CAUSES AND COSTS OF INJURIES IN MULTIPLE TRAUMA PATIENTS REQUIRING EXTRICATION FROM MOTOR-VEHICLE CRASHES

Prospective and contemporaneous medical and economic cost studies of 1 44 victims of motor vehicle crashes admitted to a regional level I tra uma center with multiple injuries (ISS greater-than-or-equal-to 16) re vealed 122 non-ejected patients, of whom 102 required extrication (EXT RIC) from the vehicle for physical or medical reasons and 20 who did n ot (N group). There were no differences in age (EXTRIC, 34 +/- 17 year s; N, 41 +/- 24 years), type of crash (Frontal: 57% EXTRIC, 60% N; Lat eral: 32% EXTRIC, 35% N) restraint use (35% EXTRIC, 35% N), or mortali ty (29% EXTRIC, 30% N). However, the estimated maximum speed before th e crash was higher in EXTRIC patients (50 +/- 16 mph vs. 46 +/- 18 mph N, p < 0.04), as was the change in velocity (DELTAV) on impact (EXTRI C 30 +/- 15 mph; N, 24 +/- 8 mph, p < 0.01). Brain injuries (51% EXTRI C vs. 35% N) and lower extremity injuries were more numerous in EXTRIC patients (59% vs. 20% N, p < 0.003) and the number of splenic, lower extremity, and pelvic injuries associated with shock was greater in EX TRIC patients, p < 0.02; as were postinjury complications. As a result , operating room costs from orthopedic and plastic surgery increased p rofessional charges in the EXTRIC group versus the N group ($20,000, E XTRIC; $17,000, N) and critical care costs ($13,000, EXTRIC; $4,000, N ) with total costs of $72,000 and $77,000, respectively. The lower ext remity injuries in EXTRIC patients were primarily a result of body par t contacts with intrusions (CIs) of the car occupant compartment struc tures (73% with vs. 24% without (p < 0.0001)). In lateral MVCs, brain injuries were also more commonly associated with CIs of the side windo w frame or A pillar (72% CI vs. 25% no CI; p < 0.035); but as a whole in MVCs in which extrication was necessary, lower extremity injuries f rom instrument panel or toepan Cls appeared more frequent than those r esulting from contacts only (p < 0.0001). In EXTRIC patients, 69% of t hose in shock had CI injuries, and 80% of the deaths in the EXTRIC gro up were associated with CI injury. These data suggest that measures de signed to prevent CIs by strengthening car passenger compartment struc tures may reduce the incidence of severe brain and lower extremity inj uries and may reduce the need for extrication after MVCs.