Prospective countywide evaluation of the effects of motor vehicle safety device use on hospital resource use and injury severity.

STUDY OBJECTIVE We evaluated the efficacy of safety devices (seat belts and air bags) on hospital resource use and injury severity while controlling for variables known to affect outcome of motor vehicle crashes. METHODS We conducted a prospective observational study of motor vehicle crash victims who were transported to the hospital in a suburban-rural county with a population of 1.4 million. Out-of-hospital providers recorded patient demographic characteristics, mechanism of injury (based on American College of Surgeons criteria), and use of seat belts or air bags. Hospital charts were reviewed for hospital admission, length of hospital stay, ICU stay, surgery, major nonorthopedic surgery or death, and severe injury (Injury Severity Score > 15). RESULTS The study group comprised 1,446 motor vehicle crash victims. Median age was 30 years, 47% were male, and 69% used safety devices. The use of safety devices reduced the likelihood of hospital admission (adjusted odds ratio [OR], .67; 95% confidence interval [CI], .46 to .98) surgery (adjusted OR, .52; 95% CI, .27 to 1.01), major surgery or death (adjusted OR, .14; 95% CI, .04 to .52), and severe injuries (adjusted OR of injury Severity Score > 15, .39; 95% CI, .19 to .83). CONCLUSION The use of safety devices is associated with decreased hospital resource use and less severe injuries for victims of motor vehicle crashes who are transported to the hospital by emergency medical services providers, even after adjustment for many other variables known to affect the outcome of motor vehicle crashes. Continued efforts to promote safety device use are warranted.

[1]  R. Knopp,et al.  Mechanism of injury and anatomic injury as criteria for prehospital trauma triage. , 1988, Annals of emergency medicine.

[2]  W G Baxt,et al.  The trauma triage rule: a new, resource-based approach to the prehospital identification of major trauma victims. , 1990, Annals of emergency medicine.

[3]  Barry A. McLellan,et al.  The relative influence of alcohol and seatbelt usage on severity of injury from motor vehicle crashes , 1990 .

[4]  H. Champion,et al.  Trauma triage: vehicle damage as an estimate of injury severity. , 1989, The Journal of trauma.

[5]  W. Long,et al.  Accuracy and relationship of mechanisms of injury, trauma score, and injury severity score in identifying major trauma. , 1986, American journal of surgery.

[6]  J. G. West,et al.  A method for evaluating field triage criteria. , 1986, The Journal of trauma.

[7]  R. Martinez Injury prevention. A new perspective. , 1994, JAMA.

[8]  K. Neely,et al.  Evaluation of injury mechanism as a criterion in trauma triage. , 1986, American journal of surgery.

[9]  Stephen Z. Turney,et al.  An ICD-9CM to AIS conversion table: Development and application , 1986 .

[10]  W. Baxt,et al.  The lack of full correlation between the Injury Severity Score and the resource needs of injured patients. , 1990, Annals of emergency medicine.

[11]  J. Stutts,et al.  The potentiating effects of alcohol on driver injury. , 1986, JAMA.

[12]  P. Knudson,et al.  Improving the field triage of major trauma victims. , 1988, The Journal of trauma.

[13]  K. Maull,et al.  Injury and cost comparison of restrained and unrestrained motor vehicle crash victims , 1988 .

[14]  J R Stewart,et al.  Observed and self-reported seat belt wearing as related to prior traffic accidents and convictions. , 1993, Accident; analysis and prevention.

[15]  K. Ikemura Development and application , 1971 .

[16]  P. Byers,et al.  A Prospective Evaluation of Field Categorization of Trauma Patients , 1987 .

[17]  D. Diamond,et al.  The utility of physiological status, injury site, and injury mechanism in identifying patients with major trauma. , 1988, The Journal of trauma.

[18]  M Fields,et al.  Coverage gaps in child-restraint and seat-belt laws affecting children. , 1994, Accident; analysis and prevention.

[19]  A K Lund,et al.  Characteristics of belted and unbelted drivers. , 1991, Accident; analysis and prevention.

[20]  Motor vehicle crashes and seat belts: a study of emergency physician procedures, charges, and documentation. , 1994, Annals of emergency medicine.

[21]  D. Feliciano,et al.  Deaths from motor vehicle crashes: patterns of injury in restrained and unrestrained victims. , 1994, The Journal of trauma.

[22]  P L Remington,et al.  The influence of safety belt laws on self-reported safety belt use in the United States. , 1992, Accident; analysis and prevention.

[23]  J. McGinnis,et al.  Healthy People 2000 at mid decade. , 1995, JAMA.

[24]  L S Robertson,et al.  The validity of self-reported behavioral risk factors: seatbelt and alcohol use. , 1992, The Journal of trauma.

[25]  E. Orsay,et al.  Prospective study of the effect of safety belts on morbidity and health care costs in motor-vehicle accidents. , 1988, JAMA.

[26]  L. Evans Safety-belt effectiveness: the influence of crash severity and selective recruitment. , 1996, Accident; analysis and prevention.

[27]  T. Buchman,et al.  Optimizing prehospital triage criteria for trauma team alerts. , 1993, The Journal of trauma.

[28]  R. Rutledge,et al.  The cost of not wearing seat belts. A comparison of outcome in 3396 patients. , 1993, Annals of surgery.

[29]  R A Cowley,et al.  Seatbelt effectiveness and cost of noncompliance among drivers admitted to a trauma center. , 1991, The American journal of emergency medicine.

[30]  W E Cooper,et al.  Safety restraint usage in fatal motor vehicle crashes. , 1993, Accident; analysis and prevention.

[31]  J H Siegel,et al.  Safety belt restraints and compartment intrusions in frontal and lateral motor vehicle crashes: mechanisms of injuries, complications, and acute care costs. , 1993, The Journal of trauma.