In motor vehicle crashes (MVC), studies suggest female occupants have a higher risk of injury and fatality. Characterization of these injuries among MVC trauma patients is critical for identifying prevention and trauma care interventions that positively impact patient care outcomes. Limited research exists on differences among high-risk injury patterns by patient sex. Our objective was to evaluate sex-stratified motor vehicle injuries resulting in emergency medical services (EMS) system activation and transport.

Methods:

In this retrospective analysis of the ImageTrend Collaborate National EMS dataset for 9-1-1 EMS activations, MVC’s were identified using ICD-10 (v40-49.4-9, v50-59.4-9, v87, v89.2-3, v89.9, v99, y85) codes in the ‘Cause of Injury’ variable. Included are patients 18 years of age and older who used seat belt restraints, met the trauma triage criteria for a high-risk trauma event or high-risk vital sign, and were treated and transported by EMS. Descriptive statistics were calculated for patient demographics, alcohol or drug use, airbag deployment, EMS system times, trauma triage for high-risk injuries and high-risk vital signs. Differences in proportions for various trauma triage high-risk injuries and high-risk vital signs between male and females were tested using chi-square. Differences for continuous variables were tested using Mann-Whitney U due to non-normal distributions.

Results:

There were 244,003 EMS 9-1-1 activations for an MVC identified in the 2023 ImageTrend Collaborate dataset. Of these, 2,589 met inclusion criteria. Patients were commonly male (53.9%), White (57.0%), and had a median age 43.0 years [IQR: 32.0]. Males had significantly higher alcohol or drug use (14.8% vs 7.5%, p<0.001), while females had higher airbag deployment (76.0% vs 71.5%, p=0.011). There were similar rates of trauma triage criteria for high-risk vital signs between males and females. Females had a higher proportion of suspected pelvic fracture compared to males (12.2% vs. 8.1%, p<0.001). Males had a higher proportion of suspected spinal injury with new motor or sensory loss compared to females (3.9% vs. 2.4%, p=0.040).

Conclusion:

High-risk traumatic injuries vary by sex in this evaluation of EMS 9-1-1 responses for MVC patients, demonstrating the need for further analysis. Future work should focus on exploring the association between vehicle occupant sex and crash patient factors such as body weight and height, crash type, and vehicle type with prehospital injury patterns. Results have potential to inform multi-level level public health interventions such as motor vehicle safety standards, vehicle safety design, trauma triage criteria revisions, EMS education- training- and protocols and vehicle occupant safety behavior. Results of this study are limited by completeness of data in Cause of Injury data element, use of a convenience sample and lack of vehicle and detailed crash data. Results of this study are limited by completeness of data in ‘Cause of Injury’ variable, convenience sample and lack of vehicle and detailed crash data.