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Intentional Traumatic Brain Injury: Causes, Risk Factors, and Injury Severity

Categories: Violence-Related Traumatic Brain Injury

The Question

What are the risk factors, causes, and injury severity levels associated with intentional traumatic brain injuries?

Past Studies

Past Studies indicate violent intentional injury and death rates are rising in the United States. In civilians, the majority of gunshot wounds to the brain are lethal. Persons determined most likely to receive intentional brain injuries have been male, of minority status, single, unemployed, and less educated. Survivors of intentional injury are more likely to be unemployed and consumers of alcohol a year after the injury, even though their functional abilities were good. A past study showed that intentionality of injury was not been found to be a significant predictor of abilities one year after injury. Overall, few studies have examined the outcome for people with intentional versus unintentional traumatic brain injury or the risk factors for intentional traumatic brain injuries.

This Study

This Study examined 2,637 adults who were admitted to a hospital in a metropolitan area for traumatic brain injury during a five year period. Intentional injuries were categorized as penetrating or blunt. Data were gathered about their age, race, gender, cause of injury, minority status, and drug or alcohol use at the time of injury. These variables were tested for association with intentional injury. The association between intentional injury and both injury severity and death rates were tested.

An intentional source of traumatic brain injury was reported in 17.8% of all cases. Persons with intentional injuries were found to be males, minorities, of lower income, and less than 50 years of age. Persons who used drugs and alcohol were twice as likely to have experienced an intentional traumatic brain injury. Firearms and blunt objects were the most common types of weapons used that caused intentional traumatic brain injuries. A person with intentional traumatic brain injuries did not have multiple body injuries, as did those with unintentional traumatic brain injuries, such as from automobile crashes. However, those with intentional traumatic brain injuries were more likely to sustain more severe brain injuries and die before hospital discharge.

Who May Be Affected By These Findings

Persons identified as being at risk for intentional brain injury, persons with intentional brain injury and their families, providers, researchers, and advocates.


Although drug or alcohol use was found to be a predictor of intentional traumatic brain injury, the authors note that a number of people in this study were not tested. Additionally, drug and alcohol tests were not conducted randomly. Future studies with consistent testing measures may provide more accurate data.

Bottom Line

Persons at risk for intentional traumatic brain injuries were found to be male, minorities, young, and have lower incomes. The most likely causes of intentional traumatic brain injury were penetrating brain injury from gunshot wounds and blunt trauma from an assault. Minority race and drug or alcohol use were found to be the strongest predictors of intentional injury. A high number of intentional brain injuries were from firearms. These penetrating brain injuries were associated with high death rates and severe injury. This differs from the overall risk factors for unintentional traumatic brain injury and may imply that treatments in the emergency room need to be adjusted accordingly. Additional studies would be helpful to further define links groups at high-risk groups for violence and intentional traumatic brain injury. Overall, these findings would be helpful to persons interested in the prevention of violence and intentional traumatic brain injury.

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Find This Study

Wagner, A. K.; Sasser, H. C.; Hammond, F. C.; Wiercisiewski, D.; & Alexander, J. (2000). Intentional traumatic brain injury: Epidemiology, risk factors, and associations with injury severity and mortality. The Journal of Trauma Injury, Infection, and Critical Care, (49), 404-410.


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