Validating the danger of vehicular protective devices and bowel injury |
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| Institution: | 1. Department of General Surgery, Trauma Surgery Unit, Hospital Sultanah Aminah, Jalan Persiaran Abu Bakar Sultan, Johor Bahru 80100, Malaysia;2. Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakob Latif, Cheras, Kuala Lumpur 56000, Malaysia;3. Ministry of Health, Malaysia, Federal Government Administrative Centre, Putrajaya 62514, Malaysia;1. Department of Surgery, National Taiwan University Hospital, Yunlin Branch, No. 579, Yunlin Road, Douliu City, 640 Yunlin, Taiwan (R.O.C.);2. Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan (R.O.C.);3. Department of Emergency Medicine, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan (R.O.C.);4. Department of Orthopedic Surgery, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan (R.O.C.);1. Department of Emergency Medicine, Haaglanden Medical Centre, PO Box 432, 2501 CK The Hague, the Netherlands;2. Department of Emergency Medicine, Erasmus MC University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands;3. Department of Public Health, Erasmus MC University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands;4. Department of Neurology, Erasmus MC University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands;5. Department of Neurology, University of Groningen, University Medical Centre Groningen, PO Box 30001, 9700 RB Groningen, the Netherlands;6. Department of Neurosurgery, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, the Netherlands;7. Department of Emergency Medicine, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, the Netherlands;8. Department of Emergency Medicine, ADRZ, PO Box 15, 4460 AA Goes, the Netherlands;9. Department of Emergency Medicine, Jeroen Bosch Hospital, PO 90153, 5200 ME ‘s-Hertogenbosch, the Netherlands;10. Department of Neurology, Jeroen Bosch Hospital, PO 90153, 5200 ME ‘s-Hertogenbosch, the Netherlands;11. Department of Radiology, Erasmus MC University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands;12. Department of Epidemiology, Erasmus MC University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands;13. Centre for Health Decision Sciences, Harvard T.H. Chan School of Public Health, Boston, USA;14. formerly Department of Emergency Medicine, Elisabeth-Tweesteden Hospital, PO Box 90151, 5000 LC Tilburg, the Netherlands;15. Department of Neurology, Bravis Hospital, PO Box 999, 4624 VT Bergen op Zoom, the Netherlands;p. Department of Neurology, Elisabeth-Tweesteden Hospital, PO Box 90151, 5000 LC Tilburg, the Netherlands;q. Department of Biomedical Data Sciences, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, the Netherlands;r. Department of Neurology, Haaglanden Medical Centre, PO Box 432, 2501 CK The Hague, the Netherlands;1. Epsom and St. Helier NHS Foundation Trust, London, United Kingdom;2. St George''s University Hospitals NHS Foundation Trust, London, United Kingdom;3. James Cook University Hospital, Middlesbrough, United Kingdom;4. Department of Health Sciences, University of York, United Kingdom;5. School of Health Sciences, University of East Anglia, Norwich, United Kingdom;2. Surgical Department, Whangārei Hospital, Manu Road, Whangārei, New Zealand |
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| Abstract: | IntroductionProtective devices such as seat belts and airbags have improved the safety of motor vehicle occupants, but limited data suggest they may be associated with increased blunt bowel (small bowel or colon) injuries (BI). Unfortunately, this risk is unquantified.MethodsWe analyzed the National Trauma Data Bank (2017-2019) using ICD-10 codes to identify adult motor vehicle occupants with BI who underwent surgical repair. We used logistic regression modeling to compare the risk of undergoing surgical repair for BI after using a protective device.ResultsOf 2,848,592 injured patients, 475,546 (16.7%) were motor vehicle occupants. Only 1.2% (n = 5627/475,546) of patients underwent a bowel repair or resection. Using a seat belt only was associated with an adjusted OR of 2.09 (95% CI 1.91, 2.28) for undergoing a bowel repair/resection when adjusting for Injury Severity Score (ISS) and age. Airbag deployment without a seat belt had an adjusted OR of 1.46 (95% CI 1.31, 1.62), while both devices combined conferred an OR of 3.27 (95% CI 3.02, 3.54). However, using a seat belt was protective against death with an OR of 0.50 (95% CI 0.48, 0.53), adjusted for age, sex, Charlson Comorbidity Score, and ISS.ConclusionSeat belts and airbags are essential public health safety interventions and protect against death in motor vehicle-associated injuries. However, patients involved in MVCs with airbag deployment or while wearing a seat belt are at an increased risk of bowel injury requiring surgery compared to unrestrained patients, despite these events being relatively uncommon. |
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