The Demographics of Non-motor Vehicle Associated Railway Injuries Seen at Trauma Centers in the United States 2007 - 2014.

Abstract

IntroductionThe majority of railway injury studies are limited by small sample size, restricted to a small geographical distribution, or located outside the United States (US). The aim of our study was to assess the demographic patterns associated with non-motor vehicle railway injuries in the US using a national trauma center database.Materials and MethodsData from the National Trauma Data Bank data from 2007 - 2014 were used; 3,506 patients were identified. For all statistical analyses, a p-value < 0.05 was considered significant.ResultsThe patients were 81% male with an average age of 38.6 + 17.1 years and an Injury Severity Score (ISS) of 16.8 + 13.8. Males compared to females were younger (37.7 vs 42.5 years, p = 0.000002), had greater length of stays (12.7 vs 9.8 days, p = 0.000006), and higher ISS scores (17.1 vs 15.4, p = 0.0007). The geographic distribution within the US was most common in the South (32.0%) and least in the Northeast (18.9%). The racial composition was 67.5% White, 19.1% Black, 11.5% Hispanic/Latino, and 1.9% others. The most common mechanisms of injury were hitting/colliding with rolling stock (38.6%), followed by a fall in or from a train (19.5%), and collision with an object (13.5%). The majority of patients were pedestrians or passengers (68.5%); employees accounted for 12.5%. Although the majority were pedestrian/passengers for all regions, the Midwest had a greater proportion of employees (22.0%) compared to the other regions (7.8% to 12.2%) (p < 10-6), and thus injuries were more commonly work-related (24.6% vs 6.7% - 13.7%, p < 10-6). Work-related injuries were less severe (ISS 11.2 vs 17.3 - p < 10-6) and more commonly occurred due to a fall (32.8% vs 17.9%, p < 10-6). Alcohol and/or drug involvement was present in 40.7% and was less in those with work-related injuries (2.2%). Overall mortality was 6.4% and was less in those having a work-related injury (2.0 vs 6.6% p = 0.000004). ConclusionFor non-motor vehicle USA railway injuries, the average age was 38.5 years; 80.6% were male. The injuries were least common in the Northeast and most common in the South. Racial distribution mirrored that of the US population. Alcohol involvement was present in 29%, lower than in previous studies. Mortality was 6.4%, also lower than previously reported.