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

doi:10.1016/j.resuscitation.2007.03.011

Resuscitation

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

https://doi.org/10.1016/j.resuscitation.2007.03.011 Get 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.

References (23)

S.A. Rowe et al.
Pelvic ring fractures: implications of vehicle design, crash type, and occupant characteristics
Surgery
(2004)
World report on road traffic injury prevention
(2004)
Kuratorium für Verkehrssicherheit, Institut für Unfallstatistik. Unfallstatistik 2004. Verkehr in Österreich; 2005....
P.L. Zador et al.
Automobile driver fatalities in frontal impacts: air bags compared with manual belts
Am J Public Health
(1993)
G.T. Loo et al.
Airbag protection versus compartment intrusion effect determines the pattern of injuries in multiple trauma motor vehicle crashes
J Trauma
(1996)
G. Regel et al.
Treatment results of patients with multiple trauma: an analysis of 3406 cases treated between 1972 and 1991 at a German Level I Trauma Center
J. Trauma
(1995)
M. Richter et al.
Correlation between crash severity, injury severity and clinical course in car occupants with thoracic trauma: a technical and medical study
J. Trauma
(2001)
G. Regel et al.
Prehospital care, importance of early intervention on outcome
Acta Anaesthesiol Scand Suppl
(1997)
D. Nast-Kolb et al.
Multiple organ failure still a major cause of morbidity but not mortality in blunt multiple trauma
J Trauma
(2001)
A. Biewener et al.
Impact of helicopter transport and hospital level on mortality of polytrauma patients
J Trauma
(2004)

P. Weninger et al.

Polytrauma and air rescue. A retrospective analysis of trauma care in eastern Austria exemplified by an urban trauma center

Unfallchirurg

(2005)

Cited by (35)

Primary Assessment of the Patient With Orbital Fractures Should Include Pupillary Response and Visual Acuity Changes to Detect Occult Major Ocular Injuries
2018, Journal of Oral and Maxillofacial Surgery
Citation Excerpt :
Our series did not show a significant correlation between MVAs and major ocular injuries, which is inconsistent with some previous studies.7-10 A possible explanation is that high-velocity MVAs are often associated with substantial morbidities and deaths.14 These patients were likely omitted from our study based on the exclusion criteria.
Sight-threatening injuries associated with orbital fractures are of major concern to maxillofacial surgeons whom are often the first asked to assess these patients. Eliciting signs and symptoms that are predictive of these injuries would allow expedited ophthalmic consultation and appropriate management. We hypothesized that abnormal pupillary response is predictive of major ocular injuries.
A retrospective cohort study of patients with facial fractures was instituted with review of all associated ophthalmic injuries. The primary predictor variables were the presence or absence of post-traumatic ocular symptoms and signs (visual acuity change, diplopia, flashes and floaters, pain on globe movement, abnormal pupillary response, restriction of eye movement, and visual field defects). Secondary predictors were pattern of fracture and mechanism of fracture. The primary outcome variable was the presence or absence of major ocular injury assessed during formal ophthalmology consultation. Descriptive statistics were calculated as categorical values. Correlation between the presence or absence of predictors and outcome (major ocular injury) was calculated using χ² analysis, with the significance value set at P ≤ .01.
The study included 75 patients (25% of whom were female patients) with a mean age of 41 ± 22 years. We recorded 165 minor ocular injuries and 43 major ocular injuries. The mechanisms of injury included assault (48%, n = 36), motor vehicle accident (21%, n = 16), fall (17%, n = 13), sport (11%, n = 8), and occupational (3%, n = 2). The fracture pattern included zygomaticomaxillary (36%, n = 27), isolated orbital floor (25%, n = 19), complex (20%, n = 15), and isolated orbital nonfloor (19%, n = 14). Of the primary outcome predictors, only abnormal pupillary response (odds ratio, 36; P < .001) and subjective visual acuity changes (odds ratio, 10; P < .001) were predictive of major ocular injury. The mechanism of injury and pattern of fracture were not predictive of major ocular injury.
During primary assessment of the patient with orbital fractures, abnormal pupillary response and subjective visual acuity changes are key predictors of occult major ocular injury.
Risk of serious injury of occupants involved in frontal crashes of cab-over-type trucks
2017, Traffic Injury Prevention
Objectives: Truck vehicles (TVs) have a different structure and stiffness than non-TVs and are used commercially for transporting goods. This study aimed to analyze whether truck occupants have a greater risk of serious injury than those of other types of vehicles.
Methods: Crash data were obtained from the Korean In-Depth Data Analysis Study (KIDAS) for calendar years 2011–2016. Vehicles involved in frontal crash were included and classified into TVs and non-TVs (passenger cars and sports utility vehicles). We compared the demographic characteristics and serious injuries by body region between the 2 groups and analyzed factors that contributed to the serious injury severity from frontal crashes.
Results: The analysis was based on 884 occupants; 177 (20.0%) were in TVs and 707 (80.0%) were in non-TVs. Non-TVs had more frontal airbags deployments than TVs (50.9% vs. 3.4%, P <.01). TV occupants were 4.8 times more likely to have a serious lower extremity (LE) injury (adjusted odds ratio [AOR] = 4.820; 95% confidence interval [CI], 2.407–9.653) and 2.5 times to have a serious abdominal injury (AOR = 2.465; 95% CI, 1.108–5.487) compared to non-TV occupants.
Conclusions: Truck occupants had more serious LE and abdominal injuries than those of other types of vehicles in frontal crashes. Structural improvement and legislative efforts to develop safety systems are necessary to improve the safety of truck occupants.
Analyzing the continuum of fatal crashes: A generalized ordered approach
2015, Analytic Methods in Accident Research
Citation Excerpt :
Higher speed, representing average driving speed, significantly increases the kinetic energy of crashes (Elvik, 2004; Sobhani et al., 2011) resulting in medical complications with multiple injuries and traumatic brain injury to the victims (Weninger and Hertz, 2007). Further, the cabin intrusion caused by high mechanical force of such crash might also increase the extrication time of victims from the damaged vehicle (Weninger and Hertz, 2007). Crashes at stop-sign controlled or other traffic controlled (such as warning sign, regulatory sign, railway crossing sign) intersections seem to increase the likelihood of early death relative to crashes at other locations, possibly suggesting non-compliance with these traffic control devices and judgment problems (Chipman, 2004; Retting et al., 2003).
In the United States, safety researchers have focused on examining fatal crashes (involving at least one fatally injured vehicle occupant) by using Fatality Analysis Reporting System (FARS) dataset. FARS database compiles crashes if at least one person involved in the crash dies within 30 consecutive days from the time of crash along with the exact timeline of the fatal occurrence. Previous studies using FARS dataset offer many useful insights on what factors affect crash related fatality, particularly in the context of fatal vs. non-fatal injury categorization. However, there is one aspect of fatal crashes that has received scarce attention in the traditional safety analysis. The studies that dichotomize crashes into fatal vs. non-fatal groups assume that all fatal crashes in the FARS dataset are similar. Keeping all else same, a fatal crash that results in an immediate fatality is clearly much more severe than another crash that leads to fatality after several days. Our study contributes to continuing research on fatal crashes. Specifically, rather than homogenizing all fatal crashes as the same, our study analyzes the fatal injury from a new perspective by examining fatality as a continuous spectrum based on survival time ranging from dying within 30 days of crash to dying instantly (as reported in the FARS data). The fatality continuum is represented as a discrete ordered dependent variable and analyzed using the mixed generalized ordered logit (MGOL) model. By doing so, we expect to provide a more accurate estimation of critical crash attributes that contribute to death. In modeling the discretized fatality timeline, the Emergency Medical Service (EMS) response time variable is an important determinant. However, it is possible that the EMS response time and fatality timeline are influenced by the same set of observed and unobserved factors, generating endogeneity in the outcome variable of interest. Hence, we propose to estimate a two equation model that comprises of a regression equation for EMS response time and MGOL for fatality continuum with residuals from the EMS model to correct for endogeneity bias on the effect of exogenous factors on the timeline of death. Such research attempts are useful in determining what factors affect the time between crash occurrence and time of death so that safety measures can be implemented to prolong survival. The model estimates are augmented by conducting elasticity analysis to highlight the important factors affecting time-to-death process.
Use of a structural deformity index as a predictor of severity among trauma victims in motor vehicle crashes
2012, Journal of Emergency Medicine
Citation Excerpt :
Newgard et al. found a correlation between deformity of the steering wheel after a collision and the severity in thoracic and abdominal injuries in both drivers and front seat passengers, and especially emphasized the importance of recording the state of the steering wheel by prehospital health care providers (24). More recently, Weninger and Hertz emphasized the importance of recording information regarding the scene of the crash, including the direction of impact, the deformity of the dashboard and the steering wheel, and intrusion into the compartments of the vehicle as predictive factors of severity of injury and mortality (25). All these studies reinforce the importance of the study of kinetics in vehicle crashes, but none of them provides an efficient tool like the SDI, which can be obtained in a simple, quick, and practical way at the scene of the crash.
Background: Information obtained from vehicle crash scenes, called kinematics, may prove useful in the management of victims and may complement anatomical and physiological findings. Objectives: In addition to analyzing the significance of age, gender, position occupied in the vehicle, the use of restraint systems, and ejection from the vehicle, the objective was to carry out a preliminary study of what we have defined as the Structural Deformity Index (SDI) to verify its usefulness in predicting injury severity at the scene of a motor vehicle crash. The index consists of various parameters that can be easily identified at the crash scene. Method: An historical cohort of vehicle occupants involved in crashes in the Navarra province of Spain from January 1, 2001 to December 31, 2002 was studied. Information was collected from the database of the Navarra Severe Trauma Victim group study. Bivariate statistical analysis and multivariate logistic regression models were employed for statistical management. Results: There were 212 vehicle occupants identified. Significant differences in severity of injury, and of mortality, were observed based on age, ejection from the vehicle, and a high SDI. Logistic regression showed significant differences in injury severity by age (odds ratio [OR] 6.55, 95% confidence interval [CI] 1.6–26.7) and high SDI (OR 1.84, 95% CI 1–3.3), as well as differences in the patient death rate by age (OR 6.92, 95% CI 1.2–38.9) and high SDI (OR 3.28, 95% CI 1.5–6.8). Conclusions: The SDI is useful to the first responders, enabling them to alert and transmit objective, reliable information to the emergency coordination center, thus efficiently activating health care resources. In addition, use of the SDI may assist prehospital and hospital health care providers to suspect the presence of particular serious injuries when anatomical and physiological criteria are not definitive.
When epidemiological databases inform injury mechanisms: biomechanical analysis of injury associations
2023, BMC Public Health
Forensic and forensic aspects of childhood traumatism as a result of domestic injuries and traffic accidents: A review
2023, Russian Journal of Forensic Medicine

View all citing articles on Scopus

^☆: 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.

^a: Tel.: +431 33110 700.

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

Summary

Introduction

Material and methods

Results

Conclusion

Introduction

Section snippets

Material and methods

Demographic data and injury patterns

Discussion

Conclusion

Conflict of interest statement

Surgery

World report on road traffic injury prevention

Automobile driver fatalities in frontal impacts: air bags compared with manual belts

Am J Public Health

Airbag protection versus compartment intrusion effect determines the pattern of injuries in multiple trauma motor vehicle crashes

J Trauma

Treatment results of patients with multiple trauma: an analysis of 3406 cases treated between 1972 and 1991 at a German Level I Trauma Center

J. Trauma

Correlation between crash severity, injury severity and clinical course in car occupants with thoracic trauma: a technical and medical study

J. Trauma

Prehospital care, importance of early intervention on outcome

Acta Anaesthesiol Scand Suppl

Multiple organ failure still a major cause of morbidity but not mortality in blunt multiple trauma

J Trauma

Impact of helicopter transport and hospital level on mortality of polytrauma patients

J Trauma

Polytrauma and air rescue. A retrospective analysis of trauma care in eastern Austria exemplified by an urban trauma center

Unfallchirurg

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