Pedestrians and motor vehicle accidents constitute a large proportion of traumatic brain injuries and other intracranial lesions in the population. Many of these patients sustain injury to their brain cells and get a traumatic brain injury that can last for many months or even a lifetime. Males have a disproportionately higher number of brain injuries and the age groups most commonly injured by traumatic brain injury include ages 0-4 years, 15-19 years and greater than 65 years of age.
One study looked at the type and severity of intracranial lesion and the overall prognosis following a closed head trauma in those who were pedestrians and were struck by a motor vehicle at the time of their injury.
A total of 225 patients were looked at following their injury at a level I trauma hospital. These patients were all in a coma at one point in time and all had intracranial hematomas, some of which needed to have them evacuated. Their initial Glasgow Coma Scale, a measure of their level of consciousness, was about 9-15 on average in 24 percent of patients, 6-8 in 32 percent of patients and 3-5 in 40 percent. Of these, the lowest scores are the most severe patients.
CT scans of the head showed subdural hematomas in 45 percent, epidural hematomas in 8 percent, cerebral contusion in 9 percent, or intracerebral hematomas in 10 percent. Those mass lesions that were clinically significant were treated with surgery and were evacuated. The intracranial pressure was monitored carefully and treated with medications or surgery as needed.
After six months, 51 percent of patients had died and 13 percent were considered vegetative or severely disabled. A total of 35 percent of patients had a moderate disability or a good outcome. The head injuries sustained by victims of a pedestrian-motor vehicle incident were usually much more severe than say, from a sports injury or fall. There was a high incidence of large intracranial hematomas and high intracranial pressures–both things that cause a high mortality rate.
Severe intracranial injuries need a great deal of treatment up front and a long rehabilitation period. The more severe injuries need longer rehabilitation times and tend to have the worst outcomes. One of the biggest problems when it comes to poor outcome is that these people have a limited access to care and don’t know who to see for rehabilitation and management of their care.
Fortunately, the majority of patients who get a brain injury such as these do get substantially better or recover fully from their injuries, usually gradually over several months. If a person doesn’t improve much after a year and a half, they often don’t really improve after that. Physical therapy often is helpful still so that the patient doesn’t lose mental and physical functioning.
It’s important to remember that these victims of a pedestrian/ motor vehicle accident suffer from mental, emotional, behavioral, and physical injuries. We often see the physical and speech injuries first but those who know the patient understand the mental, behavioral and emotional issues going on.