Mechanisms of motor vehicle accidents that predict major injury.

OBJECTIVE To assess whether prehospital triage guidelines, based on mechanistic criteria alone, accurately identify victims of motor vehicle accidents (MVA) with major injury. METHODS Retrospective analysis of the Royal Melbourne Hospital trauma database. Mechanisms analysed were those outlined by the American College of Surgeons Committee on Trauma and Advanced Trauma Life Support/Early Management of Severe Trauma prehospital triage guidelines. RESULTS There were 621 MVA analysed, 253 with major injury (40.7%). Multivariate logistic regression indicated prolonged extrication time (P < 0.0001), cabin intrusion (P = 0.047), high speed (P = 0.003) and ejection from vehicle (P = 0.04) were statistically associated with major injury. Vehicle rollover and fatality in the same vehicle were not statistically associated with major injury. CONCLUSIONS These data suggest that existing guidelines for the prehospital triage of MVA victims, based on mechanistic criteria alone may need revision.

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