ABSTRACT
@#BACKGROUND: The main objective was to identify common geographical buildup within the 100-meter buffer of severely injured based on injury severity score (ISS) among the motor vehicle crash (MVC) victims in Malaysia. METHODS: This was a prospective cohort study from July 2011 until June 2013 and involved all MVC patients attending emergency departments (ED) of two tertiary centers in a district in Malaysia. A set of digital maps was obtained from the Town Planning Unit of the district Municipal Office (local district map). Vector spaces were spanned over these maps using GIS software (ARCGIS 10.1 licensed to the study center), and data from the identified severe injured cases based on ISS of 16 or more were added. Buffer analysis was performed and included all events occurring within a 100-meter perimeter around a reference point. RESULTS: A total of 439 cases were recruited over the ten-month data collection period. Fifty two (11％) of the cases were categorized as severe cased based on ISS scoring of 16 and more. Further buffer analysis looking at the buildup areas within the vicinity of the severely injured locations showed that most of the severe injuries occurred at locations on municipal roads (15, 29％), straight roads (16, 30％) and within villages buildup (suburban) areas (18, 35％). CONCLUSION: This study has successfully achieved its objective in identifying common geographical factors and buildup areas within the vicinity of severely injured road traffic cases.
ABSTRACT
Road traffic injuries have become a major social issue. With the development of technology, legislation and safety consciousness, the fatal rate of brain and chest injuries has been declined. However, as to prevent foot and ankle injuries of occupants still no effectual protective devices have been developed. In this paper, research progress on foot and ankle injuries of occupants was reviewed, which found out that most of such injuries in the frontal motor vehicle crashes occurred more easily to the drivers, which was possibly due to the special loading on their lower extremity during braking. Although there still exists a continuing debate about taxonomy of the frontal motor vehicle crashes, researchers have approached unified understanding that foot and ankle injuries are usually caused in the real-world narrow object frontal crashes. Until now, studies on foot and ankle injury and its protective mechanisms in various types of crashes are rarely conducted. A combination of the in-vitro experiment and computational modeling would be an ideal method to solve this issue.
ABSTRACT
O Atendimento Pré-hospitalar (APH) é um importante recurso no atendimento à vítimas de trauma. No entanto, há muitas dificuldades para demonstrar o efeito benéfico das intervenções do APH na sobrevivência das vítimas, sobretudo as de suporte avançado à vida (SAV). A proposta deste estudo é caracterizar as vítimas de acidentes trânsito, com Revised Trauma Score (RTS) <11, atendidas pelo SAV municipal e encaminhadas a hospitais terciários em São Paulo, além de identificar as variáveis da fase pré-hospitalar associadas à sobrevivência e avaliar o valor predeterminante dessas variáveis sobre o resultado obtido pelas vítimas. As variáveis avaliadas foram: sexo, idade, mecanismos do acidente, procedimentos de suporte básico e SAV realizados, repercussão fisiológica do trauma na cena do acidente, (considerando o RTS , seus parâmetros e flutuações), o tempo consumido no APH, gravidade do trauma segundo o Injury Severity Score (ISS),a Maximum Abbreviated Injury Scale (MAIS) e número de lesões para cada segmento corporal. Os resultados obtidos por 175 vítimas entre 12 e 65 anos, foram submetidos a "Análise de Sobrevivência de Kaplan Meier" e ao "Modelo de Riscos Proporcionais de Cox". A variável dependente foi o tempo de sobrevivência após o acidente, considerando os intervalos até 6h,12h, 24h, 48h, até 7 dias e até o término da internação. Os homens (86,9%) e a faixa etária de 20 a 29 anos (36,0%) foram as mais frequentes. Os atropelamentos (45,1%) e o envolvimento de motocicletas e seus ocupantes (30,9%) foram os destaques dentre os mecanismos de trauma. A média do RTS na cena e do ISS, foram respectivamente 8,8 e 19,4.Os segmentos corpóreos mais atingidos foram: cabeça (58,8%), membros inferiores (45,1%) e superfície externa (40%). A média de tempo consumido na fase de APH foi 41min (tempo de cena 20,2min). Ocorreram 36% de óbitos, (metade em até 6 horas). A análise estatística revelou ) 24 fatores associados à sobrevivência, dentre eles, os procedimentos respiratórios avançados e os circulatórios básicos, as variáveis relativas ao RTS e a gravidade (ISS, MAIS e o número de lesões). No modelo final de Cox, ter sido submetido a procedimentos respiratórios avançados, compressões torácicas, apresentar lesão abdominal e ISS>25, foi associado a maior risco para o óbito até 48h após o trauma. Até 7 dias, a compressão torácica não se manteve no modelo final e a PAS de zero a 75mmHg apresentou associação com a morte após o acidente. Até a alta hospitalar, a ausência de PAS na avaliação inicial permaneceu no modelo. A reposição de volume foi o único fator com valor protetor para o risco de óbito presente em todos os momentos.
The prehospital care (PH) is an important resource to trauma victims' care. Nevertheless, there is great difficulty in demonstrating the PH intervention's positive effect in victim's survival, especially when concerning the advanced life support (ALS). The aim of this study is to characterize motor vehicle crash victims with Revised Trauma Score (RTS) <11 cared by municipal ALS and moved to tertiary hospitals in São Paulo in addition to identifying the prehospital variables associated to survival, and to evaluate their values as victim survival outcome determinant. The variables evaluated were: sex, age, trauma mechanism, basic life support and ALS procedures, physiological measures in the accident scene (considering the RTS, its parameters and fluctuations), the time consumed in PH phase, trauma severity by Injury Severity Score (ISS), the Maximum Abbreviated Injury Scale (MAIS) and number of lesions in each body region. The main results obtained by 175 victims between 12 e 65 years of age were submitted to the Kaplan Meier Survival Analysis and to Cox Proportional hazards Regression Analysis. The dependent variable was the survival time after the motor vehicle accident considering the intervals up to 6,12,24 and 48hs , up to 7 days and until the time of hospital discharge. Men (86,9%) and the 20 to 29 aged group (36%) were the most frequent. The pedestrians struck by car (45,1%) and the motorcycles (and their riders) (30,9%)were the highlight in trauma mechanisms. The RTS and the ISS average were 8,8 and 19,4 respectively. The more damaged body regions were head (58,8%), lower limbs (45,1%) and external surface (40%).The prehospital time average was 41 min (scene time 20,2min).Death rate was 36% (half of which up to 6hs).The statistical analysis revealed 24 survival associated factors. The ALS and the circulatory basic procedures, the RTS variables and the trauma severity (ISS,MAIS and number of lesions) within them. In the final Cox Model were associated to higher risk of death up to 48hs after trauma: the submission to ALS respiratory procedures, chest compressions, the presence of abdominal injuries and ISS>25 .Until the 7th day the chest compression was not sustained in a final model and the systolic blood pressure (SBP) from zero to 75mmHg revealed statistical association with death after trauma. Until hospital discharge the SBP absence in scene evaluation remained in the model. The prehospital intravenous fluid refilling was the only factor of protector value to death risk in all moments.