Method: Crashes of modern vehicles from the GIDAS (German In-Depth Accident Study) are corrected for bias and projected to the national level. Injury risk functions are computed for the injury severity levels Maximum Abbreviated Injury Scale (MAIS) 2+, MAIS 3+, and fatal, stratified by 2 age cohorts (16–44 years of age and 45 years or older). To assess the field effectivity of a “softer belt,” the projected crash frequency data are modified separately for the 2 age cohorts such that its risk structure represents the risk of a softer belt. Given those 2 samples, the field effectivity of a softer belt is derived for several shares of the younger age cohort according to the injury severity levels MAIS 2+, MAIS 3+, and fatal.
Results: The injury risk distribution of the projected crash frequency data, represented here by the injury risk functions obtained, fits well into the injury risk distribution of other data sets (Sweden, United States, and Japan) given in the literature. The relative effects of a lower belt force are stable over the different ratios of the younger and old age cohorts. At the MAIS 2+ level, a lower belt force can significantly reduce the number of injuries (about 10%). A lower belt force does not significantly affect the number of MAIS 3+ injuries. A lower belt force can, however, more than double the number of fatal injuries.
Conclusions: Because the number of fatal injuries rises dramatically due to lower belt force, the reduction in the number of MAIS 2+ injuries comes at a very high cost. Therefore, whether reducing the belt force limit is the right approach is questionable. 相似文献
Methods: Injury distributions were examined by occupant age and vehicle model year (stratified at pre- and post-2009). Logistic regression models were developed to examine the effects of various factors on injury risk (by body region), controlling for delta-V, sex, age, height, body mass index (BMI), vehicle model year (again stratified at 2009).
Results: Among other observations, these analyses indicate that newer model year vehicles (model year [MY] 2009 and later) carry less risk of Abbreviated Injury Scale (AIS) 2+ and AIS 3+ injury compared to older model year vehicles, with odds ratios of 0.69 (AIS 2+) and 0.45 (AIS 3+). The largest reductions in risk between newer model year vehicles and older model year vehicles occur in the lower extremities and in the risk of skull fracture. There is no statistically significant change in risk of AIS 3+ rib fracture or sternum injury between model year categories. Females are at greater risk of AIS 2+ and AIS 3+ injury compared to males, with increased risk across most injury types.
Conclusions: For belted occupants in frontal collisions, substantial reductions in injury risk have been realized in many body regions in recent years. Risk reduction in the thorax has lagged other body regions, resulting in increasing prevalence among skeletal injuries in newer model year vehicles (especially in the elderly). Injuries also remain common in the arm and hand/wrist for all age ranges studied. These results provide insight into where advances in the field have made gains in occupant protection and what injury types remain to be addressed. 相似文献
Methods: Disability risk (DR) was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank for the most frequently occurring Abbreviated Injury Scale (AIS) 2–5 thoracic injuries. Occupants with thoracic injury were classified as disabled or not disabled based on the FIM scale, and comparisons were made between the following age groups: pediatric, adult, middle-aged, and older occupants (ages 7–18, 19–45, 46–65, and 66+, respectively). For each age group, DR was calculated by dividing the number of patients who were disabled and sustained a given injury by the number of patients who sustained a given injury. To account for the effect of higher severity co-injuries, a maximum AIS adjusted DR (DRMAIS) was also calculated for each injury. DR and DRMAIS could range from 0 to 100% disability risk.
Results: The mean DRMAIS for MVC thoracic injuries was 20% for pediatric occupants, 22% for adults, 29% for middle-aged adults, and 43% for older adults. Older adults possessed higher DRMAIS values for diaphragm laceration/rupture, heart laceration, hemo/pneumothorax, lung contusion/laceration, and rib and sternum fracture compared to the other age groups. The pediatric population possessed a higher DRMAIS value for flail chest compared to the other age groups.
Conclusion: Older adults had significantly greater overall disability than each of the other age groups for thoracic injuries. The developed disability metrics are important in quantifying the significant burden of injuries and loss of quality life years. Such metrics can be used to better characterize severity of injury and further the understanding of age-related differences in injury outcomes, which can influence future age-specific modifications to AIS. 相似文献
Methods: Image data for 8 female and 7 male subjects in a seated posture acquired by an upright open magnetic resonance imaging (MRI) system were utilized. Spinal alignment was determined from the centers of the vertebrae and average spinal alignment patterns for both genders were estimated by multidimensional scaling (MDS). An occupant FE model of female average size (162 cm, 62 kg; the AF 50 size model) was developed by scaling THUMS AF 05. The average spinal alignment pattern for females was implemented in the model, and model validation was made with respect to female volunteer sled test data from rear end impacts. Thereafter, the average spinal alignment pattern for males and representative spinal alignments for all subjects were implemented in the validated female model, and additional FE simulations of the sled test were conducted to investigate effects of spinal alignment patterns on cervical vertebral motion.
Results: The estimated average spinal alignment pattern was slight kyphotic, or almost straight cervical and less-kyphotic thoracic spine for the females and lordotic cervical and more pronounced kyphotic thoracic spine for the males. The AF 50 size model with the female average spinal alignment exhibited spine straightening from upper thoracic vertebra level and showed larger intervertebral angular displacements in the cervical spine than the one with the male average spinal alignment.
Conclusions: The cervical spine alignment is continuous with the thoracic spine, and a trend of the relationship between cervical spine and thoracic spinal alignment was shown in this study. Simulation results suggested that variations in thoracic spinal alignment had a potential impact on cervical spine motion as well as cervical spinal alignment in rear end impact condition. 相似文献
Methods: Data regarding cycling-related injuries and hospital admissions were obtained from the National Electronic Injury Surveillance System (NEISS). Participation data were derived from the National Sporting Goods Association Sports Participation Survey, and fatality data were collected from the Fatality Analysis Reporting System (FARS). Population estimates were obtained using a complex survey design. Linear regression was used to evaluate univariate relationships between cycling injuries, hospital admissions, deaths, and participation. To evaluate factors associated with hospital admission, we developed a multivariable logistic regression model that included year, age, gender, body part injured, and injury type (i.e., contusion, fracture, or laceration).
Results: The number of individuals who cycle did not change significantly over time, but there was a substantial increase in cycling-related injuries, leading to an increase in per participant injuries from 701/100,000 in 1997 to 1,164/100,000 in 2013. When the injuries were evaluated by age group, younger cyclists have an increased risk for injury, whereas the rise in injuries among older cyclists stemmed from an increase in ridership rather than a unique susceptibility to injury. Trends in hospital admissions and fatalities appeared to be driven by increases in the older age groups. In the multivariable model evaluating factors related to hospital admission, the odds of hospital admission increased for each decade after age 25, as well as male gender and body part injured.
Conclusion: On a per participant basis, the rate of cycling-related injuries and hospital admissions increased between 1997 and 2013. This trend likely reflects a combination of shifting demographics among cyclists with an increase in older cyclists who are at increased risk of severe injury. 相似文献
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. 相似文献
Methods: An inception cohort prospective design was used. Participants included cyclists aged ≥17 years (mean age 41.7 years) who sustained a physical injury (n = 238) assessed within 28 days of the crash, following medical examination by a registered health care practitioner. Injury included musculoskeletal and soft tissue injuries and minor/moderate traumatic brain injury (TBI), excluding severe TBI, spinal cord injury, and severe multiple fractures. Assessment also occurred 6 months postinjury. Telephone-administered interviews assessed a suite of measures including sociodemographic, preinjury health and injury factors. Psychological impact was measured by pain catastrophization, trauma-related distress, and general psychological distress. The psychological health of the cyclists was compared to that of the car occupants (n = 234; mean age 43.1 years). A mixed model repeated measures analysis, adjusted for confounding factors, was used to determine differences between groups and regression analyses were used to determine contributors to psychological health in the cyclists 6 months postinjury.
Results: Cyclists had significantly better psychological health (e.g., lower pain catastrophizing, lower rates of probable posttraumatic stress disorder [PTSD], and lower general distress levels) compared to car occupants at baseline and 6 months postinjury. Factors predictive of cyclists' psychological distress included younger age, greater perceived danger of death, poorer preinjury health, and greater amount of time in hospital after the injury.
Conclusions: These data provide insight into how cyclists perceive and adjust to their traffic injuries compared to drivers and passengers who sustain traffic injuries, as well as direction for preventing the development of severe psychological injury. Future research should examine the utility of predictors of psychological health to improve recovery. 相似文献
Methods: The registry of the Finnish Road Accident (FRA) Investigation Teams was analyzed to study severe head- and eyewear-related injuries. All fatal passenger car or van accidents that occurred during the years 2009–2012 (4 years) were included (n = 734). Cases in which the driver's front airbag was deployed were subjected to analysis (n = 409). To determine the proportion of minor, potentially airbag-related eye injuries, the results were compared to the data for all new eye injury patients (n = 1,151) recorded at the Emergency Clinic of the Helsinki University Eye Hospital (HUEH) during one year, from May 1, 2011, to April 30, 2012.
Results: In the FRA data set, the unbelted drivers showed a significantly higher risk of death (odds ratio [OR] = 5.89, 95% confidence interval [CI], 3.33–10.9, P = 2.6E-12) or of sustaining head injuries (OR = 2.50, 95% CI, 1.59–3.97, P = 3.8E-5). Only 4 of the 1,151 HUEH patients were involved in a passenger car accident. In one of the crashes, the airbag operated, and the belted driver received 2 sutured eye lid wounds and showed conjunctival sugillation. No permanent eye injuries were recorded during the follow-up. The calculated annual airbag-related eye injury incidence was less than 1/1,000,000 people, 4/100,000 accidents, and 4/10,000 injured occupants.
Conclusions: Airbag-related eye injuries occurred very rarely in car accidents in cases where the occupant survived and the restraint system was appropriately used. Spectacle use did not appear to increase the risk of eye injury in restrained occupants. 相似文献
Methods: Using a unique, linked, Fatality Analysis Reporting System (FARS) and Multiple Cause of Death (MCOD) database from 2000–2010, 144,169 drivers over 16 years of age who suffered fatal injuries were identified. The merged database provides an unparalleled fidelity for identifying thoracic aortic injuries due to motor vehicle accidents. Thoracic aortic injuries were defined by ICD-10 codes S250. Univariate and multivariate logistic regression models for presence of any thoracic aortic injuries were fitted. Age, gender, BMI weight categories, vehicle class, model year, crash type/direction, severity of crash damage, airbag deployment location, and seatbelt use, fatal injury codes, and location of injury were considered. Odds ratios (OR) and corresponding 95% confidence intervals (95%CI) are calculated.
Results: There were 2953 deaths (2.10%) related to thoracic aortic injuries that met the inclusion criteria. Nearside crashes were associated with an increased odds (OR = 1.42, 1.1-1.83), while rollover crashes (OR =.44,.29-.66) were associated with a reduced odds of fatal thoracic aortic injury. Using backward selection on the full multivariate model, the only significant model effects that remained were vehicle type, crash type, body region, and injury type.
Conclusions: The increased prevalence of fatal thoracic aortic injury in nearside crashes, increasing age, and vehicle type provide some insight into the current US fleet. Important factors, including model year, had significantly lower levels of the injury in univariate analysis, demonstrating the effect of safety improvements in newer model vehicles. Further study of this fatal injury is warranted, including comparisons of those who survive the injury. 相似文献
Methods: We used our prospective cross-sectional substudy involving injured motorcyclists presenting at major trauma hospitals in Southern Klang Valley, Malaysia, between March 2010 and March 2011. of 391 subjects with facial injuries, 2 male motorcyclists sustained this laceration. The wounds were assessed and we believed that each was associated with the helmet visor. One of the visors was collected and the edge was inspected using scanning electron microscopy (SEM).
Results: The prevalence of this unusual injury was 0.51% (95% confidence interval, 0.002–0.012) among motorcyclists who sustained facial injuries. Both cases were involved in a head-on collision with their colliding partners and their helmets were intact throughout the crash. The visor in case 1 was intact, but the visor in case 2 was broken. SEM analysis showed that the visor in case 1 had a potential cutting surface.
We postulated that with helmet rotation in the forward and downward position and with some degree of visor bending or with a dislodged visor, the sharp-edged visor could potentially severely lacerate the face.
Conclusion: This injury affects facial aesthetics and early referral to the facial surgery team is advocated. Documentation of the mechanism of injury, the patient’s helmet and visor is obligatory, so that this information can be delivered to the regional road safety authority for preventive measures. 相似文献
Methods: This study analyzed data from previously conducted experiments using post mortem human subjects (PMHS). Group A tests used the upright intact head–cervical column experimental model. The inferior end of the specimen was fixed, the head was balanced by a mechanical system, and natural lordosis was removed. Specimens were placed on a testing device via a load cell. The piston applied loading at the vertex region. Spinal injuries were identified using medical images. Group B tests used the inverted head–cervical column experimental model. In one study, head–T1 specimens were fixed distally, and C7–T1 joints were oriented anteriorly, preserving lordosis. Torso mass of 16 kg was added to the specimen. In another inverted head–cervical column study, occiput–T2 columns were obtained, an artificial head was attached, T1–T2 was fixed, C4–C5 disc was maintained horizontal in the lordosis posture, and C7–T1 was unconstrained. The specimens were attached to the drop test carriage carrying a torso mass of 15 kg. A load cell at the inferior end measured neck loads in both studies. Axial neck force and age were used as the primary response variable and covariate to derive injury probability curves using survival analysis.
Results: Group A tests showed that age is a significant (P < .05) and negative covariate; that is, increasing age resulted in decreasing force for the same risk. Injuries were mainly vertebral body fractures and concentrated at one level, mid-to-lower cervical spine, and were attributed to compression-related mechanisms. However, age was not a significant covariate for the combined data from group B tests. Both group B tests produced many soft tissue injuries, at all levels, from C1 to T1. The injury mechanism was attributed to mainly extension. Multiple and noncontiguous injuries occurred. Injury probability curves, ±95% confidence intervals, and normalized confidence interval sizes representing the quality of the mean curve are given for different data sets.
Conclusions: For compression-related injuries, specimen age should be used as a covariate or individual specimen data may be prescaled to derive risk curves. For distraction- or extension-related injuries, however, specimen age need not be used as a covariate in the statistical analysis. The findings from these tests and survival analysis indicate that the age factor modulates human cervical spine tolerance to impact injury. 相似文献
Methods: A retrospective review of occupants age < 19 years within the MVC data set NASS-CDS 2000–2011 was performed. R2 values of logistic regression models using age, height, or weight to predict 18 key injury types were compared to determine which metric should be used as a covariate in a pediatric AACN algorithm. Clinical judgment, literature review, and chi-square analysis were used to create groupings of the chosen metric that would discriminate injury patterns. Adjusted odds of particular injury types at the different levels of this metric were calculated from logistic regression while controlling for gender, vehicle velocity change (delta V), belted status (optimal, suboptimal, or unrestrained), and crash mode (rollover, rear, frontal, near-side, or far-side).
Results: NASS-CDS analysis produced 11,541 occupants age < 19 years with nonmissing data. Age, height, and weight were correlated with one another and with injury patterns. Age demonstrated the best predictive power in injury patterns and was categorized into bins of 0–4 years, 5–9 years, 10–14 years, and 15–18 years. Age was a significant predictor of all 18 injury types evaluated even when controlling for all other confounders and when controlling for age- and gender-specific body mass index (BMI) classifications. Adjusted odds of key injury types with respect to these age categorizations revealed that younger children were at increased odds of sustaining Abbreviated Injury Scale (AIS) 2+ and 3+ head injuries and AIS 3+ spinal injuries, whereas older children were at increased odds of sustaining thoracic fractures, AIS 3+ abdominal injuries, and AIS 2+ upper and lower extremity injuries.
Conclusions: The injury patterns observed across developmental metrics in this study mirror those previously described among children with blunt trauma. This study identifies age as the metric best suited for use in a pediatric AACN algorithm and utilizes 12 years of data to provide quantifiable risks of particular injuries at different levels of this metric. This risk quantification will have important predictive purposes in a pediatric-specific AACN algorithm. 相似文献
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. 相似文献
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. 相似文献
Methods: We analyzed 138 road suicides (2011–2016) involving a passenger car crashing into a heavy vehicle. We used in-depth road crash investigation data from the Finnish Crash Data Institute.
Results: The results showed that all but 2 crashes were head-on collisions. Almost 30% of truck drivers were injured, but only a few suffered serious injuries. More than a quarter reported sick leave following their crash. Injury insurance compensation to heavy-vehicle drivers was just above €9,000 on average. Material damage to heavy vehicles was significant, with average insurance compensation paid being €70,500. Three out of 4 truck drivers reported that drivers committing suicide acted abruptly and left them little opportunity for preventive action.
Conclusions: Suicides by crashing into heavy vehicles can have an impact on drivers’ well-being; however, it is difficult to see how heavy-vehicle drivers could avoid a suicide attempt involving their vehicle. 相似文献
Method: Three different passenger movement types including standing, seated, and boarding/alighting were analyzed individually using classification and regression tree (CART) method based on publicly available accident database of Great Britain.
Results: According to the results of exploratory analyses, passenger age and vehicle maneuver are associated with passenger injury severity in all 3 types of accidents. Moreover, the variable “skidding and overturning” is associated with injury severity of seated passengers and driver age is correlated with injury severity of standing and boarding/alighting passengers.
Conclusions: The CART method shows its ability to identify and easily explain the complicated patterns affecting passenger injury severity. Several countermeasures to reduce bus passenger injury severity are recommended. 相似文献
Methods: A retrospective analysis of motorcycle crash data between 2011 and 2015 was conducted using a motorcycle crash data set extracted from the National Road Traffic Crash Database at the Building and Road Research Institute (BRRI) in Ghana. Injury severity was classified into 4 categories: Fatal, hospitalized, injured, and damage only. A multinomial logit modeling framework was used to identify the possible determinants of motorcycle crash severity.
Results: During the study period, a total of 8,516 motorcycle crashes were recorded, of which 22.9% were classified as fatal, 42.1% were classified as hospitalized injuries, 29.4% were classified as slight injuries, and 5.6% were classified as damage-only crashes. The estimation results indicate that the following factors increase the probability of fatal injuries: At a junction; weekend; signage; poor road shoulder; village settlement; tarred and good road surface; and collision between motorcycle and heavy goods vehicle (HGV). Motorcycle crashes occurring during the daytime and on the weekend increases the probability of hospitalized injury. The results also suggest that motorcycle crashes occurring during the daytime, in curves or inclined portions of roads, or in unclear weather conditions decrease the probability of fatal injury.
Conclusions: This study provides further empirical evidence to support motorcycle crash modeling research, which is lacking in developing countries. The ability to understand the various factors that influence motorcycle crash severity is a step forward in providing an appropriate basis upon which informed motorcycle crash policies can be developed. Particular attention should be given to the provision of road signage at junctions and speed humps and controlling traffic during the weekend. In addition, road maintenance should be carried out periodically to address motorcycle safety in Ghana. 相似文献
Methods: Using a prospective database of HIs from a neurosurgical practice in a sub-Saharan African developing country, a cross-sectional survey was conducted for the trauma demography and clinical epidemiology of this MCC-related HI.
Results: Motorcycle crashes accounted for 57% (473/833) of all RTI-related HIs in this registry. The victims, with a mean age of 33.1 years (SD = 18.3), consisted mainly of males (83.1%), those of low socioeconomic status (>90%), and those aged between 20 and 40 years old (56%). MCCs involved only riders in 114 cases (114/473, 32.1%), of which 69% were motorcycle–motorcycle crashes. The HI was moderate–severe in 50.8%; clinical symptomatology of significant HI included loss of consciousness (92%), anisocoria (35%), Abbreviated Injury Scale head (AIS–head) score > 3 (28%), and CT-Rotterdam score > 3 (30%). Extracranial systemic injury involved the limbs most frequently, with an Injury Severity Score (ISS) >25 in 49%. The fatality rate was 24%.
MCC-related HI among pedestrian victims involved more vulnerable age groups (the young and elderly) but have lower mean ISS compared to motorcycle passengers (mean ISS = 23.5 [11.6] vs. 27.4 [13.0]; 95% confidence interval [CI], 1.27–6.49; P = .004). In addition, compared to a contemporary cohort of MVC-related HIs in our registry, MCC victims were older (mean age 34.8 years [18.0] vs. 30.8 [18.4]; P = .002); had higher proportions of certain extracranial trauma like long bone fractures (71 vs. 29%; P = .02); and suffered fewer surgical brain lesions (25.5 vs. 17.2%; P = .004).
Conclusions: Motorcycle crashes are now a significant threat to the heads, limbs, and lives of vulnerable road users in developing countries. 相似文献