New Injury Severity Score is a better predictor of mortality for blunt trauma patients than the Injury Severity Score.

BACKGROUND: Trauma-related mortality depends on injury severity. Several trauma scores are used to evaluate injury severity. We compared the Injury Severity Score (ISS) and the New Injury Severity Score (NISS) in terms of predicting mortality among hospitalized blunt trauma patients. METHODS: The data of Al-Ain Hospital Trauma Registry were prospectively collected over 3 years. Data of blunt trauma patients were then analyzed retrospectively. Univariate analysis was used to compare patients who died with those who survived. Sex, age, mechanism of injury, heart rate, systolic blood pressure (SBP), and Glasgow Coma Score (GSC) on arrival at the hospital, ISS, and NISS were studied. Significant factors were then entered into a direct likelihood ratio logistic regression model. RESULTS: Of 2,573 patients in the registry, 2,115 (82.2 %) suffered blunt trauma at a mean (SD) age of 32 (15.3) years. Among them, 1,838 (87 %) were male. Main mechanisms of injury were road traffic collision (vehicle occupants) (32.8 %) and falling from a height (22.4 %). Fifty patients (2.4 %) died. Univariate analysis showed that GCS and SBP at hospital arrival, ISS, NISS, and mechanism of injury significantly affected mortality. Logistic regression model showed that mortality was significantly increased by low GCS (p < 0.0001), high NISS (p < 0.0001), and low SBP (p = 0.006) at hospital arrival. CONCLUSIONS: Mortality of blunt trauma in the UAE is significantly affected by high NISS, low GCS, and hypotension. NISS is better than ISS for predicting mortality of blunt trauma patients and may replace it.

Pedestrian injuries-related deaths: a global evaluation.

OBJECTIVE: Pedestrians are vulnerable road users who are at risk of injuries and death on the roads. We aimed to define factors affecting pedestrian injuries-related deaths worldwide and to give recommendations regarding their prevention priorities. METHODS: Data on pedestrian injuries-related deaths for years 2007 and 2010 were retrieved from the WHO global status reports on road safety. These included the country population, gross national income (GNI), number of registered vehicles, estimated pedestrian deaths rate, effectiveness of enforcement of law, and the presence of policies to promote walking or cycling. Correlations between studied variables were done using Spearman rank correlation. General linear models were used to define factors affecting pedestrian injuries-related deaths. RESULTS: The median (range) pedestrian death rates of different countries per 100,000 population significantly decreased in year 2010 compared with year 2007 [3.9 (0-13.5) compared with 4.2 (0-23.6), (p = 0.004, Wilcoxon signed rank test)]. There was a reduction of 8.1% of the global pedestrian death rate between 2007 and 2010. The estimated pedestrian lives saved annually worldwide of a population of 6.8 billion were 23,120 persons. A general linear model has shown that GNI (p = 0.001) and population density (p = 0.01) were the best predictors of pedestrian death rates in 2007, while national legislation (p = 0.03) was the best predictor of pedestrian death rates in 2010. CONCLUSIONS: There is a change in the factors affecting pedestrian mortality worldwide over time. GNI and population density became less significant than national legislation enforcement. Legislation and its enforcement are important to achieve the UN mission of reducing road traffic deaths by 5 million over the next decade.

Effects of vehicle size on pedestrian injury pattern and severity: prospective study.

BACKGROUND: The type of injuries caused by sport utility vehicles may be different from those caused by small passenger cars. We studied prospectively the effects of the offending vehicle type and design on severity and pattern of pedestrian injuries. METHODS: All injured pedestrians admitted to the two major trauma centers of Al-Ain city were studied prospectively during the period of April 2006 to October 2007. Patients were classified into two groups according to the offending vehicle type: small vehicle and sport utility vehicle. These two groups were compared regarding the distribution of injury and its severity. RESULTS: The anatomical distribution of injury in a descending order were the lower extremities (56.3, 67 %), head (53.8, 57.1 %), face (37.5, 57.1 %), and upper extremities (32.5, 28.6 %) in small vehicle and sport utility vehicle groups, respectively. No significant statistical difference has been found between the two groups regarding the anatomical distribution and severity. CONCLUSIONS: The vehicle size and design did not affect the anatomical injury distribution and severity in our setting. High-impact speed may overcome the vehicle type when it comes to injury severity and pattern of distribution.

The changing epidemiology of trauma in child-bearing age women.

BACKGROUND: In the last two decades, there have been major improvements in the trauma system in the United Arab Emirates (UAE). We aimed to study the changes in the incidence, type, severity, and outcome of trauma of hospitalized child-bearing age women in Al-Ain City, UAE, during that time. METHODS: Data from two separate trauma registries of Al-Ain Hospital, which were prospectively collected from March 2003 to March 2006 and January 2014 to December 2017, were analyzed retrospectively. All women aged 15-49 years were studied. The two periods were compared. RESULTS: Trauma incidence of hospitalized child-bearing age women was reduced by 47% during the second period. There were no significant differences in the mechanism of injury between the two periods. Road traffic collision was the main cause of injury (44% and 42%, respectively) followed by fall down (26.1% and 30.8%, respectively). The location of injury was significantly different (p = 0.018), with a strong trend of more home injuries in the second period (52.8% compared with 44%, p = 0.06). There was a strong statistical trend of mild traumatic brain injury (GCS 13-15) in the second period (p = 0.067, Fisher's Exact test). Those who had normal GCS of 15 were significantly higher in the second period compared with those in the first period (95.3% compared with 86.4%, p < 0.001, Fisher's Exact test) despite having more anatomical injury severity of the head (AIS 2 (1-5) compared with 1 (1-5), p = 0.025). The NISS was significantly higher in the second period (median (range) NISS 5 (1-45) compared with 4 (1-75), p = 0.02). Despite that, mortality was the same (1.6% compared with 1.7%, p = 0.99) while the length of hospital stay was significantly less (mean (SD) 5.6 (6.3) days compared with 10.6 (13.6) days, p < 0.0001). CONCLUSIONS: The incidence of trauma in hospitalized child-bearing-age women was reduced by 47% over the last 15 years. Road traffic collisions and falls are the leading cause of injury in our setting. Home injuries increased over time. The mortality remained stable despite the increased severity of injured patients. More injury prevention efforts should target home injuries.

Effects of seat belt usage on injury pattern and outcome of vehicle occupants after road traffic collisions: prospective study.

BACKGROUND: Injury and death from road traffic collisions (RTCs) is a major health problem worldwide. The seat belt is the most important RTC safety innovation to reduce injury severity and death from RTCs. We aimed to study the effects of seat belt usage on injury patterns and outcomes of restrained vehicle occupants compared with unrestrained occupants after RTCs. METHODS: RTC trauma patients who were vehicle occupants and admitted to Al-Ain and Tawam Hospitals, or who died after arrival at the emergency departments were prospectively studied during the period of April 2006 to October 2007. Demography of patients, position in the vehicle, usage of seat belts, injury severity markers, Glasgow Coma Scale (GCS), hospital stay, need for surgery, injured body regions, and mortality were analyzed. RESULTS: Of 783 vehicle occupants, 766 (98%) patients with known seat belt status were studied. Among them, the 631 (82.4%) who were unrestrained were significantly younger than the restrained patients (P < 0.0001). The Abbreviated Injury Scale (AIS) scores for the thorax, back, and lower extremity were significantly higher in unrestrained than in restrained patients (P = 0.001, P = 0.036, and P = 0.045 respectively). The GCS was significantly lower in unrestrained than in restrained patients (P = 0.006). More surgical operations were performed in the unrestrained patients (P = 0.027). CONCLUSIONS: Seat belt usage reduces the severity of injury, hospital stay, and number of operations in injured patients. Seat belt compliance is low in our community. More legal enforcement of seat belt usage is mandatory to reduce the severity of injury caused by RTCs.

Camel-related injuries: prospective study of 212 patients.

BACKGROUND: Camel-related injuries have been less well studied than other animal-related injuries. We aimed to study prospectively the incidence, mechanism, distribution of injury, and outcome of patients admitted to hospital with camel-related injuries in Al-Ain, United Arab Emirates. METHODS: All patients who were admitted to Al-Ain Hospital with a camel-related injury were prospectively studied during the period of October 2001 to January 2010. Patient's demography, time of injury, mechanism of injury, and distribution and severity of injury were studied. RESULTS: A total of 212 patients, all male, with a median age of 28 years (5-89 years) were studied. The estimated incidence of hospitalized camel-related injured patients in Al-Ain City was 6.88 per 100,000 population per year. Camel kicks were most common (36.8 %) followed by a fall from a camel (26.4 %) and camel bites (25.0 %). Camel kicks and falling from a camel were more common during the hot month of August, and camel bites were more common during the rutting season (November to February). Patients with a kick-related injury had a significantly higher rate of maxillofacial fractures compared with other mechanisms. Spinal injuries occurred significantly more often in vehicle occupants who collided with camels compared with other mechanisms (3/7 compared with 7/205, p = 0.0022, Fisher's exact test). Twelve patients (5.7 %) were admitted to the intensive care unit. The mean hospital stay was 8.6 days (1-103 days). Two patients died (overall mortality 1 %). CONCLUSIONS: Understanding the biomechanisms and patterns of injury and correlating them with the behavior of the camel is important for identification and prevention of camel-related injuries.

Epidemiology of head injury in the United Arab Emirates.

BACKGROUND: Head injury increases mortality in trauma patients. We aimed to study the epidemiological and clinical features of head injury in Al-Ain city, United Arab Emirates (UAE). METHODS: Trauma patients with head injury who were admitted to Al- Ain Hospital for more than 24 hours and those who died in the hospital were included in the study. Data were prospectively collected from March 2003 - March 2006. RESULTS: 589 patients were studied, and 521 were males (88.3%). The median (range) age was 30 (1-89) years. The most common mechanism of injury was road traffic collision (67.1%) followed by fall from height (11.9%). Head injury was mild in 82.2% of patients, moderate in 5.7%, and severe in 12.1%. 20.9% of patients were admitted to the intensive care unit. 35 patients died (overall mortality 5.9%). Patients who died had significantly higher Injury Severity Score (p<0.0001), lower Glasgow Coma Scale (p<0.0001), and higher Abbreviated Injury Scale of the head (p<0.0001). CONCLUSION: Motor vehicle collision was the main mechanism of head injury in the UAE followed by fall from height. Legislation for compulsory seatbelt usage and helmet usage by bicyclists and motorcyclists should be adopted. A safe work environment and preventive measures at work should be introduced.

Trauma in women of child-bearing age in a high-income developing country.

BACKGROUND: We aimed to study the distribution and causes of trauma in women of child-bearing age. METHODS: Data were collected from Al-Ain Hospital (United Arab Emirates-UAE) Trauma Registry. Females aged 16 to 45 years (child-bearing age) who were admitted with trauma between March 2003 and March 2006 were included in the study. RESULTS: Females represented 9% (n=171) of all trauma patients (n=1809) of the same age group, of which 29% were UAE nationals. The mean age for females was 30.5 years. Road traffic collision (RTC) was the main mechanism of injury (n=78, 46%). Burns were significantly higher in females than males (p=0.001). Cervical fractures were significantly higher in females (p=0.04), while lumbar fractures were significantly higher in males (p=0.03). In females, pelvic fractures were diagnosed in 6.4%, spinal fractures in 7%, and both injuries in 1.2%. Three females died (1.7%), and all were due to RTC. CONCLUSION: The majority of females involved in trauma were aged 20- 34 years. RTC is the main mechanism of injury and fatality. Female trauma is associated with a high incidence of pelvic fractures. A higher rate of cervical injuries was observed in females in contrast to lumbar injuries in males.

Reduction of motorcycle-related deaths over 15 years in a developing country.

BACKGROUND: There have been major improvements in the trauma system and injury prevention in Al-Ain City. We aimed to study the impact of these changes on the incidence, pattern, injury severity, and outcome of hospitalized motorcycle-related injured patients in Al-Ain City, United Arab Emirates. METHODS: This is a retrospective analysis of two separate periods of prospectively collected data which were retrieved from Al-Ain Hospital Trauma Registry (March 2003 to March 2006 compared with January 2014 to December 2017). All motorcycle-injured patients who were admitted to Al-Ain Hospital for more than 24 h or died in the Emergency Department or after hospitalization were studied. RESULTS: The incidence of motorcycle injuries dropped by 37.1% over the studied period. The location of injury was significantly different between the two periods (p = 0.02, Fisher's exact test), with fewer injuries occurring at streets/highways in the second period (69.1% compared with 85.3%). The anatomical injury severity of the head significantly increased over time (p = 0.03), while GCS on arrival significantly improved (p < 0.0001), indicating improvements in both prehospital and in-hospital trauma care. The mortality of the patients significantly decreased (0% compared with 6%, p = 0.002, Fisher's exact test). CONCLUSIONS: The incidence of motorcycle injuries in our city dropped by almost 40% over the last 15 years. There was a significant reduction in the mortality of hospitalized motorcycle-injured patients despite increased anatomical severity of the head injuries. This is attributed to improvements in the trauma care system, including injury prevention, and both prehospital and in-hospital trauma care.

It's time for a minimum synoptic operation template in patients undergoing laparoscopic cholecystectomy: a systematic review.

BACKGROUND: Despite the call to enhance accuracy and value of operation records few international recommended minimal standards for operative notes documentation have been described. This study undertook a systematic review of existing operative reporting systems for laparoscopic cholecystectomy (LC) to fashion a comprehensive, synoptic operative reporting template for the future. METHODS: A search for all relevant articles was conducted using PubMed version of Medline, Scopus and Web of Science databases in June 2021, for publications from January 1st 2011 to October 25th 2021, using the keywords: laparoscopic cholecystectomy AND operation notes OR operative notes OR proforma OR documentation OR report OR narrative OR audio-visual OR synoptic OR digital. Two reviewers (NOC, GMC) independently assessed each published study using a MINORS score of ≥ 16 for comparative and ≥ 10 for non-comparative for inclusion. This systematic review followed PRISMA guidelines and was registered with PROSPERO. Synoptic operative templates from published data were assimilated into one "ideal" laparoscopic operative report template following international input from the World Society of Emergency Surgery board. RESULTS: A total of 3567 articles were reviewed. Following MINORS grading 25 studies were selected spanning 14 countries and 4 continents. Twenty-two studies were prospective. A holistic overview of the operative procedure documentation was reported in 6/25 studies and a further 19 papers dealt with selective surgical aspects of LC. A unique synoptic LC operative reporting template was developed and translated into Chinese/Mandarin, French and Arabic. CONCLUSION: This systematic review identified a paucity of publications dealing with operative reporting of LC. The proposed new template may be integrated digitally with hospitals' medical systems and include additional narrative text and audio-visual data. The template may help define new OR (operating room) recording standards and impact on care for patients undergoing LC.

Epidemiological changes of geriatric trauma in the United Arab Emirates.

ABSTRACT: We aimed to study the epidemiological changes in geriatric trauma in Al-Ain City, United Arab Emirates, in the past decade to give recommendations on injury prevention.Trauma patients aged 65 years and above who were hospitalized at Al-Ain Hospital for more than 24 hours or died in the hospital after their arrival regardless of the length of stay were studied. Data were extracted from the Al-Ain Hospital trauma registry. Two periods were compared; March 2003 to March 2006 and January 2014 to December 2017. Studied variables which were compared included demography, mechanism of injury and its location, and clinical outcome.There were 66 patients in the first period and 200 patients in the second period. The estimated annual incidence of hospitalized geriatric trauma patients in Al-Ain City was 8.5 per 1000 geriatric inhabitants in the first period compared with 7.8 per 1000 geriatric inhabitants in the second period. Furthermore, mortality was reduced from 7.6% to 2% (P = 0.04). There was a significant increase in falls on the same level by14.9% (62.1%-77%, P = 0.02, Pearson χ2 test). This was associated with a significant increase of injuries occurring at home (55.4%-78.7% P = 0.0003, Fisher Exact test). There was also a strong trend in the reduction of road traffic collision injuries which was reduced by 10.8% (27.3%-16.5%, P = 0.07, Fisher Exact test).Although the incidence and severity of geriatric trauma did not change over the last decade, in-hospital mortality has significantly decreased over time. There was a significant increase in injuries occurring at homes and in falls on the same level. The home environment should be targeted in injury prevention programs so as to reduce geriatric injuries.

Current changes in the epidemiology of fall-related injuries in Al Ain City, United Arab Emirates.

BACKGROUND: Falls in the Gulf countries are the second most common cause of injuries. The United Arab Emirates government implemented various preventive measures to decrease injuries in the country. We aimed to evaluate the changes in the epidemiology of fall-related injuries in Al-Ain City over the last decade. METHODS: Data of hospitalized patients who presented with fall-related injuries to the Al-Ain Hospital during the two periods of March 2003 to March 2006 and January 2014 to December 2017 were compared. This included patients' demographics, mechanism, location, anatomical distribution and parameters related to injury severity. Non-parametric tests were used for the statistical analysis. RESULTS: 882 in the first and 1358 patients in the second period were studied. The incidence of falls decreased by 30.5% over ten years. The number of elderly, female patients, and UAE nationals increased, (p < 0.001, p = 0.004, and p < 0.001). Falls from height decreased by 32.5% (p < 0.001) while fall on the same level increased by 22.5% (p < 0.001). Fall-related injuries at home have increased significantly by 22.6% (p <0.001), while falls in workplaces decreased by 24.4% (p <0.001). CONCLUSIONS: Our study showed that the overall incidence of falls decreased compared to a decade ago. The preventive measures were effective in reducing falls from height and workplace injuries. Future preventive measures should target falls at the same level and homes.

Trauma system developments reduce mortality in hospitalized trauma patients in Al-Ain City, United Arab Emirates, despite increased severity of injury.

BACKGROUND: Trauma is a leading cause of death in the United Arab Emirates (UAE). There have been major developments in the trauma system in Al-Ain City during the last two decades. We aimed to study the effects of these developments on the trauma pattern, severity, and clinical outcome of hospitalized trauma patients in Al-Ain City, United Arab Emirates. METHODS: This is a retrospective analysis of two separate sets of prospectively collected trauma registry data of Al-Ain Hospital. Data were collected over two periods: from March 2003 to March 2006 and from January 2014 to December 2017. Demography, injury mechanism, injury location, and clinical outcomes of 2573 trauma patients in the first period were compared with 3519 patients in the second period. RESULTS: Trauma incidence decreased by 38.2% in Al-Ain City over the last 10 years. Trauma to females, UAE nationals, and the geriatric population significantly increased over time (p < 0.0001, Fisher's exact test for each). Falls on the same level significantly increased over time, while road traffic collisions and falls from height significantly decreased over time (p < 0.0001, Fisher's exact test for each). Mortality significantly decreased over time (2.3% compared with 1%, p < 0.0001, Fisher's exact test). CONCLUSIONS: Developments in the trauma system of our city have reduced mortality in hospitalized trauma patients by 56% despite an increased severity of injury. Furthermore, the injury incidence in our city decreased by 38.2% over the last decade. This was mainly in road traffic collisions and work-related injuries. Nevertheless, falls on the same level in the geriatric population continue to be a significant problem that needs to be addressed.

Hey surgeons! It is time to lead and be a champion in preventing and managing surgical infections!

Appropriate measures of infection prevention and management are integral to optimal clinical practice and standards of care. Among surgeons, these measures are often over-looked. However, surgeons are at the forefront in preventing and managing infections. Surgeons are responsible for many of the processes of healthcare that impact the risk for surgical site infections and play a key role in their prevention. Surgeons are also at the forefront in managing patients with infections, who often need prompt source control and appropriate antibiotic therapy, and are directly responsible for their outcome. In this context, the direct leadership of surgeons in infection prevention and management is of utmost importance. In order to disseminate worldwide this message, the editorial has been translated into 9 different languages (Arabic, Chinese, French, German, Italian, Portuguese, Spanish, Russian, and Turkish).

Necrotizing fasciitis: a challenging diagnosis.

The objective of the study was to evaluate our recent experience in diagnosis and management of necrotizing fasciitis. Records of patients who were diagnosed as having necrotizing fasciitis at Al-Ain Hospital in the period between March 2003 and August 2005 were studied retrospectively with regard to clinical features, risk factors, diagnosis, causative organisms, treatment, and outcome. Eleven patients, eight of whom were men of low socio-economic status, were studied. The median age (range) was 46 (8-65) years. The main risk factor was diabetes mellitus in seven patients (64%). The provisional clinical diagnosis was incorrect in seven patients (64%). Pure beta-hemolytic streptococcus group A or B was the causative organism in five patients (46%). Most of our patients underwent multiple surgical debridements with a median range of two (1-11) operations. Two patients died (overall mortality rate 18%). High clinical suspicion is essential for the diagnosis of necrotizing fasciitis. Accurate early diagnosis, aggressive resuscitation, using proper antibiotics, and extensive surgical debridement are essential for a favorable outcome.

Distraction-related road traffic collisions.

OBJECTIVES: We aimed to prospectively study distraction-related road traffic collision injuries, their contributory factors, severity, and outcome. METHODS: Data were prospectively collected on all hospitalized road traffic collision trauma patients in Al-Ain City who were drivers at the collision time over one and half years. Driver's inattentive behaviors preceding the collision were collected by interviewing the admitted drivers. RESULTS: There were 444 drivers, 330 of them were fully oriented patients, out of them only 44 (13%) were distracted. Nineteen (5.8%) drivers were distracted by using mobile phones, 12 (3.6%) were pre-occupied with deep thinking, six (1.8%) were talking with other passengers, four (1.2%) were picking things in the vehicle, and three (0.9%) were using entertainment systems. The maximum distraction occurred during the time of 6 am - 12 noon when the traffic was crowded. There were no significant differences between distracted and non-distracted drivers in demographical and physiological factors, injured regions, and outcomes. CONCLUSION: Distraction of alert drivers causes 13% of road traffic collisions in Al-Ain city. About 40 percent of the distracted drivers involved in road traffic collisions (RTC) were using mobile phones. Our study supports the ban of use of cell phones while driving.

Youth traffic-related injuries: a prospective study.

BACKGROUND: Traffic-related injuries are the most common cause of morbidity and mortality of the youth. Our aim was to study epidemiology, risk factors and outcome of hospitalized youth patients injured in road traffic collisions in order to give recommendations for prevention. METHODS: We prospectively studied all youth (15-24 years) patients having traffic-related injuries who were admitted to Al Ain or Tawam Hospitals, Al Ain City, or who died after arrival to these hospitals during an 18 months period. Demography, location and time of injury, injured body regions, severity, hospital and intensive care unit (ICU) stay and outcome were analyzed. RESULTS: Three hundred thirty-three patients having a mean age (SD) of 20 years (2.5) were studied. 87% were males and 72% were UAE nationals. Majority of injured patients were drivers or front-seat passengers (70%), followed by back seat passengers (16%), motorcyclists (5%) and pedestrians (4%). Rollover was the most common crash mechanism (35%), followed by front crash (34%). Twenty seven patients (8%) were ejected during the crash, 14 during roll-over, 7 from quadribikes and three during front crash. 20% of the patients were admitted to the ICU. Median Glasgow Coma Scale was 15 (range 3-15), median Injury Severity Score was 5 (range 1-41), and median total hospital stay was 3 days (range 1-73). Nine (3%) patients died. CONCLUSIONS: Young UAE-national males are at a higher risk of being injured at traffic. Rollover crash was frequent with high risk of ejection. Promotion of traffic safety and enforcement of safety legislation is necessary.

Epidemiology of isolated hand injuries in the United Arab Emirates.

AIM: To provide suggestions for hand injury prevention by study the demography and risk factors of casualties suffering from isolated hand injuries. METHODS: All trauma patients with isolated hand injuries who were admitted to Al Ain Hospital for more than 24 h during a period of 3 years were studied. Patient demographics, location, mechanism/time of injury, and length of hospital stay were all analyzed. RESULTS: Two hundred and ten patients were studied. Their mean age was 29.7 years. Males constituted 92%. Sixty-five point one percent of all cases were from the Indian subcontinent. The workplace was the most common location of injury (67.1%), followed by the home (17.1%) and road (6.2%). Machinery caused 36.2% of all injuries, followed by heavy object (20.5%) and fall (11%). Cases injured at home were young (P < 0.0001) with an associated higher incidence of females (P < 0.0001). CONCLUSION: Male workers in Al Ain city are at greater risk of sustaining hand injuries, predominantly from machinery. Safety education, personal protection, and the enforcement of safety standards are essential to the prevention and avoidance of hand injury.

Lower limb and associated injuries in frontal-impact road traffic collisions.

OBJECTIVES: To study the relationship between severity of injury of the lower limb and severity of injury of the head, thoracic, and abdominal regions in frontal-impact road traffic collisions. METHODS: Consecutive hospitalised trauma patients who were involved in a frontal road traffic collision were prospectively studied over 18 months. Patients with at least one Abbreviated Injury Scale (AIS) ≥3 or AIS 2 injuries within two AIS body regions were included. Patients were divided into two groups depending on the severity of injury to the head, chest or abdomen. Low severity group had an AIS < 2 and high severity group had an AIS ≥ 2. Backward likelihood logistic regression models were used to define significant factors affecting the severity of head, chest or abdominal injuries. RESULTS: Eighty-five patients were studied. The backward likelihood logistic regression model defining independent factors affecting severity of head injuries was highly significant (p =0.01, nagelkerke r square = 0.1) severity of lower limb injuries was the only significant factor (p=0.013) having a negative correlation with head injury (Odds ratio of 0.64 (95% CI: 0.45-0.91). CONCLUSION: Occupants who sustain a greater severity of injury to the lower limb in a frontal-impact collision are likely to be spared from a greater severity of head injury.

Factors affecting injury severity of vehicle occupants following road traffic collisions.

AIM: We aimed to define factors affecting injury severity of vehicle occupants following road traffic collisions (RTC). PATIENTS AND METHODS: 422 vehicle occupants (343 males, 81.3%) with RTC-related injuries were prospectively studied over 18 months. General linear model was used to test the effect of age, gender, alcohol and drug use, time of injury, mechanism of injury, size and speed of the vehicle, position in the vehicle, seatbelt usage, and air bag deployment on the Injury Severity Score (ISS) of the vehicle occupants. RESULTS: The mean (range) age of patients was 28.2 (1-78) years and the mean (range) ISS was 7.9 (1-50). Front impact was the most common mechanism of injury (32.9%) followed by rollover (25.6%) and side impact (22.3%). 18.2% used seatbelts. The general linear model was highly significant and showed that mechanism of injury (p<0.0001), speed of the vehicle (p=0.02), and age of the vehicle occupant (p=0.03) significantly affected the Injury Severity Score. CONCLUSIONS: The mechanism of the RTC, the vehicle speed, and age of the vehicle occupant are the most important factors affecting the severity of road traffic collision injuries. A detailed history of the mechanism of injury is important for alerting clinicians to severity of injury, the need for admission, and workup of the patients. Furthermore, strict speed limit enforcement is an injury prevention priority in our community.