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Peer-reviewedCC BY-NC-NDBrain & spine

Penetrating brain injury from captive-bolt guns: A retrospective multicenter study of 77 cases.

  • Norbert Svoboda1
  • Jakub Petrzelka1
  • Ivana Roskova2,3
  • Pavel Poczos4
  • Jiri Dostal5
  • Hynek Zitek6
  • Stefan Reguli7
  • Anhelina Khadanovich8
  • Marek Grubhoffer9
  • Martin Cerny1
  • David Netuka1
  • Martin Majovsky1
9 affiliations
  1. 1Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic.
  2. 2Department of Neurosurgery, University Hospital Brno, Brno, Czech Republic.
  3. 3Faculty of Medicine, Masaryk University, Brno, Czech Republic.
  4. 4Department of Neurosurgery, University Hospital Hradec Králové, Czech Republic.
  5. 5Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University and University Hospital in Pilsen, Czech Republic.
  6. 6Department of Neurosurgery, Masaryk Hospital Ústí nad Labem, Czech Republic.
  7. 7Department of Neurosurgery, University Hospital Ostrava, Czech Republic.
  8. 8Second Faculty of Medicine, Charles University, Prague, Czech Republic.
  9. 9Department of Neurosurgery, České Budějovice Hospital, České Budějovice, Czech Republic.
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Abstract

Background

Captive bolt guns (CBG), designed for animal slaughter, are occasionally misused in self-harm or assault. Data on associated cranial injuries remain limited. This study provides the largest multicenter analysis to date of CBG-related penetrating brain injuries, focusing on epidemiological, clinical, and radiological characteristics and predictors of outcome.Methods

A retrospective multicenter study was conducted across seven Czech Level 1 trauma centers between 2005 and 2025. Clinical, radiological, and epidemiological data were analyzed. Correlation and ROC analyses identified predictors of mortality and poor functional outcome (GOSE ≤ 4). Thirty-day mortality and long-term survival after self-inflicted CBG injury were compared with those of patients with self-inflicted conventional firearm brain injuries treated at Military University Hospital Prague.Results

77 patients (mean age 58; 75 male) were included. Most injuries were self-inflicted (97%) and had midline entry sites (70%). Thirty-day mortality was 56%, and poor neurological outcome occurred in 78%. Lower admission GCS, basal cistern compression, diffuse subarachnoid hemorrhage, larger intracerebral hematoma volume, and longer intracranial tract length were associated with poor outcome. Surgical treatment was associated with lower 30-day mortality. ROC-derived thresholds were 11.5 mL for hematoma volume and 60.5 mm for tract length. Five-year Kaplan-Meier mortality was 78.2% after self-inflicted CBG injury and 82.1% after conventional firearm injury (log-rank p = 0.228).Conclusions

CBG injuries represent a rare but distinct subtype of penetrating brain trauma characterized by unique radiological features and delayed mortality. These findings may improve prognostic assessment and support early clinical decision-making in patients with CBG-related brain injury.

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Cite

BibTeXRIS
BibTeX
@article{svoboda2026penetrating,
  title = {{Penetrating brain injury from captive-bolt guns: A retrospective multicenter study of 77 cases.}},
  author = {Norbert Svoboda and Jakub Petrzelka and Ivana Roskova and Pavel Poczos and Jiri Dostal and Hynek Zitek and Stefan Reguli and Anhelina Khadanovich and Marek Grubhoffer and Martin Cerny and David Netuka and Martin Majovsky},
  journal = {Brain \& spine},
  year = {2026},
  month = sep,
  doi = {10.1016/j.bas.2026.107453},
  url = {https://europepmc.org/article/MED/42898170},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Penetrating brain injury from captive-bolt guns: A retrospective multicenter study of 77 cases.
AU  - Norbert Svoboda
AU  - Jakub Petrzelka
AU  - Ivana Roskova
AU  - Pavel Poczos
AU  - Jiri Dostal
AU  - Hynek Zitek
AU  - Stefan Reguli
AU  - Anhelina Khadanovich
AU  - Marek Grubhoffer
AU  - Martin Cerny
AU  - David Netuka
AU  - Martin Majovsky
PY  - 2026
DA  - 2026/09/22
JO  - Brain & spine
DO  - 10.1016/j.bas.2026.107453
UR  - https://europepmc.org/article/MED/42898170
AB  - Background  Captive bolt guns (CBG), designed for animal slaughter, are occasionally misused in self-harm or assault. Data on associated cranial injuries remain limited. This study provides the largest multicenter analysis to date of CBG-related penetrating brain injuries, focusing on epidemiological, clinical, and radiological characteristics and predictors of outcome.Methods  A retrospective multicenter study was conducted across seven Czech Level 1 trauma centers between 2005 and 2025. Clinical, radiological, and epidemiological data were analyzed. Correlation and ROC analyses identified predictors of mortality and poor functional outcome (GOSE ≤ 4). Thirty-day mortality and long-term survival after self-inflicted CBG injury were compared with those of patients with self-inflicted conventional firearm brain injuries treated at Military University Hospital Prague.Results  77 patients (mean age 58; 75 male) were included. Most injuries were self-inflicted (97%) and had midline entry sites (70%). Thirty-day mortality was 56%, and poor neurological outcome occurred in 78%. Lower admission GCS, basal cistern compression, diffuse subarachnoid hemorrhage, larger intracerebral hematoma volume, and longer intracranial tract length were associated with poor outcome. Surgical treatment was associated with lower 30-day mortality. ROC-derived thresholds were 11.5 mL for hematoma volume and 60.5 mm for tract length. Five-year Kaplan-Meier mortality was 78.2% after self-inflicted CBG injury and 82.1% after conventional firearm injury (log-rank p = 0.228).Conclusions  CBG injuries represent a rare but distinct subtype of penetrating brain trauma characterized by unique radiological features and delayed mortality. These findings may improve prognostic assessment and support early clinical decision-making in patients with CBG-related brain injury.
SN  - 2772-5294
ER  -