":"Early-onset ventilator-associated pneumonia in patients with severe traumatic brain injury: incidence, risk factors, and consequences in cerebral oxygenation and outcome","volume":"27","author":"Esnault","year":"2017","journal-title":"Neurocrit Care"},{"key":"2026050517473551600_usaf546-B20","doi-asserted-by":"publisher","first-page":"2073","DOI":"10.1089\/neu.2013.3060","article-title":"Traumatic brain injury in rats induces lung injury and systemic immune suppression","volume":"30","author":"Vermeij","year":"2013","journal-title":"J Neurotrauma"},{"key":"2026050517473551600_usaf546-B21","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1186\/s40635-020-00359-3","article-title":"Autonomic nervous system activity and the risk of nosocomial infection in critically ill patients with brain injury","volume":"8","author":"Wirtz","year":"2020","journal-title":"Intensive Care Med Exp"},{"key":"2026050517473551600_usaf546-B22","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1097\/TA.0b013e318299616a","article-title":"Traumatic brain injury-induced alterations in peripheral immunity","volume":"75","author":"Schwulst","year":"2013","journal-title":"J Trauma Acute Care Surg"},{"key":"2026050517473551600_usaf546-B23","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1007\/s12028-019-00773-w","article-title":"Incidence, risk factors, and outcomes of ventilator-associated pneumonia in traumatic brain injury: a meta-analysis","volume":"32","author":"Li","year":"2020","journal-title":"Neurocrit Care"},{"key":"2026050517473551600_usaf546-B24","doi-asserted-by":"publisher","first-page":"L1","DOI":"10.1152\/ajplung.00485.2016","article-title":"Acute brain trauma, lung injury, and pneumonia: more than just altered mental status and decreased airway protection","volume":"313","author":"Hu","year":"2017","journal-title":"Am J Physiol Lung Cell Mol Physiol"},{"key":"2026050517473551600_usaf546-B25","doi-asserted-by":"publisher","first-page":"35","DOI":"10.4266\/acc.2021.01193","article-title":"Brain-lung interaction: a vicious cycle in traumatic brain injury","volume":"37","author":"Chac\u00f3n-Aponte","year":"2022","journal-title":"Acute Crit Care"},{"key":"2026050517473551600_usaf546-B26","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1007\/s11011-025-01658-y","article-title":"Association between traumatic brain injury and risk of developing infections in the central nervous system and periphery","volume":"40","author":"Faller","year":"2025","journal-title":"Metab Brain Dis"},{"key":"2026050517473551600_usaf546-B27","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1093\/milmed\/usy336","article-title":"Combat-related extremity wounds: injury factors predicting early onset infections","volume":"184","author":"Stewart","year":"2019","journal-title":"Mil Med"},{"key":"2026050517473551600_usaf546-B28","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1093\/milmed\/usab065","article-title":"IDCRP combat-related extremity wound infection research","volume":"187","author":"Petfield","year":"2022","journal-title":"Mil Med"},{"key":"2026050517473551600_usaf546-B29","doi-asserted-by":"publisher","first-page":"S235","DOI":"10.1097\/TA.0b013e318227ac5f","article-title":"Prevention of infections associated with combat-related extremity injuries","volume":"71","author":"Murray","year":"2011","journal-title":"J Trauma"},{"key":"2026050517473551600_usaf546-B30","doi-asserted-by":"publisher","first-page":"S21","DOI":"10.1097\/BOT.0000000000000667","article-title":"Infection after orthopaedic trauma: prevention and treatment","volume":"30","author":"Yun","year":"2016","journal-title":"J Orthop Trauma"},{"key":"2026050517473551600_usaf546-B31","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1007\/s11751-016-0250-x","article-title":"Factors influencing infection in 10 years of battlefield open tibia fractures","volume":"11","author":"Penn-Barwell","year":"2016","journal-title":"Strategies Trauma Limb Reconstr"},{"key":"2026050517473551600_usaf546-B32","doi-asserted-by":"publisher","first-page":"S496","DOI":"10.1097\/TA.0b013e318275473c","article-title":"Epidemiology of moderate-to-severe penetrating versus closed traumatic brain injury in the Iraq and Afghanistan wars","volume":"73","author":"Orman","year":"2012","journal-title":"J Trauma Acute Care Surg"},{"key":"2026050517473551600_usaf546-B33","doi-asserted-by":"publisher","first-page":"829","DOI":"10.3171\/2024.6.Jns24852","article-title":"Wartime penetrating traumatic brain injury of the anterior skull base involving the paranasal sinuses: a single-center, first-year experience from Dnipro, Ukraine","volume":"142","author":"Sirko","year":"2025","journal-title":"J Neurosurg"},{"key":"2026050517473551600_usaf546-B34","doi-asserted-by":"publisher","first-page":"R143","DOI":"10.1186\/cc13976","article-title":"Factors influencing lengths of stay in the intensive care unit for surviving trauma patients: a retrospective analysis of 30,157 cases","volume":"18","author":"B\u00f6hmer","year":"2014","journal-title":"Crit Care"},{"key":"2026050517473551600_usaf546-B35","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1197\/j.aem.2005.07.038","article-title":"Accuracy of mild traumatic brain injury case ascertainment using ICD-9 codes","volume":"13","author":"Bazarian","year":"2006","journal-title":"Acad Emerg Med"},{"key":"2026050517473551600_usaf546-B36","doi-asserted-by":"publisher","first-page":"i42","DOI":"10.1136\/injuryprev-2019-043510","article-title":"Multisite medical record review of emergency department visits for traumatic brain injury","volume":"27","author":"Gabella","year":"2021","journal-title":"Inj Prev"},{"key":"2026050517473551600_usaf546-B37","doi-asserted-by":"publisher","first-page":"i13","DOI":"10.1136\/injuryprev-2019-043517","article-title":"Multisite medical record review of emergency department visits for unspecified injury of head following the ICD-10-CM coding transition","volume":"27","author":"Peterson","year":"2021","journal-title":"Inj Prev"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/191\/5-6\/e1052\/65277345\/usaf546.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/191\/5-6\/e1052\/65277345\/usaf546.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T22:16:43Z","timestamp":1778019403000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/191\/5-6\/e1052\/8321906"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,17]]},"references-count":37,"journal-issue":{"issue":"5-6","published-online":{"date-parts":[[2026,4,17]]},"published-print":{"date-parts":[[2026,5,1]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usaf546","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,5]]},"published":{"date-parts":[[2026,4,17]]}}}