Are There Racial Disparities in the Use of Restraints and Outcomes after Motor Vehicle Collisions in Los Angeles County?

Motor vehicle collisions (MVCs) continue to be a leading cause of traumatic death, yet there is a paucity of data regarding racial/ethnic differences in injury severity, use of restraints, and outcomes. This study determines whether racial/ethnic disparities exist in adult MVC victims. A retrospective review of patients (age older than 18 years) involved in MVC in Los Angeles County from 2004 to 2009 was performed. Main outcome measures were hospital length of stay, mortality, and complication rate. Independent variables evaluated included race/ethnicity, use of restraints, age, gender, Injury Severity Score (ISS), and Glasgow Coma Scale. During the 5-year study period, 22,444 patients were involved in an MVC in Los Angeles County. Overall restraint use was 69 per cent, lowest in blacks (67%) and Hispanics (68%). Mortality and morbidity rates were both 3 per cent for all racial/ethnic groups. On multivariable analysis, higher ISS, older age, male gender, not wearing a seatbelt, and being Asian increased the risk of death. In conclusion, our study demonstrated racial/ethnic differences in MVC victims, particularly identifying that Hispanics and blacks were less likely to be restrained and thus could be the target of future injury prevention programs.

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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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Decreased Incidence of Rib Fractures in Pregnant Patients After Motor Vehicle Collisions

American Journal of Critical Care ◽

10.4037/ajcc2021505 ◽

2021 ◽

Vol 30 (5) ◽

pp. 385-390

Author(s):

Marissa Di Napoli ◽

William B. DeVoe ◽

Stuart Leon ◽

Bruce Crookes ◽

Alicia Privette ◽

...

Keyword(s):

Chest Wall ◽

Injury Severity ◽

Motor Vehicle ◽

Rib Fractures ◽

Hormonal Changes ◽

Motor Vehicle Collisions ◽

Vehicle Collisions ◽

Vehicle Collision ◽

Chest Wall Injury ◽

Wall Injury

Background Rib fractures are common after motor vehicle collisions. The hormonal changes associated with pregnancy decrease the stiffness and increase the laxity of cartilage and tendons. The effect of these changes on injury mechanics is not completely understood. Objectives To compare the incidences of chest wall injury following blunt thoracic trauma between pregnant and nonpregnant women. Methods The authors conducted a retrospective review of female patients seen at a level I trauma center from 2009 to 2017 after a motor vehicle collision. Patient characteristics were compared to determine if pregnancy affected the incidence of chest wall injury. Statistics were calculated with SPSS version 24 and are presented as mean (SD) or median (interquartile range). Results In total, 1618 patients were identified. The incidence of rib/sternal fracture was significantly lower in pregnant patients (7.9% vs 15.2%, P = .047), but the incidence of intrathoracic injury was similar between the groups. Pregnant and nonpregnant patients with rib/sternal fractures had similar Injury Severity Score results (21 [13-27] vs 17 [11-22], P = .36), but pregnant patients without fractures had significantly lower scores (1 [0-5] vs 4 [1-9], P < .001). Conclusions Pregnant patients have a lower rate of rib fracture after a motor vehicle collision than nonpregnant patients. The difference in injury mechanics may be due to hormonal changes that increase elasticity and resistance to bony injury of the ribs. In pregnant trauma patients, intrathoracic injury without rib fracture should raise concerns about injury severity. A multicenter evaluation of these findings is needed.

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Predictive modelling of injury severity in bicycle–motor vehicle collisions utilizing learning vector quantization: a case study of Britain’s cycling capital

International Journal of Crashworthiness ◽

10.1080/13588265.2019.1701361 ◽

2019 ◽

pp. 1-11

Author(s):

Meisam Siamidoudaran ◽

Mehdi Siamidodaran ◽

Ersun Iscioglu

Keyword(s):

Vector Quantization ◽

Injury Severity ◽

Motor Vehicle ◽

Predictive Modelling ◽

Learning Vector Quantization ◽

Motor Vehicle Collisions ◽

Vehicle Collisions

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Did Amendments to the Ontario Highway Traffic Act in 2009-2010 Affect the Proportion of Alcohol-Related Motor Vehicle Collisions Seen at a Level I Trauma Centre over a 10-year Period?

CJEM ◽

10.1017/cem.2016.343 ◽

2016 ◽

Vol 19 (2) ◽

pp. 106-111

Author(s):

Meghan Garnett ◽

Tanya Charyk Stewart ◽

Michael R Miller ◽

Rodrick Lim ◽

Kristine Van Aarsen ◽

...

Keyword(s):

Injury Severity ◽

Trauma Registry ◽

Motor Vehicle ◽

Trauma Centre ◽

Trauma Patients ◽

Highway Traffic ◽

Motor Vehicle Collisions ◽

Vehicle Collisions ◽

Level I ◽

Legislative Amendments

AbstractObjectivesTo determine if changes to the Ontario Highway Traffic Act (OHTA) in 2009 and 2010 had an effect on the proportion of alcohol-related motor vehicle collisions (MVCs) presenting to a trauma centre over a 10-year period.MethodsA retrospective review of the trauma registry at a Level I trauma centre in southwestern Ontario was undertaken. The trauma registry is a database of all trauma patients with an injury severity score (ISS) ≥12 and/or who had trauma team activation. Descriptive statistics were calculated. Interrupted time series analyses with ARIMA modeling were performed on quarterly data from 2004-2013.ResultsA total of 377 drivers with a detectable serum ethanol concentration (SEC) were treated at our trauma centre over the 10-year period, representing 21% of all MVCs. The majority (330; 88%) were male. The median age was 31 years, median SEC was 35.3 mmol/L, and median ISS was 21. A total of 29 (7.7%) drinking drivers died from their injuries after arriving to hospital. There was no change in the proportion of drinking drivers after the 2009 amendment, but there was a significant decline in the average SEC of drinking drivers after changes to the law. There was no difference in the proportion of drinking drivers ≤21 years after introduction of the 2010 amendment for young and novice drivers.ConclusionsThere was a significance decline in the average SEC of all drinking drivers after the 2009 OHTA amendment, suggesting that legislative amendments may have an impact on drinking before driving behaviour.

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Railway Train versus Motor Vehicle Collisions: A Comparative Study of Injury Severity and Patterns

The Journal of Trauma: Injury, Infection, and Critical Care ◽

10.1097/00005373-199911000-00019 ◽

1999 ◽

Vol 47 (5) ◽

pp. 928 ◽

Cited By ~ 5

Author(s):

Mark D. Kligman ◽

F. Barry Knotts ◽

Nancy M. Fenn Buderer ◽

Andrew J. Kerwin ◽

Jane F. Rodgers

Keyword(s):

Comparative Study ◽

Injury Severity ◽

Motor Vehicle ◽

Motor Vehicle Collisions ◽

Vehicle Collisions

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Maxillofacial Fractures of Pedestrians Injured in a Motor Vehicle Accident

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0033-1333881 ◽

2013 ◽

Vol 6 (1) ◽

pp. 37-41 ◽

Cited By ~ 6

Author(s):

Kazuhiko Yamamoto ◽

Yumiko Matsusue ◽

Satoshi Horita ◽

Kazuhiro Murakami ◽

Yoshihiro Ueyama ◽

...

Keyword(s):

Injury Severity ◽

Motor Vehicle ◽

Motor Vehicle Accident ◽

The Body ◽

Facial Injury ◽

Severity Scale ◽

Motor Vehicle Collisions ◽

Vehicle Collisions ◽

Vehicle Accident ◽

Maxillofacial Fractures

Maxillofacial fractures of pedestrians injured in a motor vehicle accident were retrospectively analyzed. The patients were 38 males and 26 females, and their age was distributed almost evenly from 1 to 91 years old (average 45.9 ± 24.8 years old). Motor vehicle collisions were with an automobile in 46 patients (71.9%), a motorcycle in 17 (26.6%), and a train in 1 (1.6%). The midface was involved in 32 patients (50.0%), the mandible in 19 (29.7%), and both the mandible and the midface in 13 (20.3%). Fractures were frequently observed in the zygoma and alveolus in the midface and in the condyle, symphysis, and body in the mandible. The facial injury severity scale (FISS) rating ranged from 1 to 9 (average 2.30 ± 1.79). Injuries to other sites of the body occurred in 29 patients (45.3%). Observation was most frequently chosen in 26 patients (40.6%), followed by open reduction and internal fixation (ORIF) in 18 (28.1%), and maxillomandibular fixation (MMF) in 8 (12.5%). The FISS rating was higher in patients treated with ORIF and MMF. Injuries to other sites of the body were observed at a higher rate in patients who collided with an automobile and were also treated by ORIF.

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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

10.21203/rs.3.rs-61529/v1 ◽

2020 ◽

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. Understanding the outcomes and injuries of those trapped following an MVC 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 who were admitted to an English hospital following an MVC from 2012-2018. 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 (0.29% of all extrications) but frequently (50.1%) associated with other severe injuries. Spinal cord injuries were more common in patients who were not 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 comas 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 <0.3% 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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