Impact of pedestrian injury on inner city trauma services

Macro-level literature analysis on pedestrian safety: Bibliometric overview, conceptual frames, and trends

Due to the high volume of documents in the pedestrian safety field, the current study conducts a systematic bibliometric analysis on the researches published before October 3, 2021, based on the science-mapping approach. Science mapping enables us to present a broad picture and comprehensive review of a significant number of documents using co-citation, bibliographic coupling, collaboration, and co-word analysis. To this end, a dataset of 6311 pedestrian safety papers was collected from the Web of Science Core Collection database. First, a descriptive analysis was carried out, covering whole yearly publications, most-cited papers, and most-productive authors, as well as sources, affiliations, and countries. In the next steps, science mapping was implemented to clarify the social, intellectual, and conceptual structures of pedestrian-safety research using the VOSviewer and Bibliometrix R-package tools. Remarkably, based on intellectual structure, pedestrian safety demonstrated an association with seven research areas: "Pedestrian crash frequency models", "Pedestrian injury severity crash models", "Traffic engineering measures in pedestrians' safety", "Global reports around pedestrian accident epidemiology", "Effect of age and gender on pedestrians' behavior", "Distraction of pedestrians", and "Pedestrian crowd dynamics and evacuation". Moreover, according to conceptual structure, five major research fronts were found to be relevant, namely "Collision avoidance and intelligent transportation systems (ITS)", "Epidemiological studies of pedestrian injury and prevention", "Pedestrian road crossing and behavioral factors", "Pedestrian flow simulation", and "Walkable environment and pedestrian safety". Finally, "autonomous vehicle", "pedestrian detection", and "collision avoidance" themes were identified as having the greatest centrality and development degrees in recent years.

Older adult pedestrian trauma: A systematic review, meta-analysis, and GRADE assessment of injury health outcomes from an aggregate study sample of 1 million pedestrians

This systematic review sought to assess older adult pedestrian injury severity, injury by anatomical location and incidence proportions, including comparisons to younger age groups when available and provide an analysis of the quality of the existing evidence. A structured search was conducted in PubMed, Embase, Scopus, CINAHL, PsycInfo, AMED, Web of Science, LILACS and TRID. STROBE was used to assess the reporting quality of the included studies. Random-effect model meta-analysis served to obtain pooled relative risk, incidence proportions and standardized mean differences for different outcomes due to pedestrian crashes comparing older and younger pedestrians, while meta-analyses could not be conducted for pedestrian falls. We screened 7460 records of which 60 studies (1,012,041 pedestrians) were included in the review. Injured pedestrians 60+ compared to those <60 were found to have a higher relative risk of severe injury (pooled relative risk RR 1.6, 95 % CI: 1.4-2.0 p < 0.001), critical care admission (pooled RR 1.5, 95 %CI: 1.3-1.8 p < 0.001), and fatality (pooled RR of 3.7, 95 % CI: 3.0-4.5 p < 0.001). Pedestrians 60+ also had higher incidence rates of pedestrian falls causing higher injury severity. GRADE was used to evaluate evidence quality, with the results suggesting that the overall quality of the evidence supporting these findings was low. Further research is needed to understand health risks associated with older pedestrian trauma and to develop effective risk management strategies.

Anatomical distribution of musculoskeletal disorders following a road traffic collision in litigants presenting to physiotherapists within a private-clinic in North-East England

Introduction: Musculoskeletal disorders (MSDs) are common following a road traffic collision (RTC) in England. Establishing the anatomical distribution of MSDs following RTC that present to physiotherapists may improve understanding and clinical practice. This study examined anatomical distribution of MSDs that present to physiotherapists within a litigant population following a RTC in England. Methods: A retrospective review of physiotherapy records was conducted at a private practice in North-East England. Data were collected from 2105 patients between January 2014 and December 2015. The primary outcome was anatomical regions with MSDs. Descriptive data is reported. Results: Overall, 90% of patients presented with a neck/upper back disorder, while 52% presented with a lower back disorder. Of the assessed patients, 46% presented with one MSD, 45% presented with two MSDs while 9% presented with ≥3 MSDs. Further analysis showed that those who presented to physiotherapy later and were not motor vehicle occupants (MVOs) were more likely to have upper-limb, lower-limb, or lumbar MSDs. Younger patients, who presented sooner and were non-MVO were more likely to have multiple regions affected by MSDs. Conclusions: This study presents epidemiological evidence that MSDs following a RTC occur primarily in the neck/upper back or lower back regions, and that multiple MSDs are common.

Elderly tibial shaft fractures: Open fractures are not associated with increased mortality rates

OBJECTIVES

This study aims to assess whether elderly patients (>65 years) with open tibial shaft fractures (OFs) have increased mortality rates than those with closed fractures (CFs).

PATIENTS AND METHODS

Patients admitted during 2003-2005 with open/closed diaphyseal (AO 42) fractures of the tibia were eligible to participate.

EXCLUSION CRITERIA

Pathological and peri-prosthetic fractures.

RESULTS

A total of 54 patients (38 females) met the inclusion criteria. Twenty-six patients had sustained CF and 28 OF (Gustilo grade I (11), grade II (five), grade IIIa (two) and grade IIIb (10)). The OF group was statistically significantly different with higher injury severity score, secondary procedures and length of hospital stay (p<0.05). A higher rate of admission/length of stay to intensive care unit and complication rate was noted in the OF group. Mortality rate between the two groups was comparable (CF=2/26, OF=3/28).

CONCLUSIONS

Elderly patients with OFs of the tibial shaft have similar mortality rate to those with CFs.

Cost, demographics and injury profile of adult pedestrian trauma in inner Sydney

BACKGROUND

Pedestrian accidents are associated with substantial morbidity, mortality and cost; however, there has been very little published work on this topic in Australasia over recent years. The objective of this study was to examine the demographics, injury profile, outcomes and cost of pedestrian versus motor vehicle accidents in a central city hospital in Sydney.

METHODS

Consecutive pedestrians injured by motor vehicles and admitted as inpatients during the years 2002-2004 were identified from our prospective trauma registry. A retrospective review included patient profiles (age, sex, time of injury and blood alcohol), injury pattern, cost, morbidity and mortality.

RESULTS

A total of 180 patients (64% men and 36% women) with a mean age of 46 and mean injury severity score of 14.1 were identified. Two peak injury periods were observed: one between 17.00 and 18.00 hours (P < 0.01) and the other between 20.00 and 22.00 hours (P < 0.01). Significantly more injuries occurred on Friday (P < 0.01) and during autumn months (P < 0.05). Musculoskeletal (34.3%), head (31.8%) and external (20.2%) injuries predominated. Forty-nine per cent of patients tested positive for consuming alcohol, with an average blood alcohol concentration (BAC) of 0.22%. Alcohol consumption was associated with a worse outcome in terms of hospital and intensive care unit stay, morbidity and mortality. The average length of stay was 13.4 days costing $A 16320 per admission. Sixteen patients died (mortality rate of 8.9%), with the highest rate in the elderly group (22.7%) (P < 0.001).

CONCLUSIONS

Pedestrian accidents in inner Sydney are common with injuries predominating in intoxicated adult males. Mortality was higher in the elderly group. Injuries to the head and lower extremities predominate. Hospital stays are lengthy, resulting in a high cost for each admission.

Resource utilization by injured automobile occupants and pedestrians

BACKGROUND

This study was designed to test the hypothesis that the hospital resources utilized in treating pedestrian trauma would be significantly greater than that for automobile occupants. This was based on previous studies that showed that the demographic features and patterns of injury sustained by the pedestrian population were significantly different from that of automobile occupants.

METHODS

A hospital-based study was designed utilizing retrospective analysis of a prospective trauma database. All primary retrievals of pedestrians (n=547) and automobile occupants (n=597) involved in accidents in Central Sydney from mid-1990 to mid-1995 were included. The length of hospital stay, use of the intensive care unit (ICU) and visits to the operating theatre (Standard Resource Cost) were compared.

RESULTS

The age and injury severity scores were significantly higher for the pedestrian group. The length of stay (days) for the pedestrians (mean, 12 SD 14; median, 7 interquartile range (IQR) 13), was significantly higher (P < 0.0001 ) than that for the automobile occupants (mean, 7 SD 11; median, 2 IQR 6). The ICU utilization (days) for the pedestrians (mean, 1.3 SD 4.0; median, 0) was significantly higher (P < 0.0001) than that of the automobile occupants (mean, 0.6 SD 2.9; median, 0). The average operating theatre utilization per pedestrian (0.65 visits) exceeded that of automobile occupants (0.43) by 50% (P < 0.0001).

CONCLUSIONS

The study confirms that the acute care of pedestrian injury utilizes more hospital resources than that of automobile occupants. Resources should be allocated to meet this need both in terms of hospital reimbursement and overall directives in public health policy.

A population-based study of outcome after injury to car occupants and to pedestrians

OBJECTIVE

The literature indicates that trauma center pedestrian mortality rates approximate twice that of injured car occupants. This study was performed to test the hypothesis that outcomes will be similar given similar degrees of injury severity if analyzed from an epidemiologic perspective. Differences are expected in the cause and place of death because of different injury profiles.

DESIGN

Prospective population-based study.

METHODS

The study group consisted of all adult car occupants and pedestrians sustaining major injury -- Injury Severity Score (ISS) of >15 -- in a defined area of central Sydney from mid-1991 to mid-1994.

MAIN RESULTS

The study included 65 car occupants (median ISS,32) and 101 pedestrians (median ISS,34). Major abdominal injury (p = 0.003) and thoracic aortic disruption (p = 0.06) were more common in car occupants, but major injury to the brains (p = 0.004), lower extremity long bone fractures (p = 0.0005), and thoracolumbar fractures (p = 0.01) occurred more frequently in pedestrians. The overall car occupant mortality was 38% compared with 46% in the pedestrians (p = 0.37). Seventy-two percent of car occupant fatalities occurred in the field, most commonly from ruptured thoracic aorta, whereas 63% of pedestrian deaths occurred in hospital (p = 0.005), most commonly from head injury.

CONCLUSION

These findings have important implications for prehospital care. A policy of "scoop and run" is advocated for injured car occupants in shock because of the high frequency of aortic and abdominal injuries. Advanced life support measures are appropriate at the scene to stabilize the airway and to protect the entire spine in pedestrians with multiple injuries because of the high frequency of brain and vertebral trauma.

A survey of rural road fatalities

This study is a retrospective case series analysis of all 82 road deaths occurring in the Orana Area Health Service (OAHS) over the 2 year period 1989-90. The OAHS services a population of 112,800 in an area of 199,077 km2 in north-west New South Wales. The aim of the study was to document timing, place and cause of deaths, severity of injuries, pre-hospital management of victims, and a TRISS analysis of outcome. This was done using ambulance, hospital, police and autopsy reports. Seventy-two (88%) of the victims were motor vehicle occupants, five (6%) were motorcyclists and four (5%) were pedestrians. The median ambulance response time to the scene of the accident was 17 min (range 2-103 min). All deaths occurred within 24 h of injury with 65 (79%) of the victims being dead at the scene, nine (11%) dying en-route and eight (10%) reaching hospital alive. A TRISS analysis was performed on 51 deaths and 8% (4/51) of these had a greater than 50% probability of survival. Of the victims that had inevitable deaths according to TRISS, 11% (5/47) may have survived if pre-hospital care arrived sooner. Reduction in the rural road toll is achievable through preventative measures and strategies to improve access to care and administration of pre-hospital care.

Value of the prospective 'before and after' study as a methodology to evaluate outcome in a trauma centre

A series of interventions (administrative, clinical and educational) was introduced to improve the quality of trauma care at Royal Prince Alfred Hospital, the designated trauma centre for the Central Sydney Area Health Service (CSAHS). A prospective, 'before and after' study was conducted to assess changes in outcome following the introduction of these measures. The trauma centre survival rate for patients admitted with serious injury (Injury Severity Scores > 15) increased significantly, from 72% in the nine months before trauma centre designation to 89% in the nine months after (P = 0.005). The peer review designated, potentially avoidable death rate did not change significantly over the two study periods, remaining in the 20-30% range. Similarly the unexpected death rate (TRISS) did not change significantly, remaining in the 20-45% range. A trend to a lower trauma centre mortality in those arriving with a systolic blood pressure < or = 90 mmHg was noted. Seven out of 14 patients 'at risk' from exsanguination died in the first 9 months compared with one out of seven in the second 9 months (P = 0.17). An unexpected finding was a change in the degree of injury severity and physiological status in patients arriving at the trauma centre. The Injury Severity Scores were significantly lower (P = 0.008) and the Revised Trauma Scores significantly higher (P = 0.0006) in the latter 9 months of the study. It was concluded that the improved trauma centre survival rate was a reflection of a reduced hospital mortality from haemorrhagic shock in conjunction with a lesser degree of injury severity in patients admitted from the CSAHS.

Factors affecting outcome in the resuscitation of severely injured patients

This is a retrospective, hospital based study of the resuscitative management of 40 consecutive, multitrauma patients (Injury Severity Score (ISS) > 25) admitted directly from an inner metropolitan environment over a one year period. The aim was to identify physiological, anatomical and time variables that correlated with an adverse outcome. Such information would facilitate the development of management protocols to improve future care. The clinical management of airways, breathing, circulation and head injury was reviewed in both the pre-hospital and Emergency Department (ED) phases of care. Eleven patients died during the resuscitative phase, 10 from blood loss and one from head injury. Nine patients died during the definitive care phase, seven from head injury and two from multiple organ failure. Scene hypotension (systolic blood pressure < or = 80 mmHg), ED Glasgow Coma Scale < 9, ISS > or = 50, and Revised Trauma Score < or = 4 were variables that correlated strongly with fatal outcomes. The median pre-hospital time was 33 min for those hypotensive in the field. The median ED time was 70 min for hypotensive patients who went to operating theatres. Survival following severe trauma may be increased by avoiding secondary insults in head injured patients and improving the management of haemorrhagic shock. The time frame from accident to operating theatre should be kept under 90 min. Warmed blood, fresh frozen plasma and platelets should be used early in the resuscitation. An early move to definitive control of bleeding should accompany vigorous volume resuscitation.