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Wang H, Liu X, Zhao Y, Ou L, Zhou Y, Li C, Liu J, Chen Y, Yu H, Wang Q, Han J, Xiang L. Incidence and pattern of traumatic spinal fractures and associated spinal cord injury resulting from motor vehicle collisions in China over 11 years: An observational study. Medicine (Baltimore) 2016; 95:e5220. [PMID: 27787384 PMCID: PMC5089113 DOI: 10.1097/md.0000000000005220] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 09/27/2016] [Accepted: 10/05/2016] [Indexed: 11/26/2022] Open
Abstract
To investigate the incidence and pattern of traumatic spinal fractures (TSFs) and associated spinal cord injury (SCI) resulting from motor vehicle collisions (MVCs).This was a cross-sectional study. We retrospectively reviewed 698 patients with TSFs resulting from MVCs admitted to our university-affiliated hospitals from 2001 to 2011. The incidence and pattern were summarized with respect to different age groups, fracture levels, and the role of patients.There were 464 males (66.5%) and 234 females (33.5%) aged 40.5 ± 13.8 years old. The most common roles of patients in MVCs were car drivers (189, 27.1%), pedestrians hurt by a car (155, 22.2%), and car passengers (145, 20.8%). The most common fracture levels were L1 (n = 198, 19.2%) and T12 (n = 116, 11.3%), followed by C2 (n = 86, 8.3%). A total of 298 (42.7%) patients suffered a spinal cord injury. The frequencies of SCIs decreased from 53.1% to 24.6% with increasing age. The patients in the 20 to 39 age group (45.3% of all patients) had the largest sex ratio (2.4) and highest frequency of complete SCIs (19.3%) and complications (3.2%). Motorcycle drivers had the youngest mean age (35.7 ± 10.2), largest sex ratio (10.4), and highest frequency of SCIs (56.0%) and complications (4.4%). Motorcycle passengers had the highest frequency of complete SCI (22.7%) and ASOIs (45.5%) and the largest mean injury severity scoring (ISS) (18.9 ± 9.6). The most common fracture levels of motorcycle drivers were C3-C7, while that of others were T11-L2.The most common role of patients who sustained TSFs were car drivers who were 20 to 39 years old. Motorcycle drivers had the highest frequency of SCIs and complications. Motorcycle passengers had the highest frequency of complete SCIs and ASOIs and the largest ISS. Therefore, we should pay more attention to MVC patients, especially car drivers and motorcycle drivers and passengers.
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Affiliation(s)
- Hongwei Wang
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA
- Correspondence: Hongwei Wang, Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, 110016 Liaoning, China (e-mail: )
| | - Xinwei Liu
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA
| | - Yiwen Zhao
- State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Science, Shenyang, Liaoning
| | - Lan Ou
- Department of Radiology, Southwest Hospital
| | - Yue Zhou
- Department of Orthopedics, Xinqiao Hospital, the Third Military Medical University, Chongqing, China
| | - Changqing Li
- Department of Orthopedics, Xinqiao Hospital, the Third Military Medical University, Chongqing, China
| | - Jun Liu
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA
| | - Yu Chen
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA
| | - Hailong Yu
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA
| | - Qi Wang
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA
| | - Jianda Han
- State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Science, Shenyang, Liaoning
| | - Liangbi Xiang
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA
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Agrawal A, Kakani A, Baisakhiya N, Galwankar S, Dwivedi S, Pal R. Developing traumatic brain injury data bank: Prospective study to understand the pattern of documentation and presentation. INDIAN JOURNAL OF NEUROTRAUMA 2012. [DOI: 10.1016/j.ijnt.2012.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wang H, Zhang Y, Xiang Q, Wang X, Li C, Xiong H, Zhou Y. Epidemiology of traumatic spinal fractures: experience from medical university-affiliated hospitals in Chongqing, China, 2001-2010. J Neurosurg Spine 2012; 17:459-68. [PMID: 22978439 DOI: 10.3171/2012.8.spine111003] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The main objective of this study was to analyze the epidemiological data obtained from patients with traumatic spinal fracture at 2 university-affiliated hospitals in Chongqing, China. METHODS The authors retrospectively reviewed the hospital records of all patients who suffered traumatic spinal fracture and were treated at Xinqiao Hospital and Southwest Hospital (both affiliated with The Third Military Medical University) between January 2001 and December 2010. The demographic characteristics, injury characteristics, and clinical outcomes of patients over this 10-year period were compared. RESULTS A total of 3142 patients (mean age 45.7 years, range 1-92 years) with traumatic spinal fractures were identified; 65.5% of the patients were male. The peak frequency of these injuries occurred in the 31- to 40-year-old age group. Accidental falls and traffic accidents were the most common causes of spinal fractures (58.9% and 20.9%, respectively). Traffic accidents tended to occur in younger patients, whereas accidental falls tended to occur in older patients. The most common area of fracture was the thoracolumbar spine (54.9%). Cervical spinal fractures were significantly more common in patients injured in traffic accidents, while lumbar spinal fractures were more common in accidental fall patients. Using the American Spinal Injury Association (ASIA) classification, 479 (15.3%) patients were classified as having ASIA A injuries; 913 (29.1%), ASIA B, ASIA C, or ASIA D; and 1750 (55.7%), ASIA E. ASIA A injuries were more common in patients who suffered thoracic spinal fractures (15.09%) than in those with fractures in other areas of the spine. A total of 954 (30.4%) patients had associated nonspinal injuries. Of these patients, 389 (40.78%) suffered a thoracic injury, and 191 (20.02%) sustained a head and neck injury. The length of hospitalization differed significantly between the accidental falls from high heights and falls from low heights, as did the mean cost of hospitalization (p < 0.05), but no significant difference was found between accidental falls from high heights and traffic accidents (p > 0.05). The length of hospitalization differed significantly among the 3 groups according to the ASIA classification, as did the mean cost of hospitalization (p < 0.05). Of patients with incomplete lesions, 39.3% improved 1 or more grades in ASIA classification during hospitalization. CONCLUSIONS Accidental falls emerged as the leading cause of traumatic spinal fracture in this study, and the numbers of fall-induced and sports-related injuries increased steadily with age. These results indicate that there should be increased concern for the consequences of fall- and sports-related injuries among the elderly.
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Affiliation(s)
- Hongwei Wang
- Department of Orthopaedics, Xinqiao Hospital, China
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Orthopedic Considerations in the Pedestrian versus Motor Vehicle Accident Polytrauma Patient. Case Rep Orthop 2012; 2012:149847. [PMID: 23259110 PMCID: PMC3504246 DOI: 10.1155/2012/149847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 04/01/2012] [Indexed: 12/03/2022] Open
Abstract
Pedestrian versus motor vehicle accidents (PVMVAs) are a common cause of morbidity and mortality around the globe. Past models of PVMVAs assume lower-extremity vehicle contact as the initiating event, with a subsequent predicted injury sequence consisting of a lower extremity injury followed by injury to the body, head, and upper extremities. The term “fatal triad” was first coined by Farley, which described concomitant injuries to the skull, pelvis, and extremity fractures. Over the years, this once well-accepted model of injury has been under scrutiny by numerous orthopedic researchers, and it has lost credibility. This case presentation glaring reveals that the patient incurred which is referred to as the “fatal triad”, in contrast to the commonly circulated thoughts of biodynamic mechanisms of PVMVA fractures. More research in this arena is warranted. This lack of information contributes to the morbidity and mortality associated with such devastating injuries. The overlying theme displayed in the data analyzed in this paper demonstrates the vital importance of the orthopedic surgeon in the management of the PVMVA patient. No matter the particular mechanism of injury, occurrence, or agreed-upon treatment protocol, the role of the orthopedic physician is instrumental to the wellbeing of the PVMVA trauma patient.
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Schmucker U, Beirau M, Frank M, Stengel D, Matthes G, Ekkernkamp A, Seifert J. Real-world car-to-pedestrian-crash data from an urban centre. J Trauma Manag Outcomes 2010; 4:2. [PMID: 20158895 PMCID: PMC2830180 DOI: 10.1186/1752-2897-4-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Accepted: 02/16/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND Pedestrians are at a high risk for crash and injury. This study aims at comparing data from real world crashes with data gathered from experimental settings. METHODS IMPAIR (In-Depth Medical Pedestrian Accident Investigation and Reconstruction) was a prospective, observational study performed in a metropolitan area. Data was collected on-scene, from clinical records, and interviews. Data comprise crash data, details on injury pattern and injury severity. RESULTS Thirty-seven pedestrians (of which 19 males) with a mean 37.1 years of age were included in the study. The mean collision speed was 49.5 km/h (SD 13.7, range, 28 - 93). The mean ISS (31.0, SD 25.4) and the 24% fatality rate indicate a substantial trauma load. The most common AIS 4+ injuries were to the head (23 subjects), followed by chest (8), pelvis (4), and abdomen (2). An association of impact side and injury side (right/left) was found for abdominal, chest, pelvic, and upper limb injuries. Primary head impacts were documented on the windscreen (19 subjects), hood (10), A-pillar (2), and edge of the car roof (2). With bivariate analysis, a significant increase of MAIS 4+ head injury risk was found for collision speeds of >40 km/h (OR 9.00, 95% CI 1.96-41.36). CONCLUSION The real-world data from this study is in agreement with previous findings from biomechanical models and other simulations. This data suggest that there may be reason to include further pedestrian regulations in EuroNCAP.
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Affiliation(s)
- Uli Schmucker
- Dept of Orthopedic and Trauma Surgery, Ernst-Moritz-Arndt-University Greifswald, Sauerbruchstrasse, 17475 Greifswald, Germany
| | - Melissa Beirau
- Dept of Orthopedic and Trauma Surgery, Unfallkrankenhaus Berlin, Warener Strasse 7, 12683 Berlin, Germany
| | - Matthias Frank
- Dept of Orthopedic and Trauma Surgery, Unfallkrankenhaus Berlin, Warener Strasse 7, 12683 Berlin, Germany.,Dept of Orthopedic and Trauma Surgery, Ernst-Moritz-Arndt-University Greifswald, Sauerbruchstrasse, 17475 Greifswald, Germany
| | - Dirk Stengel
- Dept of Orthopedic and Trauma Surgery, Unfallkrankenhaus Berlin, Warener Strasse 7, 12683 Berlin, Germany
| | - Gerrit Matthes
- Dept of Orthopedic and Trauma Surgery, Unfallkrankenhaus Berlin, Warener Strasse 7, 12683 Berlin, Germany.,Dept of Orthopedic and Trauma Surgery, Ernst-Moritz-Arndt-University Greifswald, Sauerbruchstrasse, 17475 Greifswald, Germany
| | - Axel Ekkernkamp
- Dept of Orthopedic and Trauma Surgery, Unfallkrankenhaus Berlin, Warener Strasse 7, 12683 Berlin, Germany.,Dept of Orthopedic and Trauma Surgery, Ernst-Moritz-Arndt-University Greifswald, Sauerbruchstrasse, 17475 Greifswald, Germany
| | - Julia Seifert
- Dept of Orthopedic and Trauma Surgery, Unfallkrankenhaus Berlin, Warener Strasse 7, 12683 Berlin, Germany.,Dept of Orthopedic and Trauma Surgery, Ernst-Moritz-Arndt-University Greifswald, Sauerbruchstrasse, 17475 Greifswald, Germany
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Markogiannakis H, Sanidas E, Messaris E, Koutentakis D, Alpantaki K, Kafetzakis A, Tsiftsis D. Motor vehicle trauma: analysis of injury profiles by road-user category. Emerg Med J 2006; 23:27-31. [PMID: 16373799 PMCID: PMC2564121 DOI: 10.1136/emj.2004.022392] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Vehicle accidents in Greece are among the leading causes of death and the primary one in young people. The mechanism of injury influences the patterns of injury in victims of vehicle accidents. OBJECTIVE Identification and analysis of injury profiles of motor-vehicle trauma patients in a Greek level I trauma centre, by road-user category. PATIENTS AND METHODS The trauma registry data of Herakleion University Hospital of adult trauma patients admitted to the hospital after a vehicle accident between 1997 and 2000 were retrospectively examined. Patients were grouped based on the mechanism of injury into three road-user categories: car occupants, motorcyclists, and pedestrians. RESULTS Of 730 consecutive patients, 444 were motorcyclists (60.8%), 209 were car occupants (28.7%), and 77 were pedestrians (10.5%). Young men constituted the majority of injured motorcyclists whereas older patients (p = 0.0001) and women (p = 0.0001) represented a substantial proportion of the injured pedestrians. With regard to the spectrum of injuries in the groups, craniocerebral injuries were significantly more frequent in motorcyclists and pedestrians (p = 0.0001); abdominal (p = 0.009) and spinal cord trauma (p = 0.007) in car occupants; and pelvic injuries (p = 0.0001) in pedestrians. Although the car occupants had the highest Injury Severity Score (ISS) (p = 0.04), the pedestrians had the poorest outcome with substantially higher mortality (p = 0.007) than the other two groups. CONCLUSIONS The results reveal a clear association between different road-user categories and age and sex incidence patterns, as well as outcomes and injury profiles. Recognition of these features would be useful in designing effective prevention strategies and in comprehensive prehospital and inhospital treatment of motor-vehicle trauma patients.
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Affiliation(s)
- H Markogiannakis
- Department of Surgical Oncology, Herakleion Medical School, University of Crete, Greece.
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Ameratunga SN, Norton RN, Bennett DA, Jackson RT. Risk of disability due to car crashes: a review of the literature and methodological issues. Injury 2004; 35:1116-27. [PMID: 15488502 DOI: 10.1016/j.injury.2003.12.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/23/2003] [Indexed: 02/02/2023]
Abstract
With improving rates of survival following road traffic injuries in many countries, healthy years of life lost due to crashes increasingly reflect the prevalence of disabling sequelae. This review examines the epidemiological evidence regarding the risk of disability due to car crashes, published between 1980 and 2002. Studies of sequelae limited to specific domains (e.g. head injury, whiplash, psychiatric morbidity) were excluded. Of the 19 studies meeting the criteria for review, most focused on the prevalence of disability following crashes but not the association between them. Prevalence estimates of post-crash disability varied from 2 to 87%. The potential sources of heterogeneity included differences in study settings and period, duration of follow-up, and definitions of exposure and outcome. Methodological problems that compounded the difficulties in interpretation and generalisability of study findings included selection biases and use of non-representative samples, idiosyncratic outcome measures, inadequate adjustment for confounding, and the prevailing medico-legal or compensation context. The findings highlight the need for well-designed population-based epidemiological studies using validated outcome measures and appropriate comparison groups to determine the independent risk of disability due to car crashes. The review also revealed a critical need for data from low- and middle-income countries, the setting for over 90% of the estimated global burden of road traffic injury.
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Affiliation(s)
- Shanthi N Ameratunga
- Section in Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, New Zealand.
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Abstract
OBJECTIVE The aim of the study was to determine a clinical diagnostic pathway for the imaging of the thoracolumbar spine in blunt trauma patients. METHOD A literature review was undertaken to determine the factors important in the detection of thoracolumbar injury and also to produce a trial protocol, which could be tested retrospectively. Two hundred patients admitted between 1998 and 2000 were reviewed retrospectively to form a database of the relevant clinical features. The diagnostic pathway protocol was tested retrospectively in two groups; one hundred with known thoracolumbar fractures and one hundred undifferentiated multi-trauma patients. Sensitivity and specificity indices were determined using the chi-squared test of association. RESULTS Falls and motor vehicle crashes were the most common mechanism of injury causing thoracolumbar fractures. No significant association could be found between mechanism of injury (MOI) and presence of thoracolumbar fracture. Clinical signs found to be associated with thoracolumbar fracture include: (1) back pain/midline tenderness (Sens 62.1% Spec 91.5%), (2) palpable midline step (Sens 13.8% Spec 100%), (3) back bruising (Sens 6.9% Spec 98.6%), (4) abnormal neurological signs (Sens 41.4% Spec 95.8%). Cervical level fractures were also found to be associated with an increased incidence of thoracolumbar fractures. Factors found to influence the detection of back pain/midline tenderness include: (1) GCS<15, (2) ETOH/drug intoxication, (3) major distracting injury. The proposed diagnostic pathway would have led to 92% of patients receiving TL imaging in group 2 (multi-trauma) with a sensitivity of 100%, specificity of 11.3% and a negative predictive value of 100%. CONCLUSION From the literature and the results of the study, we propose that imaging of the thoracolumbar spine is required in those patients suffering from a high force mechanism of injury if any of the following are present: (1) back pain/midline tenderness, (2) local signs of thoracolumbar injury, (3) abnormal neurological signs, (4) cervical spine fracture, (5) GCS<15, (6) major distracting injury, (7) ETOH/ drug intoxication. An evidence based diagnostic pathway has been shown to be highly sensitive in determining the presence of TL fracture in a retrospective study of blunt trauma patients.
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Affiliation(s)
- Jeremy M Hsu
- Royal North Shore Hospital, St Leonards, NSW 2065, Australia
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Malvestio MA, de Sousa RMC. [Traffic accidents: characterization of the victims by the Revised Trauma Score in the pre-hospital period]. Rev Esc Enferm USP 2002; 36:394-401. [PMID: 12876852 DOI: 10.1590/s0080-62342002000400014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This report describes age, gender, trauma mechanics aspects and procedures from 643 motor vehicle crashes, MVC, victims in Tietê and Pinheiros expressways, by considering the prehospital Revised Trauma Score (RTS). The RTS = 12 victims' were 90.8%, with RTS = 11 added 4.0% and in group with RTS < 10, 5.2%. Among the RTS < 10 victims, the pedestrians stand out (36.4%), the frontal impacts (24.2%) and the projected (36.4%) or trapped victims (15.1%), and those that received advanced life support procedures. The motorcyclists and the male victims with 21 with 30 years of age were predominant. This study is expected to contribute to a better assistance to MVC victims.
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Hui T, Avital I, Soukiasian H, Margulies DR, Shabot MM. Intensive Care Unit Outcome of Vehicle-Related Injury in Elderly Trauma Patients. Am Surg 2002. [DOI: 10.1177/000313480206801218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Vehicle-related trauma is a common mechanism of injury in elderly (age ≥65 years) trauma patients. Several hospital-based studies have shown that patients with pedestrian injury have a higher mortality compared with those with motor vehicle collision (MVC) injury partially because of older patients found in the former group. In addition the injury patterns also differ significantly between these two mechanisms of vehicle-related trauma. The purpose of the present study is to compare the demographics, injury severity, injury patterns, and outcomes of elderly patients with pedestrian injury admitted to a surgical intensive care unit (SICU) of a Level I trauma center between January 1, 1994 and December 31, 2000 with those admitted with MVC injury. During the study period there were 187 elderly patients admitted to the surgical intensive care unit with vehicle-related injury. Fifty-one per cent of the patients had MVC injury. Patients were divided into two groups based on their mechanisms of injury (pedestrian vs MVC) for comparison. There was no difference in the mean age and gender between the two groups. Injury Severity Score, admission Simplified Acute Physiology Score, and mortality were significantly higher in the pedestrian group compared with the MVC group. Using logistic regression analysis three factors were found to be independently predictive of mortality: Simplified Acute Physiology Score, intracranial hemorrhage with mass effect on CT scan, and cardiac complications.
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Affiliation(s)
- Thomas Hui
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Itzhak Avital
- Cedars-Sinai Medical Center, Los Angeles, California
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Wong E, Leong MKF, Anantharaman V, Raman L, Wee KP, Chao TC. Road traffic accident mortality in Singapore. J Emerg Med 2002; 22:139-46. [PMID: 11858917 DOI: 10.1016/s0736-4679(01)00455-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of this study was to identify factors that contribute to road traffic accident mortality and the patterns of injuries sustained by these victims, with a view to identifying areas for future intervention. All road traffic accident deaths that occurred in Singapore over a period of 1 year were reviewed. A total of 226 deaths occurred: 82.3% of the victims were male. The median age was 31 years. Blood alcohol was detected in 42 (18.7%) victims. In general, head (86.7%), followed by thoracic (67.7%) and abdominal (31.4%) injuries, were the most common injuries. Severe lower extremity trauma was most common among pedestrians and pedal cyclists (20.6% and 11.0%, respectively). The mean Injury Severity Score was 38.7. The relative risk of mortality between motorcyclists and motorcar drivers was 18.8:1. Suggestions for future prevention and intervention include stricter enforcement of speed limits, more severe penalties for drunk driving, helmet use among pedal cyclists, and the introduction of pre-hospital advanced airway management.
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Affiliation(s)
- Evelyn Wong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
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12
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Gorrie C, Duflou J, Brown J, Gibson T, Waite PM. Extent and distribution of vascular brain injury in pediatric road fatalities. J Neurotrauma 2001; 18:849-60. [PMID: 11565597 DOI: 10.1089/089771501750451776] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study used a multidisciplinary approach to examine the brains of pediatric road trauma fatalities in the Sydney area over a 3-year period. The brains of 32 children (0-16 years) were examined: 20 pedestrians, nine passengers, and three cyclists. The extent and distribution of brain injury was assessed, peak linear head acceleration determined, and the severity of brain damage was compared to that previously reported for adults using the same scoring method. Skull fractures (20/32) and subarachnoid haemorrhage (22/32) were the commonest head injuries. In general, the neuropathology was similar to that seen in adults, with a high percentage of damage in the corpus callosum and gliding contusions within the subcortical white matter. Intracerebral hemorrhage was relatively rare. For frontal and occipital head impacts, the corpus callosum was the most injured part of the brain, followed by the deep central structures and the temporal lobes, whereas for lateral impacts, the injuries were more evenly distributed. Comparison of the current data for children with the vascular injury sector scores reported for adults suggests that the brains of children are more severely damaged for the same peak linear head acceleration.
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Affiliation(s)
- C Gorrie
- Neural Injury Research Unit, School of Anatomy, University of New South Wales, Sydney, Australia.
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Marson AC, Thomson JC. The influence of prehospital trauma care on motor vehicle crash mortality. ACTA ACUST UNITED AC 2001; 50:917-20; discussion 920-1. [PMID: 11371852 DOI: 10.1097/00005373-200105000-00024] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study evaluated the impact of the prehospital trauma care system on the mortality from motor vehicle crashes and on the temporal distribution between the crash and related death. METHODS Autopsies performed by the Forensic Medical Institute on all deaths caused by motor vehicle crashes 1 year before and 1 year after the beginning of the prehospital trauma care system were evaluated. RESULTS In the first period, 128 deaths occurred, 53.9% of them in the first hour after the crash, 36.7% between the first hour and the seventh day, and 9.4% after 1 week. In the second period, 115 deaths occurred, 40.8% of them in the first hour, 52.2% between the first hour and the seventh day, and 7% after 1 week. Central nervous system injury was the most frequent cause of death in both periods. Mortality was greatest among young people as well as male victims in both periods. CONCLUSION After starting the prehospital trauma care system in our city, there was a decrease in the deaths occurring before hospital admission, a change in temporal distribution of deaths, and a reduction in the motor vehicle crash mortality rate.
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Affiliation(s)
- A C Marson
- Department of Surgery, State University of Londrina, Rua Paes Leme, 1264, sala 401, Bairro Ipiranga, Londrina, PR 86010-520, Brazil
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Rothrock SG, Green SM, Morgan R. Abdominal trauma in infants and children: prompt identification and early management of serious and life-threatening injuries. Part I: injury patterns and initial assessment. Pediatr Emerg Care 2000; 16:106-15. [PMID: 10784214 DOI: 10.1097/00006565-200004000-00012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Evaluation of children with abdominal trauma can be a difficult process. Unique anatomic features predispose children to specific injuries and potentially make identification of life-threatening injuries difficult. While Part I of this review discusses the initial assessment and diagnostic testing in children with abdominal trauma, Part II will review specific injuries and ED management of children with possible abdominal trauma. Knowledge of each of these factors will improve the ability of general and pediatric emergency physicians to expeditiously identify children with potential serious injury and initiate appropriate treatment.
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Affiliation(s)
- S G Rothrock
- Department of Emergency Medicine, Orlando Regional Medical Center, FL 32792, USA
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Calkins CM, Moore EE, Barnett C, Haenel JB. Arteriovenous fistula presenting as airway hemorrhage after percutaneous tracheostomy. THE JOURNAL OF TRAUMA 1999; 47:774-6. [PMID: 10528617 DOI: 10.1097/00005373-199910000-00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
MESH Headings
- Adult
- Angiography
- Arteries/abnormalities
- Arteriovenous Fistula/diagnostic imaging
- Arteriovenous Fistula/etiology
- Arteriovenous Fistula/therapy
- Bicycling/injuries
- Diagnosis, Differential
- Embolization, Therapeutic
- Hematoma, Epidural, Cranial/etiology
- Hematoma, Epidural, Cranial/surgery
- Hematoma, Subdural, Acute/etiology
- Hematoma, Subdural, Acute/surgery
- Hemorrhage/diagnostic imaging
- Hemorrhage/etiology
- Hemorrhage/therapy
- Humans
- Male
- Thyroid Gland/blood supply
- Tracheostomy/adverse effects
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Affiliation(s)
- C M Calkins
- Department of Surgery, Denver Health Medical Center, University of Colorado Health Sciences Center, USA
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DasGupta R, Roncal S, Hill D. Resource utilization by injured automobile occupants and pedestrians. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1998; 68:271-4. [PMID: 9572336 DOI: 10.1111/j.1445-2197.1998.tb02080.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study was designed to test the hypothesis that the hospital resources utilized in treating pedestrian trauma would be significantly greater than that for automobile occupants. This was based on previous studies that showed that the demographic features and patterns of injury sustained by the pedestrian population were significantly different from that of automobile occupants. METHODS A hospital-based study was designed utilizing retrospective analysis of a prospective trauma database. All primary retrievals of pedestrians (n=547) and automobile occupants (n=597) involved in accidents in Central Sydney from mid-1990 to mid-1995 were included. The length of hospital stay, use of the intensive care unit (ICU) and visits to the operating theatre (Standard Resource Cost) were compared. RESULTS The age and injury severity scores were significantly higher for the pedestrian group. The length of stay (days) for the pedestrians (mean, 12 SD 14; median, 7 interquartile range (IQR) 13), was significantly higher (P < 0.0001 ) than that for the automobile occupants (mean, 7 SD 11; median, 2 IQR 6). The ICU utilization (days) for the pedestrians (mean, 1.3 SD 4.0; median, 0) was significantly higher (P < 0.0001) than that of the automobile occupants (mean, 0.6 SD 2.9; median, 0). The average operating theatre utilization per pedestrian (0.65 visits) exceeded that of automobile occupants (0.43) by 50% (P < 0.0001). CONCLUSIONS The study confirms that the acute care of pedestrian injury utilizes more hospital resources than that of automobile occupants. Resources should be allocated to meet this need both in terms of hospital reimbursement and overall directives in public health policy.
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Affiliation(s)
- R DasGupta
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Austraila
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Hill DA, Delaney LM, Roncal S. A chi-square automatic interaction detection (CHAID) analysis of factors determining trauma outcomes. THE JOURNAL OF TRAUMA 1997; 42:62-6. [PMID: 9003259 DOI: 10.1097/00005373-199701000-00011] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Analysis of variables predictive of trauma outcome by the CHAID (chi-square automatic interaction detection) statistical program. DESIGN Retrospective analysis of a prospectively maintained trauma database. METHODS The study group consisted of 607 primary ambulance retrievals to Royal Prince Alfred Hospital, Sydney, for the period of 6 fiscal years (1990-1996) with major injury (Injury Severity Score > 15). MAIN RESULTS The overall mortality fell from 26.6 to 16% (chi 2 test = 14.7, p = 0.01) during the study period. The emergency room Glasgow Coma Scale (GCS) score (preresuscitation) was the strongest predictor of death or survival. CHAID segmented the study group into three categories based on GCS scores (¿3¿, ¿4-12¿, and ¿13-15¿), each with significantly different outcome predictability. The mortality rate in those with a GCS score of 3 (n = 89) was 67%. Systolic blood pressure was the strongest predictor of outcome in this subset. The mortality in those with GCS score of 4-12 (n = 160) was 18%. Injury Severity Score was the strongest predictor in this subset. The mortality rate in those with GCS score of 13-15 was 5%. Age was the strongest predictor in this group. CONCLUSION The CHAID-generated flowchart has proved useful in this pilot study to analyze the interrelation between variables predictive of outcome in an Australian urban trauma population.
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Affiliation(s)
- D A Hill
- Department of Trauma, Royal Prince Alfred Hospital, Sydney, Australia
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