Original Communication
Cardiac injuries in car occupants in fatal motor vehicle collisions – An autopsy-based study

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Abstract

Motor vehicle accidents contribute widely to population morbidity and mortality around the world, and cardiac injuries are a major factor determining outcome. Autopsy reports from 380 motor vehicle occupants who died in motor vehicle crashes in Adelaide, Australia, and Hamburg, Germany, over a 6-year period were reviewed, analysing the presence and type of cardiac injuries and their correlation with factors such as crash type, presence of seatbelt/airbag and vehicle speed as well as with the presence of other injuries which might predict the presence of cardiac injuries in a clinical setting. 21.1% had cardiac injuries identified macroscopically autopsy or histology. Cardiac injuries were the only cause of death or contributed to a fatal outcome in 76% of these cases. Sternal fractures and left-sided serial rib fractures were predictive of cardiac injury.

Introduction

More than a million people are killed in road accidents every year, making injuries sustained in motor vehicle collisions one of the leading causes of death worldwide.24, 29 Blunt cardiac injuries are a major factor influencing the prognosis of motor vehicle crash victims, and the presence and nature of cardiac injuries thus has major therapeutic implications. The diagnosis and therapy of blunt cardiac trauma has been addressed in clinical studies, but the management of blunt cardiac trauma patients is somewhat controversial, especially as the diagnosis of “minor”, but still potentially fatal, cardiac trauma remains difficult.10, 15, 19 An earlier autopsy study suggested that in unrestrained drivers, the presence of 8 or more rib fractures predicts cardiac and thoracic aortic injuries in frontal collisions.11

In order to assess the frequency and pattern, and to identify predictive factors of cardiac injuries in motor vehicle occupants, we reviewed the autopsy reports of 380 such fatalities subjected to medico-legal autopsy in Adelaide, Australia, and Hamburg, Germany, between 2000 and 2005.

Section snippets

Methods

We retrospectively analysed the reports of 380 motor vehicle occupant fatalities resulting from vehicle crashes where the victims were subjected to medico-legal autopsy in Adelaide, Australia, and Hamburg, Germany, from 2000 to 2005. The cases were identified by an electronic database search using the words “crash”, “accident”, “motor vehicle”, “car”, “driver” and “passenger”. Victims who were involved in crashes resulting from an underlying organic disease, such as a myocardial infarction,

Study population

Of the 380 motor vehicle occupant fatalities included in the study, 80 (21.1%) cases presented with cardiac injuries. The mean age of all victims was 41.5 years (41.2 years in the cardiac injury group) with an age range of 19 months to 86 years. 77.9% of the cases were males. The mean age was similar in males (40.8 years, age range 19 months to 81 years) and females (42.2 years, age range 14–86 years).

Police data

Frontal (37 cases) and lateral (33 cases) collisions accounted for the majority of cases in

Discussion

The present autopsy-based study of cardiac injuries in motor vehicle occupants following collisions demonstrates that blunt cardiac injury is a frequent event.

It has been shown repeatedly and is now generally accepted that the proper use of seat belts reduces the risk of thoracic injury in motor vehicle collisions, and airbags have also been demonstrated to lower the risk of thoracic injuries.5, 7, 13, 16, 20 Others, however, have found that in restrained drivers, the risk of thoracic injury

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