A method for linking motor vehicle victim and collision data collected by multiple county agencies.

OBJECTIVE: This study assessed roadside and bedside factors associated with early mortality following motor vehicle trauma. METHODS: This retrospective cohort study evaluated motor vehicle crashes in Orange County Florida in 2009 that became medical examiner cases. Data from the Department of Highway Safety and Motor Vehicles (DHSMV), emergency medical services (EMS), a level I trauma center, and the medical examiner were integrated for the analysis. The primary outcome measure was early death, defined by death within 48 hours of a motor vehicle trauma. Both traditional and nontraditional predictors of early mortality were assessed. RESULTS: The most significant factors associated with early mortality were as follows: (1) From autopsy: hemothorax (odds ratio [OR] = 8.26, 95% confidence interval [CI]: 1.83-37.3) and liver injury (OR = 4.26, 95% CI: 1.70-15.6); (2) from hospital data: systolic blood pressure (OR = 0.98, 95% CI: 0.96-0.99) and having cardiopulmonary resuscitation (CPR) performed in the emergency department (OR = 13.4, 95% CI: 1.51-118.72); and (3) from DHSMV: involvement of drugs and/or alcohol (OR = 4.27, 95% CI: 1.33-13.6), total fatalities (OR = 6.07, 95% CI: 1.57-23.5), speed of vehicle (OR = 1.06, 95% CI: 1.02-1.09), and number of lanes at the crash scene (OR = 1.58, 95% CI: 1.13-2.20). CONCLUSION: These results were made possible by integrating 4 distinct data sources. As future research in traffic-related injury moves toward prevention, it will be critical to evaluate new preventative strategies quickly and effectively. A unique number that is both patient and event specific that could be incorporated into each of these databases would make such integration seamless. Successful methods for linking data collected by the multiple agencies involved in motor vehicle collisions will ultimately provide invaluable information for medical personnel, researchers, engineers, planners, and policy makers at the local, state, and national levels to identify safety priorities to reduce crash-related injuries and fatalities.

Sudden death in a 27-year-old man with Chiari I malformation.

We present a case of a witnessed sudden death of a 27-year-old adult man with no antecedent trauma who subsequently was found to have a previously undiagnosed Chiari I malformation. Cases of sudden unprovoked respiratory collapse in children and adults with Chiari I malformation have been well documented, leading to death in some children. There have also been rare examples of sudden death in adults with Chiari I malformation; however, these decedents experienced recent trauma. This is a unique example of a witnessed sudden death of an adult with previously undiagnosed Chiari I malformation in the absence of trauma.