Traumatic Brain Injury in Vulnerable Road Users: Analysis of German In-Depth Crash Data to Inform Targeted Prevention

Road traffic crashes are a major cause of traumatic brain injury (TBI), particularly among vulnerable road users (VRUs). However, current injury prevention strategies often overlook the heterogeneity of TBI—which include various injury types and severities—leading to an oversimplified approach to evaluating helmets and safety systems in regulations and ratings. To identify priority TBI types and severities in VRUs and to inform targeted prevention strategies, the German In-Depth Accident Study database was analyzed and a pathoanatomic classification system, i.e., Abbreviated Injury Scale, was employed. AIS 2 (moderate) TBIs account for 70-80% of all brain injuries across VRU groups, nearly half of which are concussions. For helmeted cyclists, milder TBIs are at a greater percentage than for unhelmeted cyclists. These findings highlight the need for expanding prevention efforts to include AIS 2+ injuries. Key injury types observed include concussion (with and without loss of consciousness), skull base fracture, subdural hemorrhage, contusion and laceration. New mechanism-specific injury criteria may be needed to address these injuries. The strong similarity in injury type ranking among different road users (the Kendall’s tau values ranged from 0.90 to 0.93) suggests similar needs for injury prevention. A new brain injury assessment criterion may serve all road user types.