Factors associated with EMS transport decisions for pediatric patients after motor vehicle collisions

Background Motor vehicle collisions (MVCs) are a major cause of pediatric morbidity and mortality. However, the effect of body mass index (BMI) and seatbelt use on thoracic injuries and outcomes in pediatric patients with rib fractures remains unexplored. We aim to assess how seatbelt use and BMI affect thoracic injuries and outcomes in pediatric patients who sustained ≥3 rib fractures following an MVC. Methods The Trauma Quality Improvement Program (TQIP) database (2013-2017) was queried for pediatric patients (8-17 years and >4 feet 9 inches tall) admitted secondary to MVCs, with ≥3 rib fractures and all non-thoracic Abbreviated Injury Scale ≤2. Patients were then divided by Injury Severity Score (ISS) into low (<15) and intermediate-severe (≥15) groups, which were further subdivided according to seatbelt use and BMI. Logistic and linear regression was performed to assess the effects of seatbelt use and BMI on outcomes. Results Seatbelt compliance varied from 39.6 to 50.7%. Belted patients (intermediate-severe ISS) had a reduced hospital length of stay (HLOS), intensive care unit length of stay(ICU-LOS), and mechanical ventilation time but had increased odds of splenic laceration vs. unbelted patients (aOR = 2.46, 95% CI: 1.03-5.93, P = .044). Obese patients (low ISS) had lower incidences of hemothorax, pneumothorax, pulmonary contusion, splenic laceration, and liver injury compared to normal-weight patients. Overweight patients (intermediate-severe ISS) had a significantly reduced ICU-LOS vs. normal-weight patients (β = −.17, 95% CI: -.33,-.01, = .041). Conclusions Seatbelt use may improve outcomes for pediatric MVC patients with ≥3 rib fractures. Higher BMI may be associated with reduced thoracic injury and decreased ICU-LOS. Effective educational initiatives are needed to increase pediatric seatbelt compliance.

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Case Exercise: Biomechanics in Rearend Motor Vehicle Collisions

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2007.mayjun02 ◽

2007 ◽

Vol 12 (3) ◽

pp. 4-7

Author(s):

Charles N. Brooks ◽

Christopher R. Brigham

Keyword(s):

Motor Vehicle ◽

Body Position ◽

Motor Vehicle Collisions ◽

Time Curve ◽

Vehicle Collisions ◽

Need For Treatment ◽

Multiple Factors ◽

Bodily Injury ◽

Vehicle Collision ◽

Physical Findings

Abstract Multiple factors determine the likelihood, type, and severity of bodily injury following a motor vehicle collision and, in turn, influence the need for treatment, extent of disability, and likelihood of permanent impairment. Among the most important factors is the change in velocity due to an impact (Δv). Other factors include the individual's strength and elasticity, body position at the time of impact, awareness of the impending impact (ie, opportunity to brace, guard, or contract muscles before an impact), and effects of braking. Because Δv is the area under the acceleration vs time curve, it combines force and duration and is a useful way to quantify impact severity. The article includes a table showing the results of a literature review that concluded, “the consensus of human subject research conducted to date is that a single exposure to a rear-end impact with a Δv of 5 mph or less is unlikely to result in injury” in most healthy, restrained occupants. Because velocity incorporates direction as well as speed, a vehicular occupant is less likely to be injured in a rear impact than when struck from the side. Evaluators must consider multiple factors, including the occupant's pre-existing physical and psychosocial status, the mechanism and magnitude of the collision, and a variety of biomechanical variables. Recommendations based solely on patient history and physical findings (and, perhaps, imaging studies) may be ill-informed.

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105: Renal Injury Mechanisms in Motor Vehicle Collisions: Analysis of the Crash Injury Research and Engineering Network (CIREN) Dataset

The Journal of Urology ◽

10.1016/s0022-5347(18)30370-7 ◽

2007 ◽

Vol 177 (4S) ◽

pp. 37-37

Author(s):

James K. Kuan ◽

Robert Kaufman ◽

Jonathan L. Wright ◽

Charles Mock ◽

Avery B. Nathens ◽

...

Keyword(s):

Renal Injury ◽

Motor Vehicle ◽

Motor Vehicle Collisions ◽

Vehicle Collisions ◽

Injury Mechanisms ◽

Injury Research

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Motor Vehicle Collisions and Their Demographics: A 5-Year Retrospective Study of the Hamilton-Wentworth Niagara Region

Journal of Forensic Sciences ◽

10.1111/j.1556-4029.2008.00723.x ◽

2008 ◽

Vol 53 (3) ◽

pp. 709-715 ◽

Cited By ~ 4

Author(s):

Carolyne E. Lemieux ◽

John R. Fernandes ◽

Chitra Rao

Keyword(s):

Retrospective Study ◽

Motor Vehicle ◽

Motor Vehicle Collisions ◽

Vehicle Collisions

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A comparison of the demographics, injury patterns and outcome data for patients injured in motor vehicle collisions who are trapped compared to those patients who are not trapped

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-020-00818-6 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Tim Nutbeam ◽

Rob Fenwick ◽

Jason Smith ◽

Omar Bouamra ◽

Lee Wallis ◽

...

Keyword(s):

Spinal Cord ◽

Blood Loss ◽

Injury Severity ◽

Spinal Cord Injuries ◽

Motor Vehicle ◽

Tension Pneumothorax ◽

Research Network ◽

Motor Vehicle Collisions ◽

Vehicle Collisions ◽

Time Critical

Abstract Background Motor vehicle collisions (MVCs) are a common cause of major trauma and death. Following an MVC, up to 40% of patients will be trapped in their vehicle. Extrication methods are focused on the prevention of secondary spinal injury through movement minimisation and mitigation. This approach is time consuming and patients may have time-critical injuries. The purpose of this study is to describe the outcomes and injuries of those trapped following an MVC: this will help guide meaningful patient-focused interventions and future extrication strategies. Methods We undertook a retrospective database study using the Trauma Audit and Research Network database. Patients were included if they were admitted to an English hospital following an MVC from 2012 to 2018. Patients were excluded when their outcomes were not known or if they were secondary transfers. Results This analysis identified 426,135 cases of which 63,625 patients were included: 6983 trapped and 56,642 not trapped. Trapped patients had a higher mortality (8.9% vs 5.0%, p < 0.001). Spinal cord injuries were rare (0.71% of all extrications) but frequently (50.1%) associated with other severe injuries. Spinal cord injuries were more common in patients who were trapped (p < 0.001). Injury Severity Score (ISS) was higher in the trapped group 18 (IQR 10–29) vs 13 (IQR 9–22). Trapped patients had more deranged physiology with lower blood pressures, lower oxygen saturations and lower Glasgow Coma Scale, GCS (all p < 0.001). Trapped patients had more significant injuries of the head chest, abdomen and spine (all p < 0.001) and an increased rate of pelvic injures with significant blood loss, blood loss from other areas or tension pneumothorax (all p < 0.001). Conclusion Trapped patients are more likely to die than those who are not trapped. The frequency of spinal cord injuries is low, accounting for < 0.7% of all patients extricated. Patients who are trapped are more likely to have time-critical injuries requiring intervention. Extrication takes time and when considering the frequency, type and severity of injuries reported here, the benefit of movement minimisation may be outweighed by the additional time taken. Improved extrication strategies should be developed which are evidence-based and allow for the expedient management of other life-threatening injuries.

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Use of cannabis and/or prescription opioids among adult drivers in Ontario, Canada: Prevalence and association with motor vehicle collisions

Journal of Transport & Health ◽

10.1016/j.jth.2021.101091 ◽

2021 ◽

Vol 22 ◽

pp. 101091

Author(s):

Christine M. Wickens ◽

Anca R. Ialomiteanu ◽

Patricia Di Ciano ◽

Gina Stoduto ◽

Robert E. Mann

Keyword(s):

Motor Vehicle ◽

Prescription Opioids ◽

Motor Vehicle Collisions ◽

Vehicle Collisions

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Patterns of Pediatric Facial Fractures

Craniomaxillofacial Trauma & Reconstruction ◽

10.1177/1943387521991738 ◽

2021 ◽

pp. 194338752199173

Author(s):

Kevin Hong ◽

James Jeong ◽

Yehudah N. Susson ◽

Shelly Abramowicz

Keyword(s):

Motor Vehicle ◽

Maxillofacial Surgery ◽

Maxillofacial Trauma ◽

Oral And Maxillofacial Surgery ◽

Facial Fractures ◽

Inclusion Criteria ◽

Motor Vehicle Collisions ◽

Vehicle Collisions ◽

Peak Incidence ◽

Maxillofacial Fractures

Objective: The aim of this study was to assess patterns of maxillofacial trauma in the pediatric population in Atlanta. This information is important to help guide management and allocate resources for treatment of maxillofacial injuries at Children’s Healthcare of Atlanta (CHOA). Methods: This study was a retrospective chart review of children who presented from 2006 to 2015. Inclusion criteria were: (1) age 18 years old or younger, (2) presentation to emergency department, (3) diagnosis of maxillofacial fractures, and (4) evaluation by Oral and Maxillofacial Surgery, Otolaryngology, or Plastic Surgery services. Medical records were reviewed to record demographic, mechanism of injury, fracture location, and yearly incidence of injury. Descriptive statistics were computed to summarize findings and overall trends. Results: During the study period, 39,833 patients were identified. Of them, 1995 met the inclusion criteria. The majority were male (n = 1359, 68%) with an average age of 9.4 years old (range of 1 month to 18 years old). Mechanisms of injury were motor vehicle collisions (MVC) (n = 597, 29.9%), fall (n = 565, 28.3%), sports injury (n = 317, 15.9%), pedestrian struck (n = 215, 10.8%), assault/abuse (n = 204, 10.2%), other (n = 81, 4.1%), or gunshot wound (n = 16, 0.8%). Fracture sites were mandible (n = 519, 26%), complex (n = 479, 24%), nasal (n = 419, 21%), dentoalveolar (n = 279, 14%), orbital (n = 259, 13%), and maxilla (n = 40, 2%). Males had a higher incidence of assault than females (n = 185, 91% of assaults). The incidence of maxillofacial trauma increased with age with a peak incidence in 13 to 16-year-olds (n = 566, 28.3%). During the years examined, there was an upward trend in MVCs as the etiology with a peak incidence of facial fractures due to MVCs occurring in 2015. All other mechanisms remained constant during this time period. Conclusions: There was an increase in pediatric facial fractures secondary to motor vehicle collisions from 2007 to 2015 despite improvements in regulations, traffic safety, and technology.

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