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PubMed1991

Determinants of motor vehicle deaths in the United States: a cross-sectional analysis.

This paper uses 1987 state-level data and least-squares regression to estimate a model of motor vehicle deaths in the United States. The model includes several factors accounted for in previous cross-sectional studies of these fatalities. The estimates suggest that income, the ratio of urban to rural driving, expenditures on highway police and safety, motor vehicle inspection laws, and adult seat belt use laws with secondary enforcement provisions are inversely related to motor vehicle death rates. They also indicate that volume of driving, speed, speed variance, driving density, alcohol consumption, temperature, and a dummy variable for western states are directly related to the rates.

Accidents, Traffic↗
PubMed1991

Effects of head trauma from motor vehicle accidents on Parkinson's disease.

During 1 year we monitored changes in clinical disability scores in 10 patients with Parkinson's disease (PD) who sustained head trauma from motor vehicle accidents. Disability significantly increased immediately after trauma, but returned to baseline levels in subsequent weeks. These patients' signs deteriorated over the subsequent year, but this decline was equivalent to that of a matched control group with PD who did not have a motor vehicle accident or trauma. Based on these data, we conclude that trauma or stress caused by motor vehicle accidents can transiently exacerbate parkinsonian dysfunction without causing persistent increased disability or an alteration in disease course.

Accidents, Traffic↗
PubMed2004

Cervical spine injury and restraint system use in motor vehicle collisions.

CONTEXT: Cervical spine injury related to motor vehicle collision (MVC) is a severe and often permanently disabling injury. Although advances in automobile crashworthiness have reduced both fatalities and some severe injuries, the impact of varying occupant restraint systems (seatbelts and airbags) on cervical spine injury is unknown. OBJECTIVE: To investigate the relationship between the occurrence of cervical spine injury and occupant restraint systems among front seat occupants involved in frontal MVCs. DESIGN, SETTING, AND PATIENTS: A case-control study among subjects obtained from the 1995 to 2001 National Automotive Sampling System (NASS). Cases were identified based on having sustained a cervical spine injury score of 2 or more on the Abbreviated Injury Scale, 1990 Revision. RESULTS: Approximately half (44.7%) of 8,412 cases of cervical spine injury were unrestrained occupants while belted only, airbag only, and both restraint systems represented 38.2%, 8.8%, and 8.4% of cases, respectively. Overall, the combined use of airbag and seatbelt had the greatest protective effect, relative to unrestrained occupants, with an odds ratio (OR) of 0.19 and a 95% confidence interval (CI) of 0.12 to 0.30. Use of a seatbelt only also had a protective effect (OR: 0.40; 95% CI: 0.23-0.70). Occupant use of an airbag only neither increased nor decreased the risk of cervical spine injuries relative to unrestrained occupants (OR: 1.02; 95% CI: 0.57-2.13). CONCLUSIONS: The results of this study suggest that there is an increase in overall protection against cervical spine injury by combining airbag and seatbelt restraint systems relative to seatbelt alone.

Accidents, Traffic↗
PubMedDate not supplied

Relationship of hemoglobin to occupational exposure to motor vehicle exhaust.

OBJECTIVE: To study the relationship of hemoglobin to exposure to motor vehicle exhaust. DESIGN: Survey. PARTICIPANTS: Traffic police, bus drivers, and auto-shop workers (all exposed to auto exhaust in Madras, India) and unexposed office workers. MAIN OUTCOME MEASURES: We measured levels of blood lead (by graphite furnace atomic absorption spectrophotometry), and hemoglobin. Information also was collected on age, employment duration, smoking status, alcohol ingestion, and diet type (vegetarian or nonvegetarian). RESULTS: Increasing exposure to motor vehicle exhaust, as reflected by job category, was significantly associated with lower levels of hemoglobin (p < 0.01). A final multivariate regression model was constructed that began with indicator variables for each job (with office workers as the reference category) and included age, duration of employment, blood lead level, alcohol ingestion, dietary type, and smoking status. After a backward-elimination procedure, employment duration as an auto-shop worker or bus driver remained as significant correlates of lower hemoglobin level and current smoking and long employment duration as significant correlates of higher hemoglobin level. CONCLUSIONS: Occupational exposure to automobile exhaust may be a risk factor for decreased hemoglobin level in Madras. This effect appears to be independent of blood lead level and may represent hematopoietic suppression incurred by benzene or accumulated lead burden (which is not well reflected by blood lead levels). Smoking probably increased hemoglobin level through the chronic effects of exposure to carbon monoxide. In this study, a long employment duration may have served as a proxy for better socioeconomic, and therefore, better nutritional status.

Adult↗
PubMed2000

Development of a microscale emission factor model for CO for predicting real-time motor vehicle emissions.

The U.S. Environmental Protection Agency's (EPA) National Exposure Research Laboratory has initiated a project to improve the methodology for modeling human exposure to motor vehicle emissions. The overall project goal is to develop improved methods for modeling the source through the air pathway to human exposure in significant microenvironments of exposure. This paper presents the technical description of a newly developed model for CO emissions. The sensitivity analysis and evaluation of this emission model is presented in a companion paper titled "Sensitivity Analysis and Evaluation of MicroFacCO: A Microscale Motor Vehicle Emission Factor Model for CO Emissions." The MOBILE models (used in the United States, except California) and EMFAC models (used in California only) used to estimate emissions are suitable for supporting mostly regional (county)-scale modeling and emission inventory because of their dependence on vehicle-miles-traveled aggregate data. These emission models are not designed to estimate real-time emissions needed for human exposure studies near roadways. A number of independent studies have found that current mobile source emission factor models are not very reliable at estimating microscale emissions and are, therefore, inappropriate for use with microscale modeling necessary to estimate human exposures near roadways. A microscale emission factor model for predicting real-world real-time motor vehicle CO emissions (MicroFacCO) has been developed. It uses available information on the vehicle fleet composition. The algorithm used to calculate emission factors in MicroFacCO is disaggregated based on the on-road vehicle fleet. The emission factors are calculated from a real-time fleet rather than from a fleet-wide average estimated by a vehicle-miles-traveled weighting of the emission factors for different vehicle classes. MicroFacCO uses the same database used to develop the MOBILE6 model. As compared with MOBILE emission models, MicroFacCO requires only a few input variables, which are necessary to characterize the real-time fleet being modeled. The main input variables required are on-road vehicle fleet, time and day of year, ambient temperature, and relative humidity.

Carbon Monoxide↗
PubMed1993

A retrospective cohort study of seatbelt use and pregnancy outcome after a motor vehicle crash.

To determine the effect of seatbelt use on pregnancy outcome we conducted a population-based retrospective cohort study of pregnant women (20 weeks' gestation or more) involved in motor vehicle collisions. Birth and fetal death certificates were obtained for 1243 restrained and 1349 unrestrained pregnant women involved in police-investigated motor vehicle crashes from 1980 through 1988. Unrestrained pregnant women drivers were 1.9 times more likely to have a low birth weight baby (95% confidence intervals = 1.2, 2.9) and 2.3 times more likely to give birth within 48 hours after the motor vehicle crash (95% confidence intervals = 1.1, 4.8) than restrained pregnant women drivers after adjusting for age and gestational age at crash. Although a trend for an increased risk of fetal deaths was observed among unrestrained women, too few fetal deaths occurred to accurately describe any association with restraint status. This study provides reassurance that the current recommendations on use of seatbelts by pregnant women are appropriate and should be continued.

Accidents, Traffic↗
PubMedDate not supplied

Analysis of motor vehicle crash data in an urban trauma center: implications for nursing practice and research.

OBJECTIVE: To examine the incidence of risk behaviors (safety restraint use and alcohol use) and demographic characteristics of motor vehicle crash victims. DESIGN: Retrospective, descriptive, correlational. SETTING: One major, urban, Level 1 trauma center. SUBJECTS: The medical records of 864 motor vehicle crash victims (drivers, passengers, pedestrians, bicycle riders, and motorcycle riders) admitted to the trauma center between July 1, 1989, and June 30, 1990, were reviewed. RESULTS: Eighty-two percent of motor vehicle occupants (403 drivers and passengers) were not wearing safety restraints at the time of the crash. Thirty-six percent of drivers (92) and 42% (47) of pedestrians were intoxicated on admission to the trauma center. Failure to use safety restraints was associated with alcohol use in this population. Subjects who engaged in risk behaviors were predominantly adolescent and young adult males. CONCLUSIONS: These data suggest the need for further research into correlates of risk behaviors and interventions to prevent future injury related to these behaviors.

Accidents, Traffic↗
PubMed1994

Epidemiology of motor vehicle crash-related serious eye injuries.

The Eye Injury Registry of Alabama has been collecting epidemiologic, treatment, final outcome, and rehabilitation information on serious ocular trauma since 1982. By December 31, 1989, 150 motor vehicle crash-related eye injuries had been registered. This is the largest series of motor vehicle crash-related serious eye injuries reported. The mean age of those injured was 29 years; 61% were between 16 and 35 years of age, and 73% were males. Ten individuals (7%) suffered bilateral eye injuries. The retina was injured in 47% of eyes. The initial visual acuity was 19/200 or worse (legal blindness) in 47% of eyes. Of eyes with at least 3 months of follow-up, 63% had worse than 20/200 initial visual acuity and 41% remained legally blind. Twelve percent of eyes required removal. Possibly due to the large number of blunt ruptures, motor vehicle crash-related eye trauma carries a particularly unfavorable treatment prognosis. Prevention of these injuries is therefore of extraordinary importance.

Accidents, Traffic↗
PubMed1997

Temporomandibular disorders, headaches, and neck pain after motor vehicle accidents: a pilot investigation of persistence and litigation effects.

STATEMENT OF PROBLEM: There is a lack of long-term follow-up studies that involve post-motor vehicle accident temporomandibular disorders and compensation. PURPOSE OF STUDY: The purposes of this retrospective pilot study were (1) to assess patients who had previously been treated for temporomandibular disorders after motor vehicle accidents to determine the nature of their symptoms in terms of jaw, head, and neck pain and jaw dysfunction and (2) to determine whether there was a difference in the pain and dysfunction between those who had settled and those who had not settled their insurance claims. MATERIAL AND METHODS: Thirty previously treated patients with temporomandibular disorders after motor vehicle accidents were questioned by telephone regarding litigation status and current jaw, head, and neck pain and jaw dysfunction symptoms. They did not differ substantially from a smaller group who were not able to be interviewed. Descriptive statistics were calculated and statistical tests were performed. A total of 22 patients had their claims settled. RESULTS: Approximately three fourths had persistent complaints of jaw pain, jaw dysfunction, and headache, and more than 80% reported persistent neck pain. No apparent differences were found between those who had and had not settled their insurance claims. CONCLUSION: Jaw, head and neck pain, and jaw dysfunction continued to be problems for the majority of this patient population, regardless of litigation status in this retrospective study.

Accidents, Traffic↗
PubMed2003

Seizure-related motor vehicle crashes in Arizona before and after reducing the driving restriction from 12 to 3 months.

OBJECTIVE: To evaluate whether changing the seizure-free interval in Arizona from 12 months to 3 months affected the number of seizure-related motor vehicle crashes. METHODS: We performed a time trend study with analysis of motor vehicle crash reports in the state of Arizona 3 years before (1991-1993) and 3 years after (1994-1996) the seizure-free interval was decreased from 12 to 3 months. The number of motor vehicle crashes related to seizures, other medical conditions, and other nonmedical crashes was compared before and after the law changed. Other population trends, including population growth, registered vehicles, and registered drivers, are also reported. RESULTS: Seizure-related crashes increased from 125 to 136 for the 3 years before and 3 years after the law changed, respectively. The total rate of seizure-related crashes did not increase on the basis of an incidence rate difference of -0.03/10(9) miles (95% confidence interval [CI], -0.30 to 0.24) and a relative risk of 0.98 (95% CI, 0.77 to 1.24). Over the same time interval, crashes related to other medical conditions increased from 288 to 310, respectively, for an incidence rate difference of -0.09/10(9) miles (95% CI, -0.51 to 033) and a relative risk of 0.97 (95% CI, 0.82 to 1.13). Fatalities due to seizure-related crashes decreased during the same period, whereas the number of multiple vehicle crashes increased. CONCLUSION: The rate of seizure-related crashes did not significantly increase in the state of Arizona after the seizure-free interval was reduced from 12 to 3 months.

Accidents, Traffic↗
PubMed2006

Warfarin use and the risk of motor vehicle crash in older drivers.

AIM: On the basis of a recent report, we assessed whether the use of warfarin by elderly drivers results in an increased risk of motor vehicle crash. METHODS: We used computerized records of Quebec insurance programmes, covering a population of 7 million people, to conduct a case-control study based on 5,579 cases and 12,911 controls. RESULTS: The rate of injurious motor vehicle crash associated with the use of warfarin in the past year was not elevated (rate ratio 0.74; 95% confidence interval 0.55, 1.05). CONCLUSIONS: Warfarin therapy does not appear to increase the risk of motor vehicle accidents in elderly drivers.

Accidents, Traffic↗
PubMed1996

One-year prospective follow-up of motor vehicle accident victims.

One-hundred and thirty-two victims of motor vehicle accidents (MVAs), who sought medical attention as a result of the MVA, were assessed at three points in time: 1-4 months post-MVA, 6 months later, and 12 months later. Of the 48 who met the full criteria for Post-Traumatic Stress Disorder (PTSD) initially, half had remitted at least in part by the 6-month follow-up point and two-thirds had remitted by the 1-yr follow-up. Using logistic regression, 3 variables combined to correctly identify 79% of remitters and non-remitters at the 12-month follow-up point: initial scores on the irritability and foreshortened future symptoms of PTSD and the initial degree of vulnerability the subject felt in a motor vehicle after the MVA. Four variables combined to predict 64% of the variance in the degree of post-traumatic stress symptoms at 12 months: presence of alcohol abuse and/or an Axis-II disorder at the time of the initial assessment as well as the total scores on the hyperarousal and on avoidance symptoms of PTSD present at the initial post-MVA assessment.

Accidents, Traffic↗
PubMed2002

Incidence and characteristics of motor vehicle collision-related blunt thoracic aortic injury according to age.

BACKGROUND: Motor vehicle collision-related blunt thoracic aorta injury (BAI) is rare and highly lethal. Vascular disease as related to advancing age potentially subjects older adults to increased risk of BAI; the mechanisms associated with such injuries may be different as compared with younger adults. The goal of the present study is to test this hypothesis using population-based data. METHODS: The 1995 to 1999 National Automotive Sampling System data files were used. The National Automotive Sampling System is a national probability sample of passenger vehicles involved in police-reported tow-away crashes. BAI was defined according to the Abbreviated Injury Scale codes. Among those with BAI, information on occupant (age, seating position, restraint use), collision (collision type, delta-V, vehicle intrusion), and outcome characteristics were obtained and compared according to age. RESULTS: The overall incidence of BAI was 6.8 per 10,000 occupants and there was a steady increase in the BAI rate for advancing decades of life. The proportion of occupants with BAI who die at the scene of the collision is relatively consistent across all age groups ( approximately 85%). Among those who survive to receive medical care, ultimate survival is lowest among those aged 60 and older. Near-side collisions were responsible for more BAI among older adults than other age groups (50% vs. 20.6%, p < or = 0.05). Older adults sustained BAI in collisions with lower delta-V values compared with younger persons (p < or = 0.05). CONCLUSION: Older adults have the highest rate of motor vehicle collision-related BAI, and their injuries tend to occur in less severe collisions. A high level of suspicion for BAI among older adults should not be reserved for high-energy collisions only.

Accidents, Traffic↗
PubMed1996

Pedestrian-motor vehicle trauma: an analysis of injury profiles by age.

BACKGROUND: Pedestrian-motor vehicle trauma (PMVT) is a common mechanism of injury in urban populations. STUDY DESIGN: We performed a retrospective review of 273 PMVT victims (16 percent of all patients with blunt injuries) seen at a Level I trauma center over a three-year period. Patients were analyzed by age and grouped as children (age younger than 16 years), adults (age 16 to 59 years), or elderly (age older than 59 years). RESULTS: Children constituted 27 percent of the patients, adults 54 percent, and elderly 19 percent. This mixture had significantly more children and elderly than the population at large or the entire blunt trauma population at our hospital. The majority of patients (66 percent) were male, with females outnumbering males only in the elderly group. Elderly patients were more frequently admitted to the intensive care unit (ICU) and had significantly longer ICU and hospital stays. Injury Severity Scores were successively higher in each age group and significantly higher in the elderly. Extremity trauma was most common in all three groups, followed by head injuries. The elderly patients were more prone to chest and pelvic injuries and the children most often had femur fractures. Operations were performed in 22 percent of the patients; orthopedic procedures were most frequent. The mortality rate was 6 percent, with 69 percent of the deaths occurring during the initial resuscitation efforts. The mortality rate was significantly higher in the elderly patients (13 percent). The majority of accidents occurred during nighttime hours, especially in the adult group. Half of the accidents occurred on the weekend, with the greatest number on Saturday. One-third of the accidents occurred during the months of October to December. CONCLUSIONS: Pedestrian-motor vehicle trauma is a common injury, with distinct epidemiological features that may be useful in accident prevention strategies.

Accidents, Traffic↗
PubMed2002

The economic impact of motor vehicle crashes: the cost of restrained versus unrestrained occupants in South Carolina.

The purpose of our study was to evaluate the difference in hospital charges between restrained and unrestrained motor vehicle occupants. We were also interested in identifying whether a relationship existed between restraint usage and insurance status. The data for this study were collected from two sources. The 1998 and 1999 Crash Outcome Data Evaluation System was used to compare the hospital charges and restraint usage for all motor vehicle crashes in the state of South Carolina. The patient's insurance status was also analyzed. The hospital charges and restraint usage were also compared from one of the state's Level I trauma centers for the year 1999. These data were prospectively collected and retrospectively reviewed. The average inpatient hospital charges for the state of South Carolina were approximately 25 per cent greater or $4500 more per admission for an unrestrained versus a restrained occupant. There also appears to be a relationship between payer status and restraint usage. Medicaid and self-pay patients were least likely to be using a restraining device at the time of a motor vehicle crash. The data from a Level I trauma center showed similar but more dramatic trends. Hospital charges for unrestrained occupants were 87 per cent higher than those for restrained occupants, which translates into a cost difference of $22,358 per hospital admission. This study highlights the significant economic impact of a simple preventative strategy. The cost savings for a single Level I trauma center translate into almost 9.4 million dollars for a single year. There also appears to be a relationship between usage of a restraining device and payer status.

Accidents, Traffic↗
PubMed2001

Foot and ankle injuries in motor vehicle accidents.

BACKGROUND: We studied foot and ankle (F/A) injuries that occurred in motor vehicle accidents treated in a Level 1 trauma center. METHODS: The records of F/A injuries of 2248 consecutive orthopedic patients were reviewed to find foot and ankle injuries. RESULTS: Pilon fractures were common. Motor Vehicle Accident (MVA) occupants with F/A injuries had a higher injury Severity Score than those without (17.9 vs. 11.6, p <. 001). MVA F/A injury risk was higher without restraint [relative risk ratio (rrr) 1.68, p <. 0032] than with restraint except for air bagged drivers who were similar to unrestrained drivers (rrr 1.18, p > .05, NS). CONCLUSION: Patients with F/A injuries may have serious associated injuries. Air bags may not protect feet.

Accidents, Traffic↗
PubMedDate not supplied

Medical conditions and the risk of motor vehicle crashes in men.

OBJECTIVE: To determine whether men aged 45 to 70 years with any medical condition are at an increased risk of involvement as drivers in police-reported motor vehicle crashes. DESIGN: Case-control study. SETTING: Province-wide population-based sampling. PARTICIPANTS: A total of 2504 drivers randomly selected from those involved as a driver in a motor vehicle crash (cases) and 2520 men not involved in a crash (controls) during a 6-month period. DATA COLLECTION: The Societé de l'assurance automobile du Quebec (SAAQ) computerized files provided data on crashes, age, and medical conditions. A mailed questionnaire elicited information on usual mileage and driving conditions. RESULTS: Data from the SAAQ files were obtained for all 5024 drivers. The overall response rate to the mailed survey was 35.5% with no statistically significant differences in the distribution of characteristics between respondents and nonrespondents. There was no increase in crude (odds ratio, 0.99; 95% confidence interval, 0.85-1.17) or age-adjusted risk of crashes for men with a medical condition in the entire sample of subjects (N = 5024). Among respondents to the mailed questionnaire only, men with a medical condition showed no increased crude risk of crashes (odds ratio, 0.99; 95% confidence interval, 0.76-1.27); no difference was observed after adjustment for age, mileage driven, driver behaviors, and sociodemographic characteristics (odds ratio, 0.91; 95% confidence interval, 0.64-1.31). CONCLUSIONS: Unlike previous studies, the risk estimate was derived from a population-based sample of drivers and adjusted for age, mileage driven, driver behaviors, and sociodemographic characteristics in multivariate analyses. The adjusted estimates failed to show an increased risk of motor vehicle crashes for drivers with a medical condition.

Accidents, Traffic↗
PubMedDate not supplied

A regional review of air medical transports for fatal motor vehicle crashes.

This article presents study results from an assessment of the performance of the air medical (and advanced life support) components of the EMS system in response to fatal motor vehicle crashes. Results are presented for one of Massachusetts' five EMS regions, including the finding that air medical transports are involved in 20% of the fatal crashes for the region and transport 11% of the involved individuals. Although the study focused on air medical utilization, it also identified issues related to the future implementation of motor vehicle automatic crash notification (ACN) and telematics that could relay crash severity data from onboard computers (e.g., event data recorders) to auto manufacturers' help centers or state emergency call centers. This technology will place new demands on state EMS systems. To meet the challenges posed by these technological changes, states will need to assess the type and number of EMS services required to respond to ACN motor vehicle crashes and develop methods to determine what level of service to deploy based on the information relayed from the vehicles. An initial step in this evaluation process is to determine the current use of EMS resources to place planned system changes and demand into context.

Accidents, Traffic↗