Elsevier

Resuscitation

Volume 75, Issue 1, October 2007, Pages 35-41
Resuscitation

Clinical paper
Factors influencing the injury pattern and injury severity after high speed motor vehicle accident—A retrospective study

https://doi.org/10.1016/j.resuscitation.2007.03.011Get rights and content

Summary

Introduction

Motor vehicular accidents (MVA) are the leading cause of death among people under 40 years of age. Despite improvement in car safety and driver awareness of the use of safety devices, fatalities and severe injuries continue to occur.

Material and methods

From 1997 to 2004, 13,678 patients after MVA were admitted to our institution. Out of this cohort, 584 (4.3%) patients suffered blunt major trauma defined as Injury Severity Score (ISS) ≥16 and at least one life-threatening injury in one body region. Preclinical data were recorded in 458 patients matching the inclusion criteria. The circumstances of the trauma scene such as weather conditions were analysed as well as technical crash data such as direction of impact, security devices used and type and severity of automobile damage. In a retrospective trial, the influence of preclinical variables on the injury pattern and on injury severity was investigated.

Results

314 (68.6%) patients were male and 144 (31.4%) female. Injury severity (p = 0.015) and rate of multiple injuries (p = 0.012) were higher in patients after side-impact crashes. If automobiles with SIPS were used, injury severity was significantly reduced in case of side-impact crashes (p = 0.003). Patients after frontal impact crashes had a higher rate of severe traumatic brain injury (TBI) compared to the overall cohort (p = 0.014). Patients suffering blunt aortic (n = 29) dissection were involved in frontal crashes with seat belt use (p < 0.001). If patients were entrapped, injury severity (p = 0.021) and rate of multiple injuries (p = 0.018) were significantly higher. Rear-end collisions with trucks without rear protection led to higher mortality rates (p = 0.011).

Conclusion

According to our data significant association between technical crash data and injury pattern and injury severity can be assumed. In case of high speed MVA in rural areas the trauma mechanism and the circumstances (i.e., impact direction, automobile deformation) should be considered to identify patients at high risk of severe blunt trauma and multiple injuries.

Introduction

Motor vehicular accidents (MVA) are the leading cause of death among people under 40 years of age. Worldwide, about 1.2 million people are killed in MVA crashes every year.1 As demonstrated in the Austrian road safety report of 2004, 480 people died in more than 35,600 MVA crashes. 35,500 people were injured and 3200 patients suffered severe injuries and had to be treated in hospital.2 The majority of the fatal crashes were observed in rural areas and after high speed driving. Despite an improvement in car safety and awareness of drivers regarding the use of safety devices fatalities and severe injuries still occur.3, 4 Though an increasing number of MVAs are reported, the number of deaths has been reduced markedly over the last three decades.5 Improvement of preclinical and clinical diagnostic and therapeutic options lead to a reduction of trauma deaths after MVA.6 Nevertheless, trauma is one of the most common factors leading to disability and reduction of productive years in a population. As demonstrated in recent studies, the outcome of multiple injured patients correlates with the treatment in the initial phase.7, 8, 9, 10, 11 The principle of the so called “golden hour” has gained wide acceptance after the investigations of Cowley et al. who described the first hour after trauma as the most important phase in trauma care.12 Complications, if they occur within the first hour after trauma may cause a trauma victim to decompensate extremely rapidly but prompt and coordinated medical treatment just after an injury may lead to good outcome even in severely injured patients. Therefore, the lag time between injury and treatment should ideally be kept to a minimum. As postulated by Trunkey and Blaisdell who summarised the principle of the golden hour, “the right trauma patient should get to the right hospital at the right time”.13 After introduction of sophisticated preclinical trauma care and after installations of emergency medical service (EMS) systems, it was possible to treat severely injured victims at the scene and to provide fast transport to a trauma centre. Therefore, identification of patients with blunt major trauma is of great relevance for determining management, destination and use of EMS resources. The suspected tracer diagnosis “blunt major trauma” should be an indication for transport to a trauma centre with maximum treatment. Besides physiological and anatomical criteria, consideration of mechanism of injury might play a role in prehospital triage of trauma patients. In the present study, we tried to identify factors predicting blunt major trauma after a high speed MVA. We postulated the null hypothesis that there is no association between the trauma conditions and automobile crash data and the injury pattern and injury severity. To our knowledge only a few recent studies reported the association of prehospital triage criteria to injury pattern and severity of injury after MVA.14, 15, 16

Section snippets

Material and methods

The Trauma Hospital “Lorenz Boehler”, a 130-bed facility founded in 1926, is one of the oldest free-standing trauma hospitals in the world. Annually, more than 60,000 patients are seen, and more than 6000 are admitted. More than 97% of all patients admitted with major injuries suffer blunt trauma. Due to the fact that all cases of major trauma are treated by emergency physicians in the field almost all patients arrive monitored with an intravenous line in place. More serious cases arrive

Demographic data and injury patterns

314 (68.6%) patients were male. The mean age of our study population was 26.4 years (15–86 years) and the mean ISS was 28.3. The distribution of injuries in our patients is demonstrated in Table 2. As demonstrated, severe traumatic brain injuries (TBI) were diagnosed as dominating injury in the most cases (66.0%), followed by severe thoracic trauma (55.5%) and abdominal injuries (42.1%). 27.7% of the patients had spinal injuries. 70.1% (n = 325) of the patients had at least one long-bone

Discussion

Although a considerable increase of automobile accidents and related crash injuries was recorded in the 1950s, 60s and 70s, a comparable reduction could be observed in more recent years.1, 2 This development might be related to federal laws for seat belt use, anti-speeding law, a restrictive alcohol policy and an improvement of prehospital emergency care. Richter et al. demonstrated a significant reduction of injury severity caused by improvements in car safety.18 As demonstrated with our data,

Conclusion

In conclusion it became evident that different injury patterns and injury severity in patients after MVA seem to be influenced by automobile crash data. The incidence and severity of thoracic injuries seem to be associated with the use of protection devices. As a consequence, the importance of the mechanism of injury and the role it plays for patterns of injuries and their severity should be considered. In the prehospital setting, consideration of the trauma mechanism and automobile crash data

Conflict of interest statement

The authors have had no financial interests.

There was no cooperation with industry and no financial support.

The study was approved by our institutional review board. However, since no interventions were done, informed consent was not required.

There authors have no conflict of interest related to this work.

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    A Spanish translated version of the summary of this article appears as Appendix in the final online version at 10.1016/j.resuscitation.2007.03.011.

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