Deaths (144) from road traffic accidents occurring before arrival at hospital

Blunt and penetrating trauma of the thoracic aorta and aortic arch branches: an autopsy study

BACKGROUND

Due to the highly lethal nature of trauma of the thoracic aorta and aortic arch branches (TA-AAB), autopsy studies are essential for the investigation of its epidemiologic characteristics.

METHODS

The reports of 11,446 consecutive medicolegal autopsies were reviewed. Among 1,980 injury-related fatalities, 251 victims (12.7%) with 302 TA-AAB injuries were found. Several trauma variables were recorded and their relations were examined.

RESULTS

Blunt TA-AAB injuries were recorded in 86.4% of the victims. They were located mainly at the aortic isthmus and distal descending thoracic aorta and were accompanied to a great extent by extrathoracic trauma. The vast majority of penetrating lacerations were located at the ascending aorta, arch, and arch branches and were mostly associated with other lethal intrathoracic injuries. All penetrating trauma victims died before reaching the hospital, whereas 5.5% of the blunt trauma victims were admitted to the hospital alive.

CONCLUSION

Major differences between blunt and penetrating TA-AAB injuries were revealed, regarding their location, patterns of concomitant injuries, and victims' survival time. Patients injured in motor vehicle crashes, as opposed to various other causes of trauma, were found to have the best chances of reaching the hospital alive.

A review of fatal road accidents in Oxfordshire over a 2-year period

The records of 131 road accident fatalities which occurred in Oxfordshire over a 2-year period were reviewed. Aspects of the accident circumstances, the injuries incurred and the cause of death were examined. The majority of fatal accidents occurred during daylight hours and in dry weather. Deaths were mainly due to cerebral injury (34.4 per cent) or uncontrollable (mainly thoracic) haemorrhage (25.2 per cent), or a combination of both (8.4 per cent). A number of deaths occurred in hospital from complications rather than from the injury itself. In addition to this, there were four deaths from natural causes. Where death occurred at the scene of the accident, blood alcohol levels were determined. Almost 50 per cent of the drivers for whom a level was obtained had measurable alcohol in their bloodstream, and 28 per cent of such drivers were over the legal limit. Three cases who reached hospital alive were, on review, assessed to have potentially survivable injuries, and a further two patients died in the post-accident period of potentially survivable complications.

Maxillofacial trauma in fatally injured victims of motor vehicle accidents

A survey of 84 victims of maxillofacial injuries sustained in road traffic accidents is presented. The material was based on the files of the Finnish National Board of Traffic Accident Investigation of the Insurance Companies, comprised the years 1972-1983 and covered the whole country. 86% of the victims were occupants of motor cars; only 24% had worn seat belts. Similarly only two of the eight motor-cyclists had worn a helmet. The majority of all victims also had other head injuries but only 24% had brain injuries; over 50% had a chest injury. In 20 cases the facial injury was thought to be the definitive fatal trauma. In the remaining cases the other injuries could have been responsible for the fatal outcome. However, aspiration of blood from the facial wounds, unconciousness and an injured thorax probably all contributed to death which in 87% was immediate. Thirty-six of the 64 victims who had not used a seat-belt or helmet could certainly, or probably, have been saved by either the belt or the helmet. The possibilities of preventing fatal maxillofacial injuries in road traffic are discussed.