Trends over time in the risk of driver death: what if vehicle designs had not improved?

OBJECTIVES: Passenger vehicle driver death rates per million vehicle registrations declined steadily during calendar years 1985-2004. The present study sought to separate the effect of vehicle design changes from this trend. METHODS: Restricting the trend to a fixed set of model years removed the vehicle design effects, but there were still effects due to vehicle aging. Risk of driver death was found to increase each year vehicles aged, probably due to changes in vehicle use patterns. RESULTS: After separating out the vehicle design effects and making adjustments for the vehicle age effects, a different picture emerged of trends in death rates over time. Absent the vehicle design changes, the historical decline in driver fatality risk would have ended in 1993, with risk climbing ever since. This underlying trend has been obscured by changes in the vehicle fleet. CONCLUSIONS: The push for vehicle improvements has been worthwhile and can be credited with saving thousands of lives. However, the analysis shows that the gains in occupant protection from vehicle design improvements have been offset partially by an increasingly risky environment in recent years. Therefore, more attention needs to be paid to programs targeting improvement in roadway design and driver behavior.     

Surveillance of traffic incident management–related occupational fatalities in Kentucky, 2005–2016

Objective: Traffic incidents occurring on roadways require the coordinated effort of multiple responder and recovery entities, including communications, law enforcement, fire and rescue, emergency medical services, hazardous materials, transportation agencies, and towing and recovery. The objectives of this study were to (1) identify and characterize transportation incident management (TIM)-related occupational fatalities; (2) assess concordance of surveillance data sources in identifying TIM occupations, driver vs. pedestrian status, and occupational fatality incident location; and (3) determine and compare U.S. occupational fatality rates for TIM industries.

Methods: The Kentucky Fatality Assessment and Control Evaluation (FACE) program analyzed 2005–2016 TIM occupational fatality data using multiple data sources: death certificate data, Collision Report Analysis for Safer Highways (CRASH) data, and media reports, among others. Literal text analysis was performed on FACE data, and a multiple linear regression model and SAS proc sgpanel were used to estimate and visualize the U.S. TIM occupational mortality trend lines and confidence bounds.

Results: There were 29 TIM fatalities from 2005 to 2015 in Kentucky; 41% of decedents were in the police protection occupation, and 21% each were in the fire protection and motor vehicle towing industries. Over one half of the TIM decedents were performing work activities as pedestrians when they died. Media reports identified the majority of the occupational fatalities as TIM related (28 of 29 TIM-related deaths); the use of death certificates as the sole surveillance data source only identified 17 of the 29 deaths as TIM related, and the use of CRASH data only identified 4 of the 29 deaths as TIM related. Injury scenario text analysis showed that law enforcement vehicle pursuit, towing and recovery vehicle loading, and disabled vehicle response were particular high-risk activities that led to TIM deaths. Using U.S. data, the motor vehicle towing industry had a significantly higher risk for occupational mortality compared to the fire protection and police protection industries.

Conclusions: Multiple data sources are needed to comprehensively identify TIM fatalities and to examine the circumstances surrounding TIM fatalities, because no one data source in itself was adequate and undercounted the total number of TIM fatalities. The motor vehicle towing industry, in particular, is at elevated risk for occupational mortality, and targeted mandatory TIM training for the motor vehicle towing industry should be considered. In addition, enhanced law enforcement roadside safety training during vehicle pursuit and apprehension of suspects is recommended.     

Living dangerously: driver distraction at high speed

Recent research indicates that cell phone use can distract drivers from safe vehicle operation. However, estimates of the prevalence of cell phone use while driving have been limited to daytime hours and low-speed roadways. This paper describes the results of a study to estimate rates of cell phone use and other distractions by examining approximately 40,000 high-quality digital photographs of vehicles and drivers on the New Jersey Turnpike. The photographs, which originally were collected as part of a separate study, were taken both during the day and during the night and at different locations across the span of the Turnpike. A radar gun linked to the camera recorded the speeds of vehicles as they passed. This provided us with the speeds of every vehicle photographed, and allowed us to determine population counts of vehicles. A panel of three trained coders examined each photograph and recorded the presence of cell phone use by the drivers or any other distracting behavior. Demographic information on the driver was obtained during previous examinations of the photographs for an unrelated study. A rating was considered reliable when two out of the three coders agreed. Population estimates (and confidence intervals) of cell phone use and other distractions were estimated by weighting the cases by the inverse probability of vehicle selection. Logistic regression was used to predict cell phone use from demographic and situational factors. The results indicated that the most frequent distraction was cell phone use: 1.5% of the drivers on the Turnpike were using cell phones compared to the 3 to 4% use rates reported in the National Occupant Protection Use Survey (NOPUS) surveys conducted during the daytime on lower speed roadways. The Turnpike survey indicated that cell phones were used less on weekends and at night, and when the driver was exceeding the speed limit or had a passenger in the car.     

Evaluation of a hospital-based injury surveillance system for monitoring road traffic deaths in Phuket,Thailand

Objectives: The objective of this study was to evaluate and injury surveillance (IS) system’s ability to monitor road traffic deaths and the coverage of road traffic injury and death surveillance in Phuket, Thailand.

Methods: U.S. Centers for Disease Control and Prevention guidelines on surveillance system evaluation were used to qualitatively and quantitatively evaluate IS. Interviews with key stakeholders focused on IS’s usefulness, simplicity, flexibility, acceptability, and stability. Active case finding of 2014 road traffic deaths in all paper and electronic hospital record systems was used to assess system sensitivity, positive predictive value, and data quality. Electronic data matching software was used to determine the implications of combining IS data with other provincial-level data sources (e.g., death certificates, electronic vehicle insurance claim system).

Results: Evaluation results indicated that IS was useful, flexible, acceptable, and stable, with a high positive predictive value (99%). Simplicity was limited due to the burden of collecting data on all injuries and use of paper-based data collection forms. Sensitivity was low, with IS only identifying 55% of hospital road traffic death cases identified during active case finding; however, IS cases were representative of cases identified. Data accuracy and completeness varied across data fields. Combining IS with active case finding, death certificates, and the electronic vehicle insurance claim system more than doubled the number of road traffic death cases identified in Phuket.

Conclusion: An efficient and comprehensive road traffic injury and death surveillance system is critical for monitoring Phuket’s road traffic burden. The hospital-based IS system is a useful system for monitoring road traffic deaths and assessing risk behaviors. However, the complexity of data collection and limited coverage hinders the ability of IS to fully represent road traffic deaths in Phuket Province. Combining data sources could improve coverage and should be considered.     

Land-traffic crash leading to passenger vehicle submersion,drowning and other fatal injuries: A 44-year study based on records from the Finnish Crash Data Institute

Background: Land motor traffic crash (LMTC) -related drownings are an overlooked and preventable cause of injury death. The aim of this study was to analyze the profile of water-related LMTCs involving passenger cars and leading to drowning and fatal injuries in Finland, 1972 through 2015. Materials and methods: The database of the Finnish Crash Data Institute (FCDI) that gathers detailed information on fatal traffic accidents provided records on all LMTCs leading to drowning during the study period and, from 2002 to 2015, on all water-related LMTCs, regardless of the cause of death. For each crash, we considered variables on circumstances, vehicle, and fatality profiles. Results: During the study period, the FCDI investigated 225 water-related LMTCs resulting in 285 fatalities. The majority of crashes involved passenger cars (124), and the cause of death was mostly drowning (167). Only 61 (36.5%) fatalities suffered some–generally mild–injuries. The crashes frequently occurred during fall or summer (63.7%), in a river or ditch (60.5%), and resulted in complete vehicle’s submersion (53.7 %). Half of the crashes occurred in adverse weather conditions and in over 40% of the cases, the driver had exceeded the speed limit. Among drivers, 77 (68.8%) tested positive for alcohol (mean BAC 1.8%). Conclusion: Multidisciplinary investigations of LMTCs have a much higher potential than do exclusive police and medico-legal investigations. The risk factors of water-related LMTCs are similar to those of other traffic crashes. However, generally the fatal event in water-related LMTC is not the crash itself, but drowning. The paucity of severe physical injuries suggests that victims’ functional capacity is usually preserved during vehicle submersion. Practical Applications: In water-related LMTCs, expansion of safety measures is warranted from general traffic-injury prevention to prevention of drowning, including development of safety features for submerged vehicles and simple self-rescue protocols to escape from a sinking vehicle.     

铁路不同系统职工“三类人员”健康状况分析

为了做好运输一线职工的健康管理工作,选择车辆、车务、电务、工务和机务系统参加健康体检的职工,以其2015—2016年体检数据为研究资料,分析了各系统"三类人员"健康情况。结果表明,不同系统"三类人员"总胆固醇异常率为车辆系统最高(64.9%),车务系统最低(60.0%);低密度脂蛋白胆固醇异常率最高为机务系统(53.1%),车务系统最低(45.7%);高密度脂蛋白胆固醇异常率为车辆系统最高(32.2%),工务系统最低(22.1%);空腹血糖异常率最高为机务系统(47.6%),电务系统最低(39.6%);甘油三酯异常率为工务系统最高(69.0%),车务系统最低(65.8%);舒张压异常率最高为车辆系统(93.8%),车务系统最低(78.2%);收缩压异常率最高为车辆系统(80.8%),车务系统最低(68.6%)。     

Analysis of factors that influence hazardous material transportation accidents based on Bayesian networks: A case study in China

In this study, we applied Bayesian networks to prioritize the factors that influence hazardous material (Hazmat) transportation accidents. The Bayesian network structure was built based on expert knowledge using Dempster-Shafer evidence theory, and the structure was modified based on a test for conditional independence. We collected and analyzed 94 cases of Chinese Hazmat transportation accidents to compute the posterior probability of each factor using the expectation-maximization learning algorithm. We found that the three most influential factors in Hazmat transportation accidents were human factors, the transport vehicle and facilities, and packing and loading of the Hazmat. These findings provide an empirically supported theoretical basis for Hazmat transportation corporations to take corrective and preventative measures to reduce the risk of accidents.     

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.     

机动车辆火灾调查

近年来,机动车遍布全国各大城市,已成为移动的建筑,随之而来的机动车辆火灾事故频发,载客车辆因人员高度密集造成群死群伤;载货车辆因货物集中或运载危险品造成重大损失,并引发交通堵塞、环境污染等次生灾害。本文主要介绍了机动车火灾的现场勘验和调查,通过现场勘验确定起火点,调查询问收集和发现证据等方面对机动车辆火灾进行研究,从中发现起火原因的规律和特点,采取有针对性的措施,有效地遏制和减少此类火灾发生,达到预防机动车辆火灾的目的。     

Effect on fatality risk of changing from secondary to primary seat belt enforcement

BACKGROUND: Most seat belt use laws originally passed in the United States contained language restricting enforcement to drivers already stopped for some other reason. States that have since removed this secondary enforcement restriction have reported increased seat belt use. The purpose of the present study was to estimate the effect of these law changes on driver fatality rates. METHOD: Trends in passenger vehicle driver death rates per billion miles traveled were compared for 10 states that changed from secondary to primary seat belt enforcement and 14 states that remained with secondary enforcement. RESULTS: After accounting for possible economic effects and other general time trends, the change from secondary to primary enforcement was found to reduce annual passenger vehicle driver death rates by an estimated 7% (95% confidence limits 3.0-10.9). CONCLUSION: The majority of U.S. states still have secondary enforcement laws. If these remaining secondary laws were amended, an estimated 696 deaths per year could be prevented.     

公路隧道内CNG管束气瓶车泄漏天然气扩散CFD仿真

气体管束气瓶车是运输压缩天然气(Compressed Natural Gas, CNG)的重要工具,针对CNG管束气瓶车运输过程中在公路隧道内发生追尾导致泄漏问题,基于计算流体动力学CFD方法,建立CNG管束气瓶车遭追尾致泄漏后果预测与评估模型,对公路隧道内风场条件下泄漏天然气的扩散过程进行模拟与分析,研究CNG管束气瓶车泄漏天然气在隧道内的扩散规律和形成的危险区域范围。仿真结果表明:泄漏天然气扩散具有极速泄漏、外力作用、初期膨胀增长和稳定收缩等特征;喷射气云团能够覆盖肇事车辆前部,可能导致驾驶人员窒息或引发火灾、爆炸事故;实例工况下,泄漏气体扩散至稳态以后,形成爆炸极限浓度范围内的气云分布在肇事车辆前部1.5m至肇事车辆中部之间的区域;进行事故应急响应时,应封锁事故隧道,加强隧道内通风,在消防水枪的稀释掩护下对管束气瓶车进行堵漏作业。     

Fatal occupational injuries in Jordan during the period 1980 through 1993

All fatal occupational injuries compensated by the Social Security Corporation (SSC) in Jordan during the period 1980–1993 were studied. Variables considered in the analysis included gender, age, nationality, occupation, salary, cause of injury, body part injured and cause of death. The overall fatality rate, of the 705 cases reviewed, was 25.5/100,000/year. The majority (98%) of fatalities were males. The risk of fatal injuries increased with age. Workers over 55 years, had the highest annual fatality rate (37.8). Immigrant workers had a higher fatality rate (32.26) than Jordanians (23.95). Unskilled workers constituted 58.3% of decedents and professionals had the highest fatality rate (52.9). Transportation sector had the highest fatality rate (122.4) followed by construction (50.6). Over the study period, fatality rates tended to decrease significantly in manufacturing, construction and trade economic sectors while no such trend was established by transportation, agriculture and services sectors. The leading causes of fatal injuries were motor-vehicle related accidents (63.0%) and fall of persons (11.1%). Head was the body part most injured and was involved in 46.6% of all deaths. Haemorrhage was the main reported cause of death (24.5%). It is concluded that intervention measures targeting specific occupations (transportation and construction) and causes of fatalities such as motor-vehicle incidents are needed.     

Injury-severity analysis of lane change crashes involving commercial motor vehicles on interstate highways

Introduction: One of the challenging tasks for drivers is the ability to change lanes around large commercial motor vehicles. Lane changing is often characterized by speed, and crashes that occur due to unsafe lane changes can have serious consequences. Considering the economic importance of commercial trucks, ensuring the safety, security, and resilience of freight transportation is of paramount concern to the United States Department of Transportation and other stakeholders. Method: In this study, a mixed (random parameters) logit model was developed to better understand the relationship between crash factors and associated injury severities of commercial vehicle crashes involving lane change on interstate highways. The study was based on 2009–2016 crash data from Alabama. Results: Preliminary data analysis showed that about 4% of the observed crashes were major injury crashes and drivers of commercial motor vehicles were at-fault in more than half of the crashes. Acknowledging potential crash data limitations, the model estimation results reveal that there is increased probability of major injury when lane change crashes occurred on dark unlit portions of interstates and involve older drivers, at-fault commercial vehicle drivers, and female drivers. The results further show that lane change crashes that occurred on interstates with higher number of travel lanes were less likely to have major injury outcomes. Practical Applications: These findings can help policy makers and state transportation agencies increase awareness on the hazards of changing lanes in the immediate vicinity and driving in the blind spots of large commercial motor vehicles. Additionally, law enforcement efforts may be intensified during times and locations of increased unsafe lane changing activities. These findings may also be useful in commercial vehicle driver training and driver licensing programs.     

Trends in aggressivity and driver risk for cars,SUVs, and pickups: Vehicle incompatibility from 1989 to 2016

Abstract

Objective: When 2 vehicles of different sizes collide, the occupants of the smaller vehicle are more likely to be injured than the occupants of the larger vehicle. The larger vehicle is both more protective of its own occupants and more aggressive toward occupants of the other vehicle. However, larger, heavier vehicles tend to be designed in ways that amplify their incompatibility with smaller, lighter vehicles (by having a higher ride height, for example). A 2012 study by the Insurance Institute for Highway Safety (IIHS) concluded that fatalities caused by design incompatibility have decreased in recent years. The current study was conducted to update the 2012 IIHS analysis and to explore trends in vehicle incompatibility over time.

Methods: Analyses examined deaths in crashes involving 1- to 4-year-old passenger vehicles from 1989 to 2016 collected from the Fatality Analysis Reporting System (FARS). Trends in driver risk were examined by comparing driver death rates per million registered vehicle years across vehicle type and size. Trends in aggressivity were examined by comparing partner driver death rates across vehicle type and size.

Results: Cars and SUVs have continued their trend toward reduced incompatibility. In 1989–1992, SUVs were 132% more likely to kill the driver in a partner car compared with when a car crashed with another car. By 2013–2016, this value had dropped to 28%. Pickups and cars remain just as incompatible in 2013–2016 as they were in 1989–1992, however (159% vs. 158%). Remaining pickup incompatibility may be largely due to excess curb weight rather than to shape or design features, because light pickups were just 23% more likely to kill the driver in a partner car compared with when a car crashed with another car.

Conclusions: The trend toward reduced fleet incompatibility has continued in the latest crash data, particularly for cars and SUVs. Although pickup–car incompatibility has also decreased over time, pickups remain disproportionately aggressive toward other vehicles, possibly due to their greater average curb weight. Reducing the weight of some of the heaviest vehicles and making crash avoidance technology fitment more widespread may be promising means to reduce remaining fleet incompatibility. Identifying the source of remaining incompatibility will be important for safety improvements going forward.     

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.     

剧毒化学品甲苯-2，4-二异氰酸酯运输危险性评估

为探讨低挥发性剧毒化学品甲苯-2,4-二异氰酸酯在运输过程中大量泄漏引起群体中毒事故的可能性以及对环境的影响,对本品的急性毒性、扩散模型、环境转归、生态毒性,以及运输泄漏事故资料进行综合分析和评估。评估结果本品吸人中毒的潜在危险性指数为低度危险物质;扩散模型运输泄漏模拟危险区域下风向距离小于某些非剧毒品;环境转归研究显示本品在环境介质中没有持久性,没有明显的生物蓄积性,生态毒性较低;历年来运输泄漏事故分析未见发生大规模严重群体中毒和环境污染事故。认为本品在运输过程中大量泄漏,不会大范围扩散引起严重群体中毒事故,也不会对环境造成严重和长期的危害,建议在运输环节中运输条件适当放宽,按照一般有毒品进行管理。     

Characteristics of hazardous chemical accidents in China: A statistical investigation

Utilizing data from official sources, 1632 hazardous chemical accidents (HCAs) occurring in China (2006–2010) were investigated for statistical characteristics. The following results were obtained: (1) Time volatility: The yearly number of HCAs is shown to be almost constant (with a slightly increasing number of fixed facility HCAs); fixed facility and transportation HCAs do not always follow similar patterns at month and hour-level. (2) Location distribution: There are provincial classifications of HCA materials involved in certain types of industries and the potential for HCAs is highly concentrated in urban areas. (3) Fixed facility type versus transportation type: Explosions represent almost half (48.4%) of fixed facility HCAs followed by releases (41.5%) and fires (10.1%); whereas for transportation HCAs, releases account for 79.6%, then explosions (15.1%) and fires (5.3%). As for domino effects, releases were often the cause of subsequent explosions or fires. (4) Injury versus death: In contrast with other industrial accidents, HCAs result in more severe casualties. For explosion and release HCAs in China, the ratio of death to major injury is quite high, with the exception of fire HCAs. (5) Cause: Concerning immediate causes, human factors account for the majority of HCAs followed by equipment deficiency; environment is also a causative factor. Internal corporate management failures and lack of external government supervision (particularly HCAs occurring in illegal corporations) are both root causes in China. (6)Corporate proneness: Majority of HCAs occur in private corporations; as corporations grow, the occurrence of HCAs are shown to decline steadily then level off, following which they are forecasted to increase again in the “aging stages”, all of which can be explained by Corporate Lifecycles Theory.     

Nationwide risk factors for hospital readmission for subsequent injury after motor vehicle crashes

Abstract

Objective: Some drivers involved in motor vehicle crashes across the United States may be identified as at risk of subsequent injury by a similar mechanism. The purpose of this study was to perform a national review of the risk factors for hospitalization for a new injury due to a subsequent motor vehicle crash. It was hypothesized that presenting to a different hospital after subsequent injury would result in worse patient outcomes when compared to presentation at the same hospital.

Methods: The Nationwide Readmissions Database for 2010–2014 was queried for all inpatient hospitalizations with injury related to motor vehicle traffic. The primary patient outcome of interest was subsequent motor vehicle crash–related injury within 1 year. The secondary patient outcomes were different hospital subsequent injury presentation, higher Injury Severity Score (ISS), longer length of stay (LOS), and in-hospital death after subsequent injury. The analysis of secondary patient outcomes was performed only on patients who were reinjured. Univariable analysis was performed for each outcome using all variables during the index admission. Multivariable logistic regression was performed using all significant (P < .05) variables on univariate analysis. Results were weighted for national estimates.

Results: During the study period, 1,008,991 patients were admitted for motor vehicle–related injury; 12,474 patients (1.2%) suffered a subsequent injury within 1 year. From the reinjured patients, 32.9% presented to a different hospital, 48.9% had a higher ISS, and 22.1% had a longer LOS. The in-hospital mortality rate after subsequent injury was 1.1%. Presentation to a different hospital for subsequent injury was associated with a longer LOS (odds ratio [OR]?=?1.32; 95% confidence interval [CI], 1.20–1.45; P < .01) and a higher ISS (OR?=?1.38; 95% CI, 1.27–1.49; P < .01). Motorcyclists were more likely to suffer subsequent injury (OR?=?1.39; 95% CI, 1.32–1.46; P < .01) and motorcycle passengers were more likely to present to a different hospital with a subsequent injury (OR?=?2.49; 95% CI, 1.73–3.59; P < .01). Alcohol abuse was associated with subsequent injury (OR?=?1.12; 95% CI, 1.07–1.18; P < .01).

Conclusions: Nearly a third of patients suffering subsequent motor vehicle crash–related injury after an initial motor vehicle crash in the United States present to a different hospital. These patients are more likely to suffer more severe injuries and longer hospitalizations due to their subsequent injury. Future efforts to prevent these injuries must consider the impact of this fragmentation of care and the implications for quality and cost improvements.