Motor Vehicle Collision Trauma Research Articles

Absence of July effect on trauma outcomes at the start of the academic medical calendar

Purpose The “July effect” refers to the phenomenon of a higher complication incidence and lower survival rate for patients treated at academic institutions during the beginning of the academic medical calendar. To date, no multi-center study has examined the presence of a “July effect” in a large cohort of trauma patients. We sought to determine if there is a by-month effect on survival and length of stay (LOS) for trauma patients in large academic centers. Methods We performed a multicenter, retrospective cohort study between 2010 and 2020 from five high-volume academic trauma centers in the United States. We included all adult motor vehicle collision (MVC) traumas evaluated at all centers in the study population (age >16 years, mechanism of injury classified as “motor vehicle collision”). Data included date and time of injury, injury severity score (ISS), LOS, and mortality. Each injury was classified as minor (ISS 1–8), moderate (9–15), severe (16–24), and very severe (>25). The mortality and LOS for each range over the entire epoch was calculated by month for each ISS classification. Results We analyzed 39,668 MVC traumas (mean age 41.83, range 39.9–43.3 among sites, 58.9% male and range 56.1–60.4%, 67.4% white range 42.3–84.7%). Survival for the “very severe” traumas ranged from 86.7–90.3%. Across the five sites, there was no significant change in survival (either increased or decreased mortality) or LOS for MVC patients in July or August for any injury classification level. Both age and ISS had a significant effect on survival (OR 0.02 for ISS >25, 0.22 for patients >65 years-old, both p < 0.05). Conclusions In five high-volume centers, there was no significant effect of the July transition on survival or LOS of MVC trauma patients.

552. Derivation and Validation of a Brief Emergency Department-Based Prediction Tool for Persistent Severe Pain After Motor Vehicle Collision Trauma Using Data From the AURORA Study

552. Derivation and Validation of a Brief Emergency Department-Based Prediction Tool for Persistent Severe Pain After Motor Vehicle Collision Trauma Using Data From the AURORA Study

Representation of patients with non-English language preferences in motor vehicle collision trauma and emergency medicine research

BackgroundIndividuals with non-English language preferences (NELP) represent a growing proportion of the USA population. Prior studies demonstrate disparate health outcomes related to NELP status; however, this patient population is often...

The surgical history of head injury in motor vehicle collision.

Motor vehicle collisions (MVCs) are a significant cause of head injuries today, but efforts to manage and prevent these injuries extend as far back as the beginning of modern neurosurgery itself. Head trauma in MVCs occurred as far back as 1899, and the surgical literature of the time mentions several cases of children being struck by passing automobiles. By the 1930s, Dr. Claire L. Straith, a Detroit plastic surgeon, recommended changes to automobile design after seeing facial injuries and depressed skull fractures that resulted from automobile accidents. During World War II, Sir Hugh Cairns, a British neurosurgeon, demonstrated the efficacy of motorcycle helmets in preventing serious head injury. In the 1950s, Dr. Frank H. Mayfield, a Cincinnati neurosurgeon on the trauma committee of the American College of Surgeons, made several recommendations, such as adding padded dashboards and seatbelts, to make automobiles safer. Ford implemented the recommendations from Dr. Mayfield and others into a safety package for the 1956 models. Significant work has also been done to prevent head injury in motorsports. Efforts by surgeons, especially neurosurgeons, to prevent head injury in MVCs have saved countless lives, although it is a less frequently celebrated achievement.

Polygenic risk scoring to assess genetic overlap and protective factors influencing posttraumatic stress, depression, and chronic pain after motor vehicle collision trauma

Posttraumatic stress (PTS), depressive symptoms (DS), and musculoskeletal pain (MSP) are common sequelae of trauma exposure. Although these adverse posttraumatic neuropsychiatric sequelae (APNS) are often studied separately, clinical comorbidity is high. In a cohort of European American motor vehicle collision (MVC) trauma survivors (n = 781), substantial PTS (≥33, IES-R), DS (≥26, CES-D), and MSP (≥4, 0–10 NRS) were identified via a 6-month survey. Genetic risk was estimated using polygenic risk scores (PRSs) calculated from the largest available GWAS datasets of PTSD, MDD, and back pain. We then assessed comorbidity and genetic risk influence for developing chronic PTS, DS, and MSP after MVC. Secondary analyses explored whether common social determinants of health ameliorate genetic vulnerability. We found that 6 months after MVC, nearly half 357/781 (46%) of the participants had substantial PTS, DS, and/or MSP, and overlap was common (PTS + MSP (23%), DS + MSP (18%), PTS + DS (12%)). Genetic risk predicted post-MVC outcomes. PTSD-PRSs predicted PTS and DS (R2 = 2.21% and 2.77%, padj < 0.01), MDD-PRSs predicted DS and MSP (R2 = 1.89%, padj < 0.01) and 0.79%, padj < 0.05), and back pain-PRS predicted MSP (R2 = 1.49%, padj < 0.01). Individuals in the highest quintile of PTSD-PRSs had 2.8 and 3.5 times the odds of developing PTS and DS vs. the lowest quintile (95% CI = 1.39–5.75 and 1.58–7.76). Among these high-risk individuals, those living in non-disadvantaged neighborhoods and with college education had 47% (p = 0.048) and 52% (p = 0.04) less risk of developing PTS, and those with high social support had 60% (p = 0.008) less risk of developing DS. Overall, genetic factors influence the risk of APNS after MVC, genetic risk of distinct APNS are overlapping, and specific social determinants greatly augment genetic risk of APNS development after MVC.

(208) 17b-Estradiol as a Predictor and Potential Mediator of Chronic Musculoskeletal Pain Development in Women following Trauma Exposure

Chronic musculoskeletal pain (MSP) is common following traumatic or stressful life events and is more common in women than men. However, female specific predictors and mediators of chronic posttraumatic MSP are poorly understood. In the current study we examined the relationship between circulating 17β-estradiol (E2) levels, RNA transcripts that E2 might influence, and chronic MSP development in women following traumatic motor vehicle collision (MVC) without fractures/tissue injury. Blood plasma and RNA was collected from individuals enrolled in the emergency department (ED) following MVC trauma and MSP severity (0-10NRS) was assessed 6 weeks 6 months and 1 year following MVC. E2 levels were measured via ELISA and RNA expression via RNA seq. The association between E2 levels and post-MVC chronic MSP development (n=95) and the association between E2, RNA expression, and post-MVC chronic MSP (n=41) was assessed using repeated measures mixed models adjusted for age and ED study site. Women with higher circulating levels of E2 at the time of trauma exposure reported less severe pain following MVC compared to women with lower circulating levels of E2 (0-10NRS at 1 year: 3.24 vs 5.05, p=0.008). RNA transcripts (p

Association between the seat belt sign and intra-abdominal injuries in children with blunt torso trauma in motor vehicle collisions.

The objective was to determine the association between the abdominal seat belt sign and intra-abdominal injuries (IAIs) in children presenting to emergency departments with blunt torso trauma after motor vehicle collisions (MVCs). This was a planned subgroup analysis of prospective data from a multicenter cohort study of children with blunt torso trauma after MVCs. Patient history and physical examination findings were documented before abdominal computed tomography (CT) or laparotomy. Seat belt sign was defined as a continuous area of erythema, ecchymosis, or abrasion across the abdomen secondary to a seat belt restraint. The relative risk (RR) of IAI with 95% confidence intervals (CIs) was calculated for children with seat belt signs compared to those without. The risk of IAI in those patients with seat belt sign who were without abdominal pain or tenderness, and with Glasgow Coma Scale (GCS) scores of 14 or 15, was also calculated. A total of 3,740 children with seat belt sign documentation after blunt torso trauma in MVCs were enrolled; 585 (16%) had seat belt signs. Among the 1,864 children undergoing definitive abdominal testing (CT, laparotomy/laparoscopy, or autopsy), IAIs were more common in patients with seat belt signs than those without (19% vs. 12%; RR = 1.6, 95% CI = 1.3 to 2.1). This difference was primarily due to a greater risk of gastrointestinal injuries (hollow viscous or associated mesentery) in those with seat belt signs (11% vs. 1%; RR = 9.4, 95% CI = 5.4 to 16.4). IAI was diagnosed in 11 of 194 patients (5.7%; 95% CI = 2.9% to 9.9%) with seat belt signs who did not have initial complaints of abdominal pain or tenderness and had GCS scores of 14 or 15. Patients with seat belt signs after MVCs are at greater risk of IAI than those without seat belt signs, predominately due to gastrointestinal injuries. Although IAIs are less common in alert patients with seat belt signs who do not have initial complaints of abdominal pain or tenderness, the risk of IAI is sufficient that additional evaluation such as observation, laboratory studies, and potentially abdominal CT scanning is generally necessary.

Geriatric Motor Vehicle Collision Survival: The Role of Institutional Trauma Volume

Links between trauma center volumes and outcomes have been inconsistent in previous studies. This study examines the role of institutional trauma volume parameters in geriatric motor vehicle collision (MVC) survival. The New York Statewide Planning and Research Cooperative Systems database was analyzed for all trauma admissions to state-designated Level I and II trauma centers from 1996 to 2003. For each center, the volume of patients was calculated in each of the following four categories: Young adult (age, 17-64 years) MVC and non-MVC, and geriatric (65 years and older) MVC and non-MVC. Logistic regression analysis was used to predict patient survival to hospital discharge based on the four volume parameters of the center at which they were treated, age, gender, ICISS, year of admission, and type of center. Five thousand three hundred sixty-five geriatric MVC victims were admitted to Level I (n = 3,541) or II (n = 1,824) centers in New York State excluding New York City. Four thousand eight hundred ninety-eight (91%) patients were discharged alive. Volume of geriatric MVC at the center at which the patient was treated was an independent significant predictor of survival (odds ratio, 32.6; 95% confidence interval, 2.8-377.0; p = 0.005) as were younger age, female gender, increased ICISS, and later year of discharge. Young adult non-MVC volume was an independent significant predictor of nonsurvival of geriatric patients (odds ratio, 0.8; 95% confidence interval, 0.64-0.99; p = 0.042). Type of center was unrelated to outcome. There may be a risk-adjusted survival advantage for geriatric MVC patients treated at trauma centers with relatively higher volumes of geriatric MVC trauma and lower volumes of young adult non-MVC trauma. These results support consideration of age in trauma center transfer criteria.

What’s new beyond Forensics?

Light TD, Royer NA, Zabell J, Le MB, Thomsen TA, Kealey GP, Alpen MA, Nashelsky MB. Autopsy after Traumatic Death: A Shifting Paradigm. J Surg Res 2009, online first, doi:10.1016/j.jss.2009.07.009. The authors performed a prospective, descriptive cohort study in order to analyze the frequency of incidental findings, which are under recognized and reported by trauma surgeons, and missed trauma diagnoses. Of 496 trauma deaths identified over a 4-year period, 229 were subjected to autopsy (46%), and 204 complete autopsies were available for review. Diagnoses from the autopsy reports were compared to abstracted medical records to identify injuries known ante mortem and confirmed by autopsy, injuries not known ante mortem and incidental autopsy findings. 74% of deaths were due to blunt force trauma in motor vehicle collisions or falls. Class 3 missed diagnoses (minor, would not have changed outcome if identified) were common (33%). Class 1 (major, would have changed outcome) and 2 (major, would not have changed outcome) missed diagnoses were identified in 21% of all cases and consisted of traumatic brain injury, spine fractures and skull fractures in moribund patients. In 14% of the cases, important incidental findings were reported at autopsy. These included infectious disease, severe premature atherosclerosis, neoplasms and others such as cardiomyopathy. The authors conclude that incidental autopsy findings might have implications for family members and public health, and that autopsies are a valuable tool to validate clinical diagnoses and reveal unknown diagnoses, and they contribute to the education of health professionals. Their results should be followed up as are the results of other procedures and should be communicated to the next of kin.

Safety Device Use Affects the Incidence Patterns of Facial Trauma in Motor Vehicle Collisions: An Analysis of the National Trauma Database from 2000 to 2004

Airbags and seat belts are designed to decrease injuries sustained in motor vehicle collisions. The authors hypothesize that the use of these devices has an effect on the patterns of facial fractures and facial lacerations. The records of 15,293 facial fracture patients and 114,623 facial laceration patients from motor vehicle collisions were analyzed from the National Trauma Database. Five hundred sixty-five patients were identified as having panfacial fractures. Fisher's exact test and chi-square analysis were used to study associations between safety devices and facial trauma. Panfacial fractures occurred in 3.7 percent of all patients sustaining facial fractures. In motor vehicle collisions resulting in facial fractures, 31.2 percent of patients had a seat belt, 5.6 percent had a seat belt and an airbag, 3.9 percent had an airbag only, and 59.3 percent had no safety device. The lack of a safety device in motor vehicle collisions increased the incidence of facial fractures (odds ratio, 2.26), panfacial fractures (odds ratio, 2.98), and facial lacerations (odds ratio, 1.95). Passengers with facial fractures were more likely to have not used a safety device (odds ratio, 1.69). Based on the largest reported series on motor vehicle collision-associated facial fractures in the United States, the use of airbags and seat belts is associated with a significantly decreased incidence of facial fractures and lacerations. Given that fewer than half of these patients used a safety device and the high morbidity and costs associated with these injuries, plastic surgeons should advocate for the increased use of these safety devices.

Fibromyalgia After Motor Vehicle Collision: Evidence and Implications

Objective:Assess currently available evidence regarding the ability of a motor vehicle collision (MVC) to trigger the development of fibromyalgia (FM). Methods:Consensus standards developed by the American College of Rheumatology Environmental Disease Study Group were used to assess the ability of an MVC to trigger FM. Results:Increasing evidence suggests that FM and related disorders are characterized by abnormalities in central nervous system function related to sensory processing, autonomic regulation, and neuroendocrine function. MVC trauma appears capable of triggering FM, but generally not through direct biomechanical injury. Instead, the evidence suggests that MVC trauma can act as a “stressor,” which in concert with other factors, such as an individual's biologic vulnerability, psychosocial factors, cultural factors, and so on, may result in the development of chronic widespread pain and other somatic symptoms. MVC trauma is only one of many stressors which can trigger such disorders, and the environment within which the stressor is experienced (biological and psychosocial) may largely determine whether there is an adverse physiologic result or not. Conclusions:The evidence that MVC trauma may trigger FM meets established criteria for determining causality, and has a number of important implications, both for patient care, and for research into the pathophysiology and treatment of these disorders.

The Association between Body Mass Index and Diaphragm Injury among Motor Vehicle Collision Occupants

Obese victims of blunt force trauma have poor outcomes, often related to an increased incidence of missed injuries. Our purpose was to determine whether patients with an increased body mass index (BMI) who sustain blunt trauma in motor vehicle collisions (MVCs) have an increased risk of diaphragmatic injury, an injury often associated with diagnostic delay. The National Automotive Sampling System was used to identify front seat occupants involved in MVCs from 1995 to 2001. BMI was determined for all subjects, and diaphragmatic injury was the outcome of interest. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated to quantify the association between occupant BMI and DI. When analyzed as an independent risk factor, for all collision types, a BMI >/= 25 was not significantly associated with diaphragmatic injury (RR, 1.25; 95% CI, 0.71-2.20). However, when considering only near-side MVCs, a significant twofold increased risk was observed (RR, 2.03; 95% CI, 1.39-2.96), whereas no association for occupants involved in frontal collisions was observed (RR, 1.05; 95% CI, 0.30-3.74). An elevated BMI appears to be associated with an increased risk of diaphragmatic injury in patients involved in near-side MVCs. This association provides insight as to the cause of diaphragmatic injury and may aid clinicians in detecting these often occult injuries.

Influence of Restraining Devices on Patterns of Pediatric Facial Trauma in Motor Vehicle Collisions

In the Commonwealth of Pennsylvania, it is required that all children under the age of 4 years be restrained by an infant seat or car seat appropriate for their age and weight. Furthermore, all individuals riding in the front seat must be restrained by a seatbelt. This study examined the relationship between patterns of facial injuries and the use of restraining devices in the pediatric population. A retrospective analysis was performed on motor vehicle collision data submitted to the Pennsylvania Trauma Outcome Study database from 1990 through 1995. Criteria for submission included trauma patients who were admitted to the Intensive Care Unit, those who died during hospitalization, those who were hospitalized for more than 72 hours, or those who were transferred in or out of the receiving hospital. A subset of 412 pediatric patients, 15 years of age or younger, was analyzed for patterns of facial injury and the presence or absence of restraining devices. Restraining devices were categorized as a car seat or a seatbelt. Statistical analysis was performed using chi-square and Fisher's exact tests. Of the 412 pediatric patients, only 17 children were restrained with a car seat and 121 were wearing a seatbelt. A total of 30 children sustained facial fractures, and 50 children suffered facial lacerations. There was a statistically significant increase in the incidence of facial fractures with increasing age of the child (p < 0.001). Of children with facial fractures, 70 percent of those 5 to 12 years old and 90 percent of those 13 to 15 years old were unrestrained (p = 0.166). In conclusion, despite legislation mandating the use of restraints, a large proportion of children involved in motor vehicle collisions were unrestrained. Furthermore, there seems to be a direct relationship between the age of a child and the incidence of facial fractures sustained in motor vehicle collisions.

The influence of airbag and restraining devices on the patterns of facial trauma in motor vehicle collisions.

According to the National Highway Traffic Safety Administration (1990), there were more than 3 million motor vehicle collisions severe enough to lead to significant injury or fatality. Airbags may prevent brain and facial injury caused by these accidents. To date, however, no study has focused primarily on the correlation between facial injuries and the use of airbags and restraining devices. A retrospective analysis was performed on motor vehicle collision data submitted to the Pennsylvania Trauma Outcome Study database from 1990 through 1995. Criteria for submission to the database included admission to the intensive care unit, death during hospitalization, hospitalization for >72 hours, or transfer to or from the receiving hospital. There were 15,450 patients who sustained facial trauma (identified by ICD-9 codes) and were analyzed for patterns of injury and the presence or absence of protective devices. Protective devices were categorized into four groups: airbag alone, airbag with seatbelt, seatbelt or car seat without airbag, and no restraining devices. Statistical analysis was performed using chi-squared test of association. For contingency tables with small expected frequencies, Fisher's exact test was used. There were 9408 male and 6042 female subjects, with a mean age of 38 years (range, 3 to 98 years). There were 11,672 drivers and 3778 passengers. Airbags were deployed in 429 instances. In 276 of these cases, additional restraint was provided with a seatbelt. Airbags were not deployed in 4866 cases when a seatbelt or a car seat was used. In 10,155 cases, no restraining device was employed. There was significantly more facial trauma in patients without protective devices (p < 0.001). Drivers sustained significantly fewer facial fractures when airbags were used, either alone or in combination with a seatbelt (p < 0.001); however, there was no difference in the number of facial lacerations. Among passengers, airbags provided protection from lacerations (p < 0.001) but had no impact on the incidence of facial fractures. In collisions in which airbags were deployed, the use of a seatbelt provided no additional protection from facial fractures or lacerations. In summary, the use of any protective device decreased the incidence of facial fractures and lacerations sustained in motor vehicle collisions (p < 0.001). Airbags provided the best protection of all currently available devices.

Upper Cervical Trauma in Motor Vehicle Collisions

Motor vehicle collisions can cause a variety of injuries in pedestrians and vehicle occupants. Fatal and nonfatal trauma to the upper cervical spine, that is, atlanto-occipital junction, atlas and axis, can be part of this spectrum. Certain distinctive injuries (for example, "hangman's fracture") which occur result from the unique anatomic structure of this area and the various disruptive forces such as extension, distraction (tension), compression (axial loading), shear, and inertia generated during collision. Correlation of autopsy findings or radiological information of these cervical injuries or both with scene investigation can be informative not only in the determination of morbidity and mortality, but also in the assessment of injury mechanisms and improvements in occupant protection.