title: Characterization of the occult nature of injury for frequently occurring motor vehicle crash injuries.
abstract: BACKGROUND
  Occult injuries are not easily detected and can be potentially life-threatening. The purpose of this study was to quantify the perceived occultness of the most frequent motor vehicle crash injuries according to emergency medical services (EMS) professionals.
  
  
  METHODS
  An electronic survey was distributed to 1,125 EMS professionals who were asked to quantify the likelihood that first responders would miss symptoms related to a particular injury on a 5-point Likert scale. The Occult Score for each injury was computed from the average of all the survey responses and normalized to be a continuous metric ranging from 0 to 1 where 0 is a non-occult (highly apparent on initial presentation) injury and 1 is an occult (unapparent on initial presentation) injury.
  
  
  RESULTS
  Overall, 110,671 survey responses were collected. The Occult Score ranged from 0 to 1 with a mean, median, and standard deviation of 0.443, 0.450, and 0.233, respectively. When comparing the Occult Score of an injury to its corresponding AIS severity, there was no relationship between the metrics. When stratifying by body region, injury type, and AIS severity, it was evident that AIS 2-4 abdominal injuries with lacerations, hemorrhage, or contusions were perceived as the most occult injuries.
  
  
  CONCLUSIONS
  Timely triage is key to reduce the morbidity and mortality associated with occult injuries. The Occult Score developed in this study to describe the predictability of an injury in a motor vehicle crash will be used as part of a larger effort, including incorporation into an advanced automatic crash notification (AACN) algorithm to detect crash conditions associated with a patient's need for prompt treatment at a trauma center.
authors.affiliation: Virginia Tech-Wake Forest University Center for Injury Biomechanics, Winston-Salem, NC, USA; Wake Forest University School of Medicine, Winston-Salem, NC, USA. Electronic address: sschoell@wakehealth.edu.
authors.forename: Samantha L
authors.initials: SL
authors.lastname: Schoell
authors.affiliation: Wake Forest University School of Medicine, Winston-Salem, NC, USA.
authors.forename: Andrea N
authors.initials: AN
authors.lastname: Doud
authors.affiliation: Virginia Tech-Wake Forest University Center for Injury Biomechanics, Winston-Salem, NC, USA; Wake Forest University School of Medicine, Winston-Salem, NC, USA.
authors.forename: Ashley A
authors.initials: AA
authors.lastname: Weaver
authors.affiliation: Wake Forest University, Division of Public Health Sciences, Medical Center Boulevard, Winston-Salem, NC, USA.
authors.forename: Jennifer W
authors.initials: JW
authors.lastname: Talton
authors.affiliation: Wake Forest University, Division of Public Health Sciences, Medical Center Boulevard, Winston-Salem, NC, USA.
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Barnard
authors.affiliation: Wake Forest University School of Medicine, Winston-Salem, NC, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Winslow
authors.affiliation: Virginia Tech-Wake Forest University Center for Injury Biomechanics, Winston-Salem, NC, USA; Wake Forest University School of Medicine, Winston-Salem, NC, USA.
authors.forename: Joel D
authors.initials: JD
authors.lastname: Stitzel
mesh_terms: D015998:Abbreviated Injury Scale; D000063:Accidents, Traffic / Q000145:classification / Q000706:statistics & numerical data*; D000465:Algorithms; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D006801:Humans; D018986:Motor Vehicles / Q000706:statistics & numerical data; D009104:Multiple Trauma / Q000453:epidemiology; D011336:Probability; D018570:Risk Assessment; D014481:United States; D014947:Wounds and Injuries / Q000145:classification / Q000453:epidemiology*
keywords: Advanced automatic crash notification (AACN); Motor vehicle crash; Occult; Triage