Motorcycle Collisions Research Articles

Novel Use of Obsidio Conformable Embolic in Thoracic Duct Embolization

AbstractChylothorax is a potentially serious condition resulting from thoracic duct injury. When chyle output remains high despite medical management, invasive interventions such as surgical ligation or percutaneous thoracic duct embolization (TDE) may be necessary. Obsidio is a novel conformable embolic agent that shares properties of both coil and liquid embolic agents. A 37-year-old man presented with left-sided chylothorax, refractory to medical management, following a high-speed motorcycle collision. The thoracic duct was successfully embolized using Obsidio placed between coil packs with fibered coils. This case report demonstrates the first successful use of Obsidio for TDE in a patient with traumatic chylothorax.

Surgical treatment of peri-implant fracture with plate-on-plate technique: a case report

Due to the increased life expectancy and exposure to high-energy traumas, there has been a rise in the demand for surgical treatment using internal fixation, and consequently, an increase in refractures. Despite the growing discussion around peri-implant fractures, there is still little discussion addressing periplate fractures. This report presents a case using the plate-on-plate technique where the fracture is addressed while maintaining the previous fixation material by placing a locked plate above the previously existing material. This case involves a 54-year-old man with a peri-implant diaphyseal fracture of the distal third of the left femur after a motorcycle versus car collision. The patient underwent surgical treatment with a steel locking condylar plate, maintaining the previous fixation material through the plate-on-plate technique. Subsequently, fracture consolidation and functional range of motion were evidenced. Thus, in line with studies, the plate-on-plate technique proved to be an effective alternative for peri-implant fractures, allowing an approach with lower morbidity and mortality and reducing the risks of surgical complications; however, it requires studies with a higher level of epidemiological evidence.

Seasonal variation and preoperative risk factors for polymicrobial infection following open fracture

IntroductionDespite modern approaches to open fracture management, fracture-related infection (FRI) rates remain high. Recent studies demonstrated the seasonal and regional variation of causative organisms in FRI. This study aims to better understand the causative organisms and identify preoperative risk factors for the primary outcome of FRIs at a Level I trauma center. Materials and methodsThis retrospective cohort study examined all patients that underwent irrigation and debridement of an open fracture at a single Level I trauma center between 2007 and 2019. Exclusion criteria included gunshot wounds, hand injuries, and follow-up less than 3 months. Patients that developed FRI were compared by season, injury characteristics, patient demographics, initial management, and causative organisms. ResultsAmong 695 patients with open fractures, 78 patients (11.2 %) developed infection, of which eight were Gustilo-Anderson (GA) Type I, 16 were GA Type II, 25 were GA Type IIIA, 26 were GA Type IIIB, and three were GA Type IIIC. Gram-positive FRIs were most common (81.1 %), followed by 56.8 % polymicrobial, 54.1 % gram-negative, and 10.1 % culture-negative infections. More than half (55.1 %) of the infections were from open tibial fractures and occurred after a motorcycle (32.1 %) or motor vehicle collision (23.1 %). Patients were more likely to have high FRI rates in the summer (12.8 %, n = 29) and fall (15.8 %, n = 32) in comparison of spring (4.7 %, n = 7) and winter (8.5 %, n = 10) (p < 0.01). Staphylococcus infections were more common in fall and winter (73.8 %, n = 31) versus spring and summer (44.4 %, n = 16) (p = 0.01). Patients that were transferred from outside hospitals had significantly higher rates of polymicrobial infection when compared to those who arrived from the field (63.6 % vs 41.2 %, p = 0.03). No differences were observed in infection causative organisms based on GA type. ConclusionsTwo preoperative risk factors for polymicrobial infection following open fracture include inter-hospital transfers and warm/humid weather. Broadening antibiotic prophylaxis during spring/summer months or for transferred patients may enhance antibiotic coverage and reduce infections.

Modeling of motorcyclist injury severities: A comparison between crashes on main-, frontage-, and standard-lane of roadway

This study aims to examine the differentiated impacts of frontage-lane, main-lane, and standard-lane motorcycle collisions on rider injury severity in Thailand. Using comprehensive crash data from 2016 to 2019, a random parameters model accommodating heterogeneity in means and variances is applied. Predictive comparisons between out-of-sample and within-sample predictions uncover differences between collision location sub-models. For frontage-lane collisions, severe or fatal injuries are positively associated with male riders, truck involvement, and speeding. In main-lane collisions, increased severe/fatal injury risk is associated with nighttime, holidays, weekends, single-motorcycle crashes, and collisions with trucks or pickups. In standard-lane collisions, positive severe/fatal injury associations include male riders, nighttime, non-peak hours, speeding, truck/pickup involvement, and pillion presence. Predictive comparisons show reorienting crashes to the frontage lane could reduce fatal injury probability by 0.1199 and 0.2233 versus the main and standard lanes respectively, preventing many fatalities. This research underscores accounting for unobserved heterogeneity and predictive simulation insights. The findings inform effective countermeasures and aid safety professionals, instructors, policymakers, law enforcement, and designers in motorcycle safety efforts.

On using machine learning algorithms for motorcycle collision detection

Globally, motorcycles attract vast and varied users. However, since the rate of severe injury and fatality in motorcycle accidents far exceeds that of passenger car accidents, efforts have been directed towards increasing passive safety systems. Impact simulations show that the risk of severe injury or death in the event of a motorcycle-to-car impact can be greatly reduced if the motorcycle is equipped with passive safety measures such as airbags and seat belts. For the passive safety systems to be activated, a collision must be detected within milliseconds for a wide variety of impact configurations, but under no circumstances may it be falsely triggered. For the challenge of reliably detecting impending collisions, this paper presents an investigation towards the applicability of machine learning algorithms. First, a series of simulations of accidents and driving operation is introduced to collect data to train machine learning classification models. Their performance is henceforth assessed and compared via multiple representative and application-oriented criteria.

Examining Factors Contributing to Motorcycle Collisions with Left-Turning Vehicles at Urban Intersection Locations

Motorcycle crashes account for a significant proportion of traffic-related fatalities on U.S. roadways. Compared with motor vehicles, motorcycles traveling straight ahead are more susceptible to collisions with left-turning vehicles at intersections (note – in a system where traffic travels on the right-hand side of the road). The limited knowledge of the causes and influences of this specific type of crash deters efforts to improve motorcycle safety and is partly influenced by two issues. First, significant variables are unknown; second, motorcycles comprise a small proportion of vehicles in the traffic stream. This study sought to understand the factors that may contribute to the disproportionate crash risk left-turning vehicles pose for motorcyclists while accounting for the imbalance of vehicle proportions. Data containing motorcycle-motor vehicle and motor vehicle-motor vehicle crashes involving left-turning motor vehicles at intersections in South Florida were collected from 2015 to 2017. The study applied logistic regression on a balanced dataset generated using the random oversampling technique. The proposed model improved the predictive accuracy and enabled the identification of factors contributing to motorcycle crashes with left-turning vehicles. A Bayesian network analysis was also applied to the balanced data to analyze the interrelationship of factors associated with motorcycle crashes with left-turning vehicles. Results indicated that the type of intersection and traffic control, time of day, age of drivers, sex of the motorcyclist, roadway type, and weather were significantly associated with motorcyclists’ susceptibility to collisions with left-turning vehicles. Recognizing these attributes could help devise engineering measures and policies for promoting motorcycle safety.

Chest wall injury fracture patterns are associated with different mechanisms of injury: a retrospective review study in the United States.

Research on rib fracture management has exponentially increased. Predicting fracture patterns based on the mechanism of injury (MOI) and other possible correlations may improve resource allocation and injury prevention strategies. The Chest Injury International Database (CIID) is the largest prospective repository of the operative and nonoperative management of patients with severe chest wall trauma. The purpose of this study was to determine whether the MOI is associated with the resulting rib fracture patterns. We hypothesized that specific MOIs would be associated with distinct rib fracture patterns. The CIID was queried to analyze fracture patterns based on the MOI. Patients were stratified by MOI: falls, motor vehicle collisions (MVCs), motorcycle collisions (MCCs), automobile-pedestrian collisions, and bicycle collisions. Fracture locations, associated injuries, and patient-specific variables were recorded. Heat maps were created to display the fracture incidence by rib location. The study cohort consisted of 1,121 patients with a median RibScore of 2 (range, 0-3) and 9,353 fractures. The average age was 57±20 years, and 64% of patients were male. By MOI, the number of patients and fractures were as follows: falls (474 patients, 3,360 fractures), MVCs (353 patients, 3,268 fractures), MCCs (165 patients, 1,505 fractures), automobile-pedestrian collisions (70 patients, 713 fractures), and bicycle collisions (59 patients, 507 fractures). The most commonly injured rib was the sixth rib, and the most common fracture location was lateral. Statistically significant differences in the location and patterns of fractures were identified comparing each MOI, except for MCCs versus bicycle collisions. Different mechanisms of injury result in distinct rib fracture patterns. These different patterns should be considered in the workup and management of patients with thoracic injuries. Given these significant differences, future studies should account for both fracture location and the MOI to better define what populations benefit from surgical versus nonoperative management.

Characteristics of Femoral Shaft Fractures That Predict Ipsilateral Femoral Neck Fractures.

This study aims to characterize radiographic features and fracture characteristics in femoral shaft fractures with associated femoral neck fractures, with the goal of establishing predictive indicators for the presence of ipsilateral femoral neck fractures (IFNFs). A retrospective cohort was collected from the electronic medical record of three level I trauma centers over a 5-year period (2017 to 2022) by current procedural terminology (CPT) codes. Current CPT codes for combined femoral shaft and IFNFs were identified to generate our study group. CPT codes for isolated femur fractures were identified to generate a control group. One hundred forty patients comprised our IFNF cohort, and 280 comprised the control cohort. On univariate, there were significant differences in mechanism of injury (P < 0.001), Orthopedic Trauma Association (OTA)/Arbeitsgemeinshaft fur Osteosynthesefragen (AO) classification (P = 0.002), and fracture location (P < 0.001) between cohorts. On multivariate, motor vehicle crashes were more commonly associated with IFNFs compared with other mechanism of injuries. OTA/AO 32A fractures were more commonly associated with IFNFs when compared with OTA/AO 32B fractures (adjusted odds ratio = 0.36, P < 0.001). Fractures through the isthmus were significantly more commonly associated with IFNFs than fractures more proximal (adjusted odds ratio = 2.52, P = 0.011). Detecting IFNFs in femoral shaft fractures is challenging. Motor vehicle crashes and motorcycle collisions, OTA/AO type 32A fractures, and isthmus fractures are predictive of IFNFs.

Motorcycle Detection and Collision Warning Using Monocular Images from a Vehicle

Motorcycle detection and collision warning are essential features in advanced driver assistance systems (ADAS) to ensure road safety, especially in emergency situations. However, detecting motorcycles from videos captured from a car is challenging due to the varying shapes and appearances of motorcycles. In this paper, we propose an integrated and innovative remote sensing and artificial intelligence (AI) methodology for motorcycle detection and distance estimation based on visual data from a single camera installed in the back of a vehicle. Firstly, MD-TinyYOLOv4 is used for detecting motorcycles, refining the neural network through SPP (spatial pyramid pooling) feature extraction, Mish activation function, data augmentation techniques, and optimized anchor boxes for training. The proposed algorithm outperforms eight existing YOLO versions, achieving a precision of 81% at a speed of 240 fps. Secondly, a refined disparity map of each motorcycle’s bounding box is estimated by training a Monodepth2 with a bilateral filter for distance estimation. The proposed fusion model (motorcycle’s detection and distance from vehicle) is evaluated with depth stereo camera measurements, and the results show that 89% of warning scenes are correctly detected, with an alarm notification time of 0.022 s for each image. Outcomes indicate that the proposed integrated methodology provides an effective solution for ADAS, with promising results for real-world applications, and can be suitable for running on mobility services or embedded computing boards instead of the super expensive and powerful systems used in some high-tech unmanned vehicles.

Long-term functional outcomes of upper extremity civilian vascular trauma

ObjectiveCivilian analyses of long-term outcomes of upper extremity vascular trauma (UEVT) are limited. Our goal was to evaluate the management of UEVT in the civilian trauma population and explore the long-term functional consequences. MethodsA retrospective review and analysis was performed of patients with UEVT at an urban Level 1 trauma center (2001-2022). Management and long-term functional outcomes were analyzed. ResultsThere were 150 patients with UEVT. Mean age was 34 years, and 85% were male. There were 42% Black and 27% White patients. Mechanism was penetrating in 79%, blunt in 20%, and multifactorial in 1%. Within penetrating trauma, mechanism was from firearms in 30% of cases. Of blunt injuries, 27% were secondary to falls, 13% motorcycle collisions, 13% motor vehicle collisions, and 3% crush injuries. Injuries were isolated arterial in 62%, isolated venous in 13%, and combined in 25% of cases. Isolated arterial injuries included brachial (34%), radial (27%), ulnar (27%), axillary (8%), and subclavian (4%). The majority of arterial injuries (92%) underwent open repair with autologous vein bypass (34%), followed by primary repair (32%), vein patch (6.6%), and prosthetic graft (3.3%). There were 23% that underwent fasciotomies, 68% of which were prophylactic. Two patients were managed with endovascular interventions; one underwent covered stent placement and the other embolization. Perioperative reintervention occurred in 12% of patients. Concomitant injuries included nerves (35%), bones (17%), and ligaments (16%). Intensive care unit admission was required in 45%, with mean intensive care unit length of stay 1.6 days. Mean hospital length of stay was 6.7 days. Major amputation and in-hospital mortality rates were 1.3% and 4.6% respectively. The majority (72%) had >6-month follow-up, with a median follow-up period of 197 days. Trauma readmissions occurred in 19%. Many patients experienced chronic pain (56%), as well as motor (54%) and sensory (61%) deficits. Additionally, 41% had difficulty with activities of daily living. Of previously employed patients (57%), 39% experienced a >6-month delay in returning to work. Most patients (82%) were discharged with opioids; of these, 16% were using opioids at 6 months. ConclusionsUEVT is associated with long-term functional impairments and opioid use. It is imperative to counsel patients prior to discharge and ensure appropriate follow-up and therapy.

The Effect of Covid-19-Related Social Distancing Restrictions on Maxillofacial Fractures Epidemiology.

The purpose of the present study was to evaluate the changes in maxillofacial fracture epidemiology and etiology regarding Covid-19-related social distancing restrictions in an Iranian population. A retrospective cross-sectional study was undertaken in six major trauma center hospitals in Iran in a period of two years (March 2018 until March 2020). The primary outcome variable was the maxillofacial fractures incidence. Patients' demographic data, date of injury as well as fracture characteristics, fracture etiology, type, and site were all recorded, compared, and analyzed in the control and experimental groups. The patients consisted of 520 (83.6%) males and 102 (16.4%) females. Patients sustaining maxillofacial fractures over this two-year period displayed a mean age of 31.24±14.44, with an age range of 2 to 88 years. The incidence of maxillofacial fractures significantly decreased in all age groups (p<0.001). After social distancing restrictions were placed; there was a significant drop in the number of subjects attending due to motorcycle collisions and road traffic accidents, whereas the number of fractures caused by assaults and domestic violence significantly increased (p<0.001 for each). The investigators realized that social distancing restrictions were able to change the trends and patterns in maxillofacial fracture incidence and etiology.

EMBOLIZATION FOR THE TREATMENT OF DELAYED HEMATURIA RENAL ARTERY PSEUDOANEURYSM FOLLOWING BLUNT TRAUMA

Background: The occurrence of a renal artery pseudoaneurysm after blunt renal trauma is an infrequent complication. The occurrence of delayed bleeding is typically observed within a period of 2 to 3 weeks following an injury and is commonly attributed to the presence of an arteriovenous malformation (AVM) or pseudoaneurysm. They are frequently observed in cases of injuries of greater severity or trauma that penetrates the body. The application of angiographic catheterization is efficacious in the detection of pseudoaneurysms in the renal artery. The management of renal pseudoaneurysms necessitates the consideration of distinct clinical associations, including the location and size of the lesion as well as the presence of symptoms.&#x0D; Objective: The objective of this study is to provide a detailed account of the use of an angiographic catheter and embolization in the treatment of a patient afflicted with a post-traumatic renal artery pseudoaneurysm.&#x0D; Materials and Methods: Conducting a literature review and medical records.&#x0D; Results: A case of renal artery pseudoaneurysm is presented. A male individual aged 33 sought medical attention at the emergency department following a motorcycle collision and exhibited symptoms of pain in the right flank region. The individual underwent a medical intervention involving the placement of a double J stent. After a period of nearly fourteen days, the individual reported experiencing hematuria. The abdominal CT scan revealed a renal injury on the right side with an AAST grade of 4, while the renal CTA demonstrated the presence of a pseudoaneurysm. A pseudoaneurysm was observed at the renal poles on the right side through the use of an angiographic catheter. The procedure of selective embolization utilising coils was executed on the renal arteries located at the lower and middle poles of the right kidney.&#x0D; Conclusion: The occurrence of renal artery pseudoaneurysms is infrequent; however, it is a grave complication that may arise from renal trauma. The accurate diagnosis and effective management of pseudoaneurysms are of paramount importance due to their potential to cause severe and potentially fatal complications if left untreated. The diagnostic process for pseudoaneurysms heavily relies on the involvement of the general radiologist. Interventional radiology provides alternative minimally invasive procedures that are linked to reduced morbidity and mortality rates and have replaced surgical interventions in the management of certain conditions.&#x0D; Keywords: pseudoaneurysm, angiographic catheter, embolization

Epidemiology Of Motorcycle-Related Maxillofacial Injuries Presenting To The 37 Military Hospital, Ghana

Objective: The study examined the epidemiology of motorcycle-related maxillofacial injuries to provide data to guide the prevention and management of maxillofacial trauma. Methodology: The research was a one-year prospective cross-sectional study of patients presenting with motorcycle crash-related maxillofacial injuries. The variables recorded include the demographic data, type of motorcycle collision, day and time of motorcycle crash, location of the crash, role of injured patient, maxillofacial and concomitant injuries sustained. Descriptive statistics were used to ascertain the epidemiology of maxillofacial injuries sustained. Results: A total of 148 patients aged between 15 and 65 years were involved in the study. There was a high male dominance (96%) among patients who sustained maxillofacial injuries secondary to motorcycle-related road traffic crashes (RTC). The median age of the participants was 30.9 +/- 9.1 years. Most (55.6%) of the motorcycle crashes resulted from collisions with cars. Maxillofacial injuries were mostly soft tissue injuries with the midface sustaining the most. Skeletal injuries often occurred in the mandible with parasymphyseal fractures constituting the majority of the mandibular fractures. Conclusion: There is a male predominance in patients with motorcycle-related maxillofacial injuries with a peak age of 21-30 years. Victims of motorcycles crashes often sustain soft tissue injuries with aesthetic and functional implications. Motorcycle crashes contribute significantly to the public health burden of RTC, especially in developing countries like Ghana. Healthcare professionals ought to be conversant with the epidemiology of maxillofacial injuries in motorcycle crash victims to ensure prompt and comprehensive management.

Traumatic spinal injury patterns of on vs. off-road motorcycle crashes

Objective Two wheel motorized vehicles used in both street transportation and recreation are a common cause of severe injury in the United States (US). To date, there has been limited data describing the spinal injury patterns among these motorcycle injury patients in the US. The goal of this study is to characterize and compare differences in specific injury patterns of patients sustaining traumatic spinal injuries after motocross (off-road) and street bike (on-road) collisions in the southwestern US at a Level I Trauma Center. Methods Trauma registry data was queried for patients sustaining a spinal injury after motorcycle collision from 2010 to 2019 at a single Level I Trauma Center. Computed tomography (CT) scan and magnetic imaging resonance imaging (MRI) reports from initial trauma evaluation were reviewed and data was manually obtained regarding injury morphology and location. Results A total of 1798 injuries were identified in 549 patients who sustained a motorcycle collision, specifically 67 off-road and 482 on-road motorcycle patients. Off-road motorcycle patients were found to be significantly younger (34.75 vs. 42.66, p = 0.00015). A total of 46.2% of the off-road injuries were determined to be from compression mechanisms, compared to 32.9% in the on-road cohort (p = 0.0027). The on-road cohort was more likely to have an injury classified as insignificant, such as transverse and spinous process fractures (60.1% vs. 42.5%, p = 00.25). There was no significant difference in regards to junctional, mobile, and semirigid spine segments between the two cohorts. Conclusions Different fracture patterns were seen between the off-road and on-road motorcycle cohorts. Off road motorcyclists experienced significantly more compression and translational injuries, while on road motorcyclists experienced more frequent insignificant injury patterns. Data on the different fracture patterns may help professionals develop safety equipment for motorcyclists.

ILBME-80: Analysis of Injury and Resource Utilization Trends in Motorcycle Collisions: A Retrospective Study

ILBME-80: Analysis of Injury and Resource Utilization Trends in Motorcycle Collisions: A Retrospective Study

Bivariate-Logit-Based Severity Analysis for Motorcycle Crashes in Texas, 2017–2021

Due to the number of severe traffic collisions involving motorcycles, a comprehensive investigation is required to determine their causes. This study analyzed Texas crash data from 2017 to 2021 to determine who was at fault and how various factors affect the frequency and severity of motorcycle collisions. Moreover, the study tried to identify high-risk sites for motorcycle crashes. Utilizing bivariate analysis and logistic regression models, the study investigated the individual and combined effects of several variables. Heat maps and hotspot analyses were used to identify locations with a high incidence of both minor and severe motorcycle crashes. The survey showed that dangerous speed, inattention, lane departure, and failing to surrender the right-of-way at a stop sign or during a left turn were the leading causes of motorcycle crashes. When a motorcyclist was at fault, the likelihood of severe collisions was much higher. The study revealed numerous elements as strong predictors of catastrophic motorcycle crashes, including higher speed limits, poor illumination, darkness during the weekend, dividers or designated lanes as the principal road traffic control, an increased age of the primary crash victim, and the lack of a helmet. The concentration of motorcycle collisions was found to be relatively high in city cores, whereas clusters of severe motorcycle collisions were detected on road segments beyond city limits. This study recommends implementing reduced speed limits on high-risk segments, mandating helmet use, prioritizing resource allocation to high-risk locations, launching educational campaigns to promote safer driving practices and the use of protective gear, and inspecting existing conditions as well as the road geometry of high-risk locations to reduce the incidence and severity of motorcycle crashes.

Injury patterns and outcomes in motorcycle passengers.

Contemporary trauma literature on injuries to motorcycle passengers is scarce. The aim of this study was to examine the injury patterns and outcomes of motorcycle passengers with regard to helmet use. We hypothesized that helmet utilization affects both injury type and outcomes. The National Trauma Data Bank was queried for all motorcycle passengers who were injured in traffic accidents. Participants were stratified according to helmet utilization into helmeted (HM) and nonhelmeted (NHM) groups. Univariate and multivariate analyses were performed to compare the injury patterns and outcomes between the groups. A total of 22,855 patients were included for analysis, of which 57.1% (13,049) used helmet. The median age was 41years (IQR 26-51), 81% were female, and 16% of patients required urgent operation. NHM had higher risk of major trauma (ISS > 15: 26.8% vs 31.6%, p < 0.001). The most frequently injured body region in NHM was the head (34.6% vs 56.9%, p < 0.001), whereas in HM patients was the lower extremities (65.3% vs 56.7%, p < 0.001). NHM patients were more likely to require admission to the ICU, mechanical ventilation, and had significantly higher mortality rate (3.0% vs 6.3%, p < 0.001). The strongest predictors of mortality were GCS < 9 on admission, hypotension on admission, and severe head injury. Helmet utilization was associated with decreased odds of death (OR 0.636; 95% CI 0.531-0.762; p < 0.001). Motorcycle collisions can lead to significant injury burden and high mortality in motorcycle passengers. Middle-age females are disproportionally affected. Traumatic brain injury is the leading cause of death. Helmet use is associated with decreased risk of head injury and death.

Predictive Factors for the Application of Pelvic Binders in the Prehospital Setting

Objectives Early pelvic binder placement in the field stabilizes pelvic fractures and tamponades potential hemorrhage within the pelvis. Despite known risk factors for pelvic fracture, it remains challenging to quickly triage and correctly apply a pelvic binder. We aim to develop a prediction model that exclusively uses prehospital criteria to inform the decision to place a pelvic binder. Methods The trauma registry was used to identify all trauma patients admitted to an urban Level I trauma center between January 2013 and December 2017. Variables collected included patient demographics, mechanism of injury, prehospital vital signs, and the presence of a pelvic fracture. Participants were randomly assigned to a training group (70%) or a validation group (30%). Univariate analyses were used to identify significant predictors for use in multivariate predictive models. Results A total of 8,480 (65% male; median age 49; median ISS 9) and 3,676 (65% male; median age 48; median ISS 9) trauma patients were randomly assigned to the training and validation groups, respectively. Univariate analysis showed significant likelihood of pelvic fracture associated with female sex, hemodynamic instability (initial systolic blood pressure < 90 mmHg), blunt injury type, specific mechanisms of injury (motor vehicle collision, motorcycle collision, pedestrian struck by motor vehicle, crushing injury, and riding an animal), impact location, and position in vehicle. Multivariate models adjusting for blunt type injury, hemodynamic instability, impact location, and position in vehicle showed that presence of two or more of these risk factors is significantly associated with presence of pelvic fracture. Conclusion Establishing select prehospital criteria for the empiric application of pelvic binders for patients in the field with blunt injuries, hemodynamic instability, frontal or side motor vehicle collision impact, and non-front seat passenger may improve outcomes among patients with pelvic fractures.

Predicting Complicated Mild Traumatic Brain Injury in Adolescent Trauma to Enhance Clinical Decisions in Imaging.

The Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury algorithm is used to identify children at low risk of clinically significant traumatic brain injuries to reduce computed tomography (CT) exposure. Adapting PECARN rules based on population-specific risk stratification has been suggested to improve diagnostic accuracy. This study sought to identify center-specific patient variables, beyond PECARN rules, that may enhance the identification of patients requiring neuroimaging. This single-center, retrospective cohort study was conducted from July 1, 2016, to July 1, 2020, in a Southwestern U.S. Level II pediatric trauma center. The inclusion criteria were adolescents (10-15 years), Glasgow Coma Scale (13-15), with a confirmed mechanical blow to the head. Patients without a head CT were excluded. Logistic regression was performed to identify additional complicated mild traumatic brain injury predictor variables beyond the PECARN. There were 136 patients studied; 21 (15%) presented with a complicated mild traumatic brain injury. Relative to motorcycle collision or all-terrain vehicle trauma (odds ratio [OR] 211.75, 95% confidence interval, CI [4.51, 9931.41], p < .001), an unspecified mechanism (OR 42.0, 95% CI [1.30, 1350.97], p = .03) and consult activation (OR 17.44, 95% CI [1.75, 173.31], p = .01) were significantly associated with complicated mild traumatic brain injury. We identified additional factors associated with complex mild traumatic brain injury, including motorcycle collision and all-terrain vehicle trauma, unspecified mechanism, and consult activation that are not in the PECARN imaging decision rule. Adding these variables may aid in determining the need for appropriate CT scanning.

Expediting Treatment of Trauma Patients in the Emergency Department: Rapid Trauma Evaluation (RTE)

BackgroundCriteria for trauma determination evolves. We developed/evaluated a Rapid Trauma Evaluation (RTE) process for a trauma patient subset not meeting preestablished trauma criteria. MethodsRetrospective study (July 2019 - May 2020) for patients either > 65 years with ground level fall within 24 hours or in a motorcycle collision (MCC) arriving by EMS not meeting ACS trauma-criteria. RTE process was immediate evaluation by nurse/EMT, room placement, physician notification, undressing/gowning, vital signs, head-to-toe assessment, upgrade trauma status. Number/type of admissions, discharges, trauma upgrades, LOS obtained via trauma-registry and chart-review. For comparison, historic controls (HC) were used [all patients meeting RTE criteria seen in the ED prior to RTE (Apr- June 2019)]. ResultsThe RTE cohort (n=755) was 77% falls,23% MCCs, median age 82 [IQR 74-88] years; 42% male-Among falls, 3.2% required a modified-upgrade; 0.7% full-upgrade, 55% admitted [29.4% trauma). HC (n=575) was 92.3% falls, 7.7% MCCs, median age 81 (IQR: 67-88) years, 40.5% males-57.4% admitted (22% trauma). RTE MCC median age 42 (IQR:30-49) years, 84.4% male- 21.9% were upgraded [(6 modified-trauma; 1 full-trauma; 43.8% admitted (85.7% trauma)]. HC MCC median age 29 (IQR: 23-41) years, 95.5% male, 54.5% admitted (75% trauma]. No difference on demographics, admissions or discharges between groups (P>0.05) except HC MCC was younger (P<0.005). RTE median LOS was shorter than HC [203 (IQR: 147-278) minutes vs. 286 (IQR: 205-392) minutes, P<0.001]. ConclusionsPatients > 65 years with a ground level fall or in a MCC arriving via EMS not meeting ACS trauma criteria may benefit from RTE.