Assessment of medical care costs of injuries due to alcohol-related motor vehicle crashes

The purpose of this study was to estimate the total medical care costs of individuals injured in motor vehicle crashes and in crashes where alcohol was involved. Crashes were studied that involved 2,728 vehicle occupants and 191 pedestrians with injuries as reported in 1979 by the National Accident Sampling System, a probability sample of all motor vehicle crashes occurring in the united States. Medical care costs were assigned by using Abbreviated Injury Scale codes in accordance with other published research. Determination of alcohol involvement was based on crash characteristics. Results indicate that 20.2 % of medical care costs for motor vehicle crash injuries may be due to crashes where alcohol was involved. It was estimated that alcohol-related motor vehicle crashes cost between $434 million and $483 million in medical care alone in the United States in 1979.     

Reconstruction of crashes involving injured child occupants: the risk of serious injuries associated with sub-optimal restraint use may be reduced by better controlling occupant kinematics

OBJECTIVE: To determine whether injuries to sub-optimally restrained child occupants in real-world crashes were likely to be preventable by alternative restraint usage practices and to assess the usefulness of crash reconstruction for exploring injury mechanisms in child occupants. METHODS: Real-world crashes in which child occupants sustained significant injuries were reconstructed on a laboratory crash sled using the Hybrid III family of child dummies. Alternative restraint scenarios and cases in which children were not seriously injured were also simulated to compare dummy kinematics and dynamic responses in optimal restraint configurations. RESULTS: Restraint misuse was associated with greater motion of the dummy torso and head during crashes, often allowing contact between the child and the vehicle interior, resulting in injury. Poor pre-crash posture for a child inappropriately restrained in an adult belt appeared to worsen the geometry of the sash (shoulder) belt, resulting in a cervical injury due to direct interaction with the belt. Dynamic dummy data did not appear to discriminate between injury and non-injury cases. CONCLUSIONS: Dummy kinematics suggest that injuries in which inappropriate use and misuse were a factor were less likely if the most appropriate restraint was used correctly. Adequately controlling the head and upper body of the child occupant was seen to prevent undesirable interactions with the vehicle interior and restraint system, which were associated with injury in the real world. Neck forces and moments and injury criteria calculated from these did not predict injury reliably.     

Abdominopelvic injuries due to road traffic accidents: Characteristics in a registry of 162,695 victims

Objective: Road traffic accidents (RTAs) are the first cause of abdominopelvic injuries (APIs). The objective of this study was to describe the characteristics and severity of APIs due to traffic accidents in a large French trauma registry and to identify risk factors for API.

Methods: All victims from the French Rhône registry of victims of RTAs were analyzed from 1996 to 2013. This registry contained data that were issued over a 20-year period from 245 medical departments, from prehospital care until re-adaptation, and forensic medicine departments. All APIs, defined as an injury between the diaphragm and the pelvic bone, were extracted and studied.

Results: Among 162,695 victims, 10,165 had an API (6.7%). Accidents frequently involved young men and 2 cars. Mean Injury Severity Score (ISS) was 8.7. Mortality rate was 5.6%. Soft tissue injuries largely predominated (n = 6,388; 54.4% of patients). Overall, 2,322 victims had a pelvic bone injury. Internal abdominal organs were involved in 2,425 patients; the most frequent were the spleen, liver, and kidney. Wearing of the seat belt appeared to be a significant protective factor in API, including serious injuries. A partial analysis over the past 2 years among the most severe patients hospitalized in the intensive care unit indicated that nonoperative management was carried out in two thirds of the wounded. In uni- or multivariate analysis, sex, age, type of user, antagonist, time of occurrence, associated severe lesions, or wearing of the seat belt were statistically associated with the occurrence of API, highlighting a more dangerous user profile.

Conclusions: Abdominopelvic injuries concern a minority of road traffic injuries, but they are responsible for significant mortality. Large solid organs are the most frequently affected. Women drivers wearing a seat belt and driving in town during the day appear to be more protected against API.     

Lower extremity injuries in children seated in forward facing child restraint systems

OBJECTIVE: The lower extremity is among the most frequently injured body regions for children restrained by forward facing child restraint systems (FFCRS), accounting for 28% of their clinically significant injuries, defined as AIS 2 and greater injuries excluding concussions. Despite the prevalence of these injuries, the current U.S. Motor Vehicle Safety Standard governing FFCRS (FMVSS 213) does not provide a direct assessment of the biomechanical risk of lower extremity fracture nor do the current pediatric test devices provide adequate instrumentation to detect the risk of such injuries. Before improvements can be made to the anthropometric test devices (ATDs) or test procedures to address these limitations, understanding of the sources and mechanisms of these injuries is necessary. Therefore, the objective of this study was to document location, source, and crash circumstances of lower extremity injuries in children seated in FFCRS. METHODS: Utilizing two sources of data, PCPS and CIREN, 20 in-depth investigations of crashes involving children seated in FFCRS with lower extremity injuries were reviewed to determine the nature of the injuries and the circumstances under which they occurred. RESULTS: Injuries below the knee were the most common, particularly to the tibia/fibula, and they most often occurred due to interaction with the vehicle seatback in front of the child's seating position. These injuries were sustained most commonly in frontal impacts although interaction with the seatback also occurred in other crash types. This interaction with the seatback was exacerbated by possible contributing factors such as intrusion of the front seatback into the child's occupant space or FFCRS misuse resulting in increased excursion of the child during impact. CONCLUSIONS: This review of cases of children in FFCRS with AIS 2 and greater lower extremity injury points to the role of the seatback in the occurrence of these injuries, suggesting the need to consider this interaction in the seatback design process and to adequately represent this interaction in regulatory procedures assessing the performance of child restraints.     

Legislating child restraint usage -Its effect on self-reported child restraint use rates in a central city

Objective

To assess the effect of the newly enacted child passenger safety law, Wisconsin Act 106, on self-report of proper restraint usage of children in Milwaukee's central city population.

Method

A prospective, non-randomized study design was used. The settings used were (a) a pediatric urban health center, and (b) two Women, Infants and Children offices in Milwaukee, Wisconsin. Participants included 11,566 surveys collected over 18 months that spanned the pre-legislation and post-legislation time periods from February 2006 through August 2008.

Results

The study set out to assess appropriate child passenger restraint. The results showed that the changes in adjusted proper restraint usage rates for infants between the pre-law, grace period, and post-fine periods were 94%, 94%, and 94% respectively. For children 1-3 years old, the adjusted proper usage rates were 65%, 63%, and 59%, respectively. And for children 4-7 years old, the rates were 43%, 44% and 42%, respectively. There was a significant increase in premature booster seat use in children who should have been restrained in a rear- or forward-facing car seat (10% pre-law, 12% grace period, 20% post-fine; p < 0.0005). There was no statistically significant change over time in unrestrained children (2.1%, 1.7%, 1.7%, p = 0.7, respectively).

Conclusions

The passage of a strengthened child passenger safety law with fines did not significantly improve appropriate restraint use for 0-7 year olds, and appropriate use in 1-7 year olds remained suboptimal with a majority of urban children inappropriately restrained. Although the number of unrestrained children decreased, we identified an unintended consequence of the legislation - a significant increase in the rate of premature belt-positioning booster seat use among poor, urban children.

Impact on Industry

The design of child restraint systems maximizes protection of the child. Increasing reports of misuse is a call to those who manufacture these child passenger restraints to improve advertising and marketing to the correct age group, ease of installation, and mechanisms to prevent incorrect safety strap and harness placement. To ensure accurate and consistent use on every trip, car seat manufacturers must ensure that best practice recommendations for use as well as age, weight, and height be clearly specified on each child restraint. The authors support the United States Department of Transportation's new consumer program that will assist caregivers in identifying the child seat that will fit in their vehicle. In addition, due to the increase in premature graduation of children into belt-positioning booster seats noted as a result of legislation, promoting and marketing booster seat use for children less than 40 pounds should not be accepted. Child passenger safety technicians must continue to promote best practice recommendations for child passenger restraint use and encourage other community leaders to do the same.     

A new challenge to child and adolescent survival in urban Africa: an increasing burden of road traffic injuries

OBJECTIVES: To develop an epidemiological profile and present the burden of urban road-traffic injuries (RTI) in children and adolescents in urban Sub-Saharan Africa. METHOD: A systematic review of published and gray literature of children and adolescents < or =19 years old involved in RTI in urban regions in Sub-Saharan Africa from January 1980-December 2003. RESULTS: The mean annual incidence for urban road-traffic injuries was 109.8 per 100,000 children, and males were twice as involved as their female counterparts. Children between 10 to 14 years constitute the most frequent group involved in road crashes (36%) while pedestrians represent an average of 68% of all childhood RTI cases. Twenty Healthy Life Years per 1,000 children and adolescents are being lost annually in the region from RTI. CONCLUSIONS: There is an urgent need to develop a regional health research agenda to generate an accurate estimate of the burden of road-traffic injuries on children. This is a new challenge for child health and there is a need to raise awareness among policy makers to promote appropriate interventions.     

Methods to reduce traffic crashes involving deer: what works and what does not

More than 1.5 million traffic crashes involving deer, producing at least $1.1 billion in vehicle damage and about 150 fatalities, are estimated to occur annually in the United States. Deer-related crashes are increasing as both deer populations and vehicular travel increase. Many methods have been used in attempts to reduce deer crashes, often with little scientific foundation and limited evaluation. This article summarizes the methods and reviews the evidence of their effectiveness and the situations in which each may be useful. The only widely accepted method with solid evidence of effectiveness is well-designed and maintained fencing, combined with underpasses or overpasses as appropriate. Herd reduction is controversial but can be effective. Deer whistles appear useless. Roadside reflectors appear to have little long-term effect, although additional well-designed evaluations are needed before firm conclusions can be drawn. Both temporary passive signs and active signs appear promising in specific situations, but considerable research is required to evaluate long-term driver response and to improve and test deer detection technology for active signs. Other methods using advanced technology require substantial additional research and evaluation.     

Car safety and social differences in traffic injuries among young adult drivers: a study of two-car injury-generating crashes in Sweden

Objective—The study examines whether socioeconomic and sex differences in road-traffic crashes leading to injury vary according to car-safety level.Method—Individuals records of subjects born 1970–1972 registered in the Swedish Census of 1985 (n = 334,070) are linked to road-traffic-crash data for the period 1988–2000 for first police-registered two-car crashes leading to severe or fatal injury (n = 4875). Injuries are split into categories according to level of car safety on a five-point scale, based on criteria related to crash safety. Account is taken of both how the car is constructed and the effectiveness of its safety equipment (such as airbags and seat belts). For each car-safety level, relative risks are computed considering socioeconomic groups of origin, educational level, and sex.Results—No substantial differences between drivers in different socioeconomic positions of origin is observed except for crashes involving cars 30% better than average with regard to safety. There are consistent risk differences across all car-safety categories according to educational level. Male drivers show an elevated risk of injury in all car categories, except for cars with the poorest safety where they are at significant under-risk.Conclusions—Car-safety level impacts on social differences in road-traffic injury risks in specific and restricted manners. Car-safety development is an important factor in improved road safety, but it may not benefit all to the same extent.     

Pediatric electric bicycle injuries and comparison to other pediatric traffic injuries

Objective: The objective of this study was to conduct a comprehensive analysis of demographics, injury characteristics and hospital resource utilization of significant pediatric electric bicycle (e-bike) injuries leading to hospitalization following an emergency department visit in comparison to pediatric injuries caused by other traffic related mechanisms.

Methods: A retrospective review of all pediatric traffic injury hospitalizations following an emergency department visit to a level I trauma center between October 2014 and September 2016 was conducted. Data regarding age, sex, number of computed tomography (CT) scans obtained, number of major procedures, length of hospital stay (LOS), Injury Severity Score (ISS), and number of injuries per patient were collected and compared between e-bike injuries and other traffic injuries.

Results: Three hundred thirty-seven admissions were analyzed: 46 (14%) were due to e-bike injuries (29% of patients >12 years). Age, proportion of brain injuries, and use of CT were significantly increased compared to mechanical bicycle injuries (13.1?±?3.4 vs. 10.6?±?3.6, 13% vs. 3%, 1 [0–3] vs. 1 [0–1], P < .01, P = .03, P = .05). Age, LOS, and use of CT were significantly increased compared to injuries caused to automobile passengers (13.1?±?3.4 vs. 7.4?±?5.3, 1 [1–3] vs. 1 [1–2], 1 [0–3] vs. 0 [0–1], P < .01, P = .03, P = .01), as well as ISS and number of injuries per patient (P = .04, P < .01). Injuries caused by e-bikes were similar to injuries caused to pedestrians, except for age (13.1?±?3.4 vs. 8.5?±?3.7, P < .01). Multivariable analysis revealed a significant association between mechanism of injury and ISS, with increased ISS among e-bike injuries compared to mecahnical bike injuries (OR 2.56, CI 1.1–5.88, P = 0.03) and automobile injuries (OR 4.16, CI 1.49–12.5, (P < .01).

Conclusion: E-bikes are a significant cause of severe injury in children compared to most other traffic injuries, particularly in older children.     

Effects of head restraint and seat redesign on neck injury risk in rear-end crashes

Automobile insurance claims were examined to determine the rates of neck injuries in rear-end crashes for vehicles with and without redesigned head restraints, redesigned seats, or both. Results indicate that the improved geometric fit of head restraints observed in many newer vehicle models are reducing the risk of whiplash injury substantially among female drivers (about 37% in the Ford Taurus and Mercury Sable), but have very little effect among male drivers. New seat designs, such as active head restraints that move upward and closer to drivers' heads during a rear impact, give added benefit, producing about a 43% reduction in whiplash injury claims (55% reduction among female drivers). Estimated effects of Volvo's Whiplash Injury Prevention System and Toyota's Whiplash Injury Lessening design were based on smaller samples and were not statistically significant.     

Predicting reduced visibility related crashes on freeways using real-time traffic flow data

ObjectivesThe main objective of this paper is to investigate whether real-time traffic flow data, collected from loop detectors and radar sensors on freeways, can be used to predict crashes occurring at reduced visibility conditions. In addition, it examines the difference between significant factors associated with reduced visibility related crashes to those factors correlated with crashes occurring at clear visibility conditions.MethodRandom Forests and matched case-control logistic regression models were estimated.ResultsThe findings indicated that real-time traffic variables can be used to predict visibility related crashes on freeways. The results showed that about 69% of reduced visibility related crashes were correctly identified. The results also indicated that traffic flow variables leading to visibility related crashes are slightly different from those variables leading to clear visibility crashes.Impact on IndustryUsing time slices 5–15 minutes before crashes might provide an opportunity for the appropriate traffic management centers for a proactive intervention to reduce crash risk in real-time.     

Impact of infrastructure characteristics on road crashes on two-lane highways

OBJECTIVE: The main purpose of this study is to estimate and quantify the contribution of the infrastructure to highway crashes and to develop an infrastructure coefficient, that represents the overall characteristics of the highway and could be used as an independent variable in a crash-prediction model. METHODS: The infrastructure is defined in this study as the highway and its geometric features, including alignment, road-side elements, sight-distances, presence of guardrails, access-points, roadway consistency, and additional variables that measure the overall quality of the highway alignment and elements. The analysis and developments are conducted for two-lane rural highways. The approach taken is to identify the high crash-rate roads, those with crash rates above 0.25 crashes per million vehicle-km, by Smallest Space Analysis. This type of analysis allows the aggregation of higher crash-rate roads versus lower-crash-rate roads only by their infrastructure coefficients, without consideration of their crash records. RESULTS: Crash rates that are attached by Smallest Space Analysis to the group of roads that had less desirable infrastructure features show a high correlation between the same roads and high crash rates vs. identified better infrastructures and low crash rates. Further analysis shows that low crash-rate infrastructure, as defined in this study for two-lane rural highways, can reduce the crash rate by 44% versus high crash-rate infrastructure, at the 99% confidence level, which is almost a certainty. A model for the prediction of crash rates based on a proposed infrastructure coefficient is calibrated and presented. CONCLUSIONS: It is suggested that this model be used in evaluating alternatives for new highways or in improving the alignment and road features of existing highways.     

Underutilization of occupant restraint systems in motor vehicle injury crashes: A quantitative analysis from Qatar

Introduction: Restraint systems (seat belts and airbags) are important tools that improve vehicle occupant safety during motor vehicle crashes (MVCs). We aimed to identify the pattern and impact of the utilization of passenger restraint systems on the outcomes of MVC victims in Qatar.

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.     

Exploring the effects of state highway safety laws and sociocultural characteristics on fatal crashes

Objective: Distinguished from the traditional perspectives in crash analyses, which examined the effects of geometric design features, traffic factors, and other relevant attributes on the crash frequencies of roadway entities, our study focuses on exploring the effects of highway safety laws, as well as sociocultural characteristics, on fatal crashes across states.

Methods: Law and regulation related data were collected from the Insurance Institute for Highway Safety, State Highway Safety Offices, and Governors Highway Safety Association. A variety of sociodemographic characteristics were obtained from the U.S. Census Bureau. In addition, cultural factors and other attributes from a variety of resources are considered and incorporated in the modeling process. These data and fatal crash counts were collected for the 50 U.S. states and the District of Columbia and were analyzed using zero-truncated negative binomial (ZTNB) regression models.

Results: The results show that, in law and regulation–related factors, the use of speed cameras, no handheld cell phone ban, limited handheld cell phone ban, and no text messaging ban are found to have significant effects on fatal crashes. Regarding sociocultural characteristics, married couples with both husband and wife in the labor force are found to be associated with lower crash frequencies, the ratios of workers traveling to work by carpool, those driving alone, workers working outside the county of residence, language other than English and limited English fluency, and the number of licensed drivers are found to be associated with higher crash frequencies.

Conclusions: Through reviewing and modeling existing state highway safety laws and sociocultural characteristics, the results reveal new insights that could influence policy making. In addition, the results would benefit amending existing laws and regulations and provide testimony about highway safety issues before lawmakers consider new legislation.     

Bicyclist injury severity in traffic crashes: A spatial approach for geo-referenced crash data to uncover non-stationary correlates

Introduction: Bicyclists are among vulnerable road users with their safety a key concern. This study generates new knowledge about their safety by applying a spatial modeling approach to uncover non-stationary correlates of bicyclist injury severity in traffic crashes. Method: The approach is Geographically Weighted Ordinal Logistic Regression (GWOLR), extended from the regular Ordered Logistic Regression (OLR) by incorporating the spatial perspective of traffic crashes. The GWOLR modeling approach allows the relationships between injury severity and its contributing factors to vary across the spatial domain, to account for the spatial heterogeneity. This approach makes use of geo-referenced data. This study explored more than 7,000 geo-referenced bicycle--motor-vehicle crashes in North Carolina. Results: This study performed a series of non-stationarity tests to identify local relationships that vary substantially across the spatial domain. These local relationships are related to the bicyclist (bicyclist age, bicyclist behavior, bicyclist intoxication, bicycle direction, bicycle position), motorist (driver age, driver intoxication, driver behavior, vehicle speed, vehicle type) and traffic (traffic volume). Conclusions: Results from the regular OLR are in general consistent with previous findings. For example, an increased bicyclist injury severity is associated with older bicyclists, bicyclist being intoxicated, and higher motor-vehicle speeds. Results from the GWOLR show local (rather than global) relationships between contributing factors and bicyclist injury severity. Practical Applications: Researchers and practitioners may use GWOLR to prioritize cycling safety countermeasures for specific regions. For example, GWOLR modeling estimates in the study highlighted the west part (from Charlotte to Asheville) of North Carolina for increased bicyclist injury severity due to the intoxication of road users including both bicyclists and drivers. Therefore, if a countermeasure is concerned with the road user intoxication, there may be a priority for the region from Charlotte to Asheville (relative to other areas in North Carolina).     

Road traffic crashes among farm vehicle drivers in southern China: A cross-sectional survey

Objective: The objective of this study was to identify the prevalence and potential risk factors of farm vehicle–related road traffic crashes among farm vehicle drivers in southern China.

Methods: A cross-sectional study was used to interview 1,422 farm vehicle drivers in southern China. Farm vehicle–related road traffic crashes that occurred from December 2013 to November 2014 were investigated. Data on farm vehicle–related road traffic crashes and related factors were collected by face-to-face interviews.

Results: The prevalence of farm vehicle–related road traffic crashes among the investigated drivers was 7.2%. Farm vehicle–related road traffic crashes were significantly associated with self-reported vision problem (adjusted odds ratio [AOR] = 6.48, 95% confidence interval [CI], 3.86–10.87), self-reported sleep disorders (AOR = 10.03, 95% CI, 6.28–15.99), self-reported stress (AOR = 20.47, 95% CI, 9.96–42.08), reported history of crashes (AOR = 5.40, 95% CI, 3.47–8.42), reported history of drunk driving (AOR = 5.07, 95% CI, 2.97–8.65), and reported history of fatigued driving (AOR = 5.72, 95% CI, 3.73–8.78). The number of road traffic crashes was highest in the daytime and during harvest season. In over 96% of farm vehicle–related road traffic crashes, drivers were believed to be responsible for the crash. Major crash-causing factors included improper driving, careless driving, violating of traffic signals or signs, and being in the wrong lane.

Conclusion: Findings of this study suggest that farm vehicle–related road traffic crashes have become a burgeoning public health problem in China. Programs need to be developed to prevent farm vehicle–related road traffic crashes in this emerging country.