Patterns of Injury and Causes of Death in Severe Traffic Injury Victims.

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  • 受傷機転からみた重度交通外傷の損傷形態と死因の解析

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We studied the relationships between mechanisms of injuries and characteristics of injuries in severe traffic trauma. First we evaluated the injury severity score (ISS) in all of the traffic injury victims transported by ambulance to our Trauma Center. Of 286 cases, we selected for this study 222 cases with ISS≥16 (mortality rate 33.3%). Many of excluded 64 cases with ISS≥15 were unconscious due to drinking on admission; ambulance attendants might misjudge their iujury severity. The 222 cases were divided into 3 groups according to the mechanism of injury; car passengers (n=46), two-wheeled vehicle passengers (n=108), and pedestrians (n=68). In addition, 87 free-fall injury victims with ISS≥16 were studied as a control. In each group we examined the patterns of injuries with abbreviated injury scale (AIS)≥3 and causes of death. The highest incidence (above 60%) of head injury was similar among the groups. There was a significantly high incidence of abdominal injury in car passengers (39.1%) and pelvic injury in pedestrians (39.7%). The major causes of death were similar among the groups; they were severe head injury or massive hemorrhage. However, the major lethal hemorrhage region was different among the groups; it was the abdomen in car passengers, and the pelvis in pedestrians. A high incidence of severe hepatic injury in car passengers and severe pelvic fracture in pedestrians may be related to massive hemorrhage. Presence of unconsciousness in blunt injury victims may be the major factor leading ambulance attendants to select them for transport to the Trauma Center. Unconsciousness on admission would prevent rapid identification of the bleeding regions, which should be given preference in treatment. The study revealed that the risk region of massive hemorrhage may be peculiar to the mechanism of injury. This study should be of use in the initial treatment of severe traffic injury victims.

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