Does the Incidence and Severity of Neurological Injury Differ Based on Where Your Car Accident Happens?

Motorized vehicle collisions (MVCs) are a leading cause of traumatic injuries requiring neurosurgical intervention. Rural rollover collisions are more common due to fewer structures, high speed limits, and undivided roads. This study sought to evaluate how injury severity score (ISS), neurological injury, and surgical outcomes differ by accident location.

We analyzed MVC patients who received neurosurgical consultation over 7 y at a level I trauma center. Patients were stratified into neurosurgical operations (NS-Op), non-neurosurgical operations (Non-NS-Op), and non-operative (Non-Op) groups. Accident location was classified by Rural-Urban Commuting Area codes. Data included Glasgow Coma Scale, mortality, length of stay, operation type, diagnoses, and ISS.

Among 1434 MVC patients, 162 (11.3%) underwent surgery. ISS was highest in the NS-Op group (P < 0.001). Cranial procedures had higher mortality than spinal operations (76.7% versus 23.3%, P < 0.001). NS-Op patients were less likely to be injured in metropolitan areas compared to Non-NS-Op (P = 0.02) and Non-Op (P = 0.04) and more likely in micropolitan regions (8% versus 3%, P = 0.01). Arrival times were longest from micropolitan (490.4 ± 1267.1 min) and small-town areas (616.8 ± 1885.1 min), despite direct transport. Non-Op patients experienced a longer delay compared to Non-NS-Op (P = 0.01) but not compared to NS-Op (P = 0.96).

Patients needing neurosurgical intervention had the highest ISS and were more often injured outside metropolitan areas. These findings support the need for region-specific triage strategies, early neurotrauma screening tools, and prehospital interventions.