Features of fatal injuries in older cyclists in vehicle–bicycle accidents in Japan

Objective: The purpose of this study was to identify and better understand the features of fatal injuries in cyclists aged 75 years and over involved in collisions with either hood- or van-type vehicles.

Methods: This study investigated the fatal injuries of cyclists aged 75 years old and over by analyzing accident data. We focused on the body regions to which the fatal injury occurred using vehicle–bicycle accident data from the Institute for Traffic Accident Research and Data Analysis (ITARDA) in Japan. Using data from 2009 to 2013, we examined the frequency of fatally injured body region by gender, age, and actual vehicle travel speed. We investigated any significant differences in distributions of fatal injuries by body region for cyclists aged 75 years and over using chi-square tests to compare with cyclists in other age groups. We also investigated the cause of fatal head injuries, such as impact with a road surface or vehicle.

Results: The results indicated that head injuries were the most common cause of fatalities among the study group. At low vehicle travel speeds for both hood- and van-type vehicles, fatalities were most likely to be the result of head impacts against the road surface.

The percentage of fatalities following hip injuries was significantly higher for cyclists aged 75 years and over than for those aged 65–74 or 13–59 in impacts with hood-type vehicles. It was also higher for women than men in the over-75 age group in impacts with these vehicles.

Conclusions: For cyclists aged 75 years and over, wearing a helmet may be helpful to prevent head injuries in vehicle-to-cyclist accidents. It may also be helpful to introduce some safety measures to prevent hip injuries, given the higher level of fatalities following hip injury among all cyclists aged 75 and over, particularly women.     

Exposure factors of Victoria's active motorcycle fleet related to serious injury crash risk

Objective: The purpose of this study was to describe the nature and extent of current powered 2-wheeler (PTW) risk exposures in order to support future efforts to improve safety for this mode of transport.

Methods: A cross-sectional analysis of the control arm of a population-based case-control study was conducted. The control sample was selected from 204 sites on public roads within 150 km of the city of Melbourne that were locations of recent serious injury motorcycle crashes. Traffic observations and measurements at each site were sampled for a mean of 2 h on the same type of day (weekday, Saturday, or Sunday) and within 1 h of the crash time. Photographs of passing riders during this observation period recorded data relating to characteristics of PTWs, age of riders, travel speed of PTWs and all vehicles, time gaps between vehicles, visibility, and protective clothing use.

Results: Motorcycles and scooters represented 0.6% of all traffic (compared with 4% of all vehicle registrations). Riders were significantly more likely to have larger time gaps in front and behind when compared to other vehicles. The average travel speed of motorcycles was not significantly different than the traffic, but a significantly greater proportion were exceeding the speed limit when compared to other vehicles (6 vs. 3%, respectively). The age of registered owners of passing motorcycles was 42 years. Over half of riders were wearing dark clothing with no fluorescent or reflective surfaces. One third of motorcyclists had maximum coverage of motorcycle-specific protective clothing.

Conclusions: A very low prevalence of motorcyclists combined with relatively higher rates of larger time gaps to other vehicles around motorcycles may help explain their overrepresentation in injury crashes where another vehicle fails to give way. An increased risk of injury in the event of a crash exists for a small but greater proportion of motorcyclists (compared to other vehicle types) who were exceeding the speed limit. An apparent shift toward older age of the active rider population may be reducing injury crash risk relative to exposure time. There is significant scope to improve the physical conspicuity of motorcyclists and the frequency of motorcycle specific protective clothing use. These results can be used to inform policy development and monitor progress of current and future road safety initiatives.     

Risk of serious injury of occupants involved in frontal crashes of cab-over-type trucks

Objectives: Truck vehicles (TVs) have a different structure and stiffness than non-TVs and are used commercially for transporting goods. This study aimed to analyze whether truck occupants have a greater risk of serious injury than those of other types of vehicles.

Methods: Crash data were obtained from the Korean In-Depth Data Analysis Study (KIDAS) for calendar years 2011–2016. Vehicles involved in frontal crash were included and classified into TVs and non-TVs (passenger cars and sports utility vehicles). We compared the demographic characteristics and serious injuries by body region between the 2 groups and analyzed factors that contributed to the serious injury severity from frontal crashes.

Results: The analysis was based on 884 occupants; 177 (20.0%) were in TVs and 707 (80.0%) were in non-TVs. Non-TVs had more frontal airbags deployments than TVs (50.9% vs. 3.4%, P <.01). TV occupants were 4.8 times more likely to have a serious lower extremity (LE) injury (adjusted odds ratio [AOR] = 4.820; 95% confidence interval [CI], 2.407–9.653) and 2.5 times to have a serious abdominal injury (AOR = 2.465; 95% CI, 1.108–5.487) compared to non-TV occupants.

Conclusions: Truck occupants had more serious LE and abdominal injuries than those of other types of vehicles in frontal crashes. Structural improvement and legislative efforts to develop safety systems are necessary to improve the safety of truck occupants.     

Observed activation status of lane departure warning and forward collision warning of Honda vehicles at dealership service centers

Objective: There are little objective data on whether drivers with lane departure warning and forward collision warning systems actually use them, but self-report data indicate that lane departure warning may be used less and viewed less favorably than forward collision warning. The current study assessed whether the systems were turned on when drivers brought their vehicles to dealership service stations and whether the observational protocol is a feasible method for collecting similar data on various manufacturers' systems.

Methods: Observations of 2013–2015 Honda Accords, 2014–2015 Odysseys, and 2015 CR-Vs occurred at 2 U.S. Honda dealerships for approximately 4 weeks during Summer 2015.

Results: Of the 265 vehicles observed to have the 2 systems, 87 (32.8%) had lane departure warning turned on. Accords were associated with a 66% increase in the likelihood that lane departure warning was turned on compared with Odysseys, but the rate was still only about 40% in Accords. In contrast, forward collision warning was turned on in all but one of the observed vehicles.

Conclusions: Observations found that the activation rate was much higher for forward collision warning than lane departure warning. The observation method worked well and appears feasible for extending to other manufacturers.     

Injury risks for on-road farm equipment and horse and buggy crashes in Pennsylvania: 2010–2013

Objective: The purpose of this study was to investigate characteristics associated with farm equipment and horse and buggy roadway crashes in relation to person, incident, and injury characteristics to identify appropriate points for injury incident prevention.

Methods: Information on crashes occurring on public roads during the years 2010–2013 was obtained from the Pennsylvania Department of Transportation (PennDOT) and analyzed.

Results: There were 344 farm equipment and 246 horse and buggy crashes during the 4-year study period. These crashes involved 666 and 504 vehicles and 780 and 838 people, respectively. In incidents with farm equipment, the non-farm equipment drivers had an almost 2 times greater injury risk than farm equipment operators. Horse and buggy crashes were almost 3 times more injurious to the horse and buggy drivers than the drivers of the other vehicles.

Conclusions: The average crash rate for farm equipment was 198.4 crashes per 100,000 farm population and for horse and buggy the crash rate was calculated as 89.4 crashes per 100,000 Amish population per year. This study suggests that road safety and public health programs should focus not only on farm equipment operators and horse and buggy drivers but on other motorists sharing the roadway with them.     

Effects of vehicle power on passenger vehicle speeds

Objectives: During the past 2 decades, there have been large increases in mean horsepower and the mean horsepower-to–vehicle weight ratio for all types of new passenger vehicles in the United States. This study examined the relationship between travel speeds and vehicle power, defined as horsepower per 100 pounds of vehicle weight.

Methods: Speed cameras measured travel speeds and photographed license plates and drivers of passenger vehicles traveling on roadways in Northern Virginia during daytime off-peak hours in spring 2013. The driver licensing agencies in the District of Columbia, Maryland, and Virginia provided vehicle information numbers (VINs) by matching license plate numbers with vehicle registration records and provided the age, gender, and ZIP code of the registered owner(s). VINs were decoded to obtain the curb weight and horsepower of vehicles. The study focused on 26,659 observed vehicles for which information on horsepower was available and the observed age and gender of drivers matched vehicle registration records. Log-linear regression estimated the effects of vehicle power on mean travel speeds, and logistic regression estimated the effects of vehicle power on the likelihood of a vehicle traveling over the speed limit and more than 10 mph over the limit.

Results: After controlling for driver characteristics, speed limit, vehicle type, and traffic volume, a 1-unit increase in vehicle power was associated with a 0.7% increase in mean speed, a 2.7% increase in the likelihood of a vehicle exceeding the speed limit by any amount, and an 11.6% increase in the likelihood of a vehicle exceeding the limit by 10 mph. All of these increases were highly significant.

Conclusions: Speeding persists as a major factor in crashes in the United States. There are indications that travel speeds have increased in recent years. The current findings suggest the trend toward substantially more powerful vehicles may be contributing to higher speeds. Given the strong association between travel speed and crash risk and crash severity, this is cause for concern.     

Injury risk functions for frontal oblique collisions

Objective: The objective of this article was the construction of injury risk functions (IRFs) for front row occupants in oblique frontal crashes and a comparison to IRF of nonoblique frontal crashes from the same data set.

Method: Crashes of modern vehicles from GIDAS (German In-Depth Accident Study) were used as the basis for the construction of a logistic injury risk model. Static deformation, measured via displaced voxels on the postcrash vehicles, was used to calculate the energy dissipated in the crash. This measure of accident severity was termed objective equivalent speed (oEES) because it does not depend on the accident reconstruction and thus eliminates reconstruction biases like impact direction and vehicle model year. Imputation from property damage cases was used to describe underrepresented low-severity crashes―a known shortcoming of GIDAS. Binary logistic regression was used to relate the stimuli (oEES) to the binary outcome variable (injured or not injured).

Results: IRFs for the oblique frontal impact and nonoblique frontal impact were computed for the Maximum Abbreviated Injury Scale (MAIS) 2+ and 3+ levels for adults (18–64 years). For a given stimulus, the probability of injury for a belted driver was higher in oblique crashes than in nonoblique frontal crashes. For the 25% injury risk at MAIS 2+ level, the corresponding stimulus for oblique crashes was 40 km/h but it was 64 km/h for nonoblique frontal crashes.

Conclusions: The risk of obtaining MAIS 2+ injuries is significantly higher in oblique crashes than in nonoblique crashes. In the real world, most MAIS 2+ injuries occur in an oEES range from 30 to 60 km/h.     

Rail height effects on safety performance of Midwest Guardrail System

Objective: Guardrail heights play a crucial role in the way that errant vehicles interact with roadside barriers. Low rail heights increase the propensity of vehicle rollover and override, whereas excessively tall rails promote underride. Further, rail mounting heights and post embedment depths may be altered by variations in roadside terrain. An increased guardrail height may be desirable to accommodate construction tolerances, soil erosion, frost heave, and future roadway overlays. This study aimed to investigate and identify a maximum safe installation height for the Midwest Guardrail System that would be robust and remain crashworthy before and after pavement overlays.

Methods: A research investigation was performed to evaluate the safety performance of increased mounting heights for the standard 787-mm (31-in.)-tall Midwest Guardrail System (MGS) through crash testing and computer simulation. Two full-scale crash tests with small passenger cars were performed on the MGS with top-rail mounting heights of 864 and 914 mm (34 and 36 in.). Test results were then used to calibrate computer simulation models.

Results: In the first test, a small car impacted the MGS with 864-mm (34-in.) rail height at 102 km/h (63.6 mph) and 25.0° and was successfully redirected. In the second test, another small car impacted the MGS with a 914-mm (36-in.) rail height at 103 km/h (64.1 mph) and 25.6° and was successful. Both system heights satisfied the Manual for Assessing Safety Hardware (MASH) Test Level 3 (TL-3) evaluation criteria. Test results were then used to calibrate computer simulation models. A mounting height of 36 in. was determined to be the maximum guardrail height that would safely contain and redirect small car vehicles. Simulations confirmed that taller guardrail heights (i.e., 37 in.) would likely result in small car underride. In addition, simulation results indicated that passenger vehicle models were successfully contained by the 34- and 36-in.-tall MGS installed on approach slopes as steep as 6:1.

Conclusions: A mounting height of 914 mm (36 in.) was determined to be the maximum guardrail height that would safely contain and redirect 1100C vehicles and not allow underride or excessive vehicle snag on support posts. Recommendations were also provided regarding the safety performance of the MGS with increased height.     

Seat strength in rear body block tests

Purpose: This study collected and analyzed available testing of motor vehicle seat strength in rearward loading by a body block simulating the torso of an occupant. The data were grouped by single recliner, dual recliner, and all belts to seat (ABTS) seats.

Methods: The strength of seats to rearward loading has been evaluated with body block testing from 1964 to 2008. The database of available tests includes 217 single recliner, 65 dual recliner, and 18 ABTS seats. The trends in seat strength were determined by linear regression and differences between seat types were evaluated by Student's t-test. The average peak moment and force supported by the seat was determined by decade of vehicle model year (MY).

Results: Single recliner seats were used in motor vehicles in the 1960s to 1970s. The average strength was 918 ± 224 Nm (n = 26) in the 1960s and 1,069 ± 293 Nm (n = 65) in the 1980s. There has been a gradual increase in strength over time. Dual recliner seats started to phase into vehicles in the late 1980s. By the 2000s, the average strength of single recliner seats increased to 1,501 ± 335 Nm (n = 14) and dual recliner seats to 2,302 ± 699 Nm (n = 26). Dual recliner seats are significantly stronger than single recliner seats for each decade of comparison (P < .001). The average strength of ABTS seats was 4,395 ± 1,185 in-lb for 1989–2004 MY seats (n = 18). ABTS seats are significantly stronger than single or dual recliner seats (P < .001). The trend in ABTS strength is decreasing with time and converging toward that of dual recliner seats.

Conclusions: Body block testing is an quantitative means of evaluating the strength of seats for occupant loading in rear impacts. There has been an increase in conventional seat strength over the past 50 years. By the 2000s, most seats are 1,700–3,400 Nm moment strength. However, the safety of a seat is more complex than its strength and depends on many other factors.     

Unintentional non-traffic injury and fatal events: Threats to children in and around vehicles

Objective: There have been substantial reductions in motor vehicle crash–related child fatalities due to advances in legislation, public safety campaigns, and engineering. Less is known about non-traffic injuries and fatalities to children in and around motor vehicles. The objective of this study was to describe the frequency of various non-traffic incidents, injuries, and fatalities to children using a unique surveillance system and database.

Methods: Instances of non-traffic injuries and fatalities in the United States to children 0–14 years were tracked from January 1990 to December 2014 using a compilation of sources including media reports, individual accounts from families of affected children, medical examiner reports, police reports, child death review teams, coroner reports, medical professionals, legal professionals, and other various modes of publication.

Results: Over the 25-year period, there were at least 11,759 events resulting in 3,396 deaths. The median age of the affected child was 3.7 years. The incident types included 3,115 children unattended in hot vehicles resulting in 729 deaths, 2,251 backovers resulting in 1,232 deaths, 1,439 frontovers resulting in 692 deaths, 777 vehicles knocked into motion resulting in 227 deaths, 415 underage drivers resulting in 203 deaths, 172 power window incidents resulting in 61 deaths, 134 falls resulting in 54 deaths, 79 fires resulting in 41 deaths, and 3,377 other incidents resulting in 157 deaths.

Conclusions: Non-traffic injuries and fatalities present an important threat to the safety and lives of very young children. Future efforts should consider complementary surveillance mechanisms to systematically and comprehensively capture all non-traffic incidents. Continued education, engineering modifications, advocacy, and legislation can help continue to prevent these incidents and must be incorporated in overall child vehicle safety initiatives.     

High beam headlamp use rates: Effects of rurality,proximity of other traffic,and roadway curvature

Objective: The few observational studies of the prevalence of high beam use indicate the rate of high beam use is about 25% when vehicles are isolated from other vehicles on unlit roads. Recent studies were limited to 2-lane rural roads and used measurement methods that likely overestimated use. The current study examined factors associated with the rate of high beam use of isolated vehicles on a variety of roadways in the Ann Arbor, Michigan area.

Methods: Twenty observation sites were categorized as urban, rural, or on a rural/urban boundary and selected to estimate the effects of street lighting, road curvature, and direction of travel relative to the city on high beam use. Sites were selected in pairs so that a majority of traffic passing one site also passed through the other. Measurement of high beams relied on video data recorded for 2 nights at each site, and the video data also were used to derive a precise measure of the proximity of other traffic. Nearly 3,200 isolated vehicles (10 s or longer from other vehicles) were observed, representing 1,500-plus vehicle pairs.

Results: Across the sample, 18% of the vehicles used high beams. Seventy-three percent of the 1,500-plus vehicle pairs used low beams at each paired site, whereas 9% used high beams at both sites. Vehicles at rural sites and sites at the boundaries of Ann Arbor were more likely to use high beams than vehicles at urban sites, but use in rural areas compared with rural/urban boundary areas did not vary significantly. Rates at all sites were much lower than expected, ranging from 0.9 to 52.9%. High beam use generally increased with greater time between subject vehicles and leading vehicles and vehicles in the opposing lane. There were mixed findings associated with street lighting, road curvature, and direction of travel relative to the city.

Conclusion: Maximizing visibility available to drivers from headlights includes addressing the substantial underuse of high beam headlamps. Advanced technologies such as high beam assist, which switches automatically between high and low beam headlamps depending on the presence of other traffic, can help to address this problem.     

How motorcycle helmets affect trauma mortality: Clinical and policy implications

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

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

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

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

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

Development of cycling skills in 7- to 12-year-old children

Objective: Cycling is a complex skill consisting of motor skills such as pedalling, braking, and steering. Because the ability to perform cycling skills is based on the age-related development of the child, experience and age-related reference values are of interest in light of customized testing and training.

Methods: One hundred thirty-eight children from the second (7–8 years), fourth (9–10 years), and sixth (11–12 years) grades performed a practical bicycle test consisting of 13 test items with specific points of interest. Moreover, age at onset of cycling, cycling to and from school, independent mobility, and minutes cycling per week were estimated using a parental questionnaire.

Results: It is found that cycling skills are strongly related to age with 11- to 12-year-old children outperforming 7- to 8-year-old children for 11 test items and 9- to 10-year-old children for 8 test items.

Conclusions: Next to age, age at onset of cycling also contributed to cycling skills. Therefore, our results suggest that cycling skills are associated with physical and mental maturation. Subsequently, age-related reference values are provided to customize testing and training.     

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

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

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

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

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

Emergency braking is affected by the use of cruise control

Objective: We compared the differences in the braking response to vehicle collision between an active human emergency braking (control condition) and cruise control (CC) or adaptive cruise control (ACC).

Methods: In 11 male subjects, age 22 to 67 years, we measured the active emergency braking response during manual driving using the accelerator pedal (control condition) or in condition mimicking CC or ACC. In both conditions, we measured the brake reaction time (BRT), delay to produce the peak braking force (PBD), total emergency braking response (BRT + PBD), and peak braking force (PBF). Electromyograms of leg and thigh muscles were recorded during braking. The tonic vibratory response (TVR), Hoffman reflex (HR), and M-waves were recorded in leg muscles to explore the change in sensorimotor control.

Results: No difference in PBF, TVR amplitude, HR latency, and H_max/M_max ratio were found between the control and CC/ACC conditions. On the other hand, BRT and PBD were significantly lengthened in the CC/ACC condition (240 ± 13 ms and 704 ± 70 ms, respectively) compared to control (183 ± 7 ms and 568 ± 36 ms, respectively). BRT increased with the age of participants and the driving experience shortened PBD and increased PBF.

Conclusions: In male subjects, driving in a CC/ACC condition significantly delays the active emergency braking response to vehicle collision. This could result from higher amplitude of leg motion in the CC/ACC condition and/or by the age-related changes in motor control. Car and truck drivers must take account of the significant increase in the braking distance in a CC/ACC condition.     

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.     

Repeatability of a dynamic rollover test system

Objective: The goal of this study was to characterize the rollover crash and to evaluate the repeatability of the Dynamic Rollover Test System (DRoTS) in terms of initial roof-to-ground contact conditions, vehicle kinematics, road reaction forces, and vehicle deformation.

Methods: Four rollover crash tests were performed on 2 pairs of replicate vehicles (2 sedan tests and 2 compact multipurpose van [MPV] tests), instrumented with a custom inertial measurement unit to measure vehicle and global kinematics and string potentiometers to measure pillar deformation time histories. The road was instrumented with load cells to measure reaction loads and an optical encoder to measure road velocity. Laser scans of pre- and posttest vehicles were taken to provide detailed deformation maps.

Results: Initial conditions were found to be repeatable, with the largest difference seen in drop height of 20 mm; roll rate, roll angle, pitch angle, road velocity, drop velocity, mass, and moment of inertia were all 7% different or less. Vehicle kinematics (roll rate, road speed, roll and pitch angle, global Z′ acceleration, and global Z′ velocity) were similar throughout the impact; however, differences were seen in the sedan tests because of a vehicle fixation problem and differences were seen in the MPV tests due to an increase in reaction forces during leading side impact likely caused by disparities in roll angle (3° difference) and mass properties (2.2% in moment of inertia [MOI], 53.5 mm difference in center of gravity [CG] location).

Conclusions: Despite those issues, kinetic and deformation measures showed a high degree of repeatability, which is necessary for assessing injury risk in rollover because roof strength positively correlates with injury risk (Brumbelow 2009). Improvements of the test equipment and matching mass properties will ensure highly repeatable initial conditions, vehicle kinematics, kinetics, and deformations.