Near Side Lateral Impacts and Aortic Injury: A Parametric Study

Traumatic rupture of the aorta (TRA) remains the second most common cause of death associated with motor vehicle crashes, only less prevalent than brain injury. On average, nearly 8000 people die annually in the United States due to blunt injury to the aorta. It is observed that over 80% of occupants who suffer an aortic injury die at the scene due to exsanguination into the chest cavity. In the current study, eight near side lateral impacts, in which TRA occurred, were reconstructed using a combination of real world crash data reported in the Crash Injury Research and Engineering Network (CIREN) database, finite element (FE) models of vehicles, and the Wayne State Human Body Model - II (WSHBM). For the eight CIREN cases reconstructed, the high strain regions in the aorta closely matched with the autopsy data provided. The peak average maximum principal strains in all of the eight CIREN cases were localized in the isthmus region of the aorta, distal to the left subclavian artery, and averaged at 22 ± 6.2% while the average maximum pressure in the aorta was found to be 117 ± 14.7 kPa.

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Trauma

10.1093/med/9780190685157.003.0060 ◽

2018 ◽

Author(s):

David A. Young

Keyword(s):

Cause Of Death ◽

Life Support ◽

Motor Vehicle ◽

The United States ◽

Motor Vehicle Accidents ◽

Advanced Trauma Life Support ◽

Traumatic Injuries ◽

Vehicle Accidents ◽

One Year ◽

Uncontrolled Bleeding

Traumatic injuries are the most common cause of death within the United States for children above one year of age Most traumatic injuries in children are a result of motor vehicle accidents, child abuse (or nonaccidental trauma), drowning, thermal injury, or falls. Motor vehicle accidents are the leading cause of death for children above the age of one year. Strategies of Advanced Trauma Life Support (ATLS) utilize a standardized approach to promptly identify and manage life-threatening traumatic injuries. These strategies include recognition of cardiopulmonary disorders, volume resuscitation, and prevention of additional injuries including to the cervical spine. A management plan for severe and uncontrolled bleeding is critically important to have established when caring for children with traumatic injuries. Many strategies have been developed to manage severe and uncontrolled bleeding including the use of massive transfusion protocols, damage control surgery, and hemostatic agents.

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Motor Vehicle Traffic Crashes as a Leading Cause of Death in the United States, 2008 and 2009

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2013.02.009 ◽

2013 ◽

Vol 61 (4) ◽

pp. 484 ◽

Cited By ~ 2

Keyword(s):

United States ◽

Cause Of Death ◽

Motor Vehicle ◽

The United States ◽

Traffic Crashes ◽

Vehicle Traffic

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Graduated Licensure: A Win-Win Proposition for Teen Drivers and Parents

PEDIATRICS ◽

10.1542/peds.98.5.959 ◽

1996 ◽

Vol 98 (5) ◽

pp. 959-960

Author(s):

Mark L. Rosenberg ◽

Ricardo Martinez

Keyword(s):

United States ◽

American Academy ◽

Cause Of Death ◽

Motor Vehicle ◽

The United States ◽

Motor Vehicle Crashes ◽

Policy Statement ◽

Critical Step ◽

American Academy Of Pediatrics ◽

Teenage Drivers

In this issue of Pediatrics, the American Academy of Pediatrics has taken a strong stand for safety in their policy statement entitled "The Teenage Driver." Among their recommendations, they call for graduated licensure for teenage drivers, a position we believe shows promise. Passing such legislation could be a critical step in reducing the leading cause of death in youth from 16 through 20 years old: motor vehicle crashes. Although teens constitute only 7% of the population of the United States, they account for 14% of all motor-vehicle deaths. More than 5000 teens die andi about a half-million are injured each year in traffic deaths.2

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Trauma to the Thoracic Aorta

10.2310/7ccsp.3014 ◽

2018 ◽

Author(s):

Thurston M. Bauer ◽

Mark A. Farber

Keyword(s):

20Th Century ◽

Endovascular Repair ◽

Motor Vehicle ◽

Penetrating Trauma ◽

The United States ◽

High Energy ◽

Aortic Injury ◽

Blunt Thoracic Aortic Injury ◽

Thoracic Aortic Injury ◽

Aortic Transection

Blunt thoracic aortic injury (BTAI) is predominantly a phenomenon of the 20th century secondary to high-energy deceleration injuries. Prior to the widespread adoption of automobiles, midway through the 20th century, 85% of injuries to the aorta were attributed to penetrating trauma, with 57% caused by gunshots and 25% by stab wounds.1–4 However, BTAI has become more prevalent, with an estimated incidence of 7,500 to 8,000 cases per year in the United States. BTAI is the second most common cause of trauma-related death after head injury and accounts for 15% of all motor vehicle collision (MVC)-related deaths.5 The incidence of thoracic aortic injury among MVC victims is 1.5%.6 Prehospital mortality is 85% secondary to complete aortic transection.7 Approximately 8% of patients survive more than 4 hours, and most of those who survive to reach the hospital have small or partial-thickness tears with pseudoaneurysm formation. Up to 50% of patients who reach the hospital die prior to definitive surgery.8,9 Therefore, expeditious collaborative evaluation by trauma and aortic surgeons at a level I trauma center is necessary to provide appropriate care to these patients who may have multiple life-threatening injuries. This review contains 13 figures, 8 tables, 1 video and 56 references. Keywords: Blunt Aortic Traumatic Injury, Thoracic Transection, Aortic Transection, Aortic Injury, Blunt Traumatic Aortic Injury, Blunt Thoracic Aortic Injury, Aortic Tear, Aortic pseudoaneurysm, TEVAR for BTAI, Endovascular repair (TEVAR) of BTAI, Endovascular repair (TEVAR) for transection

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Pediatric Traumatic Brain Injury in the United States: Rural-Urban Disparities and Considerations

Brain Sciences ◽

10.3390/brainsci10030135 ◽

2020 ◽

Vol 10 (3) ◽

pp. 135 ◽

Cited By ~ 2

Author(s):

John K. Yue ◽

Pavan S. Upadhyayula ◽

Lauro N. Avalos ◽

Tene A. Cage

Keyword(s):

Mental Health ◽

United States ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Head Injury ◽

Healthcare Costs ◽

Motor Vehicle ◽

The United States ◽

Pubmed Database ◽

Pediatric Tbi

Introduction: Traumatic brain injury (TBI) remains a primary cause of pediatric morbidity. The improved characterization of healthcare disparities for pediatric TBI in United States (U.S.) rural communities is needed to advance care. Methods: The PubMed database was queried using keywords ((“brain/head trauma” OR “brain/head injury”) AND “rural/underserved” AND “pediatric/child”). All qualifying articles focusing on rural pediatric TBI, including the subtopics epidemiology (N = 3), intervention/healthcare cost (N = 6), and prevention (N = 1), were reviewed. Results: Rural pediatric TBIs were more likely to have increased trauma and head injury severity, with higher-velocity mechanisms (e.g., motor vehicle collisions). Rural patients were at risk of delays in care due to protracted transport times, inclement weather, and mis-triage to non-trauma centers. They were also more likely than urban patients to be unnecessarily transferred to another hospital, incurring greater costs. In general, rural centers had decreased access to mental health and/or specialist care, while the average healthcare costs were greater. Prevention efforts, such as mandating bicycle helmet use through education by the police department, showed improved compliance in children aged 5–12 years. Conclusions: U.S. rural pediatric patients are at higher risk of dangerous injury mechanisms, trauma severity, and TBI severity compared to urban. The barriers to care include protracted transport times, transfer to less-resourced centers, increased healthcare costs, missing data, and decreased access to mental health and/or specialty care during hospitalization and follow-up. Preventative efforts can be successful and will require an improved multidisciplinary awareness and education.

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Trauma to the Thoracic Aorta

10.2310/vasc.3014 ◽

2018 ◽

Author(s):

Thurston M. Bauer ◽

Mark A. Farber

Keyword(s):

20Th Century ◽

Endovascular Repair ◽

Motor Vehicle ◽

Penetrating Trauma ◽

The United States ◽

High Energy ◽

Aortic Injury ◽

Blunt Thoracic Aortic Injury ◽

Thoracic Aortic Injury ◽

Aortic Transection

Blunt thoracic aortic injury (BTAI) is predominantly a phenomenon of the 20th century secondary to high-energy deceleration injuries. Prior to the widespread adoption of automobiles, midway through the 20th century, 85% of injuries to the aorta were attributed to penetrating trauma, with 57% caused by gunshots and 25% by stab wounds.1–4 However, BTAI has become more prevalent, with an estimated incidence of 7,500 to 8,000 cases per year in the United States. BTAI is the second most common cause of trauma-related death after head injury and accounts for 15% of all motor vehicle collision (MVC)-related deaths.5 The incidence of thoracic aortic injury among MVC victims is 1.5%.6 Prehospital mortality is 85% secondary to complete aortic transection.7 Approximately 8% of patients survive more than 4 hours, and most of those who survive to reach the hospital have small or partial-thickness tears with pseudoaneurysm formation. Up to 50% of patients who reach the hospital die prior to definitive surgery.8,9 Therefore, expeditious collaborative evaluation by trauma and aortic surgeons at a level I trauma center is necessary to provide appropriate care to these patients who may have multiple life-threatening injuries. This review contains 13 figures, 8 tables, 1 video and 56 references. Keywords: Blunt Aortic Traumatic Injury, Thoracic Transection, Aortic Transection, Aortic Injury, Blunt Traumatic Aortic Injury, Blunt Thoracic Aortic Injury, Aortic Tear, Aortic pseudoaneurysm, TEVAR for BTAI, Endovascular repair (TEVAR) of BTAI, Endovascular repair (TEVAR) for transection

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Increased population density of neurosurgeons associated with decreased risk of death from motor vehicle accidents in the United States

Journal of Neurosurgery ◽

10.3171/2012.6.jns111281 ◽

2012 ◽

Vol 117 (3) ◽

pp. 599-603 ◽

Cited By ~ 10

Author(s):

Atman Desai ◽

Kimon Bekelis ◽

Wenyan Zhao ◽

Perry A. Ball

Keyword(s):

Population Density ◽

General Practitioners ◽

Cause Of Death ◽

Motor Vehicle ◽

The United States ◽

Median Number ◽

Motor Vehicle Accidents ◽

Outcome Variable ◽

Vehicle Accidents ◽

Risk Of Death

Object Motor vehicle accidents (MVAs) are a leading cause of death and disability in young people. Given that a major cause of death from MVAs is traumatic brain injury, and neurosurgeons hold special expertise in this area relative to other members of a trauma team, the authors hypothesized that neurosurgeon population density would be related to reduced mortality from MVAs across US counties. Methods The Area Resource File (2009–2010), a national health resource information database, was retrospectively analyzed. The primary outcome variable was the 3-year (2004–2006) average in MVA deaths per million population for each county. The primary independent variable was the density of neurosurgeons per million population in the year 2006. Multiple regression analysis was performed, adjusting for population density of general practitioners, urbanicity of the county, and socioeconomic status of the county. Results The median number of annual MVA deaths per million population, in the 3141 counties analyzed, was 226 (interquartile range [IQR] 151–323). The median number of neurosurgeons per million population was 0 (IQR 0–0), while the median number of general practitioners per million population was 274 (IQR 175–410). Using an unadjusted analysis, each increase of 1 neurosurgeon per million population was associated with 1.90 fewer MVA deaths per million population (p < 0.001). On multivariate adjusted analysis, each increase of 1 neurosurgeon per million population was associated with 1.01 fewer MVA deaths per million population (p < 0.001), with a respective decrease in MVA deaths of 0.03 per million population for an increase in 1 general practitioner (p = 0.007). Rural location, persistent poverty, and low educational level were all associated with significant increases in the rate of MVA deaths. Conclusions A higher population density of neurosurgeons is associated with a significant reduction in deaths from MVAs, a major cause of death nationally. This suggests that the availability of local neurosurgeons is an important factor in the overall likelihood of survival from an MVA, and therefore indicates the importance of promoting neurosurgical education and practice throughout the country.

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Atypical profile of aortic injury associated with blunt trauma in the metropolitan area of Japan

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2019-000342 ◽

2019 ◽

Vol 4 (1) ◽

pp. e000342

Author(s):

Shusuke Mori ◽

Tomohiko Ai ◽

Yasuhiro Otomo

Keyword(s):

Blunt Trauma ◽

Metropolitan Area ◽

High Speed ◽

Motor Vehicle ◽

Type A ◽

Aortic Injury ◽

University Hospital ◽

Type B ◽

Aortic Injuries ◽

Aortic Dissections

BackgroundAortic injury caused by blunt trauma is a critical medical condition that requires extraordinary caution in the treatment. It is often caused by direct hit and high-speed deceleration in motor vehicle accidents. We reviewed and analysed the cases of aortic injury that referred to our institution located in the midst of the metropolitan area of Tokyo, Japan.MethodsWe retrospectively reviewed the blunt trauma cases transferred to Tokyo Medical and Dental University Hospital in the past 10 years. All cases with aortic injury were analyzed regardless of the AIS scores. Results: Between 2007 and 2017, a total of 3500 blunt trauma cases were transferred. Nineteen cases showed aortic injuries associated with blunt trauma (Age: 63.5±15.6 y.o.; 15 males). Thirteen patients were injured by fall, four patients were senior pedestrians hit by cars, one was injured while riding a motor bike, and one was hit by a train. A total of 11 cases presented a cardiopulmonary arrest on arrival; 8 severe aortic injuries, 1 cardiac rupture; and 2 multiple injuries. Eight cases were alive on arrival; 3 Stanford type A aortic dissections, 3 Stanford type B aortic dissections, and 2 aortic ruptures. Two cases of Stanford type A dissection underwent emergency repairs, whereas all 3 type B dissections went on a good course with conservative treatment.ConclusionsAortic injury caused by blunt trauma seems to be rare in a metropolitan area in Japan. In addition, the leading cause in our cases was fall, which might be a rare cause of aortic injuries in the other countries. Our observation might be a manifestation of population aging.

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Start of Polytrauma Management in University Hospital: First Experience with Liver Trauma

Acta Chirurgica Latviensis ◽

10.2478/chilat-2014-0104 ◽

2014 ◽

Vol 14 (1) ◽

pp. 20-25

Author(s):

Solvita Stabina ◽

Aleksejs Kaminskis ◽

Guntars Pupelis

Keyword(s):

Liver Injury ◽

Cause Of Death ◽

Nonoperative Management ◽

Skull Fracture ◽

Flail Chest ◽

Young Patients ◽

Liver Trauma ◽

University Hospital ◽

Traumatic Rupture ◽

Liver Injuries

Summary Introduction. Trauma is a leading cause of death, particularly among young patients. Spleen is the most commonly damaged organ in blunt abdominal trauma and liver injury is the main cause of death. Aim of the study. Review of the literature and recent clinical experience in the management of blunt liver injuries in the Riga East clinical university hospital. Materials and methods. Three-year experience in the management of liver traumatic rupture was retrospectively and prospectively analysed. The study included 64 patients over 15 years of age with blunt hepatic injuries. Exclusion criteria were patients with life-incompatible haemorrhagic shock. The Statistical analysis of the data was performed by median and mean of the Microsoft Excel 2010 and SPSS 22 version. Results. A total of 64 patients were treated in our institution during the period from November 2010 till November 2013. Isolated liver injuries were diagnosed in 49 cases, combined liver and spleen injuries in 15 cases. Most commonly mechanism ofinjury were road traffic accidents, falls and low energy blunt traumas (criminal beaten, sports injuries);19 patients underwent laparotomy for haemostasis while nonoperative management was used in 45 patients. Haemodynamic stability of the patient and CT confirmed liver injury were the main criteria for nonoperative management. One patient died atthe time of laparotomy from injuries not compatible with life – severe head injury with basal skull fracture, aortic arc rupture, flail chest and liver and spleen injury. Conclusions. Conservative management of liver trauma is justified in haemodynamically(HD) stable patients after thorough risk assessment and computed tomography (CT) based injury grading in centres with sufficient expertise and medical resources.

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