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Identifying patients at risk of traumatic brain injury (TBI) is importantbecause research suggests prophylactic treatments to reduce risk of long-termsequelae. Blast pressure waves can cause TBI without penetrating wounds orblunt force trauma. Similarly, bullet impacts distant from the brain canproduce pressure waves sufficient to cause mild to moderate TBI. The fluidpercussion model of TBI shows that pressure impulses of 15-30 psi cause mild tomoderate TBI in laboratory animals. In pigs and dogs, bullet impacts to thethigh produce pressure waves in the brain of 18-45 psi and measurable injury toneurons and neuroglia. Analyses of research in goats and epidemiological datafrom shooting events involving humans show high correlations (r > 0.9) betweenrapid incapacitation and pressure wave magnitude in the thoracic cavity. A casestudy has documented epilepsy resulting from a pressure wave without the bulletdirectly hitting the brain. Taken together, these results support thehypothesis that bullet impacts distant from the brain produce pressure wavesthat travel to the brain and can retain sufficient magnitude to induce braininjury. The link to long-term sequelae could be investigated viaepidemiological studies of patients who were gunshot in the chest to determinewhether they experience elevated rates of epilepsy and other neurologicalsequelae.

Links between traumatic brain injury and ballistic pressure waves originating in the thoracic cavity and extremities