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PubMed1999

Unsafe motor vehicle practices among substance-using college students.

This study examines the relationship between substance use and behaviors that increase the risk for motor vehicle crashes and crash-related injuries. The investigation uses National College Health Risk Behavior Survey data collected in 1995 by the Centers for Disease Control and Prevention. These data are representative of 2- and 4-year undergraduate college students in private and public colleges and universities in the United States. Smokers, episodic heavy drinkers, marijuana users and users of illegal drugs in combination with alcohol were significantly more likely to drive after drinking alcohol and ride with a driver who had been drinking alcohol and significantly less likely to wear safety belts while driving or while riding in a car as a passenger. This study indicates that college students who are substance users are more likely to behave in a manner which increases their risk for motor vehicle crashes and motor vehicle crash injuries.

Adolescent↗
PubMed2004

Extensive brain injury in a premature infant following a relatively minor maternal motor vehicle accident with airbag deployment.

Traumatic injury following a motor vehicle accident during pregnancy has an enormous potential for fetal injury and demise. With the advent of seat belts, shoulder restraints and airbags, and improved maternal survival, the most common cause of fetal loss is placental injury. However, the safety of airbag deployment during pregnancy and in particular during the latter stages, and the potential for fetal trauma remains unclear. We report a case of extensive neurological injury of a premature infant with minimal maternal trauma associated with deployment of an airbag following a minor motor vehicle accident.

Accidents, Traffic↗
PubMedDate not supplied

Fatal motor vehicle traffic accidents among Native Americans.

An atypical number of motor vehicle-related deaths has been observed among Native American populations. Little is known about why Native groups exhibit increased mortality from this cause. To better understand factors influencing these occurrences, I examined fatal motor vehicle traffic accidents between 1980 and 1986 involving persons of Native American descent in New York State, exclusive of New York City. Data were obtained from a review of death certificates and coroner reports. Fatal motor vehicle collisions among Native Americans generally occurred among men (74%), in rural areas (55%), between 9:00 p.m. and 3:00 a.m. (62%), and during weekends (78%). A sizable percentage of motor vehicle deaths resulted from collisions with pedestrians (28%). Death frequently occurred before the accident victim reached a hospital (74%). Median age at death for male victims was eight years greater than for female victims. These data suggest the need for immediate efforts focusing on primary prevention to minimize risk-taking behaviors likely to result in motor vehicle accidents. I discuss behavioral and environmental factors influencing these observations.

Accidents, Traffic↗
PubMed1991

Wheelchair occupant restraints in motor vehicles.

The issue of safety for wheelchair users in motor vehicles has been raised in Australia by parents of young people with disabilities. Investigations revealed that wheelchair users were not covered by any legislated safety requirements, and each case received special dispensation from compliance with regulations covering the able-bodies population. Dynamic testing of restraint systems at the University of Michigan had revealed that existing systems were unsafe. Dynamic tests confirmed those findings on systems used at that time in Australia. Testing led to the design, development and marketing of a new wheelchair occupant and restraint system which remains a system of choice for use by organisations where the same people use the same buses in the same position each day. Australian Standard 2942-1987, Wheelchair Occupant Restraint Assemblies for Use in Motor Vehicles, has since been developed. It establishes design and performance requirements for these restraints and includes details of dynamic testing procedures. This paper describes the development of the above restraint system and the subsequent Australian Standard.

Restraint, Physical↗
PubMed1997

Photograph documentation of motor vehicle damage by EMTs at the scene: a prospective multicenter study in the United States.

The purpose of this study was to determine if emergency medical service (EMS) personnel could take instant photographs of motor vehicle damage at crash scenes depicting the area and severity of damage of the crash under adverse weather conditions, in different lighting, and quickly enough so as not to interfere with patient care. This prospective multicenter trial involved 35 ambulances responding to motor vehicle crash scenes in rural, suburban, and urban areas in five centers in four states. Emergency medical technicians (EMTs) reported their experience implementing a protocol for use of an instant camera to photograph vehicle damage at crash scenes. Time reported by EMTs to take the photographs was 1 minute or less in 204 of 288 (70.9%) of motor vehicle crashes and 2 minutes or longer in 12 of 288 (4.2%) of motor vehicle crashes. From one EMS agency in the study, 48 scene times during which photographs were taken were, on average, 1.5 minutes shorter than 48 scene times immediately before implementation of on-scene crash photography. Photographs were taken in different weather and lighting conditions. EMTs reported they were able to determine both area and severity of damage in 260 of 290 (92.5%) crash photographs, but they were unable to determine area and severity of damage in only 2 of 290 (0.7%) crash photographs.

Accidents, Traffic↗
PubMed1997

Benzodiazepine use and the risk of motor vehicle crash in the elderly.

CONTEXT: Benzodiazepines, used by a sizable number of the elderly population, may affect the ability to drive and thus increase the risk of a motor vehicle crash. Epidemiologic studies of this question have produced inconsistent results that may be due to the different effects of long- and short-half-life benzodiazepines and variations in their duration of use. OBJECTIVE: To determine whether the use of benzodiazepines of either long- or short-elimination half-life is associated with the risk of injurious motor vehicle crash in the elderly. DESIGN AND SETTING: Nested case-control design within a cohort of 224,734 drivers from the Canadian province of Quebec, aged 67 to 84 years, followed up from 1990 to 1993. Computerized data for the study were obtained from provincial driver's license files, police reports of injurious crashes, and health insurance records. PATIENTS: We identified all 5579 drivers involved in an injurious crash (cases) and a random sample of 10 controls per case selected from a subcohort of 13,256 subjects. MAIN OUTCOME: Involvement of a cohort member as a driver in a motor vehicle crash in which at least 1 person (not necessarily the driver) sustained bodily injury. RESULTS: The adjusted rate ratio of crash involvement within the first week of long-half-life benzodiazepine use was 1.45 (95% confidence interval [CI], 1.04-2.03). The rate ratio for continuous use of longer duration up to 1 year was slightly lower but remained significant (rate ratio, 1.26; 95% CI, 1.09-1.45). In contrast, there was no increased risk after the initiation of treatment with short-half-life benzodiazepines (rate ratio, 1.04; 95% CI, 0.81-1.34) or with their continued use (rate ratio, 0.91; 95% CI, 0.82-1.01). CONCLUSIONS: Brief or extended periods of exposure to long-half-life benzodiazepines are associated with an increased risk of motor vehicle crash involvement in the elderly population. There is no such elevated risk for short-half-life benzodiazepines.

Accidents, Traffic↗
PubMed2001

Gender differences in posttraumatic stress disorder after motor vehicle accidents.

OBJECTIVE: Women have higher rates of posttraumatic stress disorder (PTSD) than men. The authors examined prior trauma, PTSD, major depression, anxiety disorder not including PTSD, and peritraumatic dissociation; current peritraumatic dissociation; and passenger injury as possible explanations for the different rates of acute PTSD in women and men after a serious motor vehicle accident. METHOD: Subjects age 18-65 years who had been in a serious motor vehicle accident (N=122) were assessed with the Structured Clinical Interview for DSM-III-R and the Peritraumatic Dissociative Experiences Questionnaire-Rater Version 1 month after the accident. RESULTS: Women did not differ from men in meeting the overall reexperiencing criterion for a diagnosis of PTSD (criterion B), but women were at greater risk for the specific reexperiencing symptoms of intense feelings of distress in situations similar to the motor vehicle accident and physical reactivity to memories of the motor vehicle accident. Women were 4.7 times more likely than men to meet the overall avoidance/numbing criterion (criterion C) and 3.8 times more likely to meet the overall arousal criterion (criterion D). Women were more likely than men to report the criterion C symptoms of avoiding thoughts and situations associated with the accident, loss of interest in significant activities, and a sense of foreshortened future and the criterion D symptoms of trouble sleeping, difficulty concentrating, and exaggerated startle response. Multiple logistic regression analysis indicated that the gender differences in acute PTSD were not associated with prior trauma, PTSD, peritraumatic dissociation, major depression, or anxiety disorder not including PTSD or with passenger injury. However, peritraumatic dissociative symptoms at the time of the accident were associated with a significantly higher risk for acute PTSD in women than in men. CONCLUSIONS: Gender differences in peritraumatic dissociation may help explain differences in risk for PTSD and for some PTSD symptoms in women and men.

Accidents, Traffic↗
PubMedDate not supplied

[Motor vehicle crash fatalities at 30 days in Spain].

OBJECTIVES: To assess level of fulfillment and utility of the hospital discharge register (HDR) as a complementary source of information for estimating the number of deaths at 30 days due to motor vehicle crashes in Spain. METHODS: It is a cross-sectional study were we compared the number of people injured due to motor vehicle crashes hospitalised in a public hospital (HDR), in Spain during 2001, with the number of people severely injured or killed due to motor vehicle crashes reported by the police database (Dirección General de Tráfico, DGT) for the same year. A descriptive analysis was carried out by age, sex and region (Autonomous Community), as well as an estimation of the percentage of under-reporting of deaths by the DGT based on two assumptions. RESULTS: Police reported 27,272 severe injuries and 4,811 deaths during first 24 hours after the crash and after applying a fatality adjustment factor estimated 706 more deaths up to 30 days after the crash. The HDR reported 40,174 urgent hospitalisations. Of these, 1,099 died during the day of hospitalisation or within the following 30 days. The police only notified 68% of all cases that required hospitalisation. According to the number of deaths reported by police and contrasted with hospital register, estimations of the number of deaths at 30 days made by police could represent a level of under-reporting of between 3% and 6.6%, depending on the assumption considered. CONCLUSIONS: This study showed that the HDR is an information source that complements police statistics and is useful to estimate the number of deaths and non-fatal injuries due to motor vehicle crashes in Spain.

Accidents, Traffic↗
PubMed1995

[Development of an exposure index of air pollution caused by motor vehicles for use in epidemiological studies].

Air pollution due to motor vehicles is a worrying issue, in particular in the urban environment, all the more as a number of pollutants such as benzene and PAH are known to have carcinogenic effects. Epidemiological studies seem to be required, so a cumulated score of exposure must be developed. A correlation with pathology should be investigated. The calculation of an index of exposure to motor vehicle-related pollution requires a good assessment of pollutant emissions and a precise knowledge of pollutant transfer mechanisms by advection and spreading in built-up areas. In this study, it is proposed to use current theoretical and experimental knowledge to develop a calculation algorithm for this index. The following issues will be addressed in the presentation: an analysis of epidemiological requirements and of constraints of data acquisition using questionnaire surveys; a model for assessing, for each residential area, the average annual concentration of gaseous pollutants from motor vehicles. It will consider the environment geometry, traffic emissions and wind distributions. The model CALINE3 is used for open areas near roads and highways and the Danish model OSPM is introduced for street canyon environments.

Air Pollutants↗
PubMed1998

Patterns of injury in belted and unbelted individuals presenting to a trauma center after motor vehicle crash: seat belt syndrome revisited.

STUDY OBJECTIVE: Investigators have described a "seat belt syndrome" consisting variously of injuries to the lumbar or cervical spine, abdominal contents, or all 3. In this study we sought to identify these and any other patterns of injury associated with seat belt use in patients who presented to a trauma center after a motor vehicle crash. METHODS: The charts of all patients involved in motor vehicle crashes who presented as trauma alerts to the study institution between January 1, 1991, and December 31, 1993, were retrospectively reviewed for data regarding belt use and 35 specific injuries in 7 body regions. We calculated the positive likelihood ratio of injury between belted and unbelted patients, along with 95% confidence intervals. RESULTS: We identified 1,124 patients involved in motor vehicle crashes. Of these subjects, 376 were belted and 544 unbelted; in 204 belt status was unknown. Belted patients were more likely to have sustained sternal fracture than were unbelted patients (4% versus .7%; positive likelihood ratio, 1.97; 95% confidence interval, 1.09 to 3.29) but were less likely to have sustained head injury (30.6% versus 46.0%; positive likelihood ratio, .67; 95% confidence interval, .53 to .83). We noted no statistically significant differences in the rates of other specific injuries, including cervical and lumbar fractures and the need for abdominal surgery. CONCLUSION: Severe injuries of all types occur in both belted and unbelted individuals involved in motor vehicle crashes who present to a typical trauma center. With the exception of sternal fractures, injuries previously associated with the seat belt syndrome occurred in similar proportions of belted and unbelted patients. Head injuries were less frequent. Seat belt use cannot serve as a discriminator for specific injury. A diligent search of all body regions is indicated in both belted and unbelted patients.

Abdominal Injuries↗
PubMed1999

Systematic reviews of strategies to prevent motor vehicle injuries.

BACKGROUND: Information on which strategies have been shown to be effective, which are ineffective, and which strategies have been inadequately evaluated is important for both public policy and future research. OBJECTIVE: To provide systematic reviews of the literature on important strategies to prevent motor vehicle injuries. METHODS: The Injury Control Research Centers (ICRCs) funded by the Centers for Disease Control and Prevention identified 9 important motor vehicle injury prevention strategies. A systematic review of the literature in 9 different computerized databases was conducted to identify relevant controlled trials. These were critically reviewed and summarized. RESULTS: A total of 54,078 citations were reviewed; 1,111 met initial screening criteria. The reports for these citations were obtained and critically reviewed by the ICRCs. Standard criteria for inclusion of articles in the review and for evaluating the methodological quality of the articles were applied. Few randomized controlled trials were found; most controlled studies were either comparisons over time and/or across different populations. Nevertheless, these studies were able to be summarized to provide meaningful conclusions about the effectiveness of various interventions to decrease morbidity and mortality from motor vehicle crashes. CONCLUSIONS: A large body of literature on motor vehicle injury interventions exists. The summary of this literature will provide useful information to direct policy and future research efforts.

Accidents, Traffic↗
PubMed2005

Motor vehicle mismatch-related spinal injury.

BACKGROUND/OBJECTIVE: Motor vehicle collision (MVC)-related spinal cord injury (SCI) is the most prevalent etiology of SCI. Few studies have defined SCI risk factors. Vehicle mismatch occurs in 2-vehicle MVCs in which there are significant differences in vehicle weight, stiffness, and height. This study examined SCI risk and vehicle mismatch. METHODS: A matched case-control study using the 1995 to 2003 National Automotive Sampling System (NASS). Study subjects were identified from 2-vehicle MVCs. Cases were occupants who had suffered a cervical, thoracic, or lumbar SCI. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. RESULTS: There were 101,682 cases of SCI matched to 805,091 controls. Occupants of passenger vehicles involved in MVCs with a light truck or van (LTV) were at increased risk for SCI (OR = 1.87, 95% CI = 1.07-3.24) and this risk was greatest for thoracic SCI (OR = 5.09, 95% CI = 2.33-11.13). In addition, occupants of LTVs involved in MVCs with passenger vehicles were at significant increased risk for cervical (OR = 1.39) and lumbar (OR = 2.65) SCI; and occupants of LTVs involved in MVCs with other LTVs were at increased risk of any SCI (OR = 2.02, 95% CI = 1.52-2.69). For these subjects, significant increased risks were seen for all spine regions: cervical (OR = 1.41), thoracic (OR = 2.86), and lumbar (OR = 2.38). CONCLUSIONS: The results of this study suggest that occupants of passenger vehicles are at increased SCI risk when involved in 2-vehicle MVCs with LTVs; and that occupants of LTVs are at increased SCI risk, regardless.

Adult↗
PubMed2000

The influence of airbag and restraining devices on the patterns of facial trauma in motor vehicle collisions.

According to the National Highway Traffic Safety Administration (1990), there were more than 3 million motor vehicle collisions severe enough to lead to significant injury or fatality. Airbags may prevent brain and facial injury caused by these accidents. To date, however, no study has focused primarily on the correlation between facial injuries and the use of airbags and restraining devices. A retrospective analysis was performed on motor vehicle collision data submitted to the Pennsylvania Trauma Outcome Study database from 1990 through 1995. Criteria for submission to the database included admission to the intensive care unit, death during hospitalization, hospitalization for >72 hours, or transfer to or from the receiving hospital. There were 15,450 patients who sustained facial trauma (identified by ICD-9 codes) and were analyzed for patterns of injury and the presence or absence of protective devices. Protective devices were categorized into four groups: airbag alone, airbag with seatbelt, seatbelt or car seat without airbag, and no restraining devices. Statistical analysis was performed using chi-squared test of association. For contingency tables with small expected frequencies, Fisher's exact test was used. There were 9408 male and 6042 female subjects, with a mean age of 38 years (range, 3 to 98 years). There were 11,672 drivers and 3778 passengers. Airbags were deployed in 429 instances. In 276 of these cases, additional restraint was provided with a seatbelt. Airbags were not deployed in 4866 cases when a seatbelt or a car seat was used. In 10,155 cases, no restraining device was employed. There was significantly more facial trauma in patients without protective devices (p < 0.001). Drivers sustained significantly fewer facial fractures when airbags were used, either alone or in combination with a seatbelt (p < 0.001); however, there was no difference in the number of facial lacerations. Among passengers, airbags provided protection from lacerations (p < 0.001) but had no impact on the incidence of facial fractures. In collisions in which airbags were deployed, the use of a seatbelt provided no additional protection from facial fractures or lacerations. In summary, the use of any protective device decreased the incidence of facial fractures and lacerations sustained in motor vehicle collisions (p < 0.001). Airbags provided the best protection of all currently available devices.

Accidents, Traffic↗
PubMed2000

Effect of seating position and restraint use on injuries to children in motor vehicle crashes.

OBJECTIVE: To determine the effect of restraint use and seating position on injuries to children in motor vehicle crashes, with stratification by area of impact. METHODS: Children <15 years old involved in serious automobile crashes in Utah from 1992 through 1996 were identified from statewide motor vehicle crash records. Serious crashes are defined as those resulting in occupant injuries with broken bones or significant bleeding or property damage exceeding $750. Probabilistic methods were used to link these records with hospital records. Analysis used logistic regression controlling for age, restraint use, occupant seating position, and type of crash. RESULTS: We studied 5751 children and found 53% were rear seat passengers. More than 40% were unrestrained. Sitting in the rear seat offered a significant protective effect (adjusted odds ratio: 1.7; 95% confidence interval: 1.6-2.0), and restraint use enhanced this effect (adjusted odds ratio: 2.7; 95% confidence interval: 2.4-3.1). Mean hospital charges were significantly greater for front seat passengers. CONCLUSIONS: Rear seat position during a motor vehicle crash provides a significant protective effect, restraint use furthers this effect, and usage rates of restraint devices are low. The rear seat protective effect is in addition to and independent of the protection offered from restraints.

Accidents, Traffic↗
PubMedDate not supplied

Booster seat or seat belt? Motor vehicle injuries and child restraint laws in preschool and early school-age children.

ISSUES AND PURPOSE: Despite numerous interventions to reduce motor vehicle injuries and deaths in children living in the United States, unintentional motor vehicle injuries continue to be the leading cause of death of U.S. children. CONCLUSION: Even though child restraint laws have been enacted, many children 5 to 9 years of age continue to be injured in motor vehicle crashes. These injuries are related to the improper use of child restraints. Reasons for injuries in this age group were explored by a review of the current literature. PRACTICE IMPLICATIONS: Nurses have a unique role in educating families about proper restraint and in contributing to the evidence base for practice.

Accidents, Traffic↗
PubMed2006

Alcohol and other drug use among victims of motor-vehicle crashes--West Virginia, 2004-2005.

Alcohol use is a well-established risk factor for motor-vehicle crashes. In 2005, approximately 39% of all traffic fatalities in the United States were alcohol related. Evidence of driver impairment from use of drugs other than alcohol is less definitive. In 2005, an estimated 4.3% of persons in the United States reported driving under the influence of a drug used recreationally during the preceding year, and an unknown percentage drove while impaired by drugs being used for medical reasons. To measure the prevalence of alcohol and drug use among persons killed in motor-vehicle crashes in West Virginia (where test results were available for >80% of fatalities), CDC analyzed 2004 and 2005 data reported by the West Virginia Office of the Chief Medical Examiner (OCME) to the Fatality Analysis Reporting System (FARS) of the National Highway Traffic Safety Administration (NHTSA). This report summarizes the results of that analysis, which determined that the prevalence of drug use (25.8%) was similar to the prevalence of a blood alcohol concentration (BAC) >0.08 g/dL (27.7%) among persons killed in motor-vehicle crashes. These results suggest that drug use contributes substantially to driver impairment in West Virginia. Measuring the magnitude of this problem nationally will require better surveillance data. Both surveillance and the development of prevention measures are hampered by difficulties in quantifying and defining drug impairment.

Accidents, Traffic↗
PubMed2000

Neck injuries caused by being run over by a motor vehicle.

We report a homicide involving the use of a motor vehicle and simulating a traffic accident. This observation was the reason for a retrospective analysis of neck injuries in victims of traffic accidents, in which a person has been run over (RO) by a motor vehicle. The autopsy material of two institutes from 1990-1996 was used. The following findings were obtained in 63 victims: laryngohyoid fractures (LH-fx): 10 cases (16%) with a clear difference between the institutes (22% versus 7%). This resulted from examination with special regard to such injuries in many cases at one of the institutes, whereas only autopsy reports were taken retrospectively from the other institute. Five of these cases had suffered only minor LH-fx (as seen frequently in strangulation), although extensive run over (RO) injuries of the other cervical tissues were present. All LH-fx were caused by direct compression of the neck; in eight of the cases they were combined with mandibular fractures. Petechial hemorrhages (petH) at the eye lids/conjunctivae were seen in 19 cases (30%); 16 of these were related to thorax RO injuries, three to abdominal RO only. Four cases involved LH-fx, petH as well as cervical skin lesions and additional cervical soft tissue hemorrhages. Interpretation can be extremely difficult with this combination of findings if the character of the event cannot be established as accidental beyond doubt on the basis of the circumstances.

Accidents, Traffic↗
PubMed2001

The influence of prehospital trauma care on motor vehicle crash mortality.

BACKGROUND: This study evaluated the impact of the prehospital trauma care system on the mortality from motor vehicle crashes and on the temporal distribution between the crash and related death. METHODS: Autopsies performed by the Forensic Medical Institute on all deaths caused by motor vehicle crashes 1 year before and 1 year after the beginning of the prehospital trauma care system were evaluated. RESULTS: In the first period, 128 deaths occurred, 53.9% of them in the first hour after the crash, 36.7% between the first hour and the seventh day, and 9.4% after 1 week. In the second period, 115 deaths occurred, 40.8% of them in the first hour, 52.2% between the first hour and the seventh day, and 7% after 1 week. Central nervous system injury was the most frequent cause of death in both periods. Mortality was greatest among young people as well as male victims in both periods. CONCLUSION: After starting the prehospital trauma care system in our city, there was a decrease in the deaths occurring before hospital admission, a change in temporal distribution of deaths, and a reduction in the motor vehicle crash mortality rate.

Accidents, Traffic↗