Do entrapment, injuries, outcomes and potential for self-extrication vary with age? A pre-specified analysis of the UK trauma registry (TARN)

Abstract

Background Motor vehicle collisions (MVCs), particularly those associated with entrapment, are a common cause of major trauma. Current extrication methods are focused on spinal movement minimisation and mitigation, but for many patients self-extrication may be an appropriate alternative. Older drivers and passengers are increasingly injured in MVCs and may be at an increased risk of entrapment and its deleterious effects. The aim of this study is to describe the injuries, trapped status, outcomes, and potential for self-extrication for patients following an MVC across a range of age groups. Methods This is a retrospective study using the Trauma Audit and Research Network (TARN) database. Patients were included if they were admitted to an English hospital following an MVC from 2012 to 2019. Patients were excluded when their outcomes were not known or if they were secondary transfers. Simple descriptive analysis was used across the age groups: 16–59, 60–69, 70–79 and 80+ years. Logistic regression was performed to develop a model with known confounders, considering the odds of death by age group, and examining any interaction between age and trapped status with mortality. Results 70,027 patients met the inclusion criteria. Older patients were more likely to be trapped and to die following an MVC (p < 0.0001). Head, abdominal and limb injuries were more common in the young with thoracic and spinal injuries being more common in older patients (all p < 0.0001). No statistical difference was found between the age groups in relation to ability to self-extricate. After adjustment for confounders, the 80 + age group were more likely to die if they were trapped; adjusted OR trapped 30.2 (19.8–46), not trapped 24.2 (20.1–29.2). Conclusions Patients over the age of 80 are more likely to die when trapped following an MVC. Self-extrication should be considered the primary route of egress for patients of all ages unless it is clearly impracticable or unachievable. For those patients who cannot self-extricate, a minimally invasive extrication approach should be employed to minimise entrapment time.

Sex-disaggregated analysis of the injury patterns, outcome data and trapped status of major trauma patients injured in motor vehicle collisions: a prespecified analysis of the UK trauma registry (TARN)

“…The mean age of trapped female patients was significantly higher than trapped male patients; this may influence their own ability to self-extricate due to frailty or relative immobility. 41 An additional possible explanation may include different treatment by rescuers, for example, perhaps being less likely to recommend or facilitate self-extrication for older women. Females are more likely to sit closer to the steering wheel, meaning that less movement intrusion of the dashboard and steering wheel is required to cause entrapment.…”

A Delphi study of rescue and clinical subject matter experts on the extrication of patients following a motor vehicle collision

“…Consensus was not achieved for some of the remaining domain areas with the most contentious being the risk stratification of patients for potential cervical spinal injury, which patients should have a collar applied, and which professional groups should be providing “in vehicle” clinical care for those that remained trapped. The subject of immobilisation, patient handling and the use of cervical collars has received much attention in the literature; with increasing acknowledgement of the incomplete evidence base for historic approaches and the support of pragmatic alternative approaches [ 9 , 17 , 28 – 30 , 39 , 45 – 51 ] . These themes are explored in more detail in the SME briefing document included in the Additional file.…”

A biomechanical study to compare spinal movement in a healthy volunteer during extrication between ‘chain cabling’ and ‘roof off’ methods of extrication

“…Concerns in relation to excessive patient movement have their origins in the controversial belief that such small movements may contribute to secondary spinal injury. We have previously demonstrated that unstable spinal injuries and cord injuries in isolation are very rare in injured trapped patients, whereas other time critical injuries (such as head and chest injuries) are much more common [2][3][4] . Rescue and clinical services have moved towards increased utilisation of rapid extrication methods over recent years [10] .…”

“…Motor vehicle collisions (MVCs) are a common cause of injury and death accounting for 1.3 million deaths per year [1] . Following an MVC casualties that remain trapped in their vehicles are at risk of more severe injuries (median Injury Severity Score (ISS) not trapped 13, trapped 18) and are more likely to die (mortality non trapped 5%, trapped 8.9%) [2][3][4] .…”

“…Movement minimisation during extrication comes at the expense of time, with extrications on average taking in excess of 30 min [7] . Trapped casualties can have significant injuries, some of which may be time dependent [2][3][4] . As such some casualties will benefit from rapid extrication and minimal entrapment time [2] .…”