Motor Vehicle Crash Patients Research Articles

Assessing trauma center accessibility in the Southeastern region of the U.S. to improve healthcare efficacy using an anti-covering approach.

Accessibility to trauma centers is vital for the patients of severe motor vehicle crashes. Many vehicle crash fatalities failed to reach the proper emergency medical services since the accident location was far away from trauma centers. The spatial discordance between the service coverage area of trauma centers and actual locations of motor vehicle accidents delays the definitive medical care and results in death or disability. Many fatalities would have been prevented if the patients had a chance to get proper treatment in time at Southeastern region of the U.S. Also, the accessibility to trauma centers from the actual locations of motor vehicle accidents is different in the Southeastern region. This research aimed to facilitate the accessibility to trauma centers for severe motor vehicle crash patients in the Southeastern region. The analyses are conducted to assess current trauma center accessibility and suggest the optimal locations of future trauma centers using the Anti-covering location model for trauma centers (TraCt model). This study found that existing trauma centers failed to serve many demands, and the actual coverages of the current locations of trauma centers over potential demands are highly different in each Southeastern state. TraCt model is applied to each Southeastern state, and its solutions provide better coverage for demand locations. However, the TraCt model for each state tends to choose too many facilities, with excessively supplied facilities across the Southeastern region. The excessive service supply issue is addressed by applying the TraCt Model to a broader spatial extent. TraCt model applied to the entire Southeastern region and most of the demand, over 98% covered by the service coverage of optimal facility locations with 15 additional facilities. This research proves that the GIS and TraCt model applied to the broader spatial extent works well with increasing trauma medical service beneficiaries while providing a minimum number of additional facilities.

The prevalence of long-term rehabilitation following motor-vehicle crashes in Saudi Arabia: a multicenter study

IntroductionIn Saudi Arabia, motor-vehicle crashes (MVC) are the leading cause of disability-adjusted life years (DALYs). There is limited information locally on the magnitude and need for rehabilitation following MVC. This study examined the prevalence of MVC patients requiring long-term rehabilitation and the epidemiology of associated injuries.MethodsA retrospective study was conducted at four hospitals of the National Guard Hospitals Affairs from January 2016 to March 2019. The study used data from an institutional trauma registry of all MVC admissions. Chi-square tests, bivariate and multivariate analyses were conducted to compare patients requiring long-term and short-term rehabilitation.ResultsThe study included 506 patients. The study population was relatively young, with an average age was 32.8 ± 15.5 years, and the majority were males. Over two-thirds (71.3%) of patients required long-term rehabilitation. Half the patients sustained multiple fractures, and 17.0% sustained traumatic brain injuries. Overall, 53.1 and 61.8% of patients required occupational and physiotherapy, respectively. Those admitted to the intensive care unit were four times more likely to need long-term rehabilitation.ConclusionsWe found a significant burden of long-term rehabilitation following MVC. Patients were relatively young, thus posing a significant burden on future healthcare utilization. Policymakers should use these findings to guide primary, secondary, and tertiary prevention to improve health outcomes.

The Safety of Benzodiazepines and Opioids in the Geriatric Population: An Analysis of Patient Safety Events Reported by Hospitals and Ambulatory Surgical Facilities

Benzodiazepines may increase the risk of cognitive impairment, delirium, falls, fractures, and motor vehicle crashes in patients 65 years and older. The concomitant use of benzodiazepines and opioids may also be inappropriate for older adults due to the increased risk of overdose. We searched the Pennsylvania Patient Safety Reporting System (PA-PSRS) for reports of patient safety events related to the concomitant use of benzodiazepines and opioids in older adults in order to gain a better understanding of the potential risks of using these medications in combination. We identified 80 reports in which a patient may have experienced an adverse drug reaction (ADR) to the combined use of a benzodiazepine and an opioid pain medication. Reports were reviewed to determine the ADR(s) experienced by the patient. Changes in mental status were most common, occurring in more than two-thirds of reports (68.8%; 55 of 80), followed by respiratory reactions (51.3%; 41 of 80) and cardiovascular reactions (25.0%; 20 of 80). In over two-thirds of reports (70.0%; 56 of 80), the patient received a reversal agent, either flumazenil (10.7%; 6 of 56) or naloxone (35.7%; 20 of 56), or both (53.6%; 30 of 56). The inappropriate use of benzodiazepines and opioid pain medications in combination among patients 65 years and older is a growing problem, and an increased awareness may be the first step for providers to begin addressing it.

Motor vehicle crashes in pregnancy: Maternal and fetal outcomes.

Motor vehicle crashes (MVCs) are a leading cause of death in pregnant women. Even after minor trauma, there is risk of fetal complications. The purpose of this study was to compare injuries and outcomes in pregnant with matched nonpregnant women after MVC and evaluate the incidence and type of pregnancy-related complications. Retrospective study at a Level I trauma center included pregnant MVC patients, admitted 2009 to 2019. Pregnant patients were matched for age, seatbelt use, and airbag deployment with nonpregnant women (1:3). Gestation-related complications included uterine contractions, vaginal bleeding, emergency delivery, and fetal loss. During the study period, there were 6,930 MVC female admissions. One hundred forty-five (2%) were pregnant, matched with 387 nonpregnant. The seat belt use (71% in nonpregnant vs. 73% in pregnant, p = 0.495) and airbag deployment (10% vs. 6%, p = 0.098) were similar in both groups. Nonpregnant women had higher Injury Severity Score (4 vs. 1, p < 0.0001) and abdominal Abbreviated Injury Scale (2 vs. 1, p < 0.001), but a smaller proportion sustained abdominal injury (18% vs. 53%, p < 0.0001). Mortality (1% vs. 0.7%, p = 0.722), need for emergency operation (6% vs. 3%, p = 0.295) or angiointervention (0.3% vs. 0%, p = 0.540), ventilator days (3 vs. 8, p = 0.907), and intensive care unit (4 vs. 4, p = 0.502) and hospital length of stay (2 vs. 2, p = 0.122) were all similar. Overall, 13 (11.1%) patients developed gestation-related complications, most commonly uterine contractions (6.3%), need for emergency delivery (3.5%), and vaginal bleeding (1.4%). Most pregnant patients hospitalized for MVC suffered minor injuries. Pregnant women had lower Injury Severity Score and abdominal Abbreviated Injury Scale than matched nonpregnant women. However, there was still a considerable incidence of gestation-related complications. It is imperative that pregnant patients be closely monitored even after minor trauma. Prognostic and epidemiological, level III.

Injury Severity of Ambulatory Patients Following Motor Vehicle Crash.

On-scene ambulatory status following a motor vehicle crash (MVC) serves as an informal marker of physiologic stability. The influence of ambulatory status after an MVC on trauma team activation and injury severity is infrequently studied, yet may alter the clinician's index of suspicion for injury. The purpose of this study is to describe the injury burden of ambulatory on-scene patients following an MVC. This is a prospective descriptive study of MVC patients arriving by emergency medical services (EMS), with trauma team activation, to a Midwestern Level I trauma center from July through December 2018. The EMS records were reviewed for wording that indicated the patient's ambulatory status following an MVC. Those denoted as "ambulatory on-scene" were included in this study. Of this subset, Injury Severity Score (ISS), hospital admission status, safety mechanisms utilized, crash scene description, and demographics were collected. A total of 648 MVC patients with trauma activations were reviewed, of which 308 met criteria for study inclusion. The average ISS was 2.8, with a range of 0 to 30. The cohort was 51.3% male, with a hospital admission rate of 25.9%. Of the 308 trauma activations, six were total, and 302 were partial. This study of MVC patients with documented on-scene ambulation found that, although the average ISS was low, injuries and hospital admission were present in up to one-quarter of patients. Ambulatory status following an MVC while informative should not be used as a triage mechanism.

Motor Vehicle Crashes in Pregnancy: Maternal and Fetal Outcomes

BACKGROUND Motor vehicle crashes (MVCs) are a leading cause of death in pregnant women. Even after minor trauma, there is risk of fetal complications. The purpose of this study was to compare injuries and outcomes in pregnant with matched nonpregnant women after MVC and evaluate the incidence and type of pregnancy-related complications. METHODS Retrospective study at a Level I trauma center included pregnant MVC patients, admitted 2009 to 2019. Pregnant patients were matched for age, seatbelt use, and airbag deployment with nonpregnant women (1:3). Gestation-related complications included uterine contractions, vaginal bleeding, emergency delivery, and fetal loss. RESULTS During the study period, there were 6,930 MVC female admissions. One hundred forty-five (2%) were pregnant, matched with 387 nonpregnant. The seat belt use (71% in nonpregnant vs. 73% in pregnant, p = 0.495) and airbag deployment (10% vs. 6%, p = 0.098) were similar in both groups. Nonpregnant women had higher Injury Severity Score (4 vs. 1, p < 0.0001) and abdominal Abbreviated Injury Scale (2 vs. 1, p < 0.001), but a smaller proportion sustained abdominal injury (18% vs. 53%, p < 0.0001). Mortality (1% vs. 0.7%, p = 0.722), need for emergency operation (6% vs. 3%, p = 0.295) or angiointervention (0.3% vs. 0%, p = 0.540), ventilator days (3 vs. 8, p = 0.907), and intensive care unit (4 vs. 4, p = 0.502) and hospital length of stay (2 vs. 2, p = 0.122) were all similar. Overall, 13 (11.1%) patients developed gestation-related complications, most commonly uterine contractions (6.3%), need for emergency delivery (3.5%), and vaginal bleeding (1.4%). CONCLUSION Most pregnant patients hospitalized for MVC suffered minor injuries. Pregnant women had lower Injury Severity Score and abdominal Abbreviated Injury Scale than matched nonpregnant women. However, there was still a considerable incidence of gestation-related complications. It is imperative that pregnant patients be closely monitored even after minor trauma. LEVEL OF EVIDENCE Prognostic and epidemiological, level III.

Motor Vehicle Crash Characteristics That Are Predictive of High Acuity Patients: An Analysis of Linked Ambulance and Crash Data

Background Motor vehicle crashes (MVCs) comprise a significant component of emergency medical service workload. Due to the potential for life-threatening injuries, ambulances are often dispatched at the highest priority to MVCs. However, previous research has shown that only a small proportion of high-priority ambulance responses to MVCs encounter high acuity patients. Alternative methods for triaging patients over the phone are required to reduce the burden of over-triage. One method is to use information readily available at the scene (e.g. whether a person was a motorcyclist, ejection status or whether an airbag deployed) as potential predictors of high acuity. Methods: A retrospective cohort study was conducted of all MVC patients in Perth attended by St John Western Australia between 2014 and 2016. Ambulance data was linked with Police crash data. The outcome variable of interest was patient acuity, where high acuity was defined as where a patient (1) died on-scene or (2) was transported by ambulance on priority one (lights & sirens) from the scene to hospital. Crash characteristics that are predictive of high acuity patients were identified by estimating crude odds ratios and 95% confidence intervals. Results: Of the 18,917 MVC patients attended by SJ-WA paramedics, 6.4% were classified as high acuity patients. The odds of being a high acuity patient was greater for vulnerable road users (motorcyclists, pedestrians and cyclists) than for motor vehicle occupants (OR 3.19, 95% CI, 2.80–3.64). A ‘not ambulant patient’ (one identified by paramedics as unable to walk or having an injury incompatible with being able to walk) had 15 times the odds of being high acuity than ambulant patients (OR 15.34, 95% CI, 11.48–20.49). Those who were trapped in a vehicle compared to those not trapped (OR 4.68, 95% CI, 3.95–5.54); and those who were ejected (both partial and full) from the vehicle compared to those not ejected (OR 6.49, 95% CI, 4.62–9.12) had higher odds of being high acuity patients. Discussion: There were two important findings from this study: (1) few MVC patients were deemed to be high acuity; and (2) several crash scene characteristics were strong predictors of high acuity patients.

Patient-reported Outcomes at 6 to 12 Months Among Survivors of Firearm Injury in the United States.

Assess outcomes in survivors of firearm injuries after 6 to 12 months and compared them with a similarly injured trauma population. For every individual in the United States who died of a firearm injury in 2017, three survived, living with the burden of their injury. Current firearm research largely focuses on mortality and short-term health outcomes, while neglecting the long-term consequences. We contacted adult patients with a moderate-to-severe injury from a firearm or motor vehicle crash (MVC) treated at 3 level I trauma centers in Boston between 2015 and 2018. Patients were contacted 6 to 12 months postinjury to measure: presence of daily pain; screening for post-traumatic stress disorder (PTSD); new functional limitations; return to work; and physical and mental health-related quality of life. We matched each firearm injury patient to MVC patients using Coarsened Exact Matching. Adjusted Generalized Linear Models were used to compare matched patients. Of 177 eligible firearm injury survivors, 100 were successfully contacted and 63 completed the study. Among them, 67.7% reported daily pain, 53.2% screened positive for PTSD, 38.7% reported a new functional limitation in an activity of daily living, and 59.1% have not returned to work. Compared with population norms, overall physical and mental health-related quality of life was significantly reduced among firearm injury survivors. Compared with matched MVC survivors (n = 255), firearm injury survivors were significantly more likely to have daily pain [adjusted odds ratio (OR) 2.30, 95% confidence interval (CI) 1.08-4.87], to screen positive for PTSD (adjusted OR 3.06, 95% CI 1.42-6.58), and had significantly worse physical and mental health-related quality of life. This study highlights the need for targeted long-term follow-up care, physical rehabilitation, mental health screening, and interventions for survivors of firearm violence.

Association between seatbelt sign and internal injuries in the contemporary airbag era: A retrospective cohort study

BackgroundLiterature predating routine availability of airbags reported an association between seatbelt signs and internal injuries. We measured this association among patients involved in motor vehicle crashes (MVCs) with airbag deployment. MethodsWe conducted a retrospective cohort study by chart review of all MVC patients presenting to our Emergency Department (ED) during 1 January 2008–30 September 2015. We included all adult MVC patients in the driver or front passenger seats with both shoulder and lap seatbelts and airbag deployment. Two trained chart abstractors recorded data regarding restraints and airbag deployment. We obtained all other data via electronic medical record abstraction including demographics, injuries, and survival. We compared the prevalence of cervicothoracic and intra-abdominopelvic injuries between patients with a documented seatbelt sign versus no seatbelt sign using a logistic regression model. ResultsOf 1379 MVC patients, 350 met inclusion criteria. Of these, 138 (39.4%) had a seatbelt sign. The prevalence of cervicothoracic injury was higher among subjects with a documented seatbelt sign (54.3% versus 42.9%, p=0.036) Seatbelt sign predicted cervicothoracic injury with a positive likelihood ratio of 1.3 (95% CI 1.0–1.7) and negative likelihood ratio of 0.8 (95% CI 0.7–1.0). The odds ratio of cervicothoracic injury among patients with a seatbelt sign versus no seatbelt sign was 1.58 (95% confidence interval 1.02–2.46) in the logistic regression model. There was no association between seatbelt sign and intra-abdominopelvic injury (p=0.418). ConclusionsIn the setting of airbag deployment, there is an association between seatbelt sign and cervicothoracic injury but not intra-abdominopelvic injury.

Similarities Between Large Animal-Related and Motor Vehicle Crash-Related Injuries

Many Americans sustain large animal-related injuries (LARIs) from blunt trauma. We compare the injuries and management of LARI in our region of the United States with those of motor vehicle crashes (MVCs). A 15-year retrospective study of trauma patients with LARI matched to MVC controls by Injury Severity Score (ISS), age, and sex was conducted. Values were statistically compared, and differences were considered statistically significant at P < .05. There were 156 LARI cases, of which 87% were related to horses, 8% to bulls, and the remainder to deer, mules, bison, cows, and rams. In the LARI group, the age was 42±18 years (mean±SD), ISS was 7±4, and 61% were females. The MVC group had a significantly longer length of hospital stay (5±5 vs 4±3 days) and blood alcohol concentration (35±84 vs 3±20 g/L). There were no significant differences in injury patterns between LARI and MVC; however, additional radiological studies (RS) were performed on MVC (9±6 vs 7±5). LARI patients were more often transferred from rural locations (39% vs 25%) and traveled further to our trauma center (40±32 vs 24±29 km) than did MVC patients. LARI has a similar pattern of injury to MVC, but fewer RS. LARI typically occurred further away, requiring transfer from rural areas to our institution. We recommend a similar approach for the evaluation of LARI and MVC.

Association Between Medication Use for Attention-Deficit/Hyperactivity Disorder and Risk of Motor Vehicle Crashes

Motor vehicle crashes (MVCs) are a major public health problem. Research has demonstrated that individuals with attention-deficit/hyperactivity disorder (ADHD) are more likely to experience MVCs, but the effect of ADHD medication treatment on the risk of MVCs remains unclear. To explore associations between ADHD medication use and risk of MVCs in a large cohort of patients with ADHD. For this study, a US national cohort of patients with ADHD (n = 2 319 450) was identified from commercial health insurance claims between January 1, 2005, and December 31, 2014, and followed up for emergency department visits for MVCs. The study used within-individual analyses to compare the risk of MVCs during months in which patients received ADHD medication with the risk of MVCs during months in which they did not receive ADHD medication. Dispensed prescription of ADHD medications. Emergency department visits for MVCs. Among 2 319 450 patients identified with ADHD, the mean (SD) age was 32.5 (12.8) years, and 51.7% were female. In the within-individual analyses, male patients with ADHD had a 38% (odds ratio, 0.62; 95% CI, 0.56-0.67) lower risk of MVCs in months when receiving ADHD medication compared with months when not receiving medication, and female patients had a 42% (odds ratio, 0.58; 95% CI, 0.53-0.62) lower risk of MVCs in months when receiving ADHD medication. Similar reductions were found across all age groups, across multiple sensitivity analyses, and when considering the long-term association between ADHD medication use and MVCs. Estimates of the population-attributable fraction suggested that up to 22.1% of the MVCs in patients with ADHD could have been avoided if they had received medication during the entire follow-up. Among patients with ADHD, rates of MVCs were lower during periods when they received ADHD medication. Considering the high prevalence of ADHD and its association with MVCs, these findings warrant attention to this prevalent and preventable cause of mortality and morbidity.

Motor Vehicle Crash (MVC) Case Definitions and How They Impact MVC Surveillance

Motor vehicle crashes (MVCs) are one of the leading causes of injury in the U.S. National injury surveillance is commonly captured using E-codes. However, use of E-codes alone to capture MVC-related ED visits may result in a different picture of MVC injuries compared to using text searches of triage or chief complaint notes. In this study, we identify and describe how the case definition used to identify MVC patients can impact results when conducting MVC surveillance. We compare MVC patients identified using E-codes, text searches, or both criteria together. We found that choice of case definition impacts the picture of MVC severity.

The Buffering analysis to identify common geographical factors within the vicinity of severe injury related to motor vehicle crash in Malaysia.

The main objective was to identify common geographical buildup within the 100-meter buffer of severely injured based on injury severity score (ISS) among the motor vehicle crash (MVC) victims in Malaysia. This was a prospective cohort study from July 2011 until June 2013 and involved all MVC patients attending emergency departments (ED) of two tertiary centers in a district in Malaysia. A set of digital maps was obtained from the Town Planning Unit of the district Municipal Office (local district map). Vector spaces were spanned over these maps using GIS software (ARCGIS 10.1 licensed to the study center), and data from the identified severe injured cases based on ISS of 16 or more were added. Buffer analysis was performed and included all events occurring within a 100 -meter perimeter around a reference point. A total of 439 cases were recruited over the ten-month data collection period. Fifty two (11%) of the cases were categorized as severe cased based on ISS scoring of 16 and more. Further buffer analysis looking at the buildup areas within the vicinity of the severely injured locations showed that most of the severe injuries occurred at locations on municipal roads (15, 29%), straight roads (16, 30%) and within villages buildup (suburban) areas (18, 35%). This study has successfully achieved its objective in identifying common geographical factors and buildup areas within the vicinity of severely injured road traffic cases.

Mechanisms of motor vehicle crashes related to burns—An analysis of the German In Depth Accident Study (GIDAS) database

BackgroundPatients of motor vehicle crashes (MVCs) suffering burns are challenging for the rescue team and the admitting hospital. These patients often face worse outcomes than crash patients with trauma only. Our analysis of the German In-depth Accident Study (GIDAS) database researches the detailed crash mechanisms to identify potential prevention measures. MethodsWe analyzed the 2011 GIDAS database comprising 14,072 MVC patients and compared individuals with (Burns) and without (NoBurns) burns. Only complete data sets were included. Patients with burns obviously resulting of air bag deployment only were not included in the Burns group. Data acquisition by an on call team of medical and technical researchers starts at the crash scene immediately after the crash and comprises technical data as well as medical information until discharge from the hospital. Statistical analysis was done by Mann–Whitney-U-test. Level of significance was p<0.05. Results14,072 MVC patients with complete data sets were included in the analysis. 99 individuals suffered burns (0.7%; group “Burns”). Demographic data and injury severity showed no statistical significant difference between the two groups of Burns and NoBurns. Injury severity was measured using the Injury Severity Score (ISS). Direct frontal impact (Burns: 48.5% vs. NoBurns: 33%; p<0.05) and high-energy impacts as represented by delta-v (m/s) (Burns: 33.5±21.4 vs. NoBurns: 25.2±15.9; p<0.05) were significantly different between groups as was mortality (Burns: 12.5% vs. NoBurns: 2.1%; p<0.05). Type of patients’ motor vehicles and type of crash opponent showed no differences. ConclusionsOur results show, that frontal and high-energy impacts are associated with a frequency of burns. This may serve automobile construction companies to improve the burn safety to prevent flames spreading from the motor compartment to the passenger compartment. Communities may impose speed limits in local crash hot spots.

Road traffic crashes in South Africa: The burden of injury to a regional trauma centre

Globally, 90% of road traffic crash (RTC) deaths occur in low- and middle-income countries. To document the mortality and morbidity associated with RTCs managed at a busy regional hospital in South Africa and investigate potentially preventable factors associated with RTCs. This was a prospective study of all patients presenting to Edendale Hospital following a RTC over a 10-week period from late 2011 to early 2012. All fatalities recorded at the police mortuary for the same period were included. Medical records were reviewed and all admitted patients were interviewed about the circumstances of the accident. We calculated an injury pyramid to compare our data with European data. A total of 305 patients were seen over the study period, 100 required admission and there were 45 deaths due to RTCs in the area. Of the patients admitted, 41 were pedestrians involved in pedestrian vehicle crashes (PVCs) and 59 motor vehicle occupants involved in motor vehicle crashes (MVCs). The majority (n=58) of crashes involved a private vehicle. Only 17% of MVC patients were wearing a seatbelt and 8 were allegedly under the influence of alcohol. On average, RTC patients spent 19 days in hospital and 62 patients required at least 1 operation. According to our injury pyramid, the number of severe and fatal injuries was higher than in Europe. Our results demonstrate a high incidence of RTCs associated with a high injury score and significant morbidity. Most crashes were associated with a number of high-risk behaviours.

Inter-Observer Reliability of Candidate Predictive Morphometric Measurements for Women with Suspected Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is increasingly recognized as a public health concern. Definitive diagnosis is by overnight polysomnographic (PSG) examination. Identification of clinical predictors would be beneficial in helping prioritize high-risk patients for assessment. Practical application of morphometric predictive variables would require a high level of reproducibility in a clinical setting. In this study, our objective was to evaluate reliability between observers in measurements of candidate morphometric parameters in women. This was a prospective study of 71 women who had been referred for PSG with suspected OSA. Selected morphometric parameters were measured independently in the sleep laboratory by two trained sleep physicians. Neck circumference and truncal measurements for lower costal, midabdominal, and hip circumferences had higher reliability coefficients (intraclass correlation coefficients [ICC] of 0.78, 0.95, 0.95, and 0.81) than the smaller dimension measurements, including cricomental distance or retrognathia (ICC of 0.04 and 0.17). Of the women participating in this study, 50 of 71 had apnea-hypopnea indexes (AHI) ≥ 5. Body mass index (BMI), neck circumference, lower costal girth, midabdominal girth, and hip girth were all significantly higher (p < 0.001-0.004) in women with AHI ≥ 5. There was wide variation in inter-observer reliability for different physical dimensions. We propose that any clinical morphologic measurement employed in predictive modeling should be reliably reproducible in clinical setting conditions. Our findings support the use of several truncal measures, BMI, and neck circumference as predictive measures in women undergoing evaluation for OSA.

Commentary: Emerging Crash Avoidance Technology: What Does It Mean to My ED?

Commentary: Emerging Crash Avoidance Technology: What Does It Mean to My ED?

Mild Traumatic Brain Injury: Are ED Providers Identifying Which Patients Are at Risk?

To identify patients with specific ED discharge diagnoses reporting symptoms associated with a mild traumatic brain injury (MTBI), compare frequency/severity of MTBI symptoms by discharge diagnosis, investigate head injury education provided at ED discharge, and learn about changes made by MTBI patients after injury. The Post Concussion Symptom Scale, a demographic questionnaire, and open-ended questions about the impact the injury had on patients' lives were completed by 52 ED patients, at least 2 weeks after injury, discharged with concussion/closed head injury, head laceration, motor vehicle crash (MVC), or whiplash/cervical strain diagnoses. Between 1 and 23 MTBI symptoms were reported by 84.6% of the participants. Headache and fatigue were the most common; female patients had almost twice as many symptoms on average as male patients. Of MVC patients, 83.3% reported moderate severity scores for all 4 Post Concussion Symptom Scale categories, and these represented the highest overall severity scores. Concussion/closed head injury diagnosis patients received the most head injury education. The majority of patients were more cautious after injury. Most participants reported having MTBI symptoms. Although MVC participants reported the most severe MTBI symptoms, they had the least head injury education. Emergency nurses need to be aware patients may have an MTBI regardless of their presenting symptoms or injury severity.

Obstructive sleep apnoea and driving

British Journal of Hospital MedicineVol. 72, No. 7 EditorialsObstructive sleep apnoea and drivingHelmy Haja Mydin, Sophie D WestHelmy Haja MydinSearch for more papers by this author, Sophie D WestSearch for more papers by this authorHelmy Haja Mydin; Sophie D WestPublished Online:16 Aug 2013https://doi.org/10.12968/hmed.2011.72.7.366AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Ellen RL, Marshall SC, Palayew Met al. (2006) Systematic review of motor vehicle crash risk in persons with sleep apnea. J Clin Sleep Med 2: 193–200 Medline, Google ScholarHack M, Davies RJO, Mullins Ret al. (2000) Randomised prospective parallel trial of therapeutic versus subtherapeutic nasal continuous positive airway pressure on simulated steering performance in patients with obstructive sleep apnoea. Thorax 55: 224–232 Crossref, Medline, Google ScholarHack MA, Choi SJ, Vijayapalan P, Davies RJ, Stradling JR (2001) Comparison of the effects of sleep deprivation, alcohol and obstructive sleep apnoea (OSA) on simulated steering performance. Respir Med 95(7): 594–601 Crossref, Medline, Google ScholarMorrell MJ, Jackson ML, Twigg GLet al. (2010) Changes in brain morphology in patients with obstructive sleep apnoea. Thorax 65: 908–914 Crossref, Medline, Google ScholarMulgrew AT, Nasvadi G, Butt Aet al. (2008) Risk and severity of motor vehicle crashes in patients with obstructive sleep apnoea/hypopnoea. Thorax 63: 536–541 Crossref, Medline, Google ScholarNational Institute for Health and Clinical Excellence (2008) Sleep apnoea - continuous positive airway pressure (CPAP). National Institute for Health and Clinical Excellence, London (http://guidance.nice.org.uk/TA139 accessed 13 June 2011) Google ScholarRisser MR, Ware JC, Freeman FG (2000) Driving simulation with EEG monitoring in normal and obstructive sleep apnea patients. Sleep 23: 393–398 Medline, Google ScholarStradling JR, Crosby JH (1991) Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men. Thorax 46: 85–90 Crossref, Medline, Google Scholar FiguresReferencesRelatedDetails 1 July 2011Volume 72Issue 7ISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 16 August 2013 Published in print 1 July 2011 Information© MA Healthcare LimitedPDF download

Classification tree modeling to identify severe and moderate vehicular injuries in young and middle-aged adults

Motor vehicle crashes are a leading cause of mortality and morbidity worldwide. Even though trauma centers provide the gold standard of care for motor vehicle crash patients with life- or limb-threatening injuries, many whose lives might be saved by trauma center care are treated instead at non-trauma center hospitals. Triage algorithms, designed to identify patients with life- or limb-threatening injuries who should be transported to a trauma center, lack appropriate sensitivity to many of these injuries. The challenge to the trauma community is differentiating patients with life- or limb-threatening injuries from those with less severe injuries at the crash scene so that the patients can be transported to the most appropriate level of care. The purpose of this study was to use crash scene data available to emergency responders to classify adults with moderate and severe injuries. These classifiers might be useful to guide triage decision making. Records of 74,626 adults, age 18-64 years, from the National Automotive Sampling System Crashworthiness Data Systems database were analyzed using classification and regression trees (CART) analysis. Both CART models (moderate injury and severe injury) included 13 predictor variables. The response variables were the targeted injury severity score cut points for moderate and severe injury. Two final classification trees were developed: one that classified occupants based on moderate injury and the other on severe injury. Misclassification costs were manipulated to achieve the best model fit for each tree. The moderate injury classification tree had three splitters: police-estimated injury severity, restraint use, and number of persons injured. The severe injury classification tree had four splitters: police-estimated injury severity, manner of collision, number of persons injured in the crash, and age. Sensitivity and specificity of the classification trees were 93.70%, 77.53% (moderate) and 99.18%, 73.96% (severe), respectively. CART analysis can be used to classify injury severity using crash scene information that is available to emergency responders. This procedure offers an opportunity to examine alternative methods of identifying injury severity that might assist emergency responders to differentiate more accurately persons who should receive trauma center care from those who can be treated safely at a non-trauma center hospital.