[Changes in the injury pattern of polytraumatized patients over the last 30 years].

This study aims at describing the changes in injury patterns in traffic accidents in Germany that have taken place over a 30 year period. The basis for the analysis is the in-depth investigations by the scientific research team at the Trauma Department of the Hanover Medical School. Real accidents were investigated based on an on site random selection process. The study includes 1,235 accidents from 1973 to 1978 and 5,608 accidents from the years 1994 to 1999. A reduction in number of fatalities, as well as a change in the injury pattern and the time of death in fatalities was observed. In the earlier years, 54.2% of the fatalities occurred during hospital treatment, whereas in the currant years 78.8% of the fatalities occurred directly at the accident scene and were mainly caused by much higher impact levels. In the earlier group, the polytraumatised patients suffered injuries of AIS 3+ to nearly all body regions (head 69.6%, thorax 69.2%, abdomen 51.9%, pelvis 33.1% and lower extremities 51.9%), whereas today only the head and chest are dominant injury locations for life-threatening trauma. Analysis of the collision configuration showed that nowadays the impact of cars against structures with a low profile such as poles and trees is responsible for the majority of severe, life-threatening injuries, whereas other injury patterns are of minor importance. For pedestrians and cyclists, the impact of the body on the windscreen of the car is the major reason for severe injuries. We conclude that the currently used safety methods have led to a change in the injury pattern of polytraumatised victims. Injuries with much higher energy levels can nowadays be survived, but when the safety limits are exceeded immediate death at the scene is more common.