Ryb Gabriel E, Dischinger Patricia C
Charles C. Mathias, Jr. National Study Center for Trauma and EMS, University of Maryland, Baltimore, Maryland 21201, USA.
J Trauma. 2011 Sep;71(3):737-41. doi: 10.1097/TA.0b013e31822ac9e1.
To examine the association of scene mobility status (SMS) and injury severity and mortality among motor vehicular crash (MVC) victims.
Adult MVC victims transported to medical facilities between 1997 and 2008 and included in the National Automotive Sampling System were studied. SMS was classified as follows: "ejected," "self-exited," "exited with assistance," "removed from the vehicle with decreased mental status," "removed due to perceived serious injury," and "removed for other reasons." Associations of SMS with Injury Severity Score and death were studied with contingency tables and multiple logistic regression models.
A total of 62,634 cases representing 13,699,294 (weighted) cases were analyzed. Two percent of the cases were ejected, 38% self-exited, 18% exited with assistance, 4% removed with decreased mental status, 14% removed due to perceived serious injury, 1% other reasons, and 25% unknown. Mortality was highest among those ejected (8.7%). Those who self-exited and exited with assistance experienced a mortality of 0.02%. Injury Severity Score >8 occurred in 51% of those ejected, 37% of those removed with decreased mental status, 21% of those removed due to perceived serious injury, 4% of those who self-exited, and 5% of those exited with assistance. Multiple logistic regression revealed that those ejected, removed due to a low mental status or suspected injury, experienced higher adjusted odds ratios of dying than those who self-exited (odds ratio of 266 [69->999], 235 [61-903], and 66 (19-227), respectively).
MVC occupants who "self-exited" or "exited with assistance" experienced a very low injury severity and mortality. Further efforts are needed to decrease the overtriaging of these patients.
探讨机动车碰撞（MVC）受害者的现场移动状态（SMS）与损伤严重程度及死亡率之间的关联。
对1997年至2008年间被送往医疗机构且纳入国家汽车抽样系统的成年MVC受害者进行研究。SMS分类如下：“被弹出”“自行离开”“在协助下离开”“因精神状态下降被从车内移出”“因被认为受重伤而被移出”以及“因其他原因被移出”。采用列联表和多重逻辑回归模型研究SMS与损伤严重程度评分及死亡之间的关联。
共分析了代表13,699,294例（加权）病例的62,634例病例。2%的病例被弹出，38%自行离开，18%在协助下离开，4%因精神状态下降被移出，14%因被认为受重伤而被移出，1%因其他原因，25%情况不明。被弹出者的死亡率最高（8.7%）。自行离开和在协助下离开者的死亡率为0.02%。损伤严重程度评分>8出现在51%被弹出者中，37%因精神状态下降被移出者中，21%因被认为受重伤而被移出者中，4%自行离开者中，以及5%在协助下离开者中。多重逻辑回归显示，与自行离开者相比，被弹出、因精神状态低或疑似受伤而被移出者的调整后死亡比值比更高（分别为266 [69->999]、235 [61-903]和66 [19-227]）。
“自行离开”或“在协助下离开”的MVC车内人员损伤严重程度和死亡率非常低。需要进一步努力减少对这些患者的过度分诊。
