The relationship between road traffic collision dynamics and traumatic brain injury pathology
File(s)Baker_et_al_RAIDS_Full_Manuscript_Accepted.docx (2.81 MB)
Accepted version
Author(s)
Baker, Claire
Martin, Phil
Wilson, Mark
Ghajari, Mazdak
Sharp, David
Type
Journal Article
Abstract
Road traffic collisions are a major cause of traumatic brain injury. However, the relationship between road traffic collision dynamics and traumatic brain injury risk for different road users is unknown. We investigated 2,065 collisions from Great Britain’s Road Accident In-depth Studies collision database involving 5,374 subjects (2013-20). 595 subjects sustained a traumatic brain injury (20.2% of 2,940 casualties), including 315 moderate-severe and 133 mild-probable. Key pathologies included skull fracture (179, 31.9%), subarachnoid haemorrhage (171, 30.5%), focal brain injury (168, 29.9%) and subdural haematoma (96, 17.1%). These results were extended nationally using >1,000,000 police-reported collision casualties. Extrapolating from the in-depth data we estimate that there are ~20,000 traumatic brain injury casualties (~5,000 moderate-severe) annually on Great Britain’s roads, accounting for severity differences. Detailed collision investigation allows vehicle collision dynamics to be understood and the change-in-velocity (known as delta-V) to be estimated for a subset of in-depth collision data. Higher delta-V increased the risk of moderate-severe brain injury for all road users. The four key pathologies were not observed below 8km/h delta-V for pedestrians/cyclists and 19km/h delta-V for car occupants (higher delta-V threshold for focal injury in both groups). Traumatic brain injury risk depended on road user type, delta-V and impact direction. Accounting for delta-V, pedestrians/cyclists had a 6-times higher likelihood of moderate-severe brain injury than car occupants. Wearing a cycle helmet was protective against overall and mild-to-moderate-severe brain injury, particularly skull fracture and subdural haematoma. Cycle helmet protection was not due to travel or impact speed differences between helmeted and non-helmeted cyclist groups. We additionally examined the influence of delta-V direction. Car occupants exposed to a higher lateral delta-V component had a greater prevalence of moderate-severe brain injury, particularly subarachnoid haemorrhage. Multivariate logistic regression models created using total delta-V value and whether lateral delta-V was dominant had the best prediction capabilities (area under the receiver operator curve as high as 0.95). Collision notification systems are routinely fitted in new cars. These record delta-V and automatically alert emergency services to a collision in real-time. These risk relationships could therefore inform how routinely fitted automatic collision notification systems alert the emergency services to collisions with a high brain injury risk. Early notification of high-risk scenarios would enable quicker activation of the highest level of emergency service response. Identifying those that require neurosurgical care and ensuring they are transported directly to a centre with neuro-specialist provisions could improve patient outcomes.
Date Issued
2022-02-12
Date Acceptance
2021-12-28
Citation
Brain Communications, 2022, 4 (2)
ISSN
2632-1297
Publisher
Oxford University Press
Journal / Book Title
Brain Communications
Volume
4
Issue
2
Copyright Statement
© The Author(s) 2022. Published by Oxford University Press on behalf of the Guarantors of Brain.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
License URL
Sponsor
TRL Limited
Imperial Health Charity
The Royal British Legion
Identifier
https://academic.oup.com/braincomms/article/4/2/fcac033/6527565
Grant Number
PO 8862725
7006/R58U
BMPF_P60304
Subjects
Science & Technology
Life Sciences & Biomedicine
Clinical Neurology
Neurosciences
Neurosciences & Neurology
injury biomechanics
traumatic brain injury risk
delta-V
road traffic collision dynamics
automatic collision notification emergency response
SUBDURAL HEMATOMAS
HEAD-INJURIES
ACCIDENT DATA
DELTA-V
BIOMECHANICS
SEVERITY
IMPACT
DAMAGE
CRASHES
SCALE
automatic collision notification emergency response
delta-V
injury biomechanics
road traffic collision dynamics
traumatic brain injury risk
Publication Status
Published
Date Publish Online
2022-02-12