Emergency department visits by pediatric patients sustained as a passenger on a motorcycle

Objective: Currently only 5 out of the 50 states in the United States have laws restricting the age of passengers permitted to ride on a motorcycle. This study sought to characterize the visits by patients under the age of 16 to U.S. emergency departments (EDs) for injuries sustained as a passenger on a motorcycle.

Methods: In this retrospective cohort study, data were obtained from the Nationwide Emergency Department Sample (NEDS) for the years 2006 to 2011. Pediatric patients who were passengers on a motorcycle that was involved in a crash were identified using International Classification of Diseases, Ninth Revision (ICD-9) External Cause of Injury codes. We also examined gender, age, disposition, regional differences, common injuries, and charges.

Results: Between 2006 and 2011 there were an estimated 9,689 visits to U.S. EDs by patients under the age of 16 who were passengers on a motorcycle involved in a crash. The overall average patient age was 9.4 years, and they were predominately male (54.5%). The majority (85%) of these patients were treated and released. The average charges for discharged patients were $2,116.50 and amounted to roughly $17,500,000 during the 6 years. The average cost for admission was $51,446 per patient and totaled over $54 million. The most common primary injuries included superficial contusions; sprains and strains; upper limb fractures; open wounds of head, neck, and trunk; and intracranial injuries.

Conclusion: Although there were only about 9,700 visits to U.S. EDs for motorcycle crashes involving passengers less than 16 years old for 2006 to 2011, the total cost of visits that resulted in either ED discharge or hospital admission amounted to over $71 million.     

Occupational electrical injuries in the United States, 1992-1998, and recommendations for safety research

PROBLEM: CFOI and SOII data show that 2,287 U.S. workers died and 32,807 workers sustained days away from work due to electrical shock or electrical burn injuries between 1992 and 1998. METHOD: The narrative, work activity, job title, source of injury, location, and industry for each fatal electrical accident were examined. A primary causal factor was identified for each fatality. RESULTS: Electrical fatalities were categorized into five major groups. Overall, 44% of electrical fatalities occurred in the construction industry. Contact with overhead power lines caused 41% of all electrical fatalities. DISCUSSION: Electrical shock caused 99% of fatal and 62% of nonfatal electrical accidents. Comprising about 7% of the U.S. workforce, construction workers sustain 44% of electrical fatalities. Power line contact by mobile equipment occurs in many industries and should be the subject of focused research. Other problem areas are identified and opportunities for research are proposed. IMPACT ON INDUSTRY: Improvements in electrical safety in one industry often have application in other industries.     

Emergency department visits vs. fatalities among substance-impaired underage youths involved in motor vehicle crashes

IntroductionEmergency department (ED) visits resulting from motor vehicle crashes (MVCs) among individuals younger than 21 impaired by alcohol and/or drugs have been less studied than MVC fatalities.MethodUsing data from 2004 to 2011, we compare the magnitude and pattern of national ED visit and mortality data for alcohol- and drug-impaired youths involved in MVCs.ResultsTemporal patterns of ED visits are similar to those of fatalities, but the two differ in magnitude. The ratio of ED visits to fatalities is 3.5:1; alcohol related events involvement dominates other drugs in both categories.DiscussionThe volume of injuries serious enough to warrant ED visits imposes significant health, social, and financial burdens. In ED visits, alcohol is the prime source of MVC morbidity burden; other drugs consistently contribute less.Practical applicationsThese incidents are persistent and require interventions aimed at multiple levels of prevention, including stricter corrective steps earlier in the impaired driving career to reduce subsequent incidents. ED visits for MVC injuries can be important “teachable moments.” Limitations of the study indicate the need for improved surveillance of underage substance-involved crashes.     

The effects of minimum legal drinking age 21 laws on alcohol-related driving in the United States

Objective

To examine trends in alcohol consumption and alcohol-related crashes among people younger than 21 in the United States and to review evidence on the effects of minimum legal drinking age (MLDA) laws.

Methods

Trends in alcohol-related crashes and alcohol consumption among young people were examined, and studies on the effects of lowering and raising the drinking age were reviewed.

Results

MLDA laws underwent many changes during the 20th century in the United States. Since July 1988, the MLDA has been 21 in all 50 states and the District of Columbia. Surveys tracking alcohol consumption among high school students and young adults found that drinking declined since the late 1970 s, and most of the decline occurred by the early 1990 s. These were the years when states were establishing, or reinstating, a MLDA-21. Among fatally injured drivers ages 16-20, the percentage with positive BACs declined from 61% in 1982 to 31% in 1995, a bigger decline than for older age groups; declines occurred among the ages directly affected by raising MLDAs (ages 18-20) and among young teenagers not directly affected (ages 16-17). Almost all studies designed specifically to gauge the effects of drinking age changes show MLDAs of 21 reduce drinking, problematic drinking, drinking and driving, and alcohol-related crashes among young people. Yet many underage people still drink, many drink and drive, and alcohol remains an important risk factor in serious crashes of young drivers, especially as they progress through the teenage years. Stepped-up enforcement of MLDA and drinking and driving laws can reduce underage drinking. Recent efforts to lower MLDAs to 18 and issue licenses to drink upon completion of alcohol education have gained local and national media attention. There is no evidence that alcohol education can even partially replace the effect of MLDA-21.

Conclusions

The cause and effect relationship between MLDAs of 21 and reductions in highway crashes is clear. Initiatives to lower the drinking age to 18 ignore the demonstrated public health benefits of MLDAs of 21.

Impact on Industry

Lowering the drinking age to 18 will increase highway crash deaths among young people.     

美国应急管理的顶层设计及对我国的启示

为研究如何做好一个国家的应急管理顶层设计,以美国的应急管理为例,详细梳理其发展变更,其主要经过了无设计、联邦政府层面的顶层设计和全国层面的顶层设计3个阶段,最终通过建立一套突发事件管理系统,克服了联邦制对应急管理权力运行的阻碍,建立了能够把各级政府和社会力量组织起来、有效应对各种突发事件的应急管理系统,实现了顶层设计的目标.美国的实践,可为我国的应急管理体系建设在充分发挥制度优势、提供法律保障、实现标准化等方面提供借鉴.     

The epidemiology of lawn trimmer injuries in the United States: 2000-2009

IntroductionYard maintenance equipment is potentially dangerous, and some of the more frequency used equipment (e.g., lawn mowers) has been extensively studied. However, the extent of lawn trimmers as a source of injury has not previously been explored.MethodsData from the Consumer Product Safety Commission's National Electronic Injury Surveillance System were used to estimate the number of patients treated in U.S. emergency departments for lawn trimmer-related injuries. Injury rates were calculated according to age, sex, and race, and characteristics of the injury event were determined.ResultsAn estimated 81,907 injuries involving a lawn trimmer occurred from 2000–2009. The incidence generally increased over time. Men, people aged 40–49, and Caucasians were the groups most likely to be injured. The most commonly injured body part was the head, specifically the eye, accounting for 42.5% of the injuries. Contusions and abrasions were the most common type of injury to the head, but lacerations were the most common injury to the extremities, and strains/sprains were the most common injury to the trunk.DiscussionAlthough previous research on lawn trimmers has focused exclusively on injuries to the eyes, the results of the current study show that such injuries are one component of the problem. Because most of the injuries were due to foreign objects, it is important that the use of adequate safety gear be emphasized when operating lawn trimmers.Impact on IndustryResults suggest that lawn trimmer design changes and better safety education for trimmer use can reduce the rate of injury and reverse the current trend.     

Unintentional injuries treated in hospital emergency departments among persons aged 65 years and older,United States, 2006–2011

IntroductionWith the aging of the United States population, unintentional injuries among older adults, and especially falls-related injuries, are an increasing public health concern.MethodsWe analyzed emergency department (ED) data from the Nationwide Emergency Department Sample, 2006–2011. We examined unintentional injury trends by 5-year age groups, sex, mechanism, body region, discharge disposition, and primary payer. For 2011, we estimated the medical costs of unintentional injury and the distribution of primary payers, plus rates by injury mechanisms and body regions injured by 5-year age groups.ResultsFrom 2006 to 2011, the age-adjusted annual rate of unintentional injury-related ED visits among persons aged ≥ 65 years increased significantly from 7987 to 8163, per 100,000 population. In 2011, 65% of injuries were due to falls. Rates for fall-related injury ED visits increased with age and the highest rate was among those aged ≥ 100. Each year, about 85% of unintentional injury-related ED visits in this population were expected to be paid by Medicare. In 2011, the estimated lifetime medical cost of unintentional injury-related ED visits among those aged ≥ 65 years was $40 billion.ConclusionIncreasing rates of ED-treated unintentional injuries, driven mainly by falls among older adults, will challenge our health care system and increase the economic burden on our society. Prevention efforts to reduce falls and resulting injuries among adults aged ≥ 65 years have the potential to increase well-being and reduce health care spending, especially the costs covered by Medicare.Practical applicationsWith the aging of the U.S. population, unintentional injuries, and especially fall-related injuries, will present a growing challenge to our health care system as well as an increasing economic burden. To counteract this trend, we must implement effective public health strategies, such as increasing knowledge about fall risk factors and broadly disseminating evidence-based injury and fall prevention programs in both clinical and community settings.     

Impact of improving vehicle front design on the burden of pedestrian injuries in Germany,the United States,and India

Objective: European car design regulations and New Car Assessment Program (NCAP) ratings have led to reductions in pedestrian injuries. The aim of this study was to evaluate the impact of improving vehicle front design on mortality and morbidity due to pedestrian injuries in a European country (Germany) and 2 countries (the United States and India) that do not have pedestrian-focused NCAP testing or design regulations.

Methods: We used data from the International Road Traffic and Accident Database and the Global Burden of Disease project to estimate baseline pedestrian deaths and nonfatal injuries in each country in 2013. The effect of improved passenger car star ratings on probability of pedestrian injury was based on recent evaluations of pedestrian crash data from Germany. The effect of improved heavy motor vehicle (HMV) front end design on pedestrian injuries was based on estimates reported by simulation studies. We used burden of disease methods to estimate population health loss by combining the burden of morbidity and mortality in disability-adjusted life years (DALYs) lost.

Results: Extrapolating from evaluations in Germany suggests that improving front end design of cars can potentially reduce the burden of pedestrian injuries due to cars by up to 24% in the United States and 41% in India. In Germany, where cars comply with the United Nations regulation on pedestrian safety, additional improvements would have led to a 1% reduction. Similarly, improved HMV design would reduce DALYs lost by pedestrian victims hit by HMVs by 20% in each country. Overall, improved vehicle design would reduce DALYs lost to road traffic injuries (RTIs) by 0.8% in Germany, 4.1% in the United States, and 6.7% in India.

Conclusions: Recent evaluations show a strong correlation between Euro NCAP pedestrian scores and real-life pedestrian injuries, suggesting that improved car front end design in Europe has led to substantial reductions in pedestrian injuries. Although the United States has fewer pedestrian crashes, it would nevertheless benefit substantially by adopting similar regulations and instituting pedestrian NCAP testing. The maximum benefit would be realized in low- and middle-income countries like India that have a high proportion of pedestrian crashes. Though crash avoidance technologies are being developed to protect pedestrians, supplemental protection through design regulations may significantly improve injury countermeasures for vulnerable road users.     

Sixteen-year-old drivers in fatal crashes, United States, 2003

OBJECTIVE: Key features of graduated licensing were introduced in 46 states and the District of Columbia between 1993 and 2003. State evaluations consistently have reported positive overall effects and positive effects of nighttime and passenger restrictions. Sixteen year-olds are the main target of graduated licensing, and the present study investigated changes in their fatal crash involvement and crash characteristics that have taken place nationally during 1993-2003. By looking at 16 year-olds nationally, the study does not constitute a direct test of the effect of graduated licensing laws per se. METHODS: Data on fatal crashes were obtained from the Fatality Analysis Reporting System. Sixteen year-olds were compared with older drivers. RESULTS: During these years, the extent to which 16-year-old drivers were in fatal crashes decreased substantially compared with older age groups. The drop in the per capita crash rate for 16 year-olds was 26%. The major change was a reduction in crashes involving transporting young passengers, especially in jurisdictions with restrictions that target these crashes. There was no change in the proportion of fatal late-night crashes even in states restricting this activity. CONCLUSIONS: There has been some progress nationally in reducing the crash problem for 16 year-olds, but this still is a big problem. To achieve further progress, the gaps and weaknesses in present graduated licensing laws will need to be addressed.     

Household youth on minority operated farms in the United States, 2000: exposures to and injuries from work, horses, ATVs and tractors

INTRODUCTION: It is likely that youth living on minority operated farms (<3% of U.S. farms) face hazards similar to the general farm population; however, since minority youth are not well represented by general farm surveys, this information hasn't been confirmed. METHOD: Nonfatal injury and exposure data were obtained from the 2000 Minority Farm Operator Childhood Agricultural Injury Survey (M-CAIS). RESULTS: On racial minority farms, there were an estimated 28,600 household youth. Of these, about 41% worked, 26% rode a horse, 23% drove an ATV, and 23% operated a tractor. On Hispanic farms, there were an estimated 17,998 household youth. Of these, 44% worked, 30% rode a horse, 27% drove an ATV, and 25% operated a tractor. CONCLUSIONS: These results show the value of conducting a survey of minorities to identify high risk groups and target issues that may be unique to the minority farm population.     

Fall-related traumatic brain injury deaths and hospitalizations among older adults--United States, 2005

PROBLEM: Among older adults, both unintentional falls and traumatic brain injuries (TBI) result in significant morbidity and mortality; however, only limited national data on fall-related TBI are available. METHOD: To examine the relationship between older adult falls and TBI deaths and hospitalizations, CDC analyzed 2005 data from the National Center for Health Statistics' National Vital Statistics System and the Agency for Healthcare Research and Quality's Nationwide Inpatient Sample. RESULTS: In 2005, among adults>or=65 years, there were 7946 fall-related TBI deaths and an estimated 56,423 hospitalizations for nonfatal fall-related TBI in the United States. Fall-related TBI accounted for 50.3% of unintentional fall deaths and 8.0% of nonfatal fall-related hospitalizations. SUMMARY: These findings underscore the need for greater dissemination and implementation of evidence-based fall prevention interventions.     

Seat Belt Use in States and Territories with Primary and Secondary Laws -- United States, 2006

Problem

Motor-vehicle crashes are a leading cause of death in the United States. In the event of a crash, seat belts are highly effective in preventing serious injury and death.

Methods

Data from the 2006 Behavioral Risk Factor Surveillance System were used to calculate prevalence of seat belt use by state and territory and by type of state seat belt law (primary vs. secondary enforcement).

Results

In 2006, seat belt use among adults ranged from 58.3% to 91.9% in the states and territories. Seat belt use was 86.0% in states and territories with primary enforcement laws and 75.9% in states with secondary enforcement laws.

Discussion

Seat belt use continues to increase in the United States. Primary enforcement laws remain a more effective strategy than secondary enforcement laws in getting motor-vehicle occupants to wear their seat belts.     

Access to trauma centers for road crashes in the United States

Introduction: Existing research indicates that around 90% of all U.S. residents have access to at least one level I or II trauma center within 60 min. However, a limitation of these estimates lies in that they are based on where people live and not where people are injured, which may overestimate the access to trauma centers for seriously injured patients in fatal crashes. Method: In this study, the Fatality Analysis Reporting System (FARS) data between 2013 and 2014 were collected and analyzed to quantify the access of injured patients to trauma centers for fatal crashes across states. Two types of distance, linear distance and route distance, were calculated using ArcGIS. The estimated transport time to the nearest level I/II trauma center was also calculated and compared to the recorded on-scene and transport time. Results and Conclusions: The Northeast region had the nearest average linear and route distance between fatal crash and trauma center (25.3 km and 31.7 km, respectively), followed by the Midwest (44.4 km and 54.1 km), the South (47.3 km and 57.0 km), and the West (50.9 km and 67.5 km). The comparison between the estimated and actual transport time revealed that the different states adopted different trauma triage protocols, resulting in different utilization rates of the level I/II trauma center among states. A linear regression analysis demonstrated that the longer the average route distance, the less the seriously injured patients in fatal crashes were taken to level I/II trauma center directly. Practical applications: These findings may help to identify the access to trauma centers for road crashes and the variation of delivery ratio to trauma center among the states, therefore a better utilization of trauma centers for road crashes can be achieved for the emergency medical services (EMS) systems.     

Pedestrian fatalities, Atlanta Metropolitan Statistical Area and United States, 2000-2004

Motor vehicle crashes killed almost 5,000 pedestrians in 2005 in the United States. Pedestrian risk may be higher in areas characterized by urban sprawl. From 2000 to 2004, pedestrian fatality rates declined in the United States, but the Atlanta metropolitan statistical area did not experience the same decline. Pedestrian fatality rates for males, Hispanics, and the 15–34 and 35–54 year age groups were higher in Atlanta than in the United States overall. Pedestrian safety interventions should be targeted to high-risk populations and localized pedestrian settings.     

Consumer product-related eye injury in the United States, 1998-2002

PROBLEM: Eye injury is currently a leading cause of visual impairment and monocular blindness in the United States. Information regarding consumer products associated with eye injuries can have important implications for the prevention of these injuries. METHODS: The National Electronic Injury Surveillance System (NEISS) was used to describe the types of consumer products associated with emergency department treated eye injuries in the United States from 1998 through 2002. RESULTS: The leading product type associated with eye injuries was welding equipment followed by household cleaners, basketball equipment, workshop equipment, and adhesives. Eye injuries attributed to hardware, tools, construction, sports, toys, and lawn equipment were more common among males. In females, eye injuries attributable to chemicals, housewares, storage and organization, and bed and bath items were more common. Differences were also apparent across the age spectrum. CONCLUSION: This study identified specific products and categories of products frequently associated with eye injury and prevention initiatives should focus on these items. IMPACT ON INDUSTRY: This study has identified consumer products associated with eye injuries requiring medical treatment in the United States. Manufacturers of these products could be encouraged to add or strengthen safety messages regarding the potential for eye injury.     

School transportation mode,by distance between home and school,United States,ConsumerStyles 2012

IntroductionMotor-vehicle crashes are a leading cause of death among children in the United States, and almost one-fourth of all trips by school-aged children are trips to and from school. This study sought to determine how children (5–18 years) travel to and from school and, among those living ≤ 1 mile of school, to explore the role of school bus service eligibility on school travel mode.MethodsWe used national 2012 survey data to determine prevalence of usual school travel mode, stratified by distance from school. For those living ≤ 1 mile of school, multivariable regression was conducted to assess the association between bus service eligibility and walking or bicycling.ResultsAlmost half (46.6%) of all children rode in passenger vehicles (PV) to school and 41.8% did so for the trip home. Results were similar among those living ≤ 1 mile (48.1%, PV to school; 41.3%, PV to home). Among those living ≤ 1 mile, 21.9% and 28.4% of children walked or bicycled to and from school, respectively. Ineligibility for school bus service was strongly associated with walking or bicycling to school [adjusted prevalence ratio (aPR: 5.36; p < 0.001)] and from school (aPR: 5.36; p < 0.001).ConclusionsRegardless of distance from school, passenger vehicles were a common mode of travel. For children who live close to school, the role that school bus service eligibility plays in walking or bicycling deserves further consideration.Practical applicationsGiven the large proportion of children who use passenger vehicles for school travel, effective interventions can be adopted to increase proper child restraint and seat belt use and reduce crash risks among teen drivers. Better understanding of conditions under which bus service is offered to children who live close to school could inform efforts to improve pedestrian and bicyclist safety for school travel.     

Characteristics of teens-with-teens fatal crashes in the United States, 2005–2010

BackgroundMore than 40% of fatal crashes of 16- and 17-year-old drivers occur when transporting teenagers. Characteristics of this predominant crash type and prevention possibilities are described, based on data from fatal crashes in the United States during 2005–2010.ResultsFifty-seven percent of 16- and 17-year old drivers in fatal crashes had at least one passenger. Most commonly, all passengers were ages 13–19 (42% of all drivers and 73% of those with passengers). Of fatal crashinvolved drivers with teenage passengers and no passengers of other ages, 56% had one passenger, 24% had two, and 20% had three or more. Most frequently, passengers were the same sex and within one year of the driver. Risk factors involving speeding, alcohol use, late-night driving, lack of a valid license, seat belt non-use, and crash responsibility were more prevalent with teenage passengers than when driving alone, and the prevalence of these factors increased with the number of teenage passengers. Many risk factors were most prevalent with passengers ages 20–29, although few crashes had this occupant configuration. Risk factors were least prevalent with a passenger 30 or older.DiscussionFatal crashes of 16- and 17-year-old drivers with teen passengers are a common crash scenario, despite passenger restrictions in 42 states and the District of Columbia during some or all of the study period. The proportion of these fatal crashes decreased slightly from 46% in 1995 (pre-GDL) to 43% in 2010 and showed no signs of decreasing during the six-year study period (range 41% to 43%).Practical applicationsExisting passenger restrictions are relatively weak and could be strengthened. Fatal crashes involving teen passengers, especially multiple passengers, are more likely to involve alcohol, late-night driving, driver error, and invalid licensure, so stepped-up enforcement of existing laws involving these behaviors might reduce the prevalence of such crashes.