Motor Vehicle Collisions (MVCs)


Article Author:
Tammy Toney-Butler


Article Editor:
Matthew Varacallo


Editors In Chief:
Wanda Wright
Cynthia Oster


Managing Editors:
Avais Raja
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Khalid Alsayouri
Trevor Nezwek
Radia Jamil
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Steve Bhimji
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beata Beatty
Nazia Sadiq
Hajira Basit
Phillip Hynes
Tehmina Warsi


Updated:
7/30/2019 3:26:42 PM

Introduction

According to the Centers for Disease Control and Prevention (CDC), motor vehicle collisions (MVC) in 2013 accounted for over 2 million injuries and more than 32,000 deaths annually in the United States (US) [1]. The National Spinal Cord Injury Statistical Center cited the most common cause of spinal cord injuries (SCI) in the US between the years of 2010 and 2013 was MVCs, accounting for 38% of these injuries.  [2][3]

Mechanism of Injury

Mechanism of injury (MOI) specifically refers to the method by which trauma and its associated forces directly or indirectly impacts the human body.  MOI implies a specific transfer of energy from one source (i.e. the environment) to another (i.e. the human body).

These injury patterns assist in the determination of the extent of an injury and fundamental decision-making process regarding trauma triage guidelines.

Energy transfer from the environment can result from a variety of causes. The intensity of the energy transfer will cause damage to the surrounding tissues, organs, muscles, and other body structures when it exceeds the body’s ability to resist such rapid, forceful energy changes.

According to the Law of Conservation of Energy, “Energy can neither be destroyed or created, but it can change form.” This law goes to the essence of trauma. The kinetic or moving energy must be transferred onto the object impacted. So, if a vehicle is traveling at a high rate of speed when it impacts an object, the energy force can be quadrupled. Spinal injuries may be a result of axial loads.[4][5][6]

Function

Terminology

  • Kinematics: the actual or potential injuries realized by the human body
  • Biomechanics: refers to the actual force or impact imparted on the soft tissues and the body
  • Mechanism of Injury: the exact cause of the injury and the implied transference of energy from one body to another (i.e. from the environment to the human body)

All of these concepts ultimately impact trauma patients and their ultimate care. These three principles must guide accurate injury assessments. Kinetic and potential states of energy are fundamental physics-related ideologies which play a vital role in this energy potential.

Energy is in a potential state when at rest and an active state when in motion. Once an object or mass become mobile, the kinetic injury is formed.

These principles can apply to a motor vehicle. The vehicle is in a potential state at rest. This vehicle is now traveling along at a certain speed and strikes a tree or immovable object. The vehicle is in motion, and kinetic energy transfer will play a role through an impact sequence.[7][8]

Impact Sequence

The first impact occurs when an immovable object impacts another object (such as a car vs. tree, pole, another parked vehicle, or guard rail), leading to the passengers being launched forward violently.

The second impact happens next when the car comes to an abrupt stop. The body then impacts with the inside of the car the steering wheel, the windshield, the seatbelt or airbag, or the roadway/environment if ejected.

Lastly, the third insult or impact to the body occurs when the internal structures such as organs and tissues collide with the body cavities. For example, the aorta may tear as it propels into the thoracic cavity or ribs may puncture a lung or spleen. Third impact or insults go to the essence of trauma assessment and determination of injuries based on this violent energy transfer.

Issues of Concern

Mechanism of injury is vital in determining energy potentials and subsequent, patterns of damage based on the extent of those impacts.[4][9]

Impacts/Injury Patterns

  • Frontal and near-side collisions lead to the steering wheel or dashboard impacts with front seat passengers.
  • Head, neck, chest and abdominal injuries are expectations.
  • Suspect pulmonary contusions and rib fractures with front end damage or near side impact. Rib fractures tend to increase with age. 
  • Patient weight and body mass index (BMI) have a positive correlation with likelihood of injury. 
  • Improperly worn safety belts or unrestrained individuals can add to the risk of a lower extremity, pelvic, and abdominal trauma. 
  • T-bone impacts can cause the occupant seated closest to the point of impact a multitude of problems with any intrusion.
  • Intrusion crushes the occupant causing another impact, and if that’s not enough, they get a double hit, by contact with the interior of the car and any personal items in the car.
  • T-Bone or lateral impacts associated with aortic or organ shear injuries, as well as fractures of the pelvis, neck, clavicle, and skull on the impact side.
  • Rear impacts increase the risk of flexion and extension injuries of the neck and chance fractures of the spine.

Clinical Significance

Multi-system trauma involvement is clinically significant in that it should carry a high index of suspicion with "t-bone" collisions. Rollover crashes may cause all of these impacts as mentioned above and violent insults to the body. As the roof intrudes into the passenger compartment, head injuries are probable. If ejected, an impact with the windshield, window, and roadway or object on the road further complicate an already complicated patient. High-speed motor vehicle collisions, like those seen on the interstates, have a high probability of multi-system trauma involvement.[10][11]

Other Issues

Scene Assessment of Damage

A study conducted between 2007 and 2009, concluded that emergency medical services personnel do an excellent job of assessing roll over damage, but intrusion, deformity and safety belt use can be difficult to judge on scene unless an experienced investigator is present. On scene, accurate assessments of damages and its correlation with injury potential are vital to the decision making process regarding transfer to an appropriate tertiary care facility or trauma center. An adverse outcome may occur if transfer to a designated trauma center falls outside the “Golden Hour” of trauma. Trauma center designation involves state and local involvement in the designation process and sole triage criteria required.[12]

Trauma Center Designation

The American College of Surgeons (ACS) play a valuable role in the evaluation and trauma center verification process. Trauma centers range from Level one designation to a level five designation. Trauma center readiness is key to the allocation of resources involved in a successful treatment plan, resuscitative care and interdisciplinary of a complex trauma patient. Trauma care often takes on a multifaceted dimension with cultural, social and community ramifications.

Trauma Triage Guidelines/Allocation of Resources 

In conclusion, mechanism of injury is the key to the successful creation of trauma triage guidelines through predictability of injury patterns and life-saving interventions. Studying injury patterns and population shifts afford us valuable data to assist in the assuage of circumstances leading up to a motor vehicle crash with prevention techniques, treatment changes as well as legislation focused on improving negative outcome potential and car manufacturer safety guidelines related to airbags and safety belts[13]

As we go forth into the future, aging populations will represent a challenge in the allocation of resources both financially and medically for hospitals, long-term care facilities, and communities. Prevention, education, and legislation will have lasting ramifications on the healthcare continuum of the polytraumatized patient, finding their basis in research and evidence-based practice and policy changes. Reimbursement and fund allocation considerations will be a part of this decision-making process.[14]


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Motor Vehicle Collisions (MVCs) - Questions

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The majority of people who die following a motor vehicle accident succumb to what injury?



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A 17-year-old is thrown off his motorbike on a slippery road. At the scene, what is the first priority in the management of this patient?



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What is the most common cause of death in males aged 16-25 years in North America?



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Which of the following is not a good predictor of motor vehicle accidents in the geriatric population?



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Select the most common cause of injury-related death in patients 65 to 74 years of age.



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An 81 year old female is found to be at fault in a motor vehicle accident. The family is concerned about whether the patient should continue driving. The patient does not drink alcohol and is on no medications that could cause impairment. Cognitive function, physical exam, and vision exam are normal. What should be done?



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Which of these is not a significant risk factor for a motor vehicle crash related death?



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Which of the following is the leading cause of death in women aged 24 to 34?



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All of the following have resulted in decreasing traffic fatalities, except:



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During a motor vehicle accident (MVA), what is the most likely injury to occur after knees strike the dashboard?



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When speaking of motorcycle crashes, leather clothing is protective against:



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What must be done for a woman at 28 weeks gestation without uterine contractions following a car accident with her seatbelt on and her abdomen not struck?



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An eighteen year old presents to the emergency department by EMS after being involved in a motor vehicle collision. She was the unrestrained driver,roll-over on freeway, no airbag due to age of car, spider-webbing of windshield, and broken steering wheel. Car suffered major intrusion with extrication time of twenty minutes. What plays a vital role in anticipating the injury patterns and treatment of this patient?



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Motor Vehicle Collisions (MVCs) - References

References

Borgialli DA,Ellison AM,Ehrlich P,Bonsu B,Menaker J,Wisner DH,Atabaki S,Olsen CS,Sokolove PE,Lillis K,Kuppermann N,Holmes JF, Association between the seat belt sign and intra-abdominal injuries in children with blunt torso trauma in motor vehicle collisions. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2014 Nov;     [PubMed]
Roden-Foreman JW,Foreman ML,Funk GA,Powers MB, Driver see, driver crash: Associations between televised stock car races' audience size and the incidence of speed-related motor vehicle collisions in the United States. Proceedings (Baylor University. Medical Center). 2019 Jan;     [PubMed]
Wang H,Feng C,Liu H,Liu J,Ou L,Yu H,Xiang L, Epidemiologic Features of Traumatic Fractures in Children and Adolescents: A 9-Year Retrospective Study. BioMed research international. 2019;     [PubMed]
Elkbuli A,Dowd B,Spano PJ 2nd,Hai S,Boneva D,McKenney M, The association between seatbelt use and trauma outcomes: Does body mass index matter? The American journal of emergency medicine. 2018 Dec 13;     [PubMed]
Hartka T,Glass G,Kao C,McMurry T, Development of injury risk models to guide CT evaluation in the emergency department after motor vehicle collisions. Traffic injury prevention. 2018;     [PubMed]
Andersen TE,Ellegaard H,Schiøttz-Christensen B,Manniche C, Somatic experiencing® for patients with low back pain and comorbid posttraumatic stress disorder - protocol of a randomized controlled trial. BMC complementary and alternative medicine. 2018 Nov 22;     [PubMed]
Li B,Sun C,Zhao C,Yao X,Zhang Y,Duan H,Hao J,Guo X,Fan B,Ning G,Feng S, Epidemiological profile of thoracolumbar fracture (TLF) over a period of 10 years in Tianjin, China. The journal of spinal cord medicine. 2019 Mar;     [PubMed]
Fewster KM,Viggiani D,Gooyers CE,Parkinson RJ,Callaghan JP, Characterizing trunk muscle activations during simulated low-speed rear impact collisions. Traffic injury prevention. 2019 Apr 23;     [PubMed]
Han H,Park B,Park B,Park N,Park JO,Ahn KO,Tak YJ,Lee HA,Park H, The Pyramid of Injury: Estimation of the Scale of Adolescent Injuries According to Severity. Journal of preventive medicine and public health = Yebang Uihakhoe chi. 2018 May;     [PubMed]
Breen JM,Naess PA,Gjerde H,Gaarder C,Stray-Pedersen A, The significance of preexisting medical conditions, alcohol/drug use and suicidal behavior for drivers in fatal motor vehicle crashes: a retrospective autopsy study. Forensic science, medicine, and pathology. 2018 Mar;     [PubMed]
Inamasu J,Kato M, Airbag deployment and cervical spine injury in restrained drivers following motor vehicle collisions. Neuroradiology. 2018 Dec;     [PubMed]
Milford KL,Navsaria PH,Nicol AJ,Edu S, Trauma unit attendance: Is there a relationship with weather, sporting events and week/ month-end times? An audit at an urban tertiary trauma unit in Cape Town. South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie. 2016 Nov;     [PubMed]
Brubacher JR,Desapriya E,Erdelyi S,Chan H, The impact of child safety restraint legislation on child injuries in police-reported motor vehicle collisions in British Columbia: An interrupted time series analysis. Paediatrics     [PubMed]
Kozyr S,Ponce S,Feramisco H,Pakula A,Skinner R, High-Risk Prehospital Mechanisms in Tier II Trauma Codes: An Analysis of Under-Triage at a Level II Trauma Center. The American surgeon. 2017 Oct 1;     [PubMed]

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