PubMed · 12548280
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F Vaca. 2003. Commentary: making progress...with a growing caution.. https://doi.org/10.1016/s0196-0644(03)70100-0
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In 2000, an estimated 6.1 million light-vehicle (e.g., passenger cars, sport utility vehicles, vans, and pickup trucks) crashes on U.S. roadways were reported to police. Of these reported crashes, 247,000 (4.0%) involved incidents in which the motor vehicle (MV) directly hit an animal on the roadway. Each year, an estimated 200 human deaths result from crashes involving animals (i.e., deaths from a direct MV animal collision or from a crash in which a driver tried to avoid an animal and ran off the roadway). To characterize nonfatal injuries from these incidents, CDC analyzed data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP). This report summarizes the results of that analysis, which indicated that, during 2001-2002, an estimated 26,647 MV occupants per year were involved in crashes from encounters with animals (predominantly deer) in a roadway and treated for nonfatal injuries in U.S. hospital emergency departments (EDs). Cost-effective measures targeting both drivers (e.g., speed reduction and early warnings) and animals (e.g., fencing and underpasses) are needed to reduce injuries associated with MV collisions involving animals.
STUDY DESIGN: A single-blinded prospective study was performed into the occurrence and frequency of soft tissue neck symptoms of patients involved in high-energy road traffic accidents. OBJECTIVES: We studied the occurrence of incidental soft tissue neck symptoms in victims of high energy (defined as those severe enough to cause major trauma leading to an injury severity score >16) vehicular collisions causing significant musculoskeletal trauma requiring operative intervention. SUMMARY BACKGROUND DATA: Whiplash is considered to be a soft tissue injury of the neck sustained by occupants of motor vehicles. Use of the term in the past had been restricted to hyperextension injuries following a rear impact, but is commonly now used for all types of impact. No relationship has been found between velocity or force of injury and incidence or outcome of whiplash. The preponderance of whiplash after relatively minor vehicular accidents, the unpredictability of who will develop chronic symptoms and the lack of clinical and radiological evidence of a pathological mechanism suggests that psychosocial variables are important factors in determining the development of persistent neck pain. METHODS: A total of 36 consecutive patients were recruited who had been involved in high-energy road traffic accidents and had chest, musculoskeletal, or abdominal injuries (ISS > 16) requiring admission for treatment, but who had no diagnosed injury of the cervical spine. Patients were asked in a nonspecific or leading manner at the time of admission and again at least 6 to 8 weeks postinjury if they had any neck symptoms, headaches, or paresthesiae. RESULTS: Only 2 of the patients interviewed described any whiplash symptoms. All symptoms were resolved at the time of second interview. CONCLUSIONS: Our study demonstrates a surprisingly low incidence of neck symptoms following high-energy road traffic accidents in which patients sustained unrelated injuries requiring treatment.
CASE REPORT: A 7-year-old boy was involved in a road traffic accident. A computed tomography scan revealed an acute subdural hematoma (ASDH) of the posterior fossa, traumatic subarachnoid hemorrhage, and distortion of the brain stem. Removal of the ASDH was completed 3.5 h after injury. After extubation, the patient rapidly recovered consciousness. He was able to follow commands, although he did not speak. He began to utter 14 days after the injury. His speech became normal 39 days after injury. A magnetic resonance imaging scan revealed a post-contusional change in the right cerebellum and an ischemic lesion in the pons. DISCUSSION: Immediate removal of the hematoma is the only therapy for patients with ASDH of the posterior fossa. Although any lesions of the dentate nucleus, red nucleus, thalamus, cerebral cortex, and pons, all of which are involved in this case, are able to cause mutism, his mutism was primarily caused by the severe ASDH of the posterior fossa. The transient nature of this syndrome suggests that the cause of the mutism is trauma-related edema and/or transient ischemia of these structures.