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

Authors

Pravarakhya Puppalla, Derek Smetanick, Shiv Shah, Missy Tran, Dara Sam Farhadi, Breanna L Sheldon, Audrey L Spencer, Julie G Pilitsis

Published in

The Journal of surgical research. Volume 325. Pages 10-16. Jun 15, 2026. Epub Jun 15, 2026.

Abstract

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.

PMID:
42296575
Bibliographic data and abstract were imported from PubMed on 16 Jun 2026.

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