Occupants In Motor Vehicle Crashes Research Articles

Prehospital predictors of risk for pelvic fractures in pediatric trauma patients

Pelvic fractures are uncommon in children, but can occur as a result of high-energy impact injuries to the lower torso in association with blunt trauma. Pelvic fractures can be associated with significant morbidity while the work-up and treatment for these injuries is costly. The aim was to identify risk factors that help determine which pediatric trauma patients are at highest risk of sustaining a pelvic fracture to aid in the development of criteria for the targeted use of pelvic radiographic imaging. A retrospective analysis was conducted using the only pediatric trauma registry in the state of Maryland, located at The Johns Hopkins Children's Center. All blunt trauma patients who were younger than 15 years of age from 1990 to 2005 were included in the analysis (n = 13,360) with a final diagnosis of pelvic fracture as the primary outcome of interest. Comparisons were made using Pearson's chi-square for categorical and the Mann-Whitney rank sum test for non-normally distributed variables. Pelvic fractures following blunt trauma in children are associated with age, race, place and mechanism of injury. Compared to children 4 years and younger, pelvic fractures were more likely to occur in children aged 5-9 years (OR = 3; P = 0.000), as well as 10-14 years (OR = 5; P = 0.000). Compared to blunt trauma injuries from falls, children who were struck by vehicles or who were occupants in motor vehicle crashes (MVC) were six times (P = 0.000) and twice (P = 0.02) as likely to sustain a pelvic fracture, respectively. Four factors were demonstrated by this study to be significantly associated with pediatric pelvic fractures: being Caucasian, age between 5 and 14 years, being struck as a pedestrian or a motor vehicle crash occupant. Identification of these factors may aid clinicians in selecting patients who are at highest risk for pelvic fracture and may benefit most from pelvic radiography.

Accuracy of medical and ambulance record restraint and crash data information for child occupants

Objective:To correlate the accuracy of information on children’s restraint usage and crash characteristics recorded with medical data using in-depth crash investigation. Restraint and crash information within the medical and ambulance...

Upper extremity fracture patterns following motor vehicle crashes differ for drivers and passengers

Injury patterns of occupants in motor vehicle crashes are changing, with upper extremity injury becoming more common in patients treated at trauma centres. Although not life threatening, upper extremity injuries may result in long-term disability, including chronic deformity, neurovascular compromise and degenerative arthritis. The purpose of this study was to compare upper extremity injury in drivers and passengers using the Crash Injury Research Engineering Network (CIREN) database. CIREN data were used to compare upper extremity skeletal injury patterns and sources for drivers and passengers in frontal and side impacts. Occupant variables (age, gender, co-morbidity, avoidance maneuvers and restraint use) and crash variables (direction of impact, delta V and vehicle crush) were considered in the analysis. Only 24.8% of all occupants in the CIREN database had upper extremity injuries. One-half of upper extremity injuries to drivers were forearm fractures compared to one-third for passengers. Occupants in side impacts were more likely (OR=5.05) to have clavicle fractures, even while controlling for driver versus passenger status and safety belt use. Air bags were more likely to be a source of forearm fracture (OR=2.31) when controlling for driver versus passenger status, direction of force, sex and age compared to other sources. Only 10% of driver fractures with air bag deployment in frontal impacts were associated with air bag fling. This study found that drivers and passengers have different upper extremity injury patterns but the direction of impact also plays an important role.

Contemporary Analysis of Thoracic Aortic Injury: Importance of Screening Based on Crash Characteristics

To use motor vehicle crash (MVC) characteristics to determine risk of thoracic aortic injury (TAI) and provide updated mortality data. Vehicle crash variables and patient medical data from 64,245 MVC occupants (1988-2002) were obtained from the National Automotive Sampling System. Descriptive and logistic regression analyses were used to determine the relationship of crash and occupant characteristics to TAI. Seven hundred ninety occupants (1.2%) had TAI. Overall mortality with TAI was 92%. Prehospital mortality was 63%. Patients taken to a trauma center had significantly lower mortality (75%) than did patients taken to a non-trauma center (90%) (p = 0.006). Risk of TAI was highest with a near-side crash impact. Risk of TAI increased with increasing change in velocity and increasing mass of the striking vehicle. Seat belts were protective not only for all occupants in frontal crashes, but also for drivers and front passengers in a near side lateral impact, whereas airbags were protective only in frontal crashes. No specific injuries reliably predicted TAI with sufficient sensitivity and specificity to be clinically useful. TAI remains a highly lethal injury. Prehospital mortality in this series is lower than in most previous reports, and survival is higher at trauma centers versus non-trauma centers. Associated injuries are poor predictors of TAI. Screening for TAI should include increased emphasis on crash and vehicle occupant characteristics, especially high-velocity MVC, near-side impact, and lack of seat belt use.

Compartment syndrome in children and adolescents

Background The authors performed a computerized search of the National Pediatric Trauma Registry for all patients who had compartment syndrome during a 51-month period. Methods One hundred thirty-three cases were identified. Boys outnumbered girls 4 to 1. The median age was 12 years and the peak incidence was in the 10- to 14-year-old age group. Results The most common mechanisms of injury were pedestrians struck by motor vehicles, falls, sports, and occupants in motor vehicle crashes. Eighty-five percent of the cases were the sequelae of fractures. Forearm fractures were the most common cause in the upper extremity, and tibia and/or fibula fractures were most common in the lower extremity. Conclusions Open fractures significantly increased the risk of developing a compartment syndrome for both forearm and leg fractures. Sixty percent of the patients went directly from the emergency room to the operating room, suggesting that the others developed the compartment syndrome after admission, or had delayed diagnosis.

Airbags & children: making correct choices in child passenger restraints.

Countless numbers of young lives are lost each year due to motor vehicle crashes. One of the most effective means of reducing the number of children killed and injured as occupants in motor vehicles is through the use of child passenger restraints. Seat belts and child safety seats save lives and reduce the severity of injuries sustained by occupants in motor vehicle crashes. Nurses are in a unique position to educate and influence families on the proper way to safely transport all motor vehicle passengers. Therefore, nurses working with infants, children, and families have a moral and professional obligation to understand the basics of child passenger safety. At the very least, nurses should be able to direct families appropriately for specifics related to child passenger restraints. The intent of this article is to provide an overview of child passenger safety through a historical, theoretical, and clinical approach. Proper child restraint use is reviewed based on current recommendations for age and size. The potential hazards of child restraint misuse, with an in-depth discussion on airbags, is presented. The discussion on airbags serves to dispel any misconceptions that may be held about airbags. The article includes two case studies that illustrate the injury potential of relatively common misuse patterns. The clinical implications for maternal-child nurses include the recognition that child passenger deaths are primarily due to child restraint nonuse and misuse and the realization of nursing's role in the promotion of proper child passenger restraint.

The relationship between body weight and risk of death and serious injury in motor vehicle crashes

We sought to investigate the effect of increased body weight on the risk of death and serious injury to occupants in motor vehicle crashes. We employed a retrospective cohort study design utilizing data from the National Automotive Sampling System, Crashworthiness Data System (CDS), 1993–1996. Subjects in the study included occupants involved in tow-away crashes of passenger cars, light trucks, vans and sport utility vehicles. Two outcomes were analyzed: death within 30 days of the crash and injury severity score (ISS). Two exposures were considered: occupant body weight and body mass index (BMI; kg/m 2). Occupant weight was available on 27 263 subjects (76%) in the CDS database. Mortality was 0.67%. Increased body weight was associated with increased risk of mortality and increased risk of severe injury. The odds ratio for death was 1.013 (95% CI: 1.007, 1.018) for each kilogram increase in body weight. The odds ratio for sustaining an injury with ISS⩾9 was 1.008 (95% CI: 1.004, 1.011) for each kilogram increase in body weight. After adjustment for potentially confounding variables (age, gender, seatbelt use, seat position and vehicle curbweight), the significant relationship between occupant weight and mortality persisted. After adjustment, the relationship between occupant weight and ISS was present, although less marked. Similar trends were found when BMI was analyzed as the exposure. In conclusion, increased occupant body weight is associated with increased mortality in automobile crashes. This is probably due in part to increased co-morbid factors in the more overweight occupants. However, it is possibly also due to an increased severity of injury in these occupants. These findings may have implications for vehicle safety design, as well as for transport safety policy.

SAFETY BELT RESTRAINTS AND COMPARTMENT INTRUSIONS IN FRONTAL AND LATERAL MOTOR VEHICLE CRASHES: MECHANISMS OF INJURIES, COMPLICATIONS, AND ACUTE CARE COSTS

A 3-year prospective study examined 76 frontal (F) and 45 lateral (L) motor vehicle crash (MVC) patients with regard to seatbelt restraint use and occupant compartment contact and intrusion injuries. These 121 MVC victims with multiple injuries (39 belted [B] and 82 non-belted [NB]), admitted to a level I trauma center, were studied by accident reconstruction and medical data analysis. They had a MVC mean impact velocity (delta V) of 30 +/- 11 mph and an injury Severity Score of 29 +/- 12. Proper restraint use reduced brain injury in F MVCs (30% FB vs. 47% FNB) but had no effect in L MVCs (63% LB vs. 30% FB [p < 0.06]). Belt use did not protect against lung, liver, spleen, pelvis, or lower extremity (LE) injury. These appeared to be more a function of crash direction, with LE injuries higher in F crashes (p < 0.04) and pelvis injuries (p < 0.001) higher in L crashes. In FB crashes, however, properly used safety restraints were the primary cause of bowel or colon injuries (p < 0.006). Belts did not prevent thoracic or abdominal solid organ injuries in L crashes. Contact-intrusions (CI) of the car occupant compartment in F crashes were the main cause of brain (A-pillar), lung and liver (steering wheel and instrument panel), and LE (toepan) injuries; but in L crashes, side-door CI caused lung, aorta, liver, and pelvic injuries. In contrast, contact-only (CO) injuries of the steering assembly were mainly responsible for injuries to the lung, heart, and liver in F crashes, and side-door CO for lung, liver, and spleen injuries in L crashes. Deaths and complications after injury were higher among F MVC occupants, or when delta V was > or = 30 mph. Hospital and professional costs reflect the complex care needed for victims of multiple injuries: FB, $99,000; FNB, $95,000; LB, $75,000; LNB, $79,000; total, $10.7 million. Present vehicle safety standards are not adequate, and structural design changes are needed to improve restraints and protect occupants from intrusion-related injuries.

Patterns of injury in children

Trauma is the leading cause of death for children over 1 year of age. This study was undertaken to identify the patterns of injury among children admitted to a regional pediatric trauma center. During a 34-month period, 3,472 injured children were consecutively admitted to a regional pediatric trauma center. Data were collected on medical, etiological, and financial aspects of injury. Eight subgroups were defined by mechanism of injury: motor-vehicle crash occupants, pedestrian and cycle injuries, falls, child abuse, gunshot and stab wounds, burns, poisonings, and foreign body ingestions or aspirations. Analysis of variance, Duncan's multiple range test, and contingency table analysis were used to determine differences among subgroups of children. Blunt and penetrating trauma accounted for 64.3% of all admissions. The mean age of injured children was 5.5 years; 64% of the children were boys. Sixty-seven percent of the children were admitted directly from the scene of injury. One-way analysis of variance yielded significant differences in mean age, mean hospital length of stay (LOS), mean intensive care LOS, mean trauma score, mean injury severity, and mean hospital charges by mechanism of injury (P less than .01). The overall mortality rate was 2.4%. Child abuse, gunshot/stab wounds, and drowning had the highest mortality rates, but injuries to motor-vehicle crash occupants and pedestrians accounted for the greatest number of deaths.