Serious brain injury from traffic-related causes: Priorities for primary prevention

This study evaluated the incidence and outcome of serious brain injury from traffic-related causes in 695 patients admitted to the Department of Neurosurgery at Karolinska Hospital during 1981–1992. A total of 37.3% of patients were car occupants, 28.1% pedestrians, 12.9% bicyclists, 12.2% car–bicycle/car–moped and 9.5% motorcycle riders. The dominating injury was brain contusion (61.6%) verified with computerized tomography. The level of consciousness was evaluated by the Glasgow Coma Scale (GCS) and outcome by the Glasgow Outcome Scale (GOS) at discharge and 6–36 months thereafter. The final outcome was 67.5% good recovery (GOS 4–5), 11.5% severely disabled (GOS 2–3) and 21.0% GOS 1 or brain dead. Patients with GOS<4 (32.5%) were severely disabled and motivate priorities for injury prevention. Car occupants represent 40.7% of the total, followed by pedestrians at 33.6% and bicyclists at 18.2%. Much remains to be done in the primary prevention of disabling brain injury to car occupants and pedestrians. In order to achieve a more effective primary prevention, future research should be directed toward biomechanical aspects of brain contusion as a dominating brain injury.