Motor Vehicle Crash Victims Research Articles

Pregnancy is associated with more severe injuries from motor vehicle crashes

ObjectiveWhether pregnancy is associated with severe injuries from motor vehicle crashes (MVCs) remains unclear. This study aimed to investigate the potential relationship between pregnancy and severity of injuries from MVCs. MethodsWe identified a total of 23,559 pregnant women victims who encountered MVCs during pregnancy as well as 94,236 age- and calendar year-at MVC matched non-pregnant women victims that are also involved in MVCs. Injury severity was assessed using the Maximum Abbreviated Injury Scale (MAIS) based on the diagnosis of medical claims after MVCs. Multinomial logistic regression models were used to estimate the odds ratio and corresponding 95 % CI of injury severity levels associated with pregnancy. ResultsPregnant women had a significantly higher risk of both severe (adjusted odds ratio, aOR = 1.79, 95 % CI = 1.54–2.08) and mild injuries (aOR = 8.63, 95 % CI = 8.21–9.07) following MVCs as compared to non-pregnant women victims. Particularly, pregnant women who were riding scooters had an increased risk of severe injury (aOR = 4.25, 95 % CI = 3.58–5.04). In addition, pregnant women who experienced MVC but without any injury were more likely to visit a clinic than non-pregnant MVC victims. ConclusionPregnant women victims, particularly those who were riding scooters involved in MVCs suffered from a higher risk of severe injury as compared to their non-pregnant counterparts. Our findings suggest that women should consider avoiding riding a scooter and must use restrictive devices during pregnancy, which would help reduce the severity of injuries sustained following an MVC.

Impact of Community Socioeconomic Characteristics on Emergency Medical Service Delays in Responding to Fatal Vehicle Crashes

This study aimed to determine the impact of community socioeconomic status on emergency medical services' response time for fatal vehicle crashes. Authors used the 2019 National Highway Traffic Safety Administration Fatality Analysis Reporting System and 2019-2020 Area Health Resource Files to obtain emergency medical services' time intervals and county socioeconomic characteristics (e.g., median household income, availability of trauma centers, and rurality), generating a study sample of 18,540 individuals involved in fatal vehicle crashes between January and December 2019. Generalized linear models with log-link and Gamma-family were used to obtain estimates, and other variables were adjusted in the model. Both the mean time of the emergency medical service arrival to the site of the crash and the mean transport time from the crash site to hospital varied by county SES. Counties with a higher mean household income had 12% shorter emergency medical services' arrival times and up to 7% shorter emergency medical services' hospital transport times than counties with lower SES. The emergency medical services' hospital transport times by emergency medical services also varied by proximity to trauma centers and were 15% shorter in counties that had ≥2 trauma centers than in counties without trauma centers. This study shows socioeconomic disparities in emergency medical service rescue time for fatal vehicle crashes. Community characteristics play a major role in emergency medical services' arrival time intervals. Prior research demonstrated a strong link between the timeliness of emergency medical service response and the likelihood of survival in fatal motor vehicle accidents. These findings showing that socioeconomically disadvantaged areas and those lacking trauma facilities had slower emergency medical service rescue times, suggest that socioeconomic status may be a predictor of mortality in fatal motor vehicle accidents. Effective emergency medical services are essential to reduce the morbidity and mortality among motor vehicle crash victims; however, disparities exist in the timeliness of these services by geographic and socioeconomic county characteristics. Further research is urgently needed to inform policy interventions.

Predictors of Hospital Readmission After Motor Vehicle Crash: Prospective Cohort Study.

Motor vehicle crash (MVC) is a major public health problem worldwide and contributes to a large burden of death, disability, and economic loss. To identify the predictors of hospital readmission in victims of MVC within 1 year after discharge. A prospective cohort study conducted with individuals who suffered MVC admitted to a regional hospital and who were followed up for 12 months after discharge. Predictors of hospital readmission were verified by means of Poisson regression models with robust variance, using a hierarchical conceptual model. Of the 241 patients followed up, 200 were contacted and comprised the population of this study. Of these, 50 (25.0%) reported hospital readmission during the 12-month period after discharge. It was evidenced that being male (relative risk [RR] = 0.58; 95% CI [0.36, 0.95], p = .033) was a protective factor, whereas occurrences of greater severity (RR = 1.77; 95% CI [1.03, 3.02], p = .036), not receiving pre-hospital care (RR = 2.14; 95% CI [1.24, 3.69], p = .006), the occurrence of postdischarge infection (RR = 2.14; 95% CI [1.37, 3.36], p = .001), and having access to rehabilitation treatment (RR = 1.64; 95% CI [1.03, 2.62], p≤ .001) are configured as risk factors for hospital readmission in individuals who have suffered these events. It was found that gender, trauma severity, pre-hospital care, postdischarge infection, and rehabilitation treatment variables predict hospital readmission in MVC victims within 1 year after discharge.

An Interrupted Time Series Analysis of the Sociodemographics of Crash Victims during the Illinois Stay at Home Order

The race/ethnicity and gender of motor vehicle crash victims during the 2020 Illinois stay at home order are compared to previous years. The median poverty rate of crash victims are compared across the five years of 2016-20, finding that poverty is strongly associated with Black male and female crash victims. Several contributing crash factors like speed, distracted driving, seat belt use, and intoxication are also compared. Within race/ethnicity females significantly decreased their proportion of crash involvement while males significantly increased theirs. An interrupted time series analysis and a segmented binary logistic regression are used in conjunction with a presentation of summary statistics.

Type 2 diabetes mellitus increases the severity of non-fatal injuries, but not the risk of fatal injuries, among driver victims of motor vehicle crashes in Taiwan.

Limited information is available on whether diabetes increases the severity of injuries from motor vehicle crashes (MVCs). This study aimed to investigate the association of type 2 diabetes with injury severity among driver victims of MVCs. This cohort study involved 75,737 adult driver victims with type 2 diabetes from Taiwan's Police-Reported Traffic Accident Registry in 2015-2017, along with 150,911 sex-, age-, and calendar year-matched controls. The severity level of non- fatal injuries was derived from the International Classification of Diseases Programs for Injury Categorization based on the diagnostic codes of National Health Insurance claims within 3 days after an MVC. Information on fatal injuries within 3 days after an MVC was obtained from the Taiwan Death Registry. Logistic regression models were used to estimate the odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) of injury severity in association with type 2 diabetes. After adjusting for potential confounders, driver victims with type 2 diabetes experienced significantly higher risks of mild and severe non-fatal injuries than their counterparts without diabetes, with covariate-adjusted ORs of 1.08 (95% CI, 1.05 to 1.11) and 1.28 (95% CI, 1.20 to 1.37), respectively. By contrast, the adjusted OR for fatal injuries was not significantly elevated, at 1.02 (95% CI, 0.89 to 1.18). Similar results were found when car and scooter driver victims were analyzed separately. Type 2 diabetes was found to moderately increase the severity of non-fatal injuries from MVCs among car and scooter driver victims.

Direct Healthcare Costs of Moderate and Severe Work-Related Injuries: Estimates from the National Trauma Center of Qatar.

Work-related injuries (WRIs) are recognized as a leading cause of admission to the national trauma center of Qatar. A retrospective analysis of trauma registry data and electronic medical records was conducted on a cohort of all WRI patients who were admitted to the Hamad Trauma Center (HTC), in Doha, Qatar, between 2011 and 2017. A total of 3757 WRI patients were treated at the HTC over the 7-year study period. The overall cost for treatment was 124,671,431 USD (18 million USD per year), with a median cost of 19,071 USD. There was a strong positive correlation between the overall cost and hospital-stay cost (r2 = 0.949, p = 0.00001) and between the overall cost and procedure cost (r2 = 0.852, p = 0.00001). Motor vehicle crash (MVC) victims who wore seatbelts had significantly lower injury severity, hospital stay and median total costs. A comparison of patients by quartiles of the costs incurred showed that the proportions of MVC victims, pedestrian injuries and mortality were significantly higher in the fourth quartile when compared to other quartiles (p < 0.05). These findings suggest that investments in the primary prevention of work-related injuries from falls and MVCs, through proven interventions, should be priorities for occupational safety and health in Qatar.

Association of health insurance coverage and probability of dying in an emergency department or hospital from a motor vehicle traffic injury.

ObjectiveDescribe the association of health insurance coverage with the odds of mortality in an emergency department (ED) or hospital for adult victims of a motor vehicle crash.MethodsThis cross‐sectional study pooled and averaged 6 years of data, 2009–2014, from the Nationwide Emergency Department Sample (NEDS). Our analysis was restricted to patients 20–85 years old that were treated in an ED for an injury sustained from a motor vehicle traffic crash (N = 2,203,407 average annual hospital discharges). The outcome variables were whether the motor vehicle crash victim died in the ED or hospital. The predictor variable was health insurance status that was measured as uninsured, Medicare, Medicaid, private insurance, and other health insurance.ResultsMost patients that died had some form of health insurance with less than a quarter classified as uninsured (23%). Nearly half of the patients that died had private insurance (48%) followed by Medicare (13%), Medicaid (9%), and other insurance (8%). Compared to the uninsured, the multivariate adjusted odds ratios (ORs) for death were significantly (P < 0.001) lower for Medicare (OR = 0.83, 95% confidence interval [CI] = 0.76–0.92), Medicaid (OR = 0.76, 95% CI = 0.69–0.84), private insurance (OR = 0.63, 95% CI = 0.58–0.68), and other insurance (OR = O.61, 95% CI = 0.54–0.70).ConclusionAfter accounting for hospital and patient characteristics, lack of health insurance was associated with a higher likelihood of death for patients admitted to an ED or hospital for injuries sustained from a motor vehicle crash.

The Impact of Flame Burn Injuries on Patients Who Sustain Mild Injuries From Motor Vehicle Crashes.

The purpose of this study was to determine the differences in patient outcomes between motor vehicle crash (MVC) victims with an ISS < 15 and those with a similar ISS and a flame burn injury. Data for patients involved in a MVC with a GCS ≥12 and an ISS < 15 with and without flame burn injury were reviewed from the American College of Surgeons National Trauma Data Bank between 2007 and 2017. International Classification of Diseases-9 and -10 revisions and External Injury Codes were used to identify patients who were divided into MVC only (Group 1) and MVC with additional flame burn injury (Group 2). In-hospital mortality was the primary outcome whereas secondary outcomes included ICU admission, ICU length of stay (LOS), hospital LOS, sepsis, deep vein thrombosis, acute respiratory distress syndrome, and pneumonia. Simple linear regression was used in the form of odds ratios to investigate risk factors for mortality and secondary outcomes. The mean LOS and ICU LOS were longer in Group 2 (5.9 vs 4.0 days, p-value <0.001, and 1.2 vs 0.6 days, p-value <0.001, respectively), with more patients being admitted to the ICU as well (22.9% vs 17.3%, p-value <0.001). Also, there were significantly higher rates of pneumonia (0.8% vs 0.5%, p-value 0.0014), deep vein thrombosis (0.6% vs 0.4%, p-value 0.028), and acute respiratory distress syndrome (0.5% vs 0.3%, p-value 0.004) in Group 2. Patients in Group 1 were older and more likely had hypertension, congestive heart failure, and COPD. There was no significant difference in mortality between Groups by odds ratios (OR 0.85, p-value 0.743) or raw percentages (0.3% vs 0.3%, p-value = 0.874). MVC victims with mild injuries who also sustain a burn injury are more likely to require admission to the ICU regardless of their comorbidities and more likely to develop respiratory complications, especially pneumonia and an increase in ICU and hospital LOS.

Risk of 30-day mortality and its association with alcohol concentration level among driver victims of motor vehicle crashes: comparison of population- and hospital-based designs

BackgroundAlthough blood alcohol concentration (BAC) is undoubtedly associated with increased risk of injury among driver victims involved in motor vehicle crashes (MVCs), some studies noted that high BAC was associated...

Canine Assault with Blunt Trauma to the Chest Causing Acute Ischemic Stroke

Ischemic stroke occurs in a significant subset of patients with blunt traumatic cerebrovascular injury (TCVI). The patients are most often victims of motor vehicle crashes or assaults, and suffer ischemic stroke due to injury of the extracranial carotid or vertebral arteries. A 60 year old male described walking in a park when a large dog jumped up striking him in the chest and causing forceful rotation of the neck, but no head injury was reported. Immediately after the incident the patient complained of dizziness, clumsiness of the left arm, and difficulty seeing to the left. Computed tomography angiography of the neck demonstrated 50% stenosis of the proximal right internal carotid artery secondary to mural thrombus. Prior to the event the patient had no known history of carotid disease. Magnetic resonance imaging of the brain showed numerous subcentimeter foci of acute ischemia in the right cerebral hemisphere within the right middle and posterior cerebral artery distributions. Most literature about TCVI and stroke has been published in trauma, general surgery, and neurosurgery journals because these patients are generally primarily managed by trauma surgeons. Because of the increasing prevalence and awareness of TCVI, it is important to bring this clinical entity to the attention of all medical providers.

A novel scoring system to predict the requirement for surgical intervention in victims of motor vehicle crashes: Development and validation using independent cohorts.

Given that there are still considerable number of facilities which lack surgical specialists round the clock across the world, the ability to estimate the requirement for emergency surgery in victims of motor vehicle crashes (MVCs) can ensure appropriate resource allocation. In this study, a surgical intervention in victims of MVC (SIM) score was developed and validated, using independent patient cohorts. We retrospectively identified MVC victims in a nationwide trauma registry (2004-2016). Adults ≥ 15 years who presented with palpable pulse were included. Patients with missing data on the type/date of surgery were excluded. Patient were allocated to development or validation cohorts based on the date of injury. After missing values were imputed, predictors of the need for emergency thoracotomy and/or laparotomy were identified with multivariate logistic regression, and scores were then assigned using odds ratios. The SIM score was validated with area under the receiver operating characteristic curve (AUROC) and calibration plots of SIM score-derived probability and observed rates of emergency surgery. We assigned 13,328 and 12,348 patients to the development and validation cohorts, respectively. Age, motor vehicle collision and vital signs on hospital arrival were identified as independent predictors for emergency thoracotomy and/or laparotomy, and SIM score was developed as 0-9 scales. The score has a good discriminatory power (AUROC = 0.79; 95% confidence interval = 0.77-0.81), and both estimated and observed rates of emergency surgery increased stepwise from 1% at a score ≤ 1 to almost 40% at a score ≥ 8 with linear calibration plots. The SIM score was developed and validated to accurately estimate the need for emergent thoracotomy and/or laparotomy in MVC victims.

Geoclinical analyses for areas at high risk for motorcycle-related road traffic injury in a district in Malaysia

Objective: The goal of this prospective cross-sectional study was particularly to collect data on the epidemiology, the pattern of injury among motorcyclists and to relate with spatial data in a local district. Methods: It involved data collection from prehospital care and inhospital care record. In addition, it utilized geospatial ARCGIS® version 10.1 software in the identification of hotspot location of road traffic injury. Written informed consent was obtained from patient(s) or relatives for their anonymized information to be published in any article. Results: A total of 439 cases were recruited over 10 months. The mean age (standard deviation) of the motorvehicle crash victims was 26.04 (15.26) years. Male comprised 302 (73.3%) of the cases. A total of 176 (42.7%) of the victims were between the ages of 20–40 years. A total of 176 (42.7%) of the motorcyclists admitted were wearing the safety helmets either from the history taking or from the witness. A total of 117 (28.4%) and 28 (6.8%) of the victims were admitted to the general wards and critical care units, respectively for further management. The mean (standard deviation) length of hospital stays was 7.19 (6.94) days. Based on hotspot mapping using ARCGIS 10.1, most of the motorvehicle crash cases occurred mainly within the specific borough. This finding concurred with the locations of the state roads involved that traversed mainly within the same borough. Further geospatial and temporal analysis showed that most of the motorvehicle crash that occurred during the weekend were located within the suburban areas. Conclusion: Motorcyclists, being male and young age are the vulnerable group of road users commonly injured on our road. The initial geospatial analysis of injury-related motorvehicle crash cases has shown common hotspot trending along certain roads and borough within the district. This new knowledge can be used in the future for preventive and road safety programs in high-risk areas.

Evaluating the “cushion effect” among children in frontal motor vehicle crashes

BackgroundThe “Cushion Effect,” the phenomenon in which obesity protects against abdominal injury in adults in motor vehicle accidents, has not been evaluated among pediatric patients. This work evaluates the association between subcutaneous fat cross-sectional area, quantified using analytic morphomic techniques and abdominal injury. MethodsThis retrospective study includes 119 patients aged 1 to 18years involved in frontal impact motor vehicle accidents (2003–2015) with computed tomography scans. Subcutaneous fat cross-sectional area was measured and converted to age- and gender-adjusted percentiles from population-based normative data. Multivariable analysis determined the risk of the primary outcome, Maximum Abbreviated Injury Scale (MAIS) 2+ abdominal injury, after adjusting for age, weight, seatbelt status, and impact rating. ResultsMAIS 2+ abdominal injuries occurred in 20 (16.8%) of the patients. Subcutaneous fat area percentile was not significantly associated with MAIS 2+ abdominal injury on multivariable logistic regression (adjusted Odds Ratio, 0.86; 95% CI, 0.72–1.03; p=0.10). DiscussionThe “cushion effect” was not apparent among pediatric frontal motor vehicle crash victims in this study. Future work is needed to investigate other analytic morphomic measures. By understanding how body composition relates to injury patterns, there is a unique opportunity to improve vehicle safety design. Level of EvidencePrognosis Study, Level III.

Prehospital Extrication Techniques: Neurological Outcomes Associated with the Rapid Extrication Method and the Kendrick Extrication Device

Most emergency medical service personnel rely on one of two techniques to extricate motor vehicle crash victims; the Rapid Extrication Maneuver (REM) or the Kendrick Extrication Device (KED). The purpose of this study was to compare pre- and postextrication neurological outcomes between these two techniques. A retrospective review was conducted of all adult patients with a vertebral column injury resulting from motor vehicle collision and admitted to a Level I trauma center between January 1, 2003 and December 31, 2010. Standardized pre- and postextrication neurological examinations were reviewed for all patients. More than half of patients (N = 81) were extricated using the KED (53.1%, n = 43) and 46.9 per cent (n = 38) were extricated with the REM. Except for the thoracic Abbreviated Injury Score, no differences between groups emerged related to the Glasgow Coma Scale score, Injury Severity Score or Abbreviated Injury Score. There were no pre- and postextrication changes for motor to all extremities and sensation to all extremities using either method. The results of this study suggest that the REM and the KED are equivalent in protecting the patient from neurologic injury after motor vehicle collision.

Traumatic fatal aortic rupture in motorcycle drivers

Traumatic fatal aortic rupture (FAR) is a common finding in victims of motor vehicle crashes (MVC), but its aetiology and mechanisms of production remain an issue of major concern, above all in motorcyclists. This study reports a series of cases obtained from a retrospective analysis of traumatic FARs occurring in motorcycle drivers, with the aim of defining the injury patterns and correlating them with the mechanisms of FAR production.Circumstantial, autopsy and histology data were collected through a retrospective analysis of post mortem examinations performed at the Institute of Legal Medicine of the University of Padova between 2014 and 2016. Among 151 traffic related victims, 8 were motorcycle drivers and displayed traumatic FAR and were thus included in the study.In 7 cases, the presence of abdominal/thoracic injuries suggested that the external compression due to the accident was at least a concurrent cause of FAR, being the predominant mechanism of aortic injury in 4 cases, through the “osseous pinch” or the “waterhammer effect” mechanisms. Our study highlights the well-known role of “preventative forensic pathology”, which has become routinary in traffic medicine since many years, also for defining the points of impact and the injury patterns of motorcyclists sustaining traumatic FAR, thereby facilitating the development of new prevention strategies and devices. Further studies, however, are needed in order to widen the investigated population and to estimate the real number of victims for which traumatic FAR might hypothetically be prevented with specific countermeasures.

Injuries to the Face and Jaw

The human face is vulnerable to injury most frequently as the target of interpersonal violence or when inadequately restrained within a motor vehicle collision. Injuries to both the soft tissues and skeleton of the face are common reasons of emergency department admissions and consultations. Isolated maxillofacial trauma is rarely life threatening or an immediate cause of death unless associated with airway compromise; however, approximately 20% of all patients with facial soft tissue, dentoalveolar, or facial fracture trauma have associated injury to additional body systems. In particular, motor vehicle crash victims, personal assault, occupational injuries, and motorcycle crash victims may have associated injuries to additional body systems. This review covers the assessment and management of maxillofacial fractures, initial evaluation, comprehensive survey, treatment of soft tissue injuries, and treatment of maxillofacial fractures. Figures show a patient with a combination of blunt and penetrating trauma to the central face; fractured mandible; fractured zygoma; infraorbital fracture; broken nose; soft tissue injuries involving the facial nerve distal to the vertical line, likely too small for primary repair; injuries to the parotid duct repaired by passing a catheter through the Stensen duct and through the area of laceration and then repairing the parotid duct over the catheter; mandibular fracture; Le Fort I, Le Fort II, and Le Fort III fractures; findings in patients with Le Fort III maxillary fractures immediately after injury, before obliterative edema develops; and preoperative and postoperative right-sided orbitozygomatic fracture. This review contains 12 highly rendered figures, and 29 references Key words: Jaw injuries; Face injuries; Maxillofacial injuries; Le Fort level; Facial fractures; Orbital fractures; Maxillary fractures;

A COMBINATION OF GEOSPATIAL AND CLINICAL ANALYSIS IN PREDICTING DISABILITY OUTCOME AFTER ROAD TRAFFIC INJURY (RTI) IN A DISTRICT IN MALAYSIA

Abstract. This was a Prospective Cohort Study commencing from July 2011 until June 2013 involving all injuries related to motor vehicle crashes (MVC) attended Emergency Departments (ED) of two tertiary centers in a district in Malaysia. Selected attributes were geospatially analyzed by using ARCGIS (by ESRI) software version 10.1 licensed to the institution and Google Map free software and multiple logistic regression was performed by using SPSS version 22.0. A total of 439 cases were recruited. The mean age (SD) of the MVC victims was 26.04 years (s.d 15.26). Male comprised of 302 (71.7%) of the cases. Motorcyclists were the commonest type of victims involved [351(80.0%)]. Hotspot MVC locations occurred at certain intersections and on roads within borough of Kenali and Binjai. The number of severely injured and polytrauma are mostly on the road network within speed limit of 60 km/hour. A person with an increase in ISS of one score had a 37 % higher odd to have disability at hospital discharge (95% CI: 1.253, 1.499, p-value &lt; 0.001). Pediatric age group (less than 19 years of age) had 52.1% lesser odds to have disability at discharge from hospital (95% CI: 0.258, 0.889, p-value &lt; 0.001) and patients who underwent operation for definitive management had 4.14 times odds to have disability at discharge from hospital (95% CI: 1.681, 10.218, p-value = 0.002). Overall this study has proven that GIS with a combination of traditional statistical analysis is still a powerful tool in road traffic injury (RTI) related research.

Underutilization of occupant restraint systems in motor vehicle injury crashes: A quantitative analysis from Qatar

ABSTRACTIntroduction: Restraint systems (seat belts and airbags) are important tools that improve vehicle occupant safety during motor vehicle crashes (MVCs). We aimed to identify the pattern and impact of the utilization of passenger restraint systems on the outcomes of MVC victims in Qatar.Methods: A retrospective study was conducted for all admitted patients who sustained MVC-related injuries between March 2011 and March 2014 inclusive.Results: Out of 2,730 road traffic injury cases, 1,830 (67%) sustained MVC-related injuries, of whom 88% were young males, 70% were expatriates, and 53% were drivers. The use of seat belts and airbags was documented in 26 and 2.5% of cases, respectively. Unrestrained passengers had greater injury severity scores, longer hospital stays, and higher rates of pneumonia and mortality compared to restrained passengers (P = .001 for all). There were 311 (17%) ejected cases. Seat belt use was significantly lower and the mortality rate was 3-fold higher in the ejected group compared to the nonejected group (P = .001). The overall mortality was 8.3%. On multivariate regression analysis, predictors of not using a seat belt were being a front seat passenger, driver, or Qatari national and young age. Unrestrained males had a 3-fold increase in mortality in comparison to unrestrained females. The risk of severe injury (relative risk [RR] = 1.82, 95% confidence interval [CI], 1.49–2.26, P = .001) and death (RR = 4.13, 95% CI, 2.31–7.38, P = .001) was significantly greater among unrestrained passengers.Conclusion: The nonuse of seat belts is associated with worse outcomes during MVCs in Qatar. Our study highlights the lower rate of seat belt compliance in young car occupants that results in more severe injuries, longer hospital stays, and higher mortality rates. Therefore, we recommend more effective seat belt awareness and education campaigns, the enforcement of current seat belt laws, their extension to all vehicle occupants, and the adoption of proven interventions that will assure sustained behavioral changes toward improvements in seat belt use in Qatar.

Clinical Presentation and Time-Based Mortality in Patients With Chest Injuries Associated With Road Traffic Accidents.

Background:Blunt chest trauma (BCT) poses significant morbidity and mortality worldwide.Objectives:We investigated the clinical presentation and outcome of BCT related to road traffic accidents (RTA).Patients and Methods:A retrospective observational analysis for patients who sustained BCT secondary to RTA in terms of motor vehicle crash (MVC) and pedestrian-motor vehicle accidents (PMVA) who were admitted to the trauma center at Hamad general hospital, Doha, Qatar, between 2008 and 2011.Results:Of 5118 traumatic injury cases, 1004 (20%) were found to have BCT secondary to RTA (77% MVC and 23% PMVA). The majority were males (92%), and expatriates (72%). Among MVCs, 84% reported they did not use protective devices. There was a correlation between chest abbreviated injury score (AIS) and injury severity scoring (ISS) (r = 0.35, r2 = 0.12, P < 0.001). Regardless of mechanism of injury (MOI), multivariate analysis showed that the head injury associated with chest AIS and ISS was a predictor of mortality in BCT. Overall mortality was 15%, and the highest rate was observed within the first 24 hours post-trauma.Conclusions:Blunt chest trauma from RTA represents one-fifth of the total trauma admissions in Qatar, with a high overall mortality. Pedestrians are likely to have more severe injuries and higher fatality rates than MVC victims. Specific injury prevention programs focusing on road safety should be implemented to minimize the incidence of such preventable injuries.

Geospatial and clinical analyses on pediatric related road traffic injury in Malaysia.

The main aim of this study is to utilize the geographical information system (GIS) software and perform the spatial analysis in relation to clinical data for road traffic injury (RTI) pediatric cases attending the emergency department. The study sample included pediatric patients (age less than 18 years) with road-related injuries within a district in Malaysia who attended emergency departments of two tertiary hospitals within the district. In addition to injury, pre-hospital care and outcome data, the coordinate of the locations were obtained by the ambulance paramedics by using portable handheld GPS unit brand Garmin(®) model GPS 72 H. The data was transferred into the excel format which in turn underwent GIS analysis by using ARCGIS(®) (by ESRI) software version 10.1 licensed to the study institution. A total of 102 (24.8%) of all motor vehicle crash (MVC) victims involved the pediatric age group (age 18 years and below). The mean (SD) age of the pediatric victims was 14.30 years (SD 3.830). Male comprised of 68 (66.7%) of the cases. Motorcyclists [88 (88.0%)] were the most common type of victims involved. Interestingly, the majority of the severely injured victims [75 (73%)] sustained the RTI on roads with maximum speed limit of 60 km/hour. The mean (SD) length of hospital stay was 7.83 days (5.59). The pediatric related road traffic injury in Malaysia causes significant health and social burden in the country. This study showed both important clinical and geographical factors that need to be taken into consideration for future preventive action.