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Biomedical subjects

Brian Fildes

Publications and source records attributed to Brian Fildes.

15 recordsLinked to original sources
PubMed2006

Determining older driver crash responsibility from police and insurance data.

This study aimed to determine the extent to which older drivers can be considered responsible for their crashes, to identify key factors in those crashes for which older drivers have been judged responsible, and to assess the extent to which older drivers' extra crash responsibility contributes to the road toll. Insurance claims from the State of Tasmania, Australia, for 1998-2002 were linked with police records for crashes involving drivers aged either 41-55 years or 65 years or older. Insurance and police data sets contained independent judgments of crash responsibility. There was a high level of agreement between the two sets of judgments, with older drivers judged around 1.5 times more likely to be responsible for their crashes than middle-aged drivers and, conversely, older drivers were around 0.6 as likely to be absolved from crash responsibility. It was concluded that older drivers' additional crash responsibility while valuable in explaining "what went wrong," currently makes only a small contribution to the overall road toll.

Accidents, Traffic↗
PubMed2006

Anxiety, acute- and post-traumatic stress symptoms following involvement in traffic crashes.

Anxiety and traumatic stress symptoms are common post-crash. This study documents generalised anxiety responses post-crash, and examines the association between Acute Stress Disorder and Post-Traumatic Stress Disorder (PTSD) with personality and coping styles. Sixty-two patients aged 18-60 admitted to hospital were interviewed prior to discharge, at 2-months and at 6-8 months post-crash. Anxiety symptoms were common, with 55% of participants experiencing moderate-severe levels prior to discharge, with this decreasing to 11% and 6.5% at 2-months and 6-8 months post-discharge. Females reported significantly higher levels of anxiety and acute distress. Neuroticism and generalised coping styles were associated with acute stress responses but not PTSD. These results have important theoretical and practical implications, and indicate that females are at risk of poorer acute anxiety outcomes following injury.

Accidents, Traffic↗
PubMed2005

Analysis of finite element models for head injury investigation: reconstruction of four real-world impacts.

Previous studies have shown that both excessive linear and rotational accelerations are the cause of head injuries. Although the head injury criterion has been beneficial as an indicator of head injury risk, it only considers linear acceleration, so there is a need to consider both types of motion in future safety standards. Advanced models of the head/brain complex have recently been developed to gain a better understanding of head injury biomechanics. While these models have been verified against laboratory experimental data, there is a lack of suitable real-world data available for validation. Hence, using two computer models of the head/brain, the objective of the current study was to reconstruct four real-world crashes with known head injury outcomes in a full-vehicle crash laboratory, simulate head/brain responses using kinematics obtained during these reconstructions, and to compare the results predicted by the models against the actual injuries sustained by the occupant. Cases where the occupant sustained no head injuries (AIS 0) and head injuries of severity AIS 4, AIS 5, and multiple head injuries were selected. Data collected from a 9-accelerometer skull were input into the Wayne State University Head Injury Model (WSUHIM) and the NHTSA Simulated Injury Monitor (SIMon). The results demonstrated that both models were able to predict varying injury severities consistent with the difference in AIS injury levels in the real-world cases. The WSUHIM predicted a slightly higher injury threshold than the SIMon, probably due to the finer mesh and different software used for the simulations, and could also determine regions of the brain which had been injured. With further validation, finite element models can be used to establish an injury criterion for each type of brain injury in the future.

Journal Article↗
PubMed2005

Perceptual countermeasures to speeding.

An on-road evaluation of two perceptual countermeasure treatments (an enhanced curve post treatment and peripheral transverse edgelines on the approach to an intersection) was conducted over one year to indicate potential for reducing travel speed. Measures included speed and deceleration profiles, braking, and lateral placement observations taken from video recordings at each site. Data were collected before treatment, immediately after treatment, and 12 months after treatment. The results obtained were quite variable across sites and treatments. At curves, speed effects were mixed with both speed reductions and increases observed immediately after and 12-months later. Braking results tended to support travel speed findings and some improvement in lateral placement were also observed at these locations. At intersections, the results were more stable where speed reductions were more common both immediately after treatment as well as longer-term. There were no differences in braking and lateral placement at these straight-road locations. The findings seem to have been unduly influenced to some degree by misadventure and wear and tear at these sites. It is argued that while the effectiveness of these treatments may be site specific to some degree, they do offer a low-cost solution to reducing travel speed at hazardous locations.

Acceleration↗
PubMed2005

The relationship between perceived crash responsibility and post-crash depression.

Recent studies have shown that survivors of road traffic crashes experience significant psychological health difficulties. Perception of another party as being responsible for the occurrence of a crash has been associated with on-going distress and lower psychological well-being. This paper extends this research by examining the influence of perceived crash responsibility on depression severity. A total of 57 adults aged 18-58 years injured in a road traffic crash were interviewed prior to hospital discharge and at 2-months post-crash. The results indicate that perceiving oneself as being responsible for the crash is associated with higher levels of later depression compared to those where responsibility is perceived to be shared, and to a lesser extent compared to those perceiving another party as being responsible. Persistent pain and pre-crash psychological health were found to be strongly associated with later depression severity, while trends indicate that length of stay beyond 7 days in hospital is also an important predictor. These findings are discussed in the context of past research.

Accidents, Traffic↗
PubMed2004

Thoracic aortic injury in motor vehicle crashes: the effect of impact direction, side of body struck, and seat belt use.

BACKGROUND: Using in-depth, real-world motor vehicle crash data from the United States and the United Kingdom, we aimed to assess the incidence and risk factors associated with thoracic aorta injuries. METHODS: De-identified National Automotive Sampling System Crashworthiness Data System (U.S.) and Co-operative Crash Injury Study (U.K.) data formed the basis of this retrospective analysis. Logistic regression was used to assess the level of risk of thoracic aorta injury associated with impact direction, seat belt use and, given the asymmetry of the thoracic cavity, whether being struck toward the left side of the body was associated with increased risk in side-impact crashes. RESULTS: A total of 13,436 U.S. and 3,756 U.K. drivers and front seat passengers were analyzed. The incidence of thoracic aorta injury in the U.S. and U.K. samples was 1.5% (n = 197) and 1.9% (n = 70), respectively. The risk was higher for occupants seated on the side closest to the impact than for occupants involved in frontal impact crashes. This was the case irrespective of whether the force was applied toward the left (belted: relative risk [RR], 4.6; 95% confidence interval [CI], 2.9-7.1; p < 0.001) or the right side (belted: RR, 2.6; 95% CI, 1.4-5.1; p < 0.004) of the occupant's body. For occupants involved in side-impact crashes, there was no difference in the risk of thoracic aorta injury whether the impacting force was applied toward the left or toward the right side of the occupant's body. Seat belt use provided a protective benefit such that the risk of thoracic aorta injury among unbelted occupants was three times higher than among belted occupants (RR, 3.0; 95% CI, 2.2-4.3; p < 0.001); however, the benefit varied across impact direction. Thoracic aorta injuries were found to be associated with high impact severity, and being struck by a sports utility vehicle relative to a passenger vehicle (RR, 1.7; 95% CI, 1.2-2.3; p = 0.001). CONCLUSION: Aortic injuries have been conventionally associated with frontal impacts. However, emergency clinicians should be aware that occupants of side-impact crashes are at greater risk, particularly if the occupant was unbelted and involved in a crash of high impact severity.

Accidents, Traffic↗
PubMed2004

Benefits of Australian Design Rule 69 (full frontal crash protection) and airbags in frontal crashes in Australia.

In-depth data at MUARC was used to evaluate the Australian Design Rule 69 (ADR69) - Full frontal dynamic crash requirement, as well as the effectiveness of frontal airbag deployment on injury risk and associated cost of injury. ADR69 was introduced in Australia in mid-1995 and was based largely on the US equivalent FMVSS-208. The results indicate reductions in excess of 90% in the likelihood of sustaining AIS 2+ injuries in body regions where frontal airbags would be expected to benefit. The average injury cost savings for drivers of post-ADR69 manufactured vehicles was found to be up to AUD19,000 dollars depending on body region considered. Limitations and implications of these findings are discussed.

Abbreviated Injury Scale↗
PubMed2004

A preliminary evaluation of child restraints and anchorage systems for an Australian car.

This study examined the performance of three rear-facing and two forward-facing child restraints (CRS) with three anchorage systems: standard seatbelt, LATCH (flexible) and ISOFIX (rigid). Frontal (64 km/h) and side impact (15 km/h) HyGe sled tests were conducted using a sedan buck. Overall, the preliminary findings suggested superior performance of rigid over seatbelt and flexible anchorages, particularly in side impacts. The results also suggest a need for design improvement for CRS with flexible anchorages to increase stability in side impacts. The findings have important implications for the proposed introduction of changes to Australian Standards for CRS to permit both flexible and rigid systems to coexist with conventional seatbelt anchorage systems.

Accidents, Traffic↗
PubMed2003

A preliminary analysis of aortic injuries in lateral impacts.

Injuries to the aorta are among the more serious injuries that result from vehicle impacts, and often may be fatal. This article examines the incidence of aortic injuries in the United States and United Kingdom by using two international databases of real-world crashes. The main outcome of interest was the level of risk associated with each principal direction of force for drivers and front-seat passengers with respect to sustaining aortic injuries. The results indicate that the risk of sustaining an injury to the aorta is greater for near-side crashes than for far-side crashes. Further it is apparent that, given a near-side crash, the risk of an aortic injury is greater on the left side of the body (and left side of the vehicle) than on the right. It also was found that the delta-V of crashes where occupants sustained an injury to the aorta was considerably higher than crashes where occupants did not sustain aortic injuries. It is speculated that the anatomical asymmetry of the thorax might play a role in the differences seen in injury risk associated with different impact directions. The results presented in this article could be of use to both the emergency physician treating patients involved in motor vehicle collisions as well as the engineer involved in occupant design countermeasures. Limitations and further planned research are discussed.

Abbreviated Injury Scale↗
PubMed2003

Self-regulatory behaviours of older drivers.

This study involved a survey of self-regulatory driving practices of 656 drivers aged 55 years and older. Types and prevalence of self-regulatory behaviours were described and several key characteristics of self-regulators were identified. Those who drove less than 100 kilometres per week were more likely to be female, 75+ years, retired, with arthritis, good/fair/poor ratings for decision-making, not the principal driver and not married. Those who avoided specific driving situations were also more likely to be female, 75+ years and not the principal driver. Avoidance was also associated with vision problems, lower confidence in driving situations and crash-involvement. Implications for promotion of safe driving practices are discussed.

Accidents, Traffic↗
PubMed2003

Benefits of seat belt reminder systems.

This study sought to determine whether fitting a more aggressive seat belt reminder system to new vehicles would be cost-beneficial for Australia. While seat belt wearing rates have been observed around 95% in the front seat, non-wearing rates in casualty crashes are as high as 33% among persons killed and 19% among seriously injured occupants. Benefits were computed for three device options (simple, simple-2 and complex) and three introduction scenarios (driver-only, front seat occupants and all occupants). Four levels of effectiveness were assumed, from 10% to 40%, depending on the type of device fitted. Unit benefits were computed assuming a 5% discount rate and a 15yr fleet life. Various industry experts provided the costs. The findings showed that Benefit-Cost-Ratios ranged from 4.0:1 at best (simple device for the driver only) to 0.9:1 for all seating positions. These figures are conservative, given the assumptions made and the discounted human capital methods used.

Accidents, Traffic↗
PubMed2002

Randomised factorial trial of falls prevention among older people living in their own homes.

OBJECTIVE: To test the effectiveness of, and explore interactions between, three interventions to prevent falls among older people. DESIGN: A randomised controlled trial with a full factorial design. SETTING: Urban community in Melbourne, Australia. PARTICIPANTS: 1090 aged 70 years and over and living at home. Most were Australian born and rated their health as good to excellent; just over half lived alone. INTERVENTIONS: Three interventions (group based exercise, home hazard management, and vision improvement) delivered to eight groups defined by the presence or absence of each intervention. MAIN OUTCOME MEASURE: Time to first fall ascertained by an 18 month falls calendar and analysed with survival analysis techniques. Changes to targeted risk factors were assessed by using measures of quadriceps strength, balance, vision, and number of hazards in the home. RESULTS: The rate ratio for exercise was 0.82 (95% confidence interval 0.70 to 0.97, P=0.02), and a significant effect (P<0.05) was observed for the combinations of interventions that involved exercise. Balance measures improved significantly among the exercise group. Neither home hazard management nor treatment of poor vision showed a significant effect. The strongest effect was observed for all three interventions combined (rate ratio 0.67 (0.51 to 0.88, P=0.004)), producing an estimated 14.0% reduction in the annual fall rate. The number of people needed to be treated to prevent one fall a year ranged from 32 for home hazard management to 7 for all three interventions combined. CONCLUSIONS: Group based exercise was the most potent single intervention tested, and the reduction in falls among this group seems to have been associated with improved balance. Falls were further reduced by the addition of home hazard management or reduced vision management, or both of these. Cost effectiveness is yet to be examined. These findings are most applicable to Australian born adults aged 70-84 years living at home who rate their health as good.

Accidental Falls↗
PubMed2002

Aortic injuries in side impacts: a preliminary analysis.

Injuries to the aorta are among the more serious injuries that result from vehicle impacts, and may often be fatal. This paper examined the incidence of aortic injuries in the US and UK using real-world crash data. The main outcome of interest was the level of risk associated with each principal direction of force for drivers and front seat passengers with respect to sustaining aortic injuries. The results indicate that the risk of sustaining an injury to the aorta is greater for near side crashes than for far side crashes. Further, it is apparent that given a near side crash, the risk of an aortic injury is greater on the left side of the body (and left side of the vehicle) than on the right. It was also found that the delta-V of crashes where occupants sustained an injury to the aorta was considerably higher than crashes where occupants did not sustain aortic injuries. It was speculated that the anatomical asymmetry of the thorax might play a role in the differences seen in injury risk associated with different impact directions. Limitations and further planned research are discussed.

Accidents, Traffic↗
PubMed2002

An overview of requirements for the crash protection of older drivers.

For some time now, it has been recognised that a major shift is occurring in the population age distributions of most motorised countries resulting in a growing number of older persons with an increasing need for mobility. It is expected that the mobility of older persons will become even more reliant on the motor vehicle as European countries in particular undergo transitions towards decentralisation and suburbanisation and because of the well-established longevity factor. As a group, older drivers do not currently represent a major road safety problem in most Western societies when compared with other age groups such as the young. However, they are involved in significantly more serious injury and casualty crashes per head of population. Furthermore, as older drivers are likely to become a more significant problem in the years ahead, it is now necessary to examine some vehicle design factors that affect the safety of the older driver in a crash.

Accidents, Traffic↗