What are the differences in injury patterns of young and elderly traffic accident fatalities considering death on scene and death in hospital?

Abstract

Older traffic participants have higher risks of injury than the population up to 65 years in case of comparable road traffic accidents and further, higher mortality rates at comparable injury severities. Rib fractures as risk factors are currently discussed. However, death on scene is associated with hardly survivable injuries and might not be a matter of neither rib fractures nor age. As 60% of traffic accident fatalities are estimated to die on scene, they are not captured in hospital-based trauma registries and injury patterns remain unknown. Our database comprises 309 road traffic fatalities, autopsied at the Institute of Legal Medicine Munich in 2004 and 2005. Injuries are coded according to Abbreviated Injury Scale, AIS© 2005 update 2008 [1]. Data used for this analysis are age, sex, site of death, site of accident, traffic participation mode, measures of injury severity, and rib fractures. The injury patterns of elderly, aged 65+ years, are compared to the younger ones divided by their site of death. Elderly with death on scene more often show serious thorax injuries and pelvic fractures than the younger. Some hints point towards older fatalities showing less frequently serious abdominal injuries. In hospital, elderly fatalities show lower Injury Severity Scores (ISSs) compared to the younger. The number of rib fractures is significantly higher for the elderly but is not the reason for death. Results show that young and old fatalities have different injury patterns and reveal first hints towards the need to analyze death on scene more in-depth.

Eskişehir’de Yaşlılık Dönemi Ölümlü Trafik Kazalarının 20 Yıllık Analizi

“…It was reported in the literature that traffic accidents occurred mostly on holidays, in summer months and between 18.01-00.00 (14,19,21). In the present study, 39,7% (n=164) of the cases died between 06.00 and 12.00 (P<0,001); and 41,7% (n=172) died in summer, (P<0,001).…”

“…Etehad et al conducted a study and reported that 40.5% of the elderly who were injured in traffic accidents were injured when they were pedestrians (6). In a study which was conducted in Germany, it was reported that 57% of the cases that died in traffic accidents were pedestrians (21). In the present study, it was determined that 65.9% of the cases were pedestrians during the accidents.…”

Fatal Motor Vehicle-Pedestrian Collision Injury Patterns—A Systematic Literature Review

“…All three of these articles did not define injury patterns. Of 309 cases in a study published in 2017, the most common combination of injuries were head and thorax injury (45). Injuries described from this more recent publication were less reflective of the modern vehicle fleet because the database comprised road traffic fatalities who died in 2004 and 2005.…”

“…Heinrich et al studied 309 cases who died in 2004 and 2005 and had postmortem examinations. They wrote that postmortem computed tomography (CT) imaging was not done routinely during the study period; therefore, certain injuries to the facial bones, spine, pelvis, and extremities may have been underrepresented in the study (45).…”

“…Of the 36 articles that indicated a study period, 13 of them were published in the past decade (2010 onward) (41,(45)(46)(47)(48)(50)(51)(52)(53)(54)(55)(56)(57) and ranged from single case reports up to 309 fatally injured pedestrians. Of these apparently more contemporary studies, those with larger sample sizes had limited applicability to trauma observed in the current MVPC.…”