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.     

Using a driving simulator to identify older drivers at inflated risk of motor vehicle crashes

PROBLEM: To develop appropriate assessment criteria to measure the performance of older drivers using an interactive PC-based driving simulator, and to determine which measures were associated with the occurrence of motor-vehicle crash. METHOD: One hundred and twenty-nine older drivers residing in a metropolitan city volunteered to participate in this retrospective cohort study. Using the driving simulator, appropriate driving tasks were devised to test the older drivers, whose performances were assessed by 10 reliable assessment criteria. Logistic regression analysis was then undertaken to determine those criteria that influence the self-reported crash outcome. RESULTS: As expected, driving skill of older drivers was found to decline with age. Over 60% of the sample participants reported having at least one motor-vehicle crash during the past year. Adjusting for age in a logistic regression analysis, the cognitive abilities associated with the crash occurrence were working memory, decision making under pressure of time, and confidence in driving at high speed. SUMMARY: The findings of this retrospective study indicated those individuals at inflated risk of vehicle crashes could be identified using the PC-based interactive driving simulator. Prospective studies need to be undertaken to determine whether the driving simulator can predict future crash events. IMPACT ON INDUSTRY: This study demonstrated an economical driving simulator approach to screen out problematic or unsafe older drivers before a more detailed but expensive road test is considered.     

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.     

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.     

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.     

The effect of correct cross-chest clip use on injury outcomes in young children during motor vehicle crashes

Objective: Traffic crashes have high mortality and morbidity for young children. Though many specialized child restraint systems improve injury outcomes, no large-scale studies have investigated the cross-chest clip's role during a crash, despite concerns in some jurisdictions about the potential for neck contact injuries from the clips. This study aimed to investigate the relationship between cross-chest clip use and injury outcomes in children between 0 and 4 years of age.

Methods: Child passengers between 0 and 4 years of age were selected from the NASS-CDS data sets (2003–2014). Multiple regression analysis was used to model injury outcomes while controlling for age, crash severity, crash direction, and restraint type. The primary outcomes were overall Abbreviated Injury Score (AIS) 2+ injury, and the presence of any neck injury.

Results: Across all children aged 0–4 years, correct chest clip use was associated with decreased Abbreviated Injury Scale (AIS) 2+ injury (odds ratio [OR] = 0.44, 95% confidence interval [CI], 0.21–0.91) and was not associated with neck injury. However, outcomes varied by age. In children <12 months old, chest clip use was associated with decreased AIS 2+ injury (OR = 0.09, 95% CI, 0.02–0.44). Neck injury (n = 7, all AIS 1) for this age group only occurred with correct cross-chest clip use. For 1- to 4-year-old children, cross-chest clip use had no association with AIS 2+ injury, and correct use significantly decreased the odds of neck injury (OR = 0.49; 95% CI, 0.27–0.87) compared to an incorrectly used or absent cross-chest clip. No serious injuries were directly caused by the chest clips.

Conclusions: Correct cross-chest clip use appeared to reduce injury in crashes, and there was no evidence of serious clip-induced injury in children in 5-point harness restraints.     

Mortality in rural locations after severe injuries from motor vehicle crashes

BackgroundMortality from traffic crashes is often higher in rural regions, and this may be attributable to decreased survival probability after severe injury.MethodsData were obtained from the National Automotive Sampling System – General Estimates System (NASS-GES) for 2002–2008. Using weighted survey logistic regression, three injury outcomes were analyzed: (a) Death overall, (b) Severe injury (incapacitating or fatal), and (c) Death, after severe injury. Models controlled for (pre-crash) person, event, and county level factors.ResultsThe sample included 883,473 motorists. Applying weights, this represented a population of 98,411,993. Only 2% of the weighted sample sustained a severe injury, and 9% of these severely injured motorists died. The probability of death overall and the probability of severe injury increased with older age, safety belt nonuse, vehicle damage, high speed, and early morning crashes . Males were less likely to be severely injured, but more likely to die if severely injured. Motorists in southern states were more likely to have severe injuries, but not more likely to die if severely injured. Motorists who crashed in very rural counties were significantly more likely to die overall, and were more likely to die if severely injured.ConclusionsMotorists with severe injury are more likely to die in rural areas, after controlling for person- and event-specific factors.     

Utilization of state-wide hospital separations data and the injury impairment scale to assess the incidence of spinal cord injury arising from motor vehicle traffic crashes

The objectives of this study were to determine whether routine state-wide hospitalization data can be used for population level surveillance of the incidence of spinal cord injury (SCI) from motor vehicle traffic crashes (MVTCs) and to verify the coverage of the Australian Spinal Cord Injury Register. A method was developed to identify new injury incidents from routine South Australian hospitalization data. Mapping software was then used to derive the Abbreviated Injury Scale (AIS) and Injury Impairment Scale (IIS) codes for each incident case of spinal injury using the principal diagnosis code on the hospital data file. IIS code values in the range from 3 to 6 were considered to be comparable with the SCI coding criteria utilized by the Australian Spinal Cord Injury Register (ASCIR) which were based on the criteria of the American Spinal Injury Association. The number of estimated new incident cases of SCI based on the IIS coding of hospitalization data was compared with the actual number reported from the ASCIR. The case numbers were highly comparable overall and also by time and age group suggesting that the coverage of the ASCIR was very high. The results of the study support use of the IIS for estimating incident case numbers of MVTC-related SCI from routine state-wide hospitalization data. If routine hospital separations data elsewhere were suitable for the purpose and the IIS also proves to be applicable to non-MVTC-related SCI, the incidence of SCI could be monitored in state and national populations using the IIS and this could provide an alternative data source where registers of SCI do not exist. In addition, the IIS provides a means to assess coverage where registers do exist.     

Child passenger injury risk in motor vehicle crashes: a comparison of nighttime and daytime driving by teenage and adult drivers

INTRODUCTION: To examine the association between child passenger injury risk, restraint use, and crash time (day vs. night) for children in crashes of vehicles driven by teenage versus adult drivers. METHODS: Cross-sectional study involving telephone interviews with insured drivers in a probability sample of 6,184 crashes involving 10,028 children. RESULTS: Child passengers in teen nighttime crashes had an increased injury risk and an increased risk of restraint nonuse compared with those in teen daytime crashes. This increased injury risk can be explained by differences in the age of child passengers, collision type, and child passenger's restraint status associated with time of day. CONCLUSIONS: In order to limit the risk of injury to child passengers driven by teens, Graduated Driver Licensing (GDL) laws should include provisions restricting nighttime driving, as well as mandates for age-appropriate restraint for child passengers. Consideration should also be given for education in child passenger safety for novice teen drivers as part of the licensing process. IMPACT ON INDUSTRY: Results of this study can be used to support advocacy efforts by the automotive industry and others to promote nighttime driving restrictions on novice drivers. In addition, given that both driver groups were more likely to be involved in a single-vehicle collision during the night, technologies such as electronic stability control may offer opportunities for protection. Further reseach on specific circumstances of teen nighttime crashes is needed to inform industry efforts to improve visibility or vehicle operation under poor lighting conditions.     

Effect of age and secondary task engagement on motor vehicle crashes in a naturalistic setting

ProblemAutomobile crashes are one of the leading causes of death in the United States, especially for younger and older drivers. Additionally, distracted driving is another leading factor in the likelihood of crashes. However, there is little understanding about the interaction between age and secondary task engagement and how that impacts crash likelihood and maneuver safety.MethodData from the Naturalistic Driving Study (NDS), which was part of the Second Strategic Highway Research Program (SHRP2), were used to investigate this issue.ResultsIt was found that the distribution of crashes per one million km driven during the NDS was similar to previous research, but with fewer crashes from older drivers. Additionally, it was found that older and middle-aged drivers engaged in distracted driving more frequently than was expected, and that crashes were significantly more likely if drivers of those age groups were engaged in secondary tasks. However, secondary task engagement did not predict judgment of safe/unsafe vehicle maneuvers.Practical ApplicationsMore research is needed to better understand the interaction of age and distraction on crash likelihood. However, this research could aid future researchers in understanding the likelihood of future use of new in-vehicle technologies for different age groups, as well as provide insight to the engagement patterns of distraction for different age groups.