Death in the Context of Traffic Accidents

Karina Arrieta PosadaGeorgina Penagos HollmannManuel David Torres Guzmán

TABLE OF CONTENTS

Introduction Materials and Methods Results Discussion Conclusions Questions

INTRODUCTION

Introduced to complement the protection provided by safety belts.

This protective feature can be detrimental to infants and children:

- 49 deaths in the United States as of November 1, 1997.

- Reported 73 pediatric fatalities resulting from airbag deployment (15 were infants).

Establish if unrestrained children in the front passenger seat were at greater risk of airbag deployment trauma than unrestrained children.

MATERIALS AND METHODS

The records of all children evaluated and treated at:

- Rainhow Babies & Children’s Hospital (Cleveland).

- Children’s Hospital (Columbus).

- Children’s Hospital Medical Center (Cincinnati).

MATERIALS AND METHODS

Demographic: injury, and crash data were obtained from:

- Medical Emergency Services- Hospital Records- Coroners´ Reports.

RESULTS

27 children.

Age: 1 month - 12 years M A: 5.1 SD:3.34

Airbag injuries: 1 of 3 regional pediatric trauma centers

61% Girls

ISS: M 10 SD: 14.5

Speed: < 45 mph

RESULTS

RESULTS

RESULTS

RESULTS

DISCUSSION

Airbags reduce the morbidity in adults.

Passenger side airbag increases airbag-related injuries in children.

The severity of injury depends on the proximity to the point of explosive airbag impact.

The pattern and severity within injury classifications differed with age and size of the children.

DISCUSSION

The abdominal organ injuries were exclusive to the restrained group.

We encountered an overall mortality rate of 7.4%. Of which, one half were restrained properly.

Isolating small children from the path of an airbag can be problematic when they are transported in vehicles without rear-seating capability.

The National Highway Trafic Safety Administration recommends that children 12 years of age or younger be properly restrained in the rear seat of a motor vehicle.

INTRODUCTION

Nonpenetrating chest trauma with injury to the heart and aorta has become increasingly common

high-speed vehicular accidents, Airplane crashes, falls from height, and other severe crushing injuries of the tórax

Cardiac Injuries by Blunt Trauma

INTRODUCTION

Incidence of cardiac injury is 20% after blunt chest trauma in postmortem studies

Pediatric age group, incidence is slightly lower and previous studies suggested that cardiac injury was found in 15–20%

Incidence for all age groups might be as low as 0.5–0.8% in clinical studies

INTRODUCTION

The majority of patients die before they arrive at the emergency department

The great majority of cardiac injuries are still diagnosed by systemic autopsy

Male:female ratio 3.5:1

MATERIALS AND METHODS

Retrospective analysis of 1597 autopsies of fatalities associated with blunt trauma in Itanbul form 2001 to 2003

RESULTS 11.9% (190) had cardiac injuries

45.2% (85) cardiac injuries were cause of death

56% (106) injured by vehicle accidents 38% (72) injured by fall 13% (25) were alive on arrival to the

emergency department▪ Survival time less than 24h: 56% (14)▪ Survival time greater than 24h: 44% (11)

11.9% (190) had cardiac injuries Accompanied by:▪ Pulmonary contusions 44.2% (84)▪ Sternal fractures 62% (32.6%)▪ Serious head injuries 41.6% (79)

RESULTS

Pericardial Tearing 27.3% (52)

Injury of great vessels 28.8% (15)

Atrial and/or ventricular rupture 38.5% (20)

Myocardial Ruptures and ContusionsRight atrium Rupture 15.8% (30)

Left atrium Rupture 11.1% (21)

Right ventricle Rupture 22.6% (43)

Left Ventricle Rupture 23.2% (44)

Right Wall Contusions 12.1% (23)

Left Wall Contusions 8.9% (17)

Other Injuries

Coronary artery injuries 2.6% (5)

Heart valve injuries 3.6% (7), predominantly tricuspid and aortic

Heart completely torn off at the base 5.2% (10)

DISCUSSION

Mechanism: direct impact to the chest wall with transmission of the kinetic force to the patient, causing compression of the heart between the sternum and the spine

‘‘Hydraulic Ram Effect’’

Atria and ventricles appear to be more vulnerable to these compressive forces

DISCUSSION

A number of factors affect the spectrum of cardiac injury: force applied to the chest compliance of the chest wall exact timing of the application of force

during the cardiac cycle Pericardial injuries are the most

common findings of blunt cardiac trauma

DISCUSSION

Higher impact traumas, such as motor vehicle accidents, falls, and explosions might be responsible for injuries such as transmural ruptures

CONCLUSIONS

Airbags are an efficacious safety feature in automobiles, but are the cause of injuries to children regardless of whether the child is properly restrained

Injury prevention strategies should focus on the proper use of child restraints coupled with placing children in the rear seat

Closed Chest trauma must make physicians consider traumatic cardiac lesion

Possibility of concomitant injuries (lung, heart, trachea, bronchus, and esophagus)

CONCLUSIONS

CONCLUSIONS

A close clinical evaluation, ECG monitoring, transthoracic, and transesophageal echo examinations, even cardiac enzyme analysis (CKMB, Tn T, Tn I levels) are mandatory

Traffic events = Spectre of death possibilities; driver responsability is adviced

ANY QUESTIONS?

THANK YOU!!