Portal de Periódicos da CAPES

The Impact of Seat Belts and Airbags on High Grade Renal Injuries and Nephrectomy Rate in Motor Vehicle Collisions

2014; Lippincott Williams & Wilkins; Volume: 192; Issue: 4 Linguagem: Inglês

10.1016/j.juro.2014.04.093

1527-3792

Marc A. Bjurlin, Richard J Fantus, Richard Joseph Fantus, Michele M. Mellett, Dana Villines,

Trauma and Emergency Care Studies

No AccessJournal of UrologyAdult Urology1 Oct 2014The Impact of Seat Belts and Airbags on High Grade Renal Injuries and Nephrectomy Rate in Motor Vehicle Collisions Marc A. Bjurlin, Richard Jacob Fantus, Richard Joseph Fantus, Michele M. Mellett, and Dana Villines Marc A. BjurlinMarc A. Bjurlin Department of Urology, New York University Langone Medical Center, New York University School of Medicine, New York, New York , Richard Jacob FantusRichard Jacob Fantus Baylor College of Medicine, Houston, Texas , Richard Joseph FantusRichard Joseph Fantus Section of Trauma, Department of Surgery and Surgical Critical Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois , Michele M. MellettMichele M. Mellett Section of Trauma, Department of Surgery and Surgical Critical Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois , and Dana VillinesDana Villines Department of Research, Advocate Health Care, Chicago, Illinois View All Author Informationhttps://doi.org/10.1016/j.juro.2014.04.093AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Motor vehicle collisions are the most common cause of blunt genitourinary trauma. We compared renal injuries with no protective device to those with seat belts and/or airbags using NTDB. Our primary end point was a decrease in high grade (grades III-V) renal injuries with a secondary end point of a nephrectomy rate reduction. Materials and Methods: The NTDB research data sets for hospital admission years 2010, 2011 and 2012 were queried for motor vehicle collision occupants with renal injury. Subjects were stratified by protective device and airbag deployment. The AIS was converted to AAST renal injury grade and nephrectomy rates were evaluated. Intergroup comparisons were analyzed for renal injury grades, nephrectomy, length of stay and mortality using the chi-square test or 1-way ANOVA. The relative risk reduction of protective devices was determined. Results: A review of 466,028 motor vehicle collisions revealed a total of 3,846 renal injuries. Injured occupants without a protective device had a higher rate of high grade renal injuries (45.1%) than those with seat belts (39.9%, p = 0.008), airbags (42.3%, p = 0.317) and seat belts plus airbags (34.7%, p <0.001). Seat belts (20.0%), airbags (10.5%) and seat belts plus airbags (13.3%, each p <0.001) decreased the nephrectomy rate compared to no protective device (56.2%). The combination of seatbelts and airbags also decreased total hospital length of stay (p <0.001) and intensive care unit days (p = 0.005). The relative risk reductions of high grade renal injuries (23.1%) and nephrectomy (39.9%) were highest for combined protective devices. Conclusions: Occupants of motor vehicle collisions with protective devices show decreased rates of high grade renal injury and nephrectomy. Reduction appears most pronounced with the combination of seat belts and airbags. References 1 : Vital signs: unintentional injury deaths among persons aged 0-19 years—United States, 2000-2009. MMWR Morb Mortal Wkly Rep2012; 61: 270. Google Scholar 2 : CDC Injury Fact Book. Atlanta: Centers for Disease Control and Prevention2006. Google Scholar 3 Injury Prevention and Control: Data and Statistics (WISQARS™). Available at http://www.cdc.gov/injury/wisqars. Accessed September 2, 2013. Google Scholar 4 United States Census Bureau: Table 1102. Motor vehicle accidents—number and deaths: 1990 to 2009. In: Statistical Abstract of the United States: 2012. Washington, D.C.: United States Department of Commerce 2012. Google Scholar 5 : Early estimate of motor vehicle traffic fatalities in 2012. Publication DOT HS 811 741. Traffic Safety Facts, May 2013. Washington, D.C.: National Center for Statistics and Analysis2013: 1. Google Scholar 6 National Center for Health Statistics: Injury-Related Visits to Hospital Emergency Departments by Sex, Age, and Intent and Mechanisms of Injury Health, United States, 2012. Table 87. Available at http://www.cdc.gov/nchs/data/hus/hus12.pdf - 087. Accessed September 2, 2013. Google Scholar 7 : Incidence and total lifetime costs of motor vehicle-related fatal and nonfatal injury by road user type, United States, 2005. Traffic Inj Prev2010; 11: 353. Google Scholar 8 National Highway Traffic Safety Administration: Final Regulatory Impact Analysis: Amendment to Federal Motor Vehicle Safety Standard 208—Passenger Car Front Seat Occupant Protection. Publication DOT HS 806 572. Washington, D.C.: United States Department of Transportation1984. Google Scholar 9 : Lives saved in 2009 by restraint use and minimum-drinking-age laws. Publication DOT HS 811 383. Traffic Safety Facts, September 2010. Washington, D.C.: National Center for Statistics and Analysis2010: 1. Google Scholar 10 : Mortality reduction with air bag and seat belt use in head-on passenger car collisions. Am J Epidemiol2001; 153: 219. Google Scholar 11 : Renal injury and operative management in the United States: results of a population-based study. J Trauma2003; 54: 423. Google Scholar 12 : Renal and extrarenal predictors of nephrectomy from the national trauma data bank. J Urol2006; 175: 970. Link, Google Scholar 13 : American Association for the Surgery of Trauma Organ Injury Scale for kidney injuries predicts nephrectomy, dialysis, and death in patients with blunt injury and nephrectomy for penetrating injuries. J Trauma2006; 60: 351. Google Scholar 14 : Analysis of diagnostic angiography and angioembolization in the acute management of renal trauma using a national data set. J Urol2011; 185: 1316. Link, Google Scholar 15 : Contemporary trends in the immediate surgical management of renal trauma using a national database. J Trauma Acute Care Surg2013; 75: 602. Google Scholar 16 : Examination of the impact of airbags on renal injury using a national database. J Am Coll Surg2010; 211: 355. Google Scholar 17 : Impact of airbags on a Level I trauma center: injury patterns, infectious morbidity, and hospital costs. J Am Coll Surg2008; 206: 962. Google Scholar 18 : Do seat belts and air bags reduce mortality and injury severity after car accidents?. Am J Orthop (Belle Mead NJ)2011; 40: E26. Google Scholar 19 : Safety belt restraints and compartment intrusions in frontal and lateral motor vehicle crashes: mechanisms of injuries, complications, and acute care costs. J Trauma1993; 34: 736. Google Scholar 20 : Injuries associated with airbag deployment. Emerg Med J2002; 19: 490. Google Scholar 21 : Renal injury in a child with airbag deployment. J Trauma1997; 42: 341. Google Scholar 22 : Occult abdominal injuries to airbag-protected crash victims: a challenge to trauma systems. J Trauma1995; 38: 502. Google Scholar 23 : Abdominal injury with airbag deployment for belted drivers in frontal crashes—biomed 2009. Biomed Sci Instrum2009; 45: 262. Google Scholar 24 : Renal injury mechanisms of motor vehicle collisions: analysis of the Crash Injury Research and Engineering Network data set. J Urol2007; 178: 935. Link, Google Scholar 25 : Motor-vehicle safety: a 20th century public health achievement. MMWR Morb Mortal Wkly Rep1999; 48: 369. Google Scholar 26 : Outcomes in geriatric genitourinary trauma. J Am Coll Surg2011; 213: 415. Google Scholar © 2014 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 192Issue 4October 2014Page: 1131-1136 Advertisement Copyright & Permissions© 2014 by American Urological Association Education and Research, Inc.Keywordsaccidentsseat beltswounds and injuriestraffickidneynephrectomyMetricsAuthor Information Marc A. Bjurlin Department of Urology, New York University Langone Medical Center, New York University School of Medicine, New York, New York More articles by this author Richard Jacob Fantus Baylor College of Medicine, Houston, Texas More articles by this author Richard Joseph Fantus Section of Trauma, Department of Surgery and Surgical Critical Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois More articles by this author Michele M. Mellett Section of Trauma, Department of Surgery and Surgical Critical Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois More articles by this author Dana Villines Department of Research, Advocate Health Care, Chicago, Illinois More articles by this author Expand All Advertisement PDF downloadLoading ...