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The invention of the car transformed American society, but it also spurred a dramatic rise in traumatic brain injuries (TBI). Surgeons began to see and treat TBI injuries from motor vehicles as early as 1899.
As vehicles ownership became more widespread, it was surgeons and neurosurgeons who sounded the alarm, lobbying the automotive industry for increased vehicle safety design. One of most vocal safety proponents was Dr. Frank Mayfield, a Cincinnati neurosurgeon and inventor of the Mayfield Skull Clamp who also helped developed the first major car safety packages.
In 1900, there were only approximately 0.1 motor vehicles for every 1,000 people. Surgical literature from the early 20th century notes more cases of head injuries in children, who were often struck by passing motor vehicles. A 1926 study found that most skull injuries happened before a child reached age 10 and half were caused by motor vehicles. However, the same study noted that motor vehicle skull fractures injuries were especially severe for all age groups.
As automobiles became more commonplace, so did head injuries that led to brain damage. An article published in 1937 in The Annals of Surgery noted that more than half of TBIs were caused by motor vehicles. Surgeons treating facial injuries and depressed skull fractures from accidents began to speak out.
Detroit plastic surgeon Dr. Claire L. Straith said that metal knobs and other protruding items inside vehicles caused head and facial injuries. In a clinical lecture given in 1937, Dr. Straith also noted that car design was based on aesthetics, not safety. He installed the first seatbelt and dashboard padding in his own car and lobbied automakers for design changes, but to no avail.
Nearly 20 years later in 1954, cars were everywhere in the U.S., and head and neck injuries accounted for 70% of the 1.5 million motor vehicle-related deaths. In 1955, California neurosurgeon Dr. C. Hunter Sheldon estimated that 75% of those deaths could have been prevented simply by changes to vehicle construction. He warned that the metal dashboard pieces that manufacturers were adding to vehicle dashboards would only increase the risk and severity of future head injuries and brain damage.
Dr. Mayfield, a neurosurgeon and member the trauma committee of the American College of Surgeons, worked with the Ford Motor Company to develop recommendations for one the first major car safety packages, called Lifeguard.
Ford introduced Lifeguard for its 1956 models and included padded dashboards, seatbelts, stronger door latches and steering wheels less likely to cause chest injury. But the public was not yet convinced of the necessity of safety features, and most were unwilling to pay for the upgrade.
Car Safety Goes Mainstream
In 1965, Ralph Nader’s book, Unsafe at any Speed, argued that car manufacturers were deliberately designing unsafe cars to save money. His allegations led to congressional hearings on traffic safety and resulted in the National Traffic and Motor Vehicle Safety Act of 1966, the first to mandate motor vehicle safety standards in the U.S. The National Highway Transport Safety Administration made vehicle crash test data available beginning in the 1970s.
With the public invested in motor vehicle safety, car manufacturers began implementing advanced safety features such as airbags and crumple zones. The rate of traffic fatalities began to fall at a faster rate after 1966 and continued to fall.
Yet some of the vehicle safety mechanisms may be contributing the rise in TBIs. That’s because people who once died in car accidents are now surviving due to air bags and as a result, come away with mild or severe traumatic brain injuries.
The Future of TBIs and Car Safety
In 2014, there were approximately 2.5 million TBI-related emergency department visits with just 13.2% caused by motor vehicle crashes. Falls are now the cause of nearly half of those visits, a drastic change from the 1930s. Although motor vehicle crashes may no longer result in the most TBIs, early diagnosis and treatment is often key to better outcomes in those that have a TBI from such collisions.
Researchers are currently studying whether artificial intelligence can improve early diagnosis. In 2019, a University of Arizona aerospace and mechanical engineering professor and a graduate student began working on a machine learning tool to calculate the likelihood of traumatic brain injury after a vehicle collision.
The tool uses experimental data (how a dummy moves in a car crash) and applies motion data from a simulation to a computer model of the brain to determine how a brain would be affected and the likelihood of a TBI. It would also incorporate crash conditions, including impact velocity and angle.
“Let’s say a paramedic arrives at the scene of a car accident,” one of the researchers, Samy Missoum, told Science Daily. “They could input the information into a tool and say, ‘Okay, based on the characteristics of this accident, this person is going to have a 70 to 80 percent probability of severe traumatic brain injury.’”
Surgeons Advocate Again
With car safety still a priority in vehicle design, neurosurgeons and the medical community at large, are now turning to another public heath safety matter: gun violence. After the NRA recently told doctors to “stay in their lane” and not discuss gun violence, healthcare professionals took to social media with the hashtag #thisisourlane.
“As a neurosurgeon, we deal with the consequences of gun violence on a daily basis…shattered skull fractures, brain injury, and in most cases, death,” Dr. James K. Liu, the Director of the Center for Skull Base and Pituitary Surgery at the Neurological Institute of New Jersey, tweeted in response. “We are in the business of saving lives, promoting health, and improving humanity.”