Epidemiology of injury patterns for 4- to 10-year-olds in side and oblique impacts

Abstract

Objectives: With regard to the pediatric population involved in vehicle side impact collisions, epidemiologic data can be used to identify specific injury-producing conditions and offer possible safety technology effectiveness through population-based estimates. The objective of the current study was to perform a field data analysis to investigate injury patterns and sources of injury to 4- to 10-year-olds in side and oblique impacts to determine the potential effect of updated side impact regulations and airbag safety countermeasures.

Methods: The NASS-CDS, years 1991 to 2014, was analyzed in the current study. The Abbreviated Injury Scale (AIS) 2005–Update 2008 was used to determine specific injuries and injury severities. Injury distributions were examined by body region as specified in the AIS dictionary and the Maximum AIS (MAIS). Children ages 4 to 10 were examined in this study. All occupant seating locations were investigated. Seating positions were designated by row and as either near side, middle, or far side. Side impacts with a principal direction of force (PDOF) between 2:00 and 4:00 as well as between 8:00 and 10:00 were included. Restraint use was documented only as restrained or unrestrained and not whether the restraint was being used properly. Injury distribution by MAIS, body region, and source of injury were documented. Analysis regarding occupant injury severity, body region injured, and injury source was performed by vehicle model year to determine the effect of updated side impact testing regulation and safety countermeasures. Because the aim of the study was to identify the most common injury patterns and sources, only unweighted data were analyzed.

Results: Main results obtained from the current study with respect to 4- to 10-year-old child occupants in side impact were that a decrease was observed in frequency of MAIS 1–3 injuries; injuries to the head, face, and extremities; as well as injuries caused by child occupant interaction with the vehicle interior and seatback support structures in 1998 model year passenger cars and newer.

Conclusions: Results from this study could be useful in design advances of pediatric anthropomorphic test devices, child restraints, as well as vehicles and their safety countermeasure systems.     

Analysis of injury mechanism of the elderly and non-elderly groups in minor motor vehicle accidents

Abstract

Objective: The purpose of this study is to investigate the injury patterns of noncatastrophic accidents by individual age groups.

Methods: Data were collected from the Korean In-Depth Accident Study database based on actual accident investigation. The noncatastrophic criteria were classified according to U.S. experts from the Centers for Disease Control and Prevention’s recommendations for field triage guidelines of high-risk automobile crash criteria by vehicle intrusions more than 12 in. on occupant sites (including the roof) and more than 18 in. on any site. The Abbreviated Injury Scale (AIS) was used to determine injury patterns for each body region. Severely injured patients were classified as Maximum Abbreviated Injury Scale (MAIS) 3 or higher.

Results: In this study, the most significant injury regions were the head and neck, extremities, and thorax. In addition, the incidence of severe injury among elderly patients was nearly 1.6 times higher than that of non-elderly patients. According to age group, injured body regions among the elderly were the thorax, head and neck, and extremities, in that order. For the non-elderly groups, these were head and neck, extremities, and thorax. Severe injury rates were slightly different for the elderly group (head and neck, abdomen) and non-elderly group (thorax, head and neck).

Conclusions: In both age groups, the rate of severe injury is proportional to an increase in crush extent zone. Front airbag deployment may have a relatively significant relationship to severe injuries.     

Characteristics of bicycle crashes among children and the effect of bicycle helmets

Abstract

Objective: Focusing on children (0–17?years), this study aimed to investigate injury and accident characteristics for bicyclists and to evaluate the use and protective effect of bicycle helmets.

Method: This nationwide Swedish study included children who had visited an emergency care center due to injuries from a bicycle crash. In order to investigate the causes of bicycle crashes, data from 2014 to 2016 were analyzed thoroughly (n?=?7967). The causes of the crashes were analyzed and categorized, focusing on 3 subgroups: children 0–6, 7–12, and 13–17?years of age. To assess helmet effectiveness, the induced exposure approach was applied using data from 2006 to 2016 (n?=?24,623). In order to control for crash severity, only bicyclists who had sustained at least one Abbreviated Injury Scale (AIS) 2+ injury (moderate injury or more severe) in body regions other than the head were included.

Results: In 82% of the cases the children were injured in a single-bicycle crash, and the proportion decreased with age (0–6: 91%, 7–12: 84%, 13–17: 77%). Of AIS 2+ injuries, 8% were head injuries and 85% were injuries to the extremities (73% upper extremities and 13% lower extremities). Helmet use was relatively high up to the age of 10 (90%), after which it dropped. Helmets were much less frequently used by teenagers (14%), especially girls. Consistently, the share of head injuries increased as the children got older. Bicycle helmets were found to reduce all head injuries by 61% (95% confidence interval [CI], 10: +/? 10%) and AIS 2+ head injuries by 68% (95% CI, 12: +/? 12%). The effectiveness in reducing face injuries was lower (45% CI +/? 10% for all injuries and 54% CI +/? 32% for AIS2+ injuries).

Conclusions: This study indicated that bicycle helmets effectively reduce injuries to the head and face. The results thus point to the need for actions aimed at increasing helmet use, especially among teenagers. Protective measures are necessary to further reduce injuries, especially to the upper extremities.     

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.     

Consumer product-related eye injury in the United States, 1998-2002

PROBLEM: Eye injury is currently a leading cause of visual impairment and monocular blindness in the United States. Information regarding consumer products associated with eye injuries can have important implications for the prevention of these injuries. METHODS: The National Electronic Injury Surveillance System (NEISS) was used to describe the types of consumer products associated with emergency department treated eye injuries in the United States from 1998 through 2002. RESULTS: The leading product type associated with eye injuries was welding equipment followed by household cleaners, basketball equipment, workshop equipment, and adhesives. Eye injuries attributed to hardware, tools, construction, sports, toys, and lawn equipment were more common among males. In females, eye injuries attributable to chemicals, housewares, storage and organization, and bed and bath items were more common. Differences were also apparent across the age spectrum. CONCLUSION: This study identified specific products and categories of products frequently associated with eye injury and prevention initiatives should focus on these items. IMPACT ON INDUSTRY: This study has identified consumer products associated with eye injuries requiring medical treatment in the United States. Manufacturers of these products could be encouraged to add or strengthen safety messages regarding the potential for eye injury.     

Census Study of Real-Life Near-Side Crashes with Modern Side Airbag-Equipped Vehicles in the United States

Objective: This study aimed to investigate the crash characteristics, injury distribution, and injury mechanisms for Maximum Abbreviated Injury Score (MAIS) 2+ injured belted, near-side occupants in airbag-equipped modern vehicles. Furthermore, differences in injury distribution for senior occupants compared to non-senior occupants was investigated, as well as whether the near-side occupant injury risk to the head and thorax increases or decreases with a neighboring occupant.

Method: National Automotive Sampling System's Crashworthiness Data System (NASS-CDS) data from 2000 to 2012 were searched for all side impacts (GAD L&R, all principal direction of force) for belted occupants in modern vehicles (model year > 1999). Rollovers were excluded, and only front seat occupants over the age of 10 were included. Twelve thousand three hundred fifty-four MAIS 2+ injured occupants seated adjacent to the intruding structure (near-side) and protected by at least one deployed side airbag were studied. To evaluate the injury risk influenced by the neighboring occupant, odds ratio with an induced exposure approach was used.

Result: The most typical crash occurred either at an intersection or in a left turn where the striking vehicle impacted the target vehicle at a 60 to 70° angle, resulting in a moderate change of velocity (delta-V) and intrusion at the B-pillar. The head, thorax, and pelvis were the most frequent body regions with rib fracture the most frequent specific injury. A majority of the head injuries included brain injuries without skull fracture, and non-senior rather than senior occupants had a higher frequency of head injuries on the whole. In approximately 50% of the cases there was a neighboring occupant influencing injury outcome.

Conclusion: Compared to non-senior occupants, the senior occupants sustained a considerably higher rate of thoracic and pelvis injuries, which should be addressed by improved thorax side airbag protection. The influence on near-side occupant injury risk by the neighboring occupant should also be further evaluated. Furthermore, side airbag performance and injury assessments in intersection crashes, especially those involving senior occupants in lower severities, should be further investigated and side impact dummy biofidelity and injury criteria must be determined for these crash scenarios.     

Severity of e-scooter rider injuries associated with trip characteristics

Introduction: E-scooter rider injuries have been growing, but little is known about how trip and incident characteristics contribute to their severity. Method: We enrolled 105 adults injured while riding e-scooters who presented to an emergency department in Washington, DC, during 2019. Enrolled participants completed an interview during the emergency department visit, and their charts were abstracted to document their injuries and treatment. Logistic regression examined the association of incident location and circumstances with the likelihood of sustaining an injury on the Abbreviated Injury Scale (AIS) ≥ 2, while controlling for rider characteristics. Results: The most common locations of e-scooter injuries in our study sample occurred on the sidewalk (58%) or road (23%). Accounting for other trip and rider attributes, e-scooter riders injured on the road were about twice as likely as those injured elsewhere to sustain AIS ≥ 2 injuries (RR, 1.96; 95% CI, 1.23–2.36) and those who rode at least weekly more often sustained AIS ≥ 2 injuries compared with less frequent riders (RR, 1.86; 95% CI, 1.11–2.32). Conclusions: Greater injury severity for riders injured on the road may reflect higher travel speeds. Practical applications: Injury severity associated with riding in the road is one factor that jurisdictions can consider when setting policy on where e-scooters should be encouraged to ride, but the risk of any crash or fall associated with facilities should also be examined. Although injuries are of lower severity on sidewalks, sharing sidewalks with slower moving pedestrians could potentially lead to more conflicts.     

Estimated Injury Risk for Specific Injuries and Body Regions in Frontal Motor Vehicle Crashes

Objective: Injury risk curves estimate motor vehicle crash (MVC) occupant injury risk from vehicle, crash, and/or occupant factors. Many vehicles are equipped with event data recorders (EDRs) that collect data including the crash speed and restraint status during a MVC. This study's goal was to use regulation-required data elements for EDRs to compute occupant injury risk for (1) specific injuries and (2) specific body regions in frontal MVCs from weighted NASS-CDS data.

Methods: Logistic regression analysis of NASS-CDS single-impact frontal MVCs involving front seat occupants with frontal airbag deployment was used to produce 23 risk curves for specific injuries and 17 risk curves for Abbreviated Injury Scale (AIS) 2+ to 5+ body region injuries. Risk curves were produced for the following body regions: head and thorax (AIS 2+, 3+, 4+, 5+), face (AIS 2+), abdomen, spine, upper extremity, and lower extremity (AIS 2+, 3+). Injury risk with 95% confidence intervals was estimated for 15–105 km/h longitudinal delta-Vs and belt status was adjusted for as a covariate.

Results: Overall, belted occupants had lower estimated risks compared to unbelted occupants and the risk of injury increased as longitudinal delta-V increased. Belt status was a significant predictor for 13 specific injuries and all body region injuries with the exception of AIS 2+ and 3+ spine injuries. Specific injuries and body region injuries that occurred more frequently in NASS-CDS also tended to carry higher risks when evaluated at a 56 km/h longitudinal delta-V. In the belted population, injury risks that ranked in the top 33% included 4 upper extremity fractures (ulna, radius, clavicle, carpus/metacarpus), 2 lower extremity fractures (fibula, metatarsal/tarsal), and a knee sprain (2.4–4.6% risk). Unbelted injury risks ranked in the top 33% included 4 lower extremity fractures (femur, fibula, metatarsal/tarsal, patella), 2 head injuries with less than one hour or unspecified prior unconsciousness, and a lung contusion (4.6–9.9% risk). The 6 body region curves with the highest risks were for AIS 2+ lower extremity, upper extremity, thorax, and head injury and AIS 3+ lower extremity and thorax injury (15.9–43.8% risk).

Conclusions: These injury risk curves can be implemented into advanced automatic crash notification (AACN) algorithms that utilize vehicle EDR measurements to predict occupant injury immediately following a MVC. Through integration with AACN, these injury risk curves can provide emergency medical services (EMS) and other patient care providers with information on suspected occupant injuries to improve injury detection and patient triage.     

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.     

Changes in motorcycle-related injuries and deaths after mandatory motorcycle helmet law in a district of Vietnam

Objective: Our study measured the change in head injuries and deaths among motorcycle users in Cu Chi district, a suburban district of Ho Chi Minh City.

Methods: Hospital records for road traffic injuries (RTIs) were collected from the Cu Chi Trauma Centre and motorcycle-related death records were obtained from mortality registries in commune health offices. Head injury severity was categorized using the Abbreviated Injury Score (AIS). Rate ratios (RRs) were used to compare rates pre- and post-law (2005/2006–2009/2010). Cu Chi's population, stratified by year, age, and sex, was used as the denominator.

Results: Of records identifying the transportation mode at the time of injury, motorcyclists accounted for most injuries (3,035, 87%) and deaths (238, 90%). Head injuries accounted for 70% of motorcycle-related hospitalizations. Helmet use was not recorded in any death records and not in 97% of medical records. Males accounted for most injuries (73%) and deaths (88%). The median age was 28 years and 32 years for injuries and deaths, respectively. Compared to the pre-law period, rates of motorcycle injuries (RR = 0.53; 95% confidence interval [CI], 0.49–0.58), head injuries (RR = 0.35; 95% CI, 0.31–0.39), severe head injuries (RR = 0.47; 95% CI, 0.34–0.63), and deaths (RR = 0.69; 95% CI, 0.53–0.89) significantly decreased in the post-law period.

Conclusions: Rates of head injuries and deaths among motorcycle riders decreased significantly after implementation of the mandatory helmet law in Vietnam. To further examine the impact of the motorcycle helmet law, including compliance and helmet quality, further emphasis should be placed on gathering helmet use data from injured motorcyclists.     

The Costs and Characteristics of Occupational Injuries Admitted to a Trauma Unit

Abstract

Occupational injuries requiring admission to a trauma unit were examined to outline the events surrounding the injury and to examine the costs. Sixty-nine patients were admitted over a 12-month period, representing 4.30% of all work-related injuries attending the emergency department and 4.25% of all admissions to the trauma unit. Most were male (91%), working in skilled trade occupations (65%), with a mean age of 38.8 years. Personal protective equipment was used only by 46% of injured workers who should have been using it. Sixty-one percent of patients believed that their injury was preventable. Half of the injuries were to the upper limb, fall was the most frequent mechanism (25%) and the median duration of admission was 2 days. The direct hospital costs were estimated at over 300 000 GBP. Failure to use protective equipment and to follow health and safety guidelines suggests that opportunities exist for injury prevention.     

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.     

Comparison of epidemiology and injury profile between vulnerable road users and motor vehicle occupants in road traffic fatalities

Objective: Road traffic injuries (RTIs) are a major global health issue causing a global burden of mortality and morbidity. Half of all fatalities on the world’s roads are vulnerable road users (VRUs). The targeted intervention strategies based on fatality analysis focusing on VRUs can effectively contribute to reducing RTIs. This study aimed to compare VRUs and motor vehicle occupants (MVOs) in terms of epidemiology and injury profile.

Methods: We utilized a nationwide, prospective database of RTI-related mortality cases for patients who visited 23 emergency departments between January 2011 and December 2015. All fatalities due to RTIs in the prehospital phase or in-hospital were eligible, excluding patients with unknown mode of transport and those admitted to general wards. The primary and secondary outcomes were fracture injuries and visceral injuries diagnosed using the International Classification of Diseases, Tenth Revision (ICD-10). We compared fracture injuries between VRUs and MVOs using Abbreviated Injury Scale (AIS) 2? and 2+ classification.

Results: Among a total 3,694 road traffic fatalities (RTFs), 43.3% were pedestrians, followed by MVOs (27.0%), motorcyclists (18.9), bicyclists (6.6%), and agricultural vehicle users (4.2%). The elderly (>60 years old) accounted for 54.9% of VRU fatalities. RTFs occurred most frequently in the autumn and the VRU group and the MVO group showed significant differences in weekly and diurnal variation in RTFs. The injury severities (AIS 2+) of the head, neck, and thorax were significantly different between the 2 groups (P?Conclusions: Elderly pedestrians should be targeted for decreases in RTFs, and road traffic safety interventions for VRUs should be made based on the analysis of temporal epidemiology and injury profiles of RTFs.     

The effect of the Swedish bicycle helmet law for children: An interrupted time series study

BackgroundPrevious population-based research has shown that bicycle helmet laws can reduce head injury rates among cyclists. According to deterrence theory, such laws are mainly effective if there is a high likelihood of being apprehended. In this study, we investigated the effect of the Swedish helmet law for children under the age of 15, a population that cannot be fined.MethodAn interrupted time series design was used. Monthly inpatient data on injured cyclists from 1998–2012, stratified by age (0–14, 15 +), sex, and injury diagnosis, was obtained from the National Patient Register. The main outcome measure was the proportion of head injury admissions per month. Intervention effect estimates were obtained using generalized autoregressive moving average (GARMA) models. Pre-legislation trend and seasonality was adjusted for, and differences-in-differences estimation was obtained using adults as a non-equivalent control group.ResultsThere was a statistically significant intervention effect among male children, where the proportion of head injuries dropped by 7.8 percentage points. There was no evidence of an intervention effect on the proportion of head injuries among female children.ConclusionAccording to hospital admission data, the bicycle helmet law appears to have had an effect only on male children.Practical applicationsThis study, while quasi-experimental and thus not strictly generalizable, can contribute to increased knowledge regarding the effects of bicycle helmet laws.     

Non-occupational injuries caused by transport packaging: Residential and retail hazards

BackgroundBackground: Pallets are key components of domestic supply chains, and yet present unique hazards when used by homeowners and retailers for unintended uses. No previous works have investigated non-occupational injuries that occur due to unintentional contact with pallets. This study sought to describe the incidence and epidemiology of non-occupational pallet-related injuries as seen in United States emergency departments (EDs). Method: The National Electronic Injury Surveillance System database was used to derive national, weighted estimates of pallet-related injuries by age, sex, injured body part, and location where injury occurred. Data for the years 2014 to 2018 were analyzed with all relevant narratives reviewed. Results: From 2014 to 2018, there were an estimated 30,493 persons who visited an ED for a pallet-related injury. The yearly incidence of pallet injuries rose during this period. The 35–44 age group (n = 5,481) was most likely to be injured, but about 3,000 children and youth under 18 years of age were injured and more than 4,000 persons 65 years of age or older suffered injuries. The elderly were especially likely to suffer injuries from slip, trip and fall incidents. The lower extremities were the most commonly injured body parts. An estimated 3,964 persons, accounting for approximately 14% of all pallet-related injuries, were treated for injuries incurred while at a retail establishment. African Americans, Hispanics, and the elderly appeared to be disproportionately more likely to have pallet-related injuries in retail locations. Conclusions: Non-occupational pallet-related injuries affect a wide range of patients and cause a variety of injuries, with the elderly being especially vulnerable to tripping incidents. Retailer prevention strategies should focus on the misuse of pallets for merchandising purposes. Industry should maintain control of pallets so they are not used for unintended purposes. Practical applications: Retailers should limit the use of pallets for floor-level merchandising purposes and remove pallets from customer-facing locations where unintentional contact could occur. Owners of pallets should maintain them in a controlled supply chain so that they don’t leak out into the hands of homeowners. Policy-makers should educate the public about the dangers of used pallets.     

Differences in Long-term Medical Consequences Depending on Impact Direction Involving Passenger Cars

Objective: There is limited knowledge of the long-term medical consequences for occupants injured in car crashes in various impact directions. Thus, the objective was to evaluate whether injuries leading to permanent medical impairment differ depending on impact direction.

Methods: In total, 36,743 injured occupants in car crashes that occurred between 1995 and 2011 were included. All initial injuries (n = 61,440) were classified according to the Abbreviated Injury Scale (AIS) 2005. Injured car occupants were followed for at least 3 years to assess permanent medical impairment. The data were divided into different groups according to impact direction and levels of permanent impairment. The risk of permanent medical impairment was established for different body regions and injury severity levels, according to AIS.

Results: It was found that almost 12% of all car occupants sustained a permanent medical impairment. Given an injury, car occupants involved in rollover crashes had the highest overall risk to sustain a permanent medical impairment. Half of the head injuries leading to long-term consequences occurred in frontal impacts. Far-side occupants had almost the same risk as near-side occupants. Occupants who sustained a permanent medical impairment from cervical spine injuries had similar risk in all impact directions (13%) except from rollover (17%). However, these injuries occurred more often in rear crashes. Most of the injuries leading to long-term consequences were classified as minor injuries by AIS for all impact directions.

Conclusions: Studying crash data from a perspective of medical impairment is important to identify injuries that might not be prioritized only considering the AIS but might lead to lower quality of life for the occupant and also costs for society. These results can be used for road transport system strategies and for making priority decisions in vehicle design.     

Acute injuries resulting from accidents involving powered mobility devices (PMDs)—Development and outcomes of PMD-related accidents in Sweden

Objective: Powered mobility devices (PMDs) are commonly used as aids for older people and people with disabilities, subgroups of vulnarable road users (VRUs) who are rarely noted in traffic safety contexts. However, the problem of accidents involving PMD drivers has been reported in many countries where these vehicles have become increasingly popular.

The aim of this study is to extract and analyze national PMD-related accident and injury data reported to the Swedish Traffic Accident Data Acquisition (STRADA) database. The results will provide valuable insight into the risks and obstacles that PMD drivers are exposed to in the traffic environment and may contribute to improving the mobility of this group in the long term.

Methods: The current study is based on data from 743 accidents and 998 persons. An analysis was performed on a subset of data (N?=?301) in order to investigate the development of accidents over a period of 10 years. Thereafter, each accident in the whole data set was registered as either single (N?=?427) or collision (N?=?315).

Results: The results show that there was a 3-fold increase in the number of PMD-related accidents reported to STRADA during the period 2007–2016.

With regard to single accidents, collisions, as well as fatalities, the injury statistics were dominated by males. Single accidents were more common than collisions (N?=?427 and N?=?316, respectively) and the level of injury sustained in each type of accident is on par.

The vast majority of single accidents resulted in the PMD driver impacting the ground (87%), due to either PMD turnover (71%) or the driver falling out of the PMD (16%). The reason for many of the single accidents was a difference in ground level (34%, typically a curb).

Cars, trucks, or buses were involved in 67% of collision events; these occured predominantly at junctions or intersections (70%).

Abbreviated Injury Scale (AIS) 3+ injuries were dominated by hip and head injuries in both single accidents and collision events.

Conclusions: The present study shows that further research on PMD accidents is required, with regard to both single accidents and collision events. To ensure that appropriate decisions are made, future work should follow up on injury trends and further improve the quality of PDM-related accident data. Improved vehicle stability and design, increased usage of safety equipment, proper training programs, effective maintenance services, and development of a supporting infrastructure would contribute to increased safety for PMD drivers.     

Features of fatal injuries in older cyclists in vehicle–bicycle accidents in Japan

Objective: The purpose of this study was to identify and better understand the features of fatal injuries in cyclists aged 75 years and over involved in collisions with either hood- or van-type vehicles.

Methods: This study investigated the fatal injuries of cyclists aged 75 years old and over by analyzing accident data. We focused on the body regions to which the fatal injury occurred using vehicle–bicycle accident data from the Institute for Traffic Accident Research and Data Analysis (ITARDA) in Japan. Using data from 2009 to 2013, we examined the frequency of fatally injured body region by gender, age, and actual vehicle travel speed. We investigated any significant differences in distributions of fatal injuries by body region for cyclists aged 75 years and over using chi-square tests to compare with cyclists in other age groups. We also investigated the cause of fatal head injuries, such as impact with a road surface or vehicle.

Results: The results indicated that head injuries were the most common cause of fatalities among the study group. At low vehicle travel speeds for both hood- and van-type vehicles, fatalities were most likely to be the result of head impacts against the road surface.

The percentage of fatalities following hip injuries was significantly higher for cyclists aged 75 years and over than for those aged 65–74 or 13–59 in impacts with hood-type vehicles. It was also higher for women than men in the over-75 age group in impacts with these vehicles.

Conclusions: For cyclists aged 75 years and over, wearing a helmet may be helpful to prevent head injuries in vehicle-to-cyclist accidents. It may also be helpful to introduce some safety measures to prevent hip injuries, given the higher level of fatalities following hip injury among all cyclists aged 75 and over, particularly women.