TY - JOUR PY - 2019// TI - Hit by a train: injury burden and clinical outcomes JO - Journal of emergency medicine A1 - Byerly, Saskya A1 - Inaba, Kenji A1 - Biswas, Subarna A1 - Cheng, Vince A1 - Cho, Jayun A1 - Wang, Eugene A1 - Strumwasser, Aaron A1 - Matsushima, Kazuhide A1 - Demetriades, Demetrios SP - 6 EP - 12 VL - 57 IS - 1 N2 - BACKGROUND: Few data exist regarding the train vs. pedestrian (TVP) injury burden and outcomes.

OBJECTIVE: This study aimed to examine the epidemiology and outcomes associated with TVP injuries.

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.

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).

CONCLUSIONS: TVP is associated with a significant injury burden. These patients have a significantly higher need for immediate operation and more complicated hospital course.

Copyright © 2019 Elsevier Inc. All rights reserved.

Language: en

LA - en SN - 0736-4679 UR - http://dx.doi.org/10.1016/j.jemermed.2019.03.053 ID - ref1 ER -