Severe Traumatic Brain Injury in Austria II: Epidemiology of hospital admissions

OBJECTIVES: The goal of this paper is to describe the hospital-based epidemiology of severe TBI in Austria. PATIENTS AND METHODS: Data sets from 492 patients included in the study by 5 Austrian hospitals were available. Age and gender distribution, education, occupation, location of trauma, mechanism of injury, alcohol use, type and severity of injury, associated injuries, length of intensive care unit stay, and intensive care unit outcome were evaluated for each of the 5 centers. RESULTS: The sample represents roughly 13% of all cases with severe TBI which were treated in Austrian hospitals during the study period. Mean age was 48 +/- 21 years, and most patients were male (72%). The most important trauma locations were roads (50%), home (24%), outdoors (10%), and workplace (7%). Transportrelated trauma was the most important mechanism (44%) followed by falls < 3 m (30%), falls > 3 m (11%), and sports injuries (5%). Detailed analysis of transport-related trauma showed that car accidents (45%) were most common, followed by pedestrian (20%), motorbike (19%), and bicycle (16%) accidents. Significant differences between the centers were found for most of the variables analyzed. The severe traumatic brain injury was associated with spinal cord injury in 10%, and with severe multiple trauma in 38% of cases. Intensive care mortality was 31.7%. There were no significant correlations between mechanisms of injury and severity of trauma, nor between mechanisms and ICU outcome. CONCLUSIONS: Epidemiology of severe traumatic brain injuries in Austria is not much different from other industrialized countries. Traffic accidents are responsible for the majority of traumas, stressing the importance of road injury prevention. Attention should also be paid to the specific risks of older people and to prevent injuries at home.     

Motor vehicle trauma: analysis of injury profiles by road-user category

Background

Vehicle accidents in Greece are among the leading causes of death and the primary one in young people. The mechanism of injury influences the patterns of injury in victims of vehicle accidents.

Objective

Identification and analysis of injury profiles of motor‐vehicle trauma patients in a Greek level I trauma centre, by road‐user category.

Patients and methods

The trauma registry data of Herakleion University Hospital of adult trauma patients admitted to the hospital after a vehicle accident between 1997 and 2000 were retrospectively examined. Patients were grouped based on the mechanism of injury into three road‐user categories: car occupants, motorcyclists, and pedestrians.

Results

Of 730 consecutive patients, 444 were motorcyclists (60.8%), 209 were car occupants (28.7%), and 77 were pedestrians (10.5%). Young men constituted the majority of injured motorcyclists whereas older patients (p = 0.0001) and women (p = 0.0001) represented a substantial proportion of the injured pedestrians. With regard to the spectrum of injuries in the groups, craniocerebral injuries were significantly more frequent in motorcyclists and pedestrians (p = 0.0001); abdominal (p = 0.009) and spinal cord trauma (p = 0.007) in car occupants; and pelvic injuries (p = 0.0001) in pedestrians. Although the car occupants had the highest Injury Severity Score (ISS) (p = 0.04), the pedestrians had the poorest outcome with substantially higher mortality (p = 0.007) than the other two groups.

Conclusions

The results reveal a clear association between different road‐user categories and age and sex incidence patterns, as well as outcomes and injury profiles. Recognition of these features would be useful in designing effective prevention strategies and in comprehensive prehospital and inhospital treatment of motor‐vehicle trauma patients.     

Increased pedestrian mortality among the elderly

Elderly pedestrians struck by motor vehicles have the highest mortality rate of all pedestrian injury victims. One thousand eighty-two motor vehicle-pedestrian accidents occurring in a metropolitan area over a 5-year period were studied. Age-specific injury rates and fatality rates were evaluated with respect to the injury severity scores (ISS) for all fatally injured autopsied pedestrians. Of the 1,082 injuries, 131 fatalities occurred. Mean ISSs were found to be significantly higher for pedestrians dying at the scene of the accident (mean ISS, 54.83) and higher for those dying in the emergency department (mean ISS, 45.18), than for pedestrians who died in the hospital (mean ISS, 30.57) (P less than .0001). The mortality rate for pedestrians aged greater than or equal to 60 years was substantially higher than for those adults aged less than 60 years of age (P less than .001). Elderly patients involved in accidents were much more likely to die than younger pedestrians (44.6% v 10.4%; P less than .0001). Elderly pedestrians were significantly overrepresented in the group of pedestrians dying in the hospital compared with younger injury victims (52.5% v 21.5%; P less than .008). This study shows that elderly pedestrians struck by motor vehicles die at a higher rate because they succumb to injuries in the hospital more frequently than younger pedestrians. This may reflect the greater susceptibility of the elderly to metabolic, surgical, and infectious complications after admission to the hospital. A decrease in mortality rates of elderly patients suffering pedestrian injuries will probably follow improved in-hospital intensive care services for the elderly.     

Factors influencing the injury pattern and injury severity after high speed motor vehicle accident--a retrospective study

INTRODUCTION: Motor vehicular accidents (MVA) are the leading cause of death among people under 40 years of age. Despite improvement in car safety and driver awareness of the use of safety devices, fatalities and severe injuries continue to occur. MATERIAL AND METHODS: From 1997 to 2004, 13,678 patients after MVA were admitted to our institution. Out of this cohort, 584 (4.3%) patients suffered blunt major trauma defined as Injury Severity Score (ISS) >or=16 and at least one life-threatening injury in one body region. Preclinical data were recorded in 458 patients matching the inclusion criteria. The circumstances of the trauma scene such as weather conditions were analysed as well as technical crash data such as direction of impact, security devices used and type and severity of automobile damage. In a retrospective trial, the influence of preclinical variables on the injury pattern and on injury severity was investigated. RESULTS: 314 (68.6%) patients were male and 144 (31.4%) female. Injury severity (p=0.015) and rate of multiple injuries (p=0.012) were higher in patients after side-impact crashes. If automobiles with SIPS were used, injury severity was significantly reduced in case of side-impact crashes (p=0.003). Patients after frontal impact crashes had a higher rate of severe traumatic brain injury (TBI) compared to the overall cohort (p=0.014). Patients suffering blunt aortic (n=29) dissection were involved in frontal crashes with seat belt use (p<0.001). If patients were entrapped, injury severity (p=0.021) and rate of multiple injuries (p=0.018) were significantly higher. Rear-end collisions with trucks without rear protection led to higher mortality rates (p=0.011). CONCLUSION: According to our data significant association between technical crash data and injury pattern and injury severity can be assumed. In case of high speed MVA in rural areas the trauma mechanism and the circumstances (i.e., impact direction, automobile deformation) should be considered to identify patients at high risk of severe blunt trauma and multiple injuries.     

微创软通道血肿穿刺引流术治疗中少量基底核区高血压脑出血的效果观察

目的探讨微创软通道血肿穿刺引流术治疗中少量基底核区高血压脑出血与保守治疗基底核区高血压脑出血的效果。方法选取2013年1月至2017年6月滨州市中心医院神经外科收治的164例中少量基底核区高血压脑出血患者,男83例,女81例,年龄(56±8)岁,年龄范围为36~77岁,采用随机数表法将其随机分为传统治疗组与微创治疗组,每组82例。于患者治疗前、治疗后14 d、1个月、3个月及6个月进行神经功能缺损评分(NDS)和日常生活能力评定(ADL);并对微创治疗组和传统治疗组两组患者在14 d、1个月、3个月及6个月时的病死率、有效率及基本痊愈率进行比较。结果治疗前两组患者NDS比较,差异无统计学意义(P>0.05);微创治疗组在治疗后14 d[(21.17±4.97)分]、1个月[(18.38±5.26)分]、3个月[(12.73±3.98)分]、6个月[(8.67±3.46)分]NDS均优于传统治疗组[(28.14±5.82)分、(26.67±5.03)分、(18.15±4.17)分、(13.19±3.54)分],差异有统计学意义(P<0.05)。治疗前两组患者ADL比较,差异无统计学意义(P>0.05);微创治疗组患者在治疗后14 d[(24.34±4.64)分]、1个月[(41.54±4.51)分]、3个月[(80.84±4.36)分]、6个月[(92.29±3.76)分]ADL均优于传统治疗组[(16.26±4.32)分、(20.67±4.63)分、(65.15±4.16)分、(86.86±3.61)分],差异有统计学意义(P<0.05)。微创治疗组患者治疗后14 d基本痊愈率[12.2%(10/82)]、有效率[75.6%(62/82)]、病死率[1.2%(1/82)]均优于传统治疗组[3.7%(3/82)、46.3%(38/82)、4.9%(4/82)]患者;治疗后一个月基本痊愈率[19.5%(16/82)]、有效率[84.1%(69/82)]、病死率[2.4%(2/82)]均优于传统治疗组[9.8%(8/82)、74.4%(61/82)、6.1%(5/82)]患者;治疗后三个月基本痊愈率[26.8%(22/82)]、有效率[92.7%(76/82)]、病死率[2.4%(2/82)]均优于传统治疗组[15.9%(13/82)、82.9%(68/82)、6.1%(5/82)]患者;治疗后六个月基本痊愈率[29.3%(2/82)]、有效率[95.1%(78/82)]、病死率[2.4%(2/82)]均优于传统治疗组[18.3%(5/82)、91.5%(75/82)、6.1%(5/82)]患者;差异均有统计学意义(P<0.05)。结论微创软通道血肿穿刺引流术能简单、快速清除血肿,能明显促进脑出血患者神经功能的恢复,降低患者的病死率,是治疗中少量基底核区脑出血的有效方法。     

Incidence and significance of injuries on secondary CT imaging after initial selective imaging in blunt trauma patients

ObjectiveIt is unclear if additional computerized tomography (CT) imaging is warranted after injuries are identified on CT in blunt trauma patients. The objective of this study was to determine the incidence and significance of injuries identified on secondary CT imaging after identification of injuries on initial CTs in blunt trauma patients.MethodsThis was a retrospective cohort study at an academic Level 1 trauma center with a two-tiered trauma system. Inclusion criteria: age ≥ 18, level 2 trauma activation, injury identified on initial CT, and secondary CTs ordered. Secondary injuries were categorized as resulting in: no changes, minor changes, or major changes in management.Results537 patients underwent 1179 initial CT scans which identified 744 injuries. There were 1094 secondary CTs which identified 143 additional injuries in 94 (18%) patients. 9 (1.7%) patients had at least one major management change and 64 (12%) had at least one minor management change. Rib fracture(s) was the most common injury on secondary scans [45/143 (32%)]. The major management changes were: tube thoracostomy for pneumothorax (4 patients), blood transfusion for hemoperitoneum (1 patient), surgery for acetabular fracture (1 patient), thoracolumbar brace for spine fracture (2 patients) and angiography for splenic injury (1 patient).ConclusionWhile a significant proportion of patients (18%) had injuries on secondary CT, only 1.7% of patients had a resultant major management change. Future research is warranted to determine the need for additional CT imaging after an initial selective imaging strategy in blunt trauma patients.     

Chest X-rays in detecting injuries caused by blunt trauma

BACKGROUND: The appropriate sequence of different imagings and indications of thoracic computed tomography (TCT) in evaluating chest trauma have not yet been clarified at present. The current study was undertaken to determine the value of chest X-ray (CXR) in detecting chest injuries in patients with blunt trauma.METHODS: A total of 447 patients with blunt thoracic trauma who had been admitted to the emergency department (ED) in the period of 2009-2013 were retrospectively reviewed. The patients met inclusion criteria (age>8 years, blunt injury to the chest, hemodynamically stable, and neurologically intact) and underwent both TCT and upright CXR in the ED. Radiological imagings were re-interpreted after they were collected from the hospital database by two skilled radiologists.RESULTS: Of the 447 patients, 309 (69.1%) were male. The mean age of the 447 patients was 39.5±19.2 (range 9 and 87 years). 158 (35.3%) patients were injured in motor vehicle accidents (MVA). CXR showed the highest sensitivity in detecting clavicle fractures [95%CI 78.3 (63.6-89)] but the lowest in pneuomediastinum [95%CI 11.8 (1.5-36.4)]. The specificity of CXR was close to 100% in detecting a wide array of entities.CONCLUSION: CXR remains to be the first choice in hemodynamically unstable patients with blunt chest trauma. Moreover, stable patients with normal CXR are candidates who should undergo TCT if significant injury has not been ruled out.     

Endovascular management of traumatic arterial emergencies: A single center retrospective study

Objectives: To present our experience in delivering endovascular therapies for emergent vascular traumas with various vascular structures. Methods: Between September 2013 and February 2018, patients who underwent endovascular intervention due to penetrating, blunt and iatrogenic arterial traumas were analyzed, retrospectively. Demographic data, trauma site, mechanism of injury, angiographic findings or arterial injury patterns, treatment methods, and outcomes were recorded. Results: A total of 30 patients were included. The mean age of patients was 39 years (range: 15-87 years). Arterial trauma locations were in the compressible area with a rate of 43％ (n=13) and in the noncompressed area with a rate of 57％ (n=17). Mechanisms of injuries were blunt [53％ (n=16)], penetrating [17％ (n=5)], and iatrogenic [30％ (n=9)]. The most common indication for endovascular treatment was blunt noncompressible injury (n=12). Methods used for treatment were stent-graft (46％, n=14) and coil embolization (54％, n=16). Immediate success was obtained in all procedures. The mean follow-up duration was 5 months (range: 1-12 months). Conclusions: Endovascular treatments performed in traumatic arterial emergencies are effective and minimally invasive with very low complication rates even in hemodynamically unstable patients.     

Facial trauma in motor vehicle accidents: Etiological factors

The effects of seat belts and the use of alcohol and drugs have been studied as etiological factors in facial trauma to occupants of motor vehicle accidents (MVAs). During a 15-month period, 461 patients were admitted to a regional trauma center as a result of injuries sustained in MVAs. Two hundred thirty-seven (51%) of these patients had facial trauma. Facial trauma was the single most common injury in these patients. One hundred eighty-five patients (78%) had major soft tissue injury, and 52 patients (22%) had facial bone fractures. Forty-two of 237 patients (18%) with facial trauma were wearing seat belts compared with 74 of 224 patients (33%) without facial trauma who were wearing seat belts at the time of the accident. Large numbers of patients who were wearing seat belts at the time of the accident had minor injuries and were never admitted to the hospital. Sixty-five of 224 patients (24%) without facial trauma and 121 of 237 patients (51%) with facial trauma tested positive for alcohol or drugs. The majority of the patients who tested positive for alcohol had blood alcohol levels of more than 100 mg/dL. Head injuries and blunt chest trauma were most commonly associated injuries in these patients. This study suggests that use of alcohol and drugs in occupants of the motor vehicle had a major effect on the etiology of facial trauma. Also it supports the data that suggests that the use of seat belts prevents a wide range of injuries including facial trauma in MVAs.     

Compromising bradycardia: management in the emergency department

AIM OF THE STUDY: Bradycardia may represent a serious emergency. The need for temporary and permanent pacing is unknown. METHODS: We analysed a registry for the incidence, symptoms, presenting rhythm, underlying mechanism, management and outcome of patients presenting with compromising bradycardia to the emergency department of a university hospital retrospectively during a 10-year period. RESULTS: We identified 277 patients, 173 male (62%), median age 68 (IQR 58-78), median ventricular rate 33 min(-1) (IQR 30-40). The leading symptoms were syncope [94 (33%)], dizziness [61 (22%)], collapse [46 (17%)], angina [46 (17%)] and dyspnoea/heart failure [30 (11%)]. The initial ECG showed high grade AV block [134 (48%)], sinus bradycardia/AV block [46 (17%)], sinuatrial arrest [42 (15%)], bradycardic atrial fibrillation [39 (14%)] and pacemaker-failure [16 (6%)]. The underlying mechanisms were primary disturbance of cardiac automaticity and/or conduction [135 (49%)], adverse drug effect [58 (21%)], acute myocardial infarction [40 (14%)], pacemaker failure [16 (6%)], intoxication [16 (6%)] and electrolyte disorder [12 patients (4%)]. In 107 (39%) patients bed rest resolved the symptoms. Intravenous drugs to increase ventricular rate were given to 170 (61%) patients, 54 (20%) required additional temporary transvenous/transcutaneous pacing. Two severely intoxicated patients could be stabilised only by cardiopulmonary bypass. A permanent pacemaker was implanted in 137 patients (50%). Mortality was 5% at 30 days. CONCLUSION: In our cohort, about 20% of the patients presenting with compromising bradycardia required temporary emergency pacing for initial stabilisation, in 50% permanent pacing had to be established.     

德阳市儿童道路交通伤流行病学特点和预防措施

目的：探讨德阳市儿童道路交通伤流行病学特征,提高患儿道路交通伤救治水平和防范措施。方法：回顾分析德阳市人民医院自2010-01-2011-12收治的2498例儿童道路交通伤致伤原因及临床特点。结果：2498例儿童道路交通伤最易发生年龄段在〉4-9岁（54.28%）,明显高于其他年龄段（P〈0.05）。儿童道路交通伤以轻伤为主,擦挫伤为主要类型。汽车和摩托车是最主要肇事车辆和导致死亡的肇事车辆,主要的致死原因为颅脑损伤和腹部损伤。道路交通伤害主要发生在市区,发生时间主要在交通拥堵的上、下班时段。结论：德阳市儿童道路交通伤害有其自身的流行病学特点,倡导文明驾驶,完善道路交通公共设施建设,开展针对儿童道路交通事故防范的宣传教育,改进急救体系和服务模式等社会多方面的共同协作,将能有效的减少儿童道路交通伤害的发生。     

The motorcyclist: Easy rider or easy victim? An analysis of motorcycle accidents in Germany

This report reviews the findings from 86 motorcycle accidents during a 1-year period at the Trauma Center “Bergmannsheil” in Bochum, Germany. A study of the case histories supplemented by telephone conversations yielded the following results: 90.7% of the patients were men, and the average age was 28.8 years; most of the accidents occurred in the 25- to 30-year-old age group (27.9%). Motorcycle accidents happened mostly during recreational rides on weekends in the summertime. Although there was a high rate of helmet use (98.8%), the head region was affected in 12 victims. Two patients died because of their severe head injuries (2.3%). Lower extremity injuries (46%), especially open tibia fractures (19.7%), were among the most common injuries sustained. Fractures of the distal radius constituted the largest portion of upper extremity injuries (18.8%). The average stay in our hospital was 35.4 days; 23.4% of the patients had to change jobs after the accident. Fifty percent of the crashes happened with motorcycles between 500 and 750 cc stroke volume. Although 34.5% possessed their driver's licenses for more than 8 years, they had not had much experience handling a motorbike. These results underline the fact that motorcycle accidents are sustained by young men in their working prime; as a result, these accidents pose a tremendous burden to individuals and society and every attempt should be made to offer highly qualified surgical and trauma care to minimize the damage to the motorbiker. A plea is made for more prevention measures like driver education, better road conditions, or legislative changes to prevent motorcycle crashes. The wearing of a helmet is strongly advocated.     

Epidemiology of paediatric injury.

Thousands of young lives are lost every year as a result of accidents, and trauma remains the number one cause of paediatric death. There is a pattern and regularity to children's injury: boys are more often victims than the girls, most injuries occur during the summer months, the pedestrian child has usually been the victim of a road traffic accident (RTA) and, in 75% of these cases, has suffered head injury. The research into paediatric trauma is still very young. For instance, socio-economic and ethnic factors play a significant role in the statistics of accidental death. In order to take effective preventative measures more factors must be determined.     

An epidemiological survey on motorcycle accident victims assisted at a reference trauma center of Sergipe

The trauma caused by motorcycle accidents affects a large number of victims and is a serious public health problem in Brazil. This documental study was performed with a quantitative approach with the objective to raise epidemiological data from 554 motorcycle accident victims assisted in September and October 2006 in a referral center for trauma of Sergipe. The result analysis shows a predominance of men (82.7%) with mean age of 27.78 years, who were admitted during the night shift (45.9%), Sunday (27.3%), whose injuries were abrasions (n=169) on the head, face and neck. The victims stayed in the hospital for up to 12 hours (76%) and were discharged. Of the registered cases, 14.6% were suspected of having consumed alcohol and 19.3% were not wearing a helmet during the accident.     

广州市97 823例院前急救患者流行病学分析

目的 调查广州市院前急救患者流行病学情况,探讨院前急救病例特点.方法 从广州市急救医疗指挥中心系统数据库中导出2008年度全部数据进行统计分析.结果 ①在969 410次呼叫量中,日时间分布以16:00-18:00为最高(114 224次、占11.78%),以04:00-06:00为最低(23 237次、占2.40%).②在109 682次出车中,白云区出车量最多(29 364次、占26.77%),其次是海珠区(20 069次、占18.30%)、天河区(19 962次、占18.20%).③在97 823例院前急救患者中,男性的比例与死亡率均明显高于女性[比例:57.65%(56 394)比38.48%(37 641),死亡率:59.17%(3 269)比33.95%(1 876)].④在97 823例院前急救患者中,创伤类是院前急救中最多的,占34.57%(33 820),尤其是交通意外,占11.56%(11 307);且以21～50岁青壮年者最多;其次分别是神经系统、循环系统、呼吸系统、消化系统急症,且均以51岁(尤其是70岁)以上的中老年者最多.⑤在97 823例院前急救患者中,共死亡5 525例,占5.65%.循环系统急症死亡(尤其是猝死)居首位(1 827例、占33.07%),其次分别为其他系统急症死亡(1 646例、占29.79%)、创伤类死亡(866例、占15.67%)、呼吸系统急症死亡(413例、占7.48%)、神经系统急症死亡(329例、占5.95%);其中循环系统、呼吸系统、神经系统急症死亡均以51岁(尤其是70岁)以上的中老年者最多,其他系统急症死亡以61岁以上的老年者最多,创伤类死亡以21～40岁中青年者最多.结论 ①加强心脑血管疾病和呼吸系统疾病防治,提高中老年患者的常见急危重症早期识别与院前急救水平对降低死亡有重要意义.②加强安全生产、遵守交通法规、强化法制意识是降低创伤,尤其是交通意外发生及其死亡的有力手段.

Abstract：

Objective To investigate the epidemiological information of patients in pre-hospital medical care in Guangzhou city, and to explore the characteristics of the patients. Methods The data in the year of 2008 were retrieved from the computer database of Guangzhou Emergency Medical Rescue Command Center. Results ①In a total of 969 410 calls received, the time of distribution was found to be mainly between 16:00 and 18:00 [11.78% (114 224)], and least frequently between 04:00 and 06:00 [2.40% (23 237)]. ②Among 109 682 dispatches of ambulances, Baiyun district received the most [26.77% (29 364)], and followed by Haizhu district [18.30% (20 069)], Tianhe district [18.20% (19 962)], respectively. ③Among 97 823 cases of pre-hospital medical care, death rate of the male patients was higher than the female [amount: 57.65% (56 394) vs. 38.48% (37 641), mortality: 59.17% (3 269) vs. 33.95% (1 876)]. ④In 9 7823 cases of pre-hospital medical care, trauma constituted the highest rate [34.57% (33 820)], especially traffic accidents [11.56% (11 307)], and the age of most of the patients ranged between 21 and 50. Disease of the nervous system ranged the second, followed by diseases of circulatory system, respiratory system and digestive system, and most of them were over 51 years old, and most frequently above 70. ⑤In 97 823 cases of pre-hospital medical care, there were 5 525 deaths (5.65%), in whom the circulatory system diseases ranged first (especially sudden death) [33.07% (1 827)], followed by unclassified diseases [29.79% (1 646)], trauma [15.67% (866)], respiratory diseases [7.48% (413)], and neurological emergency illnesses [5.95% (329)]. The age of deceased was far older than 51, particularly 70. The age of most of the deceased was above 61, and age of traumatic death was 2140. Conclusion ①It is very important to reduce the death rate of the middle-old aged patients by strengthening prevention and timely treatment of cardiovascular and cerebrovascular diseases, and improve the medical strategies in emergency care, in order to lower the death rate during emergency. ②It is very important to emphasize safely in production lines and to strengthen traffic regulations in order to reduce the incidence of trauma, thus it is especially traffic accident, expect that the death rate of trauma could be lowered.     

Baby walker related injuries--a continuing problem.

Baby walkers have been associated with burns, head trauma and other types of injury. A retrospective study of all infants under the age of two years attending an accident and emergency unit demonstrated 22 injuries associated with baby walkers from a total of 1049 attendances. The most serious injuries were three skull fractures, with the most common mechanism being of a fall downstairs in the walker. Injury while in a baby walker occurred with a similar frequency to injury due to road traffic accidents. We conclude that despite previous warnings Baby Walkers still represent a considerable hazard to infants.     

Road traffic accident mortality in Singapore

The aim of this study was to identify factors that contribute to road traffic accident mortality and the patterns of injuries sustained by these victims, with a view to identifying areas for future intervention. All road traffic accident deaths that occurred in Singapore over a period of 1 year were reviewed. A total of 226 deaths occurred: 82.3% of the victims were male. The median age was 31 years. Blood alcohol was detected in 42 (18.7%) victims. In general, head (86.7%), followed by thoracic (67.7%) and abdominal (31.4%) injuries, were the most common injuries. Severe lower extremity trauma was most common among pedestrians and pedal cyclists (20.6% and 11.0%, respectively). The mean Injury Severity Score was 38.7. The relative risk of mortality between motorcyclists and motorcar drivers was 18.8:1. Suggestions for future prevention and intervention include stricter enforcement of speed limits, more severe penalties for drunk driving, helmet use among pedal cyclists, and the introduction of pre-hospital advanced airway management.     

2004年浙江省车祸死亡及交通行为分析

目的 分析浙江省车祸死亡流行病学特征和人群交通行为情况,为预防和控制道路交通事故提供依据.方法 利用浙江省公共卫生监测系统2004年资料,采用ICD-10的编码进行伤害死因分类统计,计算伤害死亡率、死因构成、潜在寿命损失年(YPLL).结果 车祸死亡率为19.49/10万,居伤害死因的首位,农村车祸死亡率高于城市0.56倍,男性高于女性1.80倍,55.98%死亡病例集中在青壮年,学生人群的车祸死亡占其总死亡的比重较高.9种车祸死亡类型中,位居首位的是人-车碰撞造成行人死亡.减寿最为严重的车祸死亡者,城市为行人,农村为骑(乘)摩托车人员.调查前30 d,分别有11.30%、11.26%、12.78%的人有酒后驾车史、疲劳驾车(3 h以上)史和无证驾驶史,有36.22%的人驾(乘)摩托车未佩带头盔,有26.33%的行人有不遵守交通规则经历.结论 应加强对全民,特别是青壮年的交通安全教育,提高人群的交通安全意识.