Car Ratings Take a Back Seat to Vehicle Type: Outcomes of SUV Versus Passenger Car Crashes.

Background: Car safety ratings are routinely utilized in making automobile purchase decisions. These 1- to 5-star ratings are based on crash test data comparing vehicles of similar type, size and weight. Objectives: We hypothesized that car safety ratings are less important than vehicle factors such as vehicle type and weight in predicting outcomes of head-on crashes. Methods: A retrospective study was conducted on severe head-on motor vehicle crashes entered into the FARS (Fatality Analysis Reporting System) database between 1995 and 2010. This database includes all US motor vehicle crashes that resulted in a death within 30 days of the accident. Outcomes of SUV versus passenger car and passenger car versus passenger car head-on crashes were compared by safety rating. Exclusion criteria was added to eliminate collisions with insufficient information or unbelted passengers. The paired crash results were entered into a logistic regression model with driver death as the outcome of interest. Results: The database contained 83,251 vehicles of any type that were involved in head-on crashes. In head-on crashes where the passenger car front driver crash rating was superior to the SUV's, the odds of death were 4.52 times higher for the driver of the passenger car (95% CI: 3.06-6.66). Ignoring crash ratings, the odds of death were 7.64 times higher for the passenger car driver (95% CI: 5.59-10.44). In passenger car versus passenger car head-on crashes, a lower car safety rating was associated with a 1.28 times higher odds of death (95% CI: 1.05-1.57). In passenger car vs. passenger car head-on crashes, each one point lower car safety rating resulted in a 1.22 times higher odds of death (95% CI: 1.03-1.44). Conclusion: Vehicle type (passenger car versus SUV) is a much more important predictor of death than crash safety ratings in SUV versus passenger car head-on crashes.

Human factors in the emergency department: Is physician perception of time to intubation and desaturation rate accurate?

OBJECTIVE: The main objective of the present study was to examine the perceived versus actual time to intubation (TTI) as an indication to help determine the situational awareness of Emergency Physicians during rapid sequence intubation and, additionally, to determine the physician's perception of desaturation events. METHODS: A timed, observation prospective cohort study was conducted. A post-intubation survey was administered to the intubating physician. Each step of the procedure was timed by an observer in order to determine actual TTI. The number of desaturation events was also recorded. RESULTS: One hundred individual intubations were included. The provider perceived TTI was significantly different and underestimated when compared with the actual TTI (23 s, 95% confidence interval (CI) 20.4-25.49 vs 45.5 s, 95% CI 40.2-50.7, P < 0.001, respectively). Pearson correlation coefficient of perceived TTI to actual TTI was r(2) = 0.39 (95% CI 0.21-0.54, P < 0.001). The provider perceived desaturation rate was also significantly different from actual desaturation rate (13, 95% CI 3-12 vs 23, 95% CI 13-29, P = 0.05, respectively). The overall time to desaturation was 65.1 s. CONCLUSIONS: Our findings have shown that provider's perception of TTI occurs sooner than actually observed. Also, the providers were less aware of desaturation during the procedure.

Twenty-four-hour packed red blood cell requirement is the strongest independent prognostic marker of mortality in ED trauma patients.

BACKGROUND: Injury severity score, serum lactate, and shock index help the physician determine the severity of injuries present and have been shown to relate to mortality. We sought to determine if an increasing amount of packed red blood cells (PRBCs) given in the first 24hours of admission is an independent predictor of mortality and how it compares to other validated markers. METHODS: A 6-year retrospective, observational study of adult trauma patients was conducted at a level 1 trauma center. Charts were reviewed for demographic data, amount of PRBC received in the first 24hours, injury severity score, shock index, and lactate levels. Subgroups were used to determine if each variable was an independent predictor of mortality. Correlation coefficients and linear regression were used to determine the strength of correlation between each variable and mortality. RESULTS: One hundred fifty-seven patients met criteria over a 6-year period. The average age was 28years, 93% were male, and 86% had penetrating injuries. The average injury severity score, serum lactate, and shock index were 18, 6.1, and 0.9, respectively. The average amount of blood given was 6.7 U. CONCLUSION: Twenty-four-hour PRBC requirement is both a novel independent predictor of and has the greatest correlation to mortality in adult trauma patients when compared to injury severity score, shock index, and serum lactate.