Motor vehicle collisions (MVCs), particularly those associated with entrapment, are a common cause of major trauma. Current extrication methods are focused on spinal movement minimisation and mitigation, but for many patients self-extrication may be an appropriate alternative. Older drivers and passengers are increasingly injured in MVCs and may be at an increased risk of entrapment and its deleterious effects. The aim of this study is to describe the injuries, trapped status, outcomes, and potential for self-extrication for patients following an MVC across a range of age groups.
What We Did
We analysed the injures and outcomes of 70,027 patients injured in motor vehicle collisions. We compared the age groups: 16-59, 60-69, 70-79 and 80+ years. We used statistical techniques to examine any interaction between age, trapped status and death. We used expert consensus to define which injuries and physiology would prevent self-extrication and report the frequency of these factors by age category.
What We Found
Older patients were more likely to be trapped and to die following a motor vehicle collision. Head, abdominal and limb injuries were more common in the young, with chest and spinal injuries being more common in older patients. No significant differences were found between the age groups in relation to ability to self- extricate. After adjustment for confounders, the 80 + age group were more likely to die if they were trapped; adjusted OR trapped 30.2, not trapped 24.2.
What This Means
Patients over the age of 80 are more likely to die when trapped following a motor vehicle collision. Older patients are more likely to have chest and spinal injuries than younger patients – however, the overall rate of spinal injuries remains low across all age groups. Older patients are no more likely to have injuries that would hinder self-extrication than younger patients.
Self-extrication should be considered the primary route of egress for patients of all ages apart from where it is clearly impracticable or unachievable. For those patients who cannot self-extricate a minimally invasive extrication approach should be employed to minimise entrapment time.
- Older people are more likely to die
- Differences in injuries are not likely to affect extrication strategy
- Self-extrication should be considered and is likely to be viable in a vast majority of cases
Authors
Tim Nutbeam, Anthony Kehoe, Rob Fenwick, Jason Smith, Omar Bouamra, Lee Wallis and Willem Stassen