An Elevated Metrorail as a Source of Orthopedic Injuries and Death at a Level-I Trauma Center

Chester J. Donnally, Jonathan I. Sheu, Eric S. Roth, Paul R. Allegra, Augustus J. Rush, Seung H. Shin, Seth D. Dodds

Research output: Contribution to journalArticle

Abstract

Background: Elevated Metrorail systems differ from conventional trains by their slower speeds and collisions with pedestrians predominantly occurring at accessible stations or platforms. Here, the orthopedic implications of pedestrians struck by a Metrorail are evaluated, as were the correlations of substance abuse and psychiatric history on injury and death. Methods: Retrospective cohort study at a single Level-1 trauma center of patients requiring admission with orthopedic injuries following Metrorail impact from 1/2004-2/2017. Demographics, substance abuse, psychiatric history, intentionality, LOS, follow-up, fracture characteristics, and management were studied. Results: 33 patients sustained 104 total orthopedic injuries requiring admission; nine sustained 15 traumatic amputations. There were at least 37 open fractures, with some incomplete data in deceased (5) and amputation (9) patients. Suicide attempts were completed at 35.7% and were associated with a documented psychiatric illness and prior psychiatric evaluation. Spine injuries were associated with increased traumatic brain injuries, rib fractures, and open pelvic ring injuries, yet fewer humerus fractures. Open fractures were significantly predictive of death. 14 patients (42.4%) required ICU admission, and 26 (78.8%) patients required orthopaedic surgery (mean 1.3 ± 1.4 operations). Conclusions: Metrorail systems are unique sources of orthopaedic injuries requiring high rates of critical care and surgical intervention. Patients sustain multiple injuries, many with amputations. With this mechanism, there is a high rate of open fractures and suicide. Trauma centers should emphasize an extensive evaluation of orthopaedic injuries in this patient setting.Level of Evidence: II.

Original languageEnglish (US)
Pages (from-to)159-164
Number of pages6
JournalThe Iowa orthopaedic journal
Volume39
Issue number1
StatePublished - Jan 1 2019
Externally publishedYes

Fingerprint

Trauma Centers
Orthopedics
Wounds and Injuries
Open Fractures
Psychiatry
Amputation
Suicide
Substance-Related Disorders
Traumatic Amputation
Rib Fractures
Multiple Trauma
Patient Admission
Humerus
Critical Care
Spine
Cohort Studies
Retrospective Studies
Demography

Keywords

  • accident prevention
  • metrorail
  • orthopedics
  • polytrauma
  • railway suicide
  • spine trauma
  • train-pedestrian fatalities
  • urban injuries

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Donnally, C. J., Sheu, J. I., Roth, E. S., Allegra, P. R., Rush, A. J., Shin, S. H., & Dodds, S. D. (2019). An Elevated Metrorail as a Source of Orthopedic Injuries and Death at a Level-I Trauma Center. The Iowa orthopaedic journal, 39(1), 159-164.

An Elevated Metrorail as a Source of Orthopedic Injuries and Death at a Level-I Trauma Center. / Donnally, Chester J.; Sheu, Jonathan I.; Roth, Eric S.; Allegra, Paul R.; Rush, Augustus J.; Shin, Seung H.; Dodds, Seth D.

In: The Iowa orthopaedic journal, Vol. 39, No. 1, 01.01.2019, p. 159-164.

Research output: Contribution to journalArticle

Donnally, CJ, Sheu, JI, Roth, ES, Allegra, PR, Rush, AJ, Shin, SH & Dodds, SD 2019, 'An Elevated Metrorail as a Source of Orthopedic Injuries and Death at a Level-I Trauma Center', The Iowa orthopaedic journal, vol. 39, no. 1, pp. 159-164.
Donnally CJ, Sheu JI, Roth ES, Allegra PR, Rush AJ, Shin SH et al. An Elevated Metrorail as a Source of Orthopedic Injuries and Death at a Level-I Trauma Center. The Iowa orthopaedic journal. 2019 Jan 1;39(1):159-164.
Donnally, Chester J. ; Sheu, Jonathan I. ; Roth, Eric S. ; Allegra, Paul R. ; Rush, Augustus J. ; Shin, Seung H. ; Dodds, Seth D. / An Elevated Metrorail as a Source of Orthopedic Injuries and Death at a Level-I Trauma Center. In: The Iowa orthopaedic journal. 2019 ; Vol. 39, No. 1. pp. 159-164.
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abstract = "Background: Elevated Metrorail systems differ from conventional trains by their slower speeds and collisions with pedestrians predominantly occurring at accessible stations or platforms. Here, the orthopedic implications of pedestrians struck by a Metrorail are evaluated, as were the correlations of substance abuse and psychiatric history on injury and death. Methods: Retrospective cohort study at a single Level-1 trauma center of patients requiring admission with orthopedic injuries following Metrorail impact from 1/2004-2/2017. Demographics, substance abuse, psychiatric history, intentionality, LOS, follow-up, fracture characteristics, and management were studied. Results: 33 patients sustained 104 total orthopedic injuries requiring admission; nine sustained 15 traumatic amputations. There were at least 37 open fractures, with some incomplete data in deceased (5) and amputation (9) patients. Suicide attempts were completed at 35.7{\%} and were associated with a documented psychiatric illness and prior psychiatric evaluation. Spine injuries were associated with increased traumatic brain injuries, rib fractures, and open pelvic ring injuries, yet fewer humerus fractures. Open fractures were significantly predictive of death. 14 patients (42.4{\%}) required ICU admission, and 26 (78.8{\%}) patients required orthopaedic surgery (mean 1.3 ± 1.4 operations). Conclusions: Metrorail systems are unique sources of orthopaedic injuries requiring high rates of critical care and surgical intervention. Patients sustain multiple injuries, many with amputations. With this mechanism, there is a high rate of open fractures and suicide. Trauma centers should emphasize an extensive evaluation of orthopaedic injuries in this patient setting.Level of Evidence: II.",
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