Maximum Abbreviated Injury Scale Score Research Articles

Changes in patterns of traumatic brain injury in the Michigan Trauma Quality Improvement Program database early in the COVID-19 pandemic.

The authors' objective was to investigate the impact of the global COVID-19 pandemic on hospital presentation and process of care for the treatment of traumatic brain injuries (TBIs). Improved understanding of these effects will inform sociopolitical and hospital policies in response to future pandemics. The Michigan Trauma Quality Improvement Program (MTQIP) database, which contains data from 36 level I and II trauma centers in Michigan and Minnesota, was queried to identify patients who sustained TBI on the basis of head/neck Abbreviated Injury Scale (AIS) codes during the periods of March 13 through July 2 of 2017-2019 (pre-COVID-19 period) and March 13, 2020, through July 2, 2020 (COVID-19 period). Analyses were performed to detect differences in incidence, patient characteristics, injury severity, and outcomes. There was an 18% decrease in the rate of encounters with TBI in the first 8 weeks (March 13 through May 7), followed by a 16% increase during the last 8 weeks (May 8 through July 2), of our COVID-19 period compared with the pre-COVID-19 period. Cumulatively, there was no difference in the rates of encounters with TBI between the COVID-19 and pre-COVID-19 periods. Severity of TBI, as measured with maximum AIS score for the head/neck region and Glasgow Coma Scale score, was also similar between periods. During the COVID-19 period, a greater proportion of patients with TBI presented more than a day after sustaining their injuries (p = 0.046). COVID-19 was also associated with a doubling in the decubitus ulcer rate from 1.0% to 2.1% (p = 0.002) and change in the distribution of discharge status (p = 0.01). Multivariable analysis showed no differences in odds of death/hospice discharge, intensive care unit stay of at least a day, or need for a ventilator for at least a day between the COVID-19 and pre-COVID-19 periods. During the early months of the COVID-19 pandemic, the number of patients who presented with TBI was initially lower than in the years 2017-2019 prior to the pandemic. However, there was a subsequent increase in the rate of encounters with TBI, resulting in overall similar rates of TBI between March 13 through July 2 during the COVID-19 period and during the pre-COVID-19 period. The COVID-19 cohort was also associated with negative impacts on time to presentation, rate of decubitus ulcers, and discharge with supervision. Policies in response to future pandemics must consider the resources necessary to care for patients with TBI.

Young adults in motor vehicle collisions in Norway: user safety errors observed in majority of cases with severe or fatal injuries

PurposeWe performed a multidisciplinary investigation of young adults involved in motor vehicle collisions (MVCs) to elucidate injury mechanisms and the role of passive safety equipment such as seat belts and airbags.MethodsMVCs resulting in death or serious injuries to the driver or passengers aged 16–24 years in southeastern Norway during 2013–2016 were investigated upon informed consent. We assessed the crash scene, the motor vehicle (MV) interior and exterior, and analyzed data from medical records, forensic autopsies and reports from police and civil road authorities.ResultsThis study included 229 young adult occupants involved in 212 MVCs. The Maximum Abbreviated Injury Scale (MAIS) score was ≥2 in 111 occupants, of which 22 were fatalities. In 59% (65/111) of the cases with MAIS score ≥2 injuries, safety errors and occupant protection inadequacies were considered to have contributed to the injury outcome. Common errors were seatbelt non-use and misuse, carrying insecure luggage, and the seat back being too reclined. MAIS score ≥2 head/neck injuries were observed in side impacts despite correct seatbelt use, related to older MVs lacking side airbag curtains. The independent risk factors for MAIS score ≥2 injuries included not using a seatbelt, driving under the influence of alcohol or drugs, nighttime driving, side impacts, heavy collision partner, and MV deformation.ConclusionUser safety errors (not using a seatbelt, seatbelt misuse, excessive seat-back reclining, and insecure cargo) and a lack of occupant protection in older MVs resulted in young adults sustaining severe or fatal injuries in MVCs.

A Case Report on a Patient Whose Road Traffic Injury Severity Was Determined by the MAIS (Maximum Abbreviated Injury Scale) Score

Abstract There are numerous definitions and classifications of severe trauma. Due to the observed heterogeneity in the existing definitions and the lack of a uniform definition of serious bodily injury, in January 2013 the High Level Group on Road Safety EU (HLGRS) published the definition of serious bodily injury in road traffic as a non-fatal injury with Maximum Abbreviated Injury Scale (MAIS) between 3 and 6, including the limit values. However, determining the MAIS score is not easy even for doctors with many years of experience. A female patient, injured as a pedestrian in a traffic accident, was examined prehospitally, and was transported to the hospital in the optimal golden hour from the time of the injury. The patient was intubated and mechanically ventilated in the Critical Care Resuscitation Unit. After the entire diagnostic procedure, diagnoses were made according to the ICD classification of diseases. During further examination, each code of the diagnosis of the disease was assigned an AIS code and the highest AIS score - AIS 5 was determined, which indicated that the patient was critically injured. Our patient's MAIS score was 5. After 39 days she was discharged from hospital. The neurological findings at discharge corresponded to left hemiparesis – ASIA D impairment grade. In conclusion, a novelty in the assessment of severe bodily injury is the introduction of the AIS/MAIS score. However, to avoid a subjective assessment of these scores, AIS dictionaries should be obtained for physicians, or a software solution should be developed to convert ICD-10 diagnoses into the AIS / MAIS injury scale.

Effect of injury location and severity on opioid use after trauma.

Recent data have suggested that persistent opioid use is prevalent following trauma. The effect of type of injury and total injury burden is not known. We sought to characterize the relationship between injury location and severity and risk of persistent opioid use. We investigated postdischarge opioid utilization among patients who were admitted for trauma between January 2010 and June 2017 using the Optum Clinformatics Database. New persistent opioid use (NPOU) was defined as one of the following scenarios: (1) two separate opioid prescription fills between 0 and 14 days postdischarge and having 1+ fills in the 91 to 180 days following discharge or (2) filling a prescription in the 15 to 90 days following discharge in addition to a filling in the 91 to 180 day postdischarge period. Multivariable logistic regression was used to assess the relationship between injury type and severity with new persistent opioid use development. A total of 26,437 opioid-naive patients were included in the analysis. Overall, 2,277 patients (8.6%) met the criteria for NPOU. After adjustment for confounding, NPOU was significantly more common for patients with injury to the extremities (adjusted odds ratio [aOR], 1.75; 95% confidence interval [CI], 1.57-1.94) or abdomen (adjusted odds ratio [aOR], 1.42; 95% CI, 1.22-1.64). Importantly, patients with maximum Abbreviated Injury Scale score of ≥2 for any body region had 1.49-fold odds of NPOU compared with patients with score of 1 (95% CI, 1.28-1.73), while no difference was seen across groupings of total injury burden based on Injury Severity Score. New persistent opioid use is common among patients suffering from trauma. In addition, patients suffering from extremity and abdominal injuries are at highest risk. Maximum individual region injury severity predicts development of new persistent use, whereas total injury severity does not. Prognostic and epidemiological, level III.

Case-control analysis of prehospital death and prolonged field care survival during recent US military combat operations.

Quantification of medical interventions administered during prolonged field care (PFC) is necessary to inform training and planning. Retrospective cohort study of Department of Defense Trauma Registry casualties with maximum Abbreviated Injury Scale (MAIS) score of 2 or greater and prehospital records during combat operations 2007 to 2015; US military nonsurvivors were linked to Armed Forces Medical Examiner System data. Medical interventions administered to survivors of 4 hours to 72 hours of PFC and nonsurvivors who died prehospital were compared by frequency-matching on mechanism (explosive, firearm, other), injury type (penetrating, blunt) and injured body regions with MAIS score of 3 or greater. Covariates for adjustment included age, sex, military Service, shock, Glasgow Coma Scale, transport team, MAIS and Injury Severity Score (ISS). Sensitivity analysis focused on US military subgroup with AIS/ISS assigned to nonsurvivors after autopsy. The total inception cohort included 16,202 casualties (5,269 US military, 10,809 non-US military), 64% Afghanistan, 36% Iraq. Of US military, 734 deaths occurred within 30 days, nearly 90% occurred within 4 hours of injury. There were 3,222 casualties (1,111 US military, 2,111 non-US military) documented for prehospital care and died prehospital (691) or survived 4 hours to 72 hours of PFC (2,531). Twenty-five percent (815/3,222) received advanced airway, 18% (583) ventilatory support, 9% (281) tourniquet. Twenty-three percent (725) received blood transfusions within 24 hours. Of the matched cohort (1,233 survivors, 490 nonsurvivors), differences were observed in care (survivors received more warming, intravenous fluids, sedation, mechanical ventilation, narcotics, antibiotics; nonsurvivors received more intubations, tourniquets, intraosseous fluids, cardiopulmonary resuscitation). Sensitivity analysis focused on US military (732 survivors, 379 nonsurvivors) showed no significant differences in prehospital interventions. Without autopsy information, the ISS of nonsurvivors significantly underestimated injury severity. Tourniquets, blood transfusion, airway, and ventilatory support are frequently required interventions for the seriously injured. Prolonged field care should direct resources, technology, and training to field technology for sustained resuscitation, airway, and breathing support in the austere environment. Prognostic, Level III.

Factors influencing the length of emergency room stay and hospital stay in non-fatal bicycle accidents: A retrospective analysis

PurposeLengthy hospitalization places a burden on patients and healthcare resources. However, the factors affecting the length of hospital stay (LHoS) and length of emergency room stay (LERS) in non-fatal bicycle accidents are currently unclear. We investigated these factors to inform efforts to minimize hospitalization. MethodsWe performed a retrospective analysis of data from non-fatal injured bicyclists admitted to the Emergency and Critical Care Center at Kyoto Medical Center between January 2012 and December 2016. We measured LHoS, LERS, mechanism of injury, head injury prevalence, polytrauma, operations performed, injury severity score (ISS), abbreviated injury scale (AIS) score, maximum AIS score, and trauma and injury severity score probability of survival. We conducted multiple regression analysis to determine predictors of LHoS and LERS. ResultsWithin the study period, 82 victims met the inclusion and exclusion criteria and were included. Mean age was (46.0 ± 24.7) years. Overall mean LHoS was (16.8 ± 25.2) days, mean LERS was (10.6 ± 14.7) days, median ISS was 9 (interquartile range (IQR): 3–16), median maximum AIS was 3 (IQR: 1–4), and median trauma and injury severity score probability of survival was 98.0% (IQR: 95.5%–99.6%). Age, maximum AIS, ISS, and prevalence of surgery were significantly greater in long LHoS and LERS group compared with short LHoS and LERS group (p < 0.05). Performance of surgery independently explained LHoS (p = 0.0003) and ISS independently explained LERS (p = 0.0009). ConclusionSurgery was associated with long hospital stays and ISS was associated with long emergency room stays. To improve the quality life of the bicyclists, preventive measures for reducing injury severity or avoiding injuries needing operation are required.

Factors influencing the long-term hospitalization of bicyclists and motorcyclists with oral and maxillofacial injuries.

Because bicyclists and motorcyclists with oral and maxillofacial injuries often suffer from disabilities requiring long-term treatment, reducing the severity of such injuries is a valuable objective for improving these people's quality of life (QOL). The aims of this study were, first, to present the prevalence and patterns of oral and maxillofacial injuries of bicyclists and motorcyclists and to compare the features of these injuries and, second, to determine the factors contributing to long-term hospitalization for these patients and to propose effective preventive measures. This was a single-center retrospective analysis. Hospital records from 2011 through 2018 were reviewed for all patients who had sustained oral and maxillofacial injuries in bicycle or motorcycle collisions and had presented at a university hospital which was the only hospital in the region attended 24hours per day by oral and maxillofacial surgeons. Characteristics of the oral and maxillofacial injuries, injury severity, and factors influencing the length of hospitalization were examined. Records of 130 patients (82 bicyclists and 48 motorcyclists) with a mean age of 28.0years were analyzed. Thirty-three patients (25.4%) had maxillofacial fractures, with 41 fracture lines while 103 patients (79.2%) had dental injuries and 57 patients (43.8%) had soft-tissue injuries. The distribution and prevalence of oral and maxillofacial injuries were similar for bicyclists and motorcyclists. However, motorcyclists had significantly higher Abbreviated Injury Scale (AIS) scores for facial injuries and the maximum AIS score than did bicyclists. According to a multiple regression analysis, the number of fracture lines and the requirement for intermaxillary fixation were independent factors influencing long-term hospitalization (standard regression coefficients: 6.795 and 6.715, respectively; P<.001). The number of fracture lines and the use of intermaxillary fixation were independent factors influencing long-term hospitalization of both bicyclists and motorcyclists with oral and maxillofacial injuries.

Serious Concomitant Injuries in Pediatric Patients with Severe Traumatic Brain Injury.

Severe traumatic brain injury (TBI) is a leading cause of death among children. Although several studies have reported the negative effects of concomitant injuries on mortality in adults with TBI, their effect on pediatric patients remains unclear. Our objective was to describe the effect of serious concomitant injuries on outcomes in pediatric patients with severe TBI. We identified pediatric patients (<18 years) with severe TBI between 2004 and 2015, through the Japan Trauma Data Bank. We excluded patients who had cardiopulmonary arrest on arrival and those whose main outcome (mortality) was missed from the analyses. Two groups with severe TBI were compared on the basis of the presence of serious concomitant injuries (maximum Abbreviated Injury Scale score ≥3 in regions other than the head) and adjusted for potential confounders using multiple logistic regression analysis. One-thousand-and-thirty-four participants were eligible for analysis, of which 472 had serious concomitant injuries. Pediatric patients with a serious concomitant injury had higher mortality. The probability difference was 11.5 (95% confidence interval [CI]: 6.1%-16.9%), which was greater than the mortality of 1.5 (95% CI: 1.2%-1.8%) observed in patients with a serious injury but not TBI. The presence of a serious concomitant injury was significantly associated with increased mortality, even after adjusting for possible confounders (adjusted odds ratio, 2.01; 95% CI, 1.40-2.89; P < 0.001). Serious concomitant injuries are associated with higher mortality in pediatric patients with severe TBI, as a direct consequence, as well as due to concomitant injuries potentiating TBI pathobiology.

Risk factors affecting injury severity determined by the MAIS score

ABSTRACTObjective: Traffic crashes result in a loss of life but also impact the quality of life and productivity of crash survivors. Given the importance of traffic crash outcomes, the issue has received attention from researchers and practitioners as well as government institutions, such as the European Commission (EC). Thus, to obtain detailed information on the injury type and severity of crash victims, hospital data have been proposed for use alongside police crash records. A new injury severity classification based on hospital data, called the maximum abbreviated injury scale (MAIS), was developed and recently adopted by the EC. This study provides an in-depth analysis of the factors that affect injury severity as classified by the MAIS score.Method: In this study, the MAIS score was derived from the International Classification of Diseases. The European Union adopted an MAIS score equal to or greater than 3 as the definition for a serious traffic crash injury. Gains are expected from using both police and hospital data because the injury severities of the victims are detailed by medical staff and the characteristics of the crash and the site of its occurrence are also provided. The data were obtained by linking police and hospital data sets from the Porto metropolitan area of Portugal over a 6-year period (2006–2011). A mixed logit model was used to understand the factors that contribute to the injury severity of traffic victims and to explore the impact of these factors on injury severity. A random parameter approach offers methodological flexibility to capture individual-specific heterogeneity. Additionally, to understand the importance of using a reliable injury severity scale, we compared MAIS with length of hospital stay (LHS), a classification used by several countries, including Portugal, to officially report injury severity. To do so, the same statistical technique was applied using the same variables to analyze their impact on the injury severity classified according to LHS.Results: This study showed the impact of variables, such as the presence of blood alcohol, the use of protection devices, the type of crash, and the site characteristics, on the injury severity classified according to the MAIS score. Additionally, the sex and age of the victims were analyzed as risk factors, showing that elderly and male road users are highly associated with MAIS 3+ injuries. The comparison between the marginal effects of the variables estimated by the MAIS and LHS models showed significant differences. In addition to the differences in the magnitude of impact of each variable, we found that the impact of the road environment variable was dependent on the injury severity classification.Conclusions: The differences in the effects of risk factors between the classifications highlight the importance of using a reliable classification of injury severity. Additionally, the relationship between LHS and MAIS levels is quite different among countries, supporting the previous conclusion that bias is expected in the assessment of risk factors if an injury severity classification other than MAIS is used.

Accidental falls related to clearing heavy snow on rooftops in a rural heavy snow area in Japan.

AimThe purpose of this study is to describe our experience with patients who fell from rooftops while clearing snow. The falls occurred in rural areas that receive heavy snowfall and are undergoing depopulation and an increasing proportion of elderly residents.MethodsA retrospective observational chart review was carried out at the sole hospital providing emergency services in a rural heavy snow area in Japan.ResultsA total of 70 patients were enrolled during four winter seasons between December 2009 and March 2013. Their mean age was 61 years, and 90% were male. The mean vertical height of falls was 4.1 m. A total of 174 injuries was observed, averaging 2.5 injuries per patient. Fractures accounted for 78% of all injuries, and main fractures included vertebra with lower extremities or rib fractures; 86% of patients sustained a maximum abbreviated injury scale score of 2–3.ConclusionsIn a rural heavy snow area in Japan, the incidence of accidental falls related to clearing snow was high, and the victims were elderly. Fractures accounted for 78% of all injuries, and most patients suffered from moderate to serious injuries.

Modeling road accident injury under-reporting in Europe

PurposeIn this research, a disaggregate analysis of road accident injury under-reporting in selected European countries is presented.MethodThe level of injury under-reporting is expressed by under-reporting coefficients, estimated as the actual estimated number of road accident injuries of a given severity to the number of related injuries recorded by the Police. These coefficients were calculated within national/regional studies in the examined countries, through a specially developed uniform methodology of linking and matching Police road accident records and hospital records. Log-rate models are developed in order to estimate the combined effects of country (CZ, FR, GR, HU, NL, ES and the UK), road user type (car occupant, motorcyclist, pedal cyclist, pedestrian), Police severity score (serious or slight injury) and MAIS score (the maximum Abbreviated Injury Scale score) on under-reporting.ResultsThe results suggest that the examined characteristics have important combined effect on under-reporting (i.e. third-order interaction). The results of the analysis of lower-order interactions reveal specific particularities of each country/region, indicating areas on which authorities should focus their efforts.ConclusionsFor example, it was found that slight injuries are more likely to be under-reported than serious injuries in the Czech Republic, France, and Greece, while the opposite is the case for the Netherlands and the UK. Moreover, although the Netherlands do not present high under-reporting rates overall, a particular issue is identified in this country for pedal cyclists’ slight injuries. Finally, a considerable part of total under-reporting in most countries can be attributed to injury severity mis-reporting.

A comparison of the Injury Severity Score and the Trauma Mortality Prediction Model

Performance benchmarking requires accurate measurement of injury severity. Despite its shortcomings, the Injury Severity Score (ISS) remains the industry standard 40 years after its creation. A new severity measure, the Trauma Mortality Prediction Model (TMPM), uses either the Abbreviated Injury Scale (AIS) or DRG International Classification of Diseases-9th Rev. (ICD-9) lexicons and may better quantify injury severity compared with ISS. We compared the performance of TMPM with ISS and other measures of injury severity in a single cohort of patients. We included 337,359 patient records with injuries reliably described in both the AIS and the ICD-9 lexicons from the National Trauma Data Bank. Five injury severity measures (ISS, maximum AIS score, New Injury Severity Score [NISS], ICD-9-Based Injury Severity Score [ICISS], TMPM) were computed using either the AIS or ICD-9 codes. These measures were compared for discrimination (area under the receiver operating characteristic curve), an estimate of proximity to a model that perfectly predicts the outcome (Akaike information criterion), and model calibration curves. TMPM demonstrated superior receiver operating characteristic curve, Akaike information criterion, and calibration using either the AIS or ICD-9 lexicons. Calibration plots demonstrate the monotonic characteristics of the TMPM models contrasted by the nonmonotonic features of the other prediction models. Severity measures were more accurate with the AIS lexicon rather than ICD-9. NISS proved superior to ISS in either lexicon. Since NISS is simpler to compute, it should replace ISS when a quick estimate of injury severity is required for AIS-coded injuries. Calibration curves suggest that the nonmonotonic nature of ISS may undermine its performance. TMPM demonstrated superior overall mortality prediction compared with all other models including ISS whether the AIS or ICD-9 lexicons were used. Because TMPM provides an absolute probability of death, it may allow clinicians to communicate more precisely with one another and with patients and families. Disagnostic study, level I; prognostic study, level II.

Incidence of posttraumatic stress disorder after traffic accidents in Germany.

Posttraumatic stress disorder (PTSD) is possibly an overlooked diagnosis of victims suffering from traffic accidents sustaining serious to severe injuries. This paper investigates the incidence of PTSD after traffic accidents in Germany. Data from an accident research unit were analyzed in regard to collision details, and preclinical and clinical data. Preclinical data included details on crash circumstances and estimated injury severity as well as data on victims' conditions (e.g. heart rate, blood pressure, consciousness, breath rate). Clinical data included initial assessment in the emergency department, radiographic diagnoses, and basic life parameters comparable to the preclinical data as well as follow-up data on the daily ward. Data were collected in the German-In-Depth Accident Research study, and included gender, type of accident (e.g. type of vehicle, road conditions, rural or urban area), mental disorder, and AIS (Abbreviated Injury Scale) head score. AIS represent a scoring system to measure the injury severity of traffic accident victims. A total 258 out of 32807 data sets were included in this analysis. Data on accident and victims was collected on scene by specialized teams following established algorithms. Besides higher AIS Head scores for male motorcyclists compared to all other subgroups, no significant correlation was found between the mean maximum AIS score and the occurrence of PTSD. Furthermore, there was no correlation between higher AIS head scores, gender, or involvement in road traffic accidents and PTSD. In our study the overall incidence of PTSD after road traffic accidents was very low (0.78% in a total of 32.807 collected data sets) when compared to other published studies. The reason for this very low incidence of PTSD in our patient sample could be seen in an underestimation of the psychophysiological impact of traffic accidents on patients. Patients suffering from direct experiences of traumatic events such as a traffic accident and presenting with signs of clinically significant distress or impairment in social interactions should be treated in a team approach including not only trauma surgeons and surgical skilled staff but also psychophysiological experienced physicians.

Assessing injury severity in bicyclists involved in traffic accidents to more effectively prevent fatal bicycle injuries in Japan

The objective of this study was to clarify the relationship between injury severity in bicyclists involved in traffic accidents and patient outcome or type of vehicle involved in order to propose effective measures to prevent fatal bicycle injuries. Hospital records were reviewed for all patients from 2007 to 2010 who had been involved in a traffic accident while riding a bicycle and were subsequently transferred to the Shock Trauma Center of Dokkyo Medical University Koshigaya Hospital. Patient outcomes and type of vehicle that caused the injury were examined. The mechanism of injury, Abbreviated Injury Scale (AIS) score, and Injury Severity Score (ISS) of the patient were determined. A total of 115 patients' records were reviewed. The mean patient age was 47.1 ± 27.4 years. The average ISS was 23.9, with an average maximum AIS (MAIS) score of 3.7. The ISS, MAIS score, head AIS score, and chest AIS score were well correlated with patient outcome. The head AIS score was significantly higher in patients who had died (mean of 4.4); however, the ISS, MAIS score, and head AIS score did not differ significantly according to the type of vehicle involved in the accident. The mean head AIS scores were as high as 2.4 or more for accidents involving any type of vehicle. This study provides useful information for forensic pathologists who suspect head injuries in bicyclists involved in traffic accidents. To effectively reduce bicyclist fatalities from traffic accidents, helmet use should be required for all bicyclists.

Delayed trauma team activation

The study aimed to characterize factors linked to delayed trauma team activation (DTTA) and to establish whether these delays are linked to worse outcomes. Registry data were analyzed in regard to DTTA for years 2008 to 2010 at a Level II trauma center. DTTA was defined as cases when a trauma team activation or trauma consult occurred more than 30 minutes after arrival at the emergency department in the presence of triaging criteria or clinical evidence of traumatic injury. Characteristics and outcomes were studied in relation to DTTA using contingency tables (χ test), Student's t tests, Wilcoxon statistics, and multivariate methods. DTTA occurred in 1.5% of the 9,525 patients and was significantly linked to age of 55 years or older, nonwhite ethnicity, blunt assault (i.e., struck with blunt object), Injury Severity Score of 16 or higher, Glasgow Coma Scale (GCS) score of 15, and head injury with maximum Abbreviated Injury Scale score of 3 or higher (MAIS3+). Firearm and motor vehicular injuries were significantly less common among those with DTTA. No link was found for sex, falls, stabbings, or blood alcohol concentration (BAC) of 80 mg/dL or more. Although mortality did not differ, hospital stay was longer, and discharge to rehabilitation was more common among those with DTTA. Multivariate models predicting DTTA revealed significant associations with age of more than 55 years (odds ratio [OR], 3.77 [2.54-5.53]), white ethnicity (OR, 0.47 [0.27-0.76]), blunt assault (OR, 3.42 [2.20-5.19]), and GCS score of 15 (OR, 4.48 [2.02-12.71]). Multivariate analyses did not reveal any association of DTTA with length of stay and mortality. DTTA occurs infrequently and is linked to older age, nonwhite ethnicity, blunt assaults, and normal GCS score. The higher rates of MAIS3+ head injuries with a maximum Abbreviated Injury Scale score of more than 3 among those with DTTA should encourage better recognition of those with these injuries. Prognostic study, level III.

Emergency Physicians’ Knowledge and Provision of Child Passenger Safety Information

While physicians provide discharge instructions to patients and families following emergency department (ED) visits, injury prevention information may not be routinely included in these instructions. This study assessed emergency physicians' knowledge and provision of child passenger safety (CPS) information to patients following motor vehicle crashes (MVCs). This study was both a survey of emergency physician knowledge and provision of CPS information and an examination of frequency of CPS information in discharge instructions at a single institution. Members of the American Academy of Pediatrics (AAP) Section on Emergency Medicine were invited to participate in the survey. Respondents were asked about their provision of CPS information to patients and knowledge of national AAP CPS recommendations. The institutional ED medical record chart review assessed the frequency of written CPS information for patients of MVC-related visits who were discharged home. There were 317 survey respondents from 1,024 eligible physicians, of whom 43 began but did not complete the survey. The data analyzed are from the 274 who completed the survey. While 85% (95% confidence interval [CI] = 81% to 89%) of physicians believed that CPS information should be included in discharge instructions, only 36% (95% CI = 31% to 42%) correctly answered all knowledge questions. Of the 51 self-identified division/department chiefs, 15 (29.4%; 95% CI = 16.9% to 41.9%) reported that their EDs routinely provide CPS information in discharge instructions for pediatric passengers in MVCs. For the medical record review, of the 152 randomly selected MVC visits, 13 (8.6%; 95% CI = 4.1% to 13.0%) had documented CPS information in the discharge instructions. Patients with documented CPS information were younger, but there were no significant differences in race, sex, or maximum abbreviated injury scale score between patients with versus without CPS information. While emergency physicians value the use of CPS information in discharge instructions following MVCs, they do not have adequate knowledge of, nor do they regularly disseminate, this information.

Crash costs by body part injured, fracture involvement, and threat-to-life severity, United States, 2000

This paper presents costs per US motor vehicle crash victim differentiated into many more diagnostic categories than prior estimates. These unit costs, which include the first keyed to the 1990 edition of Abbreviated Injury Scale (AIS) threat-to-life severity scores, are reported by body part, whether a fracture/dislocation was involved, and the maximum AIS score among the victim’s injuries. This level of detail allows for a more accurate estimation of the social costs of motor vehicle crashes. It also allows for reliable analyses of interventions targeting narrow ranges of injuries. The paper updates the medical care data underlying the US crash costs from 1979 to 1986 to the mid 1990s and improves on prior productivity cost estimates. In addition to presenting the latest generation of crash victim costs, this paper analyzes the effects of applying injury costs classified by AIS code from the 1985 edition to injury incidence data coded with the 1990 edition of AIS. This long-standing practice results in inaccurate cost-benefit analyses that typically overestimate benefits. This problem is more acute when old published costs adjusted for inflation are used rather than the recent costs.

Trauma Centers in a Managed Care Environment

Health care reform will affect the relationship of trauma centers to health maintenance organizations and other managed care plans. We studied Kaiser Permanente Medical Center (Kaiser) members admitted to the Trauma Center at San Francisco General Hospital (SFGH) to determine: (1) variables predicting transfer from SFGH to a Kaiser Hospital (repatriation), (2) the length of hospital stay (LOS), and (3) the cost of their care. The SFGH trauma registry provided data on 7,794 patients admitted before 1994. To investigate LOS, 89 Kaiser patients over 1 year were matched with non-Kaiser patients on age, maximum Abbreviated Injury Scale score (MAIS) by body region, Injury Severity Score (ISS), head injury severity, and blunt or penetrating injury and disposition. Kaiser patients were significantly younger, more likely to have blunt injury, and had a lower death rate. Significant predictors of repatriation were an MAIS score > or = 3, abdominal or extremity injury, and an ISS score of 26 to 40. The mean LOS for all Kaiser patients was 7.6 days, compared with 4.8 for controls (p = 0.20). However, mean LOS was significantly longer in repatriated Kaiser patients compared with controls (16 vs. 7.8 days, p < 0.0005). Kaiser reimbursement rates were comparable with commercial payors, but higher than others. A relatively small number of severely injured patients account for a large percentage of costly trauma care. Analyses of patient subsets are necessary for trauma centers to negotiate suitable relationships with managed care plans. A prospective study is needed to examine the cost efficiency of early transfer of managed care patients.