Analyzing pedestrian crash injury severity under different weather conditions

Objective: Pedestrians are the most vulnerable road users due to the lack of mass, speed, and protection compared to other types of road users. Adverse weather conditions may reduce road friction and visibility and thus increase crash risk. There is limited evidence and considerable discrepancy with regard to impacts of weather conditions on injury severity in the literature. This article investigated factors affecting pedestrian injury severity level under different weather conditions based on a publicly available accident database in Great Britain.

Method: Accident data from Great Britain that are publicly available through the STATS19 database were analyzed. Factors associated with pedestrian, driver, and environment were investigated using a novel approach that combines a classification and regression tree with random forest approach.

Results: Significant severity predictors under fine weather conditions from the models included speed limits, pedestrian age, light conditions, and vehicle maneuver. Under adverse weather conditions, the significant predictors were pedestrian age, vehicle maneuver, and speed limit.

Conclusions: Elderly pedestrians are associated with higher pedestrian injury severities. Higher speed limits increase pedestrian injury severity. Based on the research findings, recommendations are provided to improve pedestrian safety.     

Risk factors affecting the severity of traffic accidents at Shanghai river-crossing tunnel

Objective: With increasing traffic volume and urban development, increasing numbers of underground tunnels have been constructed to relieve conflict between strained land and heavy traffic. However, as more long tunnels are constructed, tunnel traffic safety is becoming increasingly serious. Thus, it is necessary to acquire their implications and impacts. This study examined 4,539 traffic accidents that have occurred in 14 Shanghai river-crossing tunnels for the period 2011–2012 and analyze the correlation between potential factors and accident injury severity.

Methods: An ordered logit model was developed to examine the correlation between potential factors and accident injury severity.

Results: Results show that increased injury severity is associated with male drivers, drivers aged 65 years or older, accident time from midnight to dawn, weekends, wet road surface, goods vehicles, 3 or more vehicles, 4 or more lanes, middle speed limits (50–79 km/h), zone 3, extra-long tunnels (over 3,000 m), and maximum longitudinal gradient.

Conclusions: This article aims to provide useful information for engineers to develop interventions and countermeasures to improve tunnel safety in China.     

Analyzing injury severity of bus passengers with different movements

Objective: Though public transport vehicles are rarely involved in mass casualty accidents, when they are, the number of injuries and fatalities is usually high due to the high passenger capacity. Of the few studies that have been conducted on bus safety, the majority focused on vehicle safety features, road environmental factors, as well as driver characteristics. Nevertheless, few studies have attempted to investigate the underlying risk factors related to bus occupants. This article presents an investigation aimed at identifying the risk factors affecting injury severity of bus passengers with different movements.

Method: Three different passenger movement types including standing, seated, and boarding/alighting were analyzed individually using classification and regression tree (CART) method based on publicly available accident database of Great Britain.

Results: According to the results of exploratory analyses, passenger age and vehicle maneuver are associated with passenger injury severity in all 3 types of accidents. Moreover, the variable “skidding and overturning” is associated with injury severity of seated passengers and driver age is correlated with injury severity of standing and boarding/alighting passengers.

Conclusions: The CART method shows its ability to identify and easily explain the complicated patterns affecting passenger injury severity. Several countermeasures to reduce bus passenger injury severity are recommended.     

Studded and unstudded winter tires in fatal road accidents in Finland

Objective: The aim of the study was to compare the safety effects of studded and unstudded winter tires based on fatal road accidents.

Methods: The data included 958 road accidents involving a passenger car or van that occurred in Finland from November to March between 1997 and 2012.

Results: Comparing the proportions of winter tire type in accidents and in general traffic showed that the overall effect of tire type on the number of accidents was not significant, although studded tires reduced fatal accidents by 10–15%. Compared to unstudded tires, studded tires reduced accidents significantly only on bald ice in 2005–2012. Drivers using unstudded tires were more experienced and their profession was more frequently related to driving. In addition, the vehicle age was lower for vehicles with unstudded tires. On the other hand, the state of repair was less pertinent for unstudded than for studded tires. These confounding factors offset their effects to some degree.

Conclusions: The risk of fatal road accidents in winter between studded and unstudded tires does not differ significantly. However, the accident risk has recently been substantially higher on bald ice for unstudded than for studded tires. The magnitude of this risk difference is difficult to determine without specific information on exposure by road surface.     

Analysis of posttraumatic stress disorder in children with road traffic injury in Wenzhou,China

Objective: Road traffic accidents are the leading health threat to children and cause significant long-term mental health problems. This study aimed to characterize posttraumatic stress disorder (PTSD) in children suffering from road traffic injuries (RTIs) in Wenzhou, China.

Methods: We conducted a retrospective study of 537 children (aged 1 to 13 years old) with RTIs. The epidemiological features, PTSD incidence, clinical manifestation, and risk factors were analyzed based on a customized PTSD risk factor questionnaire. The outcome factors were also evaluated by means of the logistic regression method.

Results: The PTSD incidence was 24.77% in children with RTIs. The incidence of PTSD was related to the personality, family environment, and family care of the children. It was found that early psychological intervention and reasonable family care from the family might promote physical and mental welfare as well as contribute to the development of more effective treatments to prevent PTSD.

Conclusion: For susceptible children, in addition to dealing with the somatic injury, psychological intervention and family care should be carried out as early as possible.     

How motorcycle helmets affect trauma mortality: Clinical and policy implications

Background: Motorcycles are the most popular vehicles in Taiwan, where more than 14.8 million motorcycles (1 motorcycle per 1.6 people) are in service. Despite the mandatory helmet law passed in 1997, less than 80% of motorcyclists in Taiwan wear helmets.

Objective: The objective of this study was to analyze the effect of using motorcycle helmets on fatality rates.

Methods: A clinical data set including 2,868 trauma patients was analyzed; the cross-sectional registration database was administered by a university medical center in Central Taiwan. A path analysis framework and multiple logistic regressions were used to estimate the marginal effect of helmet use on mortality.

Results: Using a helmet did not directly reduce the mortality rate but rather indirectly reduced the mortality rate through intervening variables such as the severity of head injuries, number of craniotomies, and complications during therapeutic processes. Wearing a helmet can reduce the fatality rate by 1.3%, the rate of severe head injury by 34.5%, the craniotomy rate by 7.8%, and the rate of complications during therapeutic processes by 1.5%. These rates comprise 33.3% of the mortality rate for people who do not wear helmets, 67.3% of the severe head injury rate, 60.0% of the craniotomy rate, and 12.2% of the rate of complications during therapeutic processes.

Discussion: Wearing a helmet and trauma system designation are crucial factors that reduce the fatality rate.     

Transport company safety climate—The impact on truck driver behavior and crash involvement

Objective: The present study investigated the relationships between safety climate and driving behavior and crash involvement.

Methods: A total of 339 company-employed truck drivers completed a questionnaire that measured their perceptions of safety climate, crash record, speed choice, and aberrant driving behaviors (errors, lapses, and violations).

Results: Although there was no direct relationship between the drivers' perceptions of safety climate and crash involvement, safety climate was a significant predictor of engagement in risky driving behaviors, which were in turn predictive of crash involvement.

Conclusions: This research shows that safety climate may offer an important starting point for interventions aimed at reducing risky driving behavior and thus fewer vehicle collisions.     

“Are you still driving?” Metasynthesis of patient preferences for communication with health care providers

Aim: The aim of this study was to synthesize published qualitative studies to identify older adults' preferences for communication about driving with health care providers.

Background: Health care providers play a key role in addressing driving safety and driving retirement with older adults, but conversations about driving can be difficult. Guides exist for family members and providers, but to date less is known about the types of communication and messages older drivers want from their health care providers.

Design: A qualitative metasynthesis of studies published on or before October 10, 2014, in databases (PubMed, CINAHL, PsycINFO, and Web of Science) and grey literature was performed.

Review Methods: Twenty-two published studies representing 518 older adult drivers met the following inclusion criteria: the study (1) was about driving; (2) involved older drivers; (3) was qualitative (rather than quantitative or mixed methods); and (4) contained information on older drivers' perspectives about communication with health care providers.

Results: We identified 5 major themes regarding older adults' communication preferences: (1) driving discussions are emotionally charged; (2) context matters; (3) providers are trusted and viewed as authority figures; (4) communication should occur over a period of time rather than suddenly; and (5) older adults desire agency in the decision to stop driving.

Conclusion: Various stakeholders involved in older driver safety should consider older drivers' perspectives regarding discussions about driving. Health care providers can respect and empower older drivers—and support their family members—through tactful communication about driving safety and mobility transitions during the life course.     

Epidemiology and patterns of facial fractures due to road traffic accidents in Taiwan: A 15-year retrospective study

Objective: The facial region is a commonly fractured site, but the etiology varies widely by country and geographic region. To date, there are no population-based studies of facial fractures in Taiwan.

Methods: We conducted a retrospective study of patients diagnosed with facial fracture and registered in the National Health Insurance Research Database of Taiwan between 1997 and 2011. The epidemiological characteristics of this cohort were analyzed, including the etiology, fracture site, associated injuries, and sex and age distributions.

Results: A total of 6,013 cases were identified that involved facial fractures. Most patients were male (69.8%), aged 18–29 years (35.8%), and had fractures caused by road traffic accidents (RTAs; 55.2%), particularly motorcycle accidents (31.5%). Falls increased in frequency with advancing age, reaching 23.9% among the elderly (age > 65 years). The most common sites of involvement were the malar and maxillary bones (54.0%), but nasal bone fractures were more common among those younger than 18 years.

Conclusion: Most facial injuries in Taiwan occur in young males and typically result from RTAs, particularly involving motorcycles. However, with increasing age, there is an increase in the proportion of facial injuries due to falls.     

A new approach to road accident rescue

Objective: This article develops and validates a new methodology and tool for rescue assistance in traffic accidents, with the aim of improving its efficiency and safety in the evacuation of people, reducing the number of victims in road accidents.

Method: Different tests supported by professionals and experts have been designed under different circumstances and with different categories of damaged vehicles coming from real accidents and simulated trapped victims in order to calibrate and refine the proposed methodology and tool.

Results: To validate this new approach, a tool called App_Rescue has been developed. This tool is based on the use of a computer system that allows an efficient access to the technical information of the vehicle and sanitary information of the common passengers. The time spent during rescue using the standard protocol and the proposed method was compared.

Conclusion: This rescue assistance system allows us to make vital information accessible in posttrauma care services, improving the effectiveness of interventions by the emergency services, reducing the rescue time and therefore minimizing the consequences involved and the number of victims. This could often mean saving lives. In the different simulated rescue operations, the rescue time has been reduced an average of 14%.     

Using negative emotional feedback to modify risky behavior of young moped riders

Objective: The aim of this research was to investigate whether the use of messages with negative emotional content is effective in promoting safe behavior of moped riders and how exactly these messages modulate rider behavior.

Methods: Participants received negative feedback when performing risky behaviors using a computer task. The effectiveness of this treatment was subsequently tested in a riding simulator.

Results: The results demonstrated how riders receiving negative feedback had a lower number of traffic accidents than a control group. The reduction in accidents was accompanied by a set of changes in the riding behavior. We observed a lower average speed and greater respect for speed limits. Furthermore, analysis of the steering wheel variance, throttle variance, and average braking force provided evidence for a more even and homogenous riding style. This greater abidance of traffic regulations and friendlier riding style could explain some of the causes behind the reduction in accidents.

Conclusions: The use of negative emotional feedback in driving schools or advanced rider assistance systems could enhance riding performance, making riders aware of unsafe practices and helping them to establish more accurate riding habits. Moreover, the combination of riding simulators and feedback—for example, in the training of novice riders and traffic offenders—could be an efficient tool to improve their hazard perception skills and promote safer behaviors.     

Examining motorcyclists' postcrash impressions: A qualitative study

Objective: Motorcycle-related crashes and injuries continue to be of great concern in Iran. This study seeks to explore how motorcyclists' perspectives and impressions of a crash are shaped and influence their future riding behaviors.

Methods: This was a qualitative study conducted in 3 major cities in Iran between March 2011 and February 2012. Participants included 31 male motorcyclists, of whom 22 participated in 4 focus groups and 9 in in-depth interviews. Findings were derived through the thematic method of analysis.

Results: Six delineated themes suggest different factors that influence riders' postcrash impressions. These include (1) opposing reactions from family and peers postcrash; (2) the motorcyclist's perception of his or her ability to handle risky road situations; (3) risk-taking attributes; (4) perceived responsibility in meeting family needs; (5) the severity of the crash-related injury; and (6) elapsed time from the crash experience.

Conclusions: Riders' postcrash impressions were formed by the opposing reactions of their family and peers to the crash experience (i.e., the index crash); the personality of riders, including being overconfident and a risk taker; familial obligations; feeling traumatized by the crash; and passage of time. These formed their perceptions, feelings, attitudes, and thoughts about the index crash.

These findings are an important step in understanding how perception and attitudes of motorcyclists are shaped and how these influence their future riding behavior. The needs for interventional studies to assess the effectiveness of road safety risk reduction programs aligned with the riders' degree of postcrash impressions are discussed.     

Orthopedic injury in electric bicycle-related collisions

Objective: Although electric bicycle-related injuries have become the most common reason for hospitalization due to a road crash in China, no study has comprehensively investigated electric bicycle collisions and their impact on orthopedic injuries; such a study may provide evidence to support a new road safety policy.

Methods: A retrospective review of orthopedic injuries from electric bicycle collisions was performed in an urban trauma center. We collected variables including age, gender, location of fracture, presence of open or closed fractures, concomitant vascular, and neurologic injuries.

Results: A total of 2,044 cases were involved in electric bicycle collisions. The orthopedic injury victims were predominantly male and middle aged. The most common orthopedic injury was a femur fracture. Open fractures frequently involved the forearm and tibia/fibula. Male patients were more likely to suffer from multiple fractures and associated injuries than female patients. Fewer patients age 60 years old or older wore helmets at the time of the accident compared to those in other age groups.

Conclusions: Orthopedic injuries from electric bicycle-related accidents cause patients substantial suffering that could lead to serious social consequences. Helmet use and protective clothing or similar safety gear, especially for electric bicycle users, should be required to provide greater protection.     

Analysis of risk factors affecting driver injury and crash injury with drivers under the influence of alcohol (DUI) and non-DUI

Objective: The objective of this research was to study risk factors that significantly influence the severity of crashes for drivers both under and not under the influence of alcohol.

Methods: Ordinal logistic regression was applied to analyze a crash data set involving drivers under and not under the influence of alcohol in China from January 2011 to December 2014.

Results: Four risk factors were found to be significantly associated with the severity of driver injury, including crash partner and intersection type. Age group was found to be significantly associated with the severity of crashes involving drivers under the influence of alcohol. Crash partner, intersection type, lighting conditions, gender, and time of day were found to be significantly associated with severe driver injuries, the last of which was also significantly associated with severe crashes involving drivers not under the influence of alcohol.

Conclusions: This study found that pedestrian involvement decreases the odds of severe driver injury when a driver is under the influence of alcohol, with a relative risk of 0.05 compared to the vehicle-to-vehicle group. The odds of severe driver injury at T-intersections were higher than those for traveling along straight roads. Age was shown to be an important factor, with drivers 50–60 years of age having higher odds of being involved in severe crashes compared to 20- to 30-year-olds when the driver was under the influence of alcohol.

When the driver was not under the influence of alcohol, drivers suffered more severe injuries between midnight and early morning compared to early nighttime. The vehicle-to-motorcycle and vehicle-to-pedestrian groups experienced less severe driver injuries, and vehicle collisions with fixed objects exhibited higher odds of severe driver injury than did vehicle-to-vehicle impacts. The odds of severe driver injury at cross intersections were 0.29 compared to travel along straight roads. The odds of severe driver injury when street lighting was not available at night were 3.20 compared to daylight. The study indicated that female drivers are more likely to experience severe injury than male drivers when not under the influence of alcohol. Crashes between midnight and early morning exhibited higher odds of severe injury compared to those occurring at other times of day.

The identification of risk factors and a discussion on the odds ratio between levels of the impact of the driver injury and crash severity may benefit road safety stakeholders when developing initiatives to reduce the severity of crashes.     

Identifying risky drivers with simulated driving

Objective: The present study aimed to examine whether high-risk drivers differ from low-risk drivers in driving behavior in a simulated environment.

Method: The 2 risk groups including 36 drivers (18 males and 18 females) performed driving tasks in a simulated environment. The simulated driving behaviors are compared between the 2 risk groups.

Results: The high-risk drivers drove much faster and exhibited larger offsets of the steering wheel than did the low-risk drivers in events without incidents. Additionally, the high-risk drivers used turn signals and horns less frequently than the low-risk drivers.

Conclusions: The present study revealed that the high-risk group differed from the low-risk group in driving behavior in a simulated environment. These results also suggest that simulated driving tasks might be useful tools for the evaluation of drivers’ potential risks.     

Factors affecting conviction rates of intoxicated driver patients in two large trauma centers

Objective: Outcomes from previous studies report the driving under the influence (DUI) conviction rates for trauma patients in several cities within Canada and the United States over the last 2 decades. This study reports charge, conviction, and prosecution rates for trauma patients at 2 level I trauma centers servicing a large metropolitan city.

Methods: A retrospective review of the trauma databases was completed to identify patients meeting inclusion criteria. Four hundred sixty patients were identified and their records were compared with the district attorney's records for DUI charges and convictions.

Results: The conviction rate for this study was 8.7%, demonstrating continued low rates of conviction despite growing interest and public awareness of drinking and driving.

Conclusions: We discuss legal considerations that providers should consider when treating patients who have been drinking and driving.     

Road accident fatality risks for “vulnerable” versus “protected” road users in northern Ghana

Background: Road traffic injuries (RTIs) are a serious epidemic that claims more than a million lives across the globe each year. The burden of RTIs is particularly pronounced in Africa and other low- and middle-income countries. The unfavorable disparity of the burden of road trauma in the world is largely attributable to unsafe vehicles, lack of appropriate road infrastructure, and the predominance of vulnerable road users (VRUs) in developing countries. However, little research exists in northern Ghana to highlight the scale and risk of death among road users.

Objective: The objective of this research was to establish the relative risk of death among road users in northern Ghana.

Methods: Crash data from police reports between 2007 and 2011 were analyzed for the Upper Regions of Ghana. Conditional probabilities and multivariable logistic regression techniques were used to report proportions and adjusted odds ratios (AORs), respectively.

Results: Generally, crashes in northern Ghana were extremely severe; that is, 35% of all injury related collisions were fatal. The proportion of fatal casualties ranged between 21% among victims of sideswipe collisions and 41% among pedestrians and victims of rear-end collisions. Though males were 6 times more likely to die than females overall, females were more likely to die as pedestrians (90% of all female casualty deaths) and males were more likely to die as riders/drivers (78% of all male casualty deaths). Pedestrians were 3 times more likely to die (odds ratio [OR] = 3.1; 95% confidence interval [CI], 2.4 to 4.1) compared with drivers/riders. Compared with drivers, the odds of death among cyclists was about 4 times higher (AOR = 3.6; 95% CI, 2.3 to 5.6) and about 2 times higher among motorcyclists (AOR = 1.6; 95% CI, 1.2 to 2.2). Compared with casualties aged between 30 and 59 years, children under 10 years and those aged 60 years and above were independently 2 times more likely to die in traffic collisions.

Conclusion: Provision of requisite road infrastructure is vital for the safety of VRUs in northern Ghana. Cycle paths and lanes (for cyclists) as well as sidewalks (for pedestrians) in particular will separate VRUs from motorists and improve their safety. Enforcement of traffic laws particularly regarding helmet use, speeding, and alcohol use will be beneficial. Introduction of the demerit points system in the enforcement of traffic regulations may have significant deterrent effects on road users who have the penchant for violating traffic regulations. Road safety education is also required to create responsible road users.     

A new method to assess the deformations of internal organs of the abdomen during impact

Objectives: Due to limitations of classic imaging approaches, the internal response of abdominal organs is difficult to observe during an impact. Within the context of impact biomechanics for the protection of the occupant of transports, this could be an issue for human model validation and injury prediction.

Methods: In the current study, a previously developed technique (ultrafast ultrasound imaging) was used as the basis to develop a protocol to observe the internal response of abdominal organs in situ at high imaging rates. The protocol was applied to 3 postmortem human surrogates to observe the liver and the colon during impacts delivered to the abdomen.

Results: The results show the sensitivity of the liver motion to the impact location. Compression of the colon was also quantified and compared to the abdominal compression.

Conclusions: These results illustrate the feasibility of the approach. Further tests and comparisons with simulations are under preparation.     

The analysis of influence of individual and environmental factors on 2-wheeled users’ injuries

Objective: Powered 2-wheeled motor vehicles (PTWs) are one of the most vulnerable categories of road users. Bearing that fact in mind, we have researched the effects of individual and environmental factors on the severity and type of injuries of PTW users. The aim was to recognize the circumstances that cause these accidents and take some preventive actions that would improve the level of road safety for PTWs.

Methods: In the period from 2001 to 2010, an analysis of 139 road accidents involving PTWs was made by the Faculty of Transport and Traffic Engineering in Belgrade. The effects of both individual (age, gender, etc.) and environmental factors (place of an accident, time of day, etc.) on the cause of accidents and severity and type of injuries of PTWs are reported in this article. Analyses of these effects were conducted using logistic regression, chi-square tests, and Pearson's correlation.

Results: Factors such as categories of road users, pavement conditions, place of accident, age, and time of day have a statistically significant effect on PTW injuries, whereas other factors (gender, road type; that is, straight or curvy) do not. The article also defines the interdependence of the occurrence of particular injuries at certain speeds. The results show that if PTW users died of a head injury, these were usually concurrent with chest injuries, injuries to internal organs, and limb injuries.

Conclusions: It has been shown that there is a high degree of influence of individual factors on the occurrence of accidents involving 2-wheelers (PTWs/bicycles) but with no statistically significant relation. Establishing the existence of such conditionalities enables identifying and defining factors that have an impact on the occurrence of traffic accidents involving bicyclists or PTWs. Such a link between individual factors and the occurrence of accidents makes it possible for system managers to take appropriate actions aimed at certain categories of 2-wheelers in order to reduce casualties in a particular area. The analysis showed that most of the road factors do not have a statistically significant effect on either category of 2-wheeler. Namely, the logistic regression analysis showed that there is a statistically significant effect of the place of accident on the occurrence of accidents involving bicyclists.     

Analysis of car-to-bicycle approach patterns for developing active safety devices

Objective: To reduce the severity of injuries and the number of cyclist deaths in traffic accidents, active safety devices providing cyclist detection are considered to be effective countermeasures. The features of car-to-bicycle collisions need to be known in detail to develop such safety devices.

Methods: The study investigated near-miss situations captured by drive recorders installed in passenger cars. Because similarities in the approach patterns between near-miss incidents and real-world fatal cyclist accidents in Japan were confirmed, we analyzed the 229 near-miss incident data via video capturing bicycles crossing the road in front of forward-moving cars. Using a video frame captured by a drive recorder, the time to collision (TTC) was calculated from the car's velocity and the distance between the car and bicycle at the moment when the bicycle initially appeared.

Results: The average TTC in the cases where bicycles emerged from behind obstructions was shorter than that in the cases where drivers had unobstructed views of the bicycles. In comparing the TTC of car-to-bicycle near-miss incidents to the previously obtained results of car-to-pedestrian near-miss incidents, it was determined that the average TTC in car-to-bicycle near-miss incidents was significantly longer than that in car-to-pedestrian near-miss incidents.

Conclusions: When considering the TTC in the test protocol of evaluation for safety performance of active safety devices, we propose individual TTCs for evaluation of cyclist and pedestrian detections, respectively. In the test protocols, the following 2 scenarios should be employed: bicycle emerging from behind an unobstructed view and bicycle emerging from behind obstructions.