Dataset Information

A Proposed Algorithm to Assess Concussion Potential in Rear-End Motor Vehicle Collisions: A Meta-Analysis.

ABSTRACT: Concussions represent an increasing economic burden to society. Motor vehicle collisions (MVCs) are of the leading causes for sustaining a concussion, potentially due to high head accelerations. The change in velocity (i.e., delta-V) of a vehicle in a MVC is an established metric for impact severity. Accordingly, the purpose of this paper is to analyze findings from previous research to determine the relation between delta-V and linear head acceleration, including occupant parameters. Data was collected from previous research papers comprising both linear head acceleration and delta-V at the time of incident, head position of the occupant, awareness of the occupant prior to impact, as well as gender, age, height, and weight. Statistical analysis revealed the following significant power relation between delta-V and head acceleration: head?acceleration = 0.465delta-V 1.3231 (R 2 = 0.5913, p < 0.001). Further analysis revealed that alongside delta-V, the occupant's gender and head position prior to impact were significant predictors of head acceleration (p = 0.022 and p = 0.001, respectively). The strongest model developed in this paper is considered physiologically implausible as the delta-V corresponding to a theoretical concussion threshold of 80 g exceeds the delta-V associated with probability of fatality. Future research should be aimed at providing a more thorough data set of the occupant head kinematics in MVCs to help develop a stronger predictive model for the relation between delta-V and head linear and angular acceleration.

SUBMITTER: Limousis-Gayda M

PROVIDER: S-EPMC7244952 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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A Proposed Algorithm to Assess Concussion Potential in Rear-End Motor Vehicle Collisions: A Meta-Analysis.

Limousis-Gayda Manon M Hashish Rami R

Applied bionics and biomechanics 20200513

Concussions represent an increasing economic burden to society. Motor vehicle collisions (MVCs) are of the leading causes for sustaining a concussion, potentially due to high head accelerations. The change in velocity (i.e., delta-<i>V</i>) of a vehicle in a MVC is an established metric for impact severity. Accordingly, the purpose of this paper is to analyze findings from previous research to determine the relation between delta-<i>V</i> and linear head acceleration, including occupant paramete ...[more]

PMID: 32508983

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Project description:Objective:Motor vehicle collisions generate considerable transmitted forces resulting in traumatic brain injury in children presenting to emergency departments (EDs). To date, no large study has examined post-concussive symptoms in children sustaining concussions in motor vehicle collisions. This study aimed to compare trends in acute post-concussive symptom burden in children with concussion following motor vehicle collisions as compared to other injury mechanisms. Methods:The study is a secondary analysis of the Predicting Persistent Post-concussive Problems in Pediatrics study, which prospectively recruited a multicenter cohort of 3029 children 5-17 years of age presenting to the ED with concussion from 2013-2015. Post-concussive symptom ratings were obtained at pre-specified time points for 12 weeks post-injury, using the validated Post-Concussion Symptom Inventory (PCSI). Symptom severity and recovery trajectories were measured using delta scores on the PCSI (mean post-injury symptom score minus perceived pre-injury score). A multivariable, longitudinal model evaluated the adjusted effect of mechanism of injury (motor vehicle collisions vs other mechanisms) on mean symptom scores, compared to perceived pre-injury reports, and the temporal change in mean scores over during recovery. Results:Of 3029 study participants, 56 (1.8%) sustained concussion from motor vehicle collisions. Children sustaining concussion in a motor vehicle collision had lower post-concussive symptom scores upon ED presentation, measured as differences from their perceived pre-injury reports, as compared to other injury mechanisms (-0.36 [95% confidence interval (CI) = -0.58, -0.15]). However, the motor vehicle collisions group showed the smallest decline in symptom burden over 1 month following injury (-0.54 [95% CI = -0.81, -0.27]). Conclusions:Children sustaining concussions in motor vehicle collisions may have lower initial symptom burdens but slower symptom recovery at 1 month compared to other mechanisms of injury and may represent a distinct population for prognostic counseling in the ED requiring further research.

Project description:ObjectivePrehospital non-transport events occur when emergency medicine service (EMS) providers respond to a scene, but the patient is ultimately not transported to a hospital for evaluation. The objective of this study was to determine the rate of non-transport of pediatric patients who were involved in a motor vehicle collision (MVC) and the factors associated with non-transport decisions.MethodsWe searched the National Emergency Medical Services Information System (NEMSIS) database using ICD-10 mechanism of injury codes to identify cases in which EMS responded to a pediatric occupant (age < 18 years) who had been involved in an MVC. We excluded interfacility transports, scene assists, deaths at the scene, and collisions that occurred outside the US. The outcome of interest was if pediatric patients were not transported to a hospital for evaluation. We performed univariate and multivariate analysis to identify which risk factors were associated with non-transport. We also analyzed regional variation and the reasons recorded for not transporting patients.ResultsWe identified 92,254 pediatric patients who were evaluated by EMS after an MVC, of which 31,404 (34.0%) were not transported to a hospital for evaluation. In our adjusted analysis, the factors associated with non-transport were age <1 year or >16 years, male sex, normal Glasgow Coma Scale (GCS = 15), level of training of EMS providers, response time later than 6 a.m., and region of the country. GCS was the most important factor, with only 3.0% (108/3,616) of patients not transported who had abnormal GCS (< 15). In cases of non-transport, 32.7% (10257) were due to patient or caregiver refusal, and 33.3% (10,442) were due to patients being discharged against medical advice. Only 11.5% (3,627) pediatric patients who were not transported were discharged based on an established protocol.ConclusionsPediatric patients were not transported after EMS responded to an MVC in approximately one-third of cases, and there was considerable variation in the rate of non-transports based on geographic region, provider level, and time of day. The majority of non-transports occurred because patients were discharged against medical advice or the patient/caregiver refused transport, which may indicate conflicting priorities between EMS providers and patients.

Dataset Information

A Proposed Algorithm to Assess Concussion Potential in Rear-End Motor Vehicle Collisions: A Meta-Analysis.

Publications

A Proposed Algorithm to Assess Concussion Potential in Rear-End Motor Vehicle Collisions: A Meta-Analysis.

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