Objective: Characterization of the severity of injury should account for both mortality and disability. The objective of this study was to develop a disability metric for thoracic injuries in motor vehicle crashes (MVCs) and compare the functional outcomes between the pediatric and adult populations.
Methods: Disability risk (DR) was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank for the most frequently occurring Abbreviated Injury Scale (AIS) 2–5 thoracic injuries. Occupants with thoracic injury were classified as disabled or not disabled based on the FIM scale, and comparisons were made between the following age groups: pediatric, adult, middle-aged, and older occupants (ages 7–18, 19–45, 46–65, and 66+, respectively). For each age group, DR was calculated by dividing the number of patients who were disabled and sustained a given injury by the number of patients who sustained a given injury. To account for the effect of higher severity co-injuries, a maximum AIS adjusted DR (DRMAIS) was also calculated for each injury. DR and DRMAIS could range from 0 to 100% disability risk.
Results: The mean DRMAIS for MVC thoracic injuries was 20% for pediatric occupants, 22% for adults, 29% for middle-aged adults, and 43% for older adults. Older adults possessed higher DRMAIS values for diaphragm laceration/rupture, heart laceration, hemo/pneumothorax, lung contusion/laceration, and rib and sternum fracture compared to the other age groups. The pediatric population possessed a higher DRMAIS value for flail chest compared to the other age groups.
Conclusion: Older adults had significantly greater overall disability than each of the other age groups for thoracic injuries. The developed disability metrics are important in quantifying the significant burden of injuries and loss of quality life years. Such metrics can be used to better characterize severity of injury and further the understanding of age-related differences in injury outcomes, which can influence future age-specific modifications to AIS. 相似文献
AbstractObjective: The objective of this study was to examine the medical conditions of 2 commercial drivers and the effects of physical barriers to occupant egress in a crash involving a tractor trailer and a motorcoach in order to assess and identify the factors that caused the crash and had a significant effect on occupant extrication.Methods: Physical evidence from the scene, video evidence, commercial driver information, phone records, toxicology findings, autopsy results, and personal medical information were reviewed.Results: On October 23, 2016, at 5:16 a.m., a motorcoach carrying a driver and 42 passengers struck the rear of a stopped semitrailer occupied by its driver in the center-right lane of Interstate 10 at highway speed outside Palm Springs, California. The motorcoach driver and 12 passengers died; 11 passengers were seriously injured.All traffic had been stopped on I-10 early that morning to allow electrical lines to be strung over the highway. Security camera footage showed that the truck arrived at the end of a traffic queue 2?min before traffic flow resumed. Physical evidence indicated that the truck’s parking brake was still engaged at the time of the collision about 2?min later. The truck driver had a body mass index (BMI) between 45.6 and 50?kg/m2, which placed him at very high risk of moderate to severe obstructive sleep apnea; he also inaccurately recalled that he had been stopped for 20–25?min and had placed the vehicle in gear just before the collision.The motorcoach driver was on the return leg of an overnight trip to a casino. Based on his phone records, known driving time, and security camera footage, at the time of the collision he had had 4?h of sleep opportunity in the preceding 35?h. There was no evidence that the motorcoach driver attempted any evasive action before the collision. In addition, postmortem testing revealed a hemoglobin A1C of 11.4%, indicating poorly controlled diabetes; this was apparently undiagnosed prior to the crash.The motorcoach was equipped with a single loading door at the front of the vehicle; it was rendered inoperable by the collision. Emergency egress was initially carried out through the emergency exit windows, but they repeatedly swung shut, impeding passengers’ efforts to exit. Emergency responders eventually cut open the bus wall to create a larger means of egress. Overall, it took almost 3?h to extricate the occupants from the vehicle.Conclusions: The National Transportation Safety Board (NTSB) determined that the probable cause of the accident was the truck driver’s falling asleep, most likely due to undiagnosed moderate-to-severe obstructive sleep apnea, and the motorcoach driver’s failure to identify the stopped truck as a hazard requiring evasive action, most likely as the result of fatigue. Additional easy-to-use emergency exits would have decreased the time to extricate the occupants. 相似文献
This study presents a numerical model to analyze the sudden failure of compressed natural gas (CNG) cylinder onboard a CNG vehicle. The model is developed using COMSOL. It accounts for the real gas effects, physical energy, and combustion of the flammable gas. The model is tested using experimental data.The study highlight compression energy as one of the serious concern. An unintentional rupture of a compressed cylinder filled with natural gas would generate a rapid energy release in the form of the pressure energy (blast). The release of energy and gas would cause rapid mixing and generate overpressure and may also cause flash fire. A detailed failure frequency analysis is also done to analyze the effectiveness of barriers. This study identifies critical points for the safe operation of the CNG system onboard a vehicle. 相似文献
In 2006 Texas raised the daytime speed limit for passenger vehicles on segments of I-10 and I-20 from 75 to 80 mph. Methods: Traffic speeds were measured before and 3, 12, and 16 months after the limit was changed. Results: During the 16-month period following the speed limit increase, mean speeds of passenger vehicles on I-20 increased by 9 mph relative to the comparison road, where no speed limit change occurred and traffic speeds declined. On I-10 mean speeds increased by 4 mph relative to the comparison road. Limiting the analysis to the month before the speed limit change and 1 year later, the proportion of drivers exceeding 80 mph was 18 times higher on I-20 and 2 times higher on I-10. Discussion: The smaller speed increases on I-10 may be related to its proximity to the U.S. border with Mexico. Highly visible border patrol activity coincided with posting of the higher speed limit. Long-term monitoring in other states suggests that traffic speeds in Texas are likely to continue to increase. Impact on Industry: The present study adds to the wealth of evidence that increased speed limits lead to increased travel speeds. The primary countermeasures to reduce the risk of speed-related crashes include highly visible police traffic enforcement and the use of speed cameras accompanied by publicity. 相似文献
Studies have shown that older drivers have high death rates and lower rates of involvement in crashes that kill others; but most studies have not considered drivers' responsibility for their crashes, and many have considered only one particular measure of risk.
Method
This study examines risks that drivers of various ages pose to themselves and to others on per-driver, per-trip, and per-mile bases, taking responsibility for crashes into account, using United States fatal crash data from 1999 through 2003 and travel estimates from 2001.
Results
Relative to other age groups, drivers aged 85 and older face the highest risk of their own death, whereas teens pose the greatest risk to passengers, occupants of other vehicles, and non-motorists.
Discussion
The oldest drivers pose more risk to other road users than middle-aged drivers do; the degree of their excess risk depends strongly upon how risk is measured.
Impact on industry
These results demonstrate the importance of keeping clear the meaning and implications of various risk measures. 相似文献