Patterns of traumatic brachial plexus injuries: A nationwide study of geographic, demographic, and socioeconomic factors in england and wales

Introduction Traumatic brachial plexus injuries (TBPIs) are severe, life-altering injuries associated with significant functional impairment. While previous studies have highlighted mechanisms of injury, there is limited research on the geographical and socioeconomic factors influencing TBPI incidence. This study examines TBPI patterns across England and Wales, identifying demographic risk factors and geographic "hotspots". Methods A retrospective cohort study was conducted using data from the Trauma Audit and Research Network (TARN) and the STATS-19 road traffic accident database from January 2010 to March 2022. Patients with confirmed TBPIs meeting TARN inclusion criteria were analysed. Cases were categorised into vehicular collisions (VCs) and non-vehicular injuries (NVIs). Key variables included age, sex, injury mechanism, Index of Multiple Deprivation (IMD) scores, and urban-rural classification. Geographic distribution was assessed to identify high-incidence regions. Results A total of 1003 TBPI cases were identified: 601 (60 %) vehicular and 402 (40 %) non-vehicular related injuries. VC TBPIs were more frequent in young males (median age: 35 years), whereas NVIs occurred more in older females (median age: 63 years), mainly due to falls <2 m. Higher IMD scores were associated with penetrating injuries. Urban “hotspots” for penetrating injuries included cities in Greater London, Greater Manchester, and West Yorkshire. Discussion This study describes geographic and socioeconomic patterns of TBPIs across England and Wales. Although less frequent than other trauma entities, TBPIs carry a high per-patient burden due to upper-limb paralysis and neuropathic pain, with substantial indirect costs. The identification of demographic profiles and regional clustering provides an epidemiological baseline to inform clinicians and major trauma services.