Citation

Byerly S, Inaba K, Biswas S, Cheng V, Cho J, Wang E, Strumwasser A, Matsushima K, Demetriades D. J. Emerg. Med. 2019; 57(1): 6-12.

Affiliation

Division of Trauma and Critical Care, University of Southern California, Los Angeles, California.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.jemermed.2019.03.053

PMID

31078347

Abstract

BACKGROUND: Few data exist regarding the train vs. pedestrian (TVP) injury burden and outcomes.

OBJECTIVE: This study aimed to examine the epidemiology and outcomes associated with TVP injuries.

METHODS: This is a retrospective National Trauma Databank study (January 2007 to July 2012) including trauma patients sustaining TVP injury. Demographics, injury data, interventions, and outcomes were abstracted. Patients injured by a train were compared to patients who sustained an automobile vs. pedestrian (AVP) injury.

RESULTS: Of the 152,631 patients struck by ground transportation during the study time frame, 1863 (1.2%) were TVP. Median TVP age was 38 years (interquartile range [IQR] 24-50 years), 81.6% were male, median Injury Severity Score (ISS) was 13 (IQR 6-24). TVP patients were more severely injured (ISS 13 vs. 9; p < 0.001) and required more proximal amputations (13.4% vs. 0.2%; p < 0.001) and cavitary operations (18.2% vs. 2.8%; p < 0.001). TVP patients had higher rates of intensive care unit admission, mechanical ventilation and transfusion, longer length of stay, and higher in-hospital mortality. On multivariable logistical regression, TVP was an independent predictor for higher injury burden, ISS ≥25 (adjusted odds ratio [AOR] 1.650), immediate operative need (AOR 7.535), and complications (AOR 1.317).

CONCLUSIONS: TVP is associated with a significant injury burden. These patients have a significantly higher need for immediate operation and more complicated hospital course.

Copyright © 2019 Elsevier Inc. All rights reserved.

Language: en

Keywords

epidemiology; outcomes; train; trauma