Prioritizing Severe Head Injury Prevention in U.S. Construction by Sector and Injury Pattern

Severe head injuries can leave construction workers with permanent disability, prolonged work absence, or high medical costs. Although case counts identify sectors with many reports, workforce comparisons may identify different prevention priorities. This study examined 1485 OSHA Severe Injury Reports with head-region codes across 15 U.S. construction sectors from 2015 to 2024 and linked them with Quarterly Census of Employment and Wages data. Ten pairwise tests examined relationships among construction sector, event type, injury source, head region, and injury nature, followed by intracranial proportions within common event-source combinations. Three findings emerged. (1) Building Equipment Contractors recorded the most cases but fell below workforce expectation. (2) Structural Steel and Precast Concrete Contractors had the largest workforce-relative observed-to-expected ratio, followed by Masonry and Framing Contractors. (3) Transportation incidents were strongly associated with vehicle sources, whereas lower-level falls were associated with intracranial injuries. Within struck-by reports, machinery showed a numerically higher intracranial proportion than tools or equipment; these proportions were descriptive rather than statistically ranked. These results can help agencies allocate prevention resources across sectors and help contractors focus reviews on traffic movement, elevated access, material handling, and electrical work.