Vehicle Collision Research Articles

Bilateral First Rib Fractures in Blunt Trauma Patients: A Retrospective Study

Abstract Introduction: Unilateral fracture of the first rib frequently led to severe complications such as brachial plexus or major vascular injury. Bilateral first rib fracture (BFRF) is very rare. We aimed to study the incidence, mechanism of injury, management, and outcome of BFRF in blunt trauma patients in a community-based hospital. Methods: Data of all blunt trauma patients who were admitted to our institution with (BFRF from December 2014 through January 2017) were retrospectively collected. Data included demography, mechanism of injury, severity of the injury, associated injuries, management, and outcome. Results: During the study period, 4779 patients with blunt trauma were included in the trauma registry and 12 (0.25%) patients had BFRF. The mean age of standard deviation (SD) was 29 (8.3) years. Seven (58.3%) patients were involved in road traffic collisions and 5 (41.7%) patients fell from more than 3 m height. The most commonly associated thoracic injury was lung contusions in 8 (66.7%) patients. The median (range) Glasgow Coma Score on admission was 15 (14–15) and Injury Severity Score (SD) was 19 (10.5). Length of hospital stay mean (SD) was 6.8 (6.4) days. No patients died in the study. Conclusions: BFRF is a rare entity in blunt trauma patients caused by high-energy trauma. Major vascular or brachial plexus injuries in patients with BFRF are much less than those reported in the medical literature on unilateral first rib fractures. Associated injuries are the main cause of trauma-related morbidity rather than the direct effect of BFRF.

Detecting Emotional Arousal and Aggressive Driving Using Neural Networks: A Pilot Study Involving Young Drivers in Duluth

Driving is integral to many people’s daily existence, but aggressive driving behavior increases the risk of road traffic collisions. Young drivers are more prone to aggressive driving and danger perception impairments. A driver’s physiological state (e.g., fatigue, anger, or stress) can negatively affect their driving performance. This is especially true for young drivers who have limited driving experience. This research focuses on examining the connection between emotional arousal and aggressive driving behavior in young drivers, using predictive analysis based on electrodermal activity (EDA) data through neural networks. The study involved 20 participants aged 18 to 30, who completed 84 driving sessions. During these sessions, their EDA signals and driving behaviors, including acceleration and braking, were monitored using an Empatica E4 wristband and a telematics device. This study conducted two key analyses using neural networks. The first analysis used a comprehensive set of EDA features to predict emotional arousal, achieving an accuracy of 65%. The second analysis concentrated on predicting aggressive driving behaviors by leveraging the top 10 most significant EDA features identified from the arousal prediction model. Initially, the arousal prediction was performed using the complete set of EDA features, from which feature importance was assessed. The top 10 features with the highest importance were then selected to predict aggressive driving behaviors. Another aggressive driving behavior prediction with a refined set of difference features, representing the changes from baseline EDA values, was also utilized in this analysis to enhance the prediction of aggressive driving events. Despite moderate accuracy, these findings suggest that EDA data, particularly difference features, can be valuable in predicting emotional states and aggressive driving, with future research needed to incorporate additional physiological measures for enhanced predictive performance.

Pediatric Cervical Spine Trauma: A Narrative Review.

Narrative review. To provide an updated overview of pediatric cervical spine trauma. Pediatric cervical spine trauma can cause debilitating morbidity and mortality and neurological impairment. The unique anatomic features of the developing cervical spine can predispose children to injuries. We reviewed the pediatric cervical spine trauma literature in PubMed and EMBASE. Pediatric cervical spine injury occurs in 1%-2% of pediatric trauma. The most frequent cause is motor vehicle collisions, with sports-related injuries being more common in older children. Larger head-to-body ratios and tissue elasticity can predispose young children to a greater risk of injury higher in the craniocervical junction and cervical spine. Standardized protocols and classification systems, such as the Pediatric Cervical Spine Clearance Working Group protocol and the AO Spine Injury and Subaxial Cervical Spine Injury Classifications, are valuable in triage as well as for assessing the need for operative versus nonoperative management. In general, operative approaches and principles are similar to those in adults, with modern instrumentation and fusion techniques achieving high rates of successful arthrodesis. Effective management and treatment of pediatric cervical spine injuries depends on early and accurate diagnosis, a thorough understanding of pediatric spinal anatomy, and a versatile surgical armamentarium.

Expandable Intravertebral Titanium Implants for Thoracolumbar Burst Fractures Without Neurological Deficits

Objective: A thoracolumbar burst fracture (TLBF) is defined as the failure of the anterior and middle columns of the vertebra due to high-energy trauma, such as motor vehicle collisions and falls from heights. Debate has continued for decades regarding the standard treatment, especially for TLBFs without neurological deficits (TLBF-WONDs). The aim of this study was to understand the role of expandable intravertebral titanium implants (EITIs) in treating TLBF-WONDs.Methods: We included patients aged 18–65 years who presented at our hospital Emergency Department with severe back pain (visual analogue scale [VAS] score ≥ 8), were neurologically intact, were diagnosed with TLBF-WOND by either computed tomography or magnetic resonance imaging, underwent percutaneous bilateral transpedicular EITI implantation, and were followed-up for ≥12 months. Radiological and clinical outcomes were analyzed.Results: Thirty patients satisfied the study inclusion criteria, including 9 men and 21 women, with an average age of 48.2 years. Thirteen A3 and 17 A4 burst fractures were included. The mean duration of hospitalization was 3.3 days. The mean follow-up period was 4.4 years. All patients exhibited significant improvements in radiographical (anterior, middle, and posterior vertebral heights); vertebral kyphotic angle (p<0.001); and functional outcomes (VAS and Oswestry Disability Index scores, p<0.001). One case of cement leakage into the paraspinal muscle was observed; however, no major complications occurred.Conclusion: Percutaneous bilateral transpedicular EITI placement with cement augmentation under local anesthesia may be an effective strategy for the treatment of high-energy traumatic TLBFs with neurological integrity.

Optimization of autonomous vehicle control system reliability on a commercial scale through LIF dombi methodologies.

The resilient framework of Linguistic Intuitionistic Fuzzy Sets (LIFSs) allows for the representation and management of uncertainties related to intuitionistic judgments and linguistic expressions. Recent advances in passive and active safety systems have reduced highway fatalities. Autonomous vehicles can improve safety, efficiency, and mobility by navigating traffic without a driver. One of the primary benefits associated with this technology is that it reduces the number of traffic collisions that result in millions of fatalities and numerous injuries. In this research work, we devise two novel aggregation operators: the linguistic intuitionistic fuzzy Dombi ordered weighted averaging (LIFDOWA) operator and the linguistic intuitionistic fuzzy Dombi ordered weighted geometric (LIFDOWG) operator, and explore their fundamental structural properties. We provide innovative score and accuracy functions for multiple attribute decision-making (MADM) problems within the framework of LIF knowledge. Moreover, we use these techniques to develop a specialized algorithm for MADM issues that addresses the complexities arising from ambiguous data during the selection process. We also demonstrate the effectiveness of our proposed methods by applying them to solve the MADM scenario of selecting an optimal approach to improve the credibility of autonomous vehicle control systems on a commercial scale. In addition, we also compare and evaluate the authenticity and practicability of the newly designed techniques in comparison to existing methodologies.

Path tracking with switchable stability constraints for vehicle collision avoidance based on extended stability region

There is a certain conflict between vehicle stability and the performance of path-tracking under emergency conditions. In this paper, to make full use of the lateral capacity of vehicles, a path tracking method with switchable stability constraints is proposed. First, using the Lyapunov energy equation and Hurwitz’s theorem, the lateral stability region (SR) and the critical steering angle of steady steering at different longitudinal speeds are calculated. Based on this, the extended stability region (ESR) and the extended critical steering angle of the vehicle under the control of an additional yaw moment are obtained. Furthermore, the driving area during collision avoidance is divided into unsafe and safe areas, and based on the model predictive control strategy, a path-tracking controller with switchable stability constraints is established. In the unsafe area, the vehicle states are allowed to break through the SR temporarily, and to ensure path-tracking accuracy, the ESR is taken as the stability constraint. In the safe area, the stability constraint is switched to the SR, and to make the vehicle states quickly return to SR, a regain stability controller is established. Finally, a Simulink-CarSim simulation and a hardware-in-the-loop (HIL) experiment are conducted. The simulation results show that a balance between tracking effect and vehicle stability can be effectively achieved through the proposed path-tracking system under the investigated emergency conditions. The real-time performance of the proposed control strategy is validated through the HIL experiment.

Resuming work roles after injury in a low-income context: Multiple factors influencing the return to work outcomes.

Return to work (RTW) is an important outcome indicator for the effectiveness of rehabilitation services, and the functional status and overall recovery among individuals who have experienced injury. Despite the rising incidence of traumatic injury among economically productive citizens in Ethiopia, there is a paucity of evidence about the RTW status of injury survivors. This study examined factors associated with RTW success and determinants of time to RTW after injury in Ethiopia. An institution-based cross-sectional study was conducted to collect data retrospectively one year after patients arrived at the study setting due to traumatic injuries. Medical records of all patients who visited the emergency room of a large public hospital in Addis Ababa were reviewed. Data were collected from survivors of traumatic injury, interviewed by telephone one year post-injury. Multivariable logistic regression and survival analysis were carried out to explore factors. Of the 251 participants, 75% were young adults (age </ = 39 years), 78% were male, 78% were urban residents, 41% were injured by road traffic collisions, and 59% returned to work within one year. The logistic regression model revealed short inpatient admission (AOR = 4.20; 95% CI: 2.10-8.50; p ≤ 0.001), no disability (AOR = 4.44; 95% CI: 2.10-9.60; p ≤ 0.001), motivation to RTW (AOR = 3.50; 95% CI: 1.61-7.50; p = 0.002), no chronic illness (AOR = 2.31; 95% CI: 1.14-4.70; p = 0.020), being in an administrative position (AOR = 5.32; 95% CI: 1.11-25.78; p = 0.038) and receiving injury compensation (AOR = 3.10; 95% CI: 1.22-7.73; p = 0.017) as factors for successful RTW within a year after injury. Further, the Cox regression analysis identified immediate access to healthcare after injury (AHR = 1.54; 95% CI: 1.05-2.25; p ≤ 0.026) and having injury of penetrative to internal organ, strain, sprain, dislocation or soft tissue (AHR = 1.81; 95% CI: 1.20-2.80; p = 0.007) as determinants of early RTW after traumatic injury. The study uncovers factors crucial to RTW planning and interventions, and provides insights to minimize barriers, foster a smooth transition to employment, and optimize survivors' lives after injury.

Causes of admission and mortality in European Hedgehog (Erinaceus europaeus, Linnaeus, 1758)

Erinaceus europaeus, a key indicator species for health ecosystems, faces various threats that impact the survival of the species. Most factors of threat are associated with human activity. The authors present a review of E. europaeus admission causes in wildlife rehabilitation centres and the mortality pattern of free-ranging animals. The review includes 20 papers spanning a considerable timespan from 1981 to 2024. The main causes of admission to wildlife rehabilitation centres are hoglets and starvation. The main causes of death in hedgehogs are vehicle collision and predation. It can be concluded that humans and human activity play a significant role in the mortality of these animals. In the future, a more standardised analysis of hedgehog carcasses is necessary to understand their threats and diseases and to design significant measures to protect the species.

Safety evaluation for mixed traffic flow of CAVs with different automation and connection levels

With the development of connected communication and automated driving technologies, connected automated vehicles (CAVs) are expected to gradually replace human-driven vehicles (HDVs), owing to their significant safety advantages. However, widespread adoption of CAVs will still require a considerable amount of time due to constraints such as technological development, legal regulations, and social acceptance. During the transitional period of CAVs’ proliferation, road traffic will comprise vehicles with different levels of connection and automation. These vehicles will differ in technology regarding communication, perception, decision-making, and other aspects, potentially posing severe challenges to mixed traffic flow safety. To address this issue, this paper proposes a mixed traffic flow model from both automation and connection perspectives to consider time delay and communication degradation. Four safety evaluation metrics are employed, and three-speed scenarios are set to investigate the influence of connection levels, automation levels, and their combined effects on mixed traffic flow safety. The result shows that (1) low automation enhances traffic safety in a non-connected environment, whereas medium and high automation decreases traffic safety. Conversely, in a connected environment, the role of automation levels exhibits the opposite pattern. (2) non-connected vehicles enhance traffic safety in a low-automated environment, while connected vehicles diminish it. However, connection level effects are reversed in medium and highly automated environments. (3) In connected and automated environments, traffic safety is increased by non-connected and low-automated vehicles, connected and medium automated vehicles, and connected and highly automated vehicles. However, other vehicle configurations decrease traffic safety. (4) Across various scenarios, the integration of connection and high automation proves beneficial for reducing traffic collision risks and improving traffic safety. In summary, this study provides theoretical support for managing and controlling mixed traffic flow with different automation and connection levels in the future.

Traumatic durotomy and entrapment of neural elements in a lumbar burst and laminar fracture diagnosed on preoperative imaging: illustrative case.

Traumatic dural lacerations can be caused by thoracolumbar burst fractures and, infrequently, can be associated with the entrapment of neural elements within a laminar fracture. The diagnosis of both is difficult to make on preoperative imaging, as the conditions are typically appreciated during surgical exploration. The authors present a case of traumatic durotomy with entrapment of neural elements in a laminar fracture that they believed could be appreciated on preoperative magnetic resonance imaging (MRI). A young male involved in a motor vehicle collision presented to the authors' trauma center with a lumbar burst and laminar fracture. Preoperative MRI demonstrated epidural hemorrhage and entrapment of neural elements within the laminar fracture, which was confirmed intraoperatively. The patient underwent a successful decompression, release of nerve roots, fusion, and recovery. Traumatic durotomy and entrapment of neural elements can occur after a traumatic spinal fracture, and a diagnosis made upon preoperative MRI can allow for effective preoperative planning. Clinicians should have a high index of suspicion for these pathologies when encountering certain fracture patterns and could therefore tailor the surgical approach to avoid further neurological injury during surgery. https://thejns.org/doi/10.3171/CASE24455.

Relationship of Mechanism of Injury to Asymptomatic Cervical Spine Fractures in the Elderly.

The Canadian Cervical Spine Rule, a clinical decision-making tool for patients post-trauma is often interpreted as recommending cervical spine computed tomography in patients ≥ 65 years old, who sustain a dangerous mechanism of injury, and/or have extremity paresthesias. We retrospectively reviewed 6 years' of emergency department cervical spine computed tomography reports to determine fracture rates in patients ≥ 65, symptomatic or not, who did and did not have a dangerous mechanism. Of those ≥ 65 years old, 240/13925 (1.72%) patients had cervical spine fractures. The fracture rate in asymptomatic patients ≥ 65 was 0.27%. The fracture rate in asymptomatic patients ≥ 65, who did not have a dangerous mechanism of injury was 0.15%. The rate of unstable fractures requiring surgery was 0.007%. The findings suggest that the algorithm to scan asymptomatic patients ≥ 65, and/or those ≥ 65 without a dangerous injury mechanism, should be revisited for appropriateness and overall value.ABBREVIATIONS: CCR = The Canadian Cervical Spine Rule; CSCT = cervical spine computed tomography; ED = emergency department; EMR = electronic medical record; MVC = motor vehicle collision.

Digital Traffic Lights: UAS Collision Avoidance Strategy for Advanced Air Mobility Services

With the advancing development of Advanced Air Mobility (AAM), there is a collaborative effort to increase safety in the airspace. AAM is an advancing field of aviation that aims to contribute to the safe transportation of goods and people using aerial vehicles. When aerial vehicles are operating in high-density locations such as urban areas, it can become crucial to incorporate collision avoidance systems. Currently, there are available pilot advisory systems such as Traffic Collision and Avoidance Systems (TCAS) providing assistance to manned aircraft, although there are currently no collision avoidance systems for autonomous flights. Standards Organizations such as the Institute of Electrical and Electronics Engineers (IEEE), Radio Technical Commission for Aeronautics (RTCA), and General Aviation Manufacturers Association (GAMA) are working to develop cooperative autonomous flights using UAS-to-UAS Communication in structured and unstructured airspaces. This paper presents a new approach for collision avoidance strategies within structured airspace known as “digital traffic lights”. The digital traffic lights are deployed over an area of land, controlling all UAVs that enter a potential collision zone and providing specific directions to mitigate a collision in the airspace. This strategy is proven through the results demonstrated through simulation in a Cesium Environment. With the deployment of the system, collision avoidance can be achieved for autonomous flights in all airspaces.

Soil: forensic interpretation some cases study

While investigating a crime scene related to murder, hit-and-run accidents, road accident analysis, vehicles collisions, rapes and burglaries, forensic soil examination is used for linking the suspect or an object to the crime scene. Comparison of soil provide information about location and place where from picked up by an automobile tire (location) with the soil sample taken from the crime site may help to prove that the suspect automobile may have been used in crime (place of happening). Similarly, soil or mud found adhering to clothing or shoes of a person may provide the clue that can link a suspect to a particular crime site. In the present study we reported the importance of soil and their interpretation as forensic evinces. The study has been reported with the help of cases study to provide exemplary explanation.

Frontal Impact Energy Absorbers for Passenger Cars.

Road accidents cause considerable losses to road users and to society. The steady increase in the number of vehicles leads to increased traffic volume. Therefore, there is a real need to improve passenger safety by developing passive safety systems. This article presents the results of experimental tests of structures absorbing kinetic energy, which could be used in the front section of a vehicle in order to reduce the consequences of passenger car head-on collisions. A number of crash tests of selected structures were conducted under various load conditions. An analysis was carried out of parameters enabling the authors to assess the level of energy absorption by the absorbers made, and compare these to absorbers available on the market. The tests carried out made it possible to determine energy absorption capability of the crash boxes prepared and to identify a structure exhibiting the most advantageous properties from the point of view of its prospective use. Of all of the absorbers analysed, in the context of energy absorption, it was the absorber made of glass-fibre-reinforced polyphenylene sulphide that produced the most advantageous results. Nonetheless, favourable results were obtained for all of the structures tested.

Energy absorption of the kirigami-inspired pyramid foldcore sandwich structures under low-velocity impact

Foldcore sandwich structures offer a promising alternative to conventional honeycomb sandwiches in the field of lightweight structures, demonstrating significant potential as efficient energy absorption devices. The dynamic behavior of foldcore sandwich structures is crucial in response to low-velocity impacts in various engineering scenarios such as bird strikes, airdrops, and vehicle collisions. This study investigates the dynamic responses of a kirigami-inspired pyramid foldcore sandwich subjected to low-velocity impacts, which has previously exhibited remarkable energy absorption efficiency under quasi-static compression. Through a combination of experimental investigations and numerical simulations under impact conditions, it is observed that the pyramid foldcore initially undergoes pronounced localized deformation which results in a sensitivity to the loading rate and causes the high initial peak stress. Different from the mechanism observed under quasi-static compression, additional stationary plastic hinges on the facets are triggered during the post-buckling stage, thereby slightly enhancing the overall energy absorption. Moreover, the multi-layer pyramid foldcores with graded geometries are proposed, characterized by varying height and wall thickness for each layer. The graded pyramid foldcores significantly reduce the initial peak stress while maintaining energy absorption efficiency. In comparison with the conventional square honeycomb and Miura-ori foldcore under the impact velocity of 10 m/s, the uniformity ratio of the graded pyramid foldcore decreases by 70.9 % and 80.5 %, while the specific energy absorption improves by 0.97 % and 138.37 %, respectively. To summarize, the graded pyramid foldcore shows outstanding energy absorption efficiency, indicating its potential as a high-performance sandwich structure for impact applications.

Understanding nightmares after traumatic events in Detroit (UNiTED): prospective associations with interpersonal violence and posttraumatic stress disorder symptoms

ABSTRACT Background: Research suggests trauma-related nightmares (TRNs) during the acute aftermath of trauma may contribute to posttraumatic stress disorder (PTSD). However, it is unknown who is most vulnerable to TRNs, which is critical to identify at-risk patients toward whom early nightmare-focused treatments can be targeted to prevent PTSD. Objective: We tested trauma type (interpersonal violence [e.g. assault] vs non-interpersonal trauma [e.g. motor vehicle collision]) as a risk factor for TRNs in a predominantly low-income, Black, urban sample in Detroit, MI, USA. Method: We recruited patients from the intensive care unit following traumatic injury (N = 88; M age = 39.53 ± SD 14.31 years, 67.0% male, 67.0% Black, 47.7% annual income ≤ $20,000) and administered surveys at three post trauma timepoints: one week (T1), one month (T2; n = 61), and two months (T3; n = 59). Trauma type was assessed at T1 via electronic medical records. Participants reported the extent to which their dreams’ content was similar to the trauma for which they were hospitalized across T1-T3. Participants then completed the PTSD Checklist for DSM-5 at T3. Results: TRNs were more prevalent over time among patients exposed to interpersonal violence (80%) vs non-interpersonal trauma (48.7%, p = .005). Patients hospitalized for interpersonal violence faced greater odds for TRNs across timepoints relative to non-interpersonal trauma patients (Odds Ratio = 4.95, p = .021). TRNs, in turn, prospectively predicted PTSD symptoms such that TRNs at T2 presaged more severe PTSD at T3 (p = .040, η p 2 = .31), above and beyond T1 PTSD status. Conclusions: This prospective study provides first evidence that interpersonal violence exposure is a robust risk factor for TRNs, which prospectively contribute to PTSD symptom development. Early intervention on TRNs after interpersonal violence exposure may decrease PTSD risk. Future studies are encouraged to use ambulatory methods to capture nightmares sooner after they occur.

Landscape Homogeneity May Drive the Distribution of Koala Vehicle Collisions on a Major Highway in the Clarke-Connors Range in Central Queensland, Australia

After the loss and fragmentation of habitat, vehicle collisions are one of the main threats to the long-term survival of wild koalas. Koala road strike data were analysed for a section of the Peak Downs Highway between Nebo and Spencer’s Gap, west of Mackay, Queensland, Australia. The analysis was carried out on 345 records (October 2014 to November 2023), and results suggested the spatial distribution of koala road strike followed a random pattern along this section of the highway, assuming a Poisson point pattern on a linear network. An analysis of the candidate predictors of koala vehicle collisions, including habitat and road variables, found that the amount of high-quality koala habitat (as defined by the local koalas’ tree species preference) present and the driver visibility were the only significant predictors. The relative homogeneity of landuse and vegetation across this landscape may mean that koalas do not concentrate at specific crossing points. More research, including detailed habitat mapping, is needed into this population, which currently lacks government and conservation attention, to inform mitigation efforts and reduce mortality rates for this potentially nationally significant population.

Air under pressure: a case report on tension pneumomediastinum arising from traumatic injury

Abstract Background Tension pneumomediastinum (TPM) is a rare but critical condition characterized by the accumulation of air in the mediastinum, leading to increased intrathoracic pressure and cardiovascular compromise. This case report is novel due to the rarity of TPM arising from blunt chest trauma and the necessity for emergent surgical intervention after initial conservative management failed. Case presentation A 63-year-old male presented with severe chest pain and dyspnea following a high-impact motor vehicle collision. Initial assessment revealed tachypnea, tachycardia, and hypotension, along with extensive subcutaneous emphysema over the chest and neck. Imaging confirmed pneumomediastinum and bilateral pneumothoraxes, consistent with TPM. Despite initial management with high-flow oxygen and bilateral chest tube insertion, the patient’s condition deteriorated, necessitating emergent mediastinal decompression via an anterior subxiphoid incision. This intervention resulted in immediate hemodynamic improvement. Conclusions This case underscores the importance of recognizing TPM in patients with chest trauma and highlights the need for prompt surgical intervention in cases of hemodynamic instability. Early and accurate diagnosis and timely surgical management are crucial for improving patient outcomes in TPM.

Differences in Cervical Spine Fractures in Patients Younger or Older Than 65 Years of Age: Implications for the Canadian C-Spine Rule.

There has been a distinction made in the 2001 Canadian C-Spine Rule regarding patients 65 and older and younger than 65 years of age as far as indications for cervical spine CT scanning. We sought to determine if there are differences in the symptoms, mechanisms of injury, fracture locations, and types that are still relevant in 2024. The institutional review board approved this retrospective study of cervical spine CT emergency department results from 2 hospitals in our health system after reviewing 5 years of data in patients experiencing trauma. In addition to the primary variable of age (younger than 65 years and 65 years and older), we looked at injury mechanism, fracture types, sites, symptoms, and operative or medical treatments. Because the demographics of our home site is different from most towns in the United States, we provide race/ethnicity data. Of 21,986 cervical spine CTs, 190/9455 (2.0%) participants 65 years of age and older and 199/12,531 (1.6%) participants younger than 65 years of age had fractures (total, 389/21,986, 1.8%). There were more cases of falls from standing (106, 55.8%) and falls from a height (46, 4.2%) in those 65 years and older and this mechanism was associated with a higher risk of C1 and C2 fractures (52, 27.4%; and 78, 41.1%, respectively). Among the C1 fractures, anterior and posterior arch fractures predominated (37, 19.5%). For C2 fractures, types 2 and 3 odontoid fractures (39, 20.5%; and 12, 6.3%) were more common in the older cohort. Motor vehicle collisions were more common in the younger cohort (89, 44.7%), and they were associated with more C5-C7 fractures (47, 23.6%; 60, 30.2%; and 66, 33.2%, respectively) including the facets (49, 24.6%), spinous processes (31, 15.6%), and transverse processes (52, 26.1%). Overall, the rates of instability, surgical intervention, and asymptomatic fractures were similar in the 2 age groups. Cervical spine fractures appear in about 1.8% of the CT scans performed in a busy emergency department environment. Fractures in the elderly occur more commonly due to falls, are located at C1 and C2, and may involve ligamentous injuries. Younger patients incur trauma more commonly due to motor vehicle collisions, and they are more likely to affect the posterior elements, especially C5-C7. The differences in trends for fractures in the 65 years of age and older and younger than 65 years of age groups have persisted since the Canadian C-Spine Rule 1996-1998 data were collected.

Paramedics’ anxiety and concerns around traumatic events: a Delphi study

Introduction: Trauma is a major problem in Saudi Arabia and a leading cause of mortality and morbidity. In 2018, road traffic injuries and trauma were the second-leading cause of death after ischaemic heart disease. There is a lack of research that explores the psychological effects on emergency medical service (EMS) professionals of providing prehospital care at trauma events. This study aims to identify which trauma cases cause the most anxiety and concern among EMS professionals. Methods: A study using a two-round Delphi method was undertaken online with EMS professionals working for the Saudi Red Crescent Authority. Results: In the initial round, one item—road traffic collision—achieved 70% consensus that it caused significant anxiety and concern; the second round did not achieve any consensus regarding other types of incident. Conclusion: Road traffic collisions are a leading cause of death and, based on the participants’ responses, they cause paramedics the most anxiety and concern of all case types.