Patterns of injury to restrained children in side impact motor vehicle crashes: the side impact syndrome

BACKGROUND: Injury patterns among children in frontal collisions have been well documented, but little information exists regarding injuries to children in side impact collisions. METHODS: Restrained children 14-years-old or younger admitted to the hospital for crash injuries were analyzed. Data concerning injuries, medical treatment, and outcome were correlated with crash data. Case reviews achieved consensus regarding injury contact points. Side impacts were compared with frontal impacts. These results were then compared with data from the National Automotive Sampling System. RESULTS: There were no differences between the groups with respect to age, sex, restraint type, or seat position. Compared with frontal crashes, children in side impacts were more likely to have an Injury Severity Score > 15 (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.7-5.8) and were more likely to have Abbreviated Injury Scale score 2+ injuries to the head (OR, 2.5; 95% CI, 1.4-4.4), chest (OR, 4.0; 95% CI, 2.0-8.0), and cervical spine (OR, 3.7; 95% CI, 1.2-11.3). When compared with National Automotive Sampling System data, similar trends were seen regarding Abbreviated Injury Scale score 2+ injuries to the head, chest, and extremities. CONCLUSION: In this study population, side impacts resulted in more injuries to the head, cervical spine, and chest. Knowledge of this pattern-the side impact syndrome-can help guide diagnosis, treatment, and prevention strategy.     

The role of restraint and seat position in pediatric facial fractures

BACKGROUND: Recently, head and brain injuries were identified as consequences of the inappropriate use of seat belts by children. The proposed mechanism of these injuries might also place a child at risk for facial fracture. METHODS: A probability sample of children under age 16 involved in crashes were enrolled in an ongoing crash surveillance system (1998-2001) that links insurance claims data to telephone survey and crash investigation data (unweighted, n = 12,659; weighted, n = 131,717). Incidence of facial fracture was estimated and a series of cases were examined using in-depth crash investigation to identify the mechanisms of these injuries, specifically, the role of seating position and restraint use in the mechanism of injury. RESULTS: Ninety-two children suffered a fracture of the facial bones (0.07% of all children in crashes). Among restrained children with facial fractures (n = 68), those inappropriately restrained were at a 1.6-fold higher risk (95% confidence interval, 1.2-2.1; p = 0.001) of significant injury than those appropriately restrained for their age. The in-depth investigations revealed that excessive head excursion resulting from suboptimal torso restraint caused facial impact, which resulted in the facial injuries described. CONCLUSION: The potential for disfigurement associated with these facial injuries may resonate strongly with parents, and prevention of disfigurement may provide additional motivation for proper restraint, in particular, booster seats and rear seat location, for this pediatric population.     

Patterns of severe injury in pediatric car crash victims: Crash Injury Research Engineering Network database

Background/Purpose

Motor vehicle crashes (MVCs) account for 50% of pediatric trauma. Safety improvements are typically tested with child crash dummies using an in vitro model. The Crash Injury Research Engineering Network (CIREN) provides an in vivo validation process. Previous research suggest that children in lateral crashes or front-seat locations have higher Injury Severity Scale scores and lower Glasgow Coma Scale scores than those in frontal-impact crashes. However, specific injury patterns and crash characteristics have not been characterized.

Methods

Data were collected from the CIREN multidisciplinary crash reconstruction network (10 pediatric trauma centers). Injuries were examined with regard to crash direction (frontal/lateral), restraint use, seat location, and change in velocity at impact (ΔV). Injuries were limited to Abbreviated Injury Scale (AIS) scores of 3 or higher and included head, thoracic, abdominal, pelvic, spine, and long bone (orthopedic) injuries. Standard age groupings (0-4, 5-9, 10-14, and 15-18 years) were used. Statistical analyses used Fisher's Exact test and multiple logistic regressions.

Results

Four hundred seventeen MVCs with 2500 injuries were analyzed (males = 219, females = 198). Controlling for ΔV and age, children in lateral-impact crashes (n = 232) were significantly more likely to suffer severe injuries to the head and thorax as compared with children in frontal crashes (n = 185), who were more likely to suffer severe spine and orthopedic injuries. Children in a front-seat (n = 236) vs those in a back-seat (n = 169) position had more injuries to the thoracic (27% vs 17%), abdominal (21% vs 13%), pelvic (11% vs 1%), and orthopedic (28% vs 10%) regions (P < .05 for all). Seat belts were protective for pelvic (5% vs 12% unbelted) and orthopedic (15% vs 40%) injuries (odds ratio = 3, P < .01 for both).

Conclusion

A reproducible pattern of injury is noted for children involved in lateral-impact crashes characterized by head and chest injuries. The Injury Severity Scale scores were higher for children in front-seat positions. Increased lateral-impact safety measures such as mandatory side curtain airbags may decrease morbidity. Furthermore, continued public education for positioning children in the back seat of cars is warranted.     

A latent class analysis of injury patterns among rear-seated, seat-belted children

BACKGROUND: The objective of the study was to determine the constellation of injury patterns in rear-seated, seat-belt-restrained children using data-driven latent class methodology novel to injury prevention research. METHODS: A cross-sectional probability sample of rear-seated, belt-restrained children aged 5 to 15 years in crashes was obtained via insurance claims records and a telephone survey. Eight body regions of AIS 2 or greater injury (concussion, nonconcussive head injury, face, chest, abdomen, neck/spine/back, upper extremity, lower extremity) were determined, and a latent class model was fit to determine whether underlying "injury clusters" were present. RESULTS: A three-class model appears to best fit to observed data: an "abdominal/spine" cluster that contained 11% of the population, a "concussion" cluster that contained 56% of the population, and a residual "mixture" cluster that contained the remaining 33% of the population. When compared with the mixture cluster, the abdomen/spine cluster was associated with 4 to 8 year old children, lap-only belt restraint, frontal impacts, and minivans. The concussion cluster was also more common among 4 to 8 and 9 to 12 year olds, with side or rear impact crashes, and with pickup trucks. CONCLUSIONS: Latent class analysis allows injury clusters to be estimated from the data, not predetermined by the investigator, and suggests that distinct mechanisms of abdominal injury and concussive head injury exist in a population-based sample of children in motor vehicle crashes.     

Characteristics of kangaroo-related motor vehicle crashes

BackgroundKangaroo-related motor vehicle collisions are common but there is limited literature on this topic. Drivers confronted by kangaroos may choose to swerve or to directly collide with the kangaroo. The effect of these differing crash mechanisms, along with the effect of vehicle type or time of day, has not yet been reported.MethodsA retrospective cohort study was performed, examining patients admitted to our tertiary trauma centre for kangaroo-related motor vehicle collisions between 2000 and 2020. Data on patient demographics, crash characteristics, and hospital stay were collected and analysed.ResultsA total of 366 patients were included and were predominantly male (76%) with an median age of 40. Swerve crashes were more common (59%) than direct impact and swerving was a statistically significant predictor of reduced injury severity score on multivariable analysis (other significant factors were female sex and no rollover). Motor vehicle crashes and motorbike crashes had differing crash characteristics. Motor vehicle crashes were more likely the result of swerving, and swerving was less likely to cause ejection or require extrication but more likely to cause rollover. Motorbike crashes however, were more likely the result of head on collision and riders were more likely to be ejected from the vehicle, require extrication, or be involved in a rollover. In terms of time of day, there were more crashes at dawn and there was a trend towards higher injury severity score and length of stay for night-time crashes.ConclusionFor kangaroo-related motor vehicle crashes, predictors of increased injury severity score on multivariable analysis were male sex, direct impact, and rollover. Motorbikes and motor vehicles had differing crash mechanisms and characteristics, as did night-time crashes when compared to daytime or twilight crashes.Level of evidenceIV, prognostic     

Crash analysis of lower extremity injuries in children restrained in forward-facing car seats during front and rear impacts

BACKGROUND: The mechanism, crash characteristics, and spectrum of lower extremity injuries in children restrained in forward-facing car seats during front and rear impacts have not been described. METHODS: We identified in two databases children who sustained lower extremity injuries while restrained in forward-facing car seats. To identify the mechanism, we analyzed crash reconstructions from three frontal-impact cases from the Crash Injury Research and Engineering Network. To further describe the crash and injury characteristics we evaluated children between 1 and 4 years of age with lower extremity injuries from front or rear impacts in the National Automotive Sampling System (NASS) Crashworthiness Data System (CDS) database. RESULTS: Crash reconstruction data demonstrated that the likely mechanism of lower extremity injury was contact between the legs and the front seatbacks. In the CDS database, we identified 15 children with lower extremity injuries in a forward-facing child seat, usually (13 out of 15) placed in the rear seat, incurred in frontal impacts (11 out of 15). Several (5 out of 15) children were in unbelted or improperly secured forward-facing car seats. Injury Severity Scores varied widely (5-50). CONCLUSIONS: Children in forward-facing car seats involved in severe front or rear crashes may incur a range of lower extremity injury from impact with the car interior component in front of them. Crash scene photography can provide useful information about anatomic sites at risk for injury and alert emergency department providers to possible subtle injury.     

Kinematics of belted fatalities in frontal collisions: A new approach in deep studies of injury mechanisms

BACKGROUND: More than half of car crash fatalities are belted occupants, and the majority of these occur as a consequence of frontal crashes. In an earlier study of crash configuration characteristics, we have shown that 48% of fatalities occurred in frontal small overlap (SO) crashes in which less than 30% of the vehicle front was engaged. Only 23% of fatalities occurred in large overlap (LO) crashes engaging the drive train, similar to most barrier front crash testing procedures. The main purpose of this study was to analyze the characteristics of injury mechanisms and injuries in fatal SO and LO car crashes in Sweden. METHOD: Retrospective examination and analysis of 61 fatally injured occupants from 53 car crashes within a sample area covering 40% of the population of Sweden was conducted. RESULTS: A clear difference in injury mechanisms and injuries was found between SO and LO crashes. The major injury mechanisms in SO crashes are explained by an oblique torso movement and rotation toward the outboard side, which causes a high proportion of serious lateral chest and head injuries. In contrast, LO crashes were generally characterized by serious anterior chest injuries in elderly occupants (> or =60 years). CONCLUSION: Current government and consumer barrier crash test procedures are not designed to estimate the performance of cars and restraint systems for the type of crashes which caused the majority of occupant fatalities in this data set.     

Factors influencing the patterns of injuries and outcomes in car versus car crashes compared to sport utility, van, or pick-up truck versus car crashes: Crash Injury Research Engineering Network Study.

BACKGROUND: Data using crash dummies suggest that motor vehicle crashes (MVCs) involving passenger sedans (S) vs sport utility, vans, or light trucks (SUVTs) produce more severe injuries than those involving two sedans (SvS). However, no detailed data regarding pattern of injuries or force mechanisms involved have been presented in real patients. METHODS: The relationship of injury patterns and severities with MVC reconstruction data were obtained in 412 MVC patients, drivers or front seat passengers. Crashes were examined with regard to impact direction, frontal (F) or lateral (L) crashes, vehicle mass ratio, ISS, DELTA V, seat belt use, and airbag deployment (AB). RESULTS: In 309 F-MVC, AB reduced overall ISS (24.3 to 17.9) with a reduction in the mean severity of traumatic brain injury (TBI) GCS < or = 12, from 48% to only 28%. This AB protection from TBI was preserved as DELTA V increased to > 30 mph even though non-AB protected body areas (thorax, lung, liver, and lower extremity injuries) all increased. When vehicles of incompatible size and mass (SUVT) had F-MVC with sedans the incidence of severe TBI rose as did face lacerations despite AB or belt use. In L-MVC between SUVT and sedans compared with SvS MVC, there was a cephalad shift in body injuries with increased thorax, but decreased lower extremity injuries. The incidence of TBI increased. Analysis of injury contact sites (hits) showed more hits and a wider distribution of contract sites in SUVT vs sedan MVC. These appeared due to the greater mass excess and larger mass ratio, hood height, and width in the F-SUVT vs S crashes. All of these factors plus the increased bumper height above the body frame side-door sill were injury causal factors in the L-SUVT vs S MVCs. CONCLUSION: Both F and L crashes between sedans and SUVT with a high mass ratio shift the pattern of injury cephalad with increased thorax and intrathoracic organ injuries, and more severe TBI. These data suggest that improved head and thorax side-impact buffering and design features which transmit MVC forces from the higher front end of the larger mass SUVT to the frame of the sedan may better protect sedan occupants from side-impacts.     

The influence of side airbags on the risk of head and thoracic injury after motor vehicle collisions

BACKGROUND: Side airbags (SABs) were developed as an energy-absorbing barrier to protect specific occupant body regions in near side impact motor vehicle collisions. METHODS: The National Automotive Sampling System Crashworthiness Data System was used to evaluate drivers and front-seated passengers in 1998 or newer vehicles involved in near side impact collisions. Risk ratios were calculated comparing the risk of head and thoracic injury among occupants in vehicles with and without SABs adjusting for occupant, vehicle, and collision characteristics. RESULTS: Occupants in vehicles equipped with head protection SABs had a 75% lower risk of head injury (p = 0.008) after near side collisions. With respect to thoracic injury, SABs that provide thoracic protection are associated with a 68% reduction (p = 0.01) in thoracic injury risk. CONCLUSION: As SAB-equipped vehicles become an increasingly larger segment of the on-road vehicle fleet, the impact of head and thoracic injury after near side impact collision is likely to be reduced.     

Children in side-impact motor vehicle crashes: seating positions and injury mechanisms

BACKGROUND: This study aimed to describe the injury mechanisms of children involved in side-impact car crashes, particularly as these relate to seating position, and to estimate the danger of the near-side seating position. METHODS: A prospective two-center study of children involved in severe car crashes in Canada was conducted as well as a retrospective cohort study of children involved in crashes reported in the Fatality Analysis Reporting System (FARS) and the National Automotive Sampling System: Crashworthiness Data System (NASS CDS). RESULTS: Children sitting at the side the car was struck (near-side position) sustained severe head, trunk, and limb injuries. Many of these injuries were attributable to direct intrusion, but some occurred without direct damage to the occupant compartment. Center-seat and far-side occupants had severe injuries only when unrestrained. Injury severity scores were higher for children seated on the near side, and this was statistically significant (p = 0.024) The analysis of Fatality Analysis Reporting System data showed that the risk of fatality was higher for children seated in the near-side position than for those in the center-seat position. The fatality risk ratio was 2.53 (95% confidence interval [CI], 2.08-3.07) for restrained children and 1.84 (95% CI, 1.57-2.17) for unrestrained children. Analysis of the NASS-CDS data showed that for restrained children, severe injury (ISS > or = 16) was more common among those on the near side (7 per 1,000 children) than among those in the center seat (2 per 1,000) or on the far-side seat (1 per 1,000) (p < 0.001). CONCLUSIONS: Severe injuries to near-side occupants occurred in both the presence and absence of compartment intrusion. A typical pattern of head, chest, and extremity injury similar to that seen among child pedestrians was observed among near-side child occupants in side-impact crashes. The center seat was statistically safer than the near-side seat, particularly for restrained child occupants. Scene information may be useful to trauma teams for the prediction of injury type and location. Avoiding intrusion and preventing the occupant from striking the vehicle wall are both important to side-impact protection for children. Improvement of the vehicle safety cage may protect against intrusion injuries. Seating two child occupants in inboard seating positions may provide additional protection against intrusion injuries, and also may protect against nonintrusion injuries.     

The spectrum of abdominal injuries associated with the use of seat belts

Several recent reports have described abdominal injuries occurring as a result of seat belt use, raising concerns about seat belts as an agent of injury in motor vehicle crashes. The purpose of this study was to characterize the distribution of abdominal injuries after motor vehicle crashes in belted and unbelted patients admitted to trauma centers. The mortality was higher in unbelted than belted patients (7% vs. 3.2%, respectively, p less than 0.0001). Unbelted patients also had significantly more frequent and more severe head injuries (50.0% vs. 32.9%, respectively, p less than 0.001). The incidence of abdominal injury was equal in both unbelted patients (13.9%), but the spectrum of organs injured was different in the two groups. Gastrointestinal tract injuries (stomach, small bowel, colon and rectum) were significantly more frequent in belted vs. unbelted patients (3.4% vs. 1.8%, respectively, p = 0.001). The frequency of liver and spleen injuries was the same in both groups. This study demonstrates that in patients admitted to trauma centers after motor vehicle crashes, belted and unbelted patients have an equal incidence of abdominal injury, but belted and unbelted patients have a different spectrum of injuries. Hollow viscus injuries are more common in belted crash victims. Seat belt use was associated with significantly fewer head injuries and deaths. Physicians evaluating trauma victims after motor vehicle crashes should be aware of the fact that the types of abdominal injuries may vary substantially depending on seat belt use.     

Pedestrians who required admission to hospital after collisions with motor vehicles in Sweden from 1987 to 1994.

OBJECTIVES: To report the incidence, range of injury, medical consequences, and mortality of pedestrians in collisions with motor vehicles in Sweden. DESIGN: Retrospective case study. SETTING: The Swedish Hospital Discharge Register (SHDR). SUBJECTS: 8684 pedestrians in collisions with motor vehicles had a total of 12,036 episodes treated in Swedish hospitals from 1987-1994. INTERVENTIONS: Statistical analysis of the Register. MAIN OUTCOME MEASURES: Incidence of pedestrians in collisions with motor vehicles in Sweden, mortality, range of injuries, and medical consequences. RESULTS: From 1987 to the end of 1994, a total of 8684 pedestrians were admitted to Swedish hospitals after collisions with motor vehicles. A mean of 17.6 persons were admitted/100,000 population/year. In all there were 12,036 admissions of injured pedestrians. There were 4593 men (53%) and 4091 women (47%), with a median age of 47 (range 1-100) years. The annual incidence of injured pedestrians (both men and women) decreased significantly during this period. Injuries to the extremities were commonest (39% fractures), followed by injuries to the head and neck (34%). The total number of deaths in our series of patients was 444 (5%). Of these, more than half had head injuries, 22% had fractures, and 5% abdominal or thoracic injuries. CONCLUSION: The number of pedestrians in collisions with motor vehicles is low in Sweden. Injuries to the extremities were commonest, followed by injuries to the head and neck. Old people were most likely to be injured and 5% of the patients treated in hospital died.     

Incidence and crash mechanisms of aortic injury during the past decade

BACKGROUND: Aortic injuries were traditionally thought to be the result of severe frontal crashes. Newer data has suggested other crash types such as nearside crashes may also be important in aortic injury. We hypothesized the implementation of recent safety measures would decrease the incidence of aortic injury associated with fatal motor vehicle crashes. METHODS: The autopsy reports of all traffic fatalities for motor vehicle occupants in a large urban county for the years 1993 to 2004 were examined. The demographics, impact types, safety measures used, and the presence of any aortic injury were recorded. Trends were evaluated for significance by weighted linear regression. RESULTS: The incidence of aortic injury associated with fatal motor vehicle crashes has remained unchanged during the past 12 years (r = 0.057, p = 0.45). There is a trend toward decreased aortic injuries associated with frontal crashes (r = 0.26, p = 0.089) but no change in aortic injuries associated with nearside or farside crashes (r = 0.053, p = 0.47), when the crash resulted in a fatality. This is despite an increase in seat belt use and increased presence of airbags during the same time period. CONCLUSIONS: Despite improved safety measures designed to minimize the occurrence of aortic injuries, the incidence of blunt aortic injury in fatal motor vehicle crashes has not decreased during the past decade. Although not statistically significant, there is a trend toward decreased frontal impacts in fatal motor vehicle crashes associated with aortic injuries. The nearside crash mechanism continues to play a prominent role, and efforts at improving vehicle safety should be focused on crash mechanisms as they relate to aortic injury.     

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

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

Population-based analysis of severe injuries from nonmotorized wheeled vehicles

BACKGROUND: Bicycling, skateboarding, and inline skating are popular recreational activities, with the potential of causing severe injury. METHODS: A retrospective, population-based, trauma registry analysis of severe injuries and deaths from nonmotorized wheeled vehicles (NMWV) over a 10-year period was performed. RESULTS: During the study period, 1475 cyclists, 141 skateboarders, and 112 inline skaters sustained injury meeting registry criteria (length of stay > or = 3 days or death). The majority were male. Lone crashes were the most common mechanism of injury, although collisions with motor vehicles accounted for 63.6% (n = 44) of observed deaths. Thoracic trauma and head injuries were more common in nonsurvivors. CONCLUSION: NMWV injuries pose a public health concern. We recommend enforcement of mandatory helmet laws and expansion of the existing law to include skateboarders and inline skaters. Education initiatives should also be expanded to include the adult population. NMWV should be separated from motorized vehicles as much as possible.     

Crash severity, injury patterns, and helmet use in adolescent motorcycle riders

BACKGROUND: This study examined crash severity and injury patterns between helmeted and unhelmeted adolescent motorcycle riders. METHODS: Among an initial population of 4,721 junior college students, 1,284 students were involved in 1,889 motorcycle crashes during a 20-month follow-up period. Crash severity was measured by both the type of collision object and the repair cost of motorcycle damage. RESULTS: The incidence rates of crash, injury, hospitalization, and deaths per 1,000 person-years in the cohort were 358, 104, 14, and 1.3, respectively. Compared with helmeted riders, unhelmeted riders had more noncollisions and fewer collisions with a moving car but there was no significant difference in repair cost of motorcycle damage between these groups. More injuries to the external skin, face, and head and more severe injuries occurred in unhelmeted than in helmeted riders. Among crashes resulting in hospitalization/death, more injuries to the face and head occurred in unhelmeted riders than in helmeted riders. CONCLUSION: Crashes involving unhelmeted riders were not more severe but more frequently involved face and head injuries than crashes involving helmeted riders.     

Optimal restraint reduces the risk of abdominal injury in children involved in motor vehicle crashes

BACKGROUND: The American Academy of Pediatrics has established guidelines for optimal, age-appropriate child occupant restraint. While optimal restraint has been shown to reduce the risk of injuries overall, its effect on specific types of injuries, in particular abdominal injuries, has not been demonstrated. METHODS: Cross-sectional study of children aged younger than 16 years in crashes of insured vehicles in 15 states, with data collected via insurance claims records and a telephone survey. A probability sample of 10927 crashes involving 17132 restrained children, representing 210926 children in 136734 crashes was collected between December 1, 1998 and May 31, 2002. Restraint use was categorized as optimal or suboptimal based on current American Academy of Pediatrics guidelines. The outcome of interest, abdominal injury, was defined as any reported injury to an intra-abdominal organ of Abbreviated Injury Scale >or=2 severity. RESULTS: Among all restrained children, optimal was noted in 59% (n = 120473) and suboptimal in 41% (n = 83555). An associated abdominal organ injury was noted in 0.05% (n = 62) of the optimal restrained group and 0.17% (n = 140) of the suboptimal group. After adjusting for age and seating position (front vs. rear), optimally restrained children were more than 3 times less likely [odds ratio 3.51 (95% confidence interval, 1.87-6.60, P < 0.001)] as suboptimally restrained children to suffer an abdominal injury. Of note, there were no abdominal injuries reported among optimally restrained 4- to 8-year-olds. CONCLUSIONS: Optimally restrained children are at a significantly lower risk of abdominal injury than children suboptimally restrained for age. This disparity emphasizes the need for aggressive education efforts aimed not only at getting children into restraint systems, but also the importance of optimal, age-appropriate restraint.     

Fatal blunt aortic injuries: a review of 242 autopsy cases

OBJECTIVE: To characterize fatal blunt aortic injury (BAI). METHODS: A retrospective chart review of 242 cases of fatal BAI in patients who underwent an autopsy at our institution between 1984 and 1997 was performed. Comparisons were made for statistical differences using the z-test. RESULTS: Two hundred forty-two cases of fatal BAI were reviewed, making this the largest BAI autopsy study to date. Mechanisms of BAI included driver/passenger in motor vehicle crash (MVC) (68%), pedestrian versus MVC (17%), and motorcycle crash (8%). When comparing the mechanisms in the time period 1984 to 1988 to the time period 1989 to 1997, only the pedestrian versus MVC mechanism was significantly different (12% vs. 23%, p < 0.05). MVC direction of impact included head-on (45%), lateral (35%), and complex (20%). Two thirds of the victims sustained head injuries, rib fractures, and/or hepatic trauma. Only 58% of the victims had the classic isthmus laceration. There was one preventable death secondary to delay in diagnosis. CONCLUSION: BAI is not limited to frontal impact crashes; there should be a high index of suspicion of BAI in lateral impact crashes as well as pedestrian versus MVC mechanisms. Nonisthmus and complex aortic lacerations are common in fatal BAI. Finally, BAI is a highly lethal injury with few preventable deaths in this series.     

Two wheels – too dangerous?

Background

Motorcyclists profit from improved safety measures and medical care only slightly compared with other road users. The aims of this study were to gain new insights into crash mechanisms and the resulting injuries of motorcyclists and to understand trends in road traffic accident statistics over the last 10 years.

Methods

In our prospective analysis we documented data from collisions in which at least one subject sustained an injury of 2–6 on the Maximum Abbreviated Injury Scale (MAIS). Additionally, key parameters published by the German Federal Statistical Office were analysed.

Results

Data were studied for 66 motorcycle crashes and 66 injured subjects. The mean ISS was 17.9, with injuries of the lower limb (44%) and head (41%) being the most frequent in motorcyclists. Psychometric questionnaires revealed that motorcyclists had a significantly higher willingness to take risks compared with drivers of other vehicles. Federal statistics revealed a dramatic increase in mortality in the first months of 2007, but in the next months, mortality decreased to levels comparable to those of the preceding year.

Conclusions

Knowledge of crash mechanisms, injury patterns and profiles of high-risk drivers can help reduce the collision rates and injury severity of motorcyclists.     

The increasing incidence of severe pelvic injury in motor vehicle collisions

BACKGROUND: Pelvic fractures constitute a major cause of death and residual disability in motor vehicle collisions (MVC). To date there has been poor documentation of the epidemiology of severe pelvic injuries. A detailed retrospective examination of all abbreviated injury score (AIS) > or = 4 pelvic fractures sustained in occupants of MVCs seen at this lead trauma hospital over the last 12 years and in the province of Ontario over the last 6 years was completed. METHODS: The regional trauma centre registry and provincial database were used to obtain demographics, injuries, course in hospital and crash data on patients sustaining AIS > or = 4 pelvic injuries between May 1988 and April 2000. Data was analysed for drivers (D), front (FP) and rear (RP) passengers in 4-year blocks. Means (S.D.) with t-test for continuous and chi2 for categorical data were used for analysis. RESULTS: AIS > or = 4 pelvic fractures increased significantly in D and FP over 12 years and in RP over the last 8 years. Similar significant increases were seen throughout the province over the last 6 years. No significant change in age, sex, ISS or referral patterns was seen. Lateral impact collisions also increased over the study duration. Occupants with pelvic injury compared to all MVC survivors ISS > or = 16 during the same study period had a higher ISS (P < 0.001), utilised more blood in 24h and in total (P < 0.001) and died more frequently (P < 0.001). However, significantly fewer required ICU support (P < 0.01) which may reflect the associated injuries. Patients with pelvic fractures had significantly fewer head and chest injuries as well as fewer face and neck injuries. They did have significantly more injuries in the region of the pelvis including lumbar and sacral spine fractures, genitourinary, liver, spleen and lower extremity blood vessel, nerve and bone injuries. CONCLUSION: This study documented an increasing incidence of severe pelvic injury resulting from MVCs. This may be related to an associated increase in the incidence of lateral impact collisions. The role of side impact protection and side airbags, introduced to decrease injury severity in lateral impact collisions will require further study.