Pedestrian Vehicle Accidents

‘Common Injury Patterns’

By Dr. Nic Sparrow MBBS, BSc, MRCGP

Medical Director – Pre-Hospital Care Worldwww.phcworld.org

Overview / Aims

To discuss some the common injuries patterns in Pedestrian Vehicle Accidents (PVA’s)

To explore and review key medical literature surrounding this topic

Conclude with a summary of useful things to remember when attending PVA’s

Background

1 Pedestrian is killed by a motor vehicle every 113 minutes and injured every 8 minutes in the USA

PVA’s account for a significant number of trauma admissions and deaths in urban areas

Patients can have multiple injuries & be difficult to evaluate initially

Pedestrians Injured by Automobiles: Relationship of Age to Injury Type and Severity; Demetrios Demetriades et al: J Am Coll Surg: V0l. 199, No. 3, September 2004

Key Research Paper

Demetriades D et al. Pedestrians Injured by Automobiles: Relationship to Age to Injury Type and Severity.

J AM Coll Surg Vol. 199 No.3 Sept 2004

Trauma Registry-based study in Los Angeles included all trauma admission for PVA’s by automobiles over a 10 year + 4 month period

From 1993 to 2003 = 5838 patient involved in this study

≤ 14 yrs – 19.4% (1136)15-55 yrs – 64.1% (3741)

56 -65 yrs – 7.2% (420)> 65 yrs – 9.3% (541)

Continuation

There were 972 patients (16.6%) with at least one body area with severe injuries, defined as an abbreviated injury score > 3

Head = 620 (10.6%) Most common area

Chest = 156 (2.7%) Abdomen = 125

(2.1%) Extremities = 71 (1.2%)

Factors Affecting Injury Severity

1. Age of the patient2. The speed and type of vehicle3. Objects carried at time of impact4. The main point of contact with the

vehicle

Hit at 65 km/hr - 80% chance of death Hit at 50 km/hr - 80% chance of survival

Parking defensively

protecting the scene

Watch for traffic !

Assess & Approach ‘Read the

wreck’

THINK SAFETYSELF, Scene,

Survivor

The ‘CALL – OUT’

Management of PVA’s

First Responder / EMS Provider Think Spinal Control...

AirwayBreathingCirculationDisabilityExposure

Ask yourself

1) Head injury ?2) Does this patient need intubating ?3) Does this patient have a pelvic injury ?

Head Injuries

Incidence of severe head trauma (AIS > 3) increased significantly with age:-

7.4% of the children ≤14 yrs

23.7% of the adults > 65 yrs

Subdural and subarachnoid

haemorrhages also increased

significantly with age

Spine Control Palpate the Skull

Look in Eyes & ENTGCS < 9 consider

intubation

Spinal Injuries

Rapid Assessment of the Airway / C-Spine is required

The overall incidence of Spinal Injuries was 5.1% (295 patients)

No difference between the occurrences of C-spine / Thoracic/ Lumbar Spine injuries

C-SPINE 3 POINT IMMOBILISATION

Spinal Injuries - Continuation Spinal Injuries

increase dramatically with age

Factors such as osteoarthritis and osteoporosis contribute to injuries

Risk of spinal injury is x21 greater in > 65yrs (8.5% occurrence) compared with children (0.4%)

Upper Extremity Injuries

Male 30 yrs - Hit by car on highway GCS 3/15, # L Humerus / Radius + UlnarCT Head Normal

IV access & BP monitoring impossible on L arm

Chest Injuries

A Pneumo or haemothorax was present in

247 pts (4.2%) and rose steadily through the ages

Incidence was 2.1% in children ≤ 14 yrs

Incidence was 8.5% in patients >65 yrs

Thoracic aortic injury occurred in 16 patients (0.3%) – x7 times more likely in the over 65yrs, none occurred in the ≤ 14 yrs

Fractures of the first x3 ribs, or ≥ 3 rib #’s > 10% mortality

Abdominal Trauma

Liver injuries occurred in 141 pts (2.4%)

Splenic injuries occurred in 102 pts (1.7%)

Renal injuries occurred in 44 pts (0.8%)

Gastro injuries occurred in 237 (4.1%)

There was no statistically significance difference across the age groups

Pelvic Injuries

Requires massive energy transfer

Occurred in 748 patients (12.8%)

X3.5 likely in the >65yrs (22.6%) compared with children under 14 yrs (6.3%)

Patient may complain of severe back pain, abdominal or suprapubic pain

Patient may become rapidly

hypotensive

Widened Symphysis

Pubis

> 3L of blood loss from pelvic #’s

Sheet used to compress the pelvis

Upto 1.5L blood loss from

femoral #’s

Overall Mortality

Closed fractures ~ 3.0% Compound pelvic fractures up to 40%

Lower Extremity Injuries

Tibia fractures were the most common injury accounting for 1512 cases (25.9%)

Children ≤ 14yrs were ~50% less likely to suffer tibial fractures than those older

However, children were x1.8 more likely to sustain femoral fractures

Lower Extremity Injuries

Stop overt bleeding Check for peripheral

pulses In the absence of

pulses, exclude a pelvic fracture, provide analgesia & reduce

Wrap in dressing + splint ~ 1000mls

Fatalities

The overall mortality from PVA’s was 7.7% (449 deaths)

This increased significantly with age

3.2% in the pediatric group

25.1% in the > 65 yr group

Points to remember (1)

Tibial #’s are the most common injury ~ 25%

Head injury increases significantly with age 7.4% in the ≤14 yrs to 23.7% in > 65 yrs

Look out for pelvic fractures. Occurs in ~12% of patients (22.6% incidence in > 65yrs)

Points to remember (2)

Spinal injuries occurred in 5.1% of pts; the elderly were x21 more likely to suffer spinal trauma

Haemo / Pneumothorax occur in ~ 4%

Mortality rate in >65 yrs = ~25%

The older the patient the greater the risk of serious injury

THE END

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