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					     NTDB® data points

     Planes, trains, and automobiles
     by Richard J. Fantus, MD, FACS

        When people think of a train
     ride, various images come to                                     Hospital discharge status
     mind. Some may think back
     to the glamorous travels of the
     Orient Express, which began
     service from Paris to Istanbul
     in 1883, crossing six different
     countries while enlisting the
     cooperation of 10 different rail-
     roads. Passengers, who were
     often diplomats, government
     couriers, or royalty, dined on
     fine, five-course French meals.
     Or perhaps what comes to mind
     are the more mundane travels
     of the City of New Orleans, an
     Illinois Central train running
     between Chicago and New Or-
     leans. While riding on this train
     in 1970, Steve Goodman wrote
     the famous folk song popular-
     ized by Arlo Guthrie, relating
     the images that he saw through
     the window of the club car while          train travel is a safe mode of       passenger automobiles (http://
     he played cards as his wife slept,        passenger conveyance and is          www.airlines.org/economics/
     on their way to visit his in-laws.        closer to air travel, in terms of    safety+stats/).
     Living just 2 miles from the site         safety. In 2008, trains carried        In order to examine the oc-
     of the largest train robbery in           almost 600 million passengers        currence of all train-related
     U.S. history, which netted the            over 18 billion miles, with only     injuries in the National Trauma
     bandits $3 million one June               24 passenger deaths (http://         Data Bank ® research data-
     day in 1924, I can’t help but             safetydata.fra.dot.gov/office        set 2007 admissions records
     think of all the train robberies          ofsafety/publicsite/Query/           were searched utilizing the
     that have taken place over the            statsSas.aspx). According to the     International Classification
     years and how they may have               National Safety Council, pas-        of Diseases, Ninth Revision,
     contributed to an increase in             senger transportation incidents      Clinical Modification cause of
     passenger fatalities.                     account for approximately 30         injury code E800–E807 (rail-
        The airline industry has the           percent of unintentional in-         way accidents). 331 incidents
     lowest passenger fatality rate            jury deaths. The U.S. passenger      matched these E codes and of
     of the four major modes of                fatality rate per 100 million        these, 292 records had discharge
     travel. While highway travel              passenger miles is 0.01 for air      status recorded, including 170
     by personal vehicle represents            travel, 0.04 for both railroad       discharged to home and 52 to
44
     the greatest risk of death,               and bus travel, and 0.78 for         acute care/rehabilitation; 36

     VOLUME 94, NUMBER 10, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS
were sent to nursing homes,        ing a time when there are sev-      Manager, NTDB, at mneal@
and 34 died (see Figure on         eral options for travel. We can     facs.org.
page 44). These patients were      take planes, trains, and automo-
81 percent male and, on aver-      biles to get from one destination   Acknowledgment
age, 36.8 years of age; they had   to the next. No matter what
an average length of stay of       your mode of transportation, as        The author acknowledges the
12.8 days, and an average injury   you travel across the U.S., take    assistance of Chrystal Price, data
                                                                       analyst, NTDB, in the preparation
severity score (ISS) of 15.7. Of   time to look out of the window      of this column.
those tested or suspected for      and enjoy the scenery. Perhaps
alcohol, more than 40 percent      you, too, will be inspired to pen   Dr. Fantus is director, trauma
tested positive. When compar-      the lyrics for a great folk song.   services, and chief, section of surgi-
ing the overall group versus the     The full NTDB Annual Report       cal critical care, Advocate Illinois
pedestrian-only group reported     Version 8.0 is available on the     Masonic Medical Center, and clinical
in last month’s Bulletin (pages    ACS Web site as a PDF and a         professor of surgery, University of Il-
63–64), pedestrian rail injuries   PowerPoint presentation at          linois College of Medicine, Chicago,
had a longer length of stay,       http://www.ntdb.org.                IL. He is Chair of the ad hoc Trauma
higher average ISS, and higher       If you are interested in sub-     Registry Advisory Committee of the
                                                                       Committee on Trauma.
mortality rate.                    mitting your trauma center’s
  We are fortunate to live dur-    data, contact Melanie L. Neal,

				
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