Road traffic crashes among farm vehicle drivers in southern China: A cross-sectional survey

Objective: The objective of this study was to identify the prevalence and potential risk factors of farm vehicle–related road traffic crashes among farm vehicle drivers in southern China.

Methods: A cross-sectional study was used to interview 1,422 farm vehicle drivers in southern China. Farm vehicle–related road traffic crashes that occurred from December 2013 to November 2014 were investigated. Data on farm vehicle–related road traffic crashes and related factors were collected by face-to-face interviews.

Results: The prevalence of farm vehicle–related road traffic crashes among the investigated drivers was 7.2%. Farm vehicle–related road traffic crashes were significantly associated with self-reported vision problem (adjusted odds ratio [AOR] = 6.48, 95% confidence interval [CI], 3.86–10.87), self-reported sleep disorders (AOR = 10.03, 95% CI, 6.28–15.99), self-reported stress (AOR = 20.47, 95% CI, 9.96–42.08), reported history of crashes (AOR = 5.40, 95% CI, 3.47–8.42), reported history of drunk driving (AOR = 5.07, 95% CI, 2.97–8.65), and reported history of fatigued driving (AOR = 5.72, 95% CI, 3.73–8.78). The number of road traffic crashes was highest in the daytime and during harvest season. In over 96% of farm vehicle–related road traffic crashes, drivers were believed to be responsible for the crash. Major crash-causing factors included improper driving, careless driving, violating of traffic signals or signs, and being in the wrong lane.

Conclusion: Findings of this study suggest that farm vehicle–related road traffic crashes have become a burgeoning public health problem in China. Programs need to be developed to prevent farm vehicle–related road traffic crashes in this emerging country.     

Factors associated with prehospital death among traffic accident patients in Osaka City,Japan: A population-based study

Objective: Although it is important to assess the factors associated with traffic accident fatalities to decrease them as a matter of public health, such factors have not been fully identified.

Methods: Using a large-scale data set of ambulance records in Osaka City, Japan, we retrospectively analyzed all traffic accident patients transported to hospitals by emergency medical service personnel from 2013 to 2014. In this study, prehospital death was defined as that occurring at the scene or in the emergency department immediately after hospital arrival. We assessed prehospital factors associated with prehospital death due to traffic accidents by logistic regression models.

Results: This study enrolled 28,903 emergency patients involved in traffic accidents, of whom 68 died prehospital. In a multivariate model, elderly patients aged ≥75 years (adjusted odds ratio [AOR] = 4.34; 95% confidence interval [CI], 2.29–8.23), nighttime (AOR = 2.75; 95% CI, 1.65–4.70), and type of injured person compared to bicyclists such as pedestrians (AOR = 9.58; 95% CI, 5.07–17.99), motorcyclists (AOR = 2.75; 95% CI, 1.21–6.24), and car occupants (AOR = 2.98; 95% CI, 1.39–6.40) were significantly associated with prehospital death due to traffic accidents. In addition, the AOR for automobile versus nonautomobile as the collision opponent was 4.76 (95% CI, 2.30–9.88).

Conclusions: In this population, the factors associated with prehospital death due to traffic accidents were elderly people, nighttime, and pedestrian as the type of patient. The proportion of prehospital deaths due to traffic accidents was also high when the collision component was an automobile.     

Fatally injured drivers in Norway 2005–2015—Trends in substance use and crash characteristics

Objective: Norway introduced a “Vision Zero” strategy in 2001, using multiple approaches, aiming toward a future in which no one will be killed or seriously injured in road traffic crashes (RTCs). Official statistics show that the number of fatally injured road users has declined substantially from 341 deaths in 2000 to 117 in 2015. In-depth crash investigations of all fatal RTCs started in Norway in 2005. The aim of this study was to investigate whether fatal crash characteristics, vehicle safety features, and prevalence of drugs and/or alcohol among fatally injured drivers and riders has changed during 2005–2015, accompanying the reduction in road fatalities.

Methods: Data on all car/van drivers and motorcycle/moped riders fatally injured in RTCs during 2005–2015 were extracted from Norwegian road traffic crash registries and combined with forensic toxicology data.

Results: The proportion of cars and motorcycles with antilock braking systems and cars with electronic stability control, increased significantly during the study period. The prevalence of nonuse of seat belts/helmets and speeding declined among both fatally injured drivers and riders. In addition, the prevalence of alcohol declined, though no significant change in the total prevalence of other substances was noted.

Conclusion: The observed changes toward more safety installations in cars and motorcycles and lower prevalence of driver-related risk factors like alcohol use, speeding, and nonuse of seat belts/helmets among fatally injured drivers/riders may have contributed to the decrease in road traffic deaths.     

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

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

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

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

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

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.     

Independent factors associated with bicycle helmet use in a Korean population: A cross-sectional study

Objective: Although identification of factors that influence helmet use during bicycle riding is necessary for the selection of groups that require safe cycling education, limited baseline data are available. The aim of the present study was to analyze the rate of helmet use and the demographic factors that were independently associated with helmet use among Korean bicycle riders.

Methods: In this cross-sectional study, we used public data from the Sixth Korean National Health and Nutrition Examination Survey conducted in 2013 and 2014. Helmet users were defined as subjects who always, usually, or frequently wore helmets when cycling. Independent factors associated with helmet use were determined using odds ratios (ORss) adjusted for 5 demographic factors via multivariate logistic regression analysis.

Results: In the total population, 4,103 individuals were bicycle riders; among these, 782 individuals (19.1%) wore helmets. A total of 21.1% of male riders used helmets, compared to 15.5% of female riders (P <.001). The adjusted logistic regression model revealed that female sex (OR = 0.665; 95% confidence interval [CI], 0.554–0.797), teenage status (OR = 0.475, 95% CI, 0.333–0.678), and low household income (OR = 0.657, 95% CI 0.513–0.841) were significantly associated with nonuse of helmets.

Conclusions: Female sex, teenage status, and low household income were independent factors associated with the nonuse of helmets. We identified factors associated with helmet use during bicycle riding through analysis of baseline data on helmet usage.     

Motorists' knowledge,attitudes and practices toward alcohol-impaired driving/riding in Ghana

Objectives: The main objective of this study was to establish the knowledge, attitudes, and practices toward drink driving/riding as a risk factor for road traffic crashes in 3 regional capitals in Ghana.

Methods: The study used a face-to-face approach to randomly sample motorists who were accessing various services at fuel/gas stations, garages, and lorry terminals in 3 cities in Ghana.

Results: Over the previous 12 months, 24% of all motorists and 55% of motorists who were current alcohol users reported driving or riding a vehicle within an hour of alcohol intake. On average, motorists/riders who were current alcohol users consumed 4 standard drinks per drinking occasion. Generally, 83% of motorists who currently use alcohol walked, rode, or drove home after consuming alcohol away from their homes. Motorists/riders who reported drink driving were 4 times more likely to have had previous traffic violation arrests compared to those who reported no drink driving/riding (P =.001). Respondents were of the opinion that speeding was the major cause of traffic crashes, followed by driver carelessness, poor road conditions, inexperienced driving, and drink driving, in that order. Thirty-six percent of motorists who use alcohol had the perception that consuming between 6 and 15 standard drinks was the volume of alcohol that will take them to the legal blood alcohol concentration (BAC) limit of 0.08%. Compared to females, male motorists/riders were more likely to report drink driving (adjusted odds ratio [AOR] = 5.15; 95% confidence interval [CI], 2.31 to 11.47). Private motorists also reported a higher likelihood of drink driving compared to commercial drivers (AOR = 3.36; 95% CI, 1.88 to 6.02). Only 4% of motorists knew the legal BAC limit of Ghana and only 2% had ever been tested for drink driving/riding.

Conclusion: The volumes of alcohol that motorists typically consume per drinking occasion were very high and their estimates of the number of drinks required to reach the legal BAC limit was also very high. Provision of authoritative information advising motorists about safe, responsible, or low-risk levels of alcohol consumption is imperative. Many traffic violations including drink driving were reported, thus suggesting a need for enhanced policing and enforcement. However, given the low level of knowledge of the legal BAC limit, educating motorists about how many drinks will approximate the legal BAC should be intensified prior to an increase in enforcement; otherwise, the desired outcome of enforcement may not be achieved.     

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.     

Risk factors for motorcycle loss-of-control crashes

Objective: The present article identifies and assesses the effect of critical factors on the risk of motorcycle loss-of-control (LOC) crashes.

Method: Data come from a French project on road crashes, which include all fatal road crashes and a random sample of 1/20th of nonfatal crashes in France in 2011, based on police reports. A case–control study was carried out on a sample of 903 crashes for 444 LOC motorcycle riders (case) and 470 non-LOC and nonresponsible motorcycle riders (control). The sample was weighted due to the randomization of nonfatal crashes. Missing values were imputed using multiple imputation.

Results: Road alignment and surface conditions, human factors, and motorcycle type played important roles in motorcycle LOC crashes. Riding in a curve was associated with a 3-fold greater risk of losing control of motorcycle than riding in a straight line. Poor road adhesion significantly increased the risk of losing control; the risk increased more than 20-fold when deteriorated road adhesion was encountered unexpectedly, due to loose gravel, ice, oil, bumps, road marking, metal plates, etc. For motorcyclists, riding with a positive blood alcohol concentration (over or equal to the legal limit of 0.5 g/L) was very dangerous, often resulting in losing control. The risk of LOC crash varied for different types of motorcycle: Riders of roadsters and sports bikes were more likely to have an LOC crash greater than that of riders of basic or touring motorcycles. In addition, LOC risk increased with speed; a model using the square of the traveling speed showed better fit than one using speed itself.

Conclusion: The LOC crash factors related to riders, vehicles, and road infrastructure identified here were expected but were rarely identified and taken simultaneously into account in previous studies. They could be targeted by countermeasures to improve motorcyclist safety.     

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.     

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.     

Impact of helmet use on traumatic brain injury from road traffic accidents in Cambodia

Objective: Rapid urbanization and motorization without corresponding increases in helmet usage have made traumatic brain injury due to road traffic accidents a major public health crisis in Cambodia. This analysis was conducted to quantify the impact of helmets on severity of injury, neurosurgical indication, and functional outcomes at discharge for motorcycle operators who required hospitalization for a traumatic brain injury following a road traffic accident in Cambodia.

Methods: The medical records of 491 motorcycle operators who presented to a major tertiary care center in Cambodia with traumatic brain injury were retrospectively analyzed using multivariate logistic regression.

Results: The most common injuries at presentation were contusions (47.0%), epidural hematomas (30.1%), subdural hematomas (27.9%), subarachnoid hemorrhages (12.4%), skull fractures (21.4%), and facial fractures (18.5%). Moderate-to-severe loss of consciousness was present in 36.3% of patients. Not wearing a helmet was associated with an odds ratio of 2.20 (95% confidence interval [CI], 1.15–4.22) for presenting with moderate to severe loss of consciousness compared to helmeted patients. Craniotomy or craniectomy was indicated for evacuation of hematoma in 20.0% of cases, and nonhelmeted patients had 3.21-fold higher odds of requiring neurosurgical intervention (95% CI, 1.25–8.27). Furthermore, lack of helmet usage was associated with 2.72-fold higher odds of discharge with functional deficits (95% CI, 1.14–6.49). In total, 30.1% of patients were discharged with severe functional deficits.

Conclusions: Helmets demonstrate a protective effect and may be an effective public health intervention to significantly reduce the burden of traumatic brain injury in Cambodia and other developing countries with increasing rates of motorization across the world.     

Calling,texting, and searching for information while riding a motorcycle: A study of university students in Vietnam

Objective: The objective of this study was to investigate the prevalence of calling, texting, and searching for information while riding a motorcycle among university students and the influences of sociodemographic characteristics, social norms, and risk perceptions on these behaviors.

Methods: Students at 2 university campuses in Hanoi and Ho Chi Minh City, the 2 largest cities in Vietnam, were invited to participate in an anonymous online survey. Data collection was conducted during March and May 2016.

Results: There were 741 respondents, of whom nearly 90% of students (665) were motorcycle riders. Overall prevalence of mobile phone use while riding is 80.9% (95% confidence interval [CI], 77.9–83.9%) with calling having a higher level of prevalence than texting or searching for information while riding: 74% (95% CI, 70.7–77.3%) vs. 51.7% (95% CI, 47.9–55.5%) and 49.9% (95% CI, 46.1–53.7%), respectively. Random parameter ordered probit modeling results indicate that mobile phone use while riding is associated with gender, motorcycle license duration, perceived crash risk, perceived risk of mobile phone snatching, and perceptions of friends' mobile phone use while riding.

Conclusions: Mobile phone use while riding a motorcycle is highly prevalent among university students. Educational programs should focus on the crash and economic risk of all types of mobile phone use while riding, including calling, texting, and searching for information. In addition, they should consider targeting the influence of social norms and peers on mobile phone use while riding.     

Risk factors for being the at-fault driver: A case–control study

Objective: It is estimated that road traffic accidents are globally responsible for approximately 1.2 million deaths and 20 to 50 million injuries. About 70% of traffic incidences (TIs) occur in developing countries and among countries with high TI rates; Iran is the first. The aim of this study was to measure the association between being responsible for a traffic accident and some vehicle, human; and environmental related factors in Yasuj, a city with a high incidence of road traffic injuries and deaths in Iran.

Methods: This is a time-, date-, and place-matched case–control study conducted in 2015 using all traffic accidents registered and investigated by police during 2012. In total, 194 drivers were considered the at-fault driver in a traffic accident and the 194 drivers in the same collisions were included in the analysis.

Results: Based on the results from multivariate conditional logistic regression, significant associations between vehicle maneuver (OR_{Turn to right or left/Moving forward} = 11.10, 95% confidence interval [CI], 1.77–69.58, P = .01) and age (odds ratio [OR] = 1.11, 95% CI, 1.004–1.22, P = .04) and the chance of being an at-fault driver were found.

Conclusion: Driver behavior–related interventions including training and law enforcement seem to be more effective in reducing road traffic accidents in Iran.     

Evaluating the impact of criminalizing drunk driving on years of life lost due to road traffic deaths in one megacity,China

Objective: Road safety is an important public health issue worldwide. However, few studies have analyzed the association between criminalizing drunk driving and years of life lost (YLL) due to road traffic deaths (RTDs). Our study can provide useful information about this policy.

Methods: We used interrupted time-series analysis to find the changes in monthly YLL and RTD before and after law enforcement began using RTD data from 2008 to 2014 in Tianjin.

Results: After adjustment for seasonality, months, holidays, and the number of people in each district, criminalizing drunk driving was followed by a 11.1% (95% confidence interval [CI], 1.1–21.1%) reduction in risk of RTDs and a corresponding 778.1-year (95% CI, 200–1,355.1) reduction in monthly YLL. The reduction in YLL was especially significant among males, those aged 16–64 years old, and suburban residents.

Conclusions: This study highlights that the law can lead to a reduction in YLL due to RTDs in Tianjin, China. Large immediate public health benefits resulted from the new road traffic law in China. YLL provides a complementary measure for examining the effect of criminalization on drunk driving RTDs.     

Trends and patterns in fatal US motorcycle crashes, 2000–2016

Objective: To investigate trends of motorcyclist fatalities and identify at-risk populations by motorcyclist demographics and crash characteristics.

Methods: We used the Fatality Analysis Reporting System (FARS) database (2000–2016) to track fatality rate trends, which were quantified by using Poisson mixed-effects regression models comparing 2000–2001 and 2007–2008, as well as 2009–2010 and 2015–2016.

Results: The overall fatality rate per 100,000 population increased from 2000 to 2016, defined by two trend lines—before and after the economic recession in 2008–2009. The overall fatality rate ratio between 2000–2001 and 2007–2008 was 1.60 [95% Confidence Interval (CI): 1.51–1.70], and between 2009–2010 and 2015–2016 was 1.09 (95% CI: 1.02–1.18). Fatality rates increased among all age groups, particularly for motorcyclists aged 60 and older. Those aged 18–29 had the highest fatality rates overall. Age-and-sex standardized state fatality rates were consistently highest in Wyoming, South Dakota, and South Carolina and lowest in Massachusetts, New York and New Jersey.

Conclusion: Motorcycle fatality rates increased overall and across all age groups between 2000 and 2016. Fatalities for the oldest riders showed the steadiest increasing trends. Results highlight the continued public health burden of motorcyclist fatalities and, by extension, the importance of improving motorcycle safety.     

The casualties from electric bike and motorized scooter road accidents

Objective: The objective of this study was to describe demographic and injury characteristics of hospitalized injured patients involved in e-bike and motorized scooter accidents at a national level in Israel divided by different road user groups: riders and pedestrians.

Methods: This was a retrospective study based on data from the National Trauma Registry, between January 1, 2013, and December 31, 2015. All hospitalized casualties due to the involvement of an e-bike or motorized scooter were included. The type of hospitalized road user was further categorized and described by different variables.

Results: During the study period, the Israel Trauma Registry identified 795 hospitalized patients due to an e-bike or motorized scooter accident, with a dramatic 6-fold increase from 2013 to 2015. Although the majority of the injured patients were riders, 8% were pedestrians. Among the total casualties, 33% were children aged 0–14 years and among pedestrians 42% were children and 33% were seniors (ages 60+). Five persons died in hospital, 3 riders and 2 pedestrians.

Conclusions: E-bike and motorized scooter riders represent the majority of patients hospitalized due to related traffic incident. This finding questions the social and economic advantages of electric-powered 2-wheeled vehicles.     

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.     

Suicide by crashing into a heavy vehicle: Focus on professional drivers using in-depth crash data

Objective: Road traffic suicides typically involve a passenger car driver crashing his or her vehicle into a heavy vehicle, because death is almost certain due to the large mass difference between these vehicles. For the same reason, heavy-vehicle drivers typically suffer minor injuries, if any, and have thus received little attention in the research literature. In this study, we focused on heavy-vehicle drivers who were involved as the second party in road suicides in Finland.

Methods: We analyzed 138 road suicides (2011–2016) involving a passenger car crashing into a heavy vehicle. We used in-depth road crash investigation data from the Finnish Crash Data Institute.

Results: The results showed that all but 2 crashes were head-on collisions. Almost 30% of truck drivers were injured, but only a few suffered serious injuries. More than a quarter reported sick leave following their crash. Injury insurance compensation to heavy-vehicle drivers was just above €9,000 on average. Material damage to heavy vehicles was significant, with average insurance compensation paid being €70,500. Three out of 4 truck drivers reported that drivers committing suicide acted abruptly and left them little opportunity for preventive action.

Conclusions: Suicides by crashing into heavy vehicles can have an impact on drivers’ well-being; however, it is difficult to see how heavy-vehicle drivers could avoid a suicide attempt involving their vehicle.