Simple criteria that predict major injury of front-seat passenger in frontal collision of passenger car

Abstract

Background: A frontal motor vehicle collision is the most common type of crash that results in fatalities. In this study, we suggested simple criteria that predict major injury to the frontseat occupant in the frontal collision of a passenger car.Subjects and Methods: From January 2011 to December 2013, we collected data from front-seat occupants admitted to one of two emergency centers by ambulance following a frontal collision accident. We surveyed the cause of the accident, vehicle damage, information on the occupant, and severity of injury. Vehicle damage was assessed according to the collision deformation classification code through evaluation of photographs of the actual accident vehicle, and the patient’s injury severity was evaluated by the injury severity score (ISS). Bivariate logistic regression models were formulated, and the cutoff point of deformation extent (DE) was inferred by receiver operating characteristic (ROC) curve analysis.Results: Of the 192 subjects, 113 were males and 52 were major injury patients whose ISS exceeded 15. Gender, seat belt status, extent of vertical crash, and DE were significantly different between major and minor injuries (p < 0.05). After adjusting for confounds, not fastening the seat belt doubled the risk of major injury (OR = 2.2, 95% CI 1.061–4.390), and a cutoff value of three DE tripled the risk of major injury (OR = 3.2, 95% CI 1.382–7.343). In ROC curve analysis, DE 3 in the seat-belt-unfastened group and DE 5 in the seat-beltfastened group predicted major injury (area under the curve: 0.740 [95% CI, 0.627–0.834], sensitivity: 89.3%, specificity: 52.1%; and area under the curve: 0.696 [95% CI, 0.604–0.778], sensitivity: 41.7%, specificity: 94.6%, respectively).Conclusions: At the scene of a frontal collision, emergency personnel can consider seat belt nonuse and DE ≥ 3 as criteria to transport front-seat occupants to trauma center.