Distracted Driving Case Study: Friends Just Want To Have Fun! Debbi Thomson, MSN, CPNP Wake Forest Baptist Health Center Winston Salem, NC

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1 Distracted Driving Case Study: Friends Just Want To Have Fun! Debbi Thomson, MSN, CPNP Wake Forest Baptist Health Center Winston Salem, NC Disclosure Information The speaker has no conflicts to disclose. Learning Objectives Identify specific brain injuries that are related to the mechanism of an MVC Discuss management and sequelae of severe brain injuries Recognize common distractions which affect teen drivers, and recommend safe driving practices 1

2 Patient Story 14 yo girl, 1 st day of school 2015, just moved from NY to NC Invited into car full of teenagers for ride home Middle backseat passenger, wearing lap belt Driver going 75 mph on 2 lane road, lost control on curve Driver overcorrected Head-on collision into school bus, 35 mph from opposite direction Death of front seat passenger, driver & passengers extricated, transported to local adult trauma center, our patient unresponsive Collision Scene Car vs. Bus 2

3 More of the Patient Story GCS 4 at scene, unable to be intubated Intubated at adult trauma center and resuscitated Transported to our pediatric trauma center ED, then PICU VS: T 101.7, HR: 123 RR: 29, BP 114/54, O2 Sat: 100% on 35% O2 GCS: 8T Labs: Hgb: 10.9 Hct: 32.3 CT head: right frontal subdural hematoma, left cerebellar intraparenchymal hemorrhage (punctate hemorrhage), no midline shift MVC Collison Factors Influencing TBI Impact against a fixed or moving object Angle of impact Velocity change/vehicle deformation Acceleration and deceleration Rotation-can cause shearing (DAI) Seatbelts influence severity and sites of brain lesions Un-seatbelted passengers have more occipital/parietal injuries from ejections Seat-belted-frontal brain injuries, more protection for lower body Crash Injury Research and Engineering Network (CIREN) CIREN is a multi-disciplinary study, involving trauma surgeons, research personnel, a crash investigator, and engineers to analyze the motor vehicle crashes and determine how each occupant injury was caused (sponsored by NHTSA and automobile industry.) Initiated by NHTSA in 2006 to connect medical information & engineering evidence Data available to public on CIREN website Occupant age, Ht/Wt, position in vehicle, injuries, make/model 3

4 Management of Pediatric TBI (2012 Guidelines for TBI) Intracranial pressure monitoring GCS </=8 Treat ICP >20 CPP minimum 40 mm Hg Hyperosmolar agents for ICP 3% hypertonic saline No recs for mannitol Preventing hypothermia for 1 st 24 hours Treat and prevent hypotension Seizure prophylaxis? Corticosteroids-not recommended Outcomes for our patient Awakened slowly reintubated day 3 for worsening neuro exam, CT scan- worse-layering subdural? DAI Hospitalized 16 days, G-tube for feeding, non-verbal until day 16 Acquired Brain Injury Rehab for 3 weeks Outpatient therapies for 3 months, homebound school Still has chronic headaches, distractibility, difficulty concentrating Some loss of balance, but no falls Dx: Impaired cognition, needs Neuropsychology testing She would like to return to school Distractions for Teen Drivers Cell phones, texting Friends as passengers Grooming, eating Inattentive to external environment Music Interventions: Graduated licenses with hour & passenger restrictions Enhancing driving skills (scanning, watching other drivers, minimizing distractions) 4

5 Teen Driving Teen Driving Distractions Audience Response Question #1 Which collision factor is most closely associated with diffuse axonal injury (DAI)? a. angle of impact b. acceleration c. rotation d. velocity Audience Response Question #2 Which is a 2012 Pediatric TBI Guideline recommendation for ICP >20? a. hypertonic 3% saline b. mannitol c. anti-epileptics d. corticosteroids 5

6 Audience Response Question #3 Which distraction for teen drivers causes the highest number of distraction-related car crashes? a. Texting b. Other passengers c. Grooming d. Eating References Bell, M.J, Kochanek, P.M, et al (2013) Pediatric traumatic brain injury in Critical Care Clinics 29 (2013) Doud, A.N, Weaver, A.A, et al (2015) Mortality risk in pediatric motor vehicle crash occupants: accounting for developmental stage and challenging abbreviated injury scale metrics. Traffic Injury Prevention Supl 2, s Durbin, D.R., McGehee, D.V., et al. (2014) Special considerations in distracted driving with teens. Annals of Advances in Automotive Medicine. 58, Freiss, Stuart H. (2016) Comparing apples and oranges: seizure prophylaxis in pediatric traumatic brain injury. Pediatric Critical Care Medicine 17(2) Hardcastle, N, Benson, H.A., Vavilala, M.S. (2014) Update on the 2012 guidelines for the management of pediatric traumatic brain injury-information for the anesthesiologist. Paedeatric Anaesthesia 24 (7) Hillary, F.G. et al. (2002) Motor vehicle collision factors influence severity and type of TBI. Brain Injury 16(8) Thompson-Brazil, K.A, Gettler, C.E.& Rotondo, M.F. (2005) Diffuse axonal shear injury in an 18 year old man following a high-speed motor vehicle collision. Journal of Emergency Nursing 31(1)

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