Increase in Motor Vehicle Crash Severity: An Unforeseen Consequence of COVID-19

Introduction The 2019 coronavirus (COVID-19) pandemic led to stay-at-home (SAH) orders in Pennsylvania targeted at reducing viral transmission. Limitations in population mobility under SAH have been associated with decreased motor vehicle collisions (MVC) and related injuries, but the impact of these measures on severity of injury remains unknown. The goal of this study is to measure the incidence, severity, and outcomes of MVC-related injuries associated with SAH in Pennsylvania. Materials & Methods We conducted a retrospective geospatial analysis of MVCs during the early COVID-19 pandemic using a state-wide trauma registry. We compared characteristics of patients with MVC-related injuries admitted to Pennsylvania trauma centers during SAH measures (March 21-July 31, 2020) with those from the corresponding periods in 2018 and 2019. We also compared incidence of MVCs for each zip code tabulation area (ZCTA) in Pennsylvania for the same time periods using geospatial mapping. Results Of 15,550 trauma patients treated during the SAH measures, 3486 (22.4%) resulted from MVCs. Compared to preceding years, MVC incidence decreased 10% under SAH measures with no change in mortality rate. However, in ZCTA where MVC incidence decreased, there was a 16% increase in MVC injury severity. Conclusions Stay-at-home orders issued in response to the COVID-19 pandemic in Pennsylvania were associated with significant changes in MVC incidence and severity. Identifying such changes may inform resource allocation decisions during future pandemics or SAH events.

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In-Hospital Outcome Based on the Mode of EMS Transportation in a High-Income Rapidly Developing Middle Eastern Country

Global Journal of Health Science ◽

10.5539/gjhs.v9n2p246 ◽

2016 ◽

Vol 9 (2) ◽

pp. 246

Author(s):

Hassan Al-Thani ◽

Ayman El-Menyar ◽

Yugan Pillay ◽

Monira Mollazehi ◽

Ahammed Mekkodathil ◽

...

Keyword(s):

Emergency Medical Services ◽

Injury Severity ◽

Motor Vehicle ◽

Middle Eastern ◽

Motor Vehicle Crash ◽

Medical Services ◽

Trauma Patients ◽

Severe Injuries ◽

Emergency Medical ◽

The Impact

BACKGROUND: Helicopter emergency medical services (HEMS) are considered as a standard component of advanced pre-hospital emergency care system. We assessed the clinical presentation and outcomes of trauma patients transported by HEMS versus ground emergency medical services (GEMS).METHODS: A retrospective analysis of prospectively collected trauma registry data at a level I trauma center was conducted for patients transported by GEMS and HEMS between 2011 and 2013. Patients’ data were categorized and analyzed based on the mode of transportation (MOT).RESULTS: A total of 4596 trauma patients were admitted to the hospital with a mean age of 31±15 years. Injured patients were transported to the trauma centre by GEMS (93.3%) and HEMS (6.7%). The common mechanisms of injury were motor vehicle crash (37%) and fall (25%). MVC victims were transported to the hospital by HEMS, whereas, patients with fall and pedestrian injuries (P=0.001 for all) were more likely to be transported by GEMS. Moreover, patients in the HEMS group had a higher frequency of head (p=0.001) and chest (p=0.001) injuries and required prolonged ICU and overall hospital stay (p=0.001). When compared with GEMS, HEMS group were more likely to sustain severe injuries (ISS>15; p=0.001) and needed frequent on-scene intubation (P=0.001). Hospital mortality was grater in HEMS patients (10% vs 4%, p=0.001) in comparison to GEMS. Multivariate analysis, after adjusting for the confounding factors demonstrated that polytrauma and lower scene GCS were the independent predictors of mortality.CONCLUSIONS: Patients transported by HEMS are characterized by greater injury severity, traumatic brain injury and on-scene intubation. Moreover, the mortality is 2.5 fold greater in patients transported by GEMS, however, the impact of MOT on mortality disappear after adjusting for potential confounders. Institutional guidelines that focus on clinical triage criteria, key environmental factors and reducing transport time may be informed by this study. Further investigations are needed to better quantifyestimate the pre-hospital time intervals and to identify the sub-groups of trauma patients who will clearly benefit from the use of HEMS.

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Higher Blood Alcohol Concentration is Related to Less Severe Injury Amongst Intoxicated Trauma Patients

10.21203/rs.3.rs-35227/v1 ◽

2020 ◽

Author(s):

Nikathan Kumar ◽

Kartik Prabhakaran ◽

Matthew K. McIntyre ◽

David J. Samson ◽

Rifat Latifi

Keyword(s):

Injury Severity ◽

Motor Vehicle ◽

Alcohol Intoxication ◽

Blood Alcohol Concentration ◽

Alcohol Ingestion ◽

Trauma Patients ◽

Blood Alcohol ◽

Severity Scores ◽

Severity Of Injury ◽

Level 1

Abstract Background Previous studies show varied results regarding the protective effects of alcohol intoxication upon injury and mortality in the setting of trauma. Our study aimed to determine the effects of blood alcohol content (BAC) amongst trauma patients with alcohol ingestion, upon injury type and severity, as well as outcomes. Methods This 4-year retrospective study (2013–2017) used an institutional trauma database to capture all Level 1 and 2 trauma patients (≥14 years old) with BAC > 10 mg/dL presenting to the emergency department at a Level 1 trauma center. Demographic variables including mechanism of injury (MOI) were collected. Patients’ BAC was compared to their calculated injury severity scores (ISS) and abbreviated injury scale (AIS) scores. Analysis included linear regression, T-tests and ANOVAs with Tukey’s post-hoc analysis for continuous variables and Fisher’s exact test for binary variables. Multivariate regression analysis was performed to determine independent predictors of injury severity. Results 332 intoxicated patients were identified (mean BAC: 210.2±87.14 mg/dL, range 12.7–460.0; 74.1% male; median age 35; range: 16–90). The median ISS was 6 (range: 1–48). Patients in motor vehicle collisions had lower BACs (186.0±5.59 mg/dL) than those who fell (233.8±10.42 mg/dL, p = 0.0002), were assaulted (230.4±14.04 mg/dL, p = 0.0261), or were pedestrians struck (259.4±14.17 mg/dL, p = 0.004). Overall, patients with higher BAC had lower GCS, lower ISS, and shorter intensive care unit (ICU) length of stay, but no differences in hospital stay, or ventilator days. Conclusions Trauma patients with higher BAC have lower ISS, less severe chest injury, and shorter ICU stays. These findings suggest that higher levels of alcohol ingestion may portend a protective effect in the setting of trauma with respect to severity of injury that does not mitigate the importance of education and injury prevention but warrants further study into the physiology of alcohol and trauma.

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Cirrhosis and Trauma: A Deadly Duo

The American Surgeon ◽

10.1177/000313480507101202 ◽

2005 ◽

Vol 71 (12) ◽

pp. 996-1000 ◽

Cited By ~ 14

Author(s):

A. Britton Christmas ◽

Ashley K. Wilson ◽

Glen A. Franklin ◽

Frank B. Miller ◽

J. David Richardson ◽

...

Keyword(s):

Hepatic Cirrhosis ◽

Injury Severity ◽

Prognostic Indicator ◽

Outcome Data ◽

Hospital Length Of Stay ◽

Trauma Patients ◽

Fourfold Increase ◽

Abdominal Operation ◽

Severity Of Injury ◽

The Impact

It has been previously reported that trauma patients with cirrhosis undergoing emergency abdominal operations exhibit a fourfold increase in mortality independent of their Child's classification. We undertook this review to assess the impact of cirrhosis on trauma patients. We reviewed the records of patients from 1993 to 2003 with documented hepatic cirrhosis and compared them to a 2:1 control population without hepatic cirrhosis and matched for age, sex, Injury Severity Score (ISS), and Glasgow Coma Score (GCS). Demographic, severity of injury, and outcome data were recorded. Student's t test and χ2 were used for statistical analysis and a P < 0.05 was significant. Sixty-one patients had documented cirrhosis and were compared to 156 matched controls. Comparing the two groups demonstrates there was no difference in age, ISS, or GCS. Intensive care stay, hospital length of stay, blood requirements in the first 24 hours postinjury, and mortality (33% vs 1%) was significantly greater in the trauma patients with cirrhosis. Fifty-five per cent of deaths in the cirrhosis group was due to sepsis, and, as the Child's class increases, so does the mortality (Child's A, 15%; B, 37%; and C, 63%). In 64 per cent of cirrhotics without an emergent abdominal operation, mortality was 21 per cent. In the 36 per cent of cirrhotics who had emergent abdominal operation, mortality was 55 per cent. Hepatic cirrhosis in trauma patients, regardless of severity of injury or the need for an abdominal intervention, is a poor prognostic indicator. The necessity of an abdominal operative intervention further amplifies this effect. Trauma and cirrhosis is, in fact, a deadly duo.

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Impact of COVID-19 pandemic on injury prevalence and pattern in the Washington, DC Metropolitan Region: a multicenter study by the American College of Surgeons Committee on Trauma, Washington, DC

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2020-000659 ◽

2021 ◽

Vol 6 (1) ◽

pp. e000659

Author(s):

Marc Chodos ◽

Babak Sarani ◽

Andrew Sparks ◽

Brandon Bruns ◽

Shailvi Gupta ◽

...

Keyword(s):

Multicenter Study ◽

Trauma Center ◽

Injury Severity ◽

Motor Vehicle ◽

Penetrating Trauma ◽

Motor Vehicle Crash ◽

Metropolitan Region ◽

Washington Dc ◽

Mechanism Of Injury ◽

The Impact

BackgroundThe COVID-19 pandemic has had far-reaching effects on healthcare systems and society with resultant impact on trauma systems worldwide. This study evaluates the impact the pandemic has had in the Washington, DC Metropolitan Region as compared with similar months in 2019.DesignA retrospective multicenter study of all adult trauma centers in the Washington, DC region was conducted using trauma registry data between January 1, 2019 and May 31, 2020. March 1, 2020 through May 31, 2020 was defined as COVID-19, and January 1, 2019 through February 28, 2020 was defined as pre-COVID-19. Variables examined include number of trauma contacts, trauma admissions, mechanism of injury, Injury Severity Score, trauma center location (urban vs. suburban), and patient demographics.ResultsThere was a 22.4% decrease in the overall incidence of trauma during COVID-19 compared with a 3.4% increase in trauma during pre-COVID-19. Blunt mechanism of injury decreased significantly during COVID-19 (77.4% vs. 84.9%, p<0.001). There was no change in the specific mechanisms of fall from standing, blunt assault, and motor vehicle crash. The proportion of trauma evaluations for penetrating trauma increased significantly during COVID-19 (22.6% vs. 15.1%, p<0.001). Firearm-related and stabbing injury mechanisms both increased significantly during COVID-19 (11.8% vs. 6.8%, p<0.001; 9.2%, 6.9%, p=0.002, respectively).Conclusions and relevanceThe overall incidence of trauma has decreased since the arrival of COVID-19. However, there has been a significant rise in penetrating trauma. Preparation for future pandemic response should include planning for an increase in trauma center resource utilization from penetrating trauma.Level of evidenceEpidemiological, level III.

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Characteristics and conviction rates of injured alcohol-impaired drivers admitted to a tertiary care Canadian Trauma Centre

Clinical & Investigative Medicine ◽

10.25011/cim.v30i1.446 ◽

2007 ◽

Vol 30 (1) ◽

pp. 26 ◽

Cited By ~ 8

Author(s):

Michelle E. Goecke ◽

Andrew W. Kirkpatrick ◽

Kevin B. Laupland ◽

Marija Bicanic ◽

Christi Findlay

Keyword(s):

Injury Severity ◽

Motor Vehicle ◽

Alcohol Intoxication ◽

Tertiary Care ◽

Multivariable Analysis ◽

Trauma Centre ◽

Motor Vehicle Crash ◽

Fatal Injury ◽

Severity Of Injury ◽

Legal Consequences

Purpose: Alcohol intoxication is an important factor in motor vehicle crash (MVC) related morbidity and mortality. Despite greater societal attention, medical admission after MVC results in avoidance of legal consequences. We sought to determine characteristics of, and consequences to, injured alcohol-impaired drivers (IAIDs). Methods: All injured adults [Injury Severity Score (ISS) >12, age>18] entered in a Trauma Centre registry between April 1 1995 to March 31 2003 were reviewed. Legally intoxicated patients who had been drivers involved in a MVC and who had a blood alcohol content (BAC) ≥80 mg/dl were cross-referenced to municipal and federal databases to identify investigations, charges, and legal outcomes. Results: Of BACs obtained from 1933 (41%) of 4727 patients; 39% (757) were legally intoxicated (BAC ≥80 mg/dl); 185 (24%) were IAIDs. The IAIDs were generally very intoxicated (mean BAC 190 mg/dl); seriously injured (median ISS 22); often in ICU (47%), and had 8% mortality. Charges were laid against 69 (37%) of IAIDs, only 58 (31%) suffered legal consequences; 27 (15%) of impaired driving, and 31 (17%) of other convictions. All IAIDs who caused a fatal injury to another were convicted. A lower severity of injury of the IAIDs, non-fatal injury to another, and occurrence in the more recent years of the study were independently associated with a conviction in multivariable analysis. Conclusion: Despite increasing convictions over time and among most of those charged, the majority of injured drivers escape legal consequences. Increased BAC testing and reporting of this phenomenon could address this.

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Validation of the BATT score for prehospital risk stratification of traumatic haemorrhagic death: usefulness for tranexamic acid treatment criteria

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-020-00827-5 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Francois-Xavier Ageron ◽

Timothy J. Coats ◽

Vincent Darioli ◽

Ian Roberts

Keyword(s):

Tranexamic Acid ◽

Acid Treatment ◽

Injury Severity ◽

External Validation ◽

Research Network ◽

Brier Score ◽

Trauma Patients ◽

Using Data ◽

The Uk ◽

The Impact

Abstract Background Tranexamic acid reduces surgical blood loss and reduces deaths from bleeding in trauma patients. Tranexamic acid must be given urgently, preferably by paramedics at the scene of the injury or in the ambulance. We developed a simple score (Bleeding Audit Triage Trauma score) to predict death from bleeding. Methods We conducted an external validation of the BATT score using data from the UK Trauma Audit Research Network (TARN) from 1st January 2017 to 31st December 2018. We evaluated the impact of tranexamic acid treatment thresholds in trauma patients. Results We included 104,862 trauma patients with an injury severity score of 9 or above. Tranexamic acid was administered to 9915 (9%) patients. Of these 5185 (52%) received prehospital tranexamic acid. The BATT score had good accuracy (Brier score = 6%) and good discrimination (C-statistic 0.90; 95% CI 0.89–0.91). Calibration in the large showed no substantial difference between predicted and observed death due to bleeding (1.15% versus 1.16%, P = 0.81). Pre-hospital tranexamic acid treatment of trauma patients with a BATT score of 2 or more would avoid 210 bleeding deaths by treating 61,598 patients instead of avoiding 55 deaths by treating 9915 as currently. Conclusion The BATT score identifies trauma patient at risk of significant haemorrhage. A score of 2 or more would be an appropriate threshold for pre-hospital tranexamic acid treatment.

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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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