Comparative analysis of the frequency and the severity of diagnosed lesions between pedestrians struck by motor vehicles and other blunt trauma mechanisms victims.

OBJECTIVE: to compare the frequency and the severity of diagnosed injuries between pedestrians struck by motor vehicles and victims of other blunt trauma mechanisms. METHODS: retrospective analysis of data from the Trauma Registry, including adult blunt trauma patients admitted from 2008 to 2010. We reviewed the mechanism of trauma, vital signs on admission and the injuries identified. Severity stratification was carried using RTS, AIS-90, ISS e TRISS. Patients were assigned into group A (pedestrians struck by motor vehicle) or B (victims of other mechanisms of blunt trauma). Variables were compared between groups. We considered p<0.05 as significant. RESULTS: a total of 5785 cases were included, and 1217 (21,0%) of which were in group A. Pedestrians struck by vehicles presented (p<0.05) higher mean age, mean heart rate upon admission, mean ISS and mean AIS in head, thorax, abdomen and extremities, as well as lower mean Glasgow coma scale, arterial blood pressure upon admission, RTS and TRISS. They also had a higher frequency of epidural hematomas, subdural hematomas, subarachnoid hemorrhage, brain swelling, cerebral contusions, costal fractures, pneumothorax, flail chest, pulmonary contusions, as well as pelvic, superior limbs and inferior limbs fractures. CONCLUSION: pedestrian struck by vehicles sustained intracranial, thoracic, abdominal and extremity injuries more frequently than victims of other blunt trauma mechanism as a group. They also presented worse physiologic and anatomic severity of the trauma.

Comparative analysis of the frequency and the severity of diagnosed lesions between pedestrians struck by motor vehicles and other blunt trauma mechanisms victims / Análise comparativa das lesões diagnosticadas e de sua gravidade entre vítimas de atropelamento e outros mecanismos de trauma fechado

ABSTRACTObjective:to compare the frequency and the severity of diagnosed injuries between pedestrians struck by motor vehicles and victims of other blunt trauma mechanisms.Methods:retrospective analysis of data from the Trauma Registry, including adult blunt trauma patients admitted from 2008 to 2010. We reviewed the mechanism of trauma, vital signs on admission and the injuries identified. Severity stratification was carried using RTS, AIS-90, ISS e TRISS. Patients were assigned into group A (pedestrians struck by motor vehicle) or B (victims of other mechanisms of blunt trauma). Variables were compared between groups. We considered p<0.05 as significant.Results:a total of 5785 cases were included, and 1217 (21,0%) of which were in group A. Pedestrians struck by vehicles presented (p<0.05) higher mean age, mean heart rate upon admission, mean ISS and mean AIS in head, thorax, abdomen and extremities, as well as lower mean Glasgow coma scale, arterial blood pressure upon admission, RTS and TRISS. They also had a higher frequency of epidural hematomas, subdural hematomas, subarachnoid hemorrhage, brain swelling, cerebral contusions, costal fractures, pneumothorax, flail chest, pulmonary contusions, as well as pelvic, superior limbs and inferior limbs fractures.Conclusion:pedestrian struck by vehicles sustained intracranial, thoracic, abdominal and extremity injuries more frequently than victims of other blunt trauma mechanism as a group. They also presented worse physiologic and anatomic severity of the trauma.

RESUMOObjetivo:comparar, entre vítimas de atropelamento e de outros mecanismos de trauma fechado, a frequência e gravidade das lesões identificadas.Métodos:análise retrospectiva das informações do registro de trauma, incluindo as vítimas de trauma fechado, com idade superior a 13 anos de idade, admitidas entre 2008-2010. Avaliamos o mecanismo de trauma, dados vitais à admissão e lesões diagnosticadas. A estratificação de gravidade da amostra foi realizada pelos índices RTS, AIS-90, ISS e TRISS. As vítimas de trauma fechado foram separadas em dois grupos: Grupo A- pedestres vítimas de atropelamento; Grupo B- vítimas dos demais mecanismos de trauma fechado. As variáveis foram comparadas entre os dois grupos.Resultados:foram incluídos no estudo 5785 casos, sendo que, 1217 (21,0%) foram vítimas de atropelamento. Observamos que os traumatizados do grupo A apresentaram, significativamente (p<0,05), maior média etária, de frequência cardíaca à admissão, de ISS, de AIS no segmento cefálico, torácico, abdominal e em extremidades, bem como, menor média de escala de coma de Glasgow, pressão arterial sistólica a admissão, RTS e TRISS. As vítimas de atropelamento também apresentaram (p<0,05), maior frequência de hematomas extradurais, hematomas subdurais agudos, hemorragia subaracnoidea, Brain Swelling, contusão cerebral, lesão axonal difusa, fraturas de arcos costais, pneumotórax, tórax flácido, contusão pulmonar, bem como, fraturas de pelve, de membros superiores, inferiores e expostas de membros inferiores.Conclusão:as vítimas de atropelamento apresentam maior frequência e gravidade de lesões intracranianas, torácicas, abdominais e em extremidades quando comparadas às vítimas de outros mecanismos de trauma fechado em conjunto.

Comparative analysis between identified injuries of victims of fall from height and other mechanisms of closed trauma.

OBJECTIVE: to identify predictors of death in blunt trauma patients sustaining pelvic fractures and, posteriorly, compare them to a previously reported series from the same center. METHOD: Retrospective analysis of trauma registry data, including blunt trauma patients older than 14 y.o. sustaining pelvic fractures admitted from 2008 to 2010. Patients were assigned into group 1 (dead) or 2 (survivors). We used Student's t, qui square and Fisher's tests for statistical analysis, considering p<0.05 as significant. Posteriorly, we compared predictors of death between both periods. RESULTS: Seventy-nine cases were included. Mean RTS, ISS and TRISS were, respectively, 6.44 + 2.22, 28.0 + 15.2 e 0.74 + 0.33. Nineteen patients died (24,0%). Main cause of death was hemorrhage (42,1%). Group 1 was characterized by (p<0.05) lower systolic blood pressure and Glasgow coma scale means on admission, higher heart rate, head AIS, extremity AIS and ISS means, as well as, higher frequency of severe head injuries and complex pelvic fractures. Comparing both periods, we notice that the anatomic and physiologic severity of injury increased (RTS and ISS means). Furthermore, there was a decrease in the impact of associated thoracic and abdominal injuries on the prognosis and an association of lethality with the presence of complex pelvic fractures. CONCLUSION: There were significant changes in the predictors of death between these two periods. The impact of thoracic and abdominal associated injures decreased while the importance of severe retroperitoneal hemorrhage increased. There was also an increase in trauma severity, which accounted for high lethality.

Comparative analysis between identified injuries of victims of fall from height and other mechanisms of closed trauma / Análise comparativa dos fatores preditivos de morte em vítimas de trauma fechado com fraturas pélvicas

OBJECTIVE: to identify predictors of death in blunt trauma patients sustaining pelvic fractures and, posteriorly, compare them to a previously reported series from the same center. METHOD: Retrospective analysis of trauma registry data, including blunt trauma patients older than 14 y.o. sustaining pelvic fractures admitted from 2008 to 2010. Patients were assigned into group 1 (dead) or 2 (survivors). We used Student's t, qui square and Fisher's tests for statistical analysis, considering p<0.05 as significant. Posteriorly, we compared predictors of death between both periods. RESULTS: Seventy-nine cases were included. Mean RTS, ISS and TRISS were, respectively, 6.44 + 2.22, 28.0 + 15.2 e 0.74 + 0.33. Nineteen patients died (24,0%). Main cause of death was hemorrhage (42,1%). Group 1 was characterized by (p<0.05) lower systolic blood pressure and Glasgow coma scale means on admission, higher heart rate, head AIS, extremity AIS and ISS means, as well as, higher frequency of severe head injuries and complex pelvic fractures. Comparing both periods, we notice that the anatomic and physiologic severity of injury increased (RTS and ISS means). Furthermore, there was a decrease in the impact of associated thoracic and abdominal injuries on the prognosis and an association of lethality with the presence of complex pelvic fractures. CONCLUSION: There were significant changes in the predictors of death between these two periods. The impact of thoracic and abdominal associated injures decreased while the importance of severe retroperitoneal hemorrhage increased. There was also an increase in trauma severity, which accounted for high lethality. .

OBJETIVO: analisar os fatores preditivos de morte nas vítimas de trauma fechado com fraturas pélvicas. MÉTODOS: análise retrospectiva dos dados de registro de trauma, incluindo as vítimas trauma fechado com fraturas de pelve e idade superior a 14 anos. Os que faleceram formaram o grupo 1 e, os sobreviventes, o grupo 2. Utilizamos os testes t de Student, Fisher e Qui-quadrado para a análise estatística, considerando p<0,05 como significativo. Posteriormente comparamos os fatores preditivos de morte entre os períodos estudados. RESULTADOS: Foram incluídos 79 doentes. As médias do RTS, ISS e TRISS foram, respectivamente, 6,44 + 2,22; 28,0 + 15,2 e 0,74 + 0,33. Houve 19 óbitos (24%). A causa principal foi o choque hemorrágico (42,1%). Os que morreram apresentaram, significativamente (p<0,05), menor média de pressão arterial sistólica e escala de Glasgow à admissão, maior média de frequência cardíaca à admissão, AIS segmento cefálico, AIS em extremidades e ISS, como também, maior frequência de lesões graves em segmento cefálico e de fraturas complexas de pelve. O período mais recente se caracterizou por maior gravidade anatômica e fisiológica da amostra, como também, diminuição do impacto das lesões associadas (tórax e abdome) sobre a letalidade. Ao contrário do observado anteriormente, houve relação significativa entre a complexidade da fratura de pelve e letalidade. CONCLUSÃO: Houve diferença significativa entre os dois períodos, representada por aumento na gravidade da amostra e maior impacto da hemorragia retroperitoneal como causa de morte. .

[Comparative analysis of injuries observed in motorcycle riders involved in traffic accidents and victims of other blunt trauma mechanisms]. / Análise comparativa entre as lesões encontradas em motociclistas envolvidos em acidentes de trânsito e vítimas de outros mecanismos de trauma fechado.

OBJECTIVE: To conduct a comparative analysis of the lesions found among motorcycle riders involved in traffic accidents and victims of other mechanisms of blunt trauma. METHODS: Analysis of data prospectively collected on protocols for trauma patients older than 13 years, admitted from 06/10/2008 to 09/01/2009, victims of blunt trauma. Data collected included trauma mechanism, vital signs at admission, laboratory tests, injuries, and treatment.Stratification of trauma and lesion severity was performed by calculating the trauma index: Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS) and TRISS. We compared the variables between motorcycle riders (group A) and the others (group B). Severe injuries were considered when AIS > 3. For statistical analysis, we used Student's t, Mann Whitney, chi-square and Fisher's test, with p < 0.05 considered statistically significant. RESULTS: The study included 3,783 blunt trauma victims, aged 14 to 99 years, of which 76.0% were males. The most frequent trauma mechanisms were accidents involving motorcycle riders (24.4%) and pedestrians (22.6%). When comparing the variables between groups A and B, we observed that motorcycle riders were significantly (p < 0.05) younger (28.9 ± 8.5 years vs. 42.4 ± 18.5 years) and had lower mean AIS in the head segment (0.3 ± 0.9 vs. 0.8 ± 1.1), as well as higher mean GCS at admission (14.5 ± 1.9 vs. 14.2 ± 2.2), AIS in the extremities (1.5 ± 1.2 vs. 0.9 ± 1.2), RTS (7.8 ± 0.5 vs. 7.7 ± 0.6) and TRISS (0.98 ± 0.1 vs. 0.97 ± 0.1). Men were significantly more frequent in group A (87.9% vs. 72.6%). When comparing injuries between groups, we observed that the motorcycle riders had significantly (p < 0.05) lower frequency of extradural hematomas (0.6% vs. 2.1%), subdural hematomas (0.9% vs. 2.1%), subarachnoid hemorrhage (0.9% vs. 2.2%), brain injury (1.2 vs. 3.6%), and severe head injuries (4.8% vs. 9.4% ), as well as higher frequency of diffuse axonal injury (1.6% vs. 0.7%), upper- (7.9% vs. 4.4%) and lower-limb fractures (7.7% vs. 5, 2%), and severe extremity lesions (20.6% vs. 12.6%). CONCLUSION: Compared to victims of other trauma mechanisms, motorcycle riders had a lower frequency and severity of head injuries, as well as increased frequency and severity of lesions in the extremities.

Análise comparativa entre as lesões encontradas em motociclistas envolvidos em acidentes de trânsito e vítimas de outros mecanismos de trauma fechado / Comparative analysis of injuries observed in motorcycle riders involved in traffic accidents and victims of other blunt trauma mechanisms

OBJETIVO: Realizar uma análise comparativa entre as lesões encontradas em motociclistas envolvidos em acidentes de trânsito e vítimas de outros mecanismos de trauma fechado. MÉTODOS: Análise dos protocolos (colhidos prospectivamente) dos traumatizados com idade superior a 13 anos, admitidos de 10/06/2008 a 01/09/2009, vítimas de trauma fechado. Foram coletadas informações sobre mecanismo de trauma, dados vitais à admissão, exames complementares, lesões e tratamento. A estratificação da gravidade do trauma e das lesões foi realizada pelo cálculo dos índices de trauma: RTS, escala de coma de Glasgow (ECG), AIS, ISS e TRISS. Comparamos as variáveis entre os motociclistas (grupo A) e os demais (grupo B). Consideramos graves as lesões com AIS > 3. Para a análise estatística, utilizamos os testes t de Student, Mann Whitney, qui-quadrado e Fisher, considerando p < 0,05 significativo. RESULTADOS: Foram incluídos no estudo 3.783 vítimas de trauma fechado, com idade de 14 a 99 anos, sendo 76,0 por cento do sexo masculino. Os mecanismos de trauma mais frequentes foram os acidentes com motociclistas (24,4 por cento) e atropelamentos (22,6 por cento). Na comparação das variáveis entre os grupos A e B, observamos que os motociclistas apresentaram, significativamente, (p < 0,05), menor média etária (28,9 ± 8,5 anosvs. 42,4 ± 18,5 anos) e menor média de AIS em segmento cefálico (0,3 ± 0,9 vs. 0,8 ± 1,1), como também, maior média da ECG à admissão (14,5 ± 1,9vs. 14,2 ± 2,2), de AIS em extremidades (1,5 ± 1,2 vs. 0,9 ± 1,2), de RTS (7,8 ± 0,5 vs. 7,7 ± 0,6) e de TRISS (0,98 ± 0,1 vs. 0,97 ± 0,1). O gênero masculino foi significativamente mais frequente no grupo A (87,9 por centovs. 72,6 por cento). Na comparação das lesões entre os grupos, notamos que os motociclistas apresentaram, significativamente, (p < 0,05), menor frequência de hematomas extradurais (0,6 por cento vs. 2,1 por cento), hematomas subdurais (0,9 por cento vs. 2,1 por cento), hemorragia subaracnóidea (0,9 por cento vs. 2,2 por cento), contusão encefálica (1,2 por cento vs. 3,6 por cento) e lesões graves em crânio (4,8 por centovs. 9,4 por cento), bem como maior frequência de lesão axonal difusa (1,6 por centovs. 0,7 por cento), fraturas de membros superiores (7,9 por centovs. 4,4 por cento), inferiores (7,7 por centovs. 5,2 por cento), e lesões graves em extremidades (20,6 por centovs. 12,6 por cento). CONCLUSÃO: Em comparação às vítimas dos demais mecanismos de trauma, os motociclistas apresentaram menor frequência e gravidade das lesões em segmento cefálico, bem como maior frequência e gravidade das lesões em extremidades.

OBJECTIVE: To conduct a comparative analysis of the lesions found among motorcycle riders involved in traffic accidents and victims of other mechanisms of blunt trauma. METHODS: Analysis of data prospectively collected on protocols for trauma patients older than 13 years, admitted from 06/10/2008 to 09/01/2009, victims of blunt trauma. Data collected included trauma mechanism, vital signs at admission, laboratory tests, injuries, and treatment.Stratification of trauma and lesion severity was performed by calculating the trauma index: Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS) and TRISS. We compared the variables between motorcycle riders (group A) and the others (group B). Severe injuries were considered when AIS > 3. For statistical analysis, we used Student's t, Mann Whitney, chi-square and Fisher's test, with p < 0.05 considered statistically significant. RESULTS: The study included 3,783 blunt trauma victims, aged 14 to 99 years, of which 76.0 percent were males. The most frequent trauma mechanisms were accidents involving motorcycle riders (24.4 percent) and pedestrians (22.6 percent). When comparing the variables between groups A and B, we observed that motorcycle riders were significantly (p < 0.05) younger (28.9 ± 8.5 years vs. 42.4 ± 18.5 years) and had lower mean AIS in the head segment (0.3 ± 0.9 vs. 0.8 ± 1.1), as well as higher mean GCS at admission (14.5 ± 1.9 vs. 14.2 ± 2.2), AIS in the extremities (1.5 ± 1.2 vs. 0.9 ± 1.2), RTS (7.8 ± 0.5 vs. 7.7 ± 0.6) and TRISS (0.98 ± 0.1 vs. 0.97 ± 0.1). Men were significantly more frequent in group A (87.9 percent vs. 72.6 percent). When comparing injuries between groups, we observed that the motorcycle riders had significantly (p < 0.05) lower frequency of extradural hematomas (0.6 percent vs. 2.1 percent), subdural hematomas (0.9 percent vs. 2.1 percent), subarachnoid hemorrhage (0.9 percent vs. 2.2 percent), brain injury (1.2 vs. 3.6 percent), and severe head injuries (4.8 percent vs. 9.4 percent ), as well as higher frequency of diffuse axonal injury (1.6 percent vs. 0.7 percent), upper- (7.9 percent vs. 4.4 percent) and lower-limb fractures (7.7 percent vs. 5, 2 percent), and severe extremity lesions (20.6 percent vs. 12.6 percent). CONCLUSION: Compared to victims of other trauma mechanisms, motorcycle riders had a lower frequency and severity of head injuries, as well as increased frequency and severity of lesions in the extremities.