The unrecognized danger of a new transportation mechanism of injury--pedicabs.

OBJECTIVE: Pedicabs are a new and controversial transportation innovation for tourists in congested areas in several U.S. cities. Scant literature on this trauma mechanism exists. The purpose of this study is to identify the incidence, demographics, morbidity, mortality, and potential for injury prevention of pedicab incidents amongst major trauma admissions at an urban, academic Level I Trauma Center. PATIENTS & METHODS: Researchers conducted a retrospective review of the Trauma Registry from 2000 to 2009. All patients identified as being injured in a pedicab incident were reviewed. Demographics, diagnoses, toxicology, treatments, and injury severity scale (ISS) were collected. Outcomes included mortality, ICU, and hospital length of stay (LOS), discharge disposition, and hospital charges. A photographic survey of 50 local pedicabs was examined for the presence and use of safety equipment. RESULTS: During the period of January 2000 to July 2009 there were 15 major trauma victims from identified pedicab incidents. Falling from the pedicab was the mechanism of injury in 14 of 15 cases. There were two fatalities in victims following severe traumatic brain injury. Traumatic brain injury, skull fracture, or loss of consciousness was seen in 11/15 victims. Ethanol ingestion was detected in blood tests of 10 of the 14 adult victims. Median charges of hospitalization due to a pedicab related injury was US$29,956 ± 77,482. A photographic survey of 50 local pedicabs reveals very limited use of safety belts by passengers despite existing city ordinances. CONCLUSIONS: Major trauma victims of pedicab incidents in the United States suffer significant injuries and death. Most cases occurred in passengers falling from the pedicab at night after alcohol ingestion. There is an opportunity for implementation of strategies toward improved injury prevention with this new form of transport.

Patient factors and operating room resuscitation predict mortality in traumatic abdominal aortic injury: a 20-year analysis.

BACKGROUND: Injuries to the abdominal aorta are rare and remain one of the most lethal causes of early death in trauma. The purposes of this study were to identify primary predictors of mortality and to examine the impact of a well-established operating room resuscitation protocol on survival in patients with traumatic aortic injury. METHODS: A 20-year retrospective review was performed of medical records and autopsy reports of trauma patients admitted with confirmed injury to the abdominal aorta. Data on patient demographics, admission characteristics, operative findings, and the initial location of resuscitation were collected. The main outcome measure was death. RESULTS: Abdominal aortic injuries were diagnosed in 60 patients. Their average age was 26.5 years, and the mean transport time was 10 minutes. The overall mortality rate (MR) was 73%. With the exclusion of 18 patients considered dead on arrival, the MR decreased to 61%. The mechanism of injury was blunt in 20% (MR 92%) and penetrating in 80% (MR 68%). Acidosis, defined as a pH <7.2 (MR 81%) or a base deficit >10 (MR 77%), was a predictor of death (P < .0001). Patients resuscitated directly in the operating room had a significantly lower MR (40%) than those resuscitated in the trauma room (MR 78%; P < .02). The lack of retroperitoneal tamponade (P < .02), the presence of associated intra-abdominal injuries (P < .001), and the location of aortic injury at the subdiaphragmatic (18%; MR 90%) or suprarenal location (37%; MR 71%; P < .005) at exploration resulted in significantly higher patient mortality. Surgical management consisted of primary repair in 26, end-to-end repair in 1, interposition graft in 8, or patch in 1. Resuscitative thoracotomy was performed in 27 patients (45%), with an overall MR of 92%. CONCLUSION: Despite advances in fluid resuscitation, operative strategy, and transport during the past 20 years, the mortality of traumatic injury to the abdominal aorta remains high. Shock, acidosis, suprarenal aortic injury, and a lack of retroperitoneal tamponade all independently contribute to mortality and should raise the suspicion for a potentially lethal aortic injury in a severely injured patient. Rapid identification and resuscitation in the operating room may therefore be the only factors to improve current survival rates in such devastating injuries.