Examining motor vehicle crash involvement and readiness to change on drinking and driving behaviors among injured emergency department patients

Objective: To measure the effect of motor vehicle crash (MVC) involvement and readiness to change drinking and driving behaviors on subsequent driving and drinking behaviors among injured emergency department (ED) patients who use alcohol at harmful levels.

Methods: This was a secondary analysis of a randomized controlled trial of injured ED patients who screened positive for harmful alcohol use, who at recruitment reported driving in the past 12 months and received at least one of the intended intervention sessions (brief behavioral intervention versus attention placebo control; N = 407). Outcome variables were as follows: (1) change in 6 impaired driving behaviors and (2) report of MVCs and traffic violations in the 12 months following recruitment; predictor variables were as follows: (1) treatment assignment, (2) MVC involvement at recruitment, and (3) baseline readiness to change alcohol use and drinking and driving.

Results: Modeling of change in the 6 impaired driving variables indicated that neither the recruitment visits being MVC related nor baseline readiness to change alcohol use and drinking and driving behaviors predicted greater changes in impaired driving over time. Baseline reports of past moving traffic violations and the ED visit being MVC related predicted a greater likelihood of each behavior at 12 months following study recruitment.

Conclusions: This study and others have demonstrated that ED patients with harmful alcohol use are willing to engage in behavioral interventions directed at changing risky behaviors. However, this study did not demonstrate that patients considered having the potential to be more engaged with the intervention because their ED visit was MVC related and/or they had expressed intent to change their risky alcohol use and drinking and driving behaviors were more likely to change these risky behaviors.     

Age,period, and cohort effects in motor vehicle mortality in the United States, 1980–2010: The role of sex,alcohol involvement,and position in vehicle

IntroductionAlthough substantive declines in motor vehicle fatalities in 1980–2010 have been observed, declines by position in the vehicle and alcohol involvement have not been well elucidated.MethodAnalyses of FARS data use the Intrinsic Estimator (IE) to produce estimates of all age, period, and cohort effects simultaneously by position in the car and by alcohol involvement.ResultsDeclines in MVC deaths by position in the car vary for men and women by age and cohort over time. Cohorts born before 1970 had higher risks than those born later. Analyses using proxy indicators of alcohol involvement found the highest risks for those aged 16–24. By period, these risks declined more rapidly than non- alcohol related traffic fatalities.ConclusionChanges in risk patterns are consistent with evidence regarding the contributions of new technologies and public policy efforts to reduce fatalities, but gains have not been shared evenly by sex or position in the car.Practical applicationsGreater attention is needed in reducing deaths among older drivers and pedestrians. Gender differences should be addressed in prevention efforts aimed at reducing MVCs due to alcohol involvement.     

Characterization of fatal occupational versus nonoccupational motor vehicle collisions in Kentucky (1998-2000)

Motor vehicle collisions (MVCs) are the leading cause of occupational fatalities in Kentucky as well as in the nation. The characteristics of and contributing factors for occupational versus nonoccupational MVC fatalities in the Commonwealth of Kentucky were examined from 1998 to 2000. Semi trucks were most frequently involved in fatal occupational MVCs, and passenger cars were most frequently involved in nonoccupational MVCs. More than half of the decedent drivers resided outside of Kentucky. The percentage of occupational fatalities occurring on a four-lane highway was double the percentage observed for nonoccupational MVC fatalities. In addition, an increased proportion of occupational MVC deaths occurred on limited access highways compared to nonoccupational fatalities. When human factors contributing to these fatal incidents were examined, the two primary human factors involved in occupational motor vehicle fatalities were driver distraction/inattention and falling asleep, whereas unsafe speed and alcohol were the primary human factors contributing to a nonoccupational fatality. These results suggest that semi drivers traveling on four-lane highways are more at risk for a fatal occupational injury in Kentucky. Therefore, additional epidemiological studies are needed to further examine human factors, the nature of the Kentucky highway system, and trucking controls (e.g., weigh station hours of operation) within the Kentucky transportation industry.     

Factors associated with motorcycle traffic crash fatalities among active duty U.S. Army personnel

Objective: Research on factors associated with motorcycle fatalities among active duty U.S. Army personnel is limited. This analysis describes motorcycle crash–related injuries from 1995 through 2014 and assesses the effect of alcohol use and helmet use on the risk of fatal injury among active duty U.S. Army motorcycle operators involved in a traffic crash, controlling for other factors shown to be potentially associated with fatality in this population.

Methods: Demographics, crash information, and injury data were obtained from safety reports maintained in the Army Safety Management Information System. Traffic crashes were defined as crashes occurring on a paved public or private roadway or parking area, including those on a U.S. Army installation. Analysis was limited to motorcycle operators. Odds ratios (ORs) and 95% confidence intervals (95% CIs) from a multivariable analysis estimated the effect of alcohol use and helmet use on the risk of a fatal injury given a crash occurred, controlling for operator and crash characteristics.

Results: Of the 2,852 motorcycle traffic crashes, most involved men (97%), operators aged 20–29 years of age (60%), and operators who wore helmets (95%) and did not use alcohol (92%). Two thirds of reported crashes resulted in injuries requiring a lost workday; 17% resulted in fatality. Controlling for operator and crash characteristics, motorcycle traffic crashes involving operators who had used alcohol had a 3.1 times higher odds of fatality than those who did not use alcohol (OR =3.14; 95% CI, 2.17–4.53). Operators who did not wear a helmet had 1.9 times higher odds of fatality than those who did wear a helmet (OR =1.89; 95% CI, 1.24–2.89).

Conclusions: Among U.S. Army motorcycle operators, alcohol use and not wearing a helmet increased the odds of fatality, given that a crash occurred, and additional modifiable risk factors were identified. Results will help inform U.S. Army motorcycle policies and training.     

Examination of the severity of two-lane highway traffic barrier crashes using the mixed logit model

IntroductionVehicles in transport sometimes leave the travel lane and encroach onto natural or artificial objects on the roadsides. These types of crashes are called run-off the road crashes, which account for a large proportion of fatalities and severe crashes to vehicle occupants. In the United States, there are about one million such crashes, with roadside features leading to one third of all road fatalities. Traffic barriers could be installed to keep vehicles on the roadways and to prevent vehicles from colliding with obstacles such as trees, boulder, and walls. The installation of traffic barriers would be warranted if the severity of colliding with the barrier would be less severe than colliding with other fix objects on the sides of the roadway. However, injuries and fatalities do occur when vehicle collide with traffic barriers. A comprehensive analysis of traffic barrier features is lacking due to the absence of traffic barrier features data. Previous research has focused on simulation studies or only a general evaluation of traffic barriers, without accounting for different traffic barrier features.MethodThis study is conducted using an extensive traffic barrier features database for the purpose of investigating the impact of different environmental and traffic barrier geometry on this type of crash severity. This study only included data related to two-lane undivided roadway systems, which did not involve median barrier crashes. Crash severity is modeled using a mixed binary logistic regression model in which some parameters are fixed and some are random.ResultsThe results indicated that the effects of traffic barrier height, traffic barrier offset, and shoulder width should not be separated, but rather considered as interactions that impact crash severity. Rollover, side slope height, alcohol involvement, road surface conditions, and posted speed limit are some factors that also impact the severity of these crashes. The effects of gender, truck traffic count, and time of a day were found to be best modeled with random parameters in this study. The effects of these risk factors are discussed in this paper.Practical applicationsResults from this study could provide new guidelines for the design of traffic barriers based upon the identified roadway and traffic barrier characteristics.     

Can progress in reducing alcohol-impaired driving fatalities be resumed? Results of a workshop sponsored by the Transportation Research Board,Alcohol, Other Drugs,and Transportation Committee (ANB50)

Objective: Despite successes in the 1980s and early 1990s, progress in reducing impaired driving fatalities in the United States has stagnated in recent years. Since 1997, the percentage of drivers involved in fatal crashes with illegal blood alcohol concentration (BAC) levels has remained at approximately 20 to 22%. Many experts believe that public complacency, competing social and public health issues, and the lack of political fortitude have all contributed to this stagnation. The number of alcohol-related crashes, injuries, and fatalities is still unacceptable, and most are preventable. The public needs to be aware that the problem presented by drinking drivers has not been solved. Political leaders need guidance on which measures will affect the problem, and stakeholders need to be motivated once again to implement effective strategies.

Methods: The National Academy of Sciences (NAS) Transportation Research Board (TRB), Alcohol, Other Drugs, and Transportation Committee (ANB50) sponsored a workshop held at the NAS facility in Woods Hole, Massachusetts, on August 24–25, 2015, to discuss the lack of progress in reducing impaired driving and to make recommendations for future progress. A total of 26 experts in research and policy related to alcohol-impaired driving participated in the workshop. The workshop began by examining the static situation in the rate of alcohol-impaired driving fatal crashes to determine what factors may be inhibiting further progress. The workshop then discussed 8 effective strategies that have not been fully implemented in the United States. Workshop participants (16 of the 26) rated their top 3 strategies.

Results: 3 strategies received the most support: 1. Impose administrative sanctions for drivers with BACs = 0.05 to 0.08 g/dL.

2. Require alcohol ignition interlocks for all alcohol-impaired driving offenders.

3. Increase the frequency of sobriety checkpoints, including enacting legislation to allow them in the 11 states that currently prohibit them.

5 other important strategies included the following: (1) increase alcohol taxes to raise the price and reduce alcohol consumption; (2) reengage the public and raise the priority of impaired driving; (3) lower the illegal per se BAC limit to 0.05 for a criminal offense; (4) develop and implement in-vehicle alcohol detection systems; and (5) expand the use of screening and brief interventions in medical facilities.

Conclusions: Each of these strategies is proven to be effective, yet all are substantially underutilized. Each is used in some jurisdictions in the United States or Canada, but none is used extensively. Any one of the 3 strategies implemented on a widespread basis would decrease impaired driving crashes, injuries, and fatalities. Based on the research, all 3 together would have a substantial impact on the problem.     

Fatal and serious injuries related to vulnerable road users in Canada

IntroductionThe goals of this study were to analyze possible trends of fatal and serious injuries related to vulnerable road users in Canada (pedestrians, cyclists and motorcyclists) from 1990 to 2012 and the role of alcohol and drugs in these cases. Drugs have rarely been documented with respect to vulnerable road users.MethodThe Traffic Injury Research Foundation's National Fatality and Serious Injury Databases and the Public Health Agency of Canada's Canadian Hospitals Injury Reporting and Prevention Program databases were used. Numbers and rates of fatalities and serious injuries among vulnerable road users were analyzed and regression models were used to assess changes over time.ResultsThe analyses show that while the absolute number of fatalities and the rate per 100,000 population among vulnerable road users may be decreasing, no such trends are apparent when looking at the proportions of these road user fatalities out of all motor-vehicle fatalities. The trend for the proportion of motorcyclist fatalities is significantly increasing (coef. = 0.16, p < 0.001). The elderly (76 years or older) are overrepresented among pedestrian fatalities, and serious injuries (they represent 18.5% of all pedestrian fatalities but only 5.8% of the population), while those 15 years or younger are overrepresented among cyclists (they represent 23.3% of cyclist fatalities but 19.5% of the population), and those 16 to 25 years old are overrepresented among motorcyclists (27.2% of motorcyclists fatalities and 13.6% of population). Alcohol and drug use among fatally injured vulnerable road users were significant problems, especially among pedestrians. Among fatally injured pedestrians tested for alcohol and drugs, 39.7% and 43.4% tested positive, respectively.ConclusionsWith the promotion of walking and cycling as forms of exercise and the popularity of motorcycling, the safety of vulnerable road users is an important issue. The results corroborate previous research and extend our understanding about the influence of alcohol and drugs in vulnerable road user injuries.Practical applicationsThese findings can help better inform prevention and mitigation initiatives for vulnerable road users.     

Effects of lane departure warning on police-reported crash rates

ObjectiveTo evaluate the effects of lane departure warning (LDW) on single-vehicle, sideswipe, and head-on crashes.MethodPolice-reported data for the relevant crash types were obtained from 25 U.S. states for the years 2009–2015. Observed counts of crashes with fatalities, injuries, and of all severities for vehicles with LDW were compared with expected counts based on crash involvement rates for the same passenger vehicles without LDW, with exposure by vehicle series, model year, and lighting system standardized between groups. For relevant crashes of all severities and those with injuries, Poisson regression was used to estimate the benefits of LDW while also controlling for demographic variables; fatal crashes were too infrequent to be modeled.ResultsWithout accounting for driver demographics, vehicles with LDW had significantly lower involvement rates in crashes of all severities (18%), in those with injuries (24%), and in those with fatalities (86%). Adding controls for driver demographics in the Poisson regression reduced the estimated benefit of LDW only modestly in crashes of all severities (11%, p < 0.05) and in crashes with injuries (21%, p < 0.07).ConclusionsLane departure warning is preventing the crash types it is designed to address, even after controlling for driver demographics. Results suggest that thousands of lives each year could be saved if every passenger vehicle in the United States were equipped with a lane departure warning system that performed like the study systems.Practical applicationsPurchase of LDW should be encouraged, and, because drivers do not always keep the systems turned on, future efforts should focus on designing systems to encourage greater use and educating consumers about the benefits of using the systems.     

Prevalence and characteristics of road traffic injuries among young drivers in Oman, 2009–2011

Objectives: Studies from different parts of the world have indicated that the impact of road traffic incidents disproportionally affects young adults. Few known studies have been forthcoming from Arabian Gulf countries. Within Oman, a high proportion of the population is under the age of 20. Coupled with the drastic increase in motorization in recent years, there is a need to understand the state of road safety among young people in Oman. The current research aimed to explore the prevalence and characteristics of road traffic injuries among young drivers aged 17–25 years.

Methods: Crash data from 2009 to 2011 were extracted from the Directorate General of Traffic, Royal Oman Police (ROP) database in Oman. The data were analyzed to explore the impact of road crashes on young people (17–25 years), the characteristics of young driver crashes, and how these differ from older drivers and to identify key predictors of fatalities in young driver crashes.

Results: Overall, young people were overrepresented in injuries and fatalities within the sample time period. Though it is true that many young people in crashes were driving at the time, it was also evident that young people were often victims in a crash caused by someone else. Thus, to reduce the impact of road crashes on young people, there is a need to generally address road safety within Oman. When young drivers were involved in crashes they were predominantly male. The types of crashes these drivers have can be broadly attributed to risk taking and inexperience. Speeding and nighttime driving were the key risk factors for fatalities.

Conclusion: The results highlight the need to address young driver safety in Oman. From these findings, the introduction of a graduated driver licensing system with nighttime driving restrictions could significantly improve young driver safety.     

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.     

Factors contributing to serious and fatal injuries in belted rear seat occupants in frontal crashes

Abstract

Objectives: Earlier research has shown that the rear row is safer for occupants in crashes than the front row, but there is evidence that improvements in front seat occupant protection in more recent vehicle model years have reduced the safety advantage of the rear seat versus the front seat. The study objective was to identify factors that contribute to serious and fatal injuries in belted rear seat occupants in frontal crashes in newer model year vehicles.

Methods: A case series review of belted rear seat occupants who were seriously injured or killed in frontal crashes was conducted. Occupants in frontal crashes were eligible for inclusion if they were 6 years old or older and belted in the rear of a 2000 or newer model year passenger vehicle within 10 model years of the crash year. Crashes were identified using the 2004–2015 National Automotive Sampling System Crashworthiness Data System (NASS-CDS) and included all eligible occupants with at least one Abbreviated Injury Scale (AIS) 3 or greater injury. Using these same inclusion criteria but split into younger (6 to 12 years) and older (55+ years) cohorts, fatal crashes were identified in the 2014–2015 Fatality Analysis Reporting System (FARS) and then local police jurisdictions were contacted for complete crash records.

Results: Detailed case series review was completed for 117 rear seat occupants: 36 with Maximum Abbreviated Injury Scale (MAIS) 3+ injuries in NASS-CDS and 81 fatalities identified in FARS. More than half of the injured and killed rear occupants were more severely injured than front seat occupants in the same crash. Serious chest injury, primarily caused by seat belt loading, was present in 22 of the injured occupants and 17 of the 37 fatalities with documented injuries. Nine injured occupants and 18 fatalities sustained serious head injury, primarily from contact with the vehicle interior or severe intrusion. For fatal cases, 12 crashes were considered unsurvivable due to a complete loss of occupant space. For cases considered survivable, intrusion was not a large contributor to fatality.

Discussion: Rear seat occupants sustained serious and fatal injuries due to belt loading in crashes in which front seat occupants survived, suggesting a discrepancy in restraint performance between the front and rear rows. Restraint strategies that reduce loading to the chest should be considered, but there may be potential tradeoffs with increased head excursion, particularly in the absence of rear seat airbags. Any new restraint designs should consider the unique needs of the rear seat environment.     

Unintentional non-traffic injury and fatal events: Threats to children in and around vehicles

Objective: There have been substantial reductions in motor vehicle crash–related child fatalities due to advances in legislation, public safety campaigns, and engineering. Less is known about non-traffic injuries and fatalities to children in and around motor vehicles. The objective of this study was to describe the frequency of various non-traffic incidents, injuries, and fatalities to children using a unique surveillance system and database.

Methods: Instances of non-traffic injuries and fatalities in the United States to children 0–14 years were tracked from January 1990 to December 2014 using a compilation of sources including media reports, individual accounts from families of affected children, medical examiner reports, police reports, child death review teams, coroner reports, medical professionals, legal professionals, and other various modes of publication.

Results: Over the 25-year period, there were at least 11,759 events resulting in 3,396 deaths. The median age of the affected child was 3.7 years. The incident types included 3,115 children unattended in hot vehicles resulting in 729 deaths, 2,251 backovers resulting in 1,232 deaths, 1,439 frontovers resulting in 692 deaths, 777 vehicles knocked into motion resulting in 227 deaths, 415 underage drivers resulting in 203 deaths, 172 power window incidents resulting in 61 deaths, 134 falls resulting in 54 deaths, 79 fires resulting in 41 deaths, and 3,377 other incidents resulting in 157 deaths.

Conclusions: Non-traffic injuries and fatalities present an important threat to the safety and lives of very young children. Future efforts should consider complementary surveillance mechanisms to systematically and comprehensively capture all non-traffic incidents. Continued education, engineering modifications, advocacy, and legislation can help continue to prevent these incidents and must be incorporated in overall child vehicle safety initiatives.     

Economic and statistical perspectives on traffic safety in Louisiana, 2005–2015

IntroductionThis study examines and applies recent empirical evidence from Mississippi and Alabama on fatal crashes and its relationship with gasoline prices and alcohol consumptions using the Louisiana Crash Data Reports between January 2005 and December 2015.MethodThe negative binomial models is the preferred specification for the Louisiana Crash Data. The marginal effects and related elasticities were calculated to facilitate the interpretation of the results.ResultsFindings suggest that higher gasoline prices reduce fatalities among young drivers. A fewer number of young drivers on the roads are believed to reduce the likelihood of fatal crashes. Underage drinking is still prominent in Louisiana. Extreme temperatures are positively associated with youth and other types of fatal crashes.Practical ApplicationsThis study highlights a huge toll on society in terms of social and economic costs, wealth destruction, and unfulfilled potential of the deceased or incapacitated.     

Do industrial incidents in the chemical sector create equity market contagion?

IntroductionThis paper examines a number of US chemical industry incidents and their effect on equity prices of the incident company. Furthermore, this paper then examines the contagion effect of this incident on direct competitors.MethodEvent study methodology is used to assess the impact of chemical incidents on both incident and competitor companies.ResultsThis paper finds that the incident company experiences deeper negative abnormal returns as the number of injuries and fatalities as a result of the incident increases. The equity value of the competitor companies suffer substantial losses stemming from contagion effects when disasters that occur cause ten or more injuries and fatalities, but benefit from the incident through increasing equity value when the level of injury and fatality is minor.ConclusionsPresence of contagion suggests collective action may reduce value destruction brought about by safety incidents that result in significant injury or loss of life.Practical ApplicationsThis research can be used as a resource to promote and justify the cost of safety mechanisms within the chemical industry, as incidents have been shown to negatively affect the equity value of the not just the incident company, but also their direct competitors.     

Pedestrians under influence (PUI) crashes: Patterns from correspondence regression analysis

Introduction: Alcohol-related impairment is a key contributing factor in traffic crashes. However, only a few studies have focused on pedestrian impairment as a crash characteristic. In Louisiana, pedestrian fatalities have been increasing. From 2010 to 2016, the number of pedestrian fatalities increased by 62%. A total of 128 pedestrians were killed in traffic crashes in 2016, and 34.4% of those fatalities involved pedestrians under the influence (PUI) of drugs or alcohol. Furthermore, alcohol-PUI fatalities have increased by 120% from 2010 to 2016. There is a vital need to examine the key contributing attributes that are associated with a high number of PUI crashes. Method: In this study, the research team analyzed Louisiana’s traffic crash data from 2010 to 2016 by applying correspondence regression analysis to identify the key contributing attributes and association patterns based on PUI involved injury levels. Results: The findings identified five risk clusters: intersection crashes at business/industrial locations, mid-block crashes on undivided roadways at residential and business/residential locations, segment related crashes associated with a pedestrian standing in the road, open country crashes with no lighting at night, and pedestrian violation related crashes on divided roadways. The association maps identified several critical attributes that are more associated with fatal and severe PUI crashes. These attributes are dark to no lighting, open country roadways, and non-intersection locations. Practical Applications: The findings of this study may be used to help design effective mitigation strategies to reduce PUI crashes.     

Temporal factors in motor-vehicle crash deaths: Ten years later

ObjectiveTo assess trends in traffic fatalities on several temporal scales: year to year, by month, by day of week, and by time of day, to determine why some times correspond with higher rates of crash deaths, and to assess how these trends relate to age, the role of the deceased, and alcohol consumption.MethodTraffic fatalities were identified using the Fatality Analysis Reporting System (FARS) for 1998 through 2014 and assessed for their time of occurrence. Three days that, on average, contained particularly high numbers of crash deaths were then assessed in greater detail, considering the age of the deceased, role of the deceased (vehicle occupant, bicyclist, motorcyclist, or pedestrian), and the blood alcohol content of either the driver (for passenger vehicle occupants) or the deceased.ResultsAnnual crash fatality totals were much lower in 2014 than in 1998, but the decrease was not steady; a marked drop in crash deaths occurred after 2007 and continued until 2014. On average the most fatalities per day occurred in July and August (116 per day), followed closely by June, September, and October. During the week, the greatest number of fatalities on average occur on weekend days, and during the day the most fatalities tend to occur between the hours of 3 p.m. and 7 p.m. Holidays like Independence Day and New Year's Day show elevated crash fatalities, and a greater percentage of these crashes involved alcohol, when compared with adjacent days.ConclusionCertain days and times of year stand out as posing an elevated crash risk, and even with the decrease in average daily fatalities over the past decade, these days and times of year have remained consistent.Practical applicationThese results indicate focused areas for continued efforts to reduce fatal crashes.     

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.