需要从机动车碰撞事故中解救出来的多发伤患者的损伤原因及费用

Causes and costs of injuries in multiple trauma patients requiring extrication from motor vehicle crashes.

作者信息

Siegel J H, Mason-Gonzalez S, Dischinger P C, Read K M, Cushing B M, Badellino M C, Goodarzi S, Smialek J E, Heatfield B M, Robinson R M

机构信息

Department of Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark.

出版信息

J Trauma. 1993 Dec;35(6):920-31. doi: 10.1097/00005373-199312000-00019.

DOI:10.1097/00005373-199312000-00019

PMID:8263992

Abstract

Prospective and contemporaneous medical and economic cost studies of 144 victims of motor vehicle crashes admitted to a regional level I trauma center with multiple injuries (ISS > or = 16) revealed 122 non-ejected patients, of whom 102 required extrication (EXTRIC) from the vehicle for physical or medical reasons and 20 who did not (N group). There were no differences in age (EXTRIC, 34 +/- 17 years; N, 41 +/- 24 years), type of crash (Frontal: 57% EXTRIC, 60% N; Lateral: 32% EXTRIC, 35% N) restraint use (35% EXTRIC, 35% N), or mortality (29% EXTRIC, 30% N). However, the estimated maximum speed before the crash was higher in EXTRIC patients (50 +/- 16 mph vs. 46 +/- 18 mph N, p < 0.04), as was the change in velocity (delta V) on impact (EXTRIC 30 +/- 15 mph; N, 24 +/- 8 mph, p < 0.01). Brain injuries (51% EXTRIC vs. 35% N) and lower extremity injuries were more numerous in EXTRIC patients (59% vs. 20% N, p < 0.003) and the number of splenic, lower extremity, and pelvic injuries associated with shock was greater in EXTRIC patients, p < 0.02; as were postinjury complications. As a result, operating room costs from orthopedic and plastic surgery increased professional charges in the EXTRIC group versus the N group ($20,000, EXTRIC; $17,000, N) and critical care costs ($13,000, EXTRIC; $4,000, N) with total costs of $72,000 and $77,000, respectively. The lower extremity injuries in EXTRIC patients were primarily a result of body part contacts with intrusions (CIs) of the car occupant compartment structures [73% with vs. 24% without (p < 0.0001)]. In lateral MVCs, brain injuries were also more commonly associated with CIs of the side window frame or A pillar (72% CI vs. 25% no CI; p < 0.035); but as a whole in MVCs in which extrication was necessary, lower extremity injuries from instrument panel or toepan CIs appeared more frequent than those resulting from contacts only (p < 0.0001). In EXTRIC patients, 69% of those in shock had CI injuries, and 80% of the deaths in the EXTRIC group were associated with CI injury. These data suggest that measures designed to prevent CIs by strengthening car passenger compartment structures may reduce the incidence of severe brain and lower extremity injuries and may reduce the need for extrication after MVCs.

摘要

一项针对144名因多处受伤（损伤严重度评分[ISS]≥16）而入住某地区一级创伤中心的机动车碰撞事故受害者的前瞻性同期医学和经济成本研究显示，其中122名患者未被抛出车外，其中102名因身体或医学原因需要从车内解救出来（解救组），20名不需要（非解救组）。两组在年龄（解救组34±17岁；非解救组41±24岁）、碰撞类型（正面碰撞：解救组57%，非解救组60%；侧面碰撞：解救组32%，非解救组35%）、安全带使用情况（解救组35%，非解救组35%）或死亡率（解救组29%，非解救组30%）方面无差异。然而，解救组患者碰撞前估计的最高速度更高（50±16英里/小时，非解救组为46±18英里/小时，p<0.04），碰撞时的速度变化（ΔV）也更高（解救组30±15英里/小时；非解救组24±8英里/小时，p<0.01）。解救组患者脑损伤（51%，非解救组35%）和下肢损伤更多见（59%，非解救组20%，p<0.003），与休克相关的脾、下肢和骨盆损伤数量在解救组更多（p<0.02）；损伤后并发症也是如此。结果，与非解救组相比，骨科和整形外科的手术室成本使解救组的专业费用增加（解救组20,000美元；非解救组17,000美元），重症监护成本也增加（解救组13,000美元；非解救组4,000美元），总成本分别为72,000美元和77,000美元。解救组患者的下肢损伤主要是身体部位与汽车乘员舱结构侵入物（CIs）接触的结果[有侵入物的占73%，无侵入物的占24%（p<0.0001）]。在侧面机动车碰撞事故中，脑损伤也更常见于侧窗框架或A柱的侵入物（侵入物相关的占72%，无侵入物的占25%；p<0.035）；但总体而言，在需要解救的机动车碰撞事故中，仪表板或踏板侵入物导致的下肢损伤比仅因接触导致的损伤更常见（p<0.0001）。在解救组患者中，69%休克患者有侵入物损伤，解救组80%的死亡与侵入物损伤有关。这些数据表明，通过加强汽车乘客舱结构来预防侵入物的措施可能会降低严重脑损伤和下肢损伤的发生率，并可能减少机动车碰撞事故后解救的需求。