Rodier SG, DiMaggio CJ, Wall S, Sim V, Frangos SG, Ayoung-Chee P, Bukur M, Tandon M, Todd SR, Marshall GT.
Subway-Related Trauma: An Urban Public Health Issue with a High Case-Fatality Rate.
J Emerg Med 2018;
55:165-171.e1. [PMID:
29753571 DOI:
10.1016/j.jemermed.2018.04.015]
[Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/20/2018] [Accepted: 04/10/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND
Between 1990 and 2003, there were 668 subway-related fatalities in New York City. However, subway-related trauma remains an understudied area of injury-related morbidity and mortality.
OBJECTIVE
The objective of this study was to characterize the injuries and events leading up to the injuries of all patients admitted after subway-related trauma.
METHODS
We conducted a retrospective case series of subway-related trauma at a Level I trauma center from 2001 to 2016. Descriptive epidemiology of patient demographics, incident details, injuries, and outcomes were analyzed.
RESULTS
Over 15 years, 254 patients were admitted for subway-related trauma. The mean (standard error of the mean) age was 41 (1.0) years, 80% were male (95% confidence interval [CI] 74-84%) and median Injury Severity Score was 14 (interquartile range [IQR] 5-24). The overall case-fatality rate was 10% (95% CI 7-15%). The most common injuries were long-bone fractures, intracranial hemorrhage, and traumatic amputations. Median length of stay was 6 days (IQR 1-18 days). Thirty-seven percent of patients required surgical intervention. At the time of injury, 55% of patients (95% CI 49-61%) had a positive urine drug or alcohol screen, 16% (95% CI 12-21%) were attempting suicide, and 39% (95% CI 33-45%) had a history of psychiatric illness.
CONCLUSIONS
Subway-related trauma is associated with a high case-fatality rate. Alcohol or drug intoxication and psychiatric illness can increase the risk of this type of injury.
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