Mechanism-Specific Differences in Traumatic Brain Injury: A Retrospective Urban Trauma Cohort Study

Abstract

Background: Traumatic brain injury (TBI) remains a major cause of morbidity, yet U.S. comparisons of injury mechanisms in diverse urban settings are limited. We examined differences across motorized road injuries, non-motorized road injuries, and falls. Methods: We performed a retrospective study of consecutive TBI admissions to an ACS-verified trauma center from 2017 to 2022. Mechanisms were categorized as motorized, non-motorized, or falls. Outcomes included mortality, ICU and ventilator use, and hospital length of stay (LOS). Secondary measures included GCS-based TBI severity and orthopedic injury. Group differences were evaluated using chi-square/Fisher exact and Kruskal-Wallis tests; motorized versus non-motorized road injuries were compared with Wilcoxon rank-sum tests. Results: Among 1,131 TBI admissions, falls predominated (90.2%), followed by non-motorized (5.5%) and motorized (4.3%) injuries. Fall-related TBI occurred in older adults (mean age 71.2 vs 49.6 non-motorized and 45.6 motorized). Road injuries affected more frequently male ({approx}75 to 80% vs 61%; p=0.005) and Hispanic patients, who comprised 37.1% of non-motorized and 36.7% of motorized injuries versus 23.8% of falls. Mean Injury Severity Score (ISS) was 11.9 (non-motorized), 15.1 (motorized), and 14.1 (falls); ICU days were 1.7, 4.7, and 2.2; LOS 5.4, 8.4, and 8.3 respectively. Ventilator use differed across mechanisms (p=0.02), as did orthopedic injury (p=0.009). Mortality was highest after motorized injuries (14.3%) compared with falls (7.5%) and non-motorized injuries (3.2%). In pairwise comparisons, motorized injuries showed higher ISS, greater ICU and ventilator needs, and longer LOS (all p{approx}0.01 to 0.02), with a trend toward lower GCS (p=0.058). Conclusions: Falls accounted for most TBIs and primarily affected older adults, whereas motorized road injuries, though less frequent, produced the greatest severity, resource utilization, and mortality. The elevated representation of Hispanic patients in road-related mechanisms highlights a need for targeted prevention in urban communities.

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