The impact of environmental, vehicle and driver characteristics on injury severity in older drivers hospitalized as a result of a traffic crash

INTRODUCTION: Compared to younger age groups, older people are more likely to be seriously injured or to die as a result of a traffic crash. METHOD: The aim of the study is to examine the impact of environmental, vehicle, crash, and driver characteristics on injury severity in older drivers involved in traffic crashes by using recently linked police crash records and hospitalization data from New South Wales, Australia. The severity of injury resulting from traffic crashes was measured using the International Classification of Diseases, 10th revision (ICD-10) Injury Severity Score (ICISS). RESULTS: Multivariate analysis identified rurality, presence of complex intersections, road speed limit, driver error, speeding, and seat belt use as independent predictors of injury severity in older people. The type of intersection configuration explained over half of the observed variations in injury severity. IMPACT ON INDUSTRY: Environmental modification such as intersection treatments might contribute to a decrease in the severity of injury in older people involved in road crashes.     

Responsibility of drivers, by age and gender, for motor-vehicle crash deaths

Problem: Motor-vehicle crash rate comparisons by age and gender usually are based on the extent to which drivers in a particular age/gender category are themselves injured or involved in crashes (e.g., the number of 20-year-old females in crashes). Basing comparisons instead on the extent to which drivers in various age/gender groups are responsible for deaths (including themselves) in their crashes is more revealing of their overall contribution to the problem. Methods: Data from the Fatality Analysis Reporting System (FARS, 1996–2000) were used in the analysis, which was based on crashes that involved one or two vehicles only. Drivers in fatal single-vehicle crashes were assumed to have responsibility for the crash. In fatal two-vehicle crashes, driver operator errors reported by police were used to assign crash responsibility. Results: When all crashes were considered, both the youngest and oldest drivers were most likely to be responsible for deaths in their crashes. In two-vehicle crashes, the oldest drivers were more likely than young drivers to be responsible. Young males were more likely than young females to be responsible for crash deaths, whereas females in their 50s and older were more likely than same-age males to be responsible. In terms of responsibility for deaths per licensed driver, young drivers, especially males, had the highest rates because of their high involvement rates and high responsibility rates. The majority of deaths for which young drivers were responsible occurred to people other than themselves, especially passengers in their vehicles, whereas the bulk of the deaths for which older drivers were responsible were their own. Discussion: The results highlight the contribution of young drivers to the motor-vehicle crash problem, the need for measures such as passenger restrictions in graduated licensing systems, and the need for vehicle modifications to better protect older occupants.     

Occurrence of Serious Injury in Real-World Side Impacts of Vehicles with Good Side-Impact Protection Ratings

Objective: The Insurance Institute for Highway Safety (IIHS) introduced its side impact consumer information test program in 2003. Since that time, side airbags and structural improvements have been implemented across the fleet and the proportion of good ratings has increased to 93% of 2012–2014 model year vehicles. Research has shown that drivers of good-rated vehicles are 70% less likely to die in a left-side crash than drivers of poor-rated vehicles. Despite these improvements, side impact fatalities accounted for about one quarter of passenger vehicle occupant fatalities in 2012. This study is a detailed analysis of real-world cases with serious injury resulting from side crashes of vehicles with good ratings in the IIHS side impact test.

Methods: NASS-CDS and Crash Injury Research and Engineering Network (CIREN) were queried for occupants of good-rated vehicles who sustained an Abbreviated Injury Scale (AIS) ≥ 3 injury in a side-impact crash. The resulting 110 cases were categorized by impact configuration and other factors that contributed to injury. Patterns of impact configuration, restraint performance, and occupant injury were identified and discussed in the context of potential upgrades to the current IIHS side impact test.

Results: Three quarters of the injured occupants were involved in near-side impacts. For these occupants, the most common factors contributing to injury were crash severities greater than the IIHS test, inadequate side-airbag performance, and lack of side-airbag coverage for the injured body region. In the cases where an airbag was present but did not prevent the injury, occupants were often exposed to loading centered farther forward on the vehicle than in the IIHS test. Around 40% of the far-side occupants were injured from contact with the struck-side interior structure, and almost all of these cases were more severe than the IIHS test. The remaining far-side occupants were mostly elderly and sustained injury from the center console, instrument panel, or seat belt. In addition, many far-side occupants were likely out of position due to events preceding the side impact and/or being unbelted.

Conclusion: Individual changes to the IIHS side impact test have the potential to reduce the number of serious injuries in real-world crashes. These include impacting the vehicle farther forward (relevant to 28% of all cases studied), greater test severity (17%), the inclusion of far-side occupants (9%), and more restrictive injury criteria (9%). Combinations of these changes could be more effective.     

Injury-severity analysis of lane change crashes involving commercial motor vehicles on interstate highways

Introduction: One of the challenging tasks for drivers is the ability to change lanes around large commercial motor vehicles. Lane changing is often characterized by speed, and crashes that occur due to unsafe lane changes can have serious consequences. Considering the economic importance of commercial trucks, ensuring the safety, security, and resilience of freight transportation is of paramount concern to the United States Department of Transportation and other stakeholders. Method: In this study, a mixed (random parameters) logit model was developed to better understand the relationship between crash factors and associated injury severities of commercial vehicle crashes involving lane change on interstate highways. The study was based on 2009–2016 crash data from Alabama. Results: Preliminary data analysis showed that about 4% of the observed crashes were major injury crashes and drivers of commercial motor vehicles were at-fault in more than half of the crashes. Acknowledging potential crash data limitations, the model estimation results reveal that there is increased probability of major injury when lane change crashes occurred on dark unlit portions of interstates and involve older drivers, at-fault commercial vehicle drivers, and female drivers. The results further show that lane change crashes that occurred on interstates with higher number of travel lanes were less likely to have major injury outcomes. Practical Applications: These findings can help policy makers and state transportation agencies increase awareness on the hazards of changing lanes in the immediate vicinity and driving in the blind spots of large commercial motor vehicles. Additionally, law enforcement efforts may be intensified during times and locations of increased unsafe lane changing activities. These findings may also be useful in commercial vehicle driver training and driver licensing programs.     

Factors contributing to serious and fatal injuries in belted rear seat occupants in frontal crashes

Abstract

Objectives: Earlier research has shown that the rear row is safer for occupants in crashes than the front row, but there is evidence that improvements in front seat occupant protection in more recent vehicle model years have reduced the safety advantage of the rear seat versus the front seat. The study objective was to identify factors that contribute to serious and fatal injuries in belted rear seat occupants in frontal crashes in newer model year vehicles.

Methods: A case series review of belted rear seat occupants who were seriously injured or killed in frontal crashes was conducted. Occupants in frontal crashes were eligible for inclusion if they were 6 years old or older and belted in the rear of a 2000 or newer model year passenger vehicle within 10 model years of the crash year. Crashes were identified using the 2004–2015 National Automotive Sampling System Crashworthiness Data System (NASS-CDS) and included all eligible occupants with at least one Abbreviated Injury Scale (AIS) 3 or greater injury. Using these same inclusion criteria but split into younger (6 to 12 years) and older (55+ years) cohorts, fatal crashes were identified in the 2014–2015 Fatality Analysis Reporting System (FARS) and then local police jurisdictions were contacted for complete crash records.

Results: Detailed case series review was completed for 117 rear seat occupants: 36 with Maximum Abbreviated Injury Scale (MAIS) 3+ injuries in NASS-CDS and 81 fatalities identified in FARS. More than half of the injured and killed rear occupants were more severely injured than front seat occupants in the same crash. Serious chest injury, primarily caused by seat belt loading, was present in 22 of the injured occupants and 17 of the 37 fatalities with documented injuries. Nine injured occupants and 18 fatalities sustained serious head injury, primarily from contact with the vehicle interior or severe intrusion. For fatal cases, 12 crashes were considered unsurvivable due to a complete loss of occupant space. For cases considered survivable, intrusion was not a large contributor to fatality.

Discussion: Rear seat occupants sustained serious and fatal injuries due to belt loading in crashes in which front seat occupants survived, suggesting a discrepancy in restraint performance between the front and rear rows. Restraint strategies that reduce loading to the chest should be considered, but there may be potential tradeoffs with increased head excursion, particularly in the absence of rear seat airbags. Any new restraint designs should consider the unique needs of the rear seat environment.     

A preliminary analysis of aortic injuries in lateral impacts

Injuries to the aorta are among the more serious injuries that result from vehicle impacts, and often may be fatal. This article examines the incidence of aortic injuries in the United States and United Kingdom by using two international databases of real-world crashes. The main outcome of interest was the level of risk associated with each principal direction of force for drivers and front-seat passengers with respect to sustaining aortic injuries. The results indicate that the risk of sustaining an injury to the aorta is greater for near-side crashes than for far-side crashes. Further it is apparent that, given a near-side crash, the risk of an aortic injury is greater on the left side of the body (and left side of the vehicle) than on the right. It also was found that the delta-V of crashes where occupants sustained an injury to the aorta was considerably higher than crashes where occupants did not sustain aortic injuries. It is speculated that the anatomical asymmetry of the thorax might play a role in the differences seen in injury risk associated with different impact directions. The results presented in this article could be of use to both the emergency physician treating patients involved in motor vehicle collisions as well as the engineer involved in occupant design countermeasures. Limitations and further planned research are discussed.     

Teenage driver crash incidence and factors influencing crash injury by rurality

BackgroundPrevious research has identified teenage drivers as having an increased risk for motor-vehicle crash injury compared with older drivers, and rural roads as having increased crash severity compared with urban roads. Few studies have examined incidence and characteristics of teen driver-involved crashes on rural and urban roads.MethodsAll crashes involving a driver aged 10 through 18 were identified from the Iowa Department of Transportation crash data from 2002 through 2008. Rates of overall crashes and fatal or severe injury crashes were calculated for urban, suburban, rural, and remote rural areas. The distribution of driver and crash characteristics were compared between rural and urban crashes. Logistic regression was used to identify driver and crash characteristics associated with increased odds of fatal or severe injury among urban and rural crashes.ResultsFor younger teen drivers (age 10 through 15), overall crash rates were higher for more rural areas, although for older teen drivers (age 16 through 18) the overall crash rates were lower for rural areas. Rural teen crashes were nearly five times more likely to lead to a fatal or severe injury crash than urban teen crashes. Rural crashes were more likely to involve single vehicles, be late at night, involve a failure to yield the right-of-way and crossing the center divider.ConclusionsIntervention programs to increase safe teen driving in rural areas need to address specific risk factors associated with rural roadways.Impact on IndustryTeen crashes cause lost work time for teen workers as well as their parents. Industries such as safety, health care, and insurance have a vested interest in enhanced vehicle safety, and these efforts should address risks and injury differentials in urban and rural roadways.     

A multinomial logit model of motorcycle crash severity at Australian intersections

Introduction: Motorcyclists are exposed to more fatalities and severe injuries per mile of travel as compared to other vehicle drivers. Moreover, crashes that take place at intersections are more likely to result in serious or fatal injuries as compared to those that occur at non-intersections. Therefore, the purpose of this study is to evaluate the contributing factors to motorcycle crash severity at intersections. Method: A data set of 7,714 motorcycle crashes at intersections in the State of Victoria, Australia was analyzed over the period of 2006–2018. The multinomial logit model was used for evaluating the motorcycle crashes. The severity of motorcycle crashes was divided into three categories: minor injury, serious injury and fatal injury. The risk factors consisted of four major categories: motorcyclist characteristics, environmental characteristics, intersection characteristics and crash characteristics. Results: The results of the model demonstrated that certain factors increased the probability of fatal injuries. These factors were: motorcyclists aged over 59 years, weekend crashes, midnight/early morning crashes, morning rush hours crashes, multiple vehicles involved in the crash, t-intersections, crashes in towns, crashes in rural areas, stop or give-way intersections, roundabouts, and uncontrolled intersections. By contrast, factors such as female motorcyclists, snowy or stormy or foggy weather, rainy weather, evening rush hours crashes, and unpaved roads reduced the probability of fatal injuries. Practical Applications: The results from our study demonstrated that certain treatment measures for t-intersections may reduce the probability of fatal injuries. An effective way for improving the safety of stop or give-way intersections and uncontrolled intersections could be to convert them to all-way stop controls. Further, it is recommended to educate the older riders that with ageing, there are physiological changes that occur within the body which can increase both crash likelihood and injury severity.     

Factors leading to older drivers' intersection crashes

OBJECTIVES: Older drivers are overinvolved in intersection crashes compared with younger drivers, but the reasons are not clearly understood. The purpose of the present study was to identify the factors that lead to older drivers' intersection crashes. METHOD: Study participants were composed of two groups of older drivers -- ages 70-79 (n = 78) and 80 and older (n = 76) -- and a comparison group of drivers ages 35-54 (n = 73); all were at fault in intersection crashes involving nonfatal injuries. Police crash reports, telephone interviews with at-fault drivers, and photographs of intersections were used to determine the kinds of driver actions and errors that led to the intersection crashes. RESULTS: Drivers 80 and older had fewer rear-end crashes than drivers ages 35-54 and 70-79, and both groups of older drivers had fewer ran-off-road crashes than drivers ages 35-54. Crashes where drivers failed to yield the right-of-way increased with age and occurred mostly at stop sign-controlled intersections, generally when drivers were turning left. The reasons for failure-to-yield crashes tended to vary by age. Compared with drivers ages 35-54 and 80 and older, drivers ages 70-79 made more evaluation errors -- seeing another vehicle but misjudging whether there was adequate time to proceed. In contrast, drivers 80 and older predominantly failed to see or detect the other vehicle. Drivers ages 35-54 also tended to make search errors, but theirs were due more often to distraction. CONCLUSIONS: Factors leading to intersection crashes vary with age, even between two age groups of older drivers. Because the number of older drivers is projected to increase, it is important to identify ways to reduce the frequency and severity of their intersection crashes. Roundabouts and protected left turn lanes at signalized intersections may help to reduce failure-to-yield crashes at intersections, especially among older drivers. Crash avoidance systems may help to reduce crashes for drivers of all ages, but most systems have not been thoroughly investigated using real-world crash data.     

Adjusting for car occupant injury liability in relation to age, speed limit, and gender-specific driver crash involvement risk

It is well established that older drivers' fragility is an important factor associated with higher levels of fatal crash involvement for older drivers. There has been less research on age-related fragility with respect to the sort of minor injuries that are more common in injury crashes. This study estimates a quantity that is related to injury fragility: the probability that a driver or a passenger of that driver will be injured in crashes involving two cars. The effects of other factors apart from drivers' fragility are included in this measure, including the fragility of the passengers, the crashworthiness of cars driven, seatbelt use by the occupants, and characteristics of crashes (including configuration and impact speed). The car occupant injury liability estimates appropriately includes these factors to adjust risk curves by age, gender, and speed limit accounting for overrepresentation in crashes associated with fragility and these other factors.     

Reconstruction of crashes involving injured child occupants: the risk of serious injuries associated with sub-optimal restraint use may be reduced by better controlling occupant kinematics

OBJECTIVE: To determine whether injuries to sub-optimally restrained child occupants in real-world crashes were likely to be preventable by alternative restraint usage practices and to assess the usefulness of crash reconstruction for exploring injury mechanisms in child occupants. METHODS: Real-world crashes in which child occupants sustained significant injuries were reconstructed on a laboratory crash sled using the Hybrid III family of child dummies. Alternative restraint scenarios and cases in which children were not seriously injured were also simulated to compare dummy kinematics and dynamic responses in optimal restraint configurations. RESULTS: Restraint misuse was associated with greater motion of the dummy torso and head during crashes, often allowing contact between the child and the vehicle interior, resulting in injury. Poor pre-crash posture for a child inappropriately restrained in an adult belt appeared to worsen the geometry of the sash (shoulder) belt, resulting in a cervical injury due to direct interaction with the belt. Dynamic dummy data did not appear to discriminate between injury and non-injury cases. CONCLUSIONS: Dummy kinematics suggest that injuries in which inappropriate use and misuse were a factor were less likely if the most appropriate restraint was used correctly. Adequately controlling the head and upper body of the child occupant was seen to prevent undesirable interactions with the vehicle interior and restraint system, which were associated with injury in the real world. Neck forces and moments and injury criteria calculated from these did not predict injury reliably.     

Does the Maryland graduated driver licensing law affect both 16-year-old drivers and those who share the road with them?

PROBLEM: To assess effects of the 1999 Maryland graduated driver licensing (GDL) law on both 16-year-old drivers and other road users. METHOD: Calculation and comparison of crash involvement rates and non-fatal injury rates pre-GDL (1996-1998) and post-GDL (2001-2003) by type of road user, per population, and per licensed driver, with adjustment for trends among 30-59-year-old drivers. RESULTS: Post-GDL, prevalence of licensure decreased 24% among 16-year-olds, and rates of 16-year-old drivers involved in crashes significantly decreased per 16-year-old population (corrected rate ratio (RRc) 0.82; 95% CI (0.71, 0.96)). A significant decrease also was observed for non-fatal injuries per 16-year-old population among 16-year-old drivers involved in crashes (RRc 0.63; 95% CI (0.41, 0.98)). Similarly, decreases, albeit not statistically significant, were observed among their passengers and other vehicle occupants. Per 16-year-old licensed driver, a slight non-significant increase was observed in crash involvement rates; non-fatal injury rates per 16-year-old licensed driver suggest decreased risk (non-significant) among 16-year-old drivers, their passengers, and other vehicle occupants. SUMMARY: Maryland's GDL delayed licensure and reduced crashes and non-fatal injuries among 16-year-old drivers per population. Trends in injuries among other road users involved in crashes with 16-year-old drivers were suggestive of a benefit from GDL, although observed decreases were not significant. Per licensed driver, findings were not significant, but suggested little change in crash involvement and decreased non-fatal injuries. Because one-third fewer 16-year-olds were licensed post-GDL, these results may suggest a selection effect in licensure. IMPACT ON INDUSTRY: Because Maryland had nighttime restrictions for new drivers before 1999, this study suggests other components of GDL are beneficial for drivers and possibly for other road users. States with weak GDL laws should strongly consider revising them.     

Real-World Rib Fracture Patterns in Frontal Crashes in Different Restraint Conditions

Objective: The purpose of this study was to use the detailed medical injury information in the Crash Injury Research and Engineering Network (CIREN) to evaluate patterns of rib fractures in real-world crash occupants in both belted and unbelted restraint conditions. Fracture patterns binned into rib regional levels were examined to determine normative trends associated with belt use and other possible contributing factors.

Methods: Front row adult occupants with Abbreviated Injury Scale (AIS) 3+ rib fractures, in frontal crashes with a deployed frontal airbag, were selected from the CIREN database. The circumferential location of each rib fracture (with respect to the sternum) was documented using a previously published method (Ritchie et al. 2006) and digital computed tomography scans. Fracture patterns for different crash and occupant parameters (restraint use, involved physical component, occupant kinematics, crash principal direction of force, and occupant age) were compared qualitatively and quantitatively.

Results: There were 158 belted and 44 unbelted occupants included in this study. For belted occupants, fractures were mainly located near the path of the shoulder belt, with the majority of fractures occurring on the inboard (with respect to the vehicle) side of the thorax. For unbelted occupants, fractures were approximately symmetric and distributed across both sides of the thorax. There were negligible differences in fracture patterns between occupants with frontal (0°) and near side (330° to 350° for drivers; 10° to 30° for passengers) crash principal directions of force but substantial differences between groups when occupant kinematics (and contacts within the vehicle) were considered. Age also affected fracture pattern, with fractures tending to occur more anteriorly in older occupants and more laterally in younger occupants (both belted and unbelted).

Conclusions: Results of this study confirmed with real-world data that rib fracture patterns in unbelted occupants were more distributed and symmetric across the thorax compared to belted occupants in crashes with a deployed frontal airbag. Other factors, such as occupant kinematics and occupant age, also produced differing patterns of fractures. Normative data on rib fracture patterns in real-world occupants can contribute to understanding injury mechanisms and the role of different causation factors, which can ultimately help prevent fractures and improve vehicle safety.     

Evaluating the impact of passengers on the safety of older drivers

PROBLEM: This study involved a quasi-induced exposure analysis of 4 years of crashes involving older drivers in the state of Kentucky. METHOD: Single- and multivehicle crashes were disaggregated according to the number of passengers: (a) no passenger, (b) one passenger, and (c) two or more passengers. RESULTS: Overall, the presence of two or more passengers was found to negatively impact the probability that drivers 75 years of age or older were at fault in crashes. Several potential factors were studied for interactive effects with passengers: vehicle occupant gender mix, time of the day, road curvature, grade, and number of lanes. The negative impact of passengers increased for some geometric road conditions. However, older drivers were found to be safer at night when carrying two or more passengers. The presence or absence of passengers was not found to affect the 65- to 74-year-old driver group. Groups of male vehicle occupants with a 75+ male driver were found to have high single-vehicle crash rates. IMPACT: These results are among the first to directly consider the effect of passengers on the crash-causing propensity of older drivers and the findings suggest more work is warranted to consider causes for the crash rate differences.     

Crash risk by driver age,gender, and time of day using a new exposure methodology

Introduction: Concerns have been raised that the nonlinear relation between crashes and travel exposure invalidates the conventional use of crash rates to control for exposure. A new metric of exposure that bears a linear association to crashes was used as basis for calculating unbiased crash risks. This study compared the two methods – conventional crash rates and new adjusted crash risk – for assessing the effect of driver age, gender, and time of day on the risk of crash involvement and crash fatality. Method: We used police reports of single-car and multi-car crashes with fatal and nonfatal driver injuries that occurred during 2002–2012 in Great Britain. Results: Conventional crash rates were highest in the youngest age group and declined steeply until age 60–69 years. The adjusted crash risk instead peaked at age 21–29 years and reduced gradually with age. The risk of nighttime driving, especially among teenage drivers, was much smaller when based on adjusted crash risks. Finally, the adjusted fatality risk incurred by elderly drivers remained constant across time of day, suggesting that their risk of sustaining a fatal injury due to a crash is more attributable to excess fragility than to crash seriousness. Conclusions: Our findings demonstrate a biasing effect of low travel exposure on conventional crash rates. This implies that conventional methods do not yield meaningful comparisons of crash risk between driver groups and driving conditions of varying exposure to risk. The excess crash rates typically associated with teenage and elderly drivers as well as nighttime driving are attributed in part to overestimation of risk at low travel exposure. Practical Applications: Greater attention should be directed toward crash involvement among drivers in their 20s and 30s as well as younger drivers. Countermeasures should focus on the role of physical vulnerability in fatality risk of elderly drivers.     

Collisions involving senior drivers: high-risk conditions and locations

OBJECTIVES: To better understand the characteristics of crashes involving senior drivers 65 and older, studies of these crashes were reviewed. METHODS: The review focused primarily on North American studies published since 1990. Studies point to important differences between the crashes of senior drivers and those of younger drivers. RESULTS. Numerous studies have found that senior drivers' crashes are much more likely than crashes of younger drivers to occur at intersections. Senior drivers have particularly high rates of involvement in intersection crashes when they are turning, and even more so when they are turning left. Senior drivers are more likely than younger drivers to have been at fault in these situations, typically because they failed to yield the right-of-way, disregarded the traffic signal, or committed some other traffic violation. Studies also suggest that the extent of overinvolvement of senior drivers in certain types of crashes generally increases with advancing age. CONCLUSIONS. The extent to which the distinctive characteristics of senior drivers' crashes may be due to changing travel patterns associated with aging, or physical or cognitive impairments related to the aging process, is unclear. Further research is needed to understand the pre-crash circumstances of older drivers' intersection crashes.     

The interactive effect on injury severity of driver-vehicle units in two-vehicle crashes

IntroductionThis study sets out to investigate the interactive effect on injury severity of driver-vehicle units in two-vehicle crashes.MethodA Bayesian hierarchical ordered logit model is proposed to relate the variation and correlation of injury severity of drivers involved in two-vehicle crashes to the factors of both driver-vehicle units and the crash configurations. A total of 6417 crash records with 12,834 vehicles involved in Florida are used for model calibration.ResultsThe results show that older, female and not-at-fault drivers and those without use of safety equipment are more likely to be injured but less likely to injure the drivers in the other vehicles. New vehicles and lower speed ratios are associated with lower injury degree of both drivers involved. Compared with automobiles, vans, pick-ups, light trucks, median trucks, and heavy trucks possess better self-protection and stronger aggressivity. The points of impact closer to the driver's seat in general indicate a higher risk to the own drivers while engine cover and vehicle rear are the least hazardous to other drivers. Head-on crashes are significantly more severe than angle and rear-end crashes. We found that more severe crashes occurred on roadways than on shoulders or safety zones.ConclusionsBased on these results, some suggestions for traffic safety education, enforcement and engineering are made. Moreover, significant within-crash correlation is found in the crash data, which demonstrates the applicability of the proposed model.     

Do NHTSA vehicle safety ratings affect side impact crash outcomes?

Introduction: Side impact crash injuries tend to be severe, mainly due to the effects of the mechanism of such crashes. This study addresses the relationship between side impact crash injury severities and side impact safety ratings of the passenger cars involved in such crashes. It is motivated by the lack of research on side impact safety ratings in relation to the real-world crash outcomes. Method: Analysis of Crashworthiness Data System’s (CDS) data show the head and thorax are the most common regions of impact of severe injuries, while the neck is the least. Irrespective of body regions, higher-rated vehicles were found to provide better occupant protection to both younger and older driver age groups. Assessment based on injury severity score (ISS) indicates that higher-rated vehicles have an overall lower average ISS compared to lower-rated vehicles. Results: Ultimately, this study shows that vehicles rated with National Highway Traffic Safety Administration’s (NHTSA) new criteria had lower average ISS compared to vehicles rated under the old criteria. The 2011 NHTSA side impact rating criteria being relatively new, it has very few crashes to draw meaningful statistically significant conclusions. However, this paper establishes the fact that vehicles with higher star ratings (under experimental conditions) indeed offer increased occupant protection in the field conditions. Practical applications: Previous studies have found that safety was given priority while buying new vehicles. However, people associated vehicle safety with technologies and specific safety features rather than the vehicle’s crash test results or ratings (Koppel, Charlton, Fildes, & Fitzharris, 2008). The results from this study provide a point of reference for safety advocates to educate the drivers about the importance of considering vehicle safety ratings during a vehicle purchase.     

Behavioral pathways in bicycle-motor vehicle crashes: From contributing factors,pre-crash actions,to injury severities

Introduction: This study performed a path analysis to uncover the behavioral pathways (from contributing factors, pre-crash actions to injury severities) in bicycle-motor vehicle crashes. Method: The analysis investigated more than 7,000 bicycle-motor vehicle crashes in North Carolina between 2007 and 2014. Pre-crash actions discussed in this study are actions of cyclists and motorists prior to the event of a crash, including “bicyclist failed to yield,” “motorist failed to yield,” “bicyclist overtaking motorist,” and “motorist overtaking bicyclist.” Results: Model results show significant correlates of pre-crash actions and bicyclist injury severity. For example, young bicyclists (18 years old or younger) are 23.5% more likely to fail to yield to motor traffic prior to the event of a crash than elder bicyclists. The “bicyclist failed to yield” action is associated with increased bicyclist injury severity than other actions, as this behavior is associated with an increase of 5.88 percentage points in probability of a bicyclist being at least evidently injured. The path analysis can highlight contributing factors related to risky pre-crash actions that lead to severe injuries. For example, bicyclists traveling on regular vehicle travel lanes are found to be more likely to involve the “bicyclist failed to yield” action, which resulted in a total 44.38% (7.04% direct effect + 37.34% indirect effect) higher likelihood of evident or severe injuries. The path analysis can also identify factors (e.g., intersection) that are not directly but indirectly correlated with injury severity through pre-crash actions. Practical Applications: This study offers a methodological framework to quantify the behavioral pathways in bicycle-motor vehicle crashes. The findings are useful for cycling safety improvements from the perspective of bicyclist behavior, such as the educational program for cyclists.     

Factors associated with higher levels of injury severity in occupants of motor vehicles that were severely damaged in traffic crashes in Kentucky, 2000-2001

OBJECTIVES: The majority of motor vehicle occupants who were killed or hospitalized in crashes in Kentucky in 2000-2001 occupied vehicles that were severely damaged in the crash. Even so, overall only a small percentage of all severely damaged vehicle occupants were killed or hospitalized. The purpose was to identify occupant, vehicle, crash, and roadway/environmental factors that were associated with increased risk of severe injury in crashes where the occupant's vehicle was severely damaged. METHODS: This study probabilistically linked Kentucky's statewide motor vehicle crash and inpatient hospital discharge data files for 2000 and 2001, and selected cases representing occupants of vehicles that were reported by police as having either "severe" or "very severe" damage. For occupants who were identified through data linkage as having been hospitalized, the Injury Severity Score (ISS) was calculated using ICDMAP-90 software, and the scores were stratified into the following categories: critical (>24), severe (15-24), moderate (9-14), and mild (<9). We then created an outcome variable, injury severity level, with five levels: killed; hospitalized with at least moderate injuries (ISS = critical, severe, or moderate); hospitalized with mild injuries (ISS = mild); injured according to the police report but not hospitalized; and no apparent injury according to the police report. We performed a stepwise, ordinal logistic regression of injury severity, using independent variables identified from the existing crash literature. RESULTS: Occupant risk factors for higher levels of injury severity selected by the regression were age (risk increased with age, other factors being equal), female gender, restraint non-use, ejection from the vehicle, and driver impairment (by alcohol and/or drugs). Crash risk factors included head-on collision, collision with a fixed object, vehicle rollover, and vehicle fire. Roadway/environmental factors were federal- or state-maintained roadway and posted speed limit 89 kph (55 mph) or greater. CONCLUSIONS: Many of the identified risk factors are explicitly or implicitly mentioned in the strategic plans of key organizations involved in highway safety and injury prevention in Kentucky. Our analysis provides additional evidence of their importance, and confirms that their mitigation will reduce injury severity in crashes involving severe vehicle damage. Additionally, older occupants and female occupants showed increased risks of serious injury, but to our knowledge these factors are not currently addressed in any state plans. An opportunity exists to clarify the nature of these risks through further studies, which might lead to the identification of countermeasures specific to these populations.