Goldberg B A, Mootha R K, Lindsey R W
Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, Texas, USA.
Am J Orthop (Belle Mead NJ). 1998 Apr;27(4):315-20.
In the United States, train-related accidents account for more than 18,000 injuries and 1,200 fatalities annually, yet there is a paucity of literature pertaining to this unique injury. We reviewed the medical records of 98 of 135 cases of train-related trauma treated at Ben Taub General Hospital, Baylor College of Medicine, Houston, Texas, from 1990 to 1995. There were 50 train-pedestrian accidents, 47 train-automobile accidents, and 1 train-motorcycle accident, with a mean patient age of 30.1 years (range, 2 to 66 years). Eighteen patients (18%) were pronounced dead on arrival or died shortly after admission. Of the other 80 patients, 27 (34%) were discharged from the emergency department after minor medical treatment, while 53 (66%) were hospitalized, of whom 10 (13%) later expired. The mean Injury Severity Score (ISS) was 11.9 (discharged, 1.8; hospitalized, 14.3; expired, 29.2). Forty-five patients (56%) sustained 57 extremity fractures, and 30 patients (38%) required 40 amputations. Mean Mangled Extremity Severity Score (MESS) for all injured extremities was 5.2 (amputation, 7.7; no amputation, 2.8). On average, the hospitalization cost per patient was greater than $18,698, while the reimbursement from the patients was $2,261, leaving the hospital with a net deficit of approximately 2 million dollars. Surprisingly, train accidents do not always result in serious injury. However, when serious injury is sustained, it is often of high morbidity (amputation) and mortality, which appears to correlate well with the initial MESS and ISS. Extrapolating our cost data to include all train-related accident injuries and deaths indicates that the direct costs to society may exceed 300 million dollars annually. Greater public awareness and preventive measures may reduce the tremendous human and financial costs of train-related accidents.
在美国，与火车相关的事故每年导致超过18000人受伤和1200人死亡，但关于这种独特损伤的文献却很匮乏。我们回顾了1990年至1995年在德克萨斯州休斯顿贝勒医学院本·陶布综合医院接受治疗的135例与火车相关创伤病例中的98例的医疗记录。其中有50起火车与行人事故、47起火车与汽车事故以及1起火车与摩托车事故，患者平均年龄为30.1岁（范围为2至66岁）。18名患者（18%）在抵达时被宣布死亡或入院后不久死亡。在其他80名患者中，27名（34%）在接受轻微治疗后从急诊科出院，而53名（66%）住院治疗，其中10名（13%）后来死亡。平均损伤严重程度评分（ISS）为11.9（出院患者为1.8；住院患者为14.3；死亡患者为29.2）。45名患者（56%）发生了57处肢体骨折，30名患者（38%）需要进行40次截肢手术。所有受伤肢体的平均肢体毁损严重程度评分（MESS）为5.2（截肢患者为7.7；未截肢患者为2.8）。平均每位患者的住院费用超过18698美元，而患者的报销金额为2261美元，医院净亏损约200万美元。令人惊讶的是，火车事故并不总是导致严重伤害。然而，当遭受严重伤害时，往往发病率（截肢）和死亡率都很高，这似乎与最初的MESS和ISS密切相关。将我们的成本数据外推至包括所有与火车相关的事故伤害和死亡情况表明，社会每年的直接成本可能超过3亿美元。提高公众意识和采取预防措施可能会减少与火车相关事故造成的巨大人力和财力成本。
