ABSTRACT
BACKGROUND: Further reduction in road traffic accident (RTA) fatalities is a key priority in the European Union. Since data on injury patterns related to mortality in RTAs are scarce, the aim of this study was to analyze injury patterns and injury severity of in-hospital RTA fatalities in the Netherlands. METHODS: All in-hospital deceased RTA victims in the Netherlands during the period 2015-2016 were analyzed. Data were obtained from the National Trauma Registry. Injury patterns, injury severity, accident and patient characteristics of road user groups were compared. RESULTS: A total of 497 deceased RTA victims were analyzed, of which most were bicyclists. All analyzed motorcyclists had an ISS ≥ 16. Head trauma was most frequent in pedestrians (73.7%) and bicyclists (71.3%). Thorax trauma was most frequent in motorcyclists and motorists (60.9% and 65.8%, respectively). RTA victims younger than 25 years were more severely injured (median ISS 38, interquartile range [IQR] 29-46) compared to RTA victims aged over 75 years (median ISS 25, IQR 13-30). More than 10% of the severely injured (ISS ≥ 16) RTA victims was not transported to a level I trauma center. The majority of this group was older than 75 years. CONCLUSIONS: Further prevention of head trauma is needed to reduce RTA fatalities, especially in bicyclists. Also, undertriage of severe trauma in elderly RTA victims is obvious and should be addressed in the early phases of trauma care, especially during prehospital triage and initial care at admission.
Subject(s)
Accidents, Traffic/mortality , Hospital Mortality , Injury Severity Score , Wounds and Injuries/etiology , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Netherlands/epidemiology , Registries , Retrospective Studies , Risk Assessment , Risk Factors , Triage , Wounds and Injuries/diagnosis , Wounds and Injuries/mortality , Young AdultABSTRACT
This epidemiological study analyzed the incidence, risk factors, hospital triage, and outcome of patients with severe traumatic brain injuries (sTBIs) caused by road traffic accidents (RTAs) admitted to hospitals in the Trauma Center West-Netherlands (TCWN) region. Trauma registry data were used to identify TBI in all RTA victims admitted to hospitals in the mid-West region of the Netherlands from 2003 to 2011. Type of head injury and severity were classified using the Abbreviated Injury Scale (AIS). Head injuries with AIS severity scores ≥ 3 were considered sTBI. Ten percent of all 12,503 hospital-admitted RTA victims sustained sTBI, ranging from 5.4% in motorcyclists, 7.4% in motorists, 9.6% in cyclists, and 12.7% in moped riders to 15.1% in pedestrians (p<0.0001). Among RTA victims admitted to hospital, sTBI was most prevalent in pedestrians (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.78-2.86) and moped riders (OR, 1.86; 95% CI, 1.51-2.30). Injury patterns differed between road user groups. Incidence of contusion ranged from 46.6% in cyclists to 74.2% in motorcyclists, whereas basilar and open-skull fractures were least common in motorcyclists (22.6%) and most common in moped riders (51.5%). Hemorrhage incidence ranged from 44.9% (motorists) to 63.6% (pedestrians). Subdural and -arachnoid bleedings were most frequent. Age, Glasgow Coma Scale, and type of hemorrhage were independent prognostic factors for in-hospital mortality after sTBI. In-hospital mortality ranged from 4.2% in moped riders to 14.1% in motorists. Pedestrians have the highest risk to sustain sTBI and, more specifically, intracranial hemorrhage. Hemorrhage and contusion both occur in over 50% of patients with sTBI. Specific brain injury patterns can be distinguished for specific road user groups, and independent prognostic risk factors for sTBI were identified. This knowledge may be used to improve vigilance for particular injuries in specific patient groups and stimulate development of focused diagnostic strategies.
