@article{ref1,
title="Subway-related trauma: an urban public health issue with a high case-fatality rate",
journal="Journal of emergency medicine",
year="2018",
author="Rodier, Simon G. and Dimaggio, Charles J. and Wall, Stephen and Sim, Vasiliy and Frangos, Spiros G. and Ayoung-Chee, Patricia and Bukur, Marko and Tandon, Manish and Todd, S. Rob and Marshall, Gary T.",
volume="55",
number="2",
pages="165-171.e1",
abstract="BACKGROUND: Between 1990 and 2003, there were 668 subway-related fatalities in New York City. However, subway-related trauma remains an understudied area of injury-related morbidity and mortality. <br><br>OBJECTIVE: The objective of this study was to characterize the injuries and events leading up to the injuries of all patients admitted after subway-related trauma. <br><br>METHODS: We conducted a retrospective case series of subway-related trauma at a Level I trauma center from 2001 to 2016. Descriptive epidemiology of patient demographics, incident details, injuries, and outcomes were analyzed. <br><br>RESULTS: Over 15 years, 254 patients were admitted for subway-related trauma. The mean (standard error of the mean) age was 41 (1.0) years, 80% were male (95% confidence interval [CI] 74-84%) and median Injury Severity Score was 14 (interquartile range [IQR] 5-24). The overall case-fatality rate was 10% (95% CI 7-15%). The most common injuries were long-bone fractures, intracranial hemorrhage, and traumatic amputations. Median length of stay was 6 days (IQR 1-18 days). Thirty-seven percent of patients required surgical intervention. At the time of injury, 55% of patients (95% CI 49-61%) had a positive urine drug or alcohol screen, 16% (95% CI 12-21%) were attempting suicide, and 39% (95% CI 33-45%) had a history of psychiatric illness. <br><br>CONCLUSIONS: Subway-related trauma is associated with a high case-fatality rate. Alcohol or drug intoxication and psychiatric illness can increase the risk of this type of injury.<br><br>Copyright © 2018 Elsevier Inc. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="0736-4679",
doi="10.1016/j.jemermed.2018.04.015",
url="http://dx.doi.org/10.1016/j.jemermed.2018.04.015"
}