Experience with railroad injuries at a major urban trauma center serving the United States-Mexico border

BACKGROUND: In the United States (US), railroads are commonly used to transport humans and commerce, especially along the US-Mexico border. Some people will use freight trains to travel within the US. Some of these people will suffer a train-related injury with extensive soft tissue and bone trauma. There is little information about the demographics, injuries, or outcomes of these patients, and the financial expense of providing care for these individuals. We attempt to provide insight into some of these issues. METHODS: We performed a retrospective chart review of patients from the University of Texas Health Science Center at San Antonio from January 1996 to September 2003. Various demographic, total hospital costs, operative procedures, and outcomes were examined. RESULTS: Men were well represented (61 of 67 patients), and the overall mean age was 28.8 years. Hispanics (58 of 67 patients) were the main ethnic group and 61% were undocumented aliens (41 of 67 patients). Bony and soft tissue injuries were common, necessitating an amputation in 38 patients. The mean operative procedures per patient were 2.97. Follow-up was poor. Total hospital cost for all the patients was $2,468,004.47 with a mean of $36,835.89 ($1,305.00-$331, 452.74) per patient. CONCLUSION: Victims of train-related injuries were predominantly young and male. Many patients required an amputation. Multistaged and complex reconstructive procedures may not be realistic in a group of patients in whom follow-up is poor.