Philippine Journal of Surgical Specialties Vol. 81, No. 1, January-June 2026, pp 8-17
Outcomes of the Survivors of Combat Related Penetrating Brain Injury in a Tertiary Care Military Facility from a Low to Moderate Income Country
Author(s): Christopher Brian M. Reyes, MD, DPBNS; Rhoby U. Orata, MD, FAFN, FPCS and Abdul-Aziz D. Ontok, MD, FAFN
Background:
Penetrating brain injury (PBI) is a leading cause of combat mortality but local outcome data is limited. The authors examined combat-related PBI cases to describe patient characteristics and identify clinical and radiologic predictors of functional recovery
Methods:
This is a retrospective cohort study of military personnel aged 18–56 years with combat-related PBI referred to VLGH AFPMC between January 2017 to June 2022. The authors collected demographics data, injury mechanism, pre-hospital and transfer details, admission clinical and radiologic findings, treatments, and follow-up outcomes. The Glasgow Outcome Scale (GOS), dichotomized into unfavorable (GOS 1–3) and favorable (GOS 4–5), was used to assess functional status. Associations were tested with Fisher’s Exact Test.
Results:
Thirty-seven patients met inclusion criteria: 31 survivors with follow-up and 6 who died in hospital. All were male; gunshot wounds accounted for 81% of injuries. At a median follow-up of 27 months, among survivors, 74% had a Glasgow Coma Scale (GCS) of 15 and 45% achieved good recovery (GOS 5). Pre-hospital timing measures (evacuation time, interval to surgery, and transfer delays) were not significantly associated with outcome. Favorable outcomes correlated strongly with higher admission GCS (p < 0.001), preserved baseline motor function (p < 0.001), smaller hemorrhage volume (p = 0.01), and injury limited to a single lobe (p < 0.001). Unfavorable outcomes were associated with intracranial infection, post-traumatic seizures, and need for multiple surgeries (all p < 0.001).
Conclusion:
Functional recovery after combat-related PBI in this cohort was principally determined by initial neurologic status, injury extent, and subsequent complications The lack of association with pre-hospital timing possibly reflects survivorship bias and incomplete capture of early fatalities.
Key words: Penetrating brain injury, early response, traumatic brain injury, low-middle income country