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PubMed2006

Risk factors associated with pelvic fractures sustained in motor vehicle collisions involving newer vehicles.

BACKGROUND: Despite advances in automotive safety, pelvic fractures caused by motor vehicle collisions remain a significant cause of mortality, morbidity, and functional disability. This study was designed to evaluate epidemiologic and biomechanic risk factors associated with pelvic fractures resulting from motor vehicle collisions. We utilized the Crash Injury Research Engineering Network (CIREN) database to identify these risk factors in newer vehicles. METHODS: Data were prospectively collected at the ten CIREN centers from 1996 to 2005. Specific data were then abstracted on all patients, biomechanic crash characteristics, and injuries sustained. Patients involved in a frontal or near-side lateral impact with pelvic fractures were compared with those without. Univariate analysis was performed using a chi2 analysis. Logistic regression was used to identify significant risk factors in a multivariate analysis to control for confounding associations. RESULTS: Of the 1,851 patients studied, 511 (27.6%) had a pelvic fracture. The overall mortality was 17%. Injury specific factors associated with pelvic fracture were higher Injury Severity Score (ISS) and fatality of the patient. Biomechanic factors associated with the risk of pelvic fracture included; no airbag deployment (p < 0.001), smaller vehicle (p = 0.05), and lateral deformation location (p < 0.001). When stratified by vehicle deformation location, logistic regression models revealed statically significant variables in a frontal impact which included; higher body mass index, higher ISS, large patient vehicle, no seatbelt use, and higher deltaV. For near-side lateral impacts, multivariate analysis revealed statistically significant variables of lower body mass index, higher ISS, female sex, small vehicle size, and higher deltaV. CONCLUSIONS: Even in newer vehicles with federally mandated safety features, pelvic fractures remain a common injury. Pelvic fractures may serve as a marker of crash severity and specific crash characteristics are associated with pelvic fractures. Lateral crashes are significantly more likely to result in a pelvic fracture and, therefore, prevention of pelvic fractures should focus on improving occupant safety in near-side lateral impacts. Recognition of other associations should lead researchers to further investigate causative factors that will ultimately result in improved vehicle design.

Accidents, Traffic↗
PubMed1989

Motor vehicles as a site of accidental poisonings.

Although most poisonings occur within the home, the toxic agents involved are customarily transported there by motor vehicles. Over a 9-month period, all potentially toxic exposures reported to a poison information center that occurred in a motor vehicle were collected. Common toxins were identified and associated incidence and risk were assessed; 68% were pediatric exposures and the remainder were in adults. The adult exposures were dermal and via inhalation, whereas the pediatric exposures were predominantly inhalation (44%) and ingestion (36%). Inhalant toxins included carbon monoxide (CO) (13%), fire extinguishers (48%), and hydrocarbons (17%). Ingested toxins were comprised of medications (36%), automotive products (14%), and cosmetics (14%). 26% of the exposures were treated in Emergency Departments and the remainder at home. 79% of the patients were asymptomatic or had only a mild outcome; 21% suffered moderate toxicity. Toxic exposures in motor vehicles pose a significant threat to both driver and occupants. Children are at high risk from products improperly stored in the car (shopping bags, purses, glove compartment) and resulting from the care giver's inattention while driving. These results can be used to promote community awareness of this problem.

Accidents↗
PubMed1997

Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults.

Studies have consistently shown that sleep apnea patients have high accident rates, but the generalizability of the association beyond clinic populations has been questioned. The goal of this investigation was to determine if unrecognized sleep-disordered breathing in the general population, ranging from mild to severe, is associated with motor vehicle accidents. The sample comprised 913 employed adults enrolled in an ongoing study of the natural history of sleep-disordered breathing. Sleep-disordered breathing status was determined by overnight in-laboratory polysomnography and motor vehicle accident (MVA) history was obtained from a statewide data base of all traffic violations and accidents from 1988 to 1993. Men with five or more apneas and hypopneas per hour of sleep [apnea-plus-hypopnea index (AHI) > 5], compared to those without sleep-disordered breathing, were significantly more likely to have at least one accident in 5 years (adjusted odds ratio = 3.4 for habitual snorers, 4.2 for AHI 5-15, and 3.4 for AHI > 15). Men and women combined with AHI > 15 (vs. no sleep-disordered breathing) were significantly more likely to have multiple accidents in 5 years (odds ratio = 7.3). These results, free of clinic selection bias, indicate that unrecognized sleep-disordered breathing in the general population is linked to motor vehicle accident occurrence. If the association is causal, unrecognized sleep-disordered breathing may account for a significant proportion of motor vehicle accidents.

Accidents, Traffic↗
PubMed2006

Influence of a new province-wide trauma system on motor vehicle trauma care and mortality.

BACKGROUND: Mature trauma systems have evolved to respond to high rates of major injury morbidity and mortality. Characterized by prehospital care, triage, transportation, aggressive resuscitation, surgery, and rehabilitation, trauma systems have been found to improve survival for seriously injured patients. In Nova Scotia, a province-wide trauma system was implemented between 1995 and 1998. This study investigated the influence of the province-wide trauma system on motor vehicle trauma care and mortality in its first 2 years of existence. METHODS: Subjects over the age of 15 years were identified using E-codes pertaining to motor vehicle traffic crashes from population-based hospital claims and vital statistics data. Individuals who were hospitalized or died because of a motor vehicle crash in 1993 through 1994, before trauma system implementation, were compared with those who were hospitalized or died in 1999 through 2000, after the trauma system was implemented. RESULTS: In the 2-year period after trauma system implementation, there was a 21% increase in the number of seriously injured individuals with a primary admission to tertiary care. This increase was both clinically and statistically significant even after adjustment for age, gender, multiple injuries, head injury, municipality of residence, and vital status at discharge (RR, 1.21, 95% CI, 1.05-1.35). There was no evidence that the probability of dying while in hospital significantly changed in the first 2 years after trauma system implementation. INTERPRETATION: These results indicate that individuals seriously injured in motor vehicle crashes in Nova Scotia are more likely to be admitted to tertiary care in the postimplementation period.

Accidents, Traffic↗
PubMed1986

Child restraint law effects on motor vehicle accident fatalities and injuries: the New Mexico experience.

The New Mexico State Legislature passed a child restraint law applicable to children less than 5 years of age that became effective in June 1983. To evaluate the effectiveness of this law, we analyzed traffic accident data for New Mexico from January 1981 through September 1984. During this period, there were 20,972 children younger than 5 years of age in motor vehicle accidents. Restraint usage increased for this age group from a low of about 10% in 1981 to more than 40% in 1984 (P less than 10(-6)). Unrestrained children younger than 5 years of age were five times more likely to be killed and two times more likely to be injured than restrained children. Analysis of motor vehicle accident fatality and injury rates pre- and post-law revealed a 33% reduction in motor vehicle accident fatality rates and a 12.6% reduction in nonfatal injury rates for children younger than 5 years. We conclude that child restraint devices are effective in reducing motor vehicle accident fatalities and injuries in young children and the child restraint law has been effective in increasing child restraint usage and in reducing childhood death and injury in New Mexico.

Accidents, Traffic↗
PubMed2004

Disability among adults injured in motor-vehicle crashes in the United States.

INTRODUCTION: Little population-based information exists about the long-term effects of motor-vehicle crash-related injuries. METHOD: We analyzed data from the 1995 National Health Interview Survey Disability (NHIS-D) Supplement to estimate the prevalence of crash-related disability among noninstitutionalized U.S. adults aged 18 years and older. RESULTS: More than 1.2 million adults were living in their homes with the disabling effects of motor-vehicle crash-related injuries in 1995. The prevalence of crash-related disability was highest for persons in their mid-life years, ages 35-64. Half of the respondents had sustained the injuries more than 5 years before the interview. Forty-one percent of working-aged individuals reported being unable to work because of their disability. CONCLUSIONS: Because crash-related disability is most prevalent during the mid-life years, quality of life and productivity may be affected for decades. These findings highlight the personal and societal burden associated with motor-vehicle crash-related disability in the United States.

Accidents, Traffic↗
PubMed2001

The effect of state regulations on motor vehicle fatalities for younger and older drivers: a review and analysis.

Policymakers have had a long-standing interest in improving the motor vehicle safety of both younger and older drivers. Although younger and older drivers share the distinction of having more crashes and fatalities per mile driven than other age groups, the problems posed by these two groups stem from different origins and manifest in different ways. A number of state-level policies and regulations may affect the number of motor vehicle crashes and fatalities in these two high-risk groups. A critical review of the existing literature in regard to the risk factors and the effects of various policy measures on motor vehicle crashes in these two high-risk populations provides direction for policymakers and high-priority areas of interest for the research community.

Accidents, Traffic↗
PubMed2002

Epidemiology of accidents among users of two-wheeled motor vehicles. A surveillance study in two Italian cities.

BACKGROUND: This paper describes a study on the epidemiology of accidents among users of two-wheeled motor vehicles in two Italian cities, Rome and Naples. METHODS: A surveillance study was conducted, recruiting the victims of accidents among users of two-wheeled motor vehicles, visiting the emergency departments of two Italian hospitals. The registration form includes personal data of the involved person, circumstances of the accident, means of arrival at the hospital, type of vehicles involved, helmet use, and eventually third parties involved, and data on the specific injury diagnosis. RESULTS: 736 injured drivers of two-wheeled motor vehicles were investigated for the study (65.1% males, 34.9% females). The mean age of the victims was 22.92 years; 42.9% of the injuries were the result of a single accident. In 35.5% of the injuries cars were involved and in 8.6% of the cases there was a passenger included. Only 12% of the injured people were wearing a helmet. Most of the lesions concerns the knee or lower leg (27.5%), followed by the head (17.5%), elbow and forearm (8.8%), wrist and hand (8.6%), shoulder and upper arm (8.4%) and ankle and foot (6.9%). Helmet use has a protective effect (OR = 0.23), whereas accidents in Naples and during dark hours are associated with an increased risk of head injury (respectively OR = 1.93, and OR = 1.46). CONCLUSION: In this study the lower injury risk due to the use of the helmet on the frequency and severity of head trauma was confirmed. Moreover, the results confirm that Emergency Departments can provide essential epidemiological information, and they have already provided clear arguments in favour of extending the compulsory use of helmets to people above 18 years in Italy.

Accidents, Traffic↗
PubMed1999

Mechanisms of aortic injury in fatalities occurring in motor vehicle collisions.

Case reviews based on autopsy studies have shown that motor vehicle collisions cause between 50 and 90% of traumatic aortic ruptures. Very few studies have analyzed the nature and severity of the collision forces associated with this injury. Our passenger car study (1984-1991) examined 36 collisions in which 39 fatally injured victims sustained aortic trauma. In this injury group, a disproportionate number of heavy truck and roadside fixed-object impacts occurred. Vehicle crash forces were generally severe and were either perpendicular or oblique to the vehicle surface. Intrusion into the occupant compartment was a significant factor in most of these fatal injuries. Occupant contact with vehicle interior surfaces was identified in most cases, and occupant restraints were often ineffective, especially in side collisions. The more elderly victims were seen in the least severe collisions. The most frequent site of aortic rupture was at the isthmus. A majority of victims had rib/sternal fractures indicating significant chest compression. Of the various traumatic aortic injury mechanisms proposed in motor vehicle impacts, the favored theories in the literature combine features of rapid deceleration and chest compression. This study supports that predominant impression, concluding that rapid chest deceleration/compression induces torsional and shearing forces that result in transverse laceration and rupture of the aorta, most commonly in the inherently vulnerable isthmus region.

Accidents, Traffic↗
PubMed2000

Initial posttraumatic urinary cortisol levels predict subsequent PTSD symptoms in motor vehicle accident victims.

BACKGROUND: This study was designed to examine the relationship between urinary hormone levels collected upon admission to the trauma unit following a motor vehicle accident and posttraumatic stress disorder symptomatology 1 month later. METHODS: Fifteen-hour urine samples were collected from 63 male and 36 female motor vehicle accident victims and were used to assess levels of catecholamines and cortisol reflecting peritraumatic and acute-phase posttraumatic levels. Presence of posttraumatic stress disorder symptomatology was assessed 1 month after the accident. RESULTS: Motor vehicle accident victims subsequently diagnosed with acute posttraumatic stress disorder excreted significantly lower levels of cortisol in 15-hour urines collected upon admission to the hospital. In addition, urinary levels of cortisol predicted a significant percentage of the variance in intrusive and avoidant thoughts 1 month after the accident. CONCLUSIONS: The results of our study suggest that initial cortisol levels in the immediate aftermath of a traumatic event contribute, in part, to subsequent symptoms of posttraumatic stress disorder.

Accidents, Traffic↗
PubMed1997

Motor vehicle crashes and drivers with DAT.

An increasing number of drivers with dementia is expected over the next few decades. From a public safety standpoint, there is concern that these drivers also will have an increased risk for motor vehicle crashes. This paper examines recent studies on motor vehicle crashes experienced by drivers with dementia and/or dementia of the Alzheimer type (DAT). These studies were analyzed for their common findings, strengths, and limitations. Many studies reveal an increased crash rate for drivers with DAT compared with nondemented older drivers. Studies suggest that 50% of DAT drivers stop driving within 3 years of the onset of disease, the risk for a motor vehicle crash increases with the duration of driving after disease onset, males are at increased risk for crashes, dementia severity does not correlate with risk for a crash, and additional medical conditions may further contribute to crash risk. Areas of focus for future studies in this field are discussed.

Accidents↗
PubMedDate not supplied

[Epileptic disease and fitness for specific jobs involving driving motor vehicles].

OBJECTIVE: Analysis of the problems the occupational health physician meets in health surveillance of workers with a clinical history of epilepsy, in order to assess fitness for specific jobs requiring driving of motor vehicles. METHODS: A health protocol was used which required acquisition of all information related to job features, work organization, past and current clinical-functional status of epilepsy and any treatment in progress. SUBJECTS: The cases of four workers with clinical history of epilepsy were examined who were judged to be representative both of the most frequent forms of epileptic disease and of jobs requiring driving of motor vehicles. RESULTS: Application of the chosen health protocol allowed us to make balanced assessments of fitness for the different specific jobs performed by the four workers. DISCUSSION: With the use of this protocol it was possible to protect the health and the safety of both the workers concerned and their fellow workers and also, as far as possible, to respect the occupational competence of such workers. We also addressed the problems related to anti-epileptic drug consumption and in itinere road accidents. Lastly, the different medical-legal aspects of the problem were further investigated, analysing national and international legislation with respect to epilepsy and fitness for driving motor vehicles.

Adult↗
PubMed2000

Adults and children in severe motor vehicle crashes: a matched-pairs study.

STUDY OBJECTIVE: Many articles report seat belt injuries to children. This study examines the effect of child versus adult age and seat belt use on outcome in severe motor vehicle crashes. METHODS: A population-based data set of all motor vehicle crashes statewide was analyzed by using matched-pairs logistic regression. Subjects were participants in motor vehicle crashes in which at least one occupant was killed or hospitalized and at least one was a child (age <15 years). Only passengers in cars, vans, and the front of light trucks were considered. Unique matched pairs were formed of one adult and one child from the same vehicle. The main outcome measure was death or hospitalization. Covariates were seat belt use and front or back seat position. RESULTS: Overall, 413 pairs were analyzed. Seat belt use in these severe crashes was low for children and adults (40% versus 45%). Children more often sat in the back seat (74% versus 31% for adults). Risk of death was similar (7% for children and 8% for adults), but the percentage killed or hospitalized differed (13% for children and 28% for adults; odds ratio [OR] 2.5; 95% confidence interval [CI] 1.8 to 3.7). After controlling for seat belt use and seat position, adults remained at a similarly increased risk compared with children (OR 2.6; 95% CI 1.6 to 4.2). The back seat was much safer than the front seat (OR 5.5; 95% CI 3.7 to 8.1). An adult's nonuse of restraints was strongly predictive of a child's nonuse. CONCLUSION: Seat belts were at least as protective for children as for adults, but only 40% of the children in these severe crashes were restrained.

Accidents, Traffic↗
PubMed2000

Driveway motor vehicle injuries in children.

OBJECTIVES: To describe the frequency, nature and outcome of driveway injuries in children. DESIGN: Retrospective case series of driveway-related injuries in children under 16 years of age admitted to the New Children's Hospital (NCH), New South Wales, from November 1995 to February 2000, and deaths reported to the New South Wales Paediatric Trauma Death (NPTD) Registry from January 1988 to December 1999. MAIN OUTCOME MEASURES: Circumstances of injury; type and number of injuries identified. RESULTS: 42 children were admitted to our institution with driveway-related injuries over four years and four months. These represent 12% of all children admitted with pedestrian motor vehicle injuries. Fourteen deaths (including one of the children admitted to NCH) were reported to the NPTD Registry over 12 years, accounting for 8% of all paediatric pedestrian motor vehicle deaths reported to the registry. Typically, the injury involved a parent or relative reversing a motor vehicle in the home driveway over a toddler or preschool-age child in the late afternoon or early evening. Four-wheel-drive or light commercial vehicles were involved in 42% of all injuries, although they accounted for just 30.4% of registered vehicles in NSW. These vehicles were associated with a 2.5-times increased risk of fatality. In 13 of the 14 deaths, the cause was a severe head injury not amenable to medical intervention. CONCLUSIONS: Driveway injuries in children account for a significant proportion of paediatric pedestrian motor vehicle injuries and deaths in NSW. Prevention represents the only effective approach to reducing deaths from this cause.

Accidents, Home↗
PubMed1992

[The exposure of the population to toxic substances in the interior of motor vehicles--the example of benzene].

The exposure of the population to benzene is caused in the first place by emissions of the motor-vehicle traffic. The air pollution concentrations in main traffic routes and in the sphere of influence of industrial plants amount to 5-30 micrograms Benzene/m3 in the course of the year. In indoor air about 6-12 micrograms/m3 are detectable, in the interior of motor-vehicles between 50 and 200 micrograms/m3. Smoking raises the individual burden significantly; in contrast food and drinking water amount only for a small part of the total intake of benzene. In rural areas with low outdoor-air concentrations the main source of burden can be the intake of benzene during the use of motor-vehicles. Despite the relatively low carcinogenic potency of benzene but because of the unfavourable exposure conditions and the comparatively high concentrations measures for the reduction of benzene in fuel should be taken immediately.

Air Pollutants↗
PubMed2003

Anogenital injuries in child pedestrians run over by low-speed motor vehicles: four cases with findings that mimic child sexual abuse.

OBJECTIVE: Differentiating between child sexual abuse and nonintentional causes of anogenital injury can be challenging, and a misdiagnosis can have a profound impact on the child and family. This case series documents an important nonintentional mechanism of anogenital injury that mimics the physical findings of child sexual abuse. METHODS: Four children were examined after being run over by a slow-moving motor vehicle. In each case, the wheel of the vehicle passed longitudinally over the child's torso. RESULTS: Two children had perianal lacerations, and 2 had hymenal lacerations. One child with hymen injuries was followed for 4 weeks and developed findings identical to those seen in healed sexual abuse. CONCLUSIONS: Children run over by motor vehicles should be evaluated for anogenital injury. If such injury is suspected, it should be fully delineated and documented with colposcopy and follow-up examination. Although the possibility of sexual abuse must be considered, awareness of the occurrence of anogenital injuries in children run over by motor vehicles may prevent the misdiagnosis of acute sexual abuse in children. Conversely, children presenting for evaluation of acute or past sexual abuse should be questioned as to whether they were ever run over by a motor vehicle.

Accidents, Traffic↗
PubMed1990

Emergency department nursing management of patients with orthopedic fractures resulting from motor vehicle accidents.

Nursing management of patients with orthopedic fractures resulting from motor vehicle accidents is a frequent challenge for nurses in an emergency department setting. The nurse must have knowledge of the mechanics of injury, the classification of the resulting fracture types, and the usual medical interventions. In addition, emergency department nurses should follow plans of care that are based on nursing diagnoses so that appropriate nursing interventions can be determined and consistently provided. Initiation of these care plans must not be delayed until the patient is admitted to an inpatient nursing unit, but should be begun in the emergency unit setting. This article presents information that the emergency room nurse needs in order to make plans for nursing care, and discusses seven nursing diagnoses that are almost always appropriate for patients seen in the emergency department who are experiencing orthopedic fractures resulting from motor vehicle accidents.

Accidents, Traffic↗
PubMed2001

Wheelchairs used as motor vehicle seats: seat loading in frontal impact sled testing.

Wheelchairs are not typically designed to function as motor vehicle seats. However, many wheelchair users are unable to transfer to a vehicle seat and instead travel seated in their wheelchair. ANSI/RESNA WC19: Wheelchairs Used as Seats in Motor Vehicles provides design and testing requirements, but does not provide wheelchair manufacturers with design guidance related to expected loads imposed upon wheelchair components during a crash. To provide manufacturers with crashworthy design guidance, our study measured wheelchair seat loading during 20g/48kph frontal impact sled tests with a 50th percentile male test dummy. Loading conditions were assessed using two different rear securement point positions. Results of four sled impact tests revealed downward loads ranging from 17 019 to 18 682 N, depending upon rear securement point configuration. Maximum fore/aft shear loads ranged from 4424 to 6717 N across the tests.

Accidents, Traffic↗