Motor vehicular accidents are a leading cause of death and non-fatal trauma in the United States. Although statistics have improved with safer cars, more diverse law enforcement, and better roads; annual deaths in the US still exceed 41,000. There are over 1,711,000 crashes a year, and in any given year, every person in this country has a one in a thousand chance of being injured in a car. In children aged birth to 19 years old, MVA’s are the leading cause of death. Between the ages of 16 and 64, alcohol is a factor in I of 5 fatal crashes. A large number of people still don’t wear their seatbelts which would reduce the risk of death by two-thirds.
There are several variants of accidents which influence the type of injuries received. One is whether or not there is intrusion into the passenger compartment, say from another vehicle or a stationery object. If there is intrusion, there is a risk of general injuries, along with fractures of the arms and legs. The SUV style is top-heavy and with an increased tendency to roll. If the driver or passengers are unrestrained, the chance of ejection with fatal consequences is greatly increased. Another factor in the severity of injuries is speed. The injury rate is exponentially increased by overtly exceeding the median speed of other vehicles traveling the same route. Of course, the rate and occurrence of certain injuries depend upon whether the vehicle is struck from the front, back or sides. Frontal impact increases the chance of injury to the face and chest. Being struck from the back or sides increases the chance of neck injury.
Let’s consider the most common injuries received in a MVA. Fractures of the arms and legs are very frequent especially with cabin intrusion. Head injuries are also a common consequence. These can include concussions from violent movements of the head or by striking the head on a solid part of the cabin. There can be clots of blood impinging on the brain, such as an epidural hematoma, from blows to the head. There can be complex facial fractures, including those which affect the upper airway. The Glasgow Coma Scale is a measure used in the emergency room to quantify the degree of head injury and to guide necessary diagnostic procedures. The scale goes up to a maximum of fifteen points; a score of nine or less indicates a significant head injury.
Perhaps the most feared consequence of an MVA is a neck injury. The scope of neck injuries can go all the way from whiplash to instant death by injury to the spinal cord. Whiplash is when the head is bent unusually far back, or hyper extended. This can cause stretching injury to the muscles, tendons and disk structures of the neck, and can also stretch nerves, which can give a myriad of neurological symptoms. A second type of injury is an actual fracture of the neck. The most common place is the fifth and sixth cervical vertebrae. This can cause complete loss of sensation and muscle use below the neck, so called quadriplegia. A neurosurgeon is always involved in the diagnosis and treatment of this type of injury. The quality of life consequences of this type of injury can be disastrous. Paramedics are taught to treat every neck pain as if it were a fracture in removing and transporting an accident victim with neck pain.
The next type of injury is blunt trauma to the chest. A significant number of these patients initially survive the accident, but go on to die of pulmonary complications within the first four weeks. These injuries can include multiple rib fractures with a flail chest (doesn’t move right with attempted breathing). There can be areas where lung ruptures allow air into the chest cavity which collapses the lung (pneumothorax). There can be blunt trauma to the lungs which causes the chest cavity to fill with blood (hemothorax). Then there can be blunt trauma to the heart area which can cause cardiac bruising or bleeding with rhythm abnormalities.
The next area of potential injury is the abdomen. A blow to the abdomen can lacerate solid organs such as the liver or spleen with bleeding into the abdominal cavity. There can be a rupture of the hollow organs such as the intestine with leakage of contents or bleeding into the cavity. Included in abdominal trauma would be pelvic fractures which can bleed severely and require abdominal surgery. The other injuries mentioned can also require emergency abdominal operations.
The spine can be fractured or otherwise injured at any level, and there can be loss of function in body areas supplied by the spinal cord at the point and to the extent that it is injured. The most common area for paraplegic injury (loss of leg function, bladder function, etc.) is the twelfth thoracic vertebral area, or T12. There are all sorts of variations in spinal cord injury with different manifestations, depending upon the level of the injury. Not only is their quality of life severely affected, these injured individuals don’t live as long as non-injured counterparts. A quadriplegic, on average, lives about seven years. A paraplegic often succumbs in his mid forties due to various complications.
This has been a brief discussion of MVA injuries. The psychological impact was not mentioned. Many of these people develop post traumatic stress disorder and become reclusive and unwilling to travel again. There is a tremendous incidence of depressive disorders in people with chronic pain from such trauma. These situations may require consultation from mental health and pain management clinics.