Measuring road traffic safety performance: monitoring trends in nonfatal injury

Traditional indicators used to monitor trends in nonfatal injury are influenced by a range of factors other than the incidence of injury. Indicators based on threat-to-life scales offer a means of addressing this problem. The aim of the research described in this article was to compare trends in the official indicators with trends in selected threat-to-life indicators. We compared indicators based on the New Injury Severity Score and the International Classification of Diseases-based Injury Severity Score with the official New Zealand indicators; namely, (1) reported injuries, (2) reported injuries per 10,000 vehicles, (3) reported injuries per 100,000 people, and (4) number hospitalized (discharges). All the official indicators suggest that there has been a substantive decline in nonfatal Motor Vehicle Traffic Crashes (MVTCs) for the period 1988-2000, but a notable increase in 2001. The latter appear to be artifactual increases due to changes in patterns of data collection and do not reflect any real changes in incidence. Further support for this is provided by the results for the two threat-to-life indicators, which suggest that the decline observed for 1988-98 may have been attributable to a decline in the ascertainment or occurrence of minor injuries since those injuries, which represent a significant threat to life, have not declined to the same degree. Given the prominence of motor vehicle crashes as a cause of unnecessary morbidity, more thought needs to be given to deriving valid indicators for measuring trends in serious nonfatal injury.     

Injury surveillance trends in career–technical education: New Jersey 1999–2018

Introduction: Adolescents engaging in school-sponsored work experiences may be at risk of injury due to factors such as inexperience. This article examines trends in 20 years of reported injuries among New Jersey (NJ) adolescents engaging in school-sponsored work experiences, and compares a transition from paper to online reporting format. Methods: New Jersey requires reporting of injuries occurring during school-sponsored work experiences to the NJ Department of Education. Injuries reported by NJ schools from 1999 to 2018 (n = 2,119) were examined; incidence rates for 2008 to 2018 (n = 743) were calculated using publicly available NJ Department of Education enrollment data for the denominator, including for specific groups of students: career and technical education; special healthcare needs. Results: A downward trend in reported injuries in NJ schools was observed. However, the year online reporting became required by code (2013), an increase of nearly 50% was seen from 2012 (59–89), followed by a decline in reported incidents 2014 to 2018 (mean = 65, range 76 down to 47). Injury rate trends over time paralleled those of reported incidents. Conclusions: This study suggested worker safety and public health benefits of improvements from State of NJ code required training programs and online injury surveillance report form. Practical Applications: One potential method to address the safety and health of adolescents engaging in work experiences is the use of online reporting forms, to aid in surveillance efforts, coupled with occupational safety and health training specifically geared toward teachers and administrators who both supervise young, relatively inexperienced and vulnerable workers and who make relatively frequent worksite visits. Incorporation of specific details of the instructions on the use of a reporting form into required trainings, in addition to providing a clear, accessible guidance manual online, could further help improve youth worker safety surveillance efforts.     

Development of injury risk models to guide CT evaluation in the emergency department after motor vehicle collisions

Abstract

Objective: The clinical evaluation of motor vehicle collision (MVC) victims is challenging and commonly relies on computed tomography (CT) to detect internal injuries. CT scans are financially expensive and each scan exposes the patient to additional ionizing radiation with an associated, albeit low, risk of cancer. Injury risk prediction based on regression modeling has been to be shown to be successful in estimating Injury Severity Scores (ISSs). The objective of this study was to (1) create risk models for internal injuries of occupants involved in MVCs based on CT body regions (head, neck, chest, abdomen/pelvis, cervical spine, thoracic spine, and lumbar spine) and (2) evaluate the performance of these risk prediction models to predict internal injury.

Methods: All Abbreviated Injury Scale (AIS) 2008 injury codes were classified based on which CT body region would be necessary to scan in order to make the diagnosis. Cases were identified from the NASS-CDS. The NASS-CDS data set was queried for cases of adult occupants who sought medical care and for which key crash characteristics were all present. Forward stepwise logistic regression was performed on data from 2010–2014 to create models predicting risk of internal injury for each CT body region. Injury risk for each region was grouped into 5 levels: very low (<2%), low (2–5%), medium (5–10%), high (10–20%), and very high (20%). The models were then tested using weighted data from 2015 in order to determine whether injury rates fell within the predicted risk level.

Results: The inclusion and exclusion criteria identified 5,477 cases in the NASS-CDS database. Cases from 2010–2014 were used for risk modeling (n?=?4,826). Seven internal injury risk models were created based on the CT body regions using data from 2010–2014. These models were tested against data from 2015 (n?=?651). In all CT body regions, the majority of occupants fell in the very low or low predicted injury rate groups, except for the head. On average, 57% of patients were classified as very low risk and 15% as low risk for each body region. In most cases the actual rate of injury was within the predicted injury risk range. The 95% confidence interval overlapped with predicting injury risk range in all cases.

Conclusion: This study successfully demonstrated the ability for internal injury risk models to accurately identify occupants at low risk for internal injury in individual body regions. This represents a step towards incorporating telemetry data into a clinical tool to guide physicians in the use of CT for the evaluation of MVC victims.     

Head and neck injuries in fatal motorcycle collisions as determined by detailed autopsy

Detailed layer-by-layer autopsy of the head and neck was performed on a prospective series of 73 fatally injured motorcyclists in order to identify occult injuries, particularly soft tissue neck injuries such as hemorrhage of vertebral and carotid arteries. The fatal cases were gathered as part of a larger study of 1,082 on-scene in-depth motorcycle crash investigations in Thailand. Detailed neck dissection was done on nearly all fatal cases. Injuries were coded using the 1990 revision of the Abbreviated Injury Scale (AIS 90) and an Injury Severity Score (ISS) was determined for each case. Additional AIS codes are proposed for neck injuries that were often identified during the detailed autopsy procedures, but which are not listed explicitly among existing AIS codes. Helmet use was determined based on analysis of injury patterns and helmet damage with consideration also given to witness statements. Both helmeted and unhelmeted motorcyclists showed a high frequency of occult neck injuries such as hemorrhages in the carotid sheath or surrounding the vertebral arteries, phrenic nerve, or brachial plexus. These soft tissue neck injuries sometimes accompanied more obvious injuries to cervical vertebrae or spinal cord, but about one-third of riders had no obvious injury to suggest the presence of occult neck injury. Twenty-eight motorcyclists had been wearing a helmet at the start of the collision sequence, but only nine helmets remained in place through the entire collision event. Helmeted riders showed more severe somatic (below-the-neck) injuries than unhelmeted riders, suggesting helmeted riders are less likely to die in low-threat accidents with somatic injuries below AIS-3. The most significant finding of this study was the identification of serious internal neck injuries despite the absence of external physical evidence of trauma to the neck. Virtually all riders with significant head injuries showed some of these soft tissue neck injuries. Approximately one-third of the critically injured riders who survived at least a few hours before death showed serious occult soft tissue neck injuries.     

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.     

Trends in occupational injuries and fatality in Turkey

Introduction. The aim of this study was to evaluate the trend of occupational injuries in Turkey using epidemiologic criteria such as incidence mortality and fatality/all injuries recorded – rates. Materials and methods. Safety and health data were obtained from the Annual Statistic Books of the Social Insurance Institution (1988–2006) and Social Security Institution (2007–2011) of Turkey. Results. The results from the official data showed that although total employment is increasing the number of occupational injuries and incidence and mortality rates are decreasing. The results also demonstrate that occupational fatality/all injuries recorded – rate is increasing. The fatality/all injuries recorded – rate per 1000 injuries increased to 25.5 in 2011 from 8.6 in 1988. Each work day an average of five people died because of occupational injuries. Discussion and conclusions. The fatality/all injuries recorded – rate (the number of fatal cases per 1000 occupational injuries) is an important indicator of the injury rate for a country. Systems of occupational injury and illness surveillance constitute a critical resource for the management and reduction of occupational injuries and illness.     

Pediatric electric bicycle injuries and comparison to other pediatric traffic injuries

Objective: The objective of this study was to conduct a comprehensive analysis of demographics, injury characteristics and hospital resource utilization of significant pediatric electric bicycle (e-bike) injuries leading to hospitalization following an emergency department visit in comparison to pediatric injuries caused by other traffic related mechanisms.

Methods: A retrospective review of all pediatric traffic injury hospitalizations following an emergency department visit to a level I trauma center between October 2014 and September 2016 was conducted. Data regarding age, sex, number of computed tomography (CT) scans obtained, number of major procedures, length of hospital stay (LOS), Injury Severity Score (ISS), and number of injuries per patient were collected and compared between e-bike injuries and other traffic injuries.

Results: Three hundred thirty-seven admissions were analyzed: 46 (14%) were due to e-bike injuries (29% of patients >12 years). Age, proportion of brain injuries, and use of CT were significantly increased compared to mechanical bicycle injuries (13.1?±?3.4 vs. 10.6?±?3.6, 13% vs. 3%, 1 [0–3] vs. 1 [0–1], P < .01, P = .03, P = .05). Age, LOS, and use of CT were significantly increased compared to injuries caused to automobile passengers (13.1?±?3.4 vs. 7.4?±?5.3, 1 [1–3] vs. 1 [1–2], 1 [0–3] vs. 0 [0–1], P < .01, P = .03, P = .01), as well as ISS and number of injuries per patient (P = .04, P < .01). Injuries caused by e-bikes were similar to injuries caused to pedestrians, except for age (13.1?±?3.4 vs. 8.5?±?3.7, P < .01). Multivariable analysis revealed a significant association between mechanism of injury and ISS, with increased ISS among e-bike injuries compared to mecahnical bike injuries (OR 2.56, CI 1.1–5.88, P = 0.03) and automobile injuries (OR 4.16, CI 1.49–12.5, (P < .01).

Conclusion: E-bikes are a significant cause of severe injury in children compared to most other traffic injuries, particularly in older children.     

Logging injuries for a 10-year period in Jilin Province of the People's Republic of China

PROBLEM: Logging continues to be a major source of injuries in northeast China. This paper describes logging-related injuries in the Jilin Province of the People's Republic of China. METHODS: Logging fatalities and nonfatal injuries were summarized from 1981 to 1990 in Jilin. Injury data from 1991 for the entire forestry sector in China were also analyzed. RESULTS: Fatalities were mainly from of head injuries and were caused by being struck by an object. Nonfatal injuries were most often to the lower extremities and the head and were normally caused by being struck by an object or a fall or slip. The majority of both fatal and nonfatal logging injuries occurred to workers with less than 1 year of employment and those under 35 years old. Most injuries occurred November through March in Jilin. IMPACT ON INDUSTRY: Patterns of logging injury in Jilin of China were similar, but not identical, to those described in other studies of logging injuries worldwide. Methods found to be effective in reducing logging-related injuries in other parts of the world might be used in China to reduce the injuries associated with logging.     

Official reporting and newspaper coverage of road crashes: A case study

This paper describes a case study in Flanders–Belgium on the reporting rate of road crashes. Crash data from three sources were compared: official crash data, data retrieved from an insurance company and newspaper articles. A sample of 140 injury crashes with motorcyclists from an insurance company was used as the reference category. The purpose was to explore factors that contribute to the likelihood of crashes (not) to be reported in official statistics and newspapers. Logistic regression analyses and chi-square tests were used to reveal differences in reporting rate according to some variables. About 80% of the crashes with severe injuries were reported in the official statistics whereas the reporting rate for crashes with slightly injured was about 55%. Newspapers covered about 50% of crashes with severe injuries. The reporting rate in both official statistics and newspapers increased with the severity of the crash.     

SAFEST TO TRAVEL BY BICYCLE,CAR, OR BIG TRUCK?

This study compares highway crash incidence, injuries, and costs by vehicle type. Annual crash and injury incidence were estimated using Crashworthiness Data System (1988-1991), National Automotive Sampling System (1982-1986), General Estimates System (1992-1993), and Fatal Analysis Reporting System (1993) data. Costs were computed based on restraint use, body region, and threat-to-life severity of the injury. Costs were then allocated between vehicle types using three different methods in order to answer comparative safety questions. Motor vehicle and bicycle crash costs total $389 billion annually; 75% resulting from passenger vehicles. Motorcycles and bicycles have the highest costs per 1000 vehicle and passenger miles; costs per victim are highest for pedestrians, bicyclists, and motorcyclists. Costs per vehicle mile for heavy trucks and passenger cars are comparable but exceed costs for light trucks. Passenger vehicle occupants are safest if a crash occurs. Light truck, other single truck, and bus occupants have the lowest cost per passenger mile, but higher costs than air and rail travelers. Motorcyclists face the greatest risks. Combination trucks may not impose an excess risk to other drivers, but their drivers face large risks.     

Physical,psychological and economic burden of two-wheel users after a road traffic injury: Evidence from intensive care units of three EU countries

Introduction: This study aimed to assess the physical, psychological, and economic burden shouldered by severely injured two-wheel users in three European countries as well as the cost resulting from their hospitalization. Methods: A total of seven public hospitals were involved in three countries: Greece, Italy, and Germany. Participants enrolled during a 12-month period starting in April 2013. Eligibility criteria included an injury sustained at Road Traffic Crashes (RTC) irrespective of the type of vehicle, hospitalization 1 day in the Intensive Care Unit (ICU) or sub-ICU, and age 18 years or over. Patients were interviewed at 1, 6, and 12 months upon admission. The study used widely recommended classifications for injury severity (Abbreviated Injury Severity [AIS]; Maximum Abbreviated Injury Severity [MAIS]) and standardized measures such as the Disability Assessment Schedule II (WHODAS 2.0), “Impact of Event Scale” (IES-R), Center for Epidemiological Studies Depression Scale (CES-D Scale). Health Care Expenditure was assessed through the Monash University Accident Research Centre (MUARC's) framework, which included measures of ‘Direct’ and ‘Indirect’ costs. Diagnosis-related groups (DRGs) were used to estimate hospitalization costs. Results: A total of 54 two-wheel users enrolled in the study in all the countries and 32 completed all follow-up questionnaires. Physical disability increased over 12 months following the injury. Post Traumatic Stress Disorder (PTSD) symptoms of avoidance remained at high levels over the study period. PTSD symptoms of intrusion improved significantly during the second half of the year under investigation. The total annual cost of injury for the two-wheel users who were hospitalized in the selected ICU of all the partner countries for severe injury in 2013/2014, was estimated at €714,491 made up of €123,457 direct and €591,034 indirect costs. Men, aged 50–64 years and those who sustained slight injuries primarily at the lower extremities presented higher indirect costs per person. A total of €1032.092 was spent on hospitalization payments. Women, aged 65 + and those who sustained severe injuries at the central body region presented higher direct costs per person. Women, aged 50–64 years, those with severe injuries and a major injury at the central body and the upper body region presented the highest hospitalization costs per person. Conclusions: There is a need for effective strategies to early detect and treat groups at risk of being confronted with prolonged psychosocial and economic consequences. Practical implications: A holistic understanding of the impact of injury on individuals is important in order to achieve effective treatment of psychological co-morbidities in a timely manner.     

Fall-related traumatic brain injury in children ages 0–4 years

Introduction: Falls are the leading cause of traumatic brain injury (TBI) for children in the 0–4 year age group. There is limited literature pertaining to fall-related TBIs in children age 4 and under and the circumstances surrounding these TBIs. This study provides a national estimate and describes actions and products associated with fall-related TBI in this age group. Method: Data analyzed were from the 2001–2013 National Electronic Injury Surveillance System–All Injury Program (NEISS–AIP), a nationally representative sample of emergency departments (ED). Case narratives were coded for actions associated with the fall, and product codes were abstracted to determine fall location and product type. All estimates were weighted. Results: An estimated 139,001 children younger than 5 years were treated annually in EDs for nonfatal, unintentional fall-related TBI injuries (total = 1,807,019 during 2001–2013). Overall, child actions (e.g., running) accounted for the greatest proportion of injuries and actions by others (e.g., carrying) was highest for children younger than 1 year. The majority of falls occurred in the home, and involved surfaces, fixtures, furniture, and baby products. Conclusions: Fall-related TBI in young children represents a significant public health burden. The majority of children seen for TBI assessment in EDs were released to home. Prevention efforts that target parent supervision practices and the home environment are indicated. Practical applications: Professionals in contact with parents of young children can remind them to establish a safe home and be attentive to the environment when carrying young children to prevent falls.     

Nationwide risk factors for hospital readmission for subsequent injury after motor vehicle crashes

Abstract

Objective: Some drivers involved in motor vehicle crashes across the United States may be identified as at risk of subsequent injury by a similar mechanism. The purpose of this study was to perform a national review of the risk factors for hospitalization for a new injury due to a subsequent motor vehicle crash. It was hypothesized that presenting to a different hospital after subsequent injury would result in worse patient outcomes when compared to presentation at the same hospital.

Methods: The Nationwide Readmissions Database for 2010–2014 was queried for all inpatient hospitalizations with injury related to motor vehicle traffic. The primary patient outcome of interest was subsequent motor vehicle crash–related injury within 1 year. The secondary patient outcomes were different hospital subsequent injury presentation, higher Injury Severity Score (ISS), longer length of stay (LOS), and in-hospital death after subsequent injury. The analysis of secondary patient outcomes was performed only on patients who were reinjured. Univariable analysis was performed for each outcome using all variables during the index admission. Multivariable logistic regression was performed using all significant (P < .05) variables on univariate analysis. Results were weighted for national estimates.

Results: During the study period, 1,008,991 patients were admitted for motor vehicle–related injury; 12,474 patients (1.2%) suffered a subsequent injury within 1 year. From the reinjured patients, 32.9% presented to a different hospital, 48.9% had a higher ISS, and 22.1% had a longer LOS. The in-hospital mortality rate after subsequent injury was 1.1%. Presentation to a different hospital for subsequent injury was associated with a longer LOS (odds ratio [OR]?=?1.32; 95% confidence interval [CI], 1.20–1.45; P < .01) and a higher ISS (OR?=?1.38; 95% CI, 1.27–1.49; P < .01). Motorcyclists were more likely to suffer subsequent injury (OR?=?1.39; 95% CI, 1.32–1.46; P < .01) and motorcycle passengers were more likely to present to a different hospital with a subsequent injury (OR?=?2.49; 95% CI, 1.73–3.59; P < .01). Alcohol abuse was associated with subsequent injury (OR?=?1.12; 95% CI, 1.07–1.18; P < .01).

Conclusions: Nearly a third of patients suffering subsequent motor vehicle crash–related injury after an initial motor vehicle crash in the United States present to a different hospital. These patients are more likely to suffer more severe injuries and longer hospitalizations due to their subsequent injury. Future efforts to prevent these injuries must consider the impact of this fragmentation of care and the implications for quality and cost improvements.     

Influence of age-related stature on the frequency of body region injury and overall injury severity in child pedestrian casualties

OBJECTIVE: The current study aims to evaluate the influence of age-related stature on the frequency of body region injury and overall injury severity in children involved in pedestrian versus motor vehicle collisions (PMVCs). METHODS: A trauma registry including the coded injuries sustained by 1,590 1- to 15-year-old pedestrian casualties treated at a level-one trauma center was categorized by stature-related age (1-3, 4-6, 7-9, 10-12, and 13-15 years) and body region (head and face, neck, thorax, abdomen and pelvic content, thoracic and lumbar spine, upper extremities, pelvis, and lower extremities). The lower extremity category was further divided into three sub-structures (thigh, leg, and knee). For each age group and body region/sub-structure the proportion of casualties with at least one injury was then determined at given Abbreviated Injury Scale (AIS) severity levels. In addition, the average and distribution of the Maximum Abbreviated Injury Score (MAIS) and the average Injury Severity Score (ISS) were determined for each age group. The calculated proportions, averages, and distributions were then compared between age groups using appropriate significance tests. RESULTS: The overall outcome showed relatively minor variation between age groups, with the average +/- SD MAIS and ISS ranging from 2.3 +/- 0.9 to 2.5 +/- 1.0 and 8.2 +/- 7.2 to 9.4 +/- 8.9, respectively. The subjects in the 1- to 3-year-old age group were more likely to sustain injury to the head, face, and torso regions than the older subjects. The frequency of AIS 2+ lower extremity injury was approximately 20% in the 1- to 3-year-old group, but was twice as high in the 4- to 12-years age range and 2.5 times as high in the oldest age group. The frequency of femur fracture increased from 10% in the youngest group to 26% in the 4- to 6-year-old group and then declined to 14% in the 10- to 15-years age range. The frequency of tibia/fibula fracture increased monotonically with group age from 8% in the 1- to 3-year-old group to 31% in the 13- to 15-year-old group. CONCLUSIONS: While the overall outcome of child pedestrian casualties appears to be relatively constant across the pediatric stature range considered ( approximately 74-170 cm), subject height seems to affect the frequency of injury to individual body regions, including the thorax and lower extremities. This suggests that vehicle safety designers need not only account for the difference in injury patterns between adult and pediatric pedestrian casualties, but also for the variation within the pediatric group.     

Road traffic injuries to foreigners in the People's Republic of China, 2000-2008

Introduction: China's rapid motorization has resulted in significant challenges in road safety. Method: Using official national statistics, this study examines road traffic injuries (RTIs) experienced by foreigners in China. The number of foreigners entering China has increased 2.4 times over the study period, from 10.16 million in 2000 to 24.33 million in 2008. Results: From 2000- 2008, the number of road traffic fatalities among foreigners similarly increased 2.5 fold, including 49 fatalities reported in 2008. Nonfatal RTIs during this same time frame increased by a magnitude of 1.8 (126 nonfatal injuries in 2000 to 223 in 2008). Conclusions: This study suggests that the total number of foreigners working or visiting China each year who suffer fatal and nonfatal road traffic injuries is relatively low. Impact on Industry: This study provided evidence suggesting that foreigners visiting or working in China face a relatively low risk of road traffic injuries.     

Effects of head restraint and seat redesign on neck injury risk in rear-end crashes

Automobile insurance claims were examined to determine the rates of neck injuries in rear-end crashes for vehicles with and without redesigned head restraints, redesigned seats, or both. Results indicate that the improved geometric fit of head restraints observed in many newer vehicle models are reducing the risk of whiplash injury substantially among female drivers (about 37% in the Ford Taurus and Mercury Sable), but have very little effect among male drivers. New seat designs, such as active head restraints that move upward and closer to drivers' heads during a rear impact, give added benefit, producing about a 43% reduction in whiplash injury claims (55% reduction among female drivers). Estimated effects of Volvo's Whiplash Injury Prevention System and Toyota's Whiplash Injury Lessening design were based on smaller samples and were not statistically significant.     

An analysis of occupational stair accident patterns

This report describes an analysis of existing occupational injury data concerning stairway-related falls. Injury data based on reports obtained from the Ohio and California workers' compensation agencies were analyzed to identify common stair injury patterns. Frequency tabulations are provided for the following factors: (a) location (indoors vs. outdoors, on vs. off employer's premises, site category); (b) task (ascending vs. descending, body movement on the stair, task being attempted); and (c) events (precipitating actions and conditions). One of the most outstanding findings is that 92 % of the injuries occurred when the worker was descending the stair, i.e., 636 of the 688 cases in which direction of travel was indicated. Additionally, injury records from the New York and Ohio workers' compensation agencies were used to rank industries in terms of combined frequency and severity rates of stairway-related injuries.