Whole-Body CT after Motor Vehicle Crash: No Benefit after High-Energy Impact and with Normal Physical Examination

Motor vehicle crash countermeasures often are selected after an extensive data analysis of the crash history of a roadway segment. The value of this analysis depends on the accuracy or precision with which the crash itself is located. yet this crash location only is as accurate as the estimate of the police officer. Global Positioning System (GPS) technology may have the potential to increase data accuracy and decrease the time spent to record crash locations. Over 10 months, 32 motor vehicle crash locations were determined by using both conventional methods and hand-held GPS receivers, and the timeliness and precision of the methods were compared. Local crash data analysts were asked how the improved precision affected their consideration of potential crash countermeasures with regard to five crashes selected from the sample. On average, measuring a crash location by using GPS receivers added up to 10 extra minutes, depending on the definition of the crash location, the technology employed, and how that technology was applied. The average difference between conventional methods of measuring the crash location and either GPS or a wheel ranged from 5 m (16 ft) to 39 m (130 ft), depending on how one defined the crash location. Although there are instances in which improved precision will affect the evaluation of crash countermeasures, survey respondents and the literature suggest that problems with conventional crash location methods often arise from human error, not a lack of precision inherent in the technology employed.

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Serum D-dimer level as a biomarker for identifying patients with isolated injury to prevent unnecessary whole-body computed tomography in blunt trauma care

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-020-00815-9 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Rakuhei Nakama ◽

Ryo Yamamoto ◽

Yoshimitsu Izawa ◽

Keiichi Tanimura ◽

Takashi Mato

Keyword(s):

Computed Tomography ◽

Positive Predictive Value ◽

Predictive Value ◽

High Specificity ◽

Whole Body ◽

Cutoff Value ◽

Whole Body Ct ◽

Isolated Injury ◽

D Dimer ◽

Body Ct

Abstract Background Unnecessary whole-body computed tomography (CT) may lead to excess radiation exposure. Serum D-dimer levels have been reported to correlate with injury severity. We examined the predictive value of serum D-dimer level for identifying patients with isolated injury that can be diagnosed with selected-region CT rather than whole-body CT. Methods This single-center retrospective cohort study included patients with blunt trauma (2014–2017). We included patients whose serum D-dimer levels were measured before they underwent whole-body CT. “Isolated” injury was defined as injury with Abbreviated Injury Scale (AIS) score ≤ 5 to any of five regions of interest or with AIS score ≤ 1 to other regions, as revealed by a CT scan. A receiver operating characteristic curve (ROC) was drawn for D-dimer levels corresponding to isolated injury; the area under the ROC (AUROC) was evaluated. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for several candidate cut-off values for serum D-dimer levels. Results Isolated injury was detected in 212 patients. AUROC was 0.861 (95% confidence interval [CI]: 0.815–0.907) for isolated injury prediction. Serum D-dimer level ≤ 2.5 μg/mL was an optimal cutoff value for predicting isolated injury with high specificity (100.0%) and positive predictive value (100.0%). Approximately 30% of patients had serum D-dimer levels below this cutoff value. Conclusion D-dimer level ≤ 2.5 μg/mL had high specificity and high positive predictive value in cases of isolated injury, which could be diagnosed with selected-region CT, reducing exposure to radiation associated with whole-body CT.

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High school off-campus lunch policies and adolescent motor vehicle crash risks

Journal of Adolescent Health ◽

10.1016/j.jadohealth.2003.12.009 ◽

2005 ◽

Vol 36 (1) ◽

pp. 5-8 ◽

Cited By ~ 11

Author(s):

Lorraine M. Stone ◽

Carol W. Runyan

Keyword(s):

High School ◽

Motor Vehicle ◽

Motor Vehicle Crash ◽

Vehicle Crash

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Left Hemidiaphragm Rupture Following High-Speed Motor Vehicle Crash

Current Problems in Diagnostic Radiology ◽

10.1067/j.cpradiol.2011.07.011 ◽

2012 ◽

Vol 41 (4) ◽

pp. 130-132

Author(s):

Michelle Bittle ◽

Eric Hoffer ◽

Jeffrey D. Robinson

Keyword(s):

High Speed ◽

Motor Vehicle ◽

Motor Vehicle Crash ◽

Vehicle Crash ◽

Left Hemidiaphragm

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Psychological distress following a motor vehicle crash: evidence from a statewide retrospective study examining settlement times and costs of compensation claims

BMJ Open ◽

10.1136/bmjopen-2017-017515 ◽

2017 ◽

Vol 7 (9) ◽

pp. e017515 ◽

Cited By ~ 10

Author(s):

Rebecca Guest ◽

Yvonne Tran ◽

Bamini Gopinath ◽

Ian D Cameron ◽

Ashley Craig

Keyword(s):

At Risk ◽

Psychological Distress ◽

Retrospective Study ◽

Injury Severity ◽

Motor Vehicle ◽

Multivariate Logistic Regression Analysis ◽

Musculoskeletal Injury ◽

Motor Vehicle Crash ◽

Insurance Companies ◽

Vehicle Crash

ObjectiveTo determine whether psychological distress associated with musculoskeletal injuries sustained in a motor vehicle crash (MVC), regardless of time of onset, impacts compensation outcomes such as claim settlement times and costs. Second, to identify factors routinely collected by insurance companies that contribute to psychological distress during the compensation process.DesignStatewide retrospective study.Data sourceAnalysis of the New South Wales statewide (Australia) injury register for MVC survivors who lodged a compensation claim from 2011 to 2013.Participants6341 adults who sustained a musculoskeletal injury and who settled a claim for injury after an MVC. Participants included those diagnosed with psychological distress (n=607) versus those not (n=5734).Main outcome measuresTime to settlement and total costs of claims, as well as socio-demographic and injury characteristics that may contribute to elevated psychological distress, such as socio-economic disadvantage, and injury severity.ResultsPsychological distress in those with a musculoskeletal injury was associated with significantly longer settlement times (an additional 17 weeks) and considerably higher costs (an additional $A41 575.00 or 4.3 times more expensive). Multivariate logistic regression analysis identified risk factors for psychological distress including being female, social disadvantage, unemployment prior to the claim, not being at fault in the MVC, requiring ambulance transportation and rehabilitation as part of recovery.ConclusionsResults provide compelling evidence that psychological distress has an adverse impact on people with musculoskeletal injury as they progress through compensation. Findings suggest that additional resources should be directed toward claimants who are at risk (eg, the socially disadvantaged or those unemployed prior to the claim), the major aim being to reduce risk of psychological distress, such as post-traumatic stress disorder, and associated risk of increased settlement times and claim costs. Prospective studies are now required that investigate treatment strategies for those at risk of psychological distress associated with an MVC.

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