Victims Of Motor Vehicle Collisions Research Articles

Development and Assessment of a Curriculum to Train Medical Students to Respond to Motor Vehicle Collisions in the Community

BACKGROUND: Healthcare providers may encounter opportunities to aid victims of motor vehicle collisions (MVCs) in the community as a bridge to pre-hospital care. Little is known about providers’ experience, comfort, and knowledge in responding to community MVCs. Our objective was to describe the development of a novel curriculum for educating providers on responding to community MVCs as part of a 6-session medical student elective course on community emergencies. METHODS: We performed a needs assessment through a survey sent to a multi-center convenience sample of physicians, resident trainees, and mid-level providers. We measured the frequency in which providers encountered MVCs as well as used a 5-Point Likert scale to assess their comfort responding, barriers to helping, and interest in learning more about assisting in MVCs. Free text responses about topics of interest were solicited and categorized into common themes. An educational session for medical students on responding to MVCs in the community was informed by the survey of healthcare providers. A pre- and post-course survey using a 5-Point Likert Scale was administered one month before and after the course to assess medical students’ comfort assisting in an MVC. RESULTS: There were 132 respondents to our needs assessment survey (122 MDs, 6 NPs, and 4 PAs). The most common specialties were general pediatrics (n=43, 33%), emergency medicine (n=25, 19%), and pediatric emergency medicine (n=24, 18%). Fifty-seven (43%) of the providers had the opportunity to assist in 1 or more MVCs, with 50 (89%) providing care at that time. Of providers with over 20 years in practice, 70% had the opportunity to aid in a community MVC (Figure 1). Forty-three (33%) of the providers stated they were “somewhat uncomfortable” or “very uncomfortable” assisting in an MVC. Eighty (62%) of the providers were “somewhat” or “very interested” in learning more about the topic. Provider respondents (n= 107, 81%) gave free text responses with most questions relating to preparedness, scene management, and sociolegal concerns such as liability. Eighty medical students participated in the elective course in community emergencies (53 first-years, 23 second-years, 3 third-years, and 1 fourth-year), which included a 75-minute session on responding to MVCs in the community comprised of a didactic, case presentations, and discussion. Based on the needs assessment, the session included content on Good Samaritan laws and liability, equipment preparedness, and specific aspects of on-scene management. Pre-course, medical students reported a median Likert Score of 2 (somewhat uncomfortable) for assisting in a community MVC, IQR (1,3). Post-course, the median Likert Score was 4 (somewhat comfortable), IQR (3,4). CONCLUSION: Health care providers are likely to have an opportunity to assist in community MVCs. Survey results informed learning needs for a medical student course that improved their comfort in responding to community MVCs. Future work will use survey content to inform a literature review article.

Comparison of pre-PICU and per-PICU interventions, clinical features and neurologic outcomes of motor vehicle collision trauma and other mechanisms of trauma in children.

Motor vehicle collisions (MVCs) are the number one cause of death in the pediatric age group. The aim of this study was to determine the differences between MVCs and other trauma mechanisms (OTMs) in patients who were followed up at a pediatric intensive care unit (PICU). Data were retrospectively collected for pediatric trauma patients hospitalized at a third level PICU between 2014 and 2018. Patients have been divided into two groups as MVC and OTM. Demographic data, pre-PICU interventions (cardiopulmonary resuscitation, intubation, injury severity scores, time period before intensive care), intensive care interventions (invasive mechanical ventilation, non-invasive mechanical ventilation, need for surgery, type of surgery, need for transfusion, and inotrope therapy) were compared between two groups. Outcomes were evaluated by survival, discharge from hospital, Pediatric Cerebral Performance Cate-gory (PCPC) at discharge, tracheotomy presence, and amputation performed. During the 5-year study period, 135 patients were hospitalized for trauma. The injured body regions were the head and neck (61.5%), abdomen and lumbar spine (39.4%), and extremities and pelvis (36.3%). Multiple trauma was mostly seen in the MVC trauma group (p=0.001). The need for invasive mechanical ventilation and inotrope therapy was greater in the MVC group (p=0.002, 0.001 respectively). One hundred and twenty-three patients (91.1%) survived. The mortality rate was higher in the MVC group (p=0.026). The PCPC results were better in the OTM group (p=0.017). MVCs lead to more multiple trauma cases than OTMs. Invasive mechanical ventilation, inotropes, and other inten-sive care interventions were necessary much more often in MVC victims than in OTM patients.

Case report; successful treatment of traumatic ischaemic hemiplegia secondary to blunt carotid injury associating high grade liver trauma

Introduction and importanceBlunt carotid injury (BCI) injury is a rare sequel of trauma and could result in ischemic complication if not detected and treated early. The presence of high-grade solid organ injury with ongoing bleeding represents additional challenge in treating BCI.Case presentationA 25-year-old victim of motor vehicle collision resulted in grade IV liver, grade III left kidney and grade I spleen injury. He underwent an urgent laparotomy with transient liver packing at local hospital. A full body Contrast-Enhanced Computer Tomography (CECT) upon arrival revealed right internal carotid intimal tear with intra and extra-cranial thrombosis and a 3 cm aneurysm. With a decreased level of consciousness, the patient showed a GCS of 13 and left-sided hemiplegia. After complex multidisciplinary treatment sessions, patient recovered with a partial regain of left-sided muscle power.Clinical discussionSelective embolization of active liver bleeding was a turning point in the management of our patient as it deferred the need for a second operative intervention. It was a necessary step before endovascular stenting and recanalization of the BCI to restore the circulation to the right cerebral hemisphere. Dual anti-platelet therapy (DAPT) was necessary to prevent thrombosis of the stent and continuity of carotid recanalization.ConclusionBCI with traumatic ischaemic hemiplegia associating a sum of life-threatening multiple injuries including high grade liver trauma with ongoing bleeding could still be managed non-operatively with acceptable outcome in the presence of a comprehensive specialized multidisciplinary service.

Epidemiology of pediatric trauma in the Kingdom of Bahrain: a national pediatric trauma registry pilot study

BackgroundA pediatric trauma registry for the Kingdom of Bahrain would be a novel public health tool for the Bahraini health system. The aim of this study was to explore the epidemiology of pediatric trauma at the national level by describing the distribution of pediatric injury in the Kingdom, and quantifying the burden of injury shouldered by the study population.MethodsThis multicenter observational cross-sectional study was conducted in Bahrain using data from the Pediatric Trauma Registry (PTR), which was a short-term paper-based prospective trauma registry that collected data over a three-month period in 2018. PTR was based in the pediatric emergency departments (ED) of the three national referral hospitals in the Kingdom. By simultaneously collecting data from all three trauma hospitals in the country, it was assumed that during the data collection period all major pediatric trauma patients in the country would be captured by the study, and that the data collected would provide national estimates of trauma. Inclusion criteria for the study was any individual under the age of 14, that arrived at the ED seeking care for intentional and unintentional injuries.ResultsA total of 1328 patients were included in the study. Sixty-nine percent of patients were treated and discharged from the ED, 30.5% were admitted to the hospital, admitted for surgery, or seen by a specialist, and 0.5% were declared deceased. The percentage of patients documented as unrestrained during Motor Vehicle Collisions (MVC) was 92.3%, and amongst those involved in MVC, 12% were ejected from the cabin of the vehicle.ConclusionsThere are significant implications that this study holds for policy implementation and practice surrounding injury prevention in the Kingdom of Bahrain. Low seatbelt utilization and the high proportion of ejection amongst MVC victims warrant immediate public health policy implementation, including enforcement of seat belt laws, strengthening of the traffic court system, and awareness campaigns for MVC prevention. Additionally, pediatric drowning prevention programs centered on constant adult supervision, pool isolation fencing, personal flotation devices, and swimming education should be created to address the mortality attributable to drowning in this study.

Cognitive and body manifestations of driving anxiety according to different onsets

Background Driving anxiety can have deleterious effects not only on driving behavior, but also on life quality. The interaction between motor vehicle collision (MVC) experiences and driving anxiety has been studied from different standpoints. However, the comparison with other events triggering it has been scarcely considered. Objectives: To analyze the body manifestations and the driving cognitions related to the accident, social and panic concerns in people suffering from different levels of driving anxiety. Method : A total of 260 participants suffering from driving anxiety were included in a survey, including Driving Cognition Questionnaire and Body Sensation Questionnaire. Results: Panic attacks and criticisms are the most relevant onsets of driving anxiety, more than MVC. Only 11.4% of MVC victims considered it as the onset. People with MVC history showed lower scores in social concerns than people without MVC experience and neither the responsibility of the MVC nor the role (driver/passenger) seemed to have an impact on the anxiety level. Conclusions: Although the most relevant body sensations, heart palpitations and sweating, were the same in people with panic attack experiences and MVC victims, a discrimination of the emotions behind the concept of “driving anxiety” is desirable to clarify the psychological effects of different onsets.

Marijuana Legalization and Rates of Crashing Under the Influence of Tetrahydrocannabinol and Alcohol.

To determine if statewide marijuana laws impact upon the detection of drugs and alcohol in victims of motor vehicle collisions (MVC). A retrospective analysis of data collected at trauma centers in Arizona, California, Ohio, Oregon, New Jersey, and Texas between 2006 and 2018 was performed. The percentage of patients testing positive for marijuana tetrahydrocannabinol (THC) was compared to the percentage of patients driving under the influence of alcohol (blood alcohol level >0.08g/dL) that were involved in an MVC. The data were analyzed to evaluate the trends in THC and alcohol use in victims of MVC, related to marijuana legalization. The change in incidence of THC detection (percentage) over the time period where data were available are as follows: Arizona 9.5% (0.4 to 9.9), California 5.4% (20.8 to 26.2), Ohio 5.9% (6.7 to 12.6), Oregon 3% (3.0 to 6.0), New Jersey 2.3% (2.7 to 5.0), and Texas 15.3% (3.0 to 18.3). Alcohol use did not change over time in most states. There did not appear to be a relationship between the legalization of marijuana and the likelihood of finding THC in patients admitted after MVC. In fact, in Texas, where marijuana remains illegal, there was the largest change in detection of THC. There was no apparent increase in the incidence of driving under the influence of marijuana after legalization. In addition, the changes in marijuana legislation did not appear to impact alcohol use.

Alarming Rate of Substance Use in Motor Vehicle Collisions at an Appalachian Trauma Center

Prescription drug use is a growing public health concern and studies show it is a contributing risk to motor vehicle collisions. The Appalachian region is also known to have an ever-increasing number of patients on controlled substances. This retrospective study of patients from the years 2011-2015 on controlled substances presenting to an Appalachian Level 1 trauma center after a motor vehicle or motorcycle collision was analyzed in order to determine the rate of opioid use among victims of motor vehicle collisions in the system, as well as evaluate for any differences in resource utilization between these patients and patients not using controlled substances.A total of 2,570 patients were included in the study. Seven-hundred sixty-eight (29.9%) individuals were found to be on a controlled substance. There was a similar mortality rate in both groups (2.8% vs 3.6%). There was no significant difference in hospital length of stay (LOS), intensive care unit (ICU) LOS, ventilator days, or injury severity score. Statistically significant findings include the type of crash (motor vehicle crash vs motorcycle crash) (p=0.003) and position in the vehicle (driver vs passenger) (p<0.001). Motor vehicle crashes and driver position were significantly associated with the presence of a controlled substance.

Effect of predicted travel time to trauma care on mortality in major trauma patients in Nova Scotia

Trauma is a leading contributor to the burden of disease in Canada, accounting for more than 15 000 deaths annually. Although caring for injured patients at designated trauma centres (TCs) is consistently associated with survival benefits, it is unclear how travel time to definitive care influences outcomes. Using a population-based sample of trauma patients, we studied the association between predicted travel time (PTT) to TCs and mortality for patients assigned to ground transport. Victims of penetrating trauma or motor vehicle collisions (MVCs) in Nova Scotia between 2005 and 2014 were identified from a provincial trauma registry. We conducted cost distance analyses to quantify PTT for each injury location to the nearest TC. Adjusted associations between TC access and injury-related mortality were then estimated using logistic regression. Greater than 30 minutes of PTT to a TC was associated with a 66% increased risk of death for MVC victims (p = 0.045). This association was lost when scene deaths were excluded from the analysis. Sustaining a penetrating trauma greater than 30 minutes from a TC was associated with a 3.4-fold increase in risk of death. Following the exclusion of scene deaths, this association remained and approached significance (odds ratio 3.48, 95% confidence interval 0.98–14.5, p = 0.053). Predicted travel times greater than 30 minutes were associated with worse outcomes for victims of MVCs and penetrating injuries. Improving communication across the trauma system and reducing prehospital times may help optimize outcomes for rural trauma patients.

Development of injury risk models to guide CT evaluation in the emergency department after motor vehicle collisions

Objective: The clinical evaluation of motor vehicle collision (MVC) victims is challenging and commonly relies on computed tomography (CT) to detect internal injuries. CT scans are financially expensive and each scan exposes the patient to additional ionizing radiation with an associated, albeit low, risk of cancer. Injury risk prediction based on regression modeling has been to be shown to be successful in estimating Injury Severity Scores (ISSs). The objective of this study was to (1) create risk models for internal injuries of occupants involved in MVCs based on CT body regions (head, neck, chest, abdomen/pelvis, cervical spine, thoracic spine, and lumbar spine) and (2) evaluate the performance of these risk prediction models to predict internal injury.Methods: All Abbreviated Injury Scale (AIS) 2008 injury codes were classified based on which CT body region would be necessary to scan in order to make the diagnosis. Cases were identified from the NASS-CDS. The NASS-CDS data set was queried for cases of adult occupants who sought medical care and for which key crash characteristics were all present. Forward stepwise logistic regression was performed on data from 2010–2014 to create models predicting risk of internal injury for each CT body region. Injury risk for each region was grouped into 5 levels: very low (<2%), low (2–5%), medium (5–10%), high (10–20%), and very high (20%). The models were then tested using weighted data from 2015 in order to determine whether injury rates fell within the predicted risk level.Results: The inclusion and exclusion criteria identified 5,477 cases in the NASS-CDS database. Cases from 2010–2014 were used for risk modeling (n = 4,826). Seven internal injury risk models were created based on the CT body regions using data from 2010–2014. These models were tested against data from 2015 (n = 651). In all CT body regions, the majority of occupants fell in the very low or low predicted injury rate groups, except for the head. On average, 57% of patients were classified as very low risk and 15% as low risk for each body region. In most cases the actual rate of injury was within the predicted injury risk range. The 95% confidence interval overlapped with predicting injury risk range in all cases.Conclusion: This study successfully demonstrated the ability for internal injury risk models to accurately identify occupants at low risk for internal injury in individual body regions. This represents a step towards incorporating telemetry data into a clinical tool to guide physicians in the use of CT for the evaluation of MVC victims.

Trauma to the Thoracic Aorta

Blunt thoracic aortic injury (BTAI) is predominantly a phenomenon of the 20th century secondary to high-energy deceleration injuries. Prior to the widespread adoption of automobiles, midway through the 20th century, 85% of injuries to the aorta were attributed to penetrating trauma, with 57% caused by gunshots and 25% by stab wounds.1–4 However, BTAI has become more prevalent, with an estimated incidence of 7,500 to 8,000 cases per year in the United States. BTAI is the second most common cause of trauma-related death after head injury and accounts for 15% of all motor vehicle collision (MVC)-related deaths.5 The incidence of thoracic aortic injury among MVC victims is 1.5%.6 Prehospital mortality is 85% secondary to complete aortic transection.7 Approximately 8% of patients survive more than 4 hours, and most of those who survive to reach the hospital have small or partial-thickness tears with pseudoaneurysm formation. Up to 50% of patients who reach the hospital die prior to definitive surgery.8,9 Therefore, expeditious collaborative evaluation by trauma and aortic surgeons at a level I trauma center is necessary to provide appropriate care to these patients who may have multiple life-threatening injuries. This review contains 13 figures, 8 tables, 1 video and 56 references. Keywords: Blunt Aortic Traumatic Injury, Thoracic Transection, Aortic Transection, Aortic Injury, Blunt Traumatic Aortic Injury, Blunt Thoracic Aortic Injury, Aortic Tear, Aortic pseudoaneurysm, TEVAR for BTAI, Endovascular repair (TEVAR) of BTAI, Endovascular repair (TEVAR) for transection

Trauma to the Thoracic Aorta

Blunt thoracic aortic injury (BTAI) is predominantly a phenomenon of the 20th century secondary to high-energy deceleration injuries. Prior to the widespread adoption of automobiles, midway through the 20th century, 85% of injuries to the aorta were attributed to penetrating trauma, with 57% caused by gunshots and 25% by stab wounds.1–4 However, BTAI has become more prevalent, with an estimated incidence of 7,500 to 8,000 cases per year in the United States. BTAI is the second most common cause of trauma-related death after head injury and accounts for 15% of all motor vehicle collision (MVC)-related deaths.5 The incidence of thoracic aortic injury among MVC victims is 1.5%.6 Prehospital mortality is 85% secondary to complete aortic transection.7 Approximately 8% of patients survive more than 4 hours, and most of those who survive to reach the hospital have small or partial-thickness tears with pseudoaneurysm formation. Up to 50% of patients who reach the hospital die prior to definitive surgery.8,9 Therefore, expeditious collaborative evaluation by trauma and aortic surgeons at a level I trauma center is necessary to provide appropriate care to these patients who may have multiple life-threatening injuries. This review contains 13 figures, 8 tables, 1 video and 56 references. Keywords: Blunt Aortic Traumatic Injury, Thoracic Transection, Aortic Transection, Aortic Injury, Blunt Traumatic Aortic Injury, Blunt Thoracic Aortic Injury, Aortic Tear, Aortic pseudoaneurysm, TEVAR for BTAI, Endovascular repair (TEVAR) of BTAI, Endovascular repair (TEVAR) for transection

Development of a model to quantify the accessibility of a Canadian trauma system

Trauma systems have been widely implemented across Canada, but access to trauma care remains a challenge for much of the population. This study aims to develop and validate a model to quantify the accessibility of definitive care within one provincial trauma system and identify populations with poor access to trauma care. A geographic information system (GIS) was used to generate models of pre-scene and post-scene intervals, respectively. Models were validated using a population-based trauma registry containing data on prehospital time intervals and injury locations for Nova Scotia (NS). Validated models were then applied to describe the population-level accessibility of trauma care for the NS population as well as a cohort of patients injured in motor vehicle collisions (MVCs). Predicted post-scene intervals were found to be highly correlated with documented post-scene intervals (β 1.05, p<0.001). Using the model, it was found that 88.1% and 42.7% of the population had access to Level III and Level I trauma care within 60 minutes of prehospital time from their residence, respectively. Access for victims of MVCs was lower, with 84.3% and 29.7% of the cohort having access to Level III and Level I trauma care within 60 minutes of the location of injury, respectively. GIS models can be used to identify populations with poor access to care and inform service planning in Canada. Although only 43% of the provincial population has access to Level I care within 60 minutes, the majority of the population of NS has access to Level III trauma care.

Extracorporeal life support use in pediatric trauma: a review of the National Trauma Data Bank

PurposeAs the role of extracorporeal life support (ECLS) continues to evolve in the adult and pediatric populations, smaller studies and case reports have described successful use of ECLS in specific groups of pediatric trauma patients. To further define the role of ECLS in pediatric trauma, we examined indications and outcomes for use of ECLS in injured children using a large national database. MethodsAll trauma patients ≤18years old were identified from the 2007 to 2011 National Trauma Data Bank. We collected patient demographics, mechanism of injury, injury severity, use of ECLS, and survival to discharge. Children undergoing ECLS were compared to those who did not undergo ECLS, using a 3:1 propensity matched analysis to compare outcomes between ECLS and non-ECLS patients with similar injury patterns. ResultsOf 589,895 pediatric trauma patients identified, 36 patients underwent ECLS. Within the ECLS cohort, 21/36 (58%) survived, and 10/36 (28%) were discharged directly home. Most ECLS patients were between 15 and 18years 20/36 (56%). Mechanisms of injury (MOI) resulting in ECLS use included: motor vehicle collision (MVC) 16/36 (44%), gunshot wound (GSW) 6/36 (17%), burns 6/36 (17%), and drowning/suffocation (D/S) 5/36 (14%). Among the ECLS cohort, survival varied by MOI from 75% in D/S to 56% in MVC and 33% in GSW and was 55% in patients with significant head injuries. Using propensity analysis for matched injury patterns, survival for ECLS and non-ECLS patients was similar (58% vs. 65%, p=0.61). ConclusionsIn the largest study to date of ECLS support in pediatric trauma patients, we found encouraging survival rates to discharge, comparable to patients not undergoing ECLS with similar injuries. These results support further use and focused research of ECLS in pediatric trauma, including drowning, burn, and MVC victims and those with significant head injuries. Level of evidenceLevel III; treatment study.

Seat Belt Use and its Effect on Abdominal Trauma: A National Trauma Databank Study

We sought to use the National Trauma Databank to determine the demographics, injury distribution, associated abdominal injuries, and outcomes of those patients who are restrained versus unrestrained. All victims of motor vehicle collisions (MVCs) were identified from the National Trauma Databank and stratified into subpopulations depending on the use of seat belts. A total of 150,161 MVC victims were included in this study, 72,394 (48%) were belted. Young, male passengers were the least likely to be wearing a seat belt. Restrained victims were less likely to have severe injury as measured by Injury Severity Score and Abbreviated Injury Score. Restrained victims were also less likely to suffer solid organ injuries (9.7% vs 12%, P < 0.001), but more likely to have hollow viscous injuries (1.9% vs 1.3%, P < 0.001). The hospital and intensive care unit length of stay were significantly shorter in belted victims with adjusted mean difference: -1.36 (-1.45, -1.27) and -0.96 (-1.02, -0.90), respectively. Seat belt use was associated with a significantly lower crude mortality than unrestrained victims (1.9% vs 3.3%, P < 0.001), and after adjusting for differences in age, gender, position in vehicle, and deployment of air bags, the protective effect remained (adjusted odds ratio for mortality 0.50, 95% confidence interval 0.47, 0.54). In conclusion, MVC victims wearing seat belts have a significant reduction in the severity of injuries in all body areas, lower mortality, a shorter hospital stay, and decreased length of stay in the intensive care unit. The nature of abdominal injuries, however, was significantly different, with a higher incidence of hollow viscous injury in those wearing seat belts.

Collecting information from the scene of a motor vehicle collision: The mechanism of injury

While dealing with motor vehicle collision (MVC) victims, the Paramedics on-scene make patient management decisions based on assessment of the physiological parameters, anatomic site of injury, mechanism of injury (MOI), and some special considerations (age and underlying illnesses). In victims with normal physiological and anatomical parameters, and no alarming consideration, the MOI alone is found to be an independent predictor of mortality and functional impairment (2, 3); the Emergency Physician can utilize such information to guide further management of the MVC victims. Information concerning the MOI mostly comes from the Paramedics who retrieved the patient from the crash scene. The purpose of this review is to explore the injury-predictive mechanisms of MVC and to guide the Paramedics in conveying such vital information to the Emergency Physician during handover process. A literature search was made using the online search engine PubMed to identify studies exploring the injury-predictive mechanisms of MVC. Keyword combinations were used that included: Motor/Vehicle/Collision/Road/Traffic/Accidents/Trauma/Mechanism of injury. Auto vs. pedestrian and Motorcycle crashes were excluded. A total of 8 articles were found to be relevant. The mechanisms of MVC which are highly predictive of a significant occult injury include ejection from vehicle (1,4,5), intrusion of the passenger compartment more than 12 inches (1,2,4), prolonged extrication time &gt;20 minutes (4,5), death in the same passenger compartment (1,5), high speed crashes (4), deformity of the steering wheel (2), and rollover causing significant intrusion or ejection of the victim (1). Paramedics reporting the aforementioned crash-specific variables would alert the Emergency Physician and help him better deal with MVC victims who have normal physiological and anatomical parameters, and no alarming considerations. Provision of MVC scene photographs to the emergency physician could be a future research project to assess its impact on altering patient management and outcome.

Prevalence and characteristics of child victims in motor vehicle collisions in Panama

ABSTRACTObjective: Fatalities from motor vehicle collisions are one of the leading causes of death among children in developed countries. Previous publications have shown that the rate is approximately 4 times higher in Latin American countries. We aimed to determine the prevalence and characteristics of child victims of motor vehicle collisions in Panama and to compare them with data from a more developed country. In this study, Spain was the country chosen for such comparison.Methods: A descriptive and retrospective study on the prevalence and characteristics of child victims from motor vehicle collisions that occurred from 2005 to 2012 in Panama was performed. To carry out this study, the records pertaining to victims of motor vehicle collisions in Panama were obtained from the National Institute of Statistics and Census and the Spanish data were obtained from the Road Accident Report. The variables analyzed were age, sex, number of victims, number of injuries, number of fatalities, and type of motor vehicle collision.Results: The child mortality rate in Panama by motor vehicle collisions during the evaluated time period ranged from 2.11 to 3.63, whereas mortality rates in Spain ranged from 0.6 to 1.9, making rates in Panama 3 to 4 times higher than the rates observed in Spain. Children under 5 years old were the group with the highest number of fatalities in Panama.Conclusions: In Panama, a lack of specific legislation on the use of child restraints (car seats) as well as a lack of information and awareness campaigns could be responsible for the high toll of child victims associated with motor vehicle collisions.

Emergency Department Visits by Older Adults for Motor Vehicle Collisions

Introduction:To describe the epidemiology and characteristics of emergency department (ED) visits by older adults for motor vehicle collisions (MVC) in the United States (U.S.).Methods:We analyzed ED visits for MVCs using data from the 2003–2007 National Hospital Ambulatory Medical Care Survey (NHAMCS). Using U.S. Census data, we calculated annual incidence rates of driver or passenger MVC-related ED visits and examined visit characteristics, including triage acuity, tests performed and hospital admission or discharge. We compared older (65+ years) and younger (18–64 years) MVC patients and calculated odds ratios (OR) and 95% confidence intervals (CIs) to measure the strength of associations between age group and various visit characteristics. Multivariable logistic regression was used to identify independent predictors of admissions for MVC-related injuries among older adults.Results:From 2003–2007, there were an average of 237,000 annual ED visits by older adults for MVCs. The annual ED visit rate for MVCs was 6.4 (95% CI 4.6–8.3) visits per 1,000 for older adults and 16.4 (95% CI 14.0–18.8) visits per 1,000 for younger adults. Compared to younger MVC patients, after adjustment for gender, race and ethnicity, older MVC patients were more likely to have at least one imaging study performed (OR 3.69, 95% CI 1.46–9.36). Older MVC patients were not significantly more likely to arrive by ambulance (OR 1.47; 95% CI 0.76–2.86), have a high triage acuity (OR 1.56; 95% CI 0.77–3.14), or to have a diagnosis of a head, spinal cord or torso injury (OR 0.97; 95% CI 0.42–2.23) as compared to younger MVC patients after adjustment for gender, race and ethnicity. Overall, 14.5% (95% CI 9.8–19.2) of older MVC patients and 6.1% (95% CI 4.8–7.5) of younger MVC patients were admitted to the hospital. There was also a non-statistically significant trend toward hospital admission for older versus younger MVC patients (OR 1.78; 95% CI 0.71–4.43), and admission to the ICU if hospitalized (OR 6.9, 95% CI 0.9–51.9), after adjustment for gender, race, ethnicity, and injury acuity. Markers of injury acuity studied included EMS arrival, high triage acuity category, ED imaging, and diagnosis of a head, spinal cord or internal injury.Conclusion:Although ED visits after MVC for older adults are less common per capita, older adults are more commonly admitted to the hospital and ICU. Older MVC victims require significant ED resources in terms of diagnostic imaging as compared to younger MVC patients. As the U.S. population ages, and as older adults continue to drive, EDs will have to allocate appropriate resources and develop diagnostic and treatment protocols to care for the increased volume of older adult MVC victims.

Under the Influence With a Child in the Car: Implications for Child Safety and Caregiver Intervention

Injury is the leading cause of death for those aged 1 year to 44 years in the United States, with motor vehicle collisions (MVCs) the leading cause of injury-related deaths. Little data exist on the relationship between caregiver alcohol and drug use at the time of MVC and child passenger outcomes. We examined the relationship between caregiver substance use in MVCs and a number of demographic, crash severity, and medical outcomes for caregivers and children. We identified family groups treated in the emergency department of a regional Level II trauma center after an MVC in a 1-year period from July 1, 2005, to June 30, 2006. The distribution and means of characteristics for substance and nonsubstance users were compared using χ analysis and Student's t tests, respectively. One in 10 vehicles contained an intoxicated caregiver at the time of MVC. In 363 identified caregivers, intoxication was associated with being male (p < 0.001), lack of safety device use (p = 0.003), rollover (p = 0.008), and ejection (p = 0.016). In the 278 family groups, intoxicated caregivers were related to child ejection (p = 0.009), the need for child hospital admission (p < 0.001), and driver intoxication was related to child lack of restraint (p = 0.045). These findings suggest a substantial number of child MVC victims arrive at the emergency room after riding with an intoxicated caregiver. Findings support the need for prevention programs focusing on substance use and driving for male caregivers, and further investigation on the need for screening and intervention for caregivers' risky alcohol and drug use after a child's MVC.

Are There Racial Disparities in the Use of Restraints and Outcomes after Motor Vehicle Collisions in Los Angeles County?

Motor vehicle collisions (MVCs) continue to be a leading cause of traumatic death, yet there is a paucity of data regarding racial/ethnic differences in injury severity, use of restraints, and outcomes. This study determines whether racial/ethnic disparities exist in adult MVC victims. A retrospective review of patients (age older than 18 years) involved in MVC in Los Angeles County from 2004 to 2009 was performed. Main outcome measures were hospital length of stay, mortality, and complication rate. Independent variables evaluated included race/ethnicity, use of restraints, age, gender, Injury Severity Score (ISS), and Glasgow Coma Scale. During the 5-year study period, 22,444 patients were involved in an MVC in Los Angeles County. Overall restraint use was 69 per cent, lowest in blacks (67%) and Hispanics (68%). Mortality and morbidity rates were both 3 per cent for all racial/ethnic groups. On multivariable analysis, higher ISS, older age, male gender, not wearing a seatbelt, and being Asian increased the risk of death. In conclusion, our study demonstrated racial/ethnic differences in MVC victims, particularly identifying that Hispanics and blacks were less likely to be restrained and thus could be the target of future injury prevention programs.

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

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