Changing paradigms of seat belt and air bag injuries: what we have learned in the past 3 decades

The Impact of Protective Devices Across the Spectrum of Trauma Care and Across Racial Groupings

INTRODUCTION

Protective devices such as seat belts and helmets save lives. Most studies only address one aspect of the injury profile - compliance or mortality - not the entire spectrum of trauma care, and little attention is paid to racial differences in the use or impact of protective devices.

METHODS

Patients with blunt mechanisms where using protective devices would be expected were included and were divided into utilizing (P) vs not utilizing protection (Non-P). Chart review included demographics, injuries sustained, hemodynamics, and blood alcohol level. Outcomes included need for emergent operation, complications and death.

RESULTS

Non-P patients were more likely male, presented at night and intoxicated. Highest risk behavior (intoxicated Non-P) presented at night (25.7% of nighttime presentations), and rarely during daytime (6.7% daytime presentations). Non-P were more likely hypotensive and sustain a traumatic brain injury. No race related differences were noted among young patients. Among older (>/=50 years) patients, White patients were least likely Non-P and least likely presented at night. Non-P required more emergent operative intervention, ICU admission, and longer hospital stay. Overall, Non-P was associated with increased risk of death (OR = 1.6 (95% CI = 1.28 - 2.11).

CONCLUSION

Given unique age and racial differences, we advocate for culturally and age specific public service campaigns.

Seat belt injuries and external markings at autopsy in cases of lethal vehicle crashes

A study was undertaken to determine what injuries are associated with the wearing of seat belts and if the presence of cutaneous seat belt markings observed on victims of lethal vehicle crashes increased the likelihood of underlying injury. Autopsy reports from the files at Forensic Science South Australia were reviewed for all fatal motor vehicle crashes from January 2014 to December 2018. A total of 173 cases were included for analysis with 127 occupants wearing seat belts at the time of impact (73.4%) (age range = 18-93; mean = 45 M:F = 81:46). Of these, only 38 had external seat belt markings (29.9%) (age range = 19-83; mean = 49 M:F = 20:18). Logistic regression modelling showed that occupants who were wearing seat belts were more likely to experience closed head injury without skull fractures in addition to mesenteric and gastrointestinal injury. Increasing body mass index increased the incidence of seat belt markings (p < 0.01) and markings were more likely to be found in the presence of bilateral pelvic fractures. Thus, external seat belt markings were observed in only a minority of seatbelt wearers, and more often in individuals with higher BMIs and with bilateral pelvic fractures (possibly associated with greater momentum and impact force).

Click it or give it: Increased seat belt law enforcement and organ donation

Laws mandating that individuals wear a seat belt have the presumed goal of reducing motor vehicle accident fatalities, but the prevailing view is that they may reduce the number of organs available. I provide a conceptual model identifying mechanisms whereby the law could either increase or decrease organ donation. Exploiting variation across states and time in the adoption of primary seat belt enforcement, I investigate these mechanisms and estimate the effect of the law on the supply of organs. The law increases seat belt usage and decreases motor vehicle accident fatalities, which translates to a sizeable reduction in the number of motor vehicle accident-based organ donors. In contrast, the law is not associated with changes in the number of organ donors from nonmotor vehicle accident-based sources and is robust to controlling for hospital-specific effects. The effects are concentrated within organs expected to be most negatively impacted by the seat belt. Although primary enforcement represents a net-gain to society in terms of lives saved, the negative impact on organ donation suggests further emphasis be placed on policies aimed at increasing the availability of organs.

Short Bowel Syndrome and Malabsorption - Causes and Prevention

Background

The short bowel syndrome (SBS) is a condition caused by extensive intestinal resection for a variety of conditions. The etiology varies by age group. Necrotizing enterocolitis is the leading cause in infants. In older children, trauma and malignancies are most common. Postoperative SBS has become most common in adults, followed by mesenteric vascular disease and cancer/irradiation.

Methods

Systematic literature review.

Results

Prevention of SBS should be given high priority. Each of the etiologies has been evaluated and strategies to prevent extensive resection have been developed. These include a thoughtful approach to reoperation, early identification of complications, e.g. intestinal ischemia, reducing radiation enteritis, and bowel-conserving therapies in diseases such as Crohn's disease.

Conclusion

Several operative strategies to prevent SBS are useful. Timing and extent of reoperation need careful consideration. Minimizing intestinal resection, bowel-conserving techniques for complications such as fistula or strictures, and remodeling procedures are important.

Seatbelt versus seatbelt and airbag injuries in a single motor vehicle crash

Seatbelt restraints are important for occupant safety which substantially reduces morbidity and mortality in severe motor vehicle crashes (MVC). Though, it has been established that the air bag and seatbelt use reduce injury severity and mortality but still there is limited information on the pattern of injury by restraint type. Herein, we presented two case reports which describe the injury pattern of two patients (both were restrained but only driver had airbag) involved in a single MVC. Both of them had severe traumatic injuries, however, the restrained passenger without airbag, sustained more severe injuries of intestine, kidney and spinal cord. In addition to seatbelt, airbag provides considerable protection against severe blunt abdominal trauma. Therefore, installation of airbags especially for front seat passenger is imperative for minimizing the risk of significant traumatic injuries.

Abdominal injury patterns in patients with seatbelt signs requiring laparotomy

Aims:

We analyzed our series of patients with seatbelt signs (bruising) that underwent laparotomy in order to correlate injury pattern with clinical course and outcome.

Materials and Methods:

Retrospective analysis of patients with seatbelt signs presenting to the level 1 Trauma Unit between 2005 and 2010 was performed. We evaluated the nature of injuries during laparotomy associated with seatbelt signs and their treatment and complications.

Results:

There were 41 patients, 25 (61%) male, with a median age of 26 years. Median injury severity score (ISS) was 25 (range 6–66) and overall mortality was 10% (four patients). Patients were classified into three groups according to time from injury to surgery. Median time to surgery for the immediate group (n = 12) was 1.05 h, early group (n = 22) was 2.7 h, and delayed group (n = 7) was 19.5 h. Patients in the immediate group tended to have solid organ injuries; whereas, patients in the delayed group had bowel injury. Patients with solid organ injuries were found to be more seriously injured and had higher mortality (P < 0.01) and morbidity compared with patients with the “classic” bowel injury pattern associated with a typical seatbelt sign.

Conclusion:

Our data suggest that there is a cohort of patients with seatbelt injury who have solid organ injury requiring urgent intervention. Solid organ injuries associated with malpositioned seatbelts lying higher on the abdomen tend to result in hemodynamic instability necessitating immediate surgery. They have more postoperative complications and a greater mortality. Seatbelt signs should be accurately documented after any car crash.