Heinrich Daniela, Holzmann Christopher, Wagner Anja, Fischer Anja, Pfeifer Roman, Graw Matthias, Schick Sylvia
Ludwig-Maximilians-University (LMU) Munich, Institute of Legal Medicine, Nussbaumstrasse 26, D-80336, Munich, Germany.
Department of Accident and Reconstructive Surgery, Hospital of the RWTH University Aachen, Pauwelsstrasse 30, D-52074, Aachen, Germany.
Int J Legal Med. 2017 Jul;131(4):1023-1037. doi: 10.1007/s00414-017-1531-8. Epub 2017 Feb 8.
Older traffic participants have higher risks of injury than the population up to 65 years in case of comparable road traffic accidents and further, higher mortality rates at comparable injury severities. Rib fractures as risk factors are currently discussed. However, death on scene is associated with hardly survivable injuries and might not be a matter of neither rib fractures nor age. As 60% of traffic accident fatalities are estimated to die on scene, they are not captured in hospital-based trauma registries and injury patterns remain unknown. Our database comprises 309 road traffic fatalities, autopsied at the Institute of Legal Medicine Munich in 2004 and 2005. Injuries are coded according to Abbreviated Injury Scale, AIS© 2005 update 2008 [1]. Data used for this analysis are age, sex, site of death, site of accident, traffic participation mode, measures of injury severity, and rib fractures. The injury patterns of elderly, aged 65+ years, are compared to the younger ones divided by their site of death. Elderly with death on scene more often show serious thorax injuries and pelvic fractures than the younger. Some hints point towards older fatalities showing less frequently serious abdominal injuries. In hospital, elderly fatalities show lower Injury Severity Scores (ISSs) compared to the younger. The number of rib fractures is significantly higher for the elderly but is not the reason for death. Results show that young and old fatalities have different injury patterns and reveal first hints towards the need to analyze death on scene more in-depth.
在发生类似的道路交通事故时，老年交通参与者比65岁及以下人群受伤风险更高，而且在损伤严重程度相当的情况下，死亡率也更高。目前正在讨论肋骨骨折作为风险因素的情况。然而，现场死亡与几乎无法存活的损伤相关，可能既不是肋骨骨折的问题，也不是年龄的问题。据估计，60%的交通事故死亡者死于现场，因此他们未被纳入基于医院的创伤登记系统，损伤模式仍然未知。我们的数据库包含2004年和2005年在慕尼黑法医学研究所进行尸检的309例道路交通事故死亡案例。损伤按照简明损伤定级标准（AIS© 2005，2008年第2版更新）进行编码[1]。本分析所使用的数据包括年龄、性别、死亡地点、事故地点、交通参与方式、损伤严重程度指标以及肋骨骨折情况。将65岁及以上老年人的损伤模式与按死亡地点划分的年轻人的损伤模式进行比较。与年轻人相比，在现场死亡的老年人更常出现严重的胸部损伤和骨盆骨折。一些迹象表明，老年死者较少出现严重的腹部损伤。在医院里，老年死者的损伤严重程度评分（ISS）低于年轻人。老年人肋骨骨折的数量明显更多，但这不是死亡原因。结果表明，年轻和老年死者的损伤模式不同，并首次暗示有必要更深入地分析现场死亡情况。
