Correlation Between Various Mechanisms of Injury and Clinical Outcomes in Patients with Severe Traumatic Brain Injury (TBI)

Background: Traumatic Brain Injury (TBI) is a major public health concern as global incidence continues to increase, often resulting in chronic health issues. Clinical outcomes following TBI are strongly influenced by a variety of sociodemographic factors, but the role of the primary mechanism of injury is not as well understood. This study aimed to assess the relationship between the mechanism of injury and clinical outcomes to improve future care for patients with severe TBI. Methods: We conducted a retrospective review at a Level 1 Trauma Center in Queens, New York. Patients with AIS Head ≥3 and severe TBI (Glasgow Coma Scale [GCS] ≤8 after resuscitation but before sedation) admitted between January 2020 and December 2023 were included (N = 1,124). Primary mechanism of injury was categorized as Falls, Assault, Transport-related, Struck-by/Hit by Object, Self-harm, and Other/Miscellaneous. These categories were compared against demographic characteristics, severity scales (AIS Head, Injury Severity Score [ISS], and GCS), trauma type (blunt vs. penetrating), and clinical outcomes including Emergency Department (ED) length of stay (LOS, hours), hospital LOS (days), intensive care unit (ICU) LOS (days), ventilator days, and discharge disposition (Alive vs. Died). Statistical comparisons were performed using ANOVA, the Kruskal–Wallis test, the Mann–Whitney U test, and the Chi-square test, with significance set at p < 0.05. Results: Our study included 1,124 patients (23.8% female). We observed significant between-group differences when comparing primary injury mechanism to severity scales, with the worst outcomes within the self-harm group (p< 0.001; GCS=4.64, AIS Head=4.41, ISS=39.73). Significant between-group differences were also seen for ED and hospital LOS and number of days on mechanical ventilation (p< 0.01), with the primary mechanism of injury category “other/miscellaneous” requiring the longest average hospital LOS (27.6 days) and ED LOS (18.5 hours). Penetrating injuries had significantly higher ISS (p< 0.001) and lower GCS (p< 0.001) scores than blunt injuries, and required a substantially greater number of vent days (p< 0.01). Conclusion: In agreement with existing literature, falls were the most common cause of TBI in our cohort. Penetrating injuries resulted in worse outcomes, with the greatest mortality seen among patients whose injuries were self-inflicted.