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Schellenberg M, Ruiz NS, Cheng V, Heindel P, Roedel EQ, Clark DH, Inaba K, Demetriades D. The Impact of Seat Belt Use in Pregnancy on Injuries and Outcomes After Motor Vehicle Collisions. J Surg Res 2020; 254:96-101. [PMID: 32422432 DOI: 10.1016/j.jss.2020.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/01/2020] [Accepted: 04/11/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Seat belt use during motor vehicle collisions (MVCs) has been shown to alter adults' intra-abdominal injury patterns, although the effect of seat belt use in pregnant women is unclear. The objective of this study was to determine the impact of seat belt use in pregnancy on injuries and outcomes after MVCs. METHODS Patients injured by MVCs were identified from the National Trauma Data Bank (2007-2014). The exclusion criteria were transfer from an outside hospital, male or unspecified sex, missing restraint data, and nonchildbearing age. Demographics, clinical/injury data, pregnancy status, seat belt use, and outcomes were collected. Study groups were dichotomized by pregnancy status with subgroup analysis by seat belt use. Univariate/multivariate analyses compared outcomes and determined predictors of seat belt use. RESULTS After exclusions, 162,964 women were included, of which 680 (<1%) were pregnant. Intra-abdominal injuries during pregnancy did not vary according to seat belt use (P > 0.05). Unrestrained pregnant women were more injured (Injury Severity Score: 13 versus 7, P < 0.001), more likely to need emergent operation (14% versus 10%, P < 0.001), and had a longer hospital stay (6 versus 4 d, P = 0.012) than restrained counterparts. On multivariate analysis among pregnant women, seat belt use was associated with age ≥25 y (odds ratio: 2.033, P = 0.001). The lack of restraint use was associated with the position in the passenger seat (odds ratio: 0.521, P = 0.001). CONCLUSIONS Seat belt use in pregnancy does not alter abdominal injury patterns but is associated with lower injury severity, reduced need for emergent surgery, and shortened hospital stay. Public health interventions emphasizing the importance of seat belts could be focused on younger patients and vehicle passengers to reach the high-risk pregnant subset.
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Affiliation(s)
- Morgan Schellenberg
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California.
| | - Nallely Saldana Ruiz
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - Vincent Cheng
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - Patrick Heindel
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - Erik Q Roedel
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - Damon H Clark
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - Kenji Inaba
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - Demetrios Demetriades
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
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Morikawa M, Yamada T, Kogo H, Sugawara M, Nishikawa A, Fukushi Y, Hirayama EK, Ishioka SI, Watari H. Effect of an educational leaflet on the frequency of seat belt use and the rate of motor vehicle accidents during pregnancy in Japan in 2018: a prospective, non-randomised control trial with a questionnaire survey. BMJ Open 2019; 9:e031839. [PMID: 31542766 PMCID: PMC6756446 DOI: 10.1136/bmjopen-2019-031839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To determine whether an educational leaflet had any effect on seat belt use, seat preference and motor vehicle accidents rate during pregnancy in Japan. DESIGN Prospective, non-randomised control trial with a questionnaire survey. SETTING Eight obstetric hospitals in Sapporo, Japan. PARTICIPANTS 2216 pregnant women, of whom 1105 received the leaflet (intervention group) and 1111 did not (control group). INTERVENTIONS Distribution of an educational leaflet on seat belt use to women in the intervention group. PRIMARY OUTCOME MEASURES The effect of an educational leaflet on seat belt use, each pregnant woman's seat preference and the women's rates of motor vehicle accidents rate during their pregnancies. To evaluate the effects, the intervention group's responses to the questionnaires were compared with those of the control group. RESULTS The proportion of subjects who always used seat belts during pregnancy was significantly higher in the intervention group (91.3%) than in the control group (86.7%; p=0.0005). Among all subjects, the percentage of women who preferred the driver's seat was lower during pregnancy (27.0%) than before pregnancy (38.7%), and the percentage of women who preferred the rear seat was higher during pregnancy (28.8%) than before pregnancy (21.0%). These two rates did not differ between two groups. Seventy-one women (3.2%) reported experiencing a motor vehicle accident during pregnancy. The motor vehicle accident rate for the intervention group (3.3%) was similar to that for the control group (3.2%). CONCLUSIONS An educational seat belt leaflet was effective in raising the rate of consistent seat belt use during pregnancy, but it did not decrease the rate of motor vehicle accidents. The wearing of seat belts should be promoted more extensively among pregnant women to decrease rates of pregnancy-related morbidity and mortality from motor vehicle accidents.
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Affiliation(s)
- Mamoru Morikawa
- Department of Obstetrics and Gynecology, Hokkaido University, Sapporo, Japan
| | - Takashi Yamada
- Department of Obstetrics and Gynecology, JCHO Hokkaido Hospital, Sapporo, Japan, Sapporo, Japan
| | - Hiromasa Kogo
- Department of Obstetrics and Gynecology, Sapporo Maternity Women's Hospital, Sapporo, Japan
| | - Masaki Sugawara
- Department of Obstetrics and Gynecology, Sapporo Toho Hospital, Sapporo, Sapporo, Japan
| | - Akira Nishikawa
- Department of Obstetrics and Gynecology, NTT East Sapporo General Hospital, Sapporo, Japan
| | - Yoshiyuki Fukushi
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Emi Kato Hirayama
- Obstetrics and Gynecology, Sapporo City General Hospital, Sapporo, Japan
| | - Shin-Ichi Ishioka
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Japan
| | - Hidemichi Watari
- Department of Obstetrics and Gynecology, Hokkaido University, Sapporo, Japan
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Masudi T, McMahon HC, Scott JL, Lockey AS. Seat belt-related injuries: A surgical perspective. J Emerg Trauma Shock 2017; 10:70-73. [PMID: 28367011 PMCID: PMC5357874 DOI: 10.4103/0974-2700.201590] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction: Legislation making seatbelt use mandatory is considered to have reduced fatal and serious injuries by 25%, with UK government estimates predicting more than 50,000 lives saved since its introduction. However, whilst the widespread use of seatbelts has reduced the incidence of major traumatic injury and death from road-traffic collisions (RTCs), their use has also heralded a range of different injuries. The first ever seatbelt related injury was described in 1956, and since then clear patterns of seatbelt-related injuries have been recognised. Methodology and Findings: This review of the published literature demonstrates that the combination of airbags and three-point seatbelts renders no part of the body free from injury. Serious injuries can, and do, occur even when passengers are properly restrained and attending clinicians should have a high index of suspicion for overt or covert intra-abdominal injuries when patients involved in RTCs attend the Emergency Department. Bruising to the trunk and abdomen in a seatbelt distribution is an obvious sign that suggests an increased risk of abdominal and thoracic injury, but bruising may not be apparent and its absence should not be falsely reassuring. A high index of suspicion should be retained for other subtler signs of injury. Children and pregnant women represent high-risk groups who are particularly vulnerable to injuries. Conclusion: In this review we highlight the common patterns of seatbelt-related injuries. A greater awareness of the type of injuries caused by seatbelt use will help clinicians to identify and treat overt and covert injuries earlier, and help reduce the rates of morbidity and mortality following RTCs.
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Affiliation(s)
- Tahir Masudi
- Department of Emergency Medicine, Huddersfield Royal Infirmary, Huddersfield, UK
| | | | - Jennifer L Scott
- Department of Emergency Medicine, Huddersfield Royal Infirmary, Huddersfield, UK
| | - Andrew S Lockey
- Department of Emergency Medicine, Huddersfield Royal Infirmary, Huddersfield, UK
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Whitehead NS. Prenatal counseling on seat belt use and crash-related medical care. Matern Child Health J 2014; 17:1527-32. [PMID: 21811808 DOI: 10.1007/s10995-011-0861-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Describe the prevalence of and characteristics associated with being hurt in a car accident during pregnancy; the resulting medical care needed; and the association between counseling and the medical care needed after a car accident. Secondary data analysis of PRAMS (Pregnancy Risk Assessment Monitoring System) data, a population based survey of women with a recent live birth. Two percent of women were hurt in a car accident during their pregnancy. Only 57% of them had received counseling on seat belt use. Most women (87%) who were hurt in an accident needed medical care. Being counseled on seat belt use was not associated with the level of care needed. Most pregnant women who are hurt in a car accident require medical care or bed rest. Public health action and research is needed to reduce the burden of motor-vehicle related injuries among pregnant women.
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Affiliation(s)
- Nedra S Whitehead
- RTI International, Social and Statistical Sciences, 2951 Flowers Road South, Suite 119, Atlanta, GA, 30341, USA,
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The ability of computed tomography to diagnose placental abruption in the trauma patient. J Trauma Acute Care Surg 2013; 74:236-41. [PMID: 23271100 DOI: 10.1097/ta.0b013e318278937b] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fetal demise following trauma remains a devastating complication largely owing to placental injury and abruption. Our objective was to determine if abdominopelvic computed tomographic (CT) imaging can assess for placental abruption (PA) when obtained to exclude associated maternal injuries. METHODS Retrospective review of pregnant trauma patients of 20-week gestation or longer presenting to a trauma center during a 7-year period who underwent CT imaging as part of their initial evaluation. Radiographic images were reviewed by a radiologist for evidence of PA and classified based on percentage of visualized placental enhancement. Blinded to CT results, charts were reviewed by an obstetrician for clinical evidence of PA and classified as strongly positive, possibly positive, or no evidence. RESULTS A total of 176 patients met inclusion criteria. CT imaging revealed evidence of PA in 61 patients (35%). As the percentage of placental enhancement decreased, patients were more likely to have strong clinical manifestations of PA, reaching statistical significance when enhancement was less than 50%. CT imaging evidence of PA was apparent in all patients who required delivery for nonassuring fetal heart tones. CONCLUSION CT imaging evaluation of the placenta can accurately identify PA and therefore can help stratify patients at risk for fetal complications. The likelihood of requiring delivery increased as placental enhancement declined to less than 25%. LEVEL OF EVIDENCE Diagnostic study, level III.
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Affiliation(s)
- Sandra K Cesario
- College of Nursing at Texas Woman's University in Houston, TX., USA
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Patteson SK, Snider CC, Meyer DS, Enderson BL, Armstrong JE, Whitaker GL, Carroll RC. The Consequences of High-Risk Behaviors: Trauma During Pregnancy. ACTA ACUST UNITED AC 2007; 62:1015-20. [PMID: 17426561 DOI: 10.1097/01.ta.0000221554.95815.2e] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Trauma during pregnancy places two lives at risk. Knowledge of risk factors for trauma during pregnancy may improve outcomes. METHODS We reviewed the charts of 188 such patients admitted to a Level I trauma center from 1996 to 2004. A comparison was made of injury severity and outcome from a cohort of nonpregnant female trauma patients selected with a similar temporal occurrence and age range. RESULTS Motor vehicle collisions comprised 160 cases, 67 using a restraint device. Of 84 patients tested, 45 tested positive for intoxicants, 16 positive for 2 or more intoxicants. A significant trend toward less testing through the study period was observed (p = 0.0002). Injury severity was assessed by Revised Trauma Score (RTS). RTS <11 or admission to operating room or intensive care units (OR/ICU) classified patients as severely injured. The six maternal fatalities had an RTS <11 or OR/ICU disposition. Fetal outcomes included 155 live in utero, 18 live births, and 15 fatalities correlating with injury severity by either criteria (p < 0.0001). Of the fetal fatalities, 7 occurred with RTS = 12, but only 3 fatalities occurred in the 147 cases not admitted to OR/ICU. Gestational age correlated (p < 0.0001) with fetal outcomes. The 18 live births had mean gestational ages of 35 +/- 4 weeks as compared with fetal fatalities at 20 +/- 9 weeks, and fetuses alive in utero at 22 +/- 9 weeks gestation. Coagulation tests prothrombin time (PT), international normalized ratio (INR) (both p < 0.008), and partial thromboplastin time (PTT) (p < 0.0001) correlated with maternal outcome. A matched cohort of nonpregnancy trauma cases during the same time frame indicated that, despite a significantly higher percentage of severely injured patients, fewer fatalities occurred. This might reflect a greater risk for the pregnant trauma patient. CONCLUSIONS This study of trauma in pregnancy cases revealed a high percentage with risk behaviors. There was a significant trend toward less intoxicant testing in recent years. Coagulation tests were the most predictive of outcomes. Lower gestational age correlated with fetal demise.
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Affiliation(s)
- Stephen K Patteson
- Department of Anesthesiology, University of Tennessee Graduate School of Medicine, TN, USA
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Ikossi DG, Lazar AA, Morabito D, Fildes J, Knudson MM. Profile of mothers at risk: An analysis of injury and pregnancy loss in 1,195 trauma patients. J Am Coll Surg 2005; 200:49-56. [PMID: 15631920 DOI: 10.1016/j.jamcollsurg.2004.09.016] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2004] [Revised: 09/22/2004] [Accepted: 09/23/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Trauma is the number one cause of maternal death during pregnancy, but incidence of fetal loss exceeds maternal loss by more than 3 to 1. We hypothesized that we could identify women at risk for injury during pregnancy and focus our prevention efforts. STUDY DESIGN Women of childbearing age in the American College of Surgeon's National Trauma Data Bank served as the study population. Pregnant patients were compared with nonpregnant patients with respect to age, race, mechanism of injury, injury patterns and severity, risk-taking behaviors, and outcomes. Multivariate logistic regression analysis was used to identify risk factors for loss of pregnancy in mothers who survived their trauma. RESULTS Pregnant trauma patients (n = 1,195) were younger, less severely injured, and more likely to be African American or Hispanic as compared with the nonpregnant cohort (n = 76,126). Twenty percent of injured pregnant patients tested positive for drugs or alcohol, and approximately one-third of those involved in motor vehicle crashes were not using seatbelts. Independent risk factors for fetal loss after trauma included Injury Severity Score > 15; Adjusted Injury Score > or = 3 in the head, abdomen, thorax, or lower extremities; and Glasgow Coma Score < or = 8. CONCLUSIONS Young, African-American, and Hispanic pregnant women are at higher risk for trauma in pregnancy and are most likely to benefit from primary trauma prevention efforts. Those with severe head, abdominal, thoracic, or lower extremity injuries are at high risk for pregnancy loss. Reduction of secondary insults and early recognition of fetal distress may improve outcomes for both the mother and fetus in this high-risk group.
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Affiliation(s)
- Danagra G Ikossi
- Department of Surgery, University of California-San Francisco, and San Francisco Injury Center, San Francisco, CA 94110, USA
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Ichikawa M, Nakahara S, Okubo T, Wakai S. Car seatbelt use during pregnancy in Japan: determinants and policy implications. Inj Prev 2003; 9:169-72. [PMID: 12810746 PMCID: PMC1730948 DOI: 10.1136/ip.9.2.169] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
CONTEXT Pregnant women are exempted from the current seatbelt legislation in Japan despite the fact that seatbelt use is essential to reduce the risk of fatalities for these women and their fetuses in car crashes. OBJECTIVE To examine factors that might influence seatbelt use during pregnancy. METHODS A cross sectional study, with data collected via an anonymous, self administered questionnaire at obstetric clinics in suburban areas of Japan. Altogether 880 pregnant women receiving prenatal care in July 2001 were recruited. The relative effects of factors that might influence seatbelt use during pregnancy were estimated using logistic regression analysis. RESULTS Almost 70%-80% of pregnant women were consistent seatbelt wearers before pregnancy but seatbelt compliance was reduced by about half at 20 weeks or more gestation. Only 20% had received information on maternal seatbelt use, with one third reporting that seatbelt use is beneficial during pregnancy. Those who perceived that maternal seatbelt use is beneficial tended to maintain use, but daily car users and those who knew that they were exempted from seatbelt legislation were more likely to reduce use. CONCLUSIONS Knowledge of the legislative exemption for pregnant women, misunderstanding of the benefits, and daily car use contributed to the reduction in seatbelt use after pregnancy.
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Affiliation(s)
- M Ichikawa
- Department of Community Health, School of International Health, Graduate School of Medicine, University of Tokyo, Japan.
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