Prospective study of the effect of safety belts in motor vehicle crashes

Relationship Between Restraint System Use and Brachial Plexus Injuries in Motor Vehicle Accidents: A Case-Control Study from the National Trauma Databank

INTRODUCTION

High-speed motor vehicle accidents (MVAs) are an important cause of brachial plexus injury (BPI). Some case reports have demonstrated shoulder seat belt use resulting in traction injuries to the brachial plexus. We used a national trauma registry to determine the association between seat belt use and brachial plexus injury in MVAs.

METHODS

The authors queried the National Trauma Databank between 2016 and 2017 for patients with a hospital admission following an MVA. Cases with BPI were identified using International Classification of Diseases, Tenth Edition, Clinical Modification, diagnosis codes. Case-control matching by age and sex was performed to identify 2 non-BPI controls for every case of BPI. Multivariable conditional logistic regression adjusting for body mass index, alcohol use, and drug use was then performed to determine the adjusted association between safety equipment use (seat belt use and airbag deployment) and BPI.

RESULTS

A total of 526,007 cases of MVAs were identified, of which 704 (0.13%) sustained a BPI. The incidences of BPI in patients were the following without any protective device (0.16%), with airbag deployment alone (0.08%), with seat belt use alone (0.08%), and with combined airbag deployment and seat belt use (0.07%). Following 1:2 case-control matching by age and sex and multivariable conditional logistic regression, seat belt use (odds ratio [OR] 0.55; 95% confidence interval [CI] 0.42-0.71; P < 0.001) and airbag deployment (OR 0.52; 95% CI 0.33-0.82; P = 0.004) were found to be associated with decreased odds for BPI, with the least odds observed with combined seat belt use and airbag deployment (OR 0.49; 95% CI 0.33-0.74; P = 0.001).

CONCLUSIONS

Despite anecdotal evidence suggesting increased likelihood of BPI with shoulder seat belt use, case-control analysis from a national trauma registry demonstrated that both seat belt use and airbag deployment are associated with lower odds of sustaining BPIs in MVAs, with the greatest protective effect observed with combined use. Future studies adjusting for rider location (passenger vs. driver) and other potential confounders such as make, type and speed of vehicle may help further characterize this association.

Principles and Methods for Evidence-Based Quantification of the Effect of Seat Belt Non-Use in Crash-Related Litigation

Traffic crashes are a common cause of injury and death, and often result from the negligent actions of an inattentive, speeding, or impaired driver. In such cases, a civil legal action may be brought by an injured claimant for compensation for injuries resulting from a crash. Crash-related litigation is defended on various theories, one of which is to raise the issue of contributory negligence when the claimant was not using an available seat belt at the time of the crash, based on the assertion that the claimed injuries would have been avoided or minimized to some degree if the claimant had been restrained. At present, there are no published standards or systematic approach for assessing and quantifying the contribution of seat belt non-use to the cause of a claimant’s specific injury. A reliable medicolegal analysis that addresses whether contributory negligence can be proven in a specific case requires a multidisciplinary approach: First, the nature and severity of the crash must be reconstructed as it affected the vehicle kinetics (engineering) and in turn affected the kinematics of the occupant (biomechanics), next, the injuries must be described and scaled for severity (medicine/pathology), and finally, the risk of the known injuries given the actual circumstances of the crash and occupant (i.e., unbelted) are compared to the risk of the same injuries, and the same crash circumstances, but in the hypothetical scenario in which the claimant is belted. In the present discussion, methods for analyzing the presence and quantifying the degree of contributory negligence for seat belt non-use, suitable for presentation in a medicolegal setting, are described and illustrated with an example from the author’s personal case inventory. A detailed reconstruction of the crash is described, along with the associated occupant kinematics, and the resulting observed injuries. The injuries are then categorized by their anatomical location, type, and severity using Abbreviated Injury Scale designations. Quantification of the injury risk for the actual (unbelted) vs. hypothetical (belted) scenario is based on case-specific analysis of data accessed from a US national crash injury database The difference in risk for the two exposure scenarios can be quantified in terms of either relative risk (a risk ratio) or attributable risk (a risk proportion), with the goal to determine whether the analysis meets the threshold of a relative risk of >2.0, or an attributable risk of 50%, in order to meet the “more probable than not” standard typically required by courts. As a final step in a reliable analysis that exceeds the legal threshold for relevant evidence, the absolute increase in risk is used to quantify the degree to which the claimant’s seat belt non-use contributed to the likelihood of their injuries.

Gastrointestinal Traumatic Injuries: Gastrointestinal Perforation

The abdomen is a big place even in a small person. Gastrointestinal trauma can result in injury to the stomach, small bowel, colon, or rectum. Traumatic causes include blunt or penetrating trauma, such as gunshot wounds, stabbings, motor vehicle collisions, and crush injuries. Nontraumatic causes include appendicitis, Crohn disease, cancer, diverticulitis, ulcerative colitis, blockage of the bowel, and chemotherapy. The mechanism of injury will affect both the nature and severity of any resulting injuries. Treatment must address the critical and emergent nature of these injuries as well as issues that affect all trauma situations, which include management of hemodynamic instability.

Mechanisms and Mitigation of Head and Spinal Injuries Due to Motor Vehicle Crashes

Synopsis Head and spinal injuries commonly occur during motor vehicle crashes (MVCs). The goal of this clinical commentary is to discuss real-life versus simulated MVCs and to present clinical, biomechanical, and epidemiological evidence of MVC-related injury mechanisms. It will also address how this knowledge may guide and inform the design of injury mitigation devices and assist in clinical decision making. Evidence indicates that there exists no universal injury tolerance applicable to the entire population of the occupants of MVCs. Injuries sustained by occupants depend on a number of factors, including occupant characteristics (age, height, weight, sex, bone mineral density, and pre-existing medical and musculoskeletal conditions), pre-MVC factors (awareness of the impending crash, occupant position, usage of and position of the seatbelt and head restraint, and vehicle specifications), and MVC-related factors (crash orientation, vehicle dynamics, type of active or passive safety systems, and occupant kinematic response). Injuries resulting from an MVC occur due to blunt impact and/or inertial loading. An S-shaped curvature of the cervical spine and associated injurious strains have been documented during rear-, frontal-, and side-impact MVCs. Data on the injury mechanism and the quantification of spinal instability guide and inform the emergent and subsequent conservative or surgical care. Such care may require determining optimal patient positioning during transport, which injuries may be treated conservatively, whether reduction should be performed, optimal patient positioning intraoperatively, and whether bracing should be worn prior to and/or following surgery. The continued improvement of traditional injury mitigation systems, such as seats, seatbelts, airbags, and head restraints, together with research of newer collision-avoidance technologies, will lead to safer motor vehicles and ultimately more effective injury management strategies. J Orthop Sports Phys Ther 2016;46(10):826-833. Epub 3 Sep 2016. doi:10.2519/jospt.2016.6716.

Opportunities for knowledge translation in the decade of road traffic safety

The United Nations has identified road traffic safety as an important objective for the decade 2011-2020. It has implemented a 5-tiered program: improving health care services, improving management of road safety, improving road network safety, improving vehicular safety, and improving road safety legislation. A small body of practical research has been generated by the medical and surgical (including orthopaedic) communities regarding the road traffic safety, but a substantial amount of work remains to be performed. This article will review published research in each of the 5 tiers of the Decade of Action for Road Traffic Safety and will identify areas where research is insufficient or absent, such that new research programming and funding can be developed.

The effect of rear-seat overloading in a car crash: pathological and kinematics evidences

Seat belts have been shown to decrease the incidence of lethal lesions to the head, chest, and abdomen. Since the introduction of seat belts, it is reported that the incidence of traumatic lesions in these body parts is reduced. In the meantime, the characteristic lesions to the chest and abdomen caused by the use of seat belts are described (J Trauma. 2007;62(6):1473-1480).Reported is a peculiar case of an oblique front-to-rear car collision, in which overloading of the rear seat with packages pushed forward the passenger front seat in an abnormal way, causing fatal thoracic and abdominal lesions.The authors underline that the seat belt protection device is defeated if front seats are damaged by heavy unanchored bags on the rear seat or on the rear parcel shelf of a motor vehicle.

Seat belt utilisation and awareness in UAE

Seat belts (SBs) are effective devices for reducing injury risk due to traffic accidents. Seat belt wearing was made compulsory in the United Arab Emirates (UAE) in January 1999 for drivers and front seat passengers (FSPs). No comprehensive study has ever assessed SB wearing rates across the country. Also, little is known on drivers' awareness of the importance of wearing seatbelts and how human factors affect wearing habits. This study aims to determine SB wearing rates for drivers and FSPs in UAE through an observational field study. It also aims to investigate perceptions and behaviour of drivers on this issue as well as human factors that affect wearing rate through a randomly distributed questionnaire. The results of the field study show that the overall SB wearing rate across the country was 61% for drivers and 43.4% for FSPs and that there were significant differences between the seven emirates that constitute the country. The questionnaire results show that age, education level, gender, marital status and nationality of drivers affect wearing habits and perceptions. Future implications in terms of improving traffic safety awareness are discussed.

Seatbelt use in Qatar in association with severe injuries and death in the prehospital setting

INTRODUCTION

Road traffic crashes (RTCs) are common in Qatar, and are now considered the third leading cause of mortality. In this study, the safety devices used by the Qatari public at the time of RTCs were assessed and the association between seatbelt use by vehicle occupants involved in RTCs and severe injury/death in the prehospital setting was determined.

METHODS

This study was a retrospective case-control investigation. A Hamad Medical Corporation Emergency Medical Services (EMS) database of RTCs occurring from January 2006 to April 2007 was utilized for this study, providing a total of 5,267 patient records (83.5% male, 16.5% female, median age = 28 years). Patient demographics, crash characteristics, prehospital assessments, and interventions were identified, and use of safety devices was determined. Univariate analysis including chi-square, Student's t-test, and analysis of variance (ANOVA) was performed as appropriate. "Case" patients are defined as those who had specific, critical prehospital assessments, or who received advanced cardio-respiratory life support measures in the field. Logistic regression modeling was used to predict the probability of a case being unbelted, controlling for confounders.

RESULTS

Seatbelt use in Qatar was low: 33.9% of males and 32.6% of females wore seatbelts at the time of the RTC. Victims involved in a vehicle rollover crash were less likely to be belted than were those involved in a non-rollover incident (26.2% belted vs. 37.8%; OR = 0.59; 95% CI = 0.50-0.68). Case patients-those with defined critical assessment findings or resuscitation in the field-and control patients were similar in age (30 years vs. 28 years median). Case patients were disproportionately male (89.1% vs. 83.2%; OR = 1.65; 95% CI = 1.01-2.83) and were more likely to be victims of a vehicle rollover crash (44.7% vs. 23.8%; OR = 2.57; 95% CI = 1.84-3.59). Seatbelt use was significantly lower among cases than controls: 19.7% of cases were reported to have worn seatbelts compared to 34.2% of controls (OR = 0.47; 95% CI = 0.31-0.69). This relationship also persisted (OR = 0.51; 95% CI = 0.33-0.76) after controlling for confounders.

CONCLUSIONS

Seatbelt use in Qatar is low. Seatbelts are protective: in the prehospital setting unbelted vehicle occupants involved in RTCs were nearly twice as likely to suffer severe injury or death compared to belted patients. Prehospital morbidity and mortality appears to be reduced significantly by the consistent use of seatbelts by the motoring population in Qatar.

A comprehensive statewide analysis of seatbelt non-use with injury and hospital admissions: new data, old problem

OBJECTIVES

To investigate the association of seatbelt nonuse with injury patterns, injury severity, and in-patient hospital admission among adults presenting to emergency departments (EDs) in a statewide, population-based, sample of motor vehicle crashes.

METHODS

Using data from the 2002 Crash Outcome Data Evaluation System (CODES) for Wisconsin, 23,920 occupants of motor vehicle crashes, aged 16 years or older, who were treated in an ED, were analyzed. Logistic regression was used to compare the odds ratio of having sustained an injury to specific body regions and of being admitted to an inpatient unit in unbelted individuals compared with those who were belted.

RESULTS

Compared with belted occupants presenting to an ED, their unbelted counterparts were more likely to be male (56% vs. 40%) and to have used alcohol (17% vs. 4%). Unbelted occupants were younger (31 years vs. 38 years) and incurred higher ED charges ($681 vs. $509) than belted occupants. Additionally, unbelted occupants have a higher proportion of single-vehicle crashes, such as rollovers (44% vs. 22%), and rural crashes (56% vs. 44%). Unbelted occupants comprised 20% of study patients treated in the ED and discharged, 44% of patients treated in the ED and admitted, and 68% of patients dying in the ED. Unbelted occupants were more likely to be admitted (odds ratio [OR] = 2.6) than belted individuals and were more likely to suffer severe injuries to the head, face, thorax, abdomen, spine, upper and lower extremities (OR ranging from 1.6 to 3.9).

CONCLUSIONS

Among patients presenting to an ED after a motor vehicle crash, unbelted occupants are more likely to require inpatient admission and to have sustained a severe injury to numerous body regions than are belted occupants.

Injuries caused by seatbelts

Seatbelts save lives. However, they may cause injury to adjacent structures and when they malfunction can cause injury to the abdominal viscera, bony skeleton and vascular structures. The motor industry has attempted to reduce these injuries by modification of vehicle design and safety equipment. This paper discusses the patterns of injury caused by seatbelts and the methods by which the motor industry attempts to reduce their incidence.

Improvements in passive car safety led to decreased injury severity--a comparison between the 1970s and 1990s

PURPOSE

The purpose of this study was to characterize changes in the mechanism and pattern of injury for vehicular trauma victims with modern vehicle design. Crash and injury severity were specifically investigated to isolate the influence of these improvements in vehicle design.

METHODS

Since 1972, a local, prospective, assessment of vehicular trauma victims on-scene and at medical institutions providing care has been performed including the following parameters: delta-v, collision speed, type of road using, abbreviated injury scale (AIS), injury severity score (ISS), incidence of polytrauma or death. Victims (for restrained car occupants, bicyclists, pedestrians) injured between 1973 and 1978, and between 1994 and 1999 were compared.

RESULTS

Lower crash severity (delta-v, collision speed) and injury severity (AIS, ISS, incidence of polytrauma or death) were measured for restrained car occupants, bicyclists and pedestrians during the later period. The correlation coefficient between delta-v or vehicle collision speed and ISS was higher in the earlier period for car occupants, cyclists and pedestrians.

CONCLUSIONS

This study suggests that the observed reduction in injury severity in restrained car occupants, bicyclists and pedestrians is not only linked to the reduction of crash severity, but also related to improvements in vehicle design beyond seat-belt use. Passive car safety led to decreased injury severity--a comparison.

Lost working days, productivity, and restraint use among occupants of motor vehicles that crashed in the United States

BACKGROUND

In 2001, 6.3 million passengers were involved in motor vehicle crashes. This study aimed to determine the number of work days lost as a result of motor vehicle crashes and factors that influenced people's return to work.

METHODS

This was a retrospective, population based cohort study of occupants in motor vehicles involved in crashes from the 1993-2001 Crashworthiness Data System produced by the National Highway Traffic Safety Administration. The sample population of people aged 18-65 years included two groups: occupants who survived and were working before the crash and occupants who were injured fatally and were estimated to have been working before the crash. Multivariate linear regression was used to analyze the impact of restraint use and injury type on return to work.

RESULTS

Overall, 30.1% of occupants of vehicles that crashed missed one or more days of work. A crash resulted in a mean 28.0 (95% confidence interval 15.8 to 40.1) days lost from work, including losses associated with fatalities. The 2.1 million working occupants of vehicles that crashed in 2001 lost a total of 60 million days of work, resulting in annual productivity losses of over $7.5 billion (2964 to 12 075). Unrestrained vehicle occupants accounted for $5.6 billion in lost productivity.

CONCLUSIONS

Motor vehicle crashes result in large and potentially preventable productive losses that are mostly attributable to fatal injuries.

Lateral automobile impacts and the risk of traumatic brain injury

STUDY OBJECTIVES

We determine the relative risk and severity of traumatic brain injury among occupants of lateral impacts compared with occupants of nonlateral impacts.

METHODS

This was a secondary analysis of the National Highway Traffic Safety Administration's National Automotive Sampling System, Crashworthiness Data Systems for 2000. Analysis was restricted to occupants of vehicles in which at least 1 person experienced an injury with Abbreviated Injury Scale score greater than 2. Traumatic brain injury was defined as an injury to the head or skull with an Abbreviated Injury Scale score greater than 2. Outcomes were analyzed using the chi2 test and multivariate logistic regression, with adjustment of variance to account for weighted probability sampling.

RESULTS

Of the 1,115 occupants available for analysis, impact direction was lateral for 230 (18.42%) occupants and nonlateral for 885 (81.58%) occupants. One hundred eighty-seven (16.07%) occupants experienced a traumatic brain injury, 14.63% after lateral and 16.39% after nonlateral impact. The unadjusted relative risk of traumatic brain injury after lateral impact was 0.89 (95% confidence interval [CI] 0.51 to 1.56). After adjusting for several important crash-related variables, the relative risk of traumatic brain injury was 2.60 (95% CI 1.1 to 6.0). Traumatic brain injuries were more severe after lateral impact according to Abbreviated Injury Scale and Glasgow Coma Scale scores. The proportion of fatal or critical crash-related traumatic brain injuries attributable to lateral impact was 23.5%.

CONCLUSION

Lateral impact is an important independent risk factor for the development of traumatic brain injury after a serious motor vehicle crash. Traumatic brain injuries incurred after lateral impact are more severe than those resulting from nonlateral impact. Vehicle modifications that increase head protection could reduce crash-related severe traumatic brain injuries by up to 61% and prevent up to 2,230 fatal or critical traumatic brain injuries each year in the United States.

Cervical spine injury and restraint system use in motor vehicle collisions

CONTEXT

Cervical spine injury related to motor vehicle collision (MVC) is a severe and often permanently disabling injury. Although advances in automobile crashworthiness have reduced both fatalities and some severe injuries, the impact of varying occupant restraint systems (seatbelts and airbags) on cervical spine injury is unknown.

OBJECTIVE

To investigate the relationship between the occurrence of cervical spine injury and occupant restraint systems among front seat occupants involved in frontal MVCs.

DESIGN, SETTING, AND PATIENTS

A case-control study among subjects obtained from the 1995 to 2001 National Automotive Sampling System (NASS). Cases were identified based on having sustained a cervical spine injury score of 2 or more on the Abbreviated Injury Scale, 1990 Revision.

RESULTS

Approximately half (44.7%) of 8,412 cases of cervical spine injury were unrestrained occupants while belted only, airbag only, and both restraint systems represented 38.2%, 8.8%, and 8.4% of cases, respectively. Overall, the combined use of airbag and seatbelt had the greatest protective effect, relative to unrestrained occupants, with an odds ratio (OR) of 0.19 and a 95% confidence interval (CI) of 0.12 to 0.30. Use of a seatbelt only also had a protective effect (OR: 0.40; 95% CI: 0.23-0.70). Occupant use of an airbag only neither increased nor decreased the risk of cervical spine injuries relative to unrestrained occupants (OR: 1.02; 95% CI: 0.57-2.13).

CONCLUSIONS

The results of this study suggest that there is an increase in overall protection against cervical spine injury by combining airbag and seatbelt restraint systems relative to seatbelt alone.

Correlation between crash severity, injury severity, and clinical course in car occupants with thoracic trauma: a technical and medical study

BACKGROUND

The crash mechanisms and clinical course of car occupants with thoracic injury were analyzed to determine prognostic factors and to create a basis for injury prophylaxis.

METHODS

A technical and medical investigation of car occupants with a thoracic injury (Abbreviated Injury Scale-thorax [AIS(THORAX)] > or = 1) at the scene of the crash and the primary admitting hospital was performed.

RESULTS

Between 1985 and 1998, 581 car occupants sustained a thoracic injury. Mean parameter values were as follows: AIS(THORAX), 2.5; Hannover Polytrauma Score (PTS), 21.4; Injury Severity Score (ISS), 24.2; Delta-v, 49.6 km/h (30.8 mph); and extent of passenger compartment deformation (DEF) (scale, 1--9), 4.0. In 19% (n = 112) of patients involved, the clinical course was evaluated: AIS(THORAX), 2.5; PTS, 20.0; ISS, 19.3; Delta-v, 50.1 km/h (31.1 mph); DEF, 3.9; intensive care unit time, 8.3 days; ventilation time, 5.7 days; and hospital stay, 15.3 days. In the groups with higher AIS(THORAX), ISS, PTS, and intensive care unit and ventilation time, higher Delta-v and DEF occurred. In patients with longer hospital stay, higher Delta-v, but no difference in DEF occurred.

CONCLUSION

The injury severity and the clinical course demonstrated a positive correlation with the crash severity. Therefore, our technical accident analysis allows prediction of the severity of injury and the clinical course. It may consequently serve as a tool for development of more sophisticated injury prevention strategies and may improve passive car safety.

Burn injuries caused by air bag deployment

Automobile air bags have gained acceptance as an effective measure to reduce the morbidity and mortality associated with motor vehicle accidents. As more cars have become equipped with them, new problems have been encountered that are directly attributable to the deployment of the bag itself. An increasing variety of associated injuries has been reported, including minor burns. We present two automobile drivers who were involved in front-impact crashes with air bag inflation. They sustained superficial and partial-thickness burns related to the deployment. The evaluation of these cases shows mechanisms involved in burn injuries caused by the air bag system. Most of the burns are chemical and usually attributed to sodium hydroxide in the aerosol created during deployment. Also direct thermal burns from high-temperature gases or indirect injuries due to the melting of clothing, as well as friction burns from physical contact are possible. However, the inherent risks of air bag-related burns are still outweighed by the benefits of preventing potentially life-threatening injuries.

Motor vehicle safety: current concepts and challenges for emergency physicians

Motor vehicle travel is the primary means of transportation in the United States, providing freedom in travel and enterprise for many people. Motor vehicle crashes are the leading cause of death for the young and contribute to a high degree of morbidity and mortality for all ages. Motor vehicle crashes produce an enormous burden for society in terms of suffering, disability, death, and costs. Motor vehicle crash injury prevention is developing as a focused discipline to implement proven interventions involving technology and behavior known to prevent or reduce the severity of motor vehicle crash injury. Emergency physicians have an important role in advocating motor vehicle safety and injury prevention, both in the emergency department and within the community.

Patterns of injury in belted and unbelted individuals presenting to a trauma center after motor vehicle crash: seat belt syndrome revisited

STUDY OBJECTIVE

Investigators have described a "seat belt syndrome" consisting variously of injuries to the lumbar or cervical spine, abdominal contents, or all 3. In this study we sought to identify these and any other patterns of injury associated with seat belt use in patients who presented to a trauma center after a motor vehicle crash.

METHODS

The charts of all patients involved in motor vehicle crashes who presented as trauma alerts to the study institution between January 1, 1991, and December 31, 1993, were retrospectively reviewed for data regarding belt use and 35 specific injuries in 7 body regions. We calculated the positive likelihood ratio of injury between belted and unbelted patients, along with 95% confidence intervals.

RESULTS

We identified 1,124 patients involved in motor vehicle crashes. Of these subjects, 376 were belted and 544 unbelted; in 204 belt status was unknown. Belted patients were more likely to have sustained sternal fracture than were unbelted patients (4% versus .7%; positive likelihood ratio, 1.97; 95% confidence interval, 1.09 to 3.29) but were less likely to have sustained head injury (30.6% versus 46.0%; positive likelihood ratio, .67; 95% confidence interval, .53 to .83). We noted no statistically significant differences in the rates of other specific injuries, including cervical and lumbar fractures and the need for abdominal surgery.

CONCLUSION

Severe injuries of all types occur in both belted and unbelted individuals involved in motor vehicle crashes who present to a typical trauma center. With the exception of sternal fractures, injuries previously associated with the seat belt syndrome occurred in similar proportions of belted and unbelted patients. Head injuries were less frequent. Seat belt use cannot serve as a discriminator for specific injury. A diligent search of all body regions is indicated in both belted and unbelted patients.

Seat belt use in a developing country: covert noncompliance with a primary enforcement law in Malaysia

Malaysia has strict laws requiring seat belt use by all vehicle occupants. However, neither passive devices nor inertial reel belts are mandated. Seat belt usage was investigated among 60 taxicab drivers in Kuala Lumpur, Malaysia, in 1993. Although all drivers appeared to be restrained during an initial curb-side inspection, 60% did not fasten the latch. There was no statistical difference between ethnic groups. Curb-side estimates of restraint use may overestimate actual usage, resulting in falsely low estimates of effectiveness. Requiring inertial reel belts, which would retract if not latched, could greatly increase actual restraint use. This may be cost effective for developing nations.

Isolated intrathoracic injury with air bag use

The restrained (air bag and seatbelt) driver of a vehicle involved in a high-speed motor-vehicle accident sustained a tear of the thoracic aorta with no signs of external injury. Air bag deployment may mask significant internal injury, and a high index of suspicion is warranted in such situations.

Airbag safety: deployment in an automobile crash with a fall from height

Airbag restraint systems have demonstrated a significant reduction in mortality in motor vehicle crashes (MVCs). While airbag devices are effective primarily in frontal or near-frontal impacts, little is known about the efficacy of these devices in nonfrontal types of collisions. Moreover, there are reports of injuries specific to airbag deployment that have led some investigators to question the benefit of such devices. This article reports a rollover MVC with a considerable fall from height in which lap/shoulder belts were used in addition to airbag deployment that resulted in protection of the driver from injury. The outcome of this case continues to support the combination of belt and airbag restraint systems as the most effective occupant protection in both frontal and nonfrontal types of MVCs.

Side impact motor vehicular crashes: patterns of injury

Side impact collisions represent a serious risk for injury for motor vehicle occupants. In 1992 side impact collisions were found in approximately 20% of all fatal motor vehicle crashes. This type of collision provides less protection to the occupants and is associated with a specific pattern of injuries. Because elderly drivers are frequently involved in side impact collisions, they are especially at risk for major trauma.

Air bag safety

STUDY OBJECTIVE

To describe injuries associated with deployment of air bag passive-restraint systems in use in the United States.

DESIGN

Retrospective review of data collected by the National Highway Traffic Safety Administration (NHTSA) from 1980 to 1994.

PARTICIPANTS

Occupants of air bag-equipped vehicles who were involved in crashes on US roads.

RESULTS

Of 618 reported occupant injuries related to air bag deployment, an overwhelming majority were classified as minor (96.1%). Most occupants sustained abrasions, contusions, and lacerations. The face (42.0%), wrist (16.8%), forearm (16.3%) and chest (9.6%) were the most frequently injured body areas.

CONCLUSION

Most injuries related to air bag deployment are minor and must be viewed in the context of the potentially life-threatening injuries they prevent.

Motor vehicle crashes and seat belts: a study of emergency physician procedures, charges, and documentation

STUDY OBJECTIVE

To study emergency physician documentation of seat belt use, practice patterns, and charges for patients with different restraints involved in motor vehicle crashes.

DESIGN

Retrospective examination of 2,239 emergency department records during a 5-month period.

PARTICIPANTS

Patients from four community EDs and one Level I trauma center ED.

RESULTS

Documentation of seat belt use for motor vehicle crash occupants was reported in 70% of the ED records reviewed. Only 64.5% of the records from the four community hospital EDs recorded seat belt use, compared with 81.7% of the records from the trauma center ED (P < .001). The unbelted group had a greater mean number of physician procedures performed (1.4 versus 1.2; P < .001) and more radiographs of the face and skull ordered (11.9% versus 8%, P < .01). Seat belt users had a higher average number of cervical-spine radiographs ordered than did nonusers (71.5 versus 65.7; P < .05). Physician charges for unbelted patients were higher compared with those for belted patients, averaging $22.00 more per patient (P < .001).

CONCLUSION

Emergency physician practice patterns reflect the distribution of injuries associated with seat belt use and nonuse. Reduced physician charges for belted patients contributed to health care cost savings. Emergency physicians should be encouraged to consistently obtain and record whether an individual was wearing a seat belt during a motor vehicle crash.