Emergency department visits vs. fatalities among substance-impaired underage youths involved in motor vehicle crashes

IntroductionEmergency department (ED) visits resulting from motor vehicle crashes (MVCs) among individuals younger than 21 impaired by alcohol and/or drugs have been less studied than MVC fatalities.MethodUsing data from 2004 to 2011, we compare the magnitude and pattern of national ED visit and mortality data for alcohol- and drug-impaired youths involved in MVCs.ResultsTemporal patterns of ED visits are similar to those of fatalities, but the two differ in magnitude. The ratio of ED visits to fatalities is 3.5:1; alcohol related events involvement dominates other drugs in both categories.DiscussionThe volume of injuries serious enough to warrant ED visits imposes significant health, social, and financial burdens. In ED visits, alcohol is the prime source of MVC morbidity burden; other drugs consistently contribute less.Practical applicationsThese incidents are persistent and require interventions aimed at multiple levels of prevention, including stricter corrective steps earlier in the impaired driving career to reduce subsequent incidents. ED visits for MVC injuries can be important “teachable moments.” Limitations of the study indicate the need for improved surveillance of underage substance-involved crashes.     

Comparison of epidemiology and injury profile between vulnerable road users and motor vehicle occupants in road traffic fatalities

Objective: Road traffic injuries (RTIs) are a major global health issue causing a global burden of mortality and morbidity. Half of all fatalities on the world’s roads are vulnerable road users (VRUs). The targeted intervention strategies based on fatality analysis focusing on VRUs can effectively contribute to reducing RTIs. This study aimed to compare VRUs and motor vehicle occupants (MVOs) in terms of epidemiology and injury profile.

Methods: We utilized a nationwide, prospective database of RTI-related mortality cases for patients who visited 23 emergency departments between January 2011 and December 2015. All fatalities due to RTIs in the prehospital phase or in-hospital were eligible, excluding patients with unknown mode of transport and those admitted to general wards. The primary and secondary outcomes were fracture injuries and visceral injuries diagnosed using the International Classification of Diseases, Tenth Revision (ICD-10). We compared fracture injuries between VRUs and MVOs using Abbreviated Injury Scale (AIS) 2? and 2+ classification.

Results: Among a total 3,694 road traffic fatalities (RTFs), 43.3% were pedestrians, followed by MVOs (27.0%), motorcyclists (18.9), bicyclists (6.6%), and agricultural vehicle users (4.2%). The elderly (>60 years old) accounted for 54.9% of VRU fatalities. RTFs occurred most frequently in the autumn and the VRU group and the MVO group showed significant differences in weekly and diurnal variation in RTFs. The injury severities (AIS 2+) of the head, neck, and thorax were significantly different between the 2 groups (P?Conclusions: Elderly pedestrians should be targeted for decreases in RTFs, and road traffic safety interventions for VRUs should be made based on the analysis of temporal epidemiology and injury profiles of RTFs.     

Coverage of motor vehicle crashes with injuries in U.S. newspapers, 1999-2002

Problem

The aims of the study were to evaluate information on motor-vehicle crashes with injuries provided in newspaper reports and to assess the frequency of thematic and episodic reporting of motor-vehicle crashes.

Method

The study used Fatal Analysis Reporting System (FARS) derived variables to code a nationally representative sample of U.S. newspaper reports of motor-vehicle crashes from 1999-2002. A total of 473 newspaper reports of motor-vehicle crashes with injuries were included. Information on the crash event, people involved, and vehicles was extracted. The reports were coded for episodic and thematic news framing.

Results

A majority of newspaper reports used episodic framing. The majority of reports included information on the type of crash, but characteristics about people and vehicles were rarely reported.

Discussion

Lack of information in newspapers makes them an incomplete source from which to influence public perceptions and attitudes.

Impact on industry

This provides an opportunity for news print media to improve public health content.

Impact on industry

Newspapers represent an important source of public information; they are, however, an incomplete source [Voight, B., Lapidus, G., Zavoski, R., & Banco, L. (1998). Injury reporting in Connecticut newspapers. Injury Prevention, 4, 292-294.; Baullinger, J., Quan, L., Bennett, E., Cummings, P., & Williams, K. (2001). Use of Washington state newspaper for submersion injury surveillance. Injury Prevention, 7, 339-342]. To increase the accuracy of information provided to the public through media sources, there is a need for increased communication between public health professionals and reporters.The results of this study raise concerns about the contents of motor-vehicle crash information provided in newspapers and suggest that newspapers do not provide information to allow public perception to be in accord with the importance of motor-vehicle crash injuries and health promoting actions to reduce risk of injury. More balanced and detailed information in newspapers would provide an opportunity for news print media to improve public health programs and public perception about the impact of motor-vehicle crashes on safety for all.     

Child passengers injured in motor vehicle crashes

IntroductionDuring 2010, 171,000 children aged 0–14 were injured in motor vehicle crashes. Despite the severity of the problem, research has been limited, and most of what we know about these children emanates from fatal crash databases.MethodUsing information from the General Estimates System, this effort examines the occurrence of non-fatal crashes among children aged 0–14 over the last decade.ResultsWe found that about 1% of the non-injured children in the file had been driven by a driver who was positive for alcohol. This percentage climbed to about 2% among children who had suffered injuries. Compared with the proportion of alcohol-positive drivers at the time of the crash, the proportion of drivers who sped or failed to obey a traffic signal was significantly higher.Practical applicationsThe finding that drinking and driving with children did not decrease over time questions the adequacy of the extant child endangerment laws.     

Driver's alcohol and passenger's death in motor vehicle crashes

OBJECTIVE: Previous studies on alcohol involvement associated with fatal injury in traffic crashes have focused on the drivers, but the passenger's view is not well known. This study (1) analyzes the relationship between passenger's death and alcohol inebriation of the driver and (2) estimates the role of alcohol as the cause of a crash by examining who was at fault, sober, or inebriated. METHOD: The study includes all motor vehicle passengers (n = 420) who died in crashes in Sweden 1993 through 1996 and were medicolegally autopsied. Autopsy reports from the Departments of Forensic Medicine, including toxicological analyses, and police reports were studied. Presence of alcohol among drivers was based on blood and breath tests. RESULTS: One-fifth of the fatally injured passengers and one-fifth of the tested drivers were under the influence of alcohol. The youngest drivers had the highest prevalence of drunken driving. Drivers at fault were alcohol positive in 21% of these crashes and drivers were not at fault in 2% of these crashes. In 53% of the crashes where both the passenger and driver were alcohol positive, the passenger had a lower alcohol concentration than the driver. Children (<16 years) comprised 15% of the killed passengers. Notably, the children were riding with a driver who was under influence of alcohol in 13% of these crashes. Alcohol involvement was not tested in half of the surviving drivers. CONCLUSIONS: The data show that 20% of both passengers and drivers were under the influence of alcohol. Increased testing of surviving drivers regarding alcohol and other drugs is recommended.     

Suicidal behavior by motor vehicle collision

BACKGROUND: The ability for suicides of drivers to be disguised as traffic accidents raises the possibility that suicidal behaviors of this nature are far more prevalent than previously thought, potentially impacting health, road safety, and insurance companies. METHOD: Persons residing at the Gold Coast, Australia, identified as having a history of suicidal ideation and behaviors (n = 1,196), were sent a mail-out survey after their consent was obtained in initial telephone contact (CATI random digit-dialing). Among those responding, 412 had made suicide plans or arrangements and 228 suicide attempts. RESULTS: Of those who reported planning a suicide, 14.8% (19.1% of male planners and 11.8% of female planners) had conceived to have a motor vehicle "accident" (n = 61). Of all attempters, 8.3% (13.3% of male attempters) had previously attempted via motor vehicle collision (n = 19). All attempters reported having emotional or mental problems at the time of the event. Suicide planners were significantly more likely to be in full-time employment and have a partner and children compared with other planners. CONCLUSION: The study gives a rare insight into driver suicide plans and attempts, via a large-scale community survey, to provide the best opportunity of collecting unbiased data on the driver suicide behavior. Results suggest the use of this method, particularly in attempts made by males, may be underreported leading to inaccuracy of statistics. The motives behind choosing this method are somewhat different to those behind other methods, including financial benefits and eliminating stigma in the aftermath of a suicide.     

机动车尾气污染及防治对策研究

汽车是当今社会中人们最重要的代步工具,在人们的日常生活中占据着不可替代的位置。随着我国经济快速发展,城市机动车数量不断增加,导致尾气污染问题也日益严重,这不仅对大气质量造成了不良影响,同时也严重危害到了人们的身体健康。因此,机动车尾气污染问题必须得到有关部门高度重视,并且结合造成污染加剧的主要原因,找到机动车尾气污染防治的有效对策。本文将针对机动车尾气污染危害及防治对策进行分析。     

County-level prohibition and alcohol-related fatal motor vehicle accidents

The 50 states and the District of Columbia were grouped according to whether or not they had county-level alcohol prohibition. Several motor vehicle fatality rates were calculated for each type of jurisdiction, including the single-vehicle fatality rate (an index of alcohol-related motor vehicle accidents). In all cases, motor vehicle fatality rates for drivers in states with county-level prohibition were significantly greater than in nonprohibition states. This suggests that drivers residing in counties with prohibition are compelled to drive to adjacent counties or states to drink and consequently have increased involvement in motor vehicle accidents.     

Motor vehicle fatalities among Gulf War era veterans: characteristics, mechanisms, and circumstances

OBJECTIVES: Our objective was to describe fatal motor vehicle crashes (MVC) among veterans of the 1991 Gulf War era and to compare the distribution of crash and individual characteristics between those deployed to the Gulf War (GWV) and those not deployed (NDV). METHODS: We compared individual characteristics, crash mechanisms, and crash circumstances between 765 GWV and 553 NDV who died from MVC within the first five years of the war, between May 1991 and December 1995. RESULTS: Overall, GWV and NDV who died from a MVC were more likely to be enlisted males (97%), 21-30 years old (72%), have a high school education or less (91%), drive a passenger car (52%), and not use restraints (60%). The overall annual rate of motor vehicle fatalities for GWV (23.6 per 100,000; 95% confidence interval: 21.9-25.3) was significantly greater than the rate for NDV (15.9, 95% CI: 14.6-17.3). GWV with the highest motor vehicle fatality rates include males (24.8, 95% CI: 23.0-26.6), 17-20 year olds (105.0, 95% CI: 78.2-138.1), and those not married (27.3, 95% CI: 25.1-30.1). Adjusting for differences in age distribution across GWV and NDV did not account for the difference in rates. Characteristics of MVC fatalities that were over-represented among GWV include serving as regular active duty (p = 0.001), having a high school education or less (p = 0.01), being involved in a single-vehicle crash (p = 0.008), and dying within the first hour following the crash (p = 0.004). Also, we identified a greater proportion of alcohol-related crashes among GWV during the late night and early morning hours. CONCLUSIONS: The highest rates of motor vehicle fatality among young, single males in the military mirror the experience of the general population. Further research is necessary to determine modifiable risk factors that can be targeted for specific interventions and whether the elevated late night alcohol-related crash rate among GWV is an effect of deployment or an inherent population bias among those selected for operational deployments.     

Fibromyalgia after motor vehicle collision: evidence and implications

OBJECTIVE: Assess currently available evidence regarding the ability of a motor vehicle collision (MVC) to trigger the development of fibromyalgia (FM). METHODS: Consensus standards developed by the American College of Rheumatology Environmental Disease Study Group were used to assess the ability of an MVC to trigger FM. RESULTS: Increasing evidence suggests that FM and related disorders are characterized by abnormalities in central nervous system function related to sensory processing, autonomic regulation, and neuroendocrine function. MVC trauma appears capable of triggering FM, but generally not through direct biomechanical injury. Instead, the evidence suggests that MVC trauma can act as a "stressor," which in concert with other factors, such as an individual's biologic vulnerability, psychosocial factors, cultural factors, and so on, may result in the development of chronic widespread pain and other somatic symptoms. MVC trauma is only one of many stressors which can trigger such disorders, and the environment within which the stressor is experienced (biological and psychosocial) may largely determine whether there is an adverse physiologic result or not. CONCLUSIONS: The evidence that MVC trauma may trigger FM meets established criteria for determining causality, and has a number of important implications, both for patient care, and for research into the pathophysiology and treatment of these disorders.     

Cervical and thoracic spine injury in pediatric motor vehicle crash passengers

Objective: Motor vehicle occupants aged 8 to 12 years are in transition, in terms of both restraint use (booster seat or vehicle belt) and anatomical development. Rear-seated occupants in this age group are more likely to be inappropriately restrained than other age groups, increasing their vulnerability to spinal injury. The skeletal anatomy of an 8- to 12-year-old child is also in developmental transition, resulting in spinal injury patterns that are unique to this age group. The objective of this study is to identify the upper spine injuries commonly experienced in the 8- to 12-year-old age group so that anthropomorphic test devices (ATDs) representing this size of occupant can be optimized to predict the risk of these injuries.

Methods: Motor vehicle crash cases from the National Trauma Data Bank (NTDB) were analyzed to characterize the location and nature of cervical and thoracic spine injuries in 8- to 12-year-old crash occupants compared to younger (age 0–7) and older age groups (age 13–19, 20–39).

Results: Spinal injuries in this trauma center data set tended to occur at more inferior vertebral levels with older age, with patients in the 8- to 12-year-old group diagnosed with thoracic injury more frequently than cervical injury, in contrast to younger occupants, for whom the proportion of cases with cervical injury outnumbered the proportion of cases with thoracic injury. With the cervical spine, a higher proportion of 8- to 12-year-olds had upper spine injury than adults, but a substantially lower proportion of 8- to 12-year-olds had upper spine injury than younger children. In terms of injury type, the 8- to 12-year-old group’s injury patterns were more similar to those of teens and adults, with a higher relative proportion of fracture than younger children, who were particularly vulnerable to dislocation and soft tissue injuries. However, unlike for adults and teens, catastrophic atlanto-occipital dislocations were still more common than any other type of dislocation for 8- to 12-year-olds and vertebral body fractures were particularly frequent in this age group.

Conclusions: Spinal injury location in the cervical and thoracic spine moved downward with age in this trauma center data set. This shift in injury pattern supports the need for measurement of thoracic and lower cervical spine loading in ATDs representing the 8- to 12-year-old age group.     

Nighttime pedestrian fatalities: A comprehensive examination of infrastructure,user, vehicle,and situational factors

Introduction: Pedestrian fatalities in the United States increased 45.5% between 2009 and 2017. More than 85% of those additional pedestrian fatalities occurred at night. Method: We examine Fatality Analysis Reporting System (FARS) data for fatal pedestrian crashes that occurred in the dark between 2002 and 2017. Within-variable and before/after examinations of crashes in terms of infrastructure, user, vehicle, and situational characteristics are performed with one-way analysis of variance (ANOVA) and two-sample t-tests. We model changes in crash characteristic proportions between 2002–2009 and 2010–2017 using linear regressions and test for autocorrelation with Breusch-Godfrey tests. Results: The increase in fatal nighttime pedestrian crashes is most strongly correlated with infrastructure factors: non-intersection unmarked locations (saw 80.8% of additional fatalities); 40–45 mph roads (54.6%); five-lane roads (40.7%); urban (99.7%); and arterials (81.1%). In addition, SUVs were involved in 39.7% of additional fatalities, overrepresenting their share of the fleet. Increased pedestrian alcohol and drug involvement warrant further investigation. The age of pedestrians killed increased more (18.1%) than the national average (3.2%). Conclusions: By identifying factors related to the increase in nighttime pedestrian fatalities, this work constitutes a vital first step in making our streets safer for pedestrians. Practical Applications: More research is needed to understand the efficacy of different solutions, but this paper provides guidance for such future research. Engineering solutions such as road diets or traffic calming may be used to improve identified infrastructure issues by reducing vehicle speeds and road widths. Rethinking vehicle design, especially high front profiles, may improve vehicle issues. However, the problems giving rise to these pedestrian fatalities are likely a result of not only engineering issues but also interrelated social and political factors. Solutions may be correspondingly comprehensive, employing non-linear, systems-based approaches such as Safe Systems.