Extrication as a Predictor of Outcome in Motor Vehicle Crashes

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Public Health

Background:

• Motor vehicle collisions (MVCs) are a leading cause of global mortality and severe injury.
• Vehicle extrication, the process of removing patients from wreckage, is reserved for severe MVCs.
• The association between extrication and patient prognosis requires further investigation.

Purpose of the Study:

• To review literature on vehicle extrication as a prognostic marker.
• To investigate the association between extrication and patient outcomes in a Level 1 trauma registry.

Main Methods:

• Retrospective cohort study of 3,318 trauma patients from 1/1/2016 to 1/1/2021.
• Patients categorized by extrication status (extricated vs. non-extricated).
• Analysis of demographic data and prognostic markers (admission, ICU admission, GCS, ISS, ventilator days) using t-tests and chi-squared tests.

Main Results:

• Extricated patients had significantly higher rates of medical floor (36.32% vs 32.73%) and ICU admission (35.47% vs 17.30%).
• Higher mortality observed in extricated patients (2.14% ED death vs 0.84%).
• Extricated patients presented with lower GCS (<9: 12.44% vs 3.93%), higher ISS (13.21 vs 7.09), longer ventilation (9.75 vs 6.21 days), and longer hospital/ICU stays.

Conclusions:

• Vehicle extrication is a significant indicator of poor prognosis following MVCs.
• Extrication correlates with increased critical care needs, severe injuries, and prolonged hospitalizations.
• Trauma centers should anticipate higher critical care resource utilization for extricated patients.