Collision Course: A Decade of Traumatic Brain Injury Trends and the Impact of Urban Safety Initiatives in Eastern Massachusetts

<b>Background/Objectives:</b> Traumatic brain injuries (TBI) account for over a third of all injury-related deaths, predominantly due to motor vehicle collisions (MVC). This study provides a comprehensive analysis of TBI trends in Eastern Massachusetts, focusing on injuries resulting from motorcycle MVCs (mMVC), non-motorcycle MVCs (nmMVC), and pedestrian-vehicle strikes (PVS). <b>Methods:</b> A retrospective analysis was conducted on TBI patients admitted between 2010 and 2020 to Boston Medical Center. TBI severity was assessed using the Glasgow Coma Scale (GCS) on admission (mild: 13-15, moderate: 9-12, severe: 3-8), and outcomes were determined by discharge disability scales. Descriptive and inferential statistics evaluated patient profiles, TBI severity, and group differences. <b>Results:</b> Among the 2901 identified TBI cases from MVCs, 14.1% were mMVCs, 55.1% nmMVCs, and 30.8% PVS. Mortality rates were 3.7% for mMVCs, 2.1% for nmMVCs, and 8.9% for PVS. In 2017, nmMVC-related TBIs decreased by 50% and PVS-related TBIs by 35% (<i>p</i> < 0.01). The PVS group tended to be older (mean age 41.0 years) and more racially diverse, with Asian patients overrepresented. The mMVC group had a significantly skewed gender distribution, with 91% male. TBI severity also varied significantly, with the mMVC and PVS groups experiencing more severe TBIs compared to the nmMVC group (<i>p</i> < 0.001). Discharge outcomes, as assessed by the Cerebral Performance Category (CPC) scale, differed across cohorts (<i>p</i> = 0.0005), with the PVS group showing the most severe outcomes and the nmMVC group demonstrating the highest rate of return to previous function (CPC 0: 5.6%). <b>Conclusions:</b> Our study revealed significant differences in injury severity and outcomes based on the type of vehicular collision. Notably, Asian patients were disproportionately affected by PVS. Older PVS patients exhibited higher mortality rates, while severe TBIs were more common among male mMVC patients. In contrast, nmMVC patients showed better recovery outcomes. Coinciding with the implementation of Boston's Vision Zero initiative in 2017, decreases in both nmMVC-related and PVS-related TBIs were observed; however, other contributing factors may have also influenced this decline. These findings highlight the urgent need for targeted public health strategies to mitigate TBI risks across diverse populations.