Demographics and injury profile for all PTPs involved in MVCs

A total of 727 PTPs were involved in MVCs, evaluated by trauma teams at ten Level-I trauma centers and two Level-II trauma centers. When comparing centers, PTPs were of a similar age and had a similar gestational age. However, there was a statistically significant difference in median ISS among centers, although the overall population was relatively mildly injured (range 1.1–4.6, p < 0.001). Also, the median AIS scores varied across centers for the face (p < 0.001), spine (p = 0.002), and external/other (p < 0.001) regions (Table 1).

Table 1 Demographics of pregnant trauma patients involved in motor vehicle collisions at 12 trauma centersImaging and outcomes for all PTPs involved in MVCs

There were significant variations in patients undergoing a CT head (11.8–62.5%, p < 0.001), CT cervical spine (11.8–75%, p < 0.001), CT chest (4.48–50.25%, p < 0.001), and CT abdomen/pelvis (11.8–62.5%, p < 0.001) among trauma centers. Similarly, there was variation in the use of magnetic resonance imaging (MRI) (0.0–17.6%, p = 0.002) (Table 2).

Table 2 Imaging practices for pregnant trauma patients involved in motor vehicle collisions at 12 trauma centers

There was no difference in overall hospital procedures (0–11.9%, p = 0.05) but there was variation in the rate of cesarean hysterectomy (0.0–75.0%, p = 0.01). Only three cesarean hysterectomies were performed in total, all of which occurred at one site. There was also a similar rate of fetal delivery among centers. ICU LOS was similar among centers but there was variability in overall LOS (1.1–4.6 days, p < 0.001) and ventilator days (0.0–0.3 days, p = 0.01), although ventilator days were rare. Finally, there was no difference in mortality (0.0–2.9%, 0.19) when comparing trauma centers (Table 3).

Table 3 Outcomes for pregnant trauma patients involved in motor vehicle collisions at 12 trauma centersDemographics and injury profile for PTPs involved in high-speed MVCs

Of the 729 PTPs, 480 (65.8%) were involved in high-speed MVCs. In this cohort, there were no differences in age or gestational age among centers. The median ISS varied among centers, although this high-speed MVC population was relatively mildly injured (range 1.0–4.7, p < 0.001). The median AIS scores were similar among centers, except for the face and external regions (Table 4).

Table 4 Demographics for pregnant trauma patients involved in high-speed (>25 mph) motor vehicle collisions at ten trauma centersImaging and outcomes for PTPs involved in high-speed MVCs

There was significant variability in the use of a CT head (12.5–64.3%, p<0.001), cervical spine (16.7–75%, p<0.01), chest (7.0–83.3%, p<0.001), and abdomen/pelvis (0.0–60.0%, p<0.001) when comparing trauma centers. There was also variability in the use of MRI (0.0–17.9%, p=0.02) (Table 5). Trauma centers C, G, H, I, and K (all Level-I trauma centers) had the highest rates of abdomen/pelvis CT imaging—the scans with the highest radiation dose to the fetus.

Table 5 Imaging practices for pregnant trauma patients involved in high-speed (>25 mph) motor vehicle collisions at ten trauma centers

A similar rate of overall in-hospital procedures was observed, although there was variability in cesarean hysterectomies performed (0.0–75.0%, p=0.01). In fact, all the previously mentioned cesarean hysterectomies were performed in this high-speed MVC cohort. Similarly, to the overall MVC population, there were no differences in the rate of fetal delivery (0.0–14.3%, p=0.95) and ICU LOS among centers. However, there was variation in overall LOS (1.1–5.7 days, p<0.001) and ventilator days (0.0–0.5 days, p=0.03), as was seen in the overall MVC population. No differences in mortality were observed among centers (0.0–4.2%, p=0.14) (Table 6).

Table 6 Outcomes for pregnant trauma patients involved in high-speed (>25 mph) motor vehicle collisions at ten trauma centers