The influence of vehicle damage on injury severity of drivers in head-on motor vehicle crashes.

Data from crashes investigated through the Crash Injury Research and Engineering Network (CIREN) Program were used to assess differences in injury patterns, severity, and sources for drivers, protected by safety belts and deploying steering wheel air bags, in head-on frontal impacts. We studied whether exterior vehicle damage with a different distribution (wide vs. narrow) across the front vehicle plane influenced injury characteristics.

The influence of damage distribution on serious brain injury in occupants in frontal motor vehicle crashes.

In spite of improvements in motor vehicle safety systems and crashworthiness, motor vehicle crashes remain one of the leading causes of brain injury. The purpose of this study was to determine if the damage distribution across the frontal plane affected brain injury severity of occupants in frontal impacts. Occupants in "head on" frontal impacts with a Principal Direction of Force (PDOF) equal to 11, 12, or 1o'clock who sustained serious brain injury were identified using the Crash Injury Research Engineering Network (CIREN) database.

Air medical response to traumatic brain injury: a computer learning algorithm analysis.

Background: The role of air medicine in traumatic brain injury (TBI) has been studied extensively using trauma registries but remains unclear. Learning algorithms, such as artificial neural networks (ANN), support vector machines (SVM), and decision trees, can identify relationships between data set variables but are not empirically useful for hypothesis testing.

Objective: To use ANN, SVM, and decision trees to explore the role of air medicine in TBI.

The impact of safety belt use on liver injuries in motor vehicle crashes: the importance of motor vehicle safety systems.

Background: Liver injuries (LIs) are one of the most serious and common consequences of motor vehicle crashes (MVCs). In the unstable patient, early detection of LI based on clinical suspicion will improve acute trauma care and outcomes. The specific objectives of this analysis are to identify crash scene and occupant risk factors for LI from MVC.

Motor vehicle-related cardiac and aortic injuries differ from other thoracic injuries.

Background: Traumatic cardiac and thoracic aortic injuries are hypothesized to result from rapid deceleration of occupants during a motor vehicle crash. The purpose of this study was to identify potential risk factors for motor vehicle-related cardiac and thoracic aortic (HTA) injury using the Crash Injury Research Engineering Network (CIREN) database.

Methods: CIREN data were used to test the hypothesis that there is no difference between occupants with HTA injury and occupants with thoracic injury other than the heart or aorta (non-HTA).

Head-injured patients who "talk and die": the San Diego perspective.

Background: Head-injured patients who "talk and die" are potentially salvageable, making their early identification important. This study uses a large, comprehensive database to explore risk factors for head-injured patients who deteriorate after their initial presentation.

Methods: Patients with a head Abbreviated Injury Score (AIS) score of 3+ and a preadmission verbal Glasgow Coma Scale (GCS) score of 3+ were identified from our county trauma registry during a 16-year period.

Calcaneal fractures in occupants involved in severe frontal motor vehicle crashes.

The calcaneous is the largest tarsal bone in the foot and plays an important role in walking and running. Motor vehicle crashes and falls from elevation have been associated with calcaneal fractures. Although not life-threatening, these injuries may result in permanent disability.

Upper extremity fracture patterns following motor vehicle crashes differ for drivers and passengers.

Purpose: Injury patterns of occupants in motor vehicle crashes are changing, with upper extremity injury becoming more common in patients treated at trauma centres. Although not life threatening, upper extremity injuries may result in long-term disability, including chronic deformity, neurovascular compromise and degenerative arthritis. The purpose of this study was to compare upper extremity injury in drivers and passengers using the Crash Injury Research Engineering Network (CIREN) database.

The predictive value of field versus arrival Glasgow Coma Scale score and TRISS calculations in moderate-to-severe traumatic brain injury.

Background: Glasgow Coma Scale (GCS) scores are widely used to quantify level of consciousness in the prehospital environment. The predictive value of field versus arrival GCS is not well defined but has tremendous implications with regard to triage and therapeutic decisions as well as the use of various predictive scoring systems, such as Trauma Score and Injury Severity Score (TRISS). This study explores the predictive value of field GCS (fGCS) and arrival GCS (aGCS) as well as TRISS calculations using field (fTRISS) and arrival (aTRISS) data in patients with moderate-to-severe traumatic brain injury (TBI).

Rollover crashes: predicting serious injury based on occupant, vehicle, and crash characteristics.

The purpose of this research was to determine occupant, vehicle, and crash characteristics predicting serious injury during rollover crashes. We compared 27 case occupants with serious or greater severity injuries with 606 control occupants without injury or with only minor or moderate injury. Odds ratios (OR) for individual variables and logistic regression were used to identify predictive variables for serious injury associated with rollovers.

Traumatic brain injury outcomes in pre- and post- menopausal females versus age-matched males.

Gender differences in outcomes from major trauma have been described previously, and exogenous female hormone administration appears to be neuroprotective following traumatic brain injury (TBI). This analysis explored outcomes in pre- and post-menopausal females versus age-matched males. A total of 13,437 patients (n = 3,178 females, n = 10,259 males) with moderate-to-severe TBI (head AIS > or = 3) were identified from our county trauma registry.

Early ventilation and outcome in patients with moderate to severe traumatic brain injury.

Objectives: An increase in mortality has been reported with early intubation in severe traumatic brain injury, possibly due to suboptimal ventilation. This analysis explores the impact of early ventilation on outcome in moderate to severe traumatic brain injury.

Design: Retrospective, registry-based analysis.

The impact of aeromedical response to patients with moderate to severe traumatic brain injury.

Study Objective: Aeromedical crews offer an advanced level of practice and rapid transport to definitive care; however, their efficacy remains unproven. Previous studies have used relatively small sample sizes or have been unable to adequately control for the effect of other potentially influential variables. Here we explore the impact of aeromedical response in patients with moderate to severe traumatic brain injury.

The impact of prehospital endotracheal intubation on outcome in moderate to severe traumatic brain injury.

Background: Although early intubation to prevent the mortality that accompanies hypoxia is considered the standard of care for severe traumatic brain injury (TBI), the efficacy of this approach remains unproven.

Methods: Patients with moderate to severe TBI (Head/Neck Abbreviated Injury Scale [AIS] score 3+) were identified from our county trauma registry. Logistic regression was used to explore the impact of prehospital intubation on outcome, controlling for age, gender, mechanism, Glasgow Coma Scale score, Head/Neck AIS score, Injury Severity Score, and hypotension.

Comparison of the Injury Severity Score and ICD-9 diagnosis codes as predictors of outcome in injury: analysis of 44,032 patients.

Introduction: Appropriate stratification of injury severity is a critical tool in the assessment of the treatment and the prevention of injury. Since its inception, the Injury Severity Score (ISS) has been the generally recognized "gold standard" for anatomic injury severity assessment. However, there is considerable time and expense involved in the collection of the information required to calculate an accurate ISS.

Peritoneal accumulation of infused stroma-free hemoglobin. Potential toxicity of an oxygen-carrying substitute.

The efficacy of stroma-free hemoglobin (SFH) as an oxygen-carrying red blood cell substitute in shock and trauma remains inconclusive. A major problem is the retention of sufficient intravascular persistence. The sites and mechanisms for clearance of SFH or its chemically modified variants are not well characterized.

Superoxide radicals and hemorrhagic shock: are intravascular radicals associated with mortality?

Superoxide radicals (SORs) are formed during hemorrhagic shock. However, the association between SOR formation and mortality remains undefined. Would neutralization of SORs during shock improve survival? Superoxide dismutase (SOD) was covalently linked to Ficoll to prolong vascular persistence and ensure ongoing neutralization of intravascular SORs.

The effects of heparin and splenectomy on survival and plasma fibronectin levels in rat peritonitis.

Splenectomized patients are predisposed toward developing overwhelming bacterial infections. Administration of heparin is known to improve the survival of animals with intraabdominal sepsis and endotoxemia. The present study evaluates the effect of splenectomy and heparin administration on survival and plasma fibronectin (FN) levels in rats during acute bacterial peritonitis.

Plasma fibronectin response to Escherichia coli and hemoglobin.

Low levels of plasma fibronectin (PFN), an adhesive glycoprotein postulated to augment reticuloendothelial function, can predispose animals to a poor clinical outcome following sepsis. In the present study, the PFN levels of adult male rats were measured prior to injection of intraperitoneal Escherichia coli and/or stroma-free hemoglobin (SFH) and subsequently at 4, 24, and 48 hours. Intraperitoneal E coli alone elicited insignificant PFN level depression at four hours, with significantly elevated levels only in the high-dose group at 24 (P less than .

Plasma fibronectin response to sepsis: mobilization or synthesis?

Plasma fibronectin (PFN) is a high molecular weight adhesive glycoprotein. Following trauma or sepsis PFN is acutely depleted, with rapid restoration of normal or supranormal levels after 24 to 48 hours. Cecal ligation with perforation provides an animal model of surgical trauma combined with polymicrobial sepsis.

Modulators of plasma fibronectin response during sepsis.

Plasma fibronectin (PFN) depletion has been associated with poor outcome in patients with sepsis or those who have experienced trauma; restoration of normal levels appears beneficial. PFN synthesis is increased after cecal ligation even in malnourished animals with sepsis, implying that stimulation of endogenous PFN synthesis is possible. One hundred rats received either a single therapeutic agent (gelatin, heparin, indomethacin, urokinase, captopril, or endotoxin) or the combination of a cecal ligation and a single agent (cimetidine, methylprednisolone, epsilon-aminocaproic acid (EACA), or transaminomethyl cyclohexane carboxylic acid.