B. Sharma1,2, A.M. Agcon1, G.M. Agriantonis1,2, N.D. Bhatia1,2, J. Whittington1,2, K. Twelker1,2 1NYC Health & Hospitals/Elmhurst, Surgery, Queens, NY, USA 2Icahn School of Medicine at Mount Sinai Hospital, Surgery, New York, NY, USA
Introduction: The Federal Railroad Administration reported over 21,000 collisions, 2,516 fatalities, and 8,324 injuries related to highway-rail incidents at public and private crossings in the United States from 2014 to 2023. Hence, the goal of our research is to investigate the severity of injuries and the length of hospital stays resulting from subway accidents.
Methods: This is a retrospective, single-center study of patients with subway-related injuries admitted to a level 1 trauma center from 2016 to 2024.
Results: Over 8 years, we identified 383 patients (80.7 % were males and 9.3% were females) with subway injuries. The majority was reported under Other races (56.40%), followed by White (14.62%), Black (13.05%), Asian (11.49%), and Unknown (4.44%). Injury was higher in non-Hispanics (48.56%) compared to Hispanics (43.34%). The majority of incidents (82 [21.4%]) were due to Alcoholism, 5 (1.3%) were due to alcohol and illicit drug consumption, 22 (5.7%) with only illicit drugs and 47 (12.3%) were due to psychiatric disorders. The median Injury Severity Score (ISS) was 8 (interquartile range 10). 93.99 % of patients had blunt trauma and 5.74% had penetrating trauma. The most common combinations of severe injuries were the head, thorax, lower extremities, abdomen, and spine. Overall, 168 patients (43.9%) were presented with severe injuries with an Abbreviated Injury Scale (AIS) score ≥ 3 in one body region, 90 (23.5%) head, 60 (15.7%) thorax, 52 (13.6%), 14 (3.7%) abdomen, and 9 (2.3%) spine region. The mean hospital length of stays (LOS) for patients with AIS score ≥ (at least one body region) is 13.7, compared to the overall of 8.3. The ICU LOS for severely injured patients was 3.7 compared to 1.7 overall, showing the same trend. Of the 368 patients, 9.4% went directly to the operating room, and 22.2% were transferred to the intensive care unit. The overall mortality rate was 7.6%, including trauma patients who met brain death criteria. The age range that has the highest number of subway-related trauma incidents was in their 30s (21.4%), followed by the age range 50 to 59 (16.5%), in their 40s (16.2%), and 20s (14.9%).
Conclusion: This study reveals that individuals who have experienced trauma related to subways and were admitted to a Level I trauma center belong to the age group of 20 to 60. The number of injured males was higher than females. Injured patients suffered from severe head and thorax injuries, which consequently affected the length of their hospital stay. The most common combinations of severe injuries were in the head, thorax, lower extremities, abdomen, and spine. The occurrence of blunt-type trauma was more frequent compared to the penetrating type. Non-Hispanic individuals showed higher injury rates compared to Hispanic individuals. Injury rates in Whites were higher followed by Blacks and Asians. Additionally, our findings indicate that frequent incidents were associated with alcoholism, illicit drug use, and mental disorders.