Clinical and Radiological Predictors of Outcome in Non-Missile Low-Velocity Penetrating Brain Injury: A 10-year Retrospective Cohort Study

Prognostic indicators specific to non-missile low-velocity penetrating brain injuries remain less well characterized than firearm-related or blunt traumatic brain injury. This study evaluates clinical and radiological predictors of outcome in non-firearm, low-velocity penetrating brain injury (PBI) to inform treatment and prognosis. This retrospective observational cohort study included 38 patients with non-missile, low-velocity PBIs treated at a tertiary center (January 2014–December 2024). Data included demographics, GCS, pupil reactivity, associated injuries, and radiological findings. Outcome was assessed using the Glasgow Outcome Scale–Extended. Logistic regression analysis identified predictors of poor outcome. Of 38 cases, 14 had poor outcomes. Patients with poor outcomes had lower GCS scores and more frequent pupillary and radiological abnormalities. In multivariate logistic regression, higher GCS at presentation independently reduced the odds of poor outcome (adjusted OR 0.42, 95% CI 0.21–0.86, p = 0.018). A composite major imaging finding (presence of infarct, intraventricular hemorrhage, or brainstem involvement on initial imaging) was strongly associated with poor outcome (adjusted OR 92.10, 95% CI 1.26–6730.15, p = 0.039). Age and pupillary reactivity were not independently significant. Higher GCS at presentation independently reduces the risk of poor outcome in low-velocity PBIs, underscoring its importance in early neurological assessment and prognostication. Radiological injury burden was independently associated with poor outcome, although estimates were imprecise due to small event numbers.