Clinical Outcomes and Patterns of Traumatic Injuries Associated with Subway Incidents at a Level 1 Trauma Center

Objectives: Subway-related accidents have risen with advancements in the system. We aim to study the injury patterns from these incidents. Methods: This is a retrospective study from a single center, covering patients from January 1, 2016, to December 31, 2023. Patients were identified using International Classification of Diseases (ICD) injury descriptions and Abbreviated Injury Scale (AIS) body regions. Results: Out of 360 patients (total), 23.5% presented with head injuries with an AIS score ≥ 3. Patients with blunt trauma (93.99 %) were higher than penetrating (5.74%) and burn trauma (0.3%). Overall, the mean Injury Severity Score (ISS) is 10.69, suggesting a broad range of traumatic injuries. ISS for severe injuries (17-24) comprised 9.2%, moderate injuries (10-16) were 17.5%, and minor injuries (1-9) were 60.8%. Falls had the highest percentage of traumatic brain injury (TBI) (65.60%) and fractures (67.50%). Assaults showed a significant occurrence of traumatic thoracic injuries (28.90%). Suicide attempts demonstrated a high percentage of traumatic amputations (30.80%). In the emergency department (ED), most patients (69.4%) were admitted for further care, such as trauma, neurosurgery, or others. 0.5% died in the ED, 0.5% died on arrival, and 1.04% died within 15 minutes of arrival. The mortality rate among serious fall patients was 17.20% as compared to the suicide and train-struck groups at 37.90% each. Conclusion: There were high occurrences of TBI, and fractures, thoracic injuries, amputations. Patients with blunt trauma were a lot higher than those with penetrating and burn trauma. The mortality rates observed in the suicide and train-struck groups were higher than in patients with severe falls.