Pedestrian Vehicle Accidents 'Common Injuries Patterns'

Pedestrian Vehicle Accidents ‘Common Injury Patterns’
By Dr. Nic Sparrow MBBS, BSc, MRCGP
Medical Director – Pre-Hospital Care World
www.phcworld.org

Overview / Aims
To discuss some the common injuries patterns in Pedestrian Vehicle Accidents (PVA’s)
To explore and review key medical literature surrounding this topic
Conclude with a summary of useful things to remember when attending PVA’s

Background
1 Pedestrian is killed by a motor vehicle every 113 minutes and injured every 8 minutes in the USA
PVA’s account for a significant number of trauma admissions and deaths in urban areas
Patients can have multiple injuries & be difficult to evaluate initially
Pedestrians Injured by Automobiles: Relationship of Age to Injury Type and Severity; DemetriosDemetriades et al: J Am CollSurg: V0l. 199, No. 3, September 2004

Key Research Paper
Demetriades D et al. Pedestrians Injured by Automobiles: Relationship to Age to Injury Type and Severity.
J AM CollSurg Vol. 199 No.3 Sept 2004
Trauma Registry-based study in Los Angeles included all trauma admission for PVA’s by automobiles over a 10 year + 4 month period
From 1993 to 2003 = 5838 patient involved in this study
≤ 14 yrs – 19.4% (1136)
15-55 yrs – 64.1% (3741)
56 -65 yrs – 7.2% (420)
> 65 yrs – 9.3% (541)

Continuation
There were 972 patients (16.6%) with at least one body area with severe injuries, defined as an abbreviated injury score > 3
Head = 620 (10.6%) Most common area
Chest = 156 (2.7%)
Abdomen = 125 (2.1%)
Extremities = 71 (1.2%)

Factors Affecting Injury Severity
Age of the patient
The speed and type of vehicle
Objects carried at time of impact
The main point of contact with the vehicle
Hit at 65 km/hr - 80% chance of death
Hit at 50 km/hr - 80% chance of survival

The ‘CALL – OUT’
Parking defensively protecting the scene
Watch for traffic !
Assess & Approach
‘Read the wreck’
THINK SAFETY
SELF, Scene, Survivor

Management of PVA’s
First Responder / EMS Provider
Think Spinal Control...
Airway
Breathing
Circulation
Disability
Exposure
Ask yourself
1) Head injury ?
2) Does this patient need intubating ?
3) Does this patient have a pelvic injury ?

Head Injuries
Incidence of severe head trauma (AIS > 3) increased significantly with age:-
7.4% of the children ≤14 yrs
23.7% of the adults > 65 yrs
Subdural and subarachnoid haemorrhages also increased significantly with age
Spine Control
Palpate the Skull
Look in Eyes & ENT
GCS < 9 consider intubation

Spinal Injuries
Rapid Assessment of the Airway / C-Spine is required
The overall incidence of Spinal Injuries was 5.1% (295 patients)
No difference between the occurrences of C-spine / Thoracic/ Lumbar Spine injuries
C-SPINE 3 POINT IMMOBILISATION

Spinal Injuries - Continuation
Spinal Injuries increase dramatically with age
Factors such as osteoarthritis and osteoporosis contribute to injuries
Risk of spinal injury is x21 greater in > 65yrs (8.5% occurrence) compared with children (0.4%)

Upper Extremity Injuries
Male 30 yrs - Hit by car on highway
GCS 3/15, # L Humerus / Radius + Ulnar
CT Head Normal
IV access & BP monitoring impossible on L arm

Chest Injuries
A Pneumo or haemothoraxwas present in 247 pts (4.2%) and rose steadily through the ages
Incidence was 2.1% in children ≤ 14 yrs
Incidence was 8.5% inpatients >65 yrs
Thoracic aortic injury occurred in 16 patients (0.3%) – x7 times more likely in the over 65yrs, none occurred in the ≤ 14 yrs

Fractures of the first x3 ribs, or ≥ 3 rib #’s
> 10% mortality

Abdominal Trauma
Liver injuries occurred in 141 pts (2.4%)
Splenic injuries occurred in 102 pts (1.7%)
Renal injuries occurred in 44 pts (0.8%)
Gastro injuries occurred in 237 (4.1%)
There was no statistically significance difference across the age groups

Pelvic Injuries
Requires massive energy transfer
Occurred in 748 patients (12.8%)
X3.5 likely in the >65yrs (22.6%) compared with children under 14 yrs (6.3%)
Patient may complain of severe back pain, abdominal or suprapubicpain

Patient may become rapidly hypotensive
> 3L of blood loss from pelvic #’s
Widened Symphysis Pubis
Sheet used to compress the pelvis

Upto 1.5L blood loss from femoral #’s
Overall Mortality
Closed fractures ~ 3.0%
Compound pelvic fractures up to 40%

Lower Extremity Injuries
Tibia fractures were the most common injury accounting for 1512 cases (25.9%)
Children ≤ 14yrs were ~50% less likely to suffer tibial fractures than those older
However, children were x1.8 more likely to sustain femoral fractures

Lower Extremity Injuries
Stop overt bleeding
Check for peripheral pulses
In the absence of pulses, exclude a pelvic fracture, provide analgesia & reduce
Wrap in dressing + splint
~ 1000mls

Fatalities
The overall mortality from PVA’s was 7.7% (449 deaths)
This increased significantly with age
3.2% in the pediatric group
25.1% in the > 65 yr group

Points to remember (1)
Tibial #’s are the most common injury ~ 25%
Head injury increases significantly with age 7.4% in the ≤14 yrs to 23.7% in > 65 yrs
Look out for pelvic fractures. Occurs in ~12% of patients (22.6% incidence in > 65yrs)

Points to remember (2)
Spinal injuries occurred in 5.1% of pts; the elderly were x21 more likely to suffer spinal trauma
Haemo / Pneumothorax occur in ~ 4%
Mortality rate in >65 yrs = ~25%
The older the patient the greater the risk of serious injury

THE END
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Pedestrian Vehicle Accidents 'Common Injuries Patterns'

by phcworld.org on Jan 09, 2010

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Pedestrian Vehicle Accidents ’Common Injuries Patterns’ — Presentation Transcript