Analyzing injury severity factors at highway railway grade crossing accidents involving vulnerable road users: A comparative study

Objective: The main objective of this study is to identify the main factors associated with injury severity of vulnerable road users (VRUs) involved in accidents at highway railroad grade crossings (HRGCs) using data mining techniques.

Methods: This article applies an ordered probit model, association rules, and classification and regression tree (CART) algorithms to the U.S. Federal Railroad Administration's (FRA) HRGC accident database for the period 2007–2013 to identify VRU injury severity factors at HRGCs.

Results: The results show that train speed is a key factor influencing injury severity. Further analysis illustrated that the presence of illumination does not reduce the severity of accidents for high-speed trains. In addition, there is a greater propensity toward fatal accidents for elderly road users compared to younger individuals. Interestingly, at night, injury accidents involving female road users are more severe compared to those involving males.

Conclusions: The ordered probit model was the primary technique, and CART and association rules act as the supporter and identifier of interactions between variables. All 3 algorithms' results consistently show that the most influential accident factors are train speed, VRU age, and gender. The findings of this research could be applied for identifying high-risk hotspots and developing cost-effective countermeasures targeting VRUs at HRGCs.     

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

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

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

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

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

Risk factors in urban road traffic accidents

INTRODUCTION: The urban road traffic accident (RTA) risks for the city of Zagreb, Croatia, from 1999 through 2000 were analyzed with the aim of reducing the increasing injury incidence. METHOD: Simple and bivariate analysis using chi(2), odds ratio, and confidence interval of 95% was used to determine risks in three outcome groups: killed, severely, and mildly injured. RESULTS: There were 528 RTA victims consisting of 260 severely, 213 mildly injured, and 55 killed at the scene of an accident and during transportation. More fatal accidents occurred during night hours (OR=3.78; 95% CI, 2.08-6.85), on urban road links (OR=2.33; 95% CI, 1.30-4.19), and at exceeding speed limit (OR=2.56; 95% CI, 1.43-4.61). More people were injured than killed on urban junctions (OR=5.27; 95% CI, 2.21-12.57). The highest combined risk of dying or being severely injured was found in males, driving at excessive speed, on urban links, and during bad visibility (OR=16.15; 95% CI, 3.901-66.881). CONCLUSION: These results will influence the urban traffic police enforcement measures, which will change inappropriate behavior of drivers and protect the least experienced road users.     

Analysis of posttraumatic stress disorder in children with road traffic injury in Wenzhou,China

Objective: Road traffic accidents are the leading health threat to children and cause significant long-term mental health problems. This study aimed to characterize posttraumatic stress disorder (PTSD) in children suffering from road traffic injuries (RTIs) in Wenzhou, China.

Methods: We conducted a retrospective study of 537 children (aged 1 to 13 years old) with RTIs. The epidemiological features, PTSD incidence, clinical manifestation, and risk factors were analyzed based on a customized PTSD risk factor questionnaire. The outcome factors were also evaluated by means of the logistic regression method.

Results: The PTSD incidence was 24.77% in children with RTIs. The incidence of PTSD was related to the personality, family environment, and family care of the children. It was found that early psychological intervention and reasonable family care from the family might promote physical and mental welfare as well as contribute to the development of more effective treatments to prevent PTSD.

Conclusion: For susceptible children, in addition to dealing with the somatic injury, psychological intervention and family care should be carried out as early as possible.     

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.     

Analysis of injury mechanism of the elderly and non-elderly groups in minor motor vehicle accidents

Abstract

Objective: The purpose of this study is to investigate the injury patterns of noncatastrophic accidents by individual age groups.

Methods: Data were collected from the Korean In-Depth Accident Study database based on actual accident investigation. The noncatastrophic criteria were classified according to U.S. experts from the Centers for Disease Control and Prevention’s recommendations for field triage guidelines of high-risk automobile crash criteria by vehicle intrusions more than 12 in. on occupant sites (including the roof) and more than 18 in. on any site. The Abbreviated Injury Scale (AIS) was used to determine injury patterns for each body region. Severely injured patients were classified as Maximum Abbreviated Injury Scale (MAIS) 3 or higher.

Results: In this study, the most significant injury regions were the head and neck, extremities, and thorax. In addition, the incidence of severe injury among elderly patients was nearly 1.6 times higher than that of non-elderly patients. According to age group, injured body regions among the elderly were the thorax, head and neck, and extremities, in that order. For the non-elderly groups, these were head and neck, extremities, and thorax. Severe injury rates were slightly different for the elderly group (head and neck, abdomen) and non-elderly group (thorax, head and neck).

Conclusions: In both age groups, the rate of severe injury is proportional to an increase in crush extent zone. Front airbag deployment may have a relatively significant relationship to severe injuries.     

Awareness,riding behaviors,and legislative attitudes toward electric bikes among two types of road users: An investigation in Tianjin,a municipality in China

Objective: This study aimed to understand the awareness, riding behaviors, and legislative attitudes of electric bike (e-bike) users and non-e-bike road users toward e-bikes in Tianjin, a municipality in China.

Methods: This cross-sectional investigation included 2 components. The field survey was conducted in 9 districts (4 urban and 5 rural) from 2015 to 2017. Adult participants were interviewed using a street intercept method. The online survey was conducted using the WeChat social platform. A series of questions related to awareness and practice of e-bike safety-related issues was asked.

Results: A total of 16,859 interviews were completed, including 1,653 (794 e-bike users and 859 other road users) in-person interviews by field survey and 15,206 (4,426 e-bike users and 10,780 other road users) by online survey. Except for ignoring a red light when making a left turn (P?=?.000) and waiting across the white line at a red light (P?=?.000), which e-bike users were lower than other road users, there were no significant differences between e-bike users and other road users in regards to the correct awareness rate of riding in the opposite direction, riding in a motor vehicle lane, running red lights, jaywalking, speeding, carrying adult passengers, and riding on the expressway (P?>?.05). In addition, 74.2% of e-bike users considered helmet use necessary (P?=?.000) and 54.7% thought that installing a windshield is wrong (P?=?.000), which was higher than other road users (49.1 and 48.4%, respectively). Other road users had greater awareness than e-bike users regarding whether turning left at a red light is wrong (91.7 vs. 85.1%), waiting across the white line when the light is red is wrong (86.6 vs. 75.9%), lighs should be turned on at night (94.8 vs. 90.3%). Correct practices were far behind awareness in all kinds of violation behaviors (P?=?.000) among e-bike users in the field survey. The rate of public support for legislation including those who very much support and support legislation was 93.34% in the field survey and 87.68% in the online survey.

Conclusions: E-bike users had lower correct awareness rate than other road users regarding e-bike violation behaviors but were more concerned about safety protection than other road users. E-bike users’ correct practices were far behind their awareness for all kinds of violation behaviors. Public education on the traffic law needs to be strengthened among e-bike users. The public strongly supported special regulations for e-bike use, such as helmet use.     

Road traffic injury in sub-Saharan African countries: A systematic review and summary of observational studies

Objective: The aim of this study is to evaluate, through a systematic review of hospital-based studies, the proportion of road traffic injuries and fatalities in sub-Saharan Africa (SSA).

Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology guidelines, we searched the following electronic databases: PubMed, Embase, Africa-Wide Information, Global Health, and Web of Science. Articles were eligible if they measured proportion of road traffic injuries (RTIs) in SSA by using hospital-based studies. In addition, a reference and citation analysis was conducted as well as a data quality assessment.

Results: Up to 2015, there were a total of 83 hospital-based epidemiologic studies, including 310,660 trauma patients and 99,751 RTI cases, in 13 SSA countries. The median proportion of RTIs among trauma patients was 32% (4 to 91%), of which the median proportion of death for the included articles was 5% (0.3 to 41%).

Conclusion: The number of studies evaluating RTI proportions and fatalities in SSA countries is increasing but without the exponential rise expected from World Health Organization calls for research during the Decade of Action for Road Traffic Injuries. Further research infrastructure including standardization of taxonomy, definitions, and data reporting measures, as well as funding, would allow for improved cross-country comparisons.     

Functional outcomes of motor vehicle crash thoracic injuries in pediatric and adult occupants

Objective: Characterization of the severity of injury should account for both mortality and disability. The objective of this study was to develop a disability metric for thoracic injuries in motor vehicle crashes (MVCs) and compare the functional outcomes between the pediatric and adult populations.

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 (DR_MAIS) was also calculated for each injury. DR and DR_MAIS could range from 0 to 100% disability risk.

Results: The mean DR_MAIS 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 DR_MAIS 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 DR_MAIS 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.     

我国道路交通安全教育培训思考

统计数据显示,我国2007-2009年道路运输事故呈下降趋势。但道路运输事故造成的死亡人数远远高于煤炭事故造成的死亡人数,道路交通安全形势依然很严峻。交通安全形势严峻的主要原因之一就是人为因素,加强对交通参与者的相关教育培训,提高安全意识,规范安全行为,是改善交通安全形势的根本途径。本文系统分析了我国的安全教育环境、交通文化、交通安全法律法规及交通安全教育培训存在问题,提出了改善我国交通安全教育的措施及建议。     

Comparison of young male and female drivers' attitude and self-reported traffic behaviour in Finland in 1978 and 2001

Problem: This study evaluates how the traffic behaviors of young drivers and their attitudes toward traffic regulations have changed over the last 23 years, and particularly, whether the differences in attitudes and behavior between male and female drivers have changed. Method: The study was conducted in 2001, and it replicated a traffic attitude survey administered in 1978. The same survey was used, enabling comparison between the years. The number of respondents was 3,158 in 1978 and 2,759 in 2001. Results: The comparison revealed several differences regarding the background factors, attitudes, and driving style of novice drivers. Most obvious changes in the drivers' background were the changes in education level (higher today), driver training (more private training today), and exposure/experience in terms of kilometers (more today). The summary variable measured that the young drivers showed more negative attitudes toward traffic rules and safe driving in 2001 compared to 1978. Female drivers drove less than males and evaluated their driving skill lower. Female drivers were less involved in accidents and they committed less traffic offenses than males (kilometrage controlled). Female drivers showed a more positive attitude toward traffic safety and rules than males. The difference in traffic attitudes and behavior between males and females in 1978 compared to 2001 remained the same or even increased somewhat.     

Direct and indirect costs of nonfatal road traffic injuries in Iran: A population-based study

Objectives: The objective of this study was to assess the incidence rate as well as direct and indirect costs of nonfatal road traffic injuries (RTIs) in Iran in 2011.

Methods: Data from the 2011 national household survey were used. In this survey, data on demographics, history, and costs of injury were obtained in 2 steps: first, direct face-to-face interview and second, telephone calls. We estimated the incidence rate of nonfatal RTIs in this year. The direct costs included medical care as well as nonmedical costs paid by the patient or insurance services. The indirect costs were estimated by considering the cost of absence from work or education. We also used logistic regression analyses to investigate risk factors of nonfatal RTIs.

Results: We found 76 nonfatal RTI cases (0.96%) out of 7,886 whole reference study cases. These 76 injured patients had a history of RTI in the preceding 3 months. The annual incidence of RTIs was estimated at 3.84%. The mean age of RTI cases was 28.5 ± 10.6 and 88.16% of them were male. Male gender was a major risk factor (odds ratio [OR] = 9.64, 95% confidence interval [CI], 4.79–19.41) and marriage was a protective factor (OR = 0.44, 95% CI, 0.28–0.70) for RTI. The medians of direct, indirect, and total costs were US$214, US$163, and US$387, respectively. The total cost of nonfatal RTIs in Iran was estimated at 1.29% of the gross domestic product (GDP) in 2011.

Conclusions: In Iran, nonfatal RTIs imposed a total cost of almost US$7 billion to the country for one year. Extension and more serious implementation of preventive measurements seem necessary to decrease this notable burden of RTIs.     

Deterioration of the useful visual field with ageing during simulated driving in traffic and its possible consequences for road safety

A previous study has shown that the useful visual field deteriorates in a simulated road traffic situation as a function of the driver’s age and of the vehicle’s speed under monotonous conditions [Rogé, J., Pébayle, T., Lambilliotte, E., Spitzenstetter, F., Giselbrecht, D., Muzet, A., 2004. Influence of age, speed and duration of monotonous driving task in traffic on the driver’s useful visual field. Vision Research 44 (23), 2737–2744]. The aim of this new experiment is to study the effects of traffic density and age on the useful visual field of the driver during a simulated driving task with controlled traffic characteristics (speed, number of cars) for all participants. In total, 10 young drivers (m = 28.2 years) and 10 older drivers (m = 51.2 years) followed a car in road traffic at an average speed of 126 km h⁻¹ during two 2 h sessions corresponding to two conditions of traffic (light traffic, with five vehicles around the participant; and heavy traffic, with nine vehicles). While following this vehicle, the driver had to detect changes in the colour of a signal located in the central part of his or her visual field and a signal that appeared at different eccentricities on the rear lights of other vehicles in the traffic. Analysis of the data indicated that age interacted with the location of the peripheral signal and density of traffic interacted with the duration of driving. The implications of these results are discussed in terms of road safety and in terms of models of deterioration of the useful visual field (general interference and tunnel vision).     

我国汽车行驶记录仪应用现状及对策建议

笔者通过国内外充分调研，总结了我国汽车行驶记录仪的应用现状，对我国汽车行驶记录仪目前试用及推广中存在的主要问题予以阐述和分析，并结合欧盟汽车行驶记录仪应用的实际情况和经验，对当前我国汽车行驶记录仪的推广应用提出了一些对策建议。     

Child passenger injury risk in motor vehicle crashes: a comparison of nighttime and daytime driving by teenage and adult drivers

INTRODUCTION: To examine the association between child passenger injury risk, restraint use, and crash time (day vs. night) for children in crashes of vehicles driven by teenage versus adult drivers. METHODS: Cross-sectional study involving telephone interviews with insured drivers in a probability sample of 6,184 crashes involving 10,028 children. RESULTS: Child passengers in teen nighttime crashes had an increased injury risk and an increased risk of restraint nonuse compared with those in teen daytime crashes. This increased injury risk can be explained by differences in the age of child passengers, collision type, and child passenger's restraint status associated with time of day. CONCLUSIONS: In order to limit the risk of injury to child passengers driven by teens, Graduated Driver Licensing (GDL) laws should include provisions restricting nighttime driving, as well as mandates for age-appropriate restraint for child passengers. Consideration should also be given for education in child passenger safety for novice teen drivers as part of the licensing process. IMPACT ON INDUSTRY: Results of this study can be used to support advocacy efforts by the automotive industry and others to promote nighttime driving restrictions on novice drivers. In addition, given that both driver groups were more likely to be involved in a single-vehicle collision during the night, technologies such as electronic stability control may offer opportunities for protection. Further reseach on specific circumstances of teen nighttime crashes is needed to inform industry efforts to improve visibility or vehicle operation under poor lighting conditions.     

The impact of environmental, vehicle and driver characteristics on injury severity in older drivers hospitalized as a result of a traffic crash

INTRODUCTION: Compared to younger age groups, older people are more likely to be seriously injured or to die as a result of a traffic crash. METHOD: The aim of the study is to examine the impact of environmental, vehicle, crash, and driver characteristics on injury severity in older drivers involved in traffic crashes by using recently linked police crash records and hospitalization data from New South Wales, Australia. The severity of injury resulting from traffic crashes was measured using the International Classification of Diseases, 10th revision (ICD-10) Injury Severity Score (ICISS). RESULTS: Multivariate analysis identified rurality, presence of complex intersections, road speed limit, driver error, speeding, and seat belt use as independent predictors of injury severity in older people. The type of intersection configuration explained over half of the observed variations in injury severity. IMPACT ON INDUSTRY: Environmental modification such as intersection treatments might contribute to a decrease in the severity of injury in older people involved in road crashes.     

基于马尔萨斯模型对钢铁企业伤害事故与工龄指数之间规律的研究

为了验证在钢铁企业中人的失效过程同服役年限有某种规律性的联系,采用马尔萨斯模型对人的服役年限--工龄与伤害事故频数之间的规律性进行机理推证.在对典型钢铁企业40年间工伤事故数据库中的1 465起伤害事故进行统计分析、建立回归模型后,结论显示伤害事故频数y与受害人员的本工种工龄x存在显著指数相关关系:y=167.13e0.012x、相关系数R=0.93,证实了马尔萨斯模型应用于"工龄-伤害事故频数"指数规律的准确性.改进后的指数规律模型对实际钢铁企业安全管理工作有着重要的研究价值和指导意义,且可以在其他领域中进行探索和推广.