Severity and patterns of injury in helmeted vs. non-helmeted motorcyclists in a rural state

Introduction: Under current law in our rural state, there is no universal requirement for motorcyclists to wear helmets. Roughly 500 motorcycle crashes are reported by the state each year and only a fraction of those riders wear helmets. We sought to determine the difference in injury patterns and severity in helmeted versus non-helmeted riders. Methods: Retrospective review (2014–2018) of a single level 1 trauma center’s registry was done for subjects admitted after a motorcycle collision. Demographic, injury and patient outcome data were collected. Patients were stratified by helmet use (n = 81), no helmet use (n = 144), and unknown helmet use (n = 194). Statistical analysis used Student’s t-test or Pearson’s χ² p-value ≤0.05 as significant. State Department of Transportation data registry for state level mortality and collision incidence over the same time period was also obtained. Results: Of the 2,022 state-reported motorcycle collisions, 419 individuals admitted to our trauma center were analyzed (21% capture). State-reported field fatality rate regardless of helmet use was 4%. Our inpatient mortality rate was 2% with no differences between helmet uses. Helmeted riders were found to have significantly fewer head and face injuries, higher GCS, lower face, neck, thorax and abdomen AIS, fewer required mechanical ventilation, shorter ICU length of stay, and had a greater number of upper extremity injuries and higher upper extremity AIS. Conclusions: Helmeted motorcyclists have fewer head, face, and cervical spine injuries, and lower injury severities: GCS and face, neck, thorax, abdomen AIS. Helmeted riders had significantly less mechanical ventilation requirement and shorter ICU stays. Non-helmeted riders sustained worse injuries. Practical Applications: Helmets provide safety and motorcycle riders have a 34-fold higher risk of death following a crash. Evaluating injury severities and patterns in motorcycle crash victims in a rural state with no helmet laws may provide insight into changing current legislation.     

Estimated Injury Risk for Specific Injuries and Body Regions in Frontal Motor Vehicle Crashes

Objective: Injury risk curves estimate motor vehicle crash (MVC) occupant injury risk from vehicle, crash, and/or occupant factors. Many vehicles are equipped with event data recorders (EDRs) that collect data including the crash speed and restraint status during a MVC. This study's goal was to use regulation-required data elements for EDRs to compute occupant injury risk for (1) specific injuries and (2) specific body regions in frontal MVCs from weighted NASS-CDS data.

Methods: Logistic regression analysis of NASS-CDS single-impact frontal MVCs involving front seat occupants with frontal airbag deployment was used to produce 23 risk curves for specific injuries and 17 risk curves for Abbreviated Injury Scale (AIS) 2+ to 5+ body region injuries. Risk curves were produced for the following body regions: head and thorax (AIS 2+, 3+, 4+, 5+), face (AIS 2+), abdomen, spine, upper extremity, and lower extremity (AIS 2+, 3+). Injury risk with 95% confidence intervals was estimated for 15–105 km/h longitudinal delta-Vs and belt status was adjusted for as a covariate.

Results: Overall, belted occupants had lower estimated risks compared to unbelted occupants and the risk of injury increased as longitudinal delta-V increased. Belt status was a significant predictor for 13 specific injuries and all body region injuries with the exception of AIS 2+ and 3+ spine injuries. Specific injuries and body region injuries that occurred more frequently in NASS-CDS also tended to carry higher risks when evaluated at a 56 km/h longitudinal delta-V. In the belted population, injury risks that ranked in the top 33% included 4 upper extremity fractures (ulna, radius, clavicle, carpus/metacarpus), 2 lower extremity fractures (fibula, metatarsal/tarsal), and a knee sprain (2.4–4.6% risk). Unbelted injury risks ranked in the top 33% included 4 lower extremity fractures (femur, fibula, metatarsal/tarsal, patella), 2 head injuries with less than one hour or unspecified prior unconsciousness, and a lung contusion (4.6–9.9% risk). The 6 body region curves with the highest risks were for AIS 2+ lower extremity, upper extremity, thorax, and head injury and AIS 3+ lower extremity and thorax injury (15.9–43.8% risk).

Conclusions: These injury risk curves can be implemented into advanced automatic crash notification (AACN) algorithms that utilize vehicle EDR measurements to predict occupant injury immediately following a MVC. Through integration with AACN, these injury risk curves can provide emergency medical services (EMS) and other patient care providers with information on suspected occupant injuries to improve injury detection and patient triage.     

Fun ride or risky transport: Golf cart-related injuries treated in U.S. emergency departments from 2007 through 2017

Introduction: Golf cart-related injuries constitute a substantial source of morbidity, most notably in pediatric populations. Despite the high rate of injuries, there have been no meaningful changes in golf cart design or legislation to reduce the overall burden of these injuries. This study sought to characterize the epidemiology of golf cart-related injuries treated in United States hospital emergency departments. Method: A retrospective analysis was conducted by using data from the National Electronic Injury Surveillance System for patients of all ages who were treated in emergency departments (EDs) (2007–2017) for a golf cart-related injury. Results: From 2007 through 2017, an estimated 156,040 (95% CI = 102,402–209,679) patients were treated in U.S. EDs for golf cart-related injuries. The average rate of traumatic brain injuries (TBIs) in children (1.62 per 100,000 children) was more than three times that of TBIs in adults (0.52 per 100,000 adults; rate ratio = 2.38; 95% CI = 2.36–2.41) and nearly twice that of TBIs in seniors (1.11 per 100,000 seniors; rate ratio = 1.21; 95% CI = 1.19–1.22). The rate of injuries in seniors increased significantly by 67.6% from 4.81 per 100,000 seniors in 2007 to 8.06 per 100,000 seniors in 2017 (slope = 0.096; p = 0.041). Conclusions: Golf cart use remains an important source of injury for people of all ages, especially in children. As use continues to increase, it is unlikely that golf cart-related injuries will decrease without substantial changes to product design, regulation, and/or legislation. Practical Applications: Use of golf carts pose a considerable risk of injury and morbidity; safety recommendations should be followed.     

Dogs and cats as environmental fall hazards

Problem

Falls are the leading cause of non-fatal injuries in the United States. This study assessed the prevalence of fall injuries associated with cats and dogs in the United States and describes the types of injuries sustained, the location, activity, and circumstances under which they occurred.

Methods

Data were from a nationally representative sample of emergency department visits from January 1, 2001 to December 31, 2006, available through the National Electronic Injury Surveillance System All Injury Program (NEISS-AIP).

Results

Based on 7,456 cases, an estimated 86,629 fall injuries each year were associated with cats and dogs, for an injury rate of 29.7. There were 7.5 times as many injuries involving dogs as cats and females were 2.1 times more likely to be injured than males. Injury rates were highest among people aged ≥ 75, but pets were a fall hazard for all ages. Fractures and contusions or abrasions were the most common injuries; the highest rates were for injuries to the extremities. About 66.4% of falls associated with cats and 31.3 % of falls associated with dogs were caused by falling or tripping over the pet. An additional 21.2% of falls related to dogs were caused by being pushed or pulled.

Summary

Although pets were associated with fall injuries, this risk can be reduced by increasing public awareness about situations that can lead to falls, such as dog-walking and chasing pets, and by calling attention to the importance of obedience training for dogs to minimize hazardous behaviors such as pulling and pushing.

Impact on industry

Fall injuries represent a burden to individuals, our society and our health care system. Increasing public awareness and implementing basic prevention strategies can help people of all ages enjoy their pets, reduce their chances of experiencing pet-related falls, and lessen the impact of fall injuries on our health care system.     

Sport participation and injury rates in high school students: A Canadian survey of 2029 adolescents

Introduction: The objective of this study is to examine sport and recreational (S&R) activity participation and injury rates (IR) in high school students (ages 14–19). Methods: High school students (N = 24 schools, n = 2,029; 958 male, 1,048 female, 23 identified ‘other’ or missing; ages 14–19) in Alberta completed a web-based survey during class (October 2018–March 2019). Students identified their top three sports for participation in the past year. Primary outcome measures included IR for (a) any S&R-related injury, (b) most serious S&R-related injury resulting in medical attention, and (c) most serious injury resulting in restriction from S&R for at least one day. Results: In total, 1763/2029 (86.89%) respondents [861/958 (89.87%) male, 886/1048 (84.54%) female, 16/23 (69.57%) identifying as ‘other’ or missing] participated in an S&R activity in the past year. Top sports for male participation were basketball (33.08%; 95% CI 27.67–39.00), ice hockey (20.46%; 95% CI 14.87–27.47), and soccer (19.42%; 95% CI 15.67–23.80). Top sports for female participation were dance (22.52%; 95% CI 17.98–27.82), basketball (18.32%; 95% CI 14.32–23.14), and badminton (17.84%; 95% CI 13.35–23.43). Of the 1,971 students completing the S&R injury question, 889 reported at least one injury during the past year [(IR = 45.10 injuries/100 students/year (95% CI 39.72–50.61)]. The medical attention IR was 29.09 injuries/100 students/year (95% CI 24.49–34.17) and time loss IR was 36.00 injuries/100 students/year (95% CI 30.47–41.93). Conclusions: High school student S&R IRs are high with 29% of adolescents reporting at least one medical attention injury within the past year. Injury prevention strategies targeting youth are necessary. Practical Application: Participation in S&R activities has multiple physical, psychological, and health benefits for adolescents, but some S&R activities also have greater risks of injury. This study informs the next sports to target for implementation of optimal prospective surveillance and injury prevention strategies among high school aged students.     

Injuries associated with the use of riding mowers in the United States, 2002-2007

Context: To examine injuries among patients treated in an emergency department (ED) related to the use of a riding lawn mower.Design and Setting: Data were obtained from the National Electronic Injury Surveillance System for the years 2002-2007. National estimates of ED visits for injuries associated with the use of a riding lawn mower were analyzed. Narrative text entries were categorized to provide a detailed record of the circumstances precipitating the injury. Average annual rates were calculated and logistic regression analyses were employed to determine risk estimates for patient disposition and demographic characteristics related to ED visits for injuries associated with riding mowers.Results: From 2002 through 2007, there were an estimated 66,341 ED visits for injuries related to the use of riding lawnmowers in the U.S., with an average annual rate of 6.0 ED visits per 100,000 males, and 1.6 ED visits per 100,000 females. Older adults had higher rates of ED visits for injuries (7.2/100,000) than younger age groups. The most common injuries involved contusions (24%); sprains/strains (22%) and fractures (17%). The majority of patients (90%) were treated and released the same day. Results of logistic regression analyses revealed that older adults were more likely to be hospitalized when compared to younger age groups; and incidents involving rollovers [OR = 5.45 (95% CI = 3.22-9.23)] and being run over [6.01 (95% CI 3.23-11.17)] were more likely to result in hospitalization when compared to all other circumstances of injury.Conclusions: Riding mowers present injury patterns and circumstances that are different than those reported for push mowers. Circumstances related to injuries and age groups affected were varied, making prevention of riding mower injuries challenging. Application/Impact: Findings support the need to increase awareness and/or change the design of riding mowers with respect to risk of rollover injuries.     

Coding agricultural injury: Factors affecting coder agreement

Objectives: To determine coders’ agreement level for the Occupational Injury and Illness Classification System (OIICS) source of injury and injury event codes, and the Farm and Agricultural Injury Classification (FAIC) code in the AgInjuryNews.org and to determine the effects of supplemental information and follow-up discussion in final code assignments. Methods: Two independent researchers initially coded 1304 injury cases from AgInjurynews.org using the OIICS and the FAIC coding schemes. Code agreement levels for injury source, event, and FAIC and the effect of supplemental information and follow-up discussions on final coding was assessed. Results: Coders’ agreement levels were almost perfect for OIICS source and event categories at the 3-digit level, with lower agreement at the 4-digit level. By using supplemental information and follow-up discussion, coders improved the coding accuracy by an average 20% for FAIC. Supplemental information and follow-up discussions had helped finalize the disagreed codes 55% of the time for OIICS source coding assignments and 40% of time for OIICS event coding assignments for most detailed 4-digit levels. Five key themes emerged regarding accurate and consistent coding of the agricultural injuries: inclusion/exclusion based on industry classification system; inconsistent/discrepant reports; incomplete/nonspecific reports; effects of supplemental information on coding; and differing interpretations of code selection rules. Practical applications: Quantifying the level of agreement for agricultural injuries will lead to a better understanding of coding discrepancies and may uncover areas for improvement to coding scheme itself. High level of initial and final agreement with FAIC and OIICS codes suggest that these coding schemes are user-friendly and amenable to widespread use.     

Horseback riding-related injuries treated in emergency departments: Risk factors and prevention strategies

IntroductionDespite inherit dangers of horseback riding (HBR), research on HBR-related injuries is sparse. This study used both quantitative and qualitative methods to (1) examine HBR-related injuries treated in emergency departments (EDs) and associated risk factors and (2) explore HBR-related injury experiences and recommendations for prevention strategies from the perspective of riders. Method: We retrospectively analyzed data from the Nationwide Emergency Department Sample (NEDS), identifying HBR-related ED visits between 2010 and 2014. Additionally, we conducted 10 phone interviews with active horseback riders to understand their experiences and perspectives regarding HBR-related injuries and recommendations for prevention measures. Results: A total of 21,899 ED visits for HBR-related injuries were identified. When weighted, these represented 100,964 ED visits in the United States. Females had a consistently higher proportion of ED visits compared to males across the study period, with the proportion of ED visits being highest in females aged 15–19. Most injuries (85.9%) were treated and released from the ED. Three primary themes were identified as key to the prevention of HBR-related injuries: (1) rider safety (e.g., use of protective equipment), (2) external factors (e.g., awareness of environment), and (3) rider and horse interactions (e.g., matching skill level of the rider to the horse). Conclusions: Results indicate that HBR-related injuries treated in EDs are prevalent, with female riders aged 15–19 years having the highest proportion of injuries treated in EDs. Practical Applications: There is a critical need for injury prevention programs that not only promote the use of protective equipment, but that also educate horseback riders on horse behavior, the proper handling of horses, and safe riding practices.     

Nonfatal bathroom injuries among persons aged ≥15 years--United States, 2008

Problem

Information about where nonfatal unintentional injuries occur is limited, but bathrooms commonly are believed to be a hazardous location.

Methods

Data from a nationally representative sample of hospital emergency departments (ED) was used to quantify and characterize nonfatal unintentional bathroom injuries among people aged ≥ 15 years.

Results

In 2008, an estimated 234,094 nonfatal bathroom injuries were treated in EDs. Most injuries (81.1%) were caused by falls and 37.3% of injuries occurred when bathing, showering, or getting out of the tub or shower. Both injury and hospitalization rates increased with age.

Summary

These results suggest that bathrooms tend to be most hazardous for persons in the oldest age groups.

Impact on Industry

Bathroom injuries among all household members might be reduced by increasing awareness about potentially hazardous activities in the bathroom combined with simple environmental changes such as adding grab bars inside and outside the tub or shower.     

An evaluation of the association between vehicle type and the source and severity of pedestrian injuries

To evaluate the effect of vehicle type (passenger vehicle vs. light truck vehicle) on crash trajectory and on the consequent source and severity of pedestrian injury, we analyzed data from the Pedestrian Crash Data Study (PCDS), conducted by National Highway Traffic Safety Administration (NHTSA) from 1994 to 1998. While 62% of the adults in PV (passenger vehicle)-related crashes were carried by the vehicle, such pedestrian-vehicle interaction was observed only in 28% of LTV (light truck vehicle)-adult crashes. Being thrown forward or knocked down were the most common (65%) type of pedestrian-vehicle interactions for LTV-adult crashes. For children, 93% of those struck by LTVs and 46% of those struck by PVs were thrown forward or knocked down. For adults, LTVs were more likely than PVs to cause thorax (37% vs. 20%) and abdomen injuries (33% vs. 18%). For children, LTVs were more likely than PVs to cause injuries to the upper extremity (71% vs. 56%) and abdomen (14% vs. 8%). For adults struck by PVs the most common sources of injury were windshield for head injuries (63%), hood surface for thorax (67%), abdomen (58%), spine (30%), and upper extremity (36%) injuries, and bumper for the lower extremity injuries (60%). The leading causes of injury for adult-LTV crashes were ground for head (39%) and upper extremity (37%) injuries, hood edge for thorax (48%) and abdomen (56%) injuries, hood surface for spine injuries (36%), and bumper for lower extremity injuries (45%). For child-PV crashes, ground was the most common source of face (37%) abdomen (83%), spine (43%), and upper extremity injuries (54%). For children hit by LTVs, 52% of face, 67% of abdomen, 100% of spine, and 60% of upper extremity injuries were attributed to ground contacts. Altogether, the major sources of injury were hood surface and windshield for PV-pedestrian crashes and hood surface and hood edge for LTV-pedestrian crashes. Changes in design, such as altering the geometry and stiffness of front-end structures, might be associated with considerable decrease in the frequency and severity of pedestrian injury.     

Occupational injury rates among Norwegian farmers: A sociotechnical perspective

Introduction: This study addressed relative injury risk among Norwegian farmers, who are mostly self-employed and run small farm enterprises. The aim was to explore the relative importance of individual, enterprise, and work environment risks for occupational injury and to discuss the latent conditions for injuries using sociotechnical system theory. Method: Injury report and risk factors were collected through a survey among Norwegian farm owners in November 2012. The response rate was 40% (n = 2,967). Annual work hours were used to calculate injury rates within groups. Poisson regression using the log of hours worked as the offset variable allowed for the modeling of adjusted rate ratios for variables predictive of injury risk. Finally, safety climate measures were introduced to assess potential moderating effects on risk. Results: Results showed that the most important risk factors for injuries were the design of the workplace, type of production, and off-farm work hours. The main results remained unchanged when adding safety climate measures, but the measures moderated the injury risk for categories of predominant production and increased the risk for farmers working with family members and/or employees. An overall finding is how the risk factors were interrelated. Conclusions: The study identified large structural diversities within and between groups of farmers. The study drew attention to operating conditions rather than individual characteristics. The farmer’s role (managerial responsibility) versus regulation and safety climate is important for discussions of injury risk. Practical Applications: We need to study sub-groups to understand how regulation and structural changes affect work conditions and management within different work systems, conditioned by production. It is important to encourage actors in the political-economic system to become involved in issues that were found to affect the safety of farmers.     

Injury surveillance trends in career–technical education: New Jersey 1999–2018

Introduction: Adolescents engaging in school-sponsored work experiences may be at risk of injury due to factors such as inexperience. This article examines trends in 20 years of reported injuries among New Jersey (NJ) adolescents engaging in school-sponsored work experiences, and compares a transition from paper to online reporting format. Methods: New Jersey requires reporting of injuries occurring during school-sponsored work experiences to the NJ Department of Education. Injuries reported by NJ schools from 1999 to 2018 (n = 2,119) were examined; incidence rates for 2008 to 2018 (n = 743) were calculated using publicly available NJ Department of Education enrollment data for the denominator, including for specific groups of students: career and technical education; special healthcare needs. Results: A downward trend in reported injuries in NJ schools was observed. However, the year online reporting became required by code (2013), an increase of nearly 50% was seen from 2012 (59–89), followed by a decline in reported incidents 2014 to 2018 (mean = 65, range 76 down to 47). Injury rate trends over time paralleled those of reported incidents. Conclusions: This study suggested worker safety and public health benefits of improvements from State of NJ code required training programs and online injury surveillance report form. Practical Applications: One potential method to address the safety and health of adolescents engaging in work experiences is the use of online reporting forms, to aid in surveillance efforts, coupled with occupational safety and health training specifically geared toward teachers and administrators who both supervise young, relatively inexperienced and vulnerable workers and who make relatively frequent worksite visits. Incorporation of specific details of the instructions on the use of a reporting form into required trainings, in addition to providing a clear, accessible guidance manual online, could further help improve youth worker safety surveillance efforts.     

Exploring bicyclist injury severity in bicycle-vehicle crashes using latent class clustering analysis and partial proportional odds models

Introduction: Bicyclists are more vulnerable compared to other road users. Therefore, it is critical to investigate the contributing factors to bicyclist injury severity to help provide better biking environment and improve biking safety. According to the data provided by National Highway Traffic Safety Administration (NHTSA), a total of 8,028 bicyclists were killed in bicycle-vehicle crashes from 2007 to 2017. The number of fatal bicyclists had increased rapidly by approximately 11.70% during the past 10 years (NHTSA, 2019). Methods: This paper conducts a latent class clustering analysis based on the police reported bicycle-vehicle crash data collected from 2007 to 2014 in North Carolina to identify the heterogeneity inherent in the crash data. First, the most appropriate number of clusters is determined in which each cluster has been characterized by the distribution of the featured variables. Then, partial proportional odds models are developed for each cluster to further analyze the impacts on bicyclist injury severity for specific crash patterns. Results: Marginal effects are calculated and used to evaluate and interpret the effect of each significant explanatory variable. The model results reveal that variables could have different influence on the bicyclist injury severity between clusters, and that some variables only have significant impacts on particular clusters. Conclusions: The results clearly indicate that it is essential to conduct latent class clustering analysis to investigate the impact of explanatory variables on bicyclist injury severity considering unobserved or latent features. In addition, the latent class clustering is found to be able to provide more accurate and insightful information on the bicyclist injury severity analysis. Practical Applications: In order to improve biking safety, regulations need to be established to prevent drinking and lights need to be provided since alcohol and lighting condition are significant factors in severe injuries according to the modeling results.     

Non-occupational injuries caused by transport packaging: Residential and retail hazards

BackgroundBackground: Pallets are key components of domestic supply chains, and yet present unique hazards when used by homeowners and retailers for unintended uses. No previous works have investigated non-occupational injuries that occur due to unintentional contact with pallets. This study sought to describe the incidence and epidemiology of non-occupational pallet-related injuries as seen in United States emergency departments (EDs). Method: The National Electronic Injury Surveillance System database was used to derive national, weighted estimates of pallet-related injuries by age, sex, injured body part, and location where injury occurred. Data for the years 2014 to 2018 were analyzed with all relevant narratives reviewed. Results: From 2014 to 2018, there were an estimated 30,493 persons who visited an ED for a pallet-related injury. The yearly incidence of pallet injuries rose during this period. The 35–44 age group (n = 5,481) was most likely to be injured, but about 3,000 children and youth under 18 years of age were injured and more than 4,000 persons 65 years of age or older suffered injuries. The elderly were especially likely to suffer injuries from slip, trip and fall incidents. The lower extremities were the most commonly injured body parts. An estimated 3,964 persons, accounting for approximately 14% of all pallet-related injuries, were treated for injuries incurred while at a retail establishment. African Americans, Hispanics, and the elderly appeared to be disproportionately more likely to have pallet-related injuries in retail locations. Conclusions: Non-occupational pallet-related injuries affect a wide range of patients and cause a variety of injuries, with the elderly being especially vulnerable to tripping incidents. Retailer prevention strategies should focus on the misuse of pallets for merchandising purposes. Industry should maintain control of pallets so they are not used for unintended purposes. Practical applications: Retailers should limit the use of pallets for floor-level merchandising purposes and remove pallets from customer-facing locations where unintentional contact could occur. Owners of pallets should maintain them in a controlled supply chain so that they don’t leak out into the hands of homeowners. Policy-makers should educate the public about the dangers of used pallets.     

Incidence of injury in children and adolescents with intellectual and developmental disability

Introduction: Children and adolescents living with intellectual and developmental disability (IDD) have a higher risk of experiencing morbidities and premature death when compared to children and adolescents living without IDD. Childhood injuries are a leading cause of morbidity and death, yet there are limited studies that explore the prevalence of childhood injuries for individuals living with IDD. The purpose of this study was to analyze Ontario health administrative data to identify and compare rates of injury resulting in hospitalization in children and adolescents living with and without IDD. Methods: This is a cross-sectional study of all Ontarians aged 0–19 years with and without IDD. The outcome of interest was the rate of injury resulting in hospitalization. Results: This study found that children and adolescents with IDD had 1.79 (CI 1.66, 1.92) times higher rates of both intentional and unintentional injuries that resulted in hospitalization when compared to children and adolescents without IDD. Hospitalizations for self-harm related injuries were 3.16 (CI 3.09, 3.23) times higher in the IDD group. Conclusion: Children and adolescents with IDD have a higher risk of sustaining serious injuries, particularly injuries resulting from self-harm. Practical Applications: This study provides evidence of increased injury related hospitalizations for children and adolescents with IDD when compared to their peers without IDD.     

A multinomial logit model of motorcycle crash severity at Australian intersections

Introduction: Motorcyclists are exposed to more fatalities and severe injuries per mile of travel as compared to other vehicle drivers. Moreover, crashes that take place at intersections are more likely to result in serious or fatal injuries as compared to those that occur at non-intersections. Therefore, the purpose of this study is to evaluate the contributing factors to motorcycle crash severity at intersections. Method: A data set of 7,714 motorcycle crashes at intersections in the State of Victoria, Australia was analyzed over the period of 2006–2018. The multinomial logit model was used for evaluating the motorcycle crashes. The severity of motorcycle crashes was divided into three categories: minor injury, serious injury and fatal injury. The risk factors consisted of four major categories: motorcyclist characteristics, environmental characteristics, intersection characteristics and crash characteristics. Results: The results of the model demonstrated that certain factors increased the probability of fatal injuries. These factors were: motorcyclists aged over 59 years, weekend crashes, midnight/early morning crashes, morning rush hours crashes, multiple vehicles involved in the crash, t-intersections, crashes in towns, crashes in rural areas, stop or give-way intersections, roundabouts, and uncontrolled intersections. By contrast, factors such as female motorcyclists, snowy or stormy or foggy weather, rainy weather, evening rush hours crashes, and unpaved roads reduced the probability of fatal injuries. Practical Applications: The results from our study demonstrated that certain treatment measures for t-intersections may reduce the probability of fatal injuries. An effective way for improving the safety of stop or give-way intersections and uncontrolled intersections could be to convert them to all-way stop controls. Further, it is recommended to educate the older riders that with ageing, there are physiological changes that occur within the body which can increase both crash likelihood and injury severity.     

A 6-year survey of road traffic accidents in Southwest China: Emphasis on traumatic brain injury

Background: The objective of this study is to provide an up-to-date overview of the patterns of injuries, especially traumatic brain injury (TBI) caused by RTAs and to discuss some of the public health consequences. Methods: A scientific team was established to collect road traffic accidents occurring between 2013 and 2018 in Chongqing, Southwest China. For each accident, the environment-, vehicle-, and person- variables were analyzed and determined. The overall injury distribution and TBI patterns of four types of road users (driver, passenger, motorcyclist and pedestrian) were compared. The environmental and time distribution of accidents with TBI were shown by bar and pie chart. The risks of severe brain injury whether motorcyclist wearing helmets or not were compared and the risk factors of severe TBI in pedestrian were determined by odds ratio analysis. Results: This study enrolled 2131 accidents with 2741 persons of all kind of traffic participants, 1149 of them suffered AIS1+ head injury and 1598(58%) died in 7 days. The most common cause of deaths is due to head injury with 714(85%) and 1266(79%) persons died within 2 hours. Among 423 persons suffered both skull fracture and intracranial injury, 102 (24.1%) have an intracranial injury but no skull fractures, while none of the skull fractures without intracranial injury was found. Besides, motorcyclists without a helmet were at higher risks for all the brain injury categories. The risk of pedestrian suffering severe TBI at an impact speed of more than 70 km/h is 100 times higher than that with an impact speed of less than 40 km/h. Conclusion: It is urgently needed to develop a more reliable brain injury evaluation criterion for better protection of the road users. We believe that strengthening the emergency care to head injury at the scene is the most effective way to reduce traffic fatality.     

An epidemiologic comparison of injuries presenting to a pediatric emergency department and local urgent care facilities

Problem

The objective of this study was to compare the epidemiology of injuries presenting to emergency department (ED) and urgent care (UC) facilities of a single, NEISS-affiliated hospital.

Method

Patient medical records (n = 36,811) were used to compare injury incidence, injury characteristics, and demographic characteristics between the ED, on-site UC, and off-site UC during 2006.

Results

ED presentations were more likely to be open wounds and motor vehicle-related compared to on-site UC presentations. ED presentations were more likely to be system wide/late effects, be made by an African American, or be paid through Medicaid compared to off-site UC presentations. On-site UC presentations were more likely to be made by an African American or be paid through Medicaid compared to off-site UC presentations.

Discussion

ED and UC injury characteristics and patient demographics differ. With no nationally-representative UC injury surveillance, current research likely underestimates injury incidence and presents skewed profiles. Impact on Industry: This article adds insight into the generalizability of ED-based injury surveillance to UC injuries.