Injury pattern, outcome and characteristics of severely injured pedestrian
Reith et al 2015 Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Pedestrians in motor vehicle collisions make up a unique patient population in the Emergency Department. The trauma mechanism has multiple points of impact including the bumper, hood, windshield and ground. This makes for a typical injury pattern including the head, hip/pelvis and knee which should be looked for specifically on physical exam.
In this article, authors set out to characterize this specific group of trauma patients so that physicians have a better understanding of not only their injuries and severity, but also the demographics of the population. They utilized a large multi-center database with standardized documentation and looked at 4435 patients between 2002 and 2012. They used inclusion criteria of age 2 or older and injury severity score 9 or greater, and they compared the pedestrians to motor vehicle occupants. To look at prognosis of patients, authors calculated the RISC score and compared them across groups.
Multiple interesting points found in this study: The rate of injured pedestrians that were women was 42% vs 34% in motor vehicle occupants. Pedestrians were on average 49.1 years old which is 10 years older than motor vehicle occupants even with a larger proportion of patients under 16 years old. Mortality was twice as high in the pedestrian group (21.7% vs 12.3%) and mortality within 24 h was significantly higher for pedestrians as well (13.2% vs 7.0%). Pedestrians had a worse prognosis calculated by RISC score (23.8% vs 14.5%). On scene treatment time was 12 minutes shorter in the pedestrian group (26 vs 38 min) and entire emergency transport was 16 min shorter (61 vs 78 min). Initial GCS < 9 was more frequent in pedestrians (35.5% vs 27.7%).
This article reinforces the fact that pedestrians are a generally sicker patient population and shows specifically how. The population tends to have a higher proportion of the old and young which puts them at increased risk for worse injuries; and this is evident as patients typically have a higher mortality rate and worse prognosis. Overall this is a good article illustrating injuries in pedestrians and how Emergency Medicine physicians can better serve them by knowing their background and degree of injuries.