Children's behavioral traits and risk of injury: Analyses from a case-control study of agricultural households

Problem

Children on family agricultural operations have high risk of injury. The association between children's behavioral traits and their risk of injury is not well understood.

Method

Data from the Regional Rural Injury Study-II were used to assess behavioral risk factors for injury to children ages six to < 20 years. A total of 379 injury events (cases) and 1,562 randomly selected controls were identified. Adjusted odds ratios (OR) and 95% confidence intervals (CI), calculated using logistic regression, were used to estimate injury risk in reference to behavioral traits.

Results

Injury risks were greater for children with high levels of depressive symptoms (OR = 1.9, CI = 1.0-3.7) and aggression (OR = 1.6, CI = 0.9-2.7), and low levels of careful/cautious behavior (OR = 1.8, CI = 1.1-2.9). Children with low levels of self-regulation had reduced risks (OR = 0.4, CI = 0.2-0.8).

Discussion

Results suggest that children's behaviors affect their risk of agricultural injury. Additional research could elucidate mechanisms and inform interventions.

Impact on industry

The development of multifaceted, sustainable approaches for prevention is necessary for this unique population. These findings suggest a need for interventions that incorporate specific behavior-related risk factors in the context of family farms and ranches.     

The contribution of traumatic brain injury to the medical and economic outcomes of motor vehicle-related injuries in Ohio

Objective

To describe traumatic brain injury (TBI) among injured roadway users. Aim 1 assessed the association of age, gender, alcohol/drug use, safety equipment use, type of roadway user, metropolitan area, and primary payer with motor vehicle-related TBI outcome. Aim 2 assessed the relationship of motor vehicle-related TBI and risk/protective factors with medical and economic outcomes.

Methods

Population-level hospital and trauma databases from the Ohio Hospital Association and Ohio Department of Public Safety, respectively, were probabilistically linked for 2003 through 2006. Injured roadway users (motor vehicle occupants, motorcyclists, bicyclists, pedestrians, and others) were assessed for TBI, ventilator use, intensive care unit (ICU) admission, injury severity score (ISS), need for rehabilitation, death, and total hospital charges.

Results

The odds of a motor vehicle-related TBI were greater among those not using safety equipment (OR = 1.56). The interactions of alcohol/drug use by gender and of alcohol/drug use by location were significant. Sustaining a TBI increased the odds of requiring ventilation (OR = 3.66), being admitted to the ICU (OR = 2.51), having a high ISS (OR = 4.24), requiring rehabilitation (OR = 2.22), or death (OR = 2.52). When compared with a non-TBI, total hospital charges increased by a factor of 1.35 for a TBI. Hospital charges were $46,441 on average for individuals who sustained a TBI, whereas mean hospital charges were $32,614 for patients with a non-TBI.

Conclusions

Among injured roadway users, individuals who sustain a TBI are more likely to require extensive medical care and have injuries resulting in death.

Impact on industry

Prevention strategies aimed at reducing alcohol use and increasing safety device use should be encouraged to reduce the burden of TBI.     

Rollover injury: effects of near- and far-seating position, belt use, and number of quarter rolls

PURPOSE: Vehicle and occupant responses in rollovers are complex since many factors influence both. This study analyzes the following factors: 1) belt use, 2) seated position with respect to the lead side in the rollover, 3) another front occupant in the crash, and 4) number of quarter rolls. The aim was to improve our understanding of rollover injury mechanisms. METHOD: Rollover accidents were analyzed using 1992-2004 NASS-CDS data. The sample included adult drivers and right-front passengers. All occupants were evaluated and then a subset of non-ejected occupants was analyzed. Using roll direction and seating position, the sample was divided into near- and far-seated occupants. Injury and fatality risks were determined by seatbelt use, occupancy, rollover direction, and number of quarter rolls. Risk was defined as the number of injured (e.g., MAIS 3+) divided by the number of exposed occupants (MAIS 0-6). Significance in differences was determined. A matched-pair analysis was used to determine the risk of serious injury for near- and far-seated occupants who were either belted or unbelted in the same crash. RESULTS: For all occupants, serious injury risks were highest for far-seated, unbelted occupants at 18.1% +/- 4.8%, followed by near-seated unbelted occupants at 12.0% +/- 3.5%. However, the difference was not statistically significant. Belted near- and far-seated occupants had a similar injury risk of 4.3% +/- 1.2% and 4.0% +/- 1.2%, respectively. For non-ejected occupants, serious injury risk was 9.5% +/- 3.2% for far-seated unbelted occupants and 4.9% +/- 2.1% for near-seated unbelted occupants, not a statistically significant difference. Serious injury risk was similar for belted near- and far-seated non-ejected occupants, at 3.6% +/- 1.1%. Seatbelts were 64.2%-77.9% effective in preventing serious injury for all occupants and 62.1%-26.5% for far- and near-seated, non-ejected occupants, respectively. Based on the matched pairs, seatbelts were less effective for near-seated (5.0%) compared to far-seated (2.8%) occupant MAIS 3+F risks. This was similar for non-ejected occupants. An unbelted near-seated occupant increased the risk for a belted far-seated occupant by 2.2 times, whereas an unbelted far-seated occupant increased the risk for a belted near-seated occupant by 10.2 times. For all occupants, the risk of serious injury increased with the number of quarter rolls, irrespective of seated position. For near-seated occupants, seatbelt effectiveness was higher in < or =1 roll than 1+ roll, at 72.3% compared to 28.3%. For far-seated occupants, seatbelt effectiveness was similar in < or =1 and 1+ roll samples at 78.3% and 76.8%, respectively. Near-seated occupants had the lowest serious injury risk when they were the sole occupant in the vehicle. This was also true for non-ejected occupants. However, far-seated occupants had a lower injury risk when another occupant was involved in the crash. CONCLUSIONS: The effect of carrying another occupant appears to reduce the risk of serious injury to far-seated occupants. However, near-seated occupants are better off being the sole occupant in the vehicle. Seatbelt effectiveness was lowest at 28.3% for non-ejected, near-seated occupants in 1+ rolls. This finding deserves further evaluation in an effort to improve seatbelt effectiveness in rollovers. For belted drivers alone in a rollover, fatality risks are 2.24 times higher for the far- versus near-seated position. Analysis of rollovers by quarter turns indicates that occupants are both far-side and near-side in rollovers. The extent to which this confounds the relationship between roll direction, seating position, and injury risk is unknown.     

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

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

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

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

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

Using data linkage to assess the impact of motorized recreational vehicle-related injuries in Ohio

Problem

Motorized recreational vehicle (MRV)-related injuries can result in severe medical and financial consequences. The objective of this study was to describe the epidemiology, and clinical and financial impact of MRV-related injuries in Ohio.

Method

Probabilistically linked statewide Emergency Medical Services (EMS) and hospital (inpatient and emergency department) data for 2003 and 2004 were examined. Record pairs with a MRV-related E-code (E821-E823, E825) were included in this study.

Results

There were 2,893 patients with MRV-related injuries, who had linked EMS and hospital records, resulting in more than $15 million in hospital charges and 1,921 inpatient days of hospitalization. The male-to-female ratio was nearly 4:1, and 19% were younger than 16. Almost 82% of cases were not wearing a helmet; there was a trend of decreasing helmet use with increasing age. Mean (SE) inpatient hospital charges and length of stay (LOS) were $22,218 ($1,290) and 3.8 (0.2) days, respectively. The mean (SE) Injury Severity Score (ISS) for inpatients was 9.2 (0.4). Individuals injured on a street/highway were 3.20 times more likely to sustain an ISS ≥ 16 (95% CI: 1.03, 9.88; p = 0.044) and 3.05 times more likely to sustain a traumatic brain injury (TBI) (95% CI: 1.17, 7.94; p = 0.024) than those who were injured at a place designated for sport or recreation. Children aged 12 to 15 and young adults aged 16 to 25 were 2.47 and 2.14 times more likely, respectively, to sustain a TBI than adults aged 36 or older (aged 12 to 15: 95% CI: 1.13, 5.38; p = 0.024; aged 16 to 25: 95% CI: 1.26, 3.64; p = 0.005). Higher ISS was associated with both higher total charges (p < 0.001) and longer LOS (p < 0.001).

Discussion

This study demonstrates that MRV-related injuries are an important public health problem in Ohio, with a substantial clinical and financial impact.

Impact on Industry

Enactment and enforcement of statewide MRV safety legislation and training of MRV users offer valuable opportunities to prevent these costly injuries.     

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.     

Driver and front passenger injury in frontal crashes: Update on the effect of unbelted rear occupants

Purpose: This is a study of the influence of an unbelted rear occupant on the risk of severe injury to the front seat occupant ahead of them in frontal crashes. It provides an update to earlier studies.

Methods: 1997–2015 NASS-CDS data were used to investigate the risk for severe injury (Maximum Abbreviated Injury Score [MAIS] 4+F) to belted drivers and front passengers in frontal crashes by the presence of a belted or unbelted passenger seated directly behind them or without a rear passenger. Frontal crashes were identified with GAD1 = F without rollover (rollover ≤ 0). Front and rear outboard occupants were included without ejection (ejection = 0). Injury severity was defined by MAIS and fatality (F) by TREATMNT = 1 or INJSEV = 4. Weighted data were determined. The risk for MAIS 4+F was determined using the number of occupants with known injury status MAIS 0+F. Standard errors were determined.

Results: The risk for severe injury was 0.803 ± 0.263% for the driver with an unbelted left rear occupant and 0.100 ± 0.039% with a belted left rear occupant. The driver's risk was thus 8.01 times greater with an unbelted rear occupant than with a belted occupant (P <.001). With an unbelted right rear occupant behind the front passenger, the risk for severe injury was 0.277 ± 0.091% for the front passenger. The corresponding risk was 0.165 ± 0.075% when the right rear occupant was belted. The front passenger's risk was 1.68 times greater with an unbelted rear occupant behind them than a belted occupant (P <.001). The driver's risk for MAIS 4+F was highest when their seat was deformed forward. The risk was 9.94 times greater with an unbelted rear occupant than with a belted rear occupant when the driver's seat deformed forward. It was 13.4 ± 12.2% with an unbelted occupant behind them and 1.35 ± 0.95% with a belted occupant behind them.

Conclusions: Consistent with prior literature, seat belt use by a rear occupant significantly lowered the risk for severe injury to belted occupants seated in front of them. The reduction was greater for drivers than for front passengers. It was 87.5% for the driver and 40.6% for the front passenger. These results emphasize the need for belt reminders in all seating positions.     

Time trends and predictive factors for safety perceptions among incoming South Australian university students

Problem

Young workers are over-represented in injury statistics. In order to develop injury prevention strategies, this study investigated time trends and predictive factors relating to safety skills, confidence, and attitudes.

Method

Annual surveys were conducted from 2006-2009 among incoming students at the University of Adelaide. The questions addressed safety training, injury experience, and health and safety perceptions.

Results

Time trends in training, perceived safety skills, confidence, and attitudes were not significant. In terms of skills and confidence, the most important correlate was safety training outside of high school (odds ratio = 1.6), especially when repeated, assessed, or in face to face mode. Feeling strongly about safety issues was best predicted by injury experience (OR = 1.7) and gender.

Discussion

These results emphasize the value of assessed training, but they are also consistent with published U.S. data, indicating no improvement over time. It is suggested that there be a more integrated approach in safety education, involving schools and workplaces.

Impact on industry

By developing an understanding of student safety perceptions and experiences, this research aims to target strategies to reduce the excess injury rate for young workers. Workplaces should be more aware of the limitations of school-based safety education and a more integrated and evidence-based approach should be developed, involving schools and workplaces.     

Continued progress in the prevention of nail gun injuries among apprentice carpenters: What will it take to see wider spread injury reductions?

Problem

Nail guns are a common source of acute, and potentially serious, injury in residential construction.

Method

Data on nail gun injuries, hours worked and hours of tool use were collected in 2008 from union apprentice carpenters (n = 464) through classroom surveys; this completed four years of serial cross-sectional data collection from apprentices. A predictive model of injury risk was constructed using Poisson regression.

Results

Injury rates declined 55% from baseline measures in 2005 with early training and increased use of tools with sequential actuation. Injury rates declined among users of tools with both actuation systems, but the rates of injury were consistently twice as high among those using tools with contact trip triggers.

Discussion and impact

Nail gun injuries can be reduced markedly through early training and use of tools with sequential actuation. These successful efforts need to be diffused broadly, including to the non-union sector.     

Difference in dummy responses in matched side impact tests of vehicles with and without side airbags

Objective: Insurance Institute for Highway Safety (IIHS) high-hooded side impacts were analyzed for matched vehicle tests with and without side airbags. The comparison provides a measure of the effectiveness of side airbags in reducing biomechanical responses for near-side occupants struck by trucks, SUVs, and vans at 50 km/h.

Method: The IIHS moving deformable barrier (MDB) uses a high-hooded barrier face. It weighs 1,500 kg and impacts the driver side perpendicular to the vehicle at 50 km/h. SID IIs dummies are placed in the driver and left second-row seats. They represent fifth percentile female occupants.

IIHS tests were reviewed for matches with one test with a side airbag and another without it in 2003–2007 model year (MY) vehicles. Four side airbag systems were evaluated: (1) curtain and torso side airbags, (2) head and torso side airbag, (3) curtain side airbag, and (4) torso side airbag.

There were 24 matched IIHS vehicle tests: 13 with and without a curtain and torso side airbags, 4 with and without a head and torso side airbag, 5 with and without a side curtain airbag, and 2 with and without a torso airbag. The head, chest, and pelvis responses were compared for each match and the average difference was determined across all matches for a type of side airbag.

Results: The average reduction in head injury criterion (HIC) was 68 ± 16% (P < .001) with curtain and torso side airbags compared to the HIC without side airbags. The average HIC was 296 with curtain and torso side airbags and 1,199 without them. The viscous response (VC) was reduced 54 ± 19% (P < .005) with curtain and torso side airbags. The combined acetabulum and ilium force (7 ± 15%) and pelvic acceleration (?2 ± 17%) were essentially similar in the matched tests.

The head and torso side airbag reduced HIC by 42 ± 30% (P < .1) and VC by 32 ± 26% compared to vehicles without a side airbag. The average HIC was 397 with the side head and torso airbag compared to 729 without it. The curtain airbag and torso airbag only showed lower head responses but essentially no difference in the chest and pelvis responses.

Conclusion: The curtain and torso side airbags effectively reduced biomechanical responses for the head and chest in 50 km/h side impacts with a high-hooded deformable barrier. The reductions in the IIHS tests are directionally the same as estimated fatality reductions in field crashes reported by NHTSA for side airbags.     

The impact of a standard enforcement safety belt law on fatalities and hospital charges in Ohio

Introduction

The purpose of this study was to analyze linked crash and hospital data to determine the effect that enactment of a standard enforcement safety belt law in Ohio would have on hospital charges and direct medical costs due to motor-vehicle crashes, focusing on the impact to the state's Medicaid system.

Method

The linkage and analysis was conducted as part of the Ohio Crash Outcome Data Evaluation System (CODES) program. Current safety belt usage in Ohio stands at 82% with its secondary enforcement safety belt law.

Results

Assuming an increase in usage to 92% through standard enforcement, over $15.3 million in medical costs to Medicaid for injuries that occur in a single year could be prevented over a 10-year period. Cumulative savings could reach more than $91.2 million during the 10-year period. In addition, 161 fatalities could have been prevented in one year had all unbelted occupants who sustained a fatal injury instead chosen to wear their safety belt.

Summary and Impact on Industry

Clearly, substantial progress can be made in reducing the number of deaths and injuries, as well as medical costs associated with motor-vehicle crashes, by strengthening safety belt laws and increasing safety belt usage in Ohio.     

A traffic safety evaluation of California's traffic violator school citation dismissal policy

Introduction

This study evaluated California's traffic violator school (TVS) citation dismissal policy.

Method

This study identified and compared two large samples of drivers either completing a TVS (N = 210,015) or convicted of a traffic citation (N = 168,563).

Results

Prior to adjudication, the TVS group had characteristics (e.g., lower prior conviction rate and smaller proportion of males) that were predictive of a lower subsequent crash risk. However, the TVS group exhibited significantly more crashes than did the convicted group in the subsequent one-year period. The difference (4.83%) increased to 10% after adjusting for the more favorable characteristics of the TVS group. The TVS group also had a higher adjusted subsequent crash rate at each prior driver record entry level, reflecting a loss in the general and specific deterrence of the non-conviction masked status of TVS dismissed citations. It was reported that the TVS dismissal policy results in approximately 12,300 additional crashes annually with economic costs of approximately $398,000,000.

Conclusions

The avoidance of licensing actions resulting from the dismissal policy assists in explaining why the driving public is exposed to an increased crash risk. A number of recommendations are offered to reduce the negative traffic safety impact of the TVS citation dismissal policy.     

The relationship between recruitment processes, familiarity, trust, perceived risk and safety

Introduction and Method

Participants′ perceptions of the safety-related aspects of their organization′s recruitment processes were examined, as were their perceptions of safety aspects associated with new recruits.

Results

One hundred and fifty-four professional fire fighters indicated the trust they held in the safety-related aspects of their organizations′ selection and pre-start training. Perceived trust in pre-start training was negatively correlated (r = -.24, p < .01) with the risk associated with new recruits, and positively correlated (r = .50, p < .01) with ratings of trust in recruits to immediately work safely. Furthermore, trust in recruits to immediately work safely was negatively correlated (r = -.21, p < .01) with crews′ safety behavior toward recruits.

Conclusions

These results are interpreted as particularly dangerous for workers, as new recruits lack familiarity with aspects of their new workplace that cannot be addressed by either selection or pre-start training, making them a risk.

Impact on Industry

Organizations should actively identify new recruits, and encourage existing team members not to immediately trust new recruits to work safely.     

Enhancing older driver safety: A driving survey and evaluation of the CarFit program

Objective

To evaluate CarFit, an educational program designed to promote optimal alignment of driver with vehicle.

Methods

A driving activity survey was sent to 727 randomly selected participants living in retirement communities. Drivers (n = 195) were assigned randomly to CarFit intervention (n = 83, M age = 78.1) or Comparison (n = 112, M age = 79.6) groups. After 6 months, participants completed a post-test of driving activity and CarFit recommendations.

Results

Nonconsenting drivers were older and participated in fewer driving activities. CarFit participation was moderate (71%) with 86% of the participants receiving recommendations. 60% followed the recommendations at the 6-month re-evaluation). The CarFit (67.6%) and Comparison (59.3%) groups reported at least one type of self-regulation of driving activity at baseline. There was no significant change in the driving behaviors at the six-month follow-up.

Conclusion

CarFit was able to detect addressable opportunities that may contribute to the safety of older drivers.

Impact on industry

CarFit recommendations may need stronger reinforcement in order to be enacted by a participant.     

Motor vehicle restraint system use and risk of spine injury

OBJECTIVE: Motor vehicle collision (MVC)-related spinal injury is a severe and often permanently disabling injury. In addition, strain injuries have been reported as a common outcome of MVCs. Although advances in automobile crashworthiness have reduced both fatalities and severe injuries, the impact of varying occupant restraint systems (seatbelts and airbags) on thoracolumbar spine injuries is unknown. This study examined the relationship between the occurrence of mild to severe cervical and thoracolumbar spine injury and occupant restraint systems among front seat occupants involved in frontal MVCs. METHODS: A retrospective cohort study was conducted among subjects obtained from the 1995-2004 National Automotive Sampling System. Cases were identified based on having sustained a spine injury of >/=1 on the Abbreviated Injury Scale (AIS), 1990 Revision. Risk risks (RRs) and 95% confidence intervals (CIs) were computed comparing occupant restraint systems with unrestrained occupants. RESULTS: We found an overall incidence of AIS1 cervical (11.8%) and thoracolumbar (3.7%) spinal injury. Seatbelt only restraints were associated with increased cervical AIS1 injury (RR = 1.40, 95% CI 1.04-1.88). However, seatbelt only restraints showed the greatest risk reduction for AIS2 spinal injuries. Airbag only restraints reduced thoracolumbar AIS1 injuries (RR = 0.29, 95% CI 0.08-1.04). Seatbelt combined with airbag use was protective for cervical AIS3+ injury overall (RR = 0.29, 95% CI 0.14-0.58), cervical neurological injury (RR = 0.19, 95% CI 0.05-0.81), and thoracolumbar AIS3+ injury overall (RR = 0.20, 95% CI 0.05-0.70). CONCLUSIONS: The results of this study suggest that seatbelts alone or in combination with an airbag increased the incidence of AIS1 spinal injuries, but provide protection against more severe injury to all regions of the spine. Airbag deployment without seatbelt use did not show increased protection relative to unrestrained occupants.     

Are drivers' comparative risk judgments about speeding realistic?

Introduction

This study focused on comparative judgments about speeding risks among young drivers who have a high risk of being involved in a traffic accident.

Method

We examined (a) how these drivers assess their risk of sanctions and their risk of causing an automobile crash because of speeding in comparison to the estimated risks of other drivers, and (b) how realistic their comparative risk judgments are. We measured the relationship between the drivers' comparative risk judgments, self-reported speeding, and driving-related sensation-seeking. We hypothesized that (a) they would think they have less risk of sanctions and of causing a car accident than others, and (b) their comparative judgments of speeding risks would be linked to self-reported speeding and driving-related sensation-seeking. The study was based on a computerized questionnaire survey conducted with 3,002 young drivers (mean age = 22.3) administered by professional investigators.

Results

The results confirmed our hypotheses.

Impact on Industry

In order to improve the effectiveness of prevention measures and to evaluate the effect of them, road-safety interventions should take into account comparative risk judgments about the targeted risk behavior.     

Comparison of risk factors for falls from height between commercial and residential roofers

Introduction

The purpose of this investigation was to compare commercial roofers and residential roofers in terms of their behaviors, beliefs, working conditions, and attitudes toward the use of fall protection devices, which could lead to fall accidents.

Methods

A cross-sectional sample of 252 roofers participated in the survey in the Midwest (Wisconsin, Illinois, Michigan, Indiana, and Iowa).

Results

Residential roofers were more likely to fall (adjusted prevalence ratio = 1.57, 95% CI = 0.86, 2.27) than commercial roofers. Existence of fall protection programs, enforcement of fall protection device use, actual use of fall protection devices, work type, company size, and race/ethnicity were significantly associated with fall accidents.

Impact on industry

This study adds insight into fall accidents from roofs in the construction industry and provides industry-specific cautions against fall accidents that can be reflected in regulatory agency implementation.     

An epidemiologic comparison of injuries presenting to a pediatric emergency department and local urgent care facilities

Problem

The objective of this study was to compare the epidemiology of injuries presenting to emergency department (ED) and urgent care (UC) facilities of a single, NEISS-affiliated hospital.

Method

Patient medical records (n = 36,811) were used to compare injury incidence, injury characteristics, and demographic characteristics between the ED, on-site UC, and off-site UC during 2006.

Results

ED presentations were more likely to be open wounds and motor vehicle-related compared to on-site UC presentations. ED presentations were more likely to be system wide/late effects, be made by an African American, or be paid through Medicaid compared to off-site UC presentations. On-site UC presentations were more likely to be made by an African American or be paid through Medicaid compared to off-site UC presentations.

Discussion

ED and UC injury characteristics and patient demographics differ. With no nationally-representative UC injury surveillance, current research likely underestimates injury incidence and presents skewed profiles. Impact on Industry: This article adds insight into the generalizability of ED-based injury surveillance to UC injuries.     

Occupant injury severity from lateral collisions: A literature review

Problem

Side impacts are a serious automotive injury problem; they represent about 30% of all fatalities for passenger vehicle occupants. This literature review focuses on occupant injuries resulting from real lateral collisions. It emphasizes the interaction between injury patterns and crash factors, taking into account type of injuries and their severity. It highlights what is known on the subject and suggests further studies.

Method

We reviewed papers identified by searches in two electronic databases for the 1996-2009 publication period, and in specific journals and conference proceedings.

Results

Studies on the Primary Direction of Force (PDOF) have revealed that fatal crashes occur most frequently when the PDOF is at 3 or 9 o'clock. The risk of serious injury is two to three times higher for the near-side occupant than for the far-side occupant. Head injuries predominate in oblique impacts and thoracic injuries in perpendicular ones. A few results are also reported on side airbag protection.

Conclusions

This literature review presents an overall picture of the injuries caused by lateral collisions, though each of the papers or articles examined focuses mostly on some particular aspect of the problem. The incidence of specific injuries depends on the data source used. Very few population-based analyses of lateral collision injuries were found.

Impact on industry

New studies are needed to evaluate new protective devices (e.g., lateral airbags, inflatable curtains). Without interfering with their care duties, Emergency Medical Technicians could be systematically trained to observe the collision's specific characteristics and to report all their relevant observations to the emergency physicians to increase the likelihood of prompt diagnosis and proper care.     

Does the built environment affect when American teens become drivers? Evidence from the 2001 National Household Travel Survey

Problem

Motor vehicle crashes are the most common cause of death for American adolescents. However, the impact of where teens live on when they begin driving has not been studied.

Method

Data from the 2001 National Household Travel Survey were used to estimate the effect of residential density on the driver status of teens aged 16 to 19 years after matching on demographic characteristics.

Results

Controlling for demographic characteristics, 16 and 17 year old teens in high density neighborhoods had driver rates 15 percentage points below teens living in less dense areas (p < 0.001). The effect for 18 and 19 year olds was a 9 percentage point decrease (p < 0.001).

Summary

These results suggest teens living in less dense and more sprawling communities initiate driving at a younger age than comparable teens in compact areas, placing them at increased risk for crash related injuries. Impact on Industry: The role of environmental factors, such as neighborhood walkability and provision of transit, should be considered in young driver programs.