CT Imaging Patterns and Clinical Outcomes of Traumatic Brain Injury: Distribution Across Injury Mechanisms

Background: Our goal was to evaluate the radiological patterns and clinical outcomes of brain injuries related to trauma, offering insight into the distribution of brain injuries, facial fractures and outcomes across road traffic accidents (RTAs), falls and other causes. Methods: Cerebral CT scans of 536 cases obtained between January 2019 and January 2024 were retrospectively reviewed. The collected data included demographics, etiology, transportation groups (driver, car occupant, pedestrian, motorcyclist, bicyclist), GCS (Glasgow Coma Scale), clinical outcome (ICU (intensive care unit) admission, neurosurgical intervention, mortality) and CT imaging features. Images were analyzed independently by two physicians. The findings reflect a selected population of polytrauma patients who underwent cerebral CT at a single emergency hospital. Results: Brain injury was identified in 39% of all subjects, the most frequent type of lesion being intraparenchymal hematoma (24%), followed by subdural hematoma (23%). Brain injury was numerically more frequent among patients with falls (45%) than among those involved in RTAs (37%), although this difference did not reach statistical significance in either unadjusted or age-, sex-, and mechanism-adjusted analysis (p > 0.05). CT patterns differed across transportation categories, with bicyclists showing associations with intraparenchymal hemorrhage and diffuse brain swelling and pedestrians with intraventricular hemorrhage (p < 0.05). However, given the small bicyclist subgroup (n = 6), these findings should be considered exploratory. Car occupants showed lower unadjusted odds of brain injury compared with drivers (OR: 0.50; 95% CI: 0.30-0.80), but this association was attenuated and no longer statistically significant after adjusting for age and sex (adjusted OR: 0.55; 95% CI: 0.27-1.15; p = 0.112). In multivariable analysis of in-hospital mortality, only age and severe GCS category remained independently associated with death; neither injury mechanism nor transportation category showed an independent association once these factors were accounted for. Conclusions: Brain injury was more frequently observed among patients with falls than among those involved in RTAs. Nevertheless, road traffic accidents accounted for the majority of polytrauma admissions. These findings highlight the importance of both road traffic safety measures and fall-prevention strategies, particularly among older adults.