What we did:
We considered the outcomes of 426,135 patients injured
in England between 2012 and 2018. We focused on 63,625 patients injured in motor vehicle collisions and analysed the injuries and outcomes of the patients who were trapped and those that weren’t.
What we found:
We identified 6983 trapped and 56,642 not trapped patients. Trapped patients had more injuries and a higher mortality
(8.9% vs 5.0%, p < 0.001). Trapped patients had more deranged physiology with lower blood pressures, lower oxygen saturations and lower conscious level (all p < 0.001). Trapped patients
had more significant injuries of the head chest, abdomen and spine (all p < 0.001) and an increased rate of pelvic injures with significant blood loss, blood loss from other areas or tension pneumothorax (all p < 0.001).
Importantly, spinal cord injuries were rare (0.71% of all extrications) and frequently (in patients with a spinal cord injury) there was another severe and potentially time dependent injury/ injuries.
What this means:
Trapped patients are more likely to die than those who are not trapped. The frequency of spinal cord injuries is low, accounting for < 0.7% of all patients extricated. Patients who are trapped are more likely to have time-critical injuries requiring intervention. Extrication takes time and when considering the frequency, type and severity of injuries reported here, the benefit of movement minimisation (the current extrication technique) may be outweighed by the additional time taken. Improved extrication strategies should be developed which are evidence-based and allow for the rapid management of other life-threatening injuries.
In summary:
Trapped people are more injured and more likely to die. Prolonged extrication techniques based on movement minimisation are perhaps not justified given the low rate ofspinal cord injury and the high rate of other injuries.