Bahman S. Roudsari

Pedestrian crashes: higher injury severity and mortality rate for light truck vehicles compared with passenger vehicles.

Introduction: During the last two decades changes in vehicle design and increase in the number of the light truck vehicles (LTVs) and vans have led to changes in pedestrian injury profile. Due to the dynamic nature of the pedestrian crashes biomechanical aspects of collisions can be better evaluated in field studies. Design and settings: The Pedestrian Crash Data Study, conducted from 1994 to 1998, provided a solid database upon which details and mechanism of pedestrian crashes can be investigated. Results: From 552 recorded cases in this database, 542 patients had complete injury related information, making a meaningful study of pedestrian crash characteristics possible. Pedestrians struck by LTVs had a higher risk (29%) of severe injuries (abbreviated injury scale ⩾4) compared with passenger vehicles (18%) (p = 0.02). After adjustment for pedestrian age and impact speed, LTVs were associated with 3.0 times higher risk of severe injuries (95% confidence interval (CI) 1.26 to 7.29, p = 0.013). Mortality rate for pedestrians struck by LTVs (25%) was two times higher than that for passenger vehicles (12%) (p<0.001). Risk of death for LTV crashes after adjustment for pedestrian age and impact speed was 3.4 times higher than that for passenger vehicles (95% CI 1.45 to 7.81, p = 0.005). Conclusion: Vehicle type strongly influences risk of severe injury and death to pedestrian. This may be due in part to the front end design of the vehicle. Hence vehicle front end design, especially for LTVs, should be considered in future motor vehicle safety standards.

An Evaluation of the Association Between Vehicle Type and the Source and Severity of Pedestrian Injuries

To evaluate the effect of vehicle type (passenger vehicle vs. light truck vehicle) on crash trajectory and on the consequent source and severity of pedestrian injury, we analyzed data from the Pedestrian Crash Data Study (PCDS), conducted by National Highway Traffic Safety Administration (NHTSA) from 1994 to 1998. While 62% of the adults in PV (passenger vehicle)-related crashes were carried by the vehicle, such pedestrian-vehicle interaction was observed only in 28% of LTV (light truck vehicle)-adult crashes. Being thrown forward or knocked down were the most common (65%) type of pedestrian-vehicle interactions for LTV-adult crashes. For children, 93% of those struck by LTVs and 46% of those struck by PVs were thrown forward or knocked down. For adults, LTVs were more likely than PVs to cause thorax (37% vs. 20%) and abdomen injuries (33% vs. 18%). For children, LTVs were more likely than PVs to cause injuries to the upper extremity (71% vs. 56%) and abdomen (14% vs. 8%). For adults struck by PVs the most common sources of injury were windshield for head injuries (63%), hood surface for thorax (67%), abdomen (58%), spine (30%), and upper extremity (36%) injuries, and bumper for the lower extremity injuries (60%). The leading causes of injury for adult-LTV crashes were ground for head (39%) and upper extremity (37%) injuries, hood edge for thorax (48%) and abdomen (56%) injuries, hood surface for spine injuries (36%), and bumper for lower extremity injuries (45%). For child-PV crashes, ground was the most common source of face (37%) abdomen (83%), spine (43%), and upper extremity injuries (54%). For children hit by LTVs, 52% of face, 67% of abdomen, 100% of spine, and 60% of upper extremity injuries were attributed to ground contacts. Altogether, the major sources of injury were hood surface and windshield for PV-pedestrian crashes and hood surface and hood edge for LTV-pedestrian crashes. Changes in design, such as altering the geometry and stiffness of front-end structures, might be associated with considerable decrease in the frequency and severity of pedestrian injury.

Preventable trauma death in Tehran: An estimate of trauma care quality in teaching hospitals

OBJECTIVE The purpose of this study was estimate the number of preventable trauma deaths in teaching hospitals in Tehran. METHODS We evaluated the complete prehospital, hospital, and postmortem data of 70 trauma patients who had died during a 1-year period in two of the largest university hospitals in Tehran with a multidisciplinary panel of experts. RESULTS Panel members identified 26% of all trauma deaths as preventable deaths. From 31 non-central nervous system-related deaths, 17 and 6 cases were identified as surely preventable and probably preventable, respectively. In central nervous system-related deaths, 5% of the deaths overall (2 of 38 cases) were identified as surely preventable or probably preventable. Sixty-four cases of medical errors were identified in 31 trauma deaths and 80% of these errors were directly related to the death of the patients. CONCLUSION The high preventable trauma death rate in our teaching hospitals indicates that a relatively significant percentage of trauma fatalities could have been prevented by improving prehospital and in-hospital trauma care.

Pediatric transport related injuries in Tehran: the necessity of implementation of injury prevention protocols

Prehospital and hospital data was prospectively gathered on all hospitalized trauma patients admitted to six major trauma hospitals in Tehran from August 1999 to September 2000. Data from patients of under 19 years of age was analyzed for this article. From 8000 hospitalized trauma patients, 2354 cases (29%) belonged to this age group. Fall and transport related injuries (TRIs) with 1074 (46%) and 921 (39%) cases respectively, were the most common mechanism of injury. In TRIs, boys were affected 3.5 times as often as girls. Younger children were more prone to pedestrian-related injuries while teenagers were more prone to motorcycle related injuries. Head trauma was the most common cause of death and 28 out of 32 trauma deaths were attributed to this kind of injury. Lower extremity (513) and head injuries (322) were the most common injuries. Only a few of motorcyclists and car passengers used safety devices (helmet and seat belt respectively) at the time of accident.

Childhood trauma fatality and resource allocation in injury control programs in a developing country.

BackgroundOnly a few studies have addressed the trimodal distribution of childhood trauma fatalities in lesser developed countries. We conducted this study to evaluate pre-hospital, Emergency Department (ED) and in-hospital distribution of childhood injury-related death for each mechanism of injury in Tehran, Iran. This information will be used for the efficient allocation of the limited injury control resources in the city.MethodsWe used Tehrans Legal Medicine Organization (LMO) database. This is the largest and the most complete database that receives information about trauma fatalities from more than 100 small and large hospitals in Tehran. We reviewed all the medical records and legal documents of the deceased registered in LMO from September 1999 to September 2000. Demographic and injury related characteristics of the children 15 years old or younger were extracted from the records.ResultsTen percent of the 4,233 trauma deaths registered in LMO occurred among children 15 years old or younger. Motor vehicle crashes (MVCs) (50%), burns (18%), falls (6%) and poisonings (6%) were the most common mechanisms of unintentional fatal injuries. Prehospital, emergency department and hospital deaths comprised 42%, 20% and 37% of the trauma fatalities, respectively. While, more than 80% of fatal injuries due to poisoning and drowning occurred in prehospital setting, 92% of burn-related fatalities happened after hospital admission.ConclusionInjury prevention is the single most important solution for controlling trauma fatalities due to poisoning and drowning. Improvements in the quality of care in hospitals and intensive care units might substantially alleviate the magnitude of the problem due to burns. Improvements in prehospital and ED care might significantly decrease MVC and falls-related fatalities.

Falls, Older Adults, and the Trend in Utilization of CT in a Level I Trauma Center

OBJECTIVE The purpose of this article is to evaluate the trend in the utilization of CT for fall victims older than 55 years admitted to a level I trauma center. MATERIALS AND METHODS We used trauma registry data (1996-2006) of a level I trauma center. By using the International Classification of Disease, Ninth Revision (Clinical Modification) codes, we identified the type and frequency of CT examinations for each patient. We used negative binomial regression to evaluate the association between CT utilization rates and age, year of admission, sex, insurance status, ethnicity, ICU admission status, injury severity score, and final disposition (i.e., deceased vs alive). We used logistic regression to evaluate predictors of repeat (i.e., ≥ 2) CT scans. RESULTS During the study period, the utilization rate of head, abdomen, thorax, and other body region (including spine and extremities) CT examinations increased, on average, by 7%, 16%, 14%, and 15% per year, respectively. Older age was associated with a higher utilization of head CT. Male sex and ICU admission were associated with higher utilization for all types of CT examinations. Repeat head and abdominal CT scans increased, on average, by 28% (95% CI, 20-36%) and 24% (95% CI, 2-51%) per year, respectively. CONCLUSION We quantified the increase in utilization rates of all types of CT scans for fall victims admitted to a level I trauma center. We found a marked increase in CT use over time, both for initial as well as repeat studies, and an association between CT use and variables such as sex. Future studies should focus on the evaluation of CT appropriateness and their influence on patient outcomes.

CT Use in Hospitalized Pediatric Trauma Patients: 15-year Trends in a Level I Pediatric and Adult Trauma Center

PURPOSE To evaluate the 15-year trend in the use of computed tomography (CT) in hospitalized pediatric trauma patients admitted to Harborview Medical Center (HMC) from 1996 to 2010. MATERIALS AND METHODS This Health Insurance Portability and Accountability Act-compliant retrospective study was approved by the institutional review board. The requirement for informed consent was waived. The HMC trauma registry was linked to the billing department data, and patient and injury-related characteristics were extracted, in addition to type and frequency of CT procedures. Patients discharged from the emergency department and patients hospitalized for less than 24 hours were not included in this study. Patients were classified into three categories according to age: 0-14 years, 15-18 years, and 19-54 years (reference group). Multivariate negative binomial regression was used to compare CT usage among different age groups by adjusting for patient sex, race and/or ethnicity, insurance status, mechanism of injury, injury severity, final disposition (dead vs alive), and year of admission. The trend for CT use in children and teenagers was also evaluated. RESULTS A total of 64 425 trauma patients 0-54 years of age were admitted during the study period. Compared with CT usage in adults 19-54 years old, usage in children up to 15 years of age was significantly lower for spine (incidence rate ratio [IRR], 0.89; 95% confidence interval [CI]: 0.85, 0.92), maxillofacial (IRR, 0.89; 95% CI: 0.81, 0.97), and thoracic (IRR, 0.91; 95% CI: 0.84, 0.99) CT. Increased use of head CT was observed in children up to 15 years old (IRR, 1.09; 95% CI: 1.05, 1.13) and 15-18 years old (IRR, 1.08; 95% CI: 1.04, 1.13). From 2008 to 2010, usage rates in children up to 15 years old and 15-18 years old was relatively unchanged or slightly decreased for almost all CT types. CONCLUSION A decreasing or unchanged trend was observed in CT usage in hospitalized pediatric trauma patients in recent years.

Ethnicity, Age, and Trends in Alcohol-Related Driver Fatalities in the United States

Objective: To evaluate the 8-year ethnic-specific declining trend in the proportion of alcohol-impaired driver deaths in the United States. Methods: We used the Fatality Analysis Reporting System (FARS), which is a census of all fatal motor vehicle collisions occurring in public properties in all 50 states, the District of Columbia, and Puerto Rico since 1975. For this study we only focused on driver fatalities. Data on ethnicity were not included in the FARS database until 1999, limiting the analysis to the years 1999–2006. Results: The proportion of alcohol-impaired driver deaths was higher among males compared to females, with Hispanics constituting the highest proportion in all age groups. During the past 8 years, only the decline in the proportion of alcohol-impaired driver deaths among male Hispanics 16–20 years old and male Whites 21–64 years old were significant. We were not able to identify any significant declining trend in the corresponding proportions among other age groups, or among female drivers, regardless of their age category. Conclusion: Though existing strategies have seemed to be successful in preventing an uptrend in alcohol-related fatal collisions in the country, their effectiveness in decreasing such incidents has been limited. Future studies should identify the factors that might influence the effectiveness of current anti–drunk driver policies.

Trend in the Utilization of CT for Adolescents Admitted to an Adult Level I Trauma Center

PURPOSE The aims of this study were to evaluate the trend in the utilization of CT for adolescents admitted to an adult level I trauma center and to compare the utilization pattern between adolescents and adults during the past 11 years. METHODS Trauma registry data (1996-2006) from an adult level I trauma center were used. Patients aged ≥13 years were eligible to be admitted to this hospital. From this trauma registry, the following variables were extracted: age; sex; ethnicity; insurance status; mechanism of injury; injury severity score; length of hospital and intensive care unit stay; International Classification of Diseases, Ninth Revision (ICD-9), codes; and patient disposition. Patients were categorized on the basis of their age in the following groups: 13 to 18, 19 to 55, and ≥56 years. ICD-9 procedure codes were used to create new variables that were reflective of the frequency of use of head CT (ICD-9 code 87.03), abdominal CT (ICD-9 code 88.01), thoracic CT (ICD-9 code 87.41), and other CT studies, including CT of the extremities and spine (ICD-9 code 88.38). RESULTS All age groups experienced substantial increases in the utilization of CT, and there were minimal differences in crude utilization rates among different age categories. After adjustment for potential confounders, adolescents had a slightly higher chance of being evaluated by head CT (incident risk ratio [IRR], 1.16; 95% confidence interval [CI], 1.11-1.22) and a significantly lower chance of undergoing thoracic CT (IRR, 0.54; 95% CI, 0.48-0.61) in comparison with adults aged 19 to 55 years. Among adolescents, the chance of undergoing head CT was significantly higher in 2006 relative to 1996 (IRR, 1.50; 95% CI, 1.20-1.86). However, there was no linear increase in utilization pattern from 1996 to 2006. Abdominal CT demonstrated a similar pattern. Thoracic CT and other CT studies demonstrated the most drastic increases in utilization pattern among adolescents. The IRR for the use of thoracic CT increased from 1.15 (95% CI, 0.26-5.20) in 1997 (relative to 1996) to 10.53 (95% CI, 3.24-34.26) in 2006. The IRRs for other CT studies in 2005 and 2006, relative to 1996, were 7.24 and 6.91, respectively. CONCLUSIONS Treatment of adolescents in adult level I trauma centers is challenging. Trauma centers should adopt strategies that could potentially decrease unnecessary utilization, especially among adolescents. To do this, these facilities should be familiar with patient-related and system-related characteristics that might influence overutilization. Furthermore, physicians in adult trauma centers should be reeducated with regard to potential hazardous consequences of CT for adolescents.

Utilization of Angiography and Embolization for Abdominopelvic Trauma: 14 Years' Experience at a Level I Trauma Center

OBJECTIVE The objective of our study was to evaluate the long-term trends in the use of angiography and embolization for abdominopelvic injuries. MATERIALS AND METHODS Utilization rates for pelvic and abdominal angiography, arterial embolization, and CT were analyzed for trauma patients with pelvic fractures and liver and kidney injuries admitted to a level 1 trauma center from 1996 to 2010. Multivariable linear regression was used to evaluate trends in the use of angioembolization. RESULTS A total of 9145 patients were admitted for abdominopelvic injuries during the study period. Pelvic angiography decreased annually by 5.0% (95% CI, -6.4% to -3.7%) from 1996 to 2002 and by 1.8% (-2.4% to -1.2%) from 2003 to 2010. Embolization rates for these patients varied from 49% in 1997 to 100% in 2010. Utilization of pelvic CT on the day of admission increased significantly during this period. Abdominal angiography for liver and kidney injuries decreased annually by 3.3% (95% CI, -4.8% to -1.8%) and 2.0% (-4.3% to 0.3%) between 1996 and 2002 and by 0.8% (95% CI, -1.4% to -0.1%) and 0.9% (-2.0% to 0.1%) from 2003 to 2010, respectively. Embolization rates ranged from 25% in 1999 to 100% in 2010 for liver injuries and from 0% in 1997 to 80% in 2002 for kidney injuries. Abdominal CT for liver and kidney injuries on the day of admission also increased. CONCLUSION A significant decrease in angiography use for trauma patients with pelvic fractures, liver injuries, and kidney injuries from 1996 to 2010 and a trend toward increasing embolization rates among patients who underwent angiography were found. These findings reflect a declining role of angiography for diagnostic purposes and emphasize the importance of angiography as a means to embolization for management.