DESCRIPTION OF 3225 VICTIMS OF ROAD-TRAFFIC-ACCIDENT TRAUMA ACCORDING TO TYPE OF ACCIDENT, SEVERITY OF INJURY, AND

NATURE OF LESIONS SUSTAINED

by

Knud J0rgensen, Thorsten Kruse, Ronald L . Somers, Rainer Weeth

Accident Analysis Group Odense University Hospital

Odense, Denmark

The object ives of the pr esent study were as fol lows:

1 . To establish the frequency of road-traffic -accident t raurna in a def ined area surrounding the munic ipality of Odense, Denrnark in 19787

2. To determine the d istribution of inj ured traff ic-accident victims by type of accident respons ible for their trauma;

3. �o characterize the severity of the inj uries sustained;

4. To summarize the nature of the inj uries sus­tained in terrns of body reg ions affected and region-specifi c lesions .

Al l data were collected by the Accident Analysis Group which maintains a trauma registry operating out of the eme r gency roorn at the Oden8e University Hospita l .

1 3

Description of the trauma regi stry

Since February 1972 information on a l l road-traff ic-accident victims presenting to the emergency room has been collected on a spec ial registry form . Thi s form includes personal information on the injured pa rty, medical informat ion about the injuries sustained, and a descr iption of the circumstances surrounding the accident . From year to year par t s of thi s form have been modified to focus on spec i f i c research i s sues. In 1978 AIS coding was incorporated for the f i r st t ime. The registry catch­ment area includes a popu lation of approximately 230,000 persons l iving in the mixed urban and rural area surrounding the munici­pality of Odense, Denmark. The only o f f icial emergency rnedical fac i l ity within the catchment area is at the Odense Univer s ity Hospital where accident registration takes place.

The trauma regi stry records the type of accident in which vict irns are involved according to the vi ctim's mode of transport (e . g. , bicycle, automobile, walking, etc. ) and the type of obj ect with which the v i ctim impacted. The severity of the injur ies sus­tained by victims is characterized in the registry using both AIS coding and a designation as to the type of medical management required by the victim sub sequent to treatment in the ernergency room (e . g., fol low-up treatment by farnily practit ioner, adrnis s ion to hospital, etc.). Also inc luded is a notation as to whether the victirn died of h i s injur ies within 30 days of the accident .

For purposes of the present study the body was divided into the f o l lowing nine regions: brain, head (excluding brain), neck, spine, ehest, abdomen, pelvis, arrns, and legs. The lesions to each region of the victim's body were characterized as being either to "soft tis sue" or to "bone or j oint" for regions other than the brain. Brain lesions were characterized as either suspected concus s ion, concus s ion or contus ion .

Results

In 1978 3, 225 road-traf f ic trauma vict ims were registered in and around the municipality of Odens e . A distribution of these v i c ­t ims by type of accident i s presented i n Table 1. Six maj or categories of accidents are shown as well as f i fteen subcatego-. ries which include ref erence to the nature of the obj ect impacted by the v i ctim . Moving objects with which the acc ident victims impacted are grouped according to their mass and speed potent ial relative to the victim's mode of transport.

For each type of accident the severity of inj uries sustained i s represented in two ways. First, a d i str ibution of victims i s given by the highest AIS code which was a s signed t o their inj u­r ies; second, vict ims are d i stributed according to the extent of

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the medical management that they required subsequent to their treatment in the emergency room.

Several useful facts can be di scerned in Table 1. F i r s t , it i s clear that two-wheel vehicles account f o r the maj ority (65.6 percent ) of inj ured accident v ictims in Odense. Bicycle acci­dent s in particu lar contr ibute heav i ly to the total. For each type of two-wheeler, bicyc l e , moped and motorcycle/scooter, the maj ority of injured vict ims results from sing le-party col li s i o n s , i.e., colli s i ons with stat ionary obj ects o r f a l l s from the ve­hicle . ( Single-party col l i s i ons are designated as col l i sions with 11other moving or stationary obj ect including road surface" in Table 1.) Single-party col l i s ions also account for a large number of v i ct ims inj ured in automobile accident s , although most such vict ims result from multi-party c o l l i s ions. The vast maj or­ity of pedestrian victims (77.4 percent) results from accidents involving heavy mov ing vehicles.

If attention i s turnea from the total number of victims result ing f rom each type of acc ident to the number of severely injured vict ims, the relative contribution of the accident types changes somewhat . Of the 75 persons regi stered whose most severe inj ury was a s s i gned an AIS code of 4, 5 or 6, s l i ghtly more (29) were victims of automobile accidents than were vict ims of two-wheeler accidents (27) • A higher proportion of automobi le victims (3.5 percent ) was ass igned AIS codes of 4 or higher than was the case for r iders of motorcycles/scooters (3.2 percent), bicycles (1.2 percent), or mopeds (l.O percent). As compared to automo-

bile vict ims , the proport ions for the latter two groups are s ig­n i f icantly smal ler at the . O l level. These f i ndings probably result f r om d i ff ering characteri s t i c s of both the accident cir­cumstances ( impact veloci ties, etc . ) and the people involved ( age of v ictims, etc.).

In terms of the use of hospital inpat ient fac i l i t ies for accident trauma v i ctims, two-whee lers agai.n contribute the greatest part. Among vict ims who did not die as a result of their injur i e s , r i ­ders of two-wheel vehicles accounted f o r f u l ly 56.1 percent of those for whom hospital admiss ion was necessary. The picture changes however when considering the type of acc ident which leads to the maj ority of fatal ities registered. Of the 39 victims who died within 30 days of exper iencing severe accident trauma, 17 (43.6 percent) had been involved in automobi le accidents. Fewe r , 12 (30.8 percent), were v i ct ims of two-wheeler accidents.

Tables 2 through 6 present, for f ive maj or types of traffic acci­dents , the number of vict ims experiencing injury to each of nine body regions. For each region, percentage di stribut ions of vic­t ims are shown by type of the severest lesion sustained and highest AIS score assigned to the region . For the brain, lesions were cla s s if ied as suspected concus sion, concuss ion, and contu­s i o n . For all other body region s , lesions were c las s i f i ed a s s o f t t i s sue, bone o r jo int , other o r unknown . The latter two

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1. 7

categori e s were necessary for cases in which it was not meaning­ful to designate any particular region-specif ic lesion a s 1 1most severe " .

The inf ormat ion in Tables 2 - 6 i s useful in determining the areas of the body which are most in need of biomechanical pro­phylaxi s for spe c i f i c types of transportation situat ions . For a l l types of traff ic acc ident s , inj uries to the brain, head ( excluding bra in) , arm and leg were most common . A signi f i cant

number of ehest injur i e s among victims of automobile accident s was a l so noted . As expected, brain and head inj uries tend to represent the severest injuries sustained in terms of the threat to l i f e . ehest and abdomina l injuries among automobi le­accident victims were also frequently l i f e threatening . The maj or ity of brain lesions were c l a s s i f ied as concussions in al l types of accidents . Most frequently, for a l l types of accidents and a l l body regions ( other than the brain) , the severest l e s ion sustained was a soft-t i s sue lesion .

Discussion

I n setting prior i t i e s for the study and implementat ion of bio­mechanical methods to reduce the physica l inj ury caused by im­pact s , a diverse set of int erdependent criteria must be con­s i dered. The questions of what is irnportant , what i s neces sary, and what i s possible must a l l be considered simultaneous ly . The value of hospital-based data in suggesting the answers to sorne of the relevant questions has been demonstrated rnany tirne s . Important c lues a s t o which problems are most in need o f imme­diate attention and which problems are not are often f orthcorning from such data . Neverthe l e s s , it is irnportant to bear in mind the l imitati ons of hospital-based data in genera l , including the data of the present study.

F i r st , it must be emphasi zed that the results of the 1978 regi­stration of tr aff ic-acc ident trauma in Odense cannot be used d irect ly to determine e ither the r i sk of having a given type of acc ident, or the r i sk of sustaining inj ury having had an acci­dent of a particular type . Prec ise calculation of both types of r i sk would only be pos s ible if a l l accident victims in the Odense area were regi stered regardless of whether inj ury was sustained or not . Experience has shown c learly however that many people involved in accidents do not seek emergency medical care and therefore are not regi stered . The probab i lity that such care i s sought i s inf luenced by such diverse f actors as the age of the person involved in the acc ident, the t ime and place of the acc ident, and the drama surrounding the accident as v i ewed by witnesses .

Despite the rather uncontrol led nature of the de facto sampling which is taking place, loca l experience ha s dernonstrated c learly

22

that nearly a l l of the re latively severe traff ic-accident injuries are recorded . As the f i r st a im of accident prevention must be to reduce the occurrance of tragic trauma, i . e . fatal and permanently d i s abling or d i s f iguring injuries, the information collected by the regi stry would seem to be that of greatest inherent value .

The f indings of the present study demonstrate, among other things, that a good deal more work needs to be done to improve restraint systems and steering co lumn character i s t i c s of automobile s . I t i s also c lear from the data that bicyc l i st s would prof it con­s iderably from use of some sort of head protec t ion . In f act , the who l e area of head protection f or riders of two-whee l vehicles would seem to warrant further study .

2 3