@article{ref1,
title="Hit by a train: injury burden and clinical outcomes",
journal="Journal of emergency medicine",
year="2019",
author="Byerly, Saskya and Inaba, Kenji and Biswas, Subarna and Cheng, Vince and Cho, Jayun and Wang, Eugene and Strumwasser, Aaron and Matsushima, Kazuhide and Demetriades, Demetrios",
volume="57",
number="1",
pages="6-12",
abstract="BACKGROUND: Few data exist regarding the train vs. pedestrian (TVP) injury burden and outcomes. <br><br>OBJECTIVE: This study aimed to examine the epidemiology and outcomes associated with TVP injuries. <br><br>METHODS: This is a retrospective National Trauma Databank study (January 2007 to July 2012) including trauma patients sustaining TVP injury. Demographics, injury data, interventions, and outcomes were abstracted. Patients injured by a train were compared to patients who sustained an automobile vs. pedestrian (AVP) injury. <br><br>RESULTS: Of the 152,631 patients struck by ground transportation during the study time frame, 1863 (1.2%) were TVP. Median TVP age was 38 years (interquartile range [IQR] 24-50 years), 81.6% were male, median Injury Severity Score (ISS) was 13 (IQR 6-24). TVP patients were more severely injured (ISS 13 vs. 9; p < 0.001) and required more proximal amputations (13.4% vs. 0.2%; p < 0.001) and cavitary operations (18.2% vs. 2.8%; p < 0.001). TVP patients had higher rates of intensive care unit admission, mechanical ventilation and transfusion, longer length of stay, and higher in-hospital mortality. On multivariable logistical regression, TVP was an independent predictor for higher injury burden, ISS ≥25 (adjusted odds ratio [AOR] 1.650), immediate operative need (AOR 7.535), and complications (AOR 1.317). <br><br>CONCLUSIONS: TVP is associated with a significant injury burden. These patients have a significantly higher need for immediate operation and more complicated hospital course.<br><br>Copyright © 2019 Elsevier Inc. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="0736-4679",
doi="10.1016/j.jemermed.2019.03.053",
url="http://dx.doi.org/10.1016/j.jemermed.2019.03.053"
}