Motorcycle helmet visor–related facial injury and its potential mechanism of injury: Evidence-based case study

Objectives: We encountered an unusual facial laceration wound in relation to motorcycle helmet visor use during our clinical practice. We aimed to assess the prevalence of this unusual facial injury among motorcyclists who sustained facial injuries in selected hospitals and to determine the possible mechanism involved.

Methods: We used our prospective cross-sectional substudy involving injured motorcyclists presenting at major trauma hospitals in Southern Klang Valley, Malaysia, between March 2010 and March 2011. of 391 subjects with facial injuries, 2 male motorcyclists sustained this laceration. The wounds were assessed and we believed that each was associated with the helmet visor. One of the visors was collected and the edge was inspected using scanning electron microscopy (SEM).

Results: The prevalence of this unusual injury was 0.51% (95% confidence interval, 0.002–0.012) among motorcyclists who sustained facial injuries. Both cases were involved in a head-on collision with their colliding partners and their helmets were intact throughout the crash. The visor in case 1 was intact, but the visor in case 2 was broken. SEM analysis showed that the visor in case 1 had a potential cutting surface.

We postulated that with helmet rotation in the forward and downward position and with some degree of visor bending or with a dislodged visor, the sharp-edged visor could potentially severely lacerate the face.

Conclusion: This injury affects facial aesthetics and early referral to the facial surgery team is advocated. Documentation of the mechanism of injury, the patient’s helmet and visor is obligatory, so that this information can be delivered to the regional road safety authority for preventive measures.     

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.     

Prevalence of alcohol among nonfatally injured road accident casualties in two level III trauma centers in northern Ghana

Background: Alcohol use is pervasive among motorists on the road in Ghana; however, we do not know the extent to which this behavior is implicated in road accidents in this country.

Objectives: The main objective of this research was to establish the prevalence of alcohol in the blood of nonfatally injured casualties in the emergency departments (EDs) in northern Ghana.

Method: Participants were injured road traffic crash victims, namely, pedestrians, cyclists, motorcyclists, and drivers seeking treatment at an ED. The study sites were 2 level III trauma centers located in Wa and Bolgatanga. Participants were screened for alcohol followed by breath tests for positive participants using breathalyzers.

Results: Two hundred and sixty-two accident victims visited EDs, 58% of whom were in Wa. Among the victims, 41% were hospitalized and 57% experienced slight injuries. The vast majority (76%) of the casualties were motorcyclists, 13% were pedestrians, 8% were cyclists, and 2% were drivers. Casualties who had detectable alcohol in their blood were predominantly vulnerable road users. In all, 34% of participants had detectable blood alcohol concentrations (BACs) and the mean BAC for all casualties who tested positive and could give definitive BACs was 0.2265 (226 mg/dl). The prevalence of alcohol use was 53% among cyclists, 34% among motorcyclists, 21% among pedestrians, and 17% among drivers. Male casualties were more likely to test positive for alcohol than females. In addition, the prevalence of alcohol was significantly higher among injured casualties in Bolgatanga compared to Wa.

Conclusion: There was a high prevalence of alcohol use among nonfatally injured casualties in northern Ghana and injury severity increased with BAC. AUDIT screening in the hospital, alcohol consumption guideline, road safety education with an emphasis on minimizing or eliminating alcohol consumption, and enhanced enforcement of the BAC limit among motorists are recommended.     

Evaluation of the effectiveness of toe board energy-absorbing material for foot,ankle, and lower leg injury reduction

Objective: Since 2000, numerous improvements have been made to the National Association for Stock Car Auto Racing, Incorporated (NASCAR®) driver restraint system, resulting in improved crash protection for motorsports drivers. Advancements have included seats, head and neck restraints (HNRs), seat belt restraint systems, driver helmets, and others. These enhancements have increased protection for drivers from severe crash loading. Extending protection to the driver's extremities remains challenging. Though the drivers’ legs are well contained for lateral and vertical crashes, they remain largely unrestrained in frontal and frontal oblique crashes.

Method: Sled testing was conducted for the evaluation of an energy-absorbing (EA) toe board material to be used as a countermeasure for leg and foot injuries. Testing included baseline rigid toe boards, tests with EA material–covered toe boards, and pretest positioning of the 50th percentile male frontal Hybrid III anthropomorphic test device (ATD) lower extremities. ATD leg and foot instrumentation included foot acceleration and tibia forces and moments.

Results: The sled test data were evaluated using established injury criteria for tibial plateau fractures, leg shaft fractures, and calcaneus, talus, ankle, and midfoot fractures.

Conclusion: A polyurethane EA foam was found to be effective in limiting axial tibia force and foot accelerations when subjected to frontal impacts using the NASCAR motorsport restraint system.     

Safe speed limits for a safe system: The relationship between speed limit and fatal crash rate for different crash types

Objective: The objective of this article is to provide empirical evidence for safe speed limits that will meet the objectives of the Safe System by examining the relationship between speed limit and injury severity for different crash types, using police-reported crash data.

Method: Police-reported crashes from 2 Australian jurisdictions were used to calculate a fatal crash rate by speed limit and crash type. Example safe speed limits were defined using threshold risk levels.

Results: A positive exponential relationship between speed limit and fatality rate was found. For an example fatality rate threshold of 1 in 100 crashes it was found that safe speed limits are 40 km/h for pedestrian crashes; 50 km/h for head-on crashes; 60 km/h for hit fixed object crashes; 80 km/h for right angle, right turn, and left road/rollover crashes; and 110 km/h or more for rear-end crashes.

Conclusions: The positive exponential relationship between speed limit and fatal crash rate is consistent with prior research into speed and crash risk. The results indicate that speed zones of 100 km/h or more only meet the objectives of the Safe System, with regard to fatal crashes, where all crash types except rear-end crashes are exceedingly rare, such as on a high standard restricted access highway with a safe roadside design.     

Pelvic restraint cushion sled test evaluation of pelvic forward motion

Objective: This study was designed to evaluate the performance of a pelvic restraint cushion (PRC), a submarining countermeasure that deploys under the thighs when a crash is detected in order to block the forward motion of the pelvis.

Methods: Sled tests approximating low- and high-speed frontal impacts were conducted with 4 female postmortem human subjects (PMHS) restrained by a lap and shoulder belt in the right front passenger seat. The subjects were tested with and without a PRC.

Results: The PRC is effective in reducing forward motion of the PMHS pelvis and reduces the risk of injury due to lap belt loading in a high-speed frontal crash.

Conclusions: Although small sample size limits the utility of the study's findings, the results suggest that the PRC can limit pelvic forward motion and that pelvic injury due to PRC deployment is not likely.     

Motorcycle crashes potentially preventable by three crash avoidance technologies on passenger vehicles

Objective: The objective of this study was to identify and quantify the motorcycle crash population that would be potential beneficiaries of 3 crash avoidance technologies recently available on passenger vehicles.

Methods: Two-vehicle crashes between a motorcycle and a passenger vehicle that occurred in the United States during 2011–2015 were classified by type, with consideration of the functionality of 3 classes of passenger vehicle crash avoidance technologies: frontal crash prevention, lane maintenance, and blind spot detection. Results were expressed as the percentage of crashes potentially preventable by each type of technology, based on all known types of 2-vehicle crashes and based on all crashes involving motorcycles.

Results: Frontal crash prevention had the largest potential to prevent 2-vehicle motorcycle crashes with passenger vehicles. The 3 technologies in sum had the potential to prevent 10% of fatal 2-vehicle crashes and 23% of police-reported crashes. However, because 2-vehicle crashes with a passenger vehicle represent fewer than half of all motorcycle crashes, these technologies represent a potential to avoid 4% of all fatal motorcycle crashes and 10% of all police-reported motorcycle crashes.

Discussion: Refining the ability of passenger vehicle crash avoidance systems to detect motorcycles represents an opportunity to improve motorcycle safety. Expanding the capabilities of these technologies represents an even greater opportunity. However, even fully realizing these opportunities can affect only a minority of motorcycle crashes and does not change the need for other motorcycle safety countermeasures such as helmets, universal helmet laws, and antilock braking systems.     

Impact of perceptual countermeasures on driving behavior at curves using driving simulator

Objective: The probability of crash occurrence on horizontal curves is 1.5 to 4 times higher than that on tangent sections. A majority of these crashes are associated with human errors. Therefore, human behavior in curves needs to be corrected.

Methodology: In this study, 2 different road marking treatments, optical circles and herringbone patterns, were used to influence driver behavior while entering a curve on a 2-lane rural road section. A driving simulator was used to perform the experiment. The simulated road sections are replicas of 2 real road sections in Flanders.

Results: Both treatments were found to reduce speed before entering the curve. However, speed reduction was more gradual when optical circles were used. A herringbone pattern had more influence on lateral position than optical circles by forcing drivers to maintain a safe distance from opposing traffic in the adjacent lane.

Conclusion: The study concluded that among other low-cost speed reduction methods, optical circles are effective tools to reduce speed and increase drivers’ attention. Moreover, a herringbone pattern can be used to reduce crashes on curves, mainly for head-on crashes where the main problem is inappropriate lateral position.     

A novel driver hazard perception sensitivity model based on drivers’ characteristics: A simulator study

Objective: Considering the high annual number of fatal driving accidents in Iran, any approach for reducing the number or severity of driving accidents is a positive step toward decreasing accident-related losses. Accidents can often be avoided by a timely reaction of the driver. One of the steps before reacting to a hazard is perception. Some driver characteristics may affect road hazard perception. In this research, it was assumed that various driver characteristics, including demographic characteristics and cognitive characteristics, have an impact on driver perception.

Methods: The driving simulator used in this research provides various scenarios; for example, passing a pedestrian or animal across the road or placing fixed objects in a 2-lane separated rural road for 2 groups of experienced and inexperienced drivers under day and night lighting conditions. The go/no-go test was carried out in order to assess drivers’ attention to driving tasks and inhibitory control. A structural equation model (SEM) was used to estimate the relation between driver characteristics and sensitivity to road hazard perception. A new hazard perception index was proposed based on the time intervals in the hazard vulnerability.

Results: The results show that the most effective variables in the analysis of sensitivity to hazard perception are driving experience (in kilometers) during the last 3 years and road lighting conditions. Moreover, hazard perception sensitivity was improved by better inhibitory control, selective attention, and decision making, more carefulness, the average amount of daily sleep, and marital status.

Conclusion: The results of this research may be useful in educating and advertising programs. It also could enhance sensitivity to perception of hazards such as pedestrians, animals, and fixed obstacles among young and novice drivers.     

Transdermal alcohol monitoring combined with contingency management for driving while impaired offenders: A pilot randomized controlled study

Objectives: In a pilot randomized controlled trial of contingency management (CM) and transdermal alcohol monitoring (TAM) with offenders driving while impaired by alcohol (DWI), perceptions regarding the acceptability of a TAM device, recruitment issues, and the impact of CM and TAM on alcohol use over a 6-week period were evaluated. The results aimed to inform the design of future trials and programs involving CM and TAM for DWI remediation.

Methods: TAM devices were affixed to 37 voluntary, community-recruited male DWI offenders with problem alcohol use. They were randomized to one of 3 groups: (1) CM; (2) alcohol use feedback (FB); and (3) TAM device only (CTL). Quantitative and qualitative data were gathered on the acceptability of TAM devices and recruitment, and alcohol use was monitored via TAM and self-report.

Results: The TAM device was perceived positively, with benefits for reducing drinking noted. Nevertheless, some of its inconveniences appeared to influence participant recruitment and attrition, including its large size and limited water resistance. TAM data revealed a significant main effect of time for reduction in weekly peak transdermal alcohol concentration (P = .02), with a decrease between means of weeks 1 and 6 (M = 0.15, SE = 0.02 vs. M = 0.09, SE = 0.02; P = .005). No significant group effect was detected.

Conclusions: TAM is a viable adjunct to CM with DWI offenders, though the TAM device used here may influence both study recruitment and adherence. These findings can guide the design of future studies into CM and TAM for DWI remediation.     

State helmet laws and helmet use among fatally injured moped riders in the United States, 2011–2015

Objective: Research has found that mandatory motorcycle helmet laws increase helmet use and reduce motorcycle-related fatalities. However, the association between state moped helmet laws and helmet use in the United States has not been examined. This study investigated this association among a census of fatally injured moped riders in the United States.

Methods: A logistic regression model was constructed to analyze data extracted from the Fatality Analysis Reporting System (FARS) to examine risk factors for helmet nonuse among 572 moped riders fatally injured between 2011 and 2015.

Results: Fatally injured moped riders in states with universal helmet laws had 69 times the odds of wearing a helmet (P < .001).

Conclusions: Findings suggest that universal moped helmet laws increase helmet use. However, additional research is needed to examine helmet laws and use among nonfatally injured moped riders.     

Trauma demography and clinical epidemiology of motorcycle crash–related head injury in a neurosurgery practice in an African developing country

Objective: Though motor vehicle crashes (MVCs) were the main cause of head trauma from road traffic injuries (RTIs), motorcycle crashes (MCCs) are now a major cause of RTI-related head injury (HI) in many developing countries.

Methods: Using a prospective database of HIs from a neurosurgical practice in a sub-Saharan African developing country, a cross-sectional survey was conducted for the trauma demography and clinical epidemiology of this MCC-related HI.

Results: Motorcycle crashes accounted for 57% (473/833) of all RTI-related HIs in this registry. The victims, with a mean age of 33.1 years (SD = 18.3), consisted mainly of males (83.1%), those of low socioeconomic status (>90%), and those aged between 20 and 40 years old (56%). MCCs involved only riders in 114 cases (114/473, 32.1%), of which 69% were motorcycle–motorcycle crashes. The HI was moderate–severe in 50.8%; clinical symptomatology of significant HI included loss of consciousness (92%), anisocoria (35%), Abbreviated Injury Scale head (AIS–head) score > 3 (28%), and CT-Rotterdam score > 3 (30%). Extracranial systemic injury involved the limbs most frequently, with an Injury Severity Score (ISS) >25 in 49%. The fatality rate was 24%.

MCC-related HI among pedestrian victims involved more vulnerable age groups (the young and elderly) but have lower mean ISS compared to motorcycle passengers (mean ISS = 23.5 [11.6] vs. 27.4 [13.0]; 95% confidence interval [CI], 1.27–6.49; P = .004). In addition, compared to a contemporary cohort of MVC-related HIs in our registry, MCC victims were older (mean age 34.8 years [18.0] vs. 30.8 [18.4]; P = .002); had higher proportions of certain extracranial trauma like long bone fractures (71 vs. 29%; P = .02); and suffered fewer surgical brain lesions (25.5 vs. 17.2%; P = .004).

Conclusions: Motorcycle crashes are now a significant threat to the heads, limbs, and lives of vulnerable road users in developing countries.     

Behavioral influences on driver crash risks in Ghana: A qualitative study of commercial passenger drivers

Objectives: Though there is a growing body of literature on crash risks in the developed world, little is known about how well these models apply to motoring in developing countries, the context in which the majority of road traffic fatalities occur. This qualitative study explores factors perceived to influence crash risks for commercial drivers in Ghana.

Method: Twenty commercial drivers of varied ages and experience were sampled from 7 major lorry terminals in 3 regions (Greater Accra, Ashanti, and Volta) of Ghana. Data were collected through semistructured interviews.

Results: The participants identified some issues that are shared with drivers in the developed world, though moderated by the Ghanaian context. These included work pressures (e.g., fatigued driving), speeding, distracted driving, and inadequate vehicle maintenance. Other factors identified by participants are less frequently considered in research addressing driving behavior in developed countries. These included aggressive competition over passengers and corruption (e.g., improper licensing practices), among others.

Conclusion: The findings have implications for building a research base to support the development of road safety policy and interventions in developing countries.     

Trends in the use of psychoactive substances by truck drivers in São Paulo State,Brazil: A time-series cross sectional roadside survey (2009–2016)

Objective: Truck drivers represent a group that is susceptible to the use of stimulant substances to reduce the symptoms of fatigue, which may be caused by a stressful and exhausting work environment. The use of psychoactive substances may increase the risk for involvement in road traffic crashes. Previous studies have demonstrated that amphetamine, cocaine, and cannabis are the 3 main drugs used by Brazilian truck drivers. We studied the prevalence of amphetamine, benzoylecgonine (indicating use of cocaine), and Δ-9-tetrahydrocannabinol-9-carboxylic acid (THC-COOH; indicating use of cannabis) in urine samples from truck drivers in the state of São Paulo, Brazil, using the same methodology during 8 years (2009–2016).

Methods: Samples were collected during a health program supported by the Federal Highway Police. Toxicological analyses were performed using immunoassays and gas chromatography–mass spectrometry.

Results: The total prevalence of illicit drugs was 7.8%. Benzoylecgonine was the most prevalent substance (3.6%), followed by amphetamine (3.4%) and THC-COOH (1.6%). We found the highest drug prevalence in 2010 (11.3%) and the lowest in 2011 (6.1%). We could detect a slight change in the pattern of stimulant use: until 2010, amphetamine was the most prevalent substance; however, in 2011 benzoylecgonine became the most frequently detected substance. This lasted until 2015, probably due to changes in Brazilian legislation regarding appetite suppressants; the most common one is metabolized to amphetamine.

Conclusion: These data show that the use of psychoactive substances by truck drivers in Brazil did not decrease during the study period. This reinforces the need for further preventive measures to reduce drug use among drivers, which could lead to a decrease in traffic crashes in Brazil.     

Evaluation of a hospital-based injury surveillance system for monitoring road traffic deaths in Phuket,Thailand

Objectives: The objective of this study was to evaluate and injury surveillance (IS) system’s ability to monitor road traffic deaths and the coverage of road traffic injury and death surveillance in Phuket, Thailand.

Methods: U.S. Centers for Disease Control and Prevention guidelines on surveillance system evaluation were used to qualitatively and quantitatively evaluate IS. Interviews with key stakeholders focused on IS’s usefulness, simplicity, flexibility, acceptability, and stability. Active case finding of 2014 road traffic deaths in all paper and electronic hospital record systems was used to assess system sensitivity, positive predictive value, and data quality. Electronic data matching software was used to determine the implications of combining IS data with other provincial-level data sources (e.g., death certificates, electronic vehicle insurance claim system).

Results: Evaluation results indicated that IS was useful, flexible, acceptable, and stable, with a high positive predictive value (99%). Simplicity was limited due to the burden of collecting data on all injuries and use of paper-based data collection forms. Sensitivity was low, with IS only identifying 55% of hospital road traffic death cases identified during active case finding; however, IS cases were representative of cases identified. Data accuracy and completeness varied across data fields. Combining IS with active case finding, death certificates, and the electronic vehicle insurance claim system more than doubled the number of road traffic death cases identified in Phuket.

Conclusion: An efficient and comprehensive road traffic injury and death surveillance system is critical for monitoring Phuket’s road traffic burden. The hospital-based IS system is a useful system for monitoring road traffic deaths and assessing risk behaviors. However, the complexity of data collection and limited coverage hinders the ability of IS to fully represent road traffic deaths in Phuket Province. Combining data sources could improve coverage and should be considered.     

What can a hazard function teach us about drivers’ perception of hazards?

Objective: Hazard perception (HP) is typically defined as the ability to read the road and anticipate hazardous situations. Several studies have shown that HP is a driving skill that correlates with traffic crashes. Measuring HP differences between various groups of drivers typically involves a paradigm in which participants observe short videos of real-world traffic scenes taken from a driver’s or a pedestrian’s perspective and press a response button each time they identify a hazard. Young, inexperienced drivers are considered to have poor HP skills compared to experienced drivers, as evident by their slower response times (RTs) to road hazards. Nevertheless, though several studies report RT differences between young, inexperienced and experienced drivers, other studies did not find such differences. We have already suggested that these contradictory findings may be attributed to how cases of no response—that is, a situation where a participant did not respond to a hazard—are being treated. Specifically, we showed that though survival analysis handles cases of no response appropriately, common practices fail to do so. These methods often replace a case of no response with the mean RT of those who responded or any other central tendency parameters. The present work aims to show that treating cases of no response appropriately as well as selecting a distribution that fits the RT data is more than just a technical phase in the analysis.

Method: This work used simulation of predefined distributions and real-world data.

Results: It was demonstrated that selecting the appropriate distribution and treating nonresponse cases appropriately affect the shape and characteristics of the density, survival, and hazard functions.

Conclusions: The suggested process has the ability to provide researchers with additional information regarding the nature of the traffic scenes that enables differentiating between various hazardous situations and between various users with different characteristics such as age or experience.     

Population-based assessment of a vehicle fleet with seat belts providing lower shoulder belt forces than today

Objective: The objective of this study was to quantify the population-based effects of a lower shoulder belt load limit on front row occupants in frontal car crashes.

Method: Crashes of modern vehicles from the GIDAS (German In-Depth Accident Study) are corrected for bias and projected to the national level. Injury risk functions are computed for the injury severity levels Maximum Abbreviated Injury Scale (MAIS) 2+, MAIS 3+, and fatal, stratified by 2 age cohorts (16–44 years of age and 45 years or older). To assess the field effectivity of a “softer belt,” the projected crash frequency data are modified separately for the 2 age cohorts such that its risk structure represents the risk of a softer belt. Given those 2 samples, the field effectivity of a softer belt is derived for several shares of the younger age cohort according to the injury severity levels MAIS 2+, MAIS 3+, and fatal.

Results: The injury risk distribution of the projected crash frequency data, represented here by the injury risk functions obtained, fits well into the injury risk distribution of other data sets (Sweden, United States, and Japan) given in the literature. The relative effects of a lower belt force are stable over the different ratios of the younger and old age cohorts. At the MAIS 2+ level, a lower belt force can significantly reduce the number of injuries (about 10%). A lower belt force does not significantly affect the number of MAIS 3+ injuries. A lower belt force can, however, more than double the number of fatal injuries.

Conclusions: Because the number of fatal injuries rises dramatically due to lower belt force, the reduction in the number of MAIS 2+ injuries comes at a very high cost. Therefore, whether reducing the belt force limit is the right approach is questionable.