[Enhanced automatic collision notification system. First field experience]. / Automatische Unfallmelder. Erste Erfahrungen aus der Anwendung.

Motor vehicle accidents are the leading cause of severe injuries. Outcome of these victims is substantially influenced by rescue time and primary trauma centre care. Nowadays, automatic crash notification systems (ACN) are available offering the major possibility of immediate initiation of the rescue chain and thereby shortening rescue time up to 50%. According to the EU commission a nationwide equipping of motor vehicles with automatic crash notification systems could save up to 2,500 lives per year. Therefore, all new vehicles should be equipped with an automatic crash notification system by 2014. BMW is the first manufacturer to install an enhanced automatic crash notification system (eACN), which could optimize the rescue triage by estimating the risk for severe injuries (MAIS3+) based on telemetric transmitted accident data.

Noise raises blood pressure without impairing auditory sensitivity.

Two rhesus monkeys, exposed continuously to realistic patterns and levels of noise for 9 months, exhibited sustained elevations in blood pressure that did not return to baseline values after the noise ended. Auditory brainstem responses, measured before and after exposure, indicated no change in auditory sensitivity.

Management strategies for the open abdomen: survey of the American Association for the Surgery of Trauma membership.

PURPOSE: The purpose of this study is to report results from a survey of members of the American Association for the Surgery of Trauma (AAST) on strategies for management of the open abdomen. MATERIAL AND METHODS: Invitations to participate in a web-based survey were sent to AAST members via email. MAIN RESULTS: The response rate was 26%. For 74% of surgeons surveyed, the number of cases treated per year has increased over the last 10 years. The abdomen is left open for damage control (46% of respondents) and abdominal organ distention (22%). Most respondents use the vacuum pack system to temporarily close the abdomen (57%) and a smaller proportion use a bogota bag (18%). Ventilatory failure was the most frequent complication (72%) and elderly patients have the worse outcome. SIGNIFICANT CONCLUSIONS: Given the lack of consensus regarding optimal management strategies for the open abdomen, there is a need for prospective, multi-institutional studies to evaluate therapeutic approaches to treat this challenging problem.

Age appropriate restraints for the right front passenger.

This study applies NASS/CDS, GES and FARS data to examine occupant exposure plus injury and fatality rates for belted occupants in frontal crashes by seating position, age and gender. The NASS data was used to examine the distributions by crash severity. The GES data showed that when two elderly occupants (age 65+) were present, the female occupied the right front passenger position 73% of the time. A paired comparison analysis using FARS data showed that, for elderly occupants (age 65+), the fatality risk for elderly right front passengers is 42% higher than for elderly drivers. The NASS/CDS analysis found 74% of the seriously injured vulnerable passengers with MAIS 3+ injuries were in crashes less severe than 26 mph. This group of injured occupants was made up of 43% aged 50 and older and 42% younger females. The injury rates for the older (age 50+) right front passengers were 1.8 times the rates for the elderly drivers. These results suggest the need for more benign safety systems for the right front passenger that are appropriate for the lower injury tolerance of the predominant occupants of that seating position.

The SceneScore for improved pre-hospital triage of motor-vehicle crash victims.

The SceneScore is a simple mechanism of injury scoring system designed to facilitate the appropriate triage of crash victims. It comprises 7 variables including age, collision type, impact location, airbag deployment, steering wheel deformity, intrusion, and restraint use. A cutoff value of 7 or 8 provides the maximum balance between sensitivity and specificity, with sensitivities of 75% to 83% and specificities of 29% to 46%. For cases triaged to the trauma center based only on high suspicion of injury, the SceneScore reduces the overtriage rate by almost half. Proper application of the SceneScore may lead to improved triage and enhanced communication of mechanism of injury criteria.

Residual injuries after recent safety improvements.

This study examines the residual injuries reported in NASS/CDS 1997-2004 by crash mode, crash severity, body region and occupant age. It examines how serious injuries are distributed in present day crashes and identifies opportunities for further injury reduction. In planar crashes, approximately 66% of the MAIS 3+ injuries occur in crashes less severe than 25 mph delta-V. Chest injuries predominate in these crashes, particularly among elderly occupants. A reduction in chest injuries to belted elderly occupants during low severity frontal crashes offers a prime opportunity for further improvement of safety systems. Younger occupants could also benefit from improved chest protection.

Investigation of the performance of safety systems for protection of the elderly.

This study investigates injury occurrence for belted occupants as a function of age. An analysis of NASS/CDS 1997-2003 data was conducted to determine crash involvement rates and injury rates for front seat occupants versus mean occupant age. In frontal and near-side crashes, the average age of MAIS 3+ belted front seat occupants injured in crashes less severe than 15 mph is of the order of 50 years. The average age of the population exposed to crashes less severe than 15 mph is under 40 years old. The crash exposure and frequency if injuries to the elderly were both found to be the highest in low severity crashes. The chest is the most frequent body region injured for the elderly. These findings suggest the need for more benign safety systems to protect the elderly in low severity crashes. Design of safety systems for the elderly should give priority to reducing the chest loading in low severity frontal and near-side crashes.

The use of serum amylase and lipase in evaluating and managing blunt abdominal trauma.

In order to determine the usefulness of serum amylase and lipase in the initial evaluation and subsequent management of blunt abdominal trauma (BAT) patients, we collected serum amylase and lipase on 85 consecutive BAT patients at admission, hospital day 1, hospital day 3, and hospital day 7. Only one patient had a pancreatic injury. A total of 45 patients (53%) had at least one enzyme abnormality during the study. There was no correlation between amylase or lipase values and age, sex, type of injury, diagnostic tests, operation, and outcome. In a control group of nonabdominal-trauma patients with admit studies only, all enzyme values were normal. We conclude that serum amylase and lipase are randomly elevated in patients with nonpancreatic-BAT both initially and during subsequent hospitalization and are not useful clinical tools in these patients.

Evaluating blunt abdominal trauma with sonography: a cost analysis.

Ultrasonography (US) is becoming increasingly utilized in the United States for the evaluation of blunt abdominal trauma (BAT). The objective of this study was to assess the cost impact of utilizing US in the evaluation of patients with BAT in a major trauma center. All patients sustaining BAT during a 6-month period before US was used at our institution (Jan-Jun 1993) were compared to BAT patients from a recent period in which US has been utilized (Jan-Jun 1995). The numbers of US, computed tomography (CT), and diagnostic peritoneal lavage (DPL) were tabulated for each group. Financial cost for each of these procedures as determined by our finance department were as follows: US $96, CT $494, DPL $137. These numbers are representative of actual hospital expenditures exclusive of physician fees as calculated in 1994 U.S. dollars. Cost analysis was performed with t test and chi squared test, and significance was defined as P < 0.05. There were 890 BAT admissions in the 1993 study period and 1033 admissions in the 1995 study period. During the 1993 period, 642 procedures were performed on the 890 patients to evaluate the abdomen: 0 US, 466 CT, and 176 DPL (see table) [table: see text]. This compares to 801 procedures on the 1,033 patients in 1995: 552 US, 228 CT, and 21 DPL. Total cost was $254,316 for the 1993 group and $168,501 for the 1995 group. Extrapolated to a 1-year period, a significant (P < 0.05) cost savings of $171,630 would be realized. Cost per patient evaluated was significantly reduced from $285.75 in 1993 to $163.12 in 1995 (P < 0.05). This represents a 43 per cent reduction in per patient expenditure for evaluating the abdomen. By effectively utilizing ultrasonography in the evaluation of patients with blunt abdominal trauma, a significant cost savings can be realized. This effect results chiefly from an eight-fold reduction in the use of DPL, and a two-fold reduction in the use of CT.

Validation of the urgency algorithm for near-side crashes.

The URGENCY algorithm uses vehicle crash sensor data in Automatic Crash Notification (ACN) systems to assist in instantly identifying crashes that are most likely to have time critical injuries. The algorithm also provides the capability of improving injury identification, using data obtained from the scene. The prime purpose of the algorithm is to automatically provide emergency medical responders with objective information on crash severity to assist in detecting the approximately 1% of crashes with serious injuries needing the most urgent medical care. The algorithm calculates the risk of a MAIS 3+ injury being present in the crashed vehicle, instantly at the time of the crash. The prediction can be subsequently updated as more information becomes available. The algorithm was based on a multiple regression analysis using data from the National Accident Sampling System/Crashworthiness Data System, (NASS/CDS) years 1988-95. In this paper, the accuracy of the algorithm was evaluated for near side crashes by applying it retrospectively to the population of injured occupants in NASS 1997-2000. URGENCY was applied to the population of injured occupants in near side crashes. Using an injury risk criterion of 50%, URGENCY identified 69% of the crashes with MAIS 3+ injuries. By lowering injury risk criterion to 40%, URGENCY identified 78% of the crashes with MAIS 3+ injuries. Vehicle side intrusion was found to be a highly influential variable. By changing side intrusion from a binary to a continuous variable, the correctly identified crashes increased from 69% to 81%. Examination of the consequence of missing variables found that unknown values of occupant height and weight had a negligible effect on the ability to capture the MAIS 3+ injured. However, lack of knowledge of these variables did increase the magnitude of the false positives.

Dummy measurement of chest injuries induced by two-point shoulder belts.

The University of Miami's William Lehman Injury Research Center at the Jackson Memorial Medical Center conducts interdisciplinary investigations to study seriously injured restrained occupants in frontal automobile collisions. Engineering analysis of these crashes is conducted in conjunction with the National Crash Analysis Center at the George Washington University. The multidisciplinary research team includes expertise in crash investigation, crash reconstruction, computer graphics, biomechanics of injuries, crash data analysis, trauma care, and all of the medical specialties associated with the Ryder Trauma Center at Jackson Memorial Hospital. More than 350 injured occupants and their crashes have been studied in depth. The purpose of this paper is to report on an observed pattern of liver lacerations suffered by drivers wearing shoulder belts, without the lap belt fastened and to assess the ability of existing crash test dummies to measure the potential for these injuries. During the initial years of the study, 48 cases of drivers protected by shoulder belts but without the lap belt fastened met the criteria for the study. Fifty percent of these drivers suffered liver lacerations. Further study showed that 22 of the crashes involved damage to the right front of the vehicle. Among the drivers in vehicles with right front damage, 92% sustained injuries to the liver. This observation indicated that 2-point belts were most likely to produce liver injuries in low severity frontal collisions when the crash direction is 1 to 2 o'clock. An analysis of the National Accident Sampling System for the years 1988-95 indicated that liver injuries constitute about 0.5% of the injuries suffered by drivers who are in tow-away crashes. NASS data showed that the risk of chest injury is more likely among drivers with automatic shoulder belts than drivers with 3-point manual belts. The crash test dummies showed no difference in chest injury measures. Finite element computer modeling demonstrated that the high deflection of the right lower rib on the Hybrid III dummy predicts the liver injuries in the 1 o'clock crashes. These higher deflections were less apparent at the location of the center chest deflection measurement device on the Hybrid III.

Injuries to restrained occupants in far-side crashes.

Occupants exposed to far-side crashes are those seated on the side of the vehicle opposite the struck side. This study uses the NASS/CDS 1988-98 to determine distributions of AIS 3+ injuries among occupants exposed to far-side crashes and the sources of the injuries. The William Lehman Injury Research Center (WLIRC) data from 1994-98 is used to assess injury mechanisms among seriously injured crash exposed far-side occupants. The NASS/CDS indicated that injury patterns for far-side restrained drivers were different from far-side restrained front passengers. For the driver, the head accounted for 40% of the AIS 3+ injuries in far-side collisions and the chest/abdomen accounted for 45.5%. For the right front passengers, head injuries contributed 27.2%, while chest and abdominal injuries accounted for 64.5%. The opposite-side interior was the most frequent contact associated with driver AIS 3+ injuries (30.5%). The seat belt was second, accounting for 22.6%. Among thirteen WLIRC cases of far-side belted occupants with MAIS 3+ injuries, five of the most serious injuries were attributed to the seat belt. The liver or the spleen was the most seriously injured body organ in all five cases. The seat was the most frequent source of passenger AIS 3+ injuries for the NASS/CDS weighted cases. However, non-contacts, contacts with other occupants, and the seat belt contacts were more frequent sources when considering the raw number of injuries. Overall, contacts with the opposite side of the car interior and with safety belts were the most frequent causes of AIS 3+ injuries in far-side crashes. The presence of an occupant on the near-side changed the injury pattern of the far-side occupant, mitigating injuries from contacts with the opposite side interior of the vehicle.

Tricon hybrid total knee arthroplasty: a review of 81 knees followed for 2 to 4 years.

The authors discuss the results of 81 total knee arthroplasties in 65 patients performed between April 1987 and April 1989 using a Tricon hybrid system, consisting of the Tricon M bio-ingrowth femoral prosthesis and the Tricon C cemented tibial component. The Tricon metal-backed patella was used until February 29, 1988, when the all-plastic Tricon C patella was introduced. With an average follow up of 24 months (range: 12 to 48), 38 arthroplasties using this hybrid system were rated as excellent (47%) and 38 were rated as good (47%). The Hospital for Special Surgery scores, which averaged 53 preoperatively, averaged 80 at the most recent follow-up assessment. At the most recent follow-up assessment, 79% of osteoarthritis patients and 56% of rheumatoid arthritis patients have no pain at rest, while 19% of osteoarthritis patients and 44% of rheumatoid arthritis patients have mild pain at rest. Sixty-four percent of osteoarthritis patients and 33% of rheumatoid arthritis patients have no pain while walking, whereas 26% of osteoarthritis patients and 56% of rheumatoid arthritis patients have mild pain while walking. Postoperative complications included fragmentation of the patella in five patients, all occurring with the metal-backed patella. Five patients also experienced petellar subluxation (two metal-backed and three all-polyethylene). One patient had deep venous thrombosis which was treated successfully by re-hospitalization and heparin therapy; one patient with chronic heart disease expired 4 days postoperatively. Use of the Tricon hybrid system has resulted in 94% of all patients having a good or excellent result an average of 24 months postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Pilot evaluation of hypnotic medication during acute traumatic stress response.

Early intervention aimed at secondary prevention is a high priority for posttraumatic stress disorder (PTSD) research. Disrupted sleep may have a role in the initiation and maintenance of PTSD. Three of the participants were recruited from a surgical trauma service, and one had sought treatment in a psychiatric setting. All were within 1-3 weeks of trauma exposure and had acute PTSD symptoms that included disturbed sleep. Temazepam, a benzodiazepine hypnotic, was administered for 5 nights, tapered for 2 nights, and then discontinued. Evaluations 1-week after the medication had been discontinued revealed improved sleep and reduced PTSD severity. These observations suggest an approach that may be clinically useful and a need for more systematic trials.

Necrotizing fasciitis: a rare complication of appendicitis.

The mortality of acute appendicitis increases sixfold if perforation occurs. We have reported a case of perforated appendix complicated by necrotizing fasciitis of the abdominal wall and retroperitoneum. We believe this complication has not been previously described in the English literature.

Daily noise duration influences cardiovascular responses.

In this study, third in a series on non-auditory health effects of noise, we provide data on the previously developed proposition that exposure to intense noise is linked with altered blood pressure regulation through the establishment of a long-term dose----response relationship between the two variables. We also sought to determine the effect of interposed rest sessions on the course of heart rate (HR) and blood pressure (BP) during 97 days of exposure to tape-recorded industrial noise. The stimulus, delivered to 2 female adult macaque monkeys (M. fascicularis) fitted with indwelling cannulas, consisted of pile-driver impacts and other construction noises presented either in 4-hr (Leq24 = 86.6 db) or 8-hr (Leq24 = 89.6 db) daily sessions. When compared to their pre-exposure responses, mean arterial pressure (MAP) for the Ss rose 8.2% during 4-hr and 16.5% during 8-hr exposure sessions, i.e., close to a doubling effect for a doubling of total energy. When compared with control monkeys (N:10) used in earlier studies, however, MAP rose in the present Ss only 44% for the same doubling of energy. In general, HR and BP displayed quite different tendencies during the per-exposure rest sessions and the post-exposure period: HR tended to return to baseline levels upon noise termination whereas MAP, once elevated, tended to remain significantly elevated. Applicability of the "law" of Initial Values was demonstrated for noise-induced BP increases, in the sense that the percentage of change in BP produced by 8-hr exposure sessions in the 2 present Ss was 16.5%, or somewhat less than that previously observed in exposed monkeys with lower baseline levels (i.e., 30.5%), even though absolute levels of per-exposure MAP were similar (i.e., 99 vs 100 mmHg) for the two sets of exposed monkeys.

Posttraumatic pulmonary insufficiency: a treatable disease.

Posttraumatic pulmonary insufficiency was treated using positive end-expiratory pressure (PEEP), intermittent mandatory ventilation, and cardiovascular monitoring and support. These were begun when intrapulmonary shunt exceeded 15% and before development of hypoxemia despite high inspired oxygen fractions; or retention of CO2; or infiltrative changes on roentgenogram. Of 39 patients treated, 28 required aggressive intervention with levels of PEEP up to 40 cm H2O and support of cardiovascular function with fluids, blood, and ionitropic agents. Those sustaining blunt trauma required the same level of interventions as those with penetrating trauma, but for a significantly longer time. All had reversal of respiratory failure with reduction of shunt to 15%. There were no deaths from respiratory failure or the treatment modalities. Early aggressive treatment for all cases was successful and allowed differentiation of the severity of the original insult.

Selective autonomic blockade of conditioned and unconditioned cardiovascular changes in rhesus monkeys (Macaca mulatta).

Changes in heart rate and in systolic and diastolic blood pressures were examined in eight rhesus monkeys during six sessions of differential classical conditioning. The conditioned stimuli consisted of tones differing in frequency and the unconditioned stimuli consisted of tail shock. Both the conditioned responses (CRS) and unconditioned responses (UCRs) consisted of increases in heart rate and in systolic and diastolic pressures, but blood pressure CRs sometimes occurred in the absence of heart rate CRs. Graded doses of the selective blocking agents propranolol, phentolamine, and atropine methylnitrate were systemically administered to four of the monkeys prior to additional conditioning sessions. The results suggested that the CRs and UCRs were mediated by both sympathetic and parasympathetic influences.

Some cardiovascular effects of noise.

We recently reported that exposure to moderately high noise levels for 9 months produced sustained blood pressure elevations in rhesus monkeys (M. mulatta) without impairing their auditory sensitivity (Peterson et al, Science, 1981, 211, 143Off). In the present study, a continuation and elaboration of the earlier work, 4 chair-restrained monkeys (M. fascicularis) were studied concurrently. After 3 mo of low-noise conditions, 2 experimental Ss were exposed to a realistic noise sequence [Leq24: 85 db(A)], 24 hrs per day for about 6 mo. Compared to control animals who remained under low-noise conditions throughout the experiment, the noise-exposed Ss again exhibited a substantial increase in blood pressure, and also manifested orderly changes in the diurnal rhythm of heart rate, blood pressure, and "pauses" in cardiac rhythm. Our results conflict in detail with certain findings from earlier epidemiological studies, possibly because of differences in the species used, experimental design, or sampling strategies. The desirability of undertaking long-term prospective studies in this area is discussed.