title: The pregnant motor vehicle accident casualty: adherence to basic workup and admission guidelines.
abstract: OBJECTIVE
  To investigate the workup/treatment provided to pregnant motor vehicle accident (MVA) casualties in a mature trauma system. Adherence to recommendations was used to measure quality of care.
  
  
  BACKGROUND
  MVAs affect approximately 3% of pregnant women. Trauma casualty outcome improves after implementation of guidelines.
  
  
  METHODS
  A 5-year audit of clinical practice in 2 university hospitals with a trauma call system where the general surgeon is the primary care physician. Trauma guidelines (general/specific to treatment of pregnant MVA casualties) were used to examine adherence. Pregnant casualties aged >18 years, injured in a private vehicle were identified via computerized hospital databases. Data relevant to the study were extracted from ED/admission files.
  
  
  RESULTS
  Among the 236 casualties included there were no maternal deaths. Six casualties (2.5%) had significant injuries and 3 (1.2%) required surgery (all within 24-hours of admission). Contrary to established procedure, maternal vital signs were often not documented. In contrast, fetal viability was usually documented; most casualties underwent ultrasound fetal evaluation (233 of 236, 98.7%) and those with viable pregnancies underwent fetal heart rate monitoring (162 of 169, 96%). A sixth of the MVA casualties (16%) were examined only by an obstetrician. All casualties were admitted but only 15 (6.4%) were admitted in accordance with guidelines. Readmission rates (1.3%) were similar to those observed in nonpregnant casualties.
  
  
  CONCLUSIONS
  Pregnant MVA casualties are underexamined and overadmitted. Concerns regarding potential obstetrical complications distract medical attention away from basic trauma guidelines. Education programs should emphasize prioritizing the mother and adhering to the basic rules of trauma care despite the presence of the fetus.
authors.affiliation: Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Jerusalem, Israel. hys2104@columbia.edu
authors.forename: Hen Y
authors.initials: HY
authors.lastname: Sela
authors.forename: Carolyn F
authors.initials: CF
authors.lastname: Weiniger
authors.forename: Moshe
authors.initials: M
authors.lastname: Hersch
authors.forename: Arnon
authors.initials: A
authors.lastname: Smueloff
authors.forename: Neri
authors.initials: N
authors.lastname: Laufer
authors.forename: Sharon
authors.initials: S
authors.lastname: Einav
mesh_terms: D000063:Accidents, Traffic; D015148:Cardiotocography / Q000706:statistics & numerical data*; D004282:Documentation / Q000592:standards; D005260:Female; D005328:Fetal Viability / Q000502:physiology*; D019983:Guideline Adherence / Q000592:standards*; D006753:Hospital Records / Q000592:standards; D006785:Hospitals, University; D006801:Humans; D033183:Interdisciplinary Communication; D007557:Israel; D008485:Medical Audit; D010343:Patient Admission / Q000592:standards*; D010348:Patient Care Team; D011787:Quality of Health Care / Q000592:standards*; D014193:Trauma Centers; D016216:Ultrasonography, Prenatal / Q000706:statistics & numerical data*; D055986:Vital Signs; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000601:surgery*