Evaluation of the benefits of vehicle safety technology: The MUNDS study

This paper was published in the journal, Accident Analysis and Prevention [© Elsevier Ltd.] and the definitive version is available at: http://dx.doi.org/10.1016/j.aap.2013.02.027Real-world retrospective evaluation of the safety benefits of new integrated safety technologies is hampered by the lack of sufficient data to assess early reliable benefits. This MUNDS study set out to examine if a “prospective” case-control meta-analysis had the potential to provide more rapid and rigorous analyses of vehicle and infrastructure safety improvements. To examine the validity of the approach, an analysis of the effectiveness of ESC using a consistent analytic strategy across 6 European and Australasian databases was undertaken. It was hypothesised that the approach would be valid if the results of the MUNDS analysis were consistent with those published earlier (this would confirm the suitability of the MUNDS approach). The findings confirm the hypothesis and also found stronger and more robust findings across the range of crash-types, road conditions, vehicle sizes and speed zones than previous. The study recommends that while a number of limitations were identified with the findings that need be addressed in future research, the MUNDS approach nevertheless should be adopted widely for the benefit of all vehicle occupants

Splenic trauma : WSES classification and guidelines for adult and pediatric patients

Spleen injuries are among the most frequent trauma-related injuries. At present, they are classified according to the anatomy of the injury. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. Thus, the management of splenic trauma should be ultimately multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. Lastly, as the management of adults and children must be different, children should always be treated in dedicated pediatric trauma centers. In fact, the vast majority of pediatric patients with blunt splenic trauma can be managed non-operatively. This paper presents the World Society of Emergency Surgery (WSES) classification of splenic trauma and the management guidelines.Peer reviewe

Ten-year review of BMW Accident Research Program-investigated cases

Objective: Over the past 10 years, the BMW Accident Research Program (ARP) has investigated how and why occupants are injured in motor vehicle crashes by reconstructing the crash. This research discusses the 2006-2017 ARP case study methodology and comprehensively describes the cases investigated over the past decade. Methods: Accident research program cases are selected according to emerging trends and issues identified by BMW. Driver interviews, inspection approvals, police reports, and medical records are obtained. ARP case investigations involve a multidisciplinary team of engineers, automobile crash experts, and a trauma team. For each case, the team reconstructs the crash and explores in detail the crash characteristics, injury outcomes, as well as case significance and countermeasures that could have prevented the crash or mitigated the severity of the crash or injuries sustained. Results: The ARP investigated 476 BMW-involved crashes between 2006 and 2017 in the United States. The majority of the crash investigations involved a frontal crash (55%). The other crash types included rollover (17%), nearside (13%), farside (9%), and rear crashes (5%). Crash characteristics such as roadway departure (26%), fatality (8%), elderly (>65 years old) occupant crashes (7%), crashes preceded by a medical event (4%), and crashes preceded by the driver falling asleep at the wheel (4%) are particularly informative in regards to advanced driver assistance systems (ADAS) role. The distribution of Maximum Abbreviated Injury Scale (MAIS) scores for the occupants were AIS 1 (23%), AIS 2 (33%), AIS 3 (10%), AIS 4 (4%), and AIS 5 + (7%); 16% of crashes involved uninjured occupants and 7% included no injury information. Conclusions: In-depth case reviews of moderate and severe crashes remain vital to determine emerging trends, patterns of crash injury, and analysis of driver assistance systems and other factors with potential to prevent the crash or limit severity

The Benefits and Tradeoffs for Varied High-Severity Injury Risk Thresholds for Advanced Automatic Crash Notification Systems

<div><p><b>Objectives:</b> The objectives of this study are to (1) characterize the population of crashes meeting the Centers for Disease Control and Prevention (CDC)-recommended 20% risk of Injury Severity Score (ISS) > 15 injury and (2) explore the positive and negative effects of an advanced automatic crash notification (AACN) system whose threshold for high-risk indications is 10% versus 20%.</p><p><b>Methods:</b> Binary logistic regression analysis was performed to predict the occurrence of motor vehicle crash injuries at both the ISS > 15 and Maximum Abbreviated Injury Scale (MAIS) 3+ level. Models were trained using crash characteristics recommended by the CDC Committee on Advanced Automatic Collision Notification and Triage of the Injured Patient. Each model was used to assign the probability of severe injury (defined as MAIS 3+ or ISS > 15 injury) to a subset of NASS-CDS cases based on crash attributes. Subsequently, actual AIS and ISS levels were compared with the predicted probability of injury to determine the extent to which the seriously injured had corresponding probabilities exceeding the 10% and 20% risk thresholds. Models were developed using an 80% sample of NASS-CDS data from 2002 to 2012 and evaluations were performed using the remaining 20% of cases from the same period.</p><p><b>Results:</b> Within the population of seriously injured (i.e., those having one or more AIS 3 or higher injuries), the number of occupants whose injury risk did not exceed the 10% and 20% thresholds were estimated to be 11,700 and 18,600, respectively, each year using the MAIS 3+ injury model. For the ISS > 15 model, 8,100 and 11,000 occupants sustained ISS > 15 injuries yet their injury probability did not reach the 10% and 20% probability for severe injury respectively. Conversely, model predictions suggested that, at the 10% and 20% thresholds, 207,700 and 55,400 drivers respectively would be incorrectly flagged as injured when their injuries had not reached the AIS 3 level. For the ISS > 15 model, 87,300 and 41,900 drivers would be incorrectly flagged as injured when injury severity had not reached the ISS > 15 injury level.</p><p><b>Conclusions:</b> This article provides important information comparing the expected positive and negative effects of an AACN system with thresholds at the 10% and 20% levels using 2 outcome metrics. Overall, results suggest that the 20% risk threshold would not provide a useful notification to improve the quality of care for a large number of seriously injured crash victims. Alternately, a lower threshold may increase the over triage rate. Based on the vehicle damage observed for crashes reaching and exceeding the 10% risk threshold, we anticipate that rescue services would have been deployed based on current Public Safety Answering Point (PSAP) practices.</p></div

Safety of intravenous alteplase within 4.5 hours for patients awakening with stroke symptoms

<div><p>Background</p><p>Up to 25% of acute stroke patients first note symptoms upon awakening. We hypothesized that patients awaking with stroke symptoms may be safely treated with intravenous alteplase (IV tPA) using non-contrast head CT (NCHCT), if they meet all other standard criteria.</p><p>Methods</p><p>The SAfety of Intravenous thromboLytics in stroke ON awakening (SAIL ON) was a prospective, open-label, single treatment arm, pilot safety trial of standard dose IV tPA in patients who presented with stroke symptoms within 0–4.5 hours of awakening. From January 30, 2013, to September 1, 2015, twenty consecutive wakeup stroke patients selected by NCHCT were enrolled. The primary outcome was symptomatic intracerebral hemorrhage (sICH) in the first 36 hours. Secondary outcomes included NIH stroke scale (NIHSS) at 24 hours; and modified Rankin Score (mRS), NIHSS, and Barthel index at 90 days.</p><p>Results</p><p>The average age was 65 years (range 47–83); 40% were women; 50% were African American. The average NIHSS was 6 (range 4–11). The average time from wake-up to IV tPA was 205 minutes (range 114–270). The average time from last known well to IV tPA was 580 minutes (range 353–876). The median mRS at 90 days was 1 (range 0–5). No patients had sICH; two of 20 (10%) had asymptomatic ICH on routine post IV tPA brain imaging.</p><p>Conclusions</p><p>Administration of IV tPA was feasible and may be safe in wakeup stroke patients presenting within 4.5 hours from awakening, screened with NCHCT. An adequately powered randomized clinical trial is needed.</p><p>Clinical trial registration</p><p>ClinicalTrials.gov <a target="_blank">NCT01643902</a>.</p></div

Primary and secondary outcomes.

<p>Primary and secondary outcomes.</p

CONSORT flowchart of the SAIL ON study.

<p>CONSORT flowchart of the SAIL ON study.</p