Trauma scores and trauma outcome measures

Evaluating the Potential Benefits of Advanced Automatic Crash Notification

OBJECTIVE

Advanced Automatic Collision Notification (AACN) services in passenger vehicles capture crash data during collisions that could be transferred to Emergency Medical Services (EMS) providers. This study explored how EMS response times and other crash factors impacted the odds of fatality. The goal was to determine if information transmitted by AACN could help decrease mortality by allowing EMS providers to be better prepared upon arrival at the scene of a collision.

METHODS

The Crash Injury Research and Engineering Network (CIREN) database of the US Department of Transportation/National Highway Traffic Safety Administration (USDOT/NHTSA; Washington DC, USA) was searched for all fatal crashes between 1996 and 2012. The CIREN database also was searched for illustrative cases. The NHTSA's Fatal Analysis Reporting System (FARS) and National Automotive Sampling System Crashworthiness Data System (NASS CDS) databases were queried for all fatal crashes between 2000 and 2011 that involved a passenger vehicle. Detailed EMS time data were divided into prehospital time segments and analyzed descriptively as well as via multiple logistic regression models.

RESULTS

The CIREN data showed that longer times from the collision to notification of EMS providers were associated with more frequent invasive interventions within the first three hours of hospital admission and more transfers from a regional hospital to a trauma center. The NASS CDS and FARS data showed that rural collisions with crash-notification times >30 minutes were more likely to be fatal than collisions with similar crash-notification times occurring in urban environments. The majority of a patient's prehospital time occurred between the arrival of EMS providers on-scene and arrival at a hospital. The need for extrication increased the on-scene time segment as well as total prehospital time.

CONCLUSION

An AACN may help decrease mortality following a motor vehicle collision (MVC) by alerting EMS providers earlier and helping them discern when specialized equipment will be necessary in order to quickly extricate patients from the collision site and facilitate expeditious transfer to an appropriate hospital or trauma center. Plevin RE , Kaufman R , Fraade-Blanar L , Bulger EM . Evaluating the potential benefits of advanced automatic crash notification. Prehosp Disaster Med. 2017;32(2):156-164.

Mortality and injury patterns associated with roof crush in rollover crashes

BACKGROUND

In the United States, a significant number of spine injuries, traumatic brain injuries (TBI), and deaths result from motor vehicle rollover crashes each year though they make up a small percentage of total crashes. We sought to explore the relationship between these injuries and the degree of roof crush.

METHODS

We searched the NASS CDS database for belted, adult (> or =16), non-middle seat passengers involved in rollover crashes from 1993 to 2006. We also searched the CIREN database for illustrative cases. Logistic regression was used to evaluate the relationship between different levels of roof crush and mortality, severe injury (AIS > or = 3) to the spine, spinal cord, and head injury.

RESULTS

The risk of mortality, TBI, and spine injury all increased as the degree of roof crush increased. For mortality increased risk occurred at >15 cm [15-30 cm: OR 2.089 (95% CI: 1.461-2.987); >30 cm: OR 6.301 (95% CI: 4.369-9.087)]. For TBI, increased risk was seen above 15 cm crush [15-30 cm: OR 1.52 (95% CI: 1.045-2.21); >30 cm: OR 3.672 (95% CI: 2.456-5.490)]. For spine injury increased risk was seen above 8 cm crush [8-15 cm: OR 1.968 (95% CI 1.273-3.043); 15-30 cm: OR 2.530 (95% CI 1.634-3.917); > or =30 cm OR 2.682 (95% CI 1.474, 4.877). Results were similar across the different statistical models.

CONCLUSION

There is an association between the degree of roof crush and mortality, spine injury, and head injury in rollover crashes.