Pediatric electric bicycle injuries and comparison to other pediatric traffic injuries

Objective: The objective of this study was to conduct a comprehensive analysis of demographics, injury characteristics and hospital resource utilization of significant pediatric electric bicycle (e-bike) injuries leading to hospitalization following an emergency department visit in comparison to pediatric injuries caused by other traffic related mechanisms.

Methods: A retrospective review of all pediatric traffic injury hospitalizations following an emergency department visit to a level I trauma center between October 2014 and September 2016 was conducted. Data regarding age, sex, number of computed tomography (CT) scans obtained, number of major procedures, length of hospital stay (LOS), Injury Severity Score (ISS), and number of injuries per patient were collected and compared between e-bike injuries and other traffic injuries.

Results: Three hundred thirty-seven admissions were analyzed: 46 (14%) were due to e-bike injuries (29% of patients >12 years). Age, proportion of brain injuries, and use of CT were significantly increased compared to mechanical bicycle injuries (13.1?±?3.4 vs. 10.6?±?3.6, 13% vs. 3%, 1 [0–3] vs. 1 [0–1], P < .01, P = .03, P = .05). Age, LOS, and use of CT were significantly increased compared to injuries caused to automobile passengers (13.1?±?3.4 vs. 7.4?±?5.3, 1 [1–3] vs. 1 [1–2], 1 [0–3] vs. 0 [0–1], P < .01, P = .03, P = .01), as well as ISS and number of injuries per patient (P = .04, P < .01). Injuries caused by e-bikes were similar to injuries caused to pedestrians, except for age (13.1?±?3.4 vs. 8.5?±?3.7, P < .01). Multivariable analysis revealed a significant association between mechanism of injury and ISS, with increased ISS among e-bike injuries compared to mecahnical bike injuries (OR 2.56, CI 1.1–5.88, P = 0.03) and automobile injuries (OR 4.16, CI 1.49–12.5, (P < .01).

Conclusion: E-bikes are a significant cause of severe injury in children compared to most other traffic injuries, particularly in older children.     

The effect of helmets on motorcycle outcomes in a level I trauma center in Connecticut

Objective: The State of Connecticut has a partial motorcycle helmet law, which has been linked to one of the lowest helmet compliance rates in the Northeast. We examine the clinical and financial impact of low motorcycle helmet use in the State of Connecticut.

Methods: A retrospective cohort study comparing the outcomes between helmeted and nonhelmeted motorcycle crash victims over a 12.5-year period, from July 2, 2002, to December 31, 2013. All patients who were admitted to the hospital after a motorcycle crash were included in the study. Patients were stratified into helmeted and nonhelmeted cohorts. Group differences were compared using t-test or Wilcoxon rank test for continuous variables and chi-square test for dichotomous outcomes. Regression models were created to evaluate predictors of helmet use, alcohol and drugs as confounding variables, and factors that influenced hospital costs.

Results: The registry included 986 eligible patients. Of this group, 335 (34%) were helmeted and 651 (66%) were nonhelmeted. Overall, nonhelmeted patients had a worse clinical presentation, with lower Glasgow Coma Scale (GCS; P <.01), higher Injury Severity Score (ISS; P <.01), higher incidence of loss of consciousness (LOC; P <.01), longer intensive care unit (ICU; P <.01) admissions, and higher incidence of head (P <.01) or face injuries (P <.01). Nonhelmeted patients were also twice as more likely to die from their injuries (P =.04, odds ratio [OR] = 1.89, 95% confidence interval [CI], 1.02–3.45). Financially, nonhelmeted patients incurred mean hospital costs of $18,458, whereas helmeted patients incurred $14,970 (P =.18). ISS, GCS, and ICU length of stay were significantly correlated with increased hospital costs (P <.01). Not using a helmet was a significant predictor of mortality (P =.04) after adjusting for alcohol/drug use and age.

Conclusions: Helmet use is associated with lower injury severity and increased survival after a motorcycle crash. These outcomes remained consistent even after controlling for age and alcohol and drug use. The medical and financial impact of Connecticut's partial helmet law should be carefully evaluated to petition for increased education and enforcement of helmet use.     

Decomposition analysis of the effects of vehicle safety technologies on the motor vehicle collision–related mortality rate from 1994 to 2015

Abstract

Objective: Though the mortality rate for motor vehicle collisions (MVCs) has been decreasing since the 1960s with the advent of the first federal seat belt laws in 1968, MVC remains a leading cause of death for individuals aged 1 to 44 years. The purpose of this study is to examine the effects of frontal (FABs) and side airbags (SABs) and electronic stability control (ESC) on the components of the MVC mortality rate.

Methods: The MVC mortality rate from 1994 to 2015 was separated into its components of exposure of vehicles, exposure of travel, collision density, injury incidence, and case fatality rate. Year was categorized on the availability of safety technology in vehicles: 1994–1997 (first-generation FABs mandated), 1998–2001 (sled-certified, second-generation FABs mandated), 2002–2006 (increasing prevalence of SABs and ESC), 2007–2011 (advanced airbags mandated), and 2012–2015 (ESC mandated, SAB in over 90% of vehicles, introduction of advanced safety systems). Relative contributions (RCs) of the components to changes in the MVC-related mortality rate were calculated as the absolute value of the component’s beta coefficient divided by the sum of the absolute values of all components’ beta coefficients. Negative binomial regression–estimated rate ratios (RRs) for the changes in the rate of each component by year category compared to the prior year category.

Results: Significant decreases in the MVC mortality rate were observed for 2007–2011 and 2012–2015. The decrease in 2007–2011 was due in most part to an 18% decrease in the injury incidence (RR?=?0.82, P?<?.0001, RC?=?63%), though there was a noted contribution by the decrease in vehicle miles traveled (RR?=?0.95, P?<?.0001, RC?=?15%). The continued decrease in mortality in 2012–2015 was due is most part to the 10% decreased case fatality rate (RR?=?0.90, P?<?.0001, RC?=?66%) because there was no significant change in the vehicle miles traveled and injury incidence.

Conclusions: The results of this study highlight the effects of vehicle safety technologies on the MVC-related mortality rate and can help direct prevention efforts. Through the study period, there was no meaningful contribution to decreases in the MVC-related mortality rate due to components related to exposure (i.e., vehicles per population and the rate of vehicle miles traveled), suggesting that prevention efforts at decreasing exposure prevalence would have little effect on the MVC-related mortality rate. Instead, prevention efforts should continue to focus on event-phase methods to decrease injury occurrence and mitigate injury severity during the collision.     

Injury Severity Score alone predicts mortality when compared to EMS scene time and transport time for motor vehicle trauma patients who arrive alive to hospital

ABSTRACT

Objective: This study aims to identify the association, if any, between prehospital scene time, prehospital transport time, and Injury Severity Score (ISS) with in-hospital mortality.

Methods: A retrospective analysis was performed on patients at least 18 years of age who arrived to the hospital alive via emergency medical services (EMS) after a motor vehicle collision (MVC) between 1992 and 2016. These patients were divided into groups based on minutes spent at the scene and in transport. The ISS of the in-hospital mortalities, as well as the entire patient sample for each time frame, was collected. Patients without documented scene time, transport time, or ISS were excluded.

Results: Four thousand one hundred ninety-four patients were captured when analyzing scene time, though only 3,980 met inclusion criteria. In addition, 4,177 patients were captured when analyzing transport time, though only 3,979 met inclusion criteria. Scene time and transport time were not statistically significant predictors of in-hospital mortality (P = .31 and P = .458, respectively). ISS was found to be a statistically significant predictor of in-hospital mortality (P < .001).

Conclusions: ISS predicts mortality independent of scene time or transport time for patients who arrive to the hospital alive following an MVC at Guthrie Robert Packer Hospital. Limitations of our study include inability to capture prehospital deaths and inability to correlate ISS with prehospital injury severity scores.     

Risk of motor vehicle crash for older adults after receiving a traffic charge: A case–crossover study

Objective: After the age of 65, the number of motor vehicle crashes per mile driven increases. Traffic-related charges issued by law enforcement can help identify drivers who are at a higher risk of having a crash. This study examines the relationship between motor vehicle crashes and traffic-related charges among older adult drivers.

Methods: Iowa Department of Transportation crash data from 2011–2012 were linked with Iowa Court Information System data for moving violations that occurred during 2009–2012 for drivers over the age of 50. A time-stratified case–crossover design was used matching on time periods 1 year apart. Case exposure was defined as having a traffic-related charge 30 days before the crash. Control exposure was the same 30-day time period 1 year before the crash for each individual. Conditional logistic regression was used to analyze the self-matched pairs. Additional time periods of 31–60, 61–90, 91–120, 121–150, 151–180, and 181–210 days before the crash were also assessed.

Results: There were 38,171 adults at least 50 years of age with an Iowa driver's license who were involved in a crash in Iowa between 2011 and 2012. In addition, 13,129 adults over the age of 50 received a charge during 2009–2012. Relative to the control time period, experiencing a traffic-related charge in the 30-day time period before the crash increased the risk of a crash by 21% (odds ration [OR] = 1.21, 95% confidence interval [CI], 1.03–1.42) for all drivers included in the study. This crash risk was similar for adults aged 50–64 (OR = 1.20, 95% CI, 1.00–1.45) and adults 65 and older (OR = 1.24, 95% CI, 0.90–1.72). In the 30 days after receiving a traffic-related charge, the risk of a crash was also increased for crashes occurring in adverse weather (OR = 1.79, 95% CI, 1.12–2.84) or during night, dawn, or twilight (OR = 1.89, 95% CI, 1.31–2.72).

Conclusions: A traffic-related charge for an adult over the age of 50 indicates an increased risk of experiencing a crash in the 30 days following the charge. The risk for crashes occurring in adverse conditions or outside of daylight hours was also increased in the 30 days after receiving a traffic-related charge. The risk of experiencing a crash decreases as time passes after receiving a charge. Measures to restrict or increase driving safety during these conditions could help reduce the crash risk for older adults who receive a traffic-related charge.     

Field effectiveness evaluation of advanced driver assistance systems

Abstract

Objective: Advanced driver assistance systems (ADAS) are a class of vehicle technologies designed to increase safety by providing drivers with timely warnings and autonomously intervening to avoid hazardous situations. Though laboratory testing suggests that ADAS technologies will greatly impact crash involvement rates, real-world evidence that characterizes their effectiveness is still limited. This study evaluates and quantifies the association of ADAS technologies with the likelihood of a moderate or severe crash for new-model BMWs in the United States.

Methods: Vehicle ADAS option information for the cohort of model year 2014 and later BMW passenger vehicles sold after January 1, 2014 (n?=?1,063,503), was coded using VIN-identified options data. ADAS technologies of interest include frontal collision warning with autonomous emergency braking, lane departure warning, and blind spot detection. BMW Automated Crash Notification system data (from January 2014 to November 2017) were merged with vehicle data by VIN to identify crashed vehicles (n?=?15,507), including date, crash severity (delta V), and area of impact. Using Cox proportional hazards regression modeling, the study calculates the adjusted hazard ratio for crashing among BMW passenger vehicles with versus without ADAS technologies. The adjusted percentage reduction in moderate and severe crashes associated with ADAS is interpreted as one minus the hazard ratio.

Results: Vehicles equipped with both autonomous emergency braking and lane departure warning were 23% less likely to crash than those not equipped (hazard ratio [HR]?=?0.77; 95% confidence interval [CI], 0.73–0.81), controlling for model year, vehicle size and body type. Autonomous emergency braking and lane departure warning generally occur together, making it difficult to tease apart their individual effects. Blind spot detection was associated with a 14% reduction in crashes after controlling for the presence of autonomous emergency braking and lane departure warning (HR =0.86; 95% CI, 0.744–0.99). Differences were observed by vehicle type and crash type. The combined effect of autonomous emergency braking and lane departure warning was greater in newer model vehicles: Equipped vehicles were 13% less likely to crash (HR =0.87; 95% CI, 0.79–0.95) among 2014 model year vehicles versus 34% less likely to crash (HR =0.66; 95% CI, 0.57–0.77) among 2017 model year vehicles.

Conclusion: This robust cohort study contributes to the growing evidence on the effectiveness of ADAS technologies.     

Characteristics of rear-end crashes involving passenger vehicles with automatic emergency braking

Abstract

Objectives: Automatic emergency braking (AEB) is a proven effective countermeasure for preventing front-to-rear crashes, but it has not yet fully lived up to its estimated potential. This study identified the types of rear-end crashes in which striking vehicles with AEB are overrepresented to determine whether the system is more effective in some situations than in others, so that additional opportunities for increasing AEB effectiveness might be explored.

Methods: Rear-end crash involvements were extracted from 23?U.S. states during 2009–2016 for striking passenger vehicles with and without AEB among models where the system was optional. Logistic regression was used to examine the odds that rear-end crashes with various characteristics involved a striking vehicle with AEB, controlling for driver and vehicle features.

Results: Striking vehicles were significantly more likely to have AEB in crashes where the striking vehicle was turning relative to when it was moving straight (odds ratio [OR]?=?2.35; 95% confidence interval [CI], 1.76, 3.13); when the struck vehicle was turning (OR = 1.66; 95% CI, 1.25, 2.21) or changing lanes (OR = 2.05; 95% CI, 1.13, 3.72) relative to when it was slowing or stopped; when the struck vehicle was not a passenger vehicle or was a special use vehicle relative to a car (OR = 1.61; 95% CI, 1.01, 2.55); on snowy or icy roads relative to dry roads (OR = 1.83; 95% CI, 1.16, 2.86); or on roads with speed limits of 70+ mph relative to those with 40 to 45?mph speed limits (OR = 1.49; 95% CI, 1.10, 2.03). Overall, 25.3% of crashes where the striking vehicle had AEB had at least one of these overrepresented characteristics, compared with 15.9% of strikes by vehicles without AEB.

Conclusions: The typical rear-end crash occurs when 2 passenger vehicles are proceeding in line, on a dry road, and at lower speeds. Because atypical crash circumstances are overrepresented among rear-end crashes by striking vehicles with AEB, it appears that the system is doing a better job of preventing the more typical crash scenario. Consumer information testing programs of AEB use a test configuration that models the typical rear-end crash type. Testing programs promoting good AEB performance in crash circumstances where vehicles with AEB are overrepresented could guide future development of AEB systems that perform well in these additional rear-end collision scenarios.     

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.     

Crash risk of ESC-fitted passenger cars

Objective: We examined both fatal and injury at-fault crashes of a population of passenger cars fitted with electronic stability control (ESC). Crash rates were calculated in relation to both registration years and mileage. Crash rates were also calculated for a non-ESC car population and crash rate ratios were calculated to compare the crash risk between ESC-fitted and non-ESC-fitted passenger cars.

Methods: Passenger car models with and without ESC were identified (ESC-equipped cars: 3,352,813 registration years; non-ESC-equipped: 5,839,946 registration years) and their vehicle information for the period 2009–2013, including mileage (ESC-equipped vehicles: 89.3 billion kilometers; non-ESC-equipped: 72.4 billion kilometers), was drawn from the national Vehicular and Driver Data Register.

The registry of Finnish road accident investigation teams was accessed and all fatal at-fault crashes among the cars in the study populations (ESC 97; non-ESC 377) for the period 2009–2013 were analyzed. The motor insurance database includes at-fault crashes leading to injuries and was utilized for analyses (ESC: N?=?8,827, non-ESC: N?=?21,437).

Crash rates and crash rate ratios were calculated to evaluate crash risk of both ESC-equipped and non-ESC-equipped passenger cars. Poisson regression was used to model crash involvement rate ratios both per registration year and per mileage for vehicles with ESC and without ESC, controlling for age and gender of the vehicle owner and vehicle mass.

Results: Passenger cars fitted with ESC showed lower crash rates than non-ESC-equipped cars in all crash types studied. In general, the difference in crash rates between ESC-equipped and non-ESC-equipped vehicles was greater when the crashes were compared to the mileage rather than registration years. The mileage-proportional crash rate of ESC-equipped cars was 64% (95% confidence interval, 61%; 67%) lower in run-off-road crashes resulting in injury and as much as 82% (65%; 91%) lower in fatal run-off-road crashes when suicides and disease attacks were not taken into account.

Conclusions: Our results show that modern passenger cars provide a significant crash risk reduction, which depends on both ESC and passive safety features introduced. Results also show that exposure evaluation in terms of registration years (or vehicle population) instead of true mileage can provide an overly pessimistic view of the crash risk.     

Mortality Risk in Pediatric Motor Vehicle Crash Occupants: Accounting for Developmental Stage and Challenging Abbreviated Injury Scale Metrics

Objective: Survival risk ratios (SRRs) and their probabilistic counterpart, mortality risk ratios (MRRs), have been shown to be at odds with Abbreviated Injury Scale (AIS) severity scores for particular injuries in adults. SRRs have been validated for pediatrics but have not been studied within the context of pediatric age stratifications. We hypothesized that children with similar motor vehicle crash (MVC) injuries may have different mortality risks (MR) based upon developmental stage and that these MRs may not correlate with AIS severity.

Methods: The NASS-CDS 2000–2011 was used to define the top 95% most common AIS 2+ injuries among MVC occupants in 4 age groups: 0–4, 5–9, 10–14, and 15–18 years. Next, the National Trauma Databank 2002–2011 was used to calculate the MR (proportion of those dying with an injury to those sustaining the injury) and the co-injury-adjusted MR (MR_MAIS) for each injury within 6 age groups: 0–4, 5–9, 10–14, 15–18, 0–18, and 19+ years. MR differences were evaluated between age groups aggregately, between age groups based upon anatomic injury patterns and between age groups on an individual injury level using nonparametric Wilcoxon tests and chi-square or Fisher's exact tests as appropriate. Correlation between AIS and MR within each age group was also evaluated.

Results: MR and MR_MAIS distributions of the most common AIS 2+ injuries were right skewed. Aggregate MR of these most common injuries varied between the age groups, with 5- to 9-year-old and 10- to 14-year-old children having the lowest MRs and 0- to 4-year-old and 15- to 18-year-old children and adults having the highest MRs (all P <.05). Head and thoracic injuries imparted the greatest mortality risk in all age groups with median MR_MAIS ranging from 0 to 6% and 0 to 4.5%, respectively. Injuries to particular body regions also varied with respect to MR based upon age. For example, thoracic injuries in adults had significantly higher MR_MAIS than such injuries among 5- to 9-year-olds and 10- to 14-year-olds (P =.04; P <.01). Furthermore, though AIS was positively correlated with MR within each age group, less correlation was seen for children than for adults. Large MR variations were seen within each AIS grade, with some lower AIS severity injuries demonstrating greater MRs than higher AIS severity injuries. As an example, MR_MAIS in 0- to 18-year-olds was 0.4% for an AIS 3 radius fracture versus 1.4% for an AIS 2 vault fracture.

Conclusions: Trauma severity metrics are important for outcome prediction models and can be used in pediatric triage algorithms and other injury research. Trauma severity may vary for similar injuries based upon developmental stage, and this difference should be reflected in severity metrics. The MR-based data-driven determination of injury severity in pediatric occupants of different age cohorts provides a supplement or an alternative to AIS severity classification for pediatric occupants in MVCs.     

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

Abstract

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

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

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

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

Development of injury risk models to guide CT evaluation in the emergency department after motor vehicle collisions

Abstract

Objective: The clinical evaluation of motor vehicle collision (MVC) victims is challenging and commonly relies on computed tomography (CT) to detect internal injuries. CT scans are financially expensive and each scan exposes the patient to additional ionizing radiation with an associated, albeit low, risk of cancer. Injury risk prediction based on regression modeling has been to be shown to be successful in estimating Injury Severity Scores (ISSs). The objective of this study was to (1) create risk models for internal injuries of occupants involved in MVCs based on CT body regions (head, neck, chest, abdomen/pelvis, cervical spine, thoracic spine, and lumbar spine) and (2) evaluate the performance of these risk prediction models to predict internal injury.

Methods: All Abbreviated Injury Scale (AIS) 2008 injury codes were classified based on which CT body region would be necessary to scan in order to make the diagnosis. Cases were identified from the NASS-CDS. The NASS-CDS data set was queried for cases of adult occupants who sought medical care and for which key crash characteristics were all present. Forward stepwise logistic regression was performed on data from 2010–2014 to create models predicting risk of internal injury for each CT body region. Injury risk for each region was grouped into 5 levels: very low (<2%), low (2–5%), medium (5–10%), high (10–20%), and very high (20%). The models were then tested using weighted data from 2015 in order to determine whether injury rates fell within the predicted risk level.

Results: The inclusion and exclusion criteria identified 5,477 cases in the NASS-CDS database. Cases from 2010–2014 were used for risk modeling (n?=?4,826). Seven internal injury risk models were created based on the CT body regions using data from 2010–2014. These models were tested against data from 2015 (n?=?651). In all CT body regions, the majority of occupants fell in the very low or low predicted injury rate groups, except for the head. On average, 57% of patients were classified as very low risk and 15% as low risk for each body region. In most cases the actual rate of injury was within the predicted injury risk range. The 95% confidence interval overlapped with predicting injury risk range in all cases.

Conclusion: This study successfully demonstrated the ability for internal injury risk models to accurately identify occupants at low risk for internal injury in individual body regions. This represents a step towards incorporating telemetry data into a clinical tool to guide physicians in the use of CT for the evaluation of MVC victims.     

The effect of correct cross-chest clip use on injury outcomes in young children during motor vehicle crashes

Objective: Traffic crashes have high mortality and morbidity for young children. Though many specialized child restraint systems improve injury outcomes, no large-scale studies have investigated the cross-chest clip's role during a crash, despite concerns in some jurisdictions about the potential for neck contact injuries from the clips. This study aimed to investigate the relationship between cross-chest clip use and injury outcomes in children between 0 and 4 years of age.

Methods: Child passengers between 0 and 4 years of age were selected from the NASS-CDS data sets (2003–2014). Multiple regression analysis was used to model injury outcomes while controlling for age, crash severity, crash direction, and restraint type. The primary outcomes were overall Abbreviated Injury Score (AIS) 2+ injury, and the presence of any neck injury.

Results: Across all children aged 0–4 years, correct chest clip use was associated with decreased Abbreviated Injury Scale (AIS) 2+ injury (odds ratio [OR] = 0.44, 95% confidence interval [CI], 0.21–0.91) and was not associated with neck injury. However, outcomes varied by age. In children <12 months old, chest clip use was associated with decreased AIS 2+ injury (OR = 0.09, 95% CI, 0.02–0.44). Neck injury (n = 7, all AIS 1) for this age group only occurred with correct cross-chest clip use. For 1- to 4-year-old children, cross-chest clip use had no association with AIS 2+ injury, and correct use significantly decreased the odds of neck injury (OR = 0.49; 95% CI, 0.27–0.87) compared to an incorrectly used or absent cross-chest clip. No serious injuries were directly caused by the chest clips.

Conclusions: Correct cross-chest clip use appeared to reduce injury in crashes, and there was no evidence of serious clip-induced injury in children in 5-point harness restraints.     

Factors associated with motorcycle traffic crash fatalities among active duty U.S. Army personnel

Objective: Research on factors associated with motorcycle fatalities among active duty U.S. Army personnel is limited. This analysis describes motorcycle crash–related injuries from 1995 through 2014 and assesses the effect of alcohol use and helmet use on the risk of fatal injury among active duty U.S. Army motorcycle operators involved in a traffic crash, controlling for other factors shown to be potentially associated with fatality in this population.

Methods: Demographics, crash information, and injury data were obtained from safety reports maintained in the Army Safety Management Information System. Traffic crashes were defined as crashes occurring on a paved public or private roadway or parking area, including those on a U.S. Army installation. Analysis was limited to motorcycle operators. Odds ratios (ORs) and 95% confidence intervals (95% CIs) from a multivariable analysis estimated the effect of alcohol use and helmet use on the risk of a fatal injury given a crash occurred, controlling for operator and crash characteristics.

Results: Of the 2,852 motorcycle traffic crashes, most involved men (97%), operators aged 20–29 years of age (60%), and operators who wore helmets (95%) and did not use alcohol (92%). Two thirds of reported crashes resulted in injuries requiring a lost workday; 17% resulted in fatality. Controlling for operator and crash characteristics, motorcycle traffic crashes involving operators who had used alcohol had a 3.1 times higher odds of fatality than those who did not use alcohol (OR =3.14; 95% CI, 2.17–4.53). Operators who did not wear a helmet had 1.9 times higher odds of fatality than those who did wear a helmet (OR =1.89; 95% CI, 1.24–2.89).

Conclusions: Among U.S. Army motorcycle operators, alcohol use and not wearing a helmet increased the odds of fatality, given that a crash occurred, and additional modifiable risk factors were identified. Results will help inform U.S. Army motorcycle policies and training.     

Advanced driver assistance systems for teen drivers: A national survey of teen and parent perceptions

Abstract

Objective: Recently developed advanced driver assistance systems (ADAS) have the potential to compensate for teen driving errors and reduce overall crash risk. To date, very limited research has been conducted on the suitability of ADAS for teen drivers—the population most likely to benefit from such systems. The opportunity for ADAS to reduce the frequency and severity of crashes involving teen drivers is hindered when there is a lack of trust, acceptance, and use of those technologies. Therefore, there is a need to study teen and parent perceptions of ADAS to help identify and overcome any potential barriers to ADAS use.

Methods: A U.S. national survey was developed based on themes from previously conducted teen and parent ADAS focus groups. Survey topics included trust in ADAS, effect of ADAS on teen driver safety and driving behavior, effect of ADAS on skill development, data privacy, and cybersecurity. Responses included 5-point Likert scales and open-ended questions. The survey was managed through an online respondent panel by ResearchNow. Eligibility criteria included licensed teens (16–19 years) and parents of licensed teens. Teen and parent responses were compared using chi-square statistics in SAS 9.4.

Results: Two thousand and three (teens?=?1,000; parents?=?1,003) respondents qualified for and completed the survey between September 1 and September 20, 2017. Overall, teens (72%) and parents (61%) felt that ADAS would have a positive impact on transportation. However, teens were more likely to exhibit a positive outlook on ADAS, whereas parents were more likely to have a negative outlook (P?<?.01). Teens felt that ADAS would be useful during bad weather or drowsy driving but were less concerned than parents about ADAS intervention during their own risky driving (P?<?.01). The majority of teens (65%) and parents (71%) agreed that teens should learn to drive on vehicles without ADAS, with parents being more likely to agree than teens (P?<?.01). Parents (55%) were more likely than teens (47%) to be concerned about insurance companies keeping track of teen driving data (P?<?.01). Most respondents exhibited some concern of ADAS being susceptible to hacking (57%).

Conclusions: This study represents the first effort to quantify ADAS perceptions among teen drivers and their parents at the U.S. national level. These data highlight potential barriers to ADAS use among teen drivers, including a relative disinterest among teens for ADAS intervention during risky driving as well as concerns among both teens and parents that ADAS will inhibit skill development. These survey findings will help inform educational programs to accelerate fleet turnover and provide the foundation for ADAS optimization and evaluation studies among sociodemographic groups.     

Prevalence of alcohol impairment and odds of a driver injury or fatality in on-road farm equipment crashes

Objective: The objective of this article was to estimate the prevalence of alcohol impairment in crashes involving farm equipment on public roadways and the effect of alcohol impairment on the odds of crash injury or fatality.

Methods: On-road farm equipment crashes were collected from 4 Great Plains state departments of transportation during 2005–2010. Alcohol impairment was defined as an involved driver having blood alcohol content of ≥0.08 g/100 ml or a finding of alcohol impairment as a driver contributing circumstance recorded on the police crash report. Injury or fatality was categorized as (a) no injury (no and possible injury combined), (b) injury (nonincapacitating or incapacitating injury), and (c) fatality. Hierarchical multivariable logistic regression modeling, clustered on crash, was used to estimate the odds of an injury/fatality in crashes involving an alcohol-impaired driver.

Results: During the 5 years under study, 3.1% (61 of 1971) of on-road farm equipment crashes involved an alcohol-impaired driver. One in 20 (5.6%) injury crashes and 1 in 6 (17.8%) fatality crashes involved an alcohol-impaired driver. The non-farm equipment driver was significantly more likely to be alcohol impaired than the farm equipment driver (2.4% versus 1.1% respectively, P = .0012). After controlling for covariates, crashes involving an alcohol-impaired driver had 4.10 (95% confidence interval [CI], 2.30–7.28) times the odds of an injury or fatality. In addition, the non-farm vehicle driver was at 2.28 (95% CI, 1.92–2.71) times higher odds of an injury or fatality than the farm vehicle driver. No differences in rurality of the crash site were found in the multivariable model.

Conclusion: On-road farm equipment crashes involving alcohol result in greater odds of an injury or fatality. The risk of injury or fatality is higher among the non-farm equipment vehicle drivers who are also more likely to be alcohol impaired. Further studies are needed to measure the impact of alcohol impairment in on-road farm equipment crashes.     

Cross-correlation between the controlled collision environment and real-world motor vehicle collisions: Evaluating the protection of the thoracic side airbag

Objective: Thoracic side airbags (tSABs) were integrated into the vehicle fleet to attenuate and distribute forces on the occupant's chest and abdomen, dissipate the impact energy, and move the occupant away from the intruding structure, all of which reduce the risk of injury. This research piece investigates and evaluates the safety performance of the airbag unit by cross-correlating data from a controlled collision environment with field data.

Method: We focus exclusively on vehicle–vehicle lateral impacts from the NHTSA's Vehicle Crash Test Database and NASS-CDS database, which are replicated in the controlled environment by the (crabbed) barrier impact. Similar collisions with and without seat-embedded tSABs are matched to each other and the injury risks are compared.

Results: Results indicated that dummy-based thoracic injury metrics were significantly lower with tSAB exposure (P <.001). Yet, when the controlled collision environment data were cross-correlated with NASS-CDS collisions, deployment of the tSAB indicated no association with thoracic injury (tho. MAIS 2+ unadjusted relative risk [RR] = 1.14; 90% confidence interval [CI], 0.80–1.62; tho. MAIS 3+ unadjusted RR = 1.12; 90% CI, 0.76–1.65).

Conclusion: The data from the controlled collision environment indicated an unequivocal benefit provided by the thoracic side airbag for the crash dummy; however, the real-world collisions demonstrate that no benefit is provided to the occupant. This has resulted from a noncorrelation between the crash test/dummy-based design taking the abstracting process too far to represent the real-world collision scenario.     

Computational modeling and analysis of thoracolumbar spine fractures in frontal crash reconstruction

Abstract

Objective: This study aimed to reconstruct 11 motor vehicle crashes (6 with thoracolumbar fractures and 5 without thoracolumbar fractures) and analyze the fracture mechanism, fracture predictors, and associated parameters affecting thoracolumbar spine response.

Methods: Eleven frontal crashes were reconstructed with a finite element simplified vehicle model (SVM). The SVM was tuned to each case vehicle and the Total HUman Model for Safety (THUMS) Ver. 4.01 was scaled and positioned in a baseline configuration to mimic the documented precrash driver posture. The event data recorder crash pulse was applied as a boundary condition. For the 6 thoracolumbar fracture cases, 120 simulations to quantify uncertainty and response variation were performed using a Latin hypercube design of experiments (DOE) to vary seat track position, seatback angle, steering column angle, steering column position, and D-ring height. Vertebral loads and bending moments were analyzed, and lumbar spine indices (unadjusted and age-adjusted) were developed to quantify the combined loading effect. Maximum principal strain and stress data were collected in the vertebral cortical and trabecular bone. DOE data were fit to regression models to examine occupant positioning and thoracolumbar response correlations.

Results: Of the 11 cases, both the vertebral compression force and bending moment progressively increased from superior to inferior vertebrae. Two thoracic spine fracture cases had higher average compression force and bending moment across all thoracic vertebral levels, compared to 9 cases without thoracic spine fractures (force: 1,200.6 vs. 640.8 N; moment: 13.7 vs. 9.2?Nm). Though there was no apparent difference in bending moment at the L1–L2 vertebrae, lumbar fracture cases exhibited higher vertebral bending moments in L3–L4 (fracture/nonfracture: 45.7 vs. 33.8?Nm). The unadjusted lumbar spine index correctly predicted thoracolumbar fracture occurrence for 9 of the 11 cases (sensitivity?=?1.0; specificity?=?0.6). The age-adjusted lumbar spine index correctly predicted thoracolumbar fracture occurrence for 10 of the 11 cases (sensitivity?=?1.0; specificity?=?0.8). The age-adjusted principal stress in the trabecular bone was an excellent indicator of fracture occurrence (sensitivity?=?1.0; specificity?=?1.0). A rearward seat track position and reclined seatback increased the thoracic spine bending moment by 111–329%. A more reclined seatback increased the lumbar force and bending moment by 16–165% and 67–172%, respectively.

Conclusions: This study provided a computational framework for assessing thoracolumbar fractures and also quantified the effect of precrash driver posture on thoracolumbar response. Results aid in the evaluation of motor vehicle crash–induced vertebral fractures and the understanding of factors contributing to fracture risk.     

Underutilization of occupant restraint systems in motor vehicle injury crashes: A quantitative analysis from Qatar

Introduction: Restraint systems (seat belts and airbags) are important tools that improve vehicle occupant safety during motor vehicle crashes (MVCs). We aimed to identify the pattern and impact of the utilization of passenger restraint systems on the outcomes of MVC victims in Qatar.

Methods: A retrospective study was conducted for all admitted patients who sustained MVC-related injuries between March 2011 and March 2014 inclusive.

Results: Out of 2,730 road traffic injury cases, 1,830 (67%) sustained MVC-related injuries, of whom 88% were young males, 70% were expatriates, and 53% were drivers. The use of seat belts and airbags was documented in 26 and 2.5% of cases, respectively. Unrestrained passengers had greater injury severity scores, longer hospital stays, and higher rates of pneumonia and mortality compared to restrained passengers (P = .001 for all). There were 311 (17%) ejected cases. Seat belt use was significantly lower and the mortality rate was 3-fold higher in the ejected group compared to the nonejected group (P = .001). The overall mortality was 8.3%. On multivariate regression analysis, predictors of not using a seat belt were being a front seat passenger, driver, or Qatari national and young age. Unrestrained males had a 3-fold increase in mortality in comparison to unrestrained females. The risk of severe injury (relative risk [RR] = 1.82, 95% confidence interval [CI], 1.49–2.26, P = .001) and death (RR = 4.13, 95% CI, 2.31–7.38, P = .001) was significantly greater among unrestrained passengers.

Conclusion: The nonuse of seat belts is associated with worse outcomes during MVCs in Qatar. Our study highlights the lower rate of seat belt compliance in young car occupants that results in more severe injuries, longer hospital stays, and higher mortality rates. Therefore, we recommend more effective seat belt awareness and education campaigns, the enforcement of current seat belt laws, their extension to all vehicle occupants, and the adoption of proven interventions that will assure sustained behavioral changes toward improvements in seat belt use in Qatar.