The Impact of Protective Devices Across the Spectrum of Trauma Care and Across Racial Groups
Chibueze Nwaiwu, Andrew Stephen, Carla Moreira, Daithi Heffernan
Department of Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
Objective: Protective devices such as seat belts and helmets have been shown to save lives. Most studies only address one aspect of the injury profile such as compliance, prehospital care/triage, or overall mortality. Few studies have reviewed how protective devices affect the entire spectrum of trauma care. Furthermore, little attention is paid to racial differences in the use and/or impact of protective devices upon trauma outcomes. We reviewed the impact of protective devices on prehospital incidence of injury, hospital course, and outcomes. We also assessed for racial discrepancies in potentially modifiable prehospital risky behaviors in the trauma setting.
Design: 5-year retrospective review (trauma registry).
Setting: Level 1 trauma center.
Patients: Patients (≥18 years old) with blunt mechanisms where the use of protective devices would be expected were included and categorized into utilizing (P) and not utilizing protection (Non-P). Extracted data included patient age, race (Black, White, Other), injuries sustained, pre-hospital and emergency department (ED) hemodynamic profile, use of protective devices (seatbelts, helmets), injuries sustained, injury severity score, and blood alcohol level. Hospital course included need for emergent operation (within 6 hours), trauma related complications and death.
Main Outcome Measures: Traumatic injury sustained, trauma related complications (emergent operation, ICU admission), hospital length of stay (LOS), inpatient mortality.
Results: 4,048 patients were included. Non-P (43.9%) were more likely male (74.3% vs 61.2%; p<0.001), present at night (63.1% vs 54.5%; p<0.001) and be intoxicated (34.7% vs 24.6%; p<0.001). Intoxicated Non-P (highest risk behavior) accounted for 25.7% of all nighttime (7pm-6:59am) presentations but only 6.7% daytime presentations. Non-P were more likely to be tachycardic (30.7% vs 25.4%; p=0.002) or hypotensive (10.5% vs 7.1%; p=0.001) at the scene and on ED presentation (tachycardia: 29.1% vs 25.6%; p=0.014, hypotension: 13.2% vs 7.7%; p<0.001). Non-P were also more likely to sustain a traumatic brain injury (14.9% vs 7.2%; p<0.001) but less likely to have thoracic trauma (19.7% vs 28.4%; p<0.001). No race related differences were noted among young patients. Among older (≥50 years) patients, White patients were least likely Non-P (40.8% vs 58.3% Black vs 52.3% Other; p=0.007) and least likely presented at night (24.6% vs 45.5% Black vs 45.9% Other; p=0.002). Non-P more likely required emergent operative intervention (17.1% vs 11.9%; p=0.002), ICU admission (38.4% vs 34.8%, p= 0.01), and extended LOS (9.4±0.2 vs 7.5±0.2 days; p<0.001). In regression analysis Non-P was associated with increased risk of death (OR=1.6 (95%CI=1.28 - 2.11).
Conclusion: The lack of use of protective devices increases risk of trauma related complications and mortality. Given unique age and racial differences, we advocate for culturally and/or age specific public service campaigns.
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