Mechanism of injury predicts patient mortality and impairment after blunt trauma.
BACKGROUND
Different mechanisms of injury (MOI), such as motor vehicle crashes, falls, or pedestrians struck by motor vehicle impart varying degrees of force and energy transfer that may impact outcomes. This study analyzed the independent relationship between MOI and mortality and functional outcomes following blunt trauma among adults.


METHODS
Retrospective review of blunt trauma patients 15 y and older in the National Trauma Data Bank from 2001 to 2005. Primary outcome measures were mortality and presence of functional deficit in speech, walking, or feeding at discharge. MOI categories, identified by ICD-9 E codes, were motor vehicle crash, pedestrian struck by motor vehicle, motorcycle crash, falls at same level and from any height, and bicycle crash. A multiple regression analysis was performed adjusting for patient demographics and injury severity variables with motor vehicle crash as the reference mechanism group.


RESULTS
Over the period studied, 515,464 patients met inclusion criteria. Mean Injury Severity Score (16.9), mortality rate (11%), and extremity injury (20%) were highest among pedestrians struck by motor vehicle, and head injury (16%) highest for motorcyclists. Overall, 52% had impaired ambulation, 16% impaired feeding, and 10% impaired speech. Adjusted odds of death, impaired walking, and impaired speaking were highest for pedestrians struck by motor vehicle, and impaired feeding highest for motorcyclists.


CONCLUSIONS
After adjusting for confounders, MOI was found to independently predict mortality and functional impairment at hospital discharge. Current injury assessment models could be greatly enhanced by including MOI, and we propose routine adjustment for injury mechanism in trauma outcomes research.
Haider
Adil H
AH
Department of Surgery, Division of Trauma, Johns Hopkins University, School of Medicine, Baltimore, MD 21287, USA. ahaider1@jhmi.edu
Chang
David C
DC
Haut
Elliott R
ER
Cornwell
Edward E
EE
Efron
David T
DT
D000058:Accidental Falls / Q000706:statistics & numerical data; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000328:Adult; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D009017:Morbidity; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D014481:United States; D014949:Wounds, Nonpenetrating / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality