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The crash mechanisms and clinical course of car occupants with thoracic injury were analyzed to determine prognostic factors and to create a basis for injury prophylaxis.A technical and medical investigation of car occupants with a thoracic injury (Abbreviated Injury Scale-thorax [AISTHORAX] ≥ 1) at the scene of the crash and the primary admitting hospital was performed.Between 1985 and 1998, 581 car occupants sustained a thoracic injury. Mean parameter values were as follows: AISTHORAX, 2.5; Hannover Polytrauma Score (PTS), 21.4; Injury Severity Score (ISS), 24.2; Delta-v, 49.6 km/h (30.8 mph); and extent of passenger compartment deformation (DEF) (scale, 1–9), 4.0. In 19% (n = 112) of patients involved, the clinical course was evaluated: AISTHORAX, 2.5; PTS, 20.0; ISS, 19.3; Delta-v, 50.1 km/h (31.1 mph); DEF, 3.9; intensive care unit time, 8.3 days; ventilation time, 5.7 days; and hospital stay, 15.3 days. In the groups with higher AISTHORAX, ISS, PTS, and intensive care unit and ventilation time, higher Delta-v and DEF occurred. In patients with longer hospital stay, higher Delta-v, but no difference in DEF occurred.The injury severity and the clinical course demonstrated a positive correlation with the crash severity. Therefore, our technical accident analysis allows prediction of the severity of injury and the clinical course. It may consequently serve as a tool for development of more sophisticated injury prevention strategies and may improve passive car safety.