Byerly S, Inaba K, Biswas S, Cheng V, Cho J, Wang E, Strumwasser A, Matsushima K, Demetriades D. Hit by a Train: Injury Burden and Clinical Outcomes.
J Emerg Med 2019;
57:6-12. [PMID:
31078347 DOI:
10.1016/j.jemermed.2019.03.053]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 03/17/2019] [Accepted: 03/30/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND
Few data exist regarding the train vs. pedestrian (TVP) injury burden and outcomes.
OBJECTIVE
This study aimed to examine the epidemiology and outcomes associated with TVP injuries.
METHODS
This is a retrospective National Trauma Databank study (January 2007 to July 2012) including trauma patients sustaining TVP injury. Demographics, injury data, interventions, and outcomes were abstracted. Patients injured by a train were compared to patients who sustained an automobile vs. pedestrian (AVP) injury.
RESULTS
Of the 152,631 patients struck by ground transportation during the study time frame, 1863 (1.2%) were TVP. Median TVP age was 38 years (interquartile range [IQR] 24-50 years), 81.6% were male, median Injury Severity Score (ISS) was 13 (IQR 6-24). TVP patients were more severely injured (ISS 13 vs. 9; p < 0.001) and required more proximal amputations (13.4% vs. 0.2%; p < 0.001) and cavitary operations (18.2% vs. 2.8%; p < 0.001). TVP patients had higher rates of intensive care unit admission, mechanical ventilation and transfusion, longer length of stay, and higher in-hospital mortality. On multivariable logistical regression, TVP was an independent predictor for higher injury burden, ISS ≥25 (adjusted odds ratio [AOR] 1.650), immediate operative need (AOR 7.535), and complications (AOR 1.317).
CONCLUSIONS
TVP is associated with a significant injury burden. These patients have a significantly higher need for immediate operation and more complicated hospital course.
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