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!!