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

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.

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.

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).

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.