安大略省多伦多市 1 级创伤中心的与地铁相关创伤。

Subway-related trauma at a level 1 trauma centre in Toronto, Ontario.

机构信息

From the Schulich School of Medicine and Dentistry, Western University, London, Ont. (Ho); the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ont. (Ho, Mansour, Gomez); the Department of Surgery A, Galilee Medical Center, Nahariya, Israel (Mansour); the Azrieli Faculty of Medicine of the Galilee, Bar-Ilan University, Safed, Israel (Mansour); the Division of General Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ont. (Gomez); and the Division of General Surgery, Department of Surgery, University of Toronto, Ont. (Gomez).

出版信息

Can J Surg. 2021 Nov 2;64(6):E588-E593. doi: 10.1503/cjs.020219. Print 2021 Nov-Dec.

DOI:10.1503/cjs.020219

PMID:34728524

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8565880/

Abstract

BACKGROUND

Given the rising prevalence of subways in combination with an increasing incidence of subway-related injuries, understanding subway-related trauma is becoming ever more relevant. The aim of this study was to characterize the potential causes, injury characteristics and outcomes of subway-related trauma at a level 1 adult trauma centre in Toronto, Ontario.

METHODS

We conducted a retrospective cohort study to identify patients who presented to the emergency department a level 1 adult trauma centre with a subway-related injury between Jan. 1, 2010, and Dec. 31, 2018. Patients were identified via E-codes (X81, Y02, V050, V051 and W17). We then further screened for descriptions of subway-related injuries. Patients whose injuries did not involve a moving subway train were excluded.

RESULTS

We identified 51 patients who presented to the emergency department after being hit by a moving subway train. The majority of incidents (39 [76%]) were due to self-harm, 10 (20%) were unintentional injuries, and 2 (4%) were due to assault. The presence of alcohol was detected in 8 patients (80%) with unintentional injuries and 3 (8%) of those with self-inflicted injuries. Thirteen patients (25%) had a systolic blood pressure less than 90 mm Hg. The median Injury Severity Score was 17 (interquartile range 9-29). Seventeen patients (33%) presented with severe injuries (Abbreviated Injury Scale score ≥ 3) in 1 body region, and 19 (37%) had severe injuries in 2 or more body regions. The most common isolated severe injury was in the lower extremity, and the most common combinations of severe injuries were in the head and lower extremity, and head and thorax. Ten patients (20%) were declared dead in the emergency department. Of the 41 patients who survived their initial presentation, 12 (29%) went directly to the operating room, and 17 (41%) were transferred to the intensive care unit. The overall mortality rate was 29%.

CONCLUSION

Patients with subway-related injuries experienced high mortality rates and severe injuries. Most incidents were due to self-harm or alcohol-related. Further research into early identification of those at risk and optimal prevention strategies is necessary to curb further incidents.

摘要

背景

随着地铁的普及和与地铁相关的伤害发生率的增加，了解与地铁相关的创伤变得越来越重要。本研究的目的是描述在安大略省多伦多市一家成人一级创伤中心发生的与地铁相关的创伤的潜在原因、损伤特征和结局。

方法

我们进行了一项回顾性队列研究，以确定 2010 年 1 月 1 日至 2018 年 12 月 31 日期间在一家成人一级创伤中心因与地铁相关的伤害而就诊的患者。通过 E 编码（X81、Y02、V050、V051 和 W17）识别患者。然后，我们进一步筛选与地铁相关的损伤描述。排除那些损伤不涉及移动地铁列车的患者。

结果

我们共识别出 51 名因被移动的地铁列车撞击而到急诊科就诊的患者。大多数事件（39 例[76%]）是自残所致，10 例（20%）为非故意伤害，2 例（4%）为攻击所致。8 例（80%）非故意伤害患者和 3 例（8%）自残患者检测到酒精。13 例（25%）患者的收缩压低于 90mmHg。损伤严重度评分中位数为 17（四分位距 9-29）。17 例（33%）患者在 1 个身体部位有严重损伤（损伤严重度评分≥3），19 例（37%）患者在 2 个或更多身体部位有严重损伤。最常见的孤立性严重损伤是下肢，最常见的严重损伤组合是头部和下肢、头部和胸部。10 例（20%）患者在急诊科宣告死亡。在最初就诊时存活的 41 例患者中，12 例（29%）直接进入手术室，17 例（41%）转入重症监护病房。总死亡率为 29%。