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PubMed2002

Kangaroo-related motor vehicle collisions.

BACKGROUND: Motor vehicle collisions that are caused by large animals affect motorists in most parts of the world and tend to be increasing in incidence. Although traffic accidents involving kangaroos are common in Australia, we are not aware of any series that reported human injuries caused by such accidents. We aimed to study the mechanism, type, and outcome of these injuries. METHODS: Forty-six patients (32 male and 14 female patients; median age, 31.5 years) who presented to Royal Perth Hospital and who had been involved in a motor vehicle collision that was related to kangaroos between July 1994 and June 2000 were studied. RESULTS: The patients had a median Injury Severity Score of 9 (range, 1-41); 67.4% were car collisions and 32.6% were motorbike collisions, 41.3% had direct collision with a kangaroo, 34.8% hit a secondary object, and 32.6% rolled over. Most of these injuries affected the head and face (54.3%), upper extremities (57.4%), and lower extremities (40.4%). Only four had intracranial injuries (8.7%). Ninety percent of these collisions occurred at night, 74% in the countryside and 85% on highways or streets. The incidence was reduced during winter. Only one patient in this series died (2.2%). CONCLUSION: Most kangaroo-related motor vehicle collisions occurred at night, in the countryside, and on highways when the driver tried to avoid a kangaroo. Although injuries resulting from these collisions are relatively mild, increased awareness of their presence and ways to reduce them have to be promoted.

Accidents, Traffic↗
PubMed1985

Pedestrian injury. The next motor vehicle injury challenge.

Motor vehicle injuries are the leading causes of death and disability in childhood after age 1 year. Educational efforts by physicians and public policy have focused on the protection of motor vehicle occupants. However, fatal pedestrian injuries are more common than fatal occupant injuries in preschool and school-aged children. The importance of pedestrian injury as a cause of early childhood morbidity and mortality is likely to become even clearer in the coming years as passenger injury rates decline. Existing patterns and trends in pedestrian injury statistics are poorly understood. The development of effective strategies for injury prevention requires greater understanding of how and why pedestrian injuries occur. Improved knowledge is needed that concerns the roles of environmental, psychosocial, medical, and behavioral factors in child pedestrian injury. Multidisciplinary accident investigation, which involves physicians, traffic engineers, psychologists, and social scientists, is most likely to provide the information needed to develop candidate educational and environmental strategies for study. Prevention of child pedestrian injury is a challenge that has not yet been addressed by pediatricians or policymakers. Pediatricians can promote and direct a national focus on this area that has been understudied by researchers, public health officials, and policymakers.

Accidents, Traffic↗
PubMed2001

Challenges in motor vehicle safety.

Reductions in motor vehicle injury and death represent a major public health success. Since the advent of the federal program in highway safety in 1966, motor vehicle deaths have dropped dramatically, not only in rates per miles driven but also in absolute numbers. Key to this success has been the broad-based comprehensive approach promoted by the program's first administrator, a public health physician. The federal program provided leadership and coordination that leveraged national, state, and local programs to bring about safer vehicles, improved traffic records, more effective enforcement, enormously improved emergency medical services, more responsible judicial systems, and many other accomplishments. Although progress has been made on many fronts, major areas addressed here include federal motor vehicle safety standards, alcohol safety programs, occupant restraint laws and usage, and speed limits. The achievements in motor vehicle safety provide a model for other injury control efforts.

Accidents, Traffic↗
PubMed2001

Methods for conducting systematic reviews of the evidence of effectiveness and economic efficiency of interventions to reduce injuries to motor vehicle occupants.

BACKGROUND: Motor vehicle occupant injury prevention is included in the Guide to Community Preventive Services because of the enormous health impact of these largely preventable injuries. This article describes the methods for conducting systematic literature reviews of interventions for three key injury prevention strategies: increasing child safety seat use, increasing safety belt use, and decreasing alcohol-impaired driving. METHODS: Systematic review methods follow those established for the Guide to Community Preventive Services and include: (1) recruiting a systematic review development team, (2) developing a conceptual approach for selecting interventions and for selecting outcomes that define the success of the interventions, (3) defining and conducting a search for evidence of effectiveness, (4) evaluating and summarizing the body of evidence of effectiveness, (5) evaluating other potential beneficial and harmful effects of the interventions, (6) evaluating economic efficiency, (7) identifying implementation barriers, (8) translating the strength of the evidence into recommendations, and (9) identifying and summarizing research gaps. RESULTS: The systematic review development team evaluated 13 interventions for the three strategic areas. More than 10,000 titles and abstracts were identified and screened; of these, 277 met the a priori systematic review inclusion criteria. Systematic review findings for each of the 13 interventions are provided in the accompanying articles in this supplement. CONCLUSION: The general methods established for conducting systematic reviews for the Guide to Community Preventive Services were successfully applied to interventions to reduce injuries to motor vehicle occupants.

Accidents, Traffic↗
PubMed1994

[Driving a vehicle--driving a motor vehicle, a necessary differentiation for proven limit of alcohol-induced absolute driving incapacity].

There are special cases of vehicle driving, such as driving or moving a certain type of vehicle without an engine as part of the division of labour. These cause distinguishing problems in the area of paragraphs 21, 24, 25 StVG and 44, 69, 69 b, 315 c, 316 StGB with consequences for the type and extent of the proof of dangerous driving due to alcohol. From the jurisdiction so far published on this topic, relevant limiting criteria will be summarised and clearly laid out.

Alcohol Drinking↗
PubMed2005

[Psychoreactive disorders after motor vehicle accidents. Is it possible to predict the development of psychoreactive disorders after motor vehicle accidents?].

The aim of this study was to assess common risk factors for the early development of psychoreactive disorders during traumatological treatment and to estimate their predictive potential. The sample consisted of 126 consecutive patients with accidental injuries recruited in an emergency room of the university hospital. We assessed this population 1 week (T1) and-on average-8 months following the accident (T2). At T1 34.5% of all patients indicated moderate and 26.4% strong symptoms of an acute stress disorder; 26.7% of all patients assessed at T2 suffered from severe post-traumatic symptoms. Linear regression analysis, using morbidity status at T2 as the dependent variable, allowed the explanation of 46.2% of the variance. The degree of early acute stress symptoms, injury, and pain intensity contributed significantly to the predictive model. We conclude that a substantial proportion of severely injured accident victims that will develop PTSD can be screened to some degree by the assessment of early stress disorder, the degree of their injury, and pain intensity, enabling secondary prevention of trauma-dependent symptomatology.

Accidents, Traffic↗
PubMed1994

An unexpected fetal outcome following a severe maternal motor vehicle accident.

BACKGROUND: Maternal motor vehicle injury occurs commonly and can cause serious fetal injury. Optimum pregnancy management at the time of maternal presentation following trauma requires reliable methods of fetal assessment. In this report, we present a case in which currently accepted methods of fetal assessment initially failed to demonstrate catastrophic fetal brain injury following a maternal motor vehicle accident. CASE: A 28-year-old primigravida woman at 27 weeks' gestation was in a pedestrian motor vehicle accident, suffering a closed head injury and multiple fractures. Initial fetal assessment included cardiotocographic monitoring for 24 hours fetal ultrasound, both of which were normal, as was a biophysical profile done on the fifth day after the accident. These were repeated at intervals, but definite evidence of fetal brain injury was not seen until unilateral ventricular dilatation was documented on ultrasound at 35 weeks' gestation. Postnatal imaging showed microcephaly, hydrocephalus ex vacuo, and multiple hemispheric hypodensities, likely representing post-traumatic hemorrhages with secondary infarction. At the age of 4 years, the child is cortically blind, epileptic, and quadriparetic. CONCLUSION: This pregnancy outcome was unexpectedly poor despite the reassuring initial assessment. We caution that these methods may not provide accurate early fetal assessment, especially when fetal brain stem function is spared.

Accidents, Traffic↗
PubMed2002

Risk factors for motor vehicle crashes in older women.

BACKGROUND: Motor vehicle crash and fatality rates are higher per mile driven for elderly drivers, with an exponential increase above age 75. Identifying elderly drivers who are at risk for automobile crashes may help direct interventions to reduce their high rate of injuries and deaths. METHODS: Subjects were 1416 women aged 65 to 84 enrolled in the Portland, Ore. site of the Study of Osteoporotic Fractures. Motor vehicle crash information for the years 1986-1995 for each participant was obtained from the Oregon State Department of Transportation. Items from questionnaires, interviews, and physical examinations were tested prospectively for associations with the occurrence of motor vehicle crashes. RESULTS: About one third of participants (415 of 1416) had a motor vehicle crash during a mean follow-up time of 5.7 years. After adjustment for age and weekly driving mileage, risk factors significantly associated with motor vehicle crashes were a fall in the previous year [hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.26-1.86], a greater orthostatic systolic blood pressure drop (HR 1.11 per 12.5 mm Hg, 95% CI 1.01-1.22), and increased foot reaction time (HR 1.10 per 0.06 second, 95% CI 1.00-1.22). Other neuromuscular tests, functional status, medical diagnoses, vision tests, and cognitive tests did not predict motor vehicle crashes in this study population. CONCLUSIONS: This prospective study with extended follow-up of a large cohort of elderly women has identified crash risk factors that can be measured in the clinical setting. Further study is needed to determine if interventions aimed at these risk factors can decrease the risk of motor vehicle crashes.

Accidental Falls↗
PubMed2003

Posttraumatic stress disorder and its impact on the economic and health costs of motor vehicle accidents in South australia.

BACKGROUND: Motor vehicle accident studies thus far have focused primarily on psychiatric consequences and outcomes and medicolegal and treatment aspects, particularly of posttraumatic stress disorder (PTSD). This study aimed to determine the impact of motor vehicle accident-related psychiatric disorders on health and economic costs in quantitative terms. METHOD: Of the 3088 victims of motor vehicle accidents who made a claim through the State Insurance Commission, South Australia, between November 27, 1996, and March 23, 1999, 391 responded to the study and were assessed using the 28-item General Health Questionnaire, the PTSD Checklist-Civilian Version, and the Dissociative Experiences Scale. At the end of the study period, computerized cost records and accounting data on the health and economic costs incurred were obtained for each of the subjects. RESULTS: The total health and economic cost in Australian dollars for the 391 motor vehicle accident victims was A$6,369,519.52. At about 9 months after the accident, of the 391 subjects who replied to the questionnaires, 31% were identified as depressed and 62% as anxious, while 29% met criteria for PTSD. PTSD cases incurred significantly higher health care costs compared with non-PTSD cases (p <.001). Untreated PTSD cases incurred significantly higher economic losses compared with treated PTSD and non-PTSD cases (p <.05). CONCLUSION: The health and economic costs associated with motor vehicle accidents are enormous. Psychiatric morbidity among victims was high, and motor vehicle accident-related PTSD significantly contributed to increased overall health care and economic costs.

Accidents, Traffic↗
PubMed2004

Estimating the risk of collisions between bicycles and motor vehicles at signalized intersections.

Collisions between bicycles and motor vehicles have caused severe life and property losses in many countries. The majority of bicycle-motor vehicle (BMV) accidents occur at intersections. In order to reduce the number of BMV accidents at intersections, a substantial understanding of the causal factors for the collisions is required. In this study, intersection BMV accidents were classified into three types based on the movements of the involved motor vehicles and bicycles. The three BMV accident classifications were through motor vehicle related collisions, left-turn motor vehicle related collisions, and right-turn motor vehicle related collisions. A methodology for estimating these BMV accident risks was developed based on probability theory. A significant difference between this proposed methodology and most current approaches is that the proposed approach explicitly relates the risk of each specific BMV accident type to its related flows. The methodology was demonstrated using a 4-year (1992-1995) data set collected from 115 signalized intersections in the Tokyo Metropolitan area. This data set contains BMV accident data, bicycle flow data, motor vehicle flow data, traffic control data, and geometric data for each intersection approach. For each BMV risk model, an independent explanatory variable set was chosen according to the characteristics of the accident type. Three negative binomial regression models (one corresponding to each BMV accident type) were estimated using the maximum likelihood method. The coefficient value and its significance level were estimated for each selected variable. The negative binomial dispersion parameters for all the three models were significant at 0.01 levels. This supported the choice of the negative binomial regression over the Poisson regression for the quantitative analyses in this study.

Accidents, Traffic↗
PubMed2002

Crosswalk markings and the risk of pedestrian-motor vehicle collisions in older pedestrians.

CONTEXT: Motor vehicles struck and killed 4739 pedestrians in the United States in the year 2000. Older pedestrians are at especially high risk. OBJECTIVE: To determine whether crosswalk markings at urban intersections influence the risk of injury to older pedestrians. DESIGN: Case-control study in which the units of study were crossing locations. SETTING: Six cities in Washington and California, with case accrual from February 1995 through January 1999. PARTICIPANTS: A total of 282 case sites were street-crossing locations at an intersection where a pedestrian aged 65 years or older had been struck by a motor vehicle while crossing the street; 564 control sites were other nearby crossings that were matched to case sites based on street classification. Trained observers recorded environmental characteristics, vehicular traffic flow and speed, and pedestrian use at each site on the same day of the week and time of day as when the case event had occurred. MAIN OUTCOME MEASURE: Risk of pedestrian-motor vehicle collision involving an older pedestrian. RESULTS: After adjusting for pedestrian flow, vehicle flow, crossing length, and signalization, risk of a pedestrian-motor vehicle collision was 2.1-fold greater (95% confidence interval, 1.1-4.0) at sites with a marked crosswalk. Almost all of the excess risk was due to 3.6-fold (95% confidence interval, 1.7-7.9) higher risk associated with marked crosswalks at sites with no traffic signal or stop sign. CONCLUSIONS: Crosswalk markings appear associated with increased risk of pedestrian-motor vehicle collision to older pedestrians at sites where no signal or stop sign is present to halt traffic.

Accidents, Traffic↗
PubMed1975

A survey of motor vehicle burn accidents in children: report of 45 cases.

The association of burns with motor vehicles was reviewed from the records of 1,532 children treated at the Galveston Shriners Burns Institute since 1966. Forty-five children were burned in or about a motor vehicle. The most common causes were gasoline spillage in moving vehicle accidents, and small children playing with matches unattended in a stationary vehicle. Motor vehicle burn patients had more serious and larger burns than in the general burn population. Of the 34 children burned within the confined space of a motor vehicle, 94% suffered face and/or hand burns. There was a high incidence of respiratory problems. In the moving motor-vehicle fire accident group there were 13 major injuries seen in 17 patients. Of the total motor vehicle occupancy in 38 separate accidents, 19 people died and 66 were hospitalized at the SBI or elsewhere.

Accidents, Traffic↗
PubMed1998

The relationship between acute stress disorder and posttraumatic stress disorder: a prospective evaluation of motor vehicle accident survivors.

Motor vehicle accident survivors (n = 92) were assessed for acute stress disorder (ASD) within 1 month of the trauma and reassessed (n = 71) for posttraumatic stress disorder (PTSD) 6 months posttrauma. ASD was diagnosed in 13% of participants, and a further 21% had subclinical levels of ASD. At follow-up, 78% of ASD participants and 60% of subclinical ASD participants met criteria for PTSD. The strong predictive power of acute numbing, depersonalization, a sense of relieving the trauma, and motor restlessness, in contrast to the low to moderate predictive power of other symptoms, indicates that only a subset of ASD symptoms is strongly related to the development of chronic PTSD. Although these findings support the use of the ASD diagnosis, they suggest that the dissociative and arousal clusters may require revision.

Accidents, Traffic↗
PubMed1988

Historical changes in motor vehicle death rates among the elderly.

Motor vehicle death rates among the elderly decreased substantially between 1940 and 1980, while the number of registered motor vehicles in the United States increased fourfold and death rates from motor vehicle injury changed little for the entire population. The annual death rate per 100,000 males aged 75-79 declined from 120 in 1940 to 41 in 1980. Much of the decrease can be attributed to reduced pedestrian deaths. Rates for other elderly age and sex groups showed similar patterns but the rates were lower and the changes smaller. Displaying age-specific motor vehicle death rates by birth cohort provides a graphic demonstration that these death rates have decreased markedly for all age groups 60 and older. Implications and possible causes of this decrease are discussed.

Accidents, Traffic↗
PubMed1983

Suicide by motor vehicle.

Five suicides by motor vehicle drivers are reported. Possible frequency of such incidents and methods for their investigation, as well as patterns and characteristics of suicidal behavior, are discussed. Published reports of suicide by motor vehicle are scarce. Proven cases should be reported by medical examiners and coroners to help establish the patterns of such deaths.

Adult↗
PubMed1990

Childhood motor vehicle occupant injuries.

Motor vehicle occupant trauma is the major cause of mortality among the pediatric population. The mortality rate for adolescents is approximately 10 times that of the younger age groups. Despite enactment of child passenger safety laws in all states and mandatory seat belt use laws in two thirds of the states, mortality rates have not decreased to the extent expected. Additional interventions targeted at the adolescent driver, substance use and driving, and improved occupant protection for all children will be required to further decrease occupant trauma. Lack of comprehensive trauma data is a major roadblock to the calculation of morbidity and disability rates.

Accident Prevention↗
PubMed2004

Effect of restraint systems on maxillofacial injury in frontal motor vehicle collisions.

PURPOSE: Motor vehicle collisions (MVCs) are the leading cause of maxillofacial fractures. Additionally, maxillofacial injuries are the most common injury related to air bag deployment. We sought to characterize the occupant restraint system (seat belt and air bag) and collision characteristics associated with MVC-related maxillofacial injuries. MATERIALS AND METHODS: The 1991-2000 National (United States) Automotive Sampling System Crashworthiness Data System (CDS) data files were used. The CDS is a national probability sample of passenger vehicles involved in police-reported tow-away MVCs. Analysis was limited to front seat occupants involved in frontal collisions of delta-V (estimated change in velocity) of greater than 15 km/hr. The risk of facial injury was calculated according to occupants' restraint use (unrestrained, seat belt only, air bag only, and seat belt and air bag combined) and compared using risk ratios (RRs) and associated 95% confidence intervals (CIs). RESULTS: Occupants restrained with a seat belt only (RR, 0.48; 95% CI, 0.40 to 0.57) or a seat belt and an air bag (RR, 0.83; 95% CI, 0.73 to 0.94) had a significantly reduced risk of any facial injury compared with completely unrestrained occupants. There was no association for those restrained with an air bag only (RR, 1.19; 95% CI, 0.82 to 1.73). A similar pattern of results was observed for moderate to severe facial injuries and for facial fractures. CONCLUSION: Seat belt use significantly reduces the risk of facial injury in frontal MVCs. Air bag use was not associated with the risk of facial injury.

Accidents, Traffic↗
PubMed2002

Injury to the spinal cord in motor vehicle traffic crashes.

Motor vehicle traffic crashes (MVTCs) are the leading cause of traumatic spinal cord injury. Evidence of putative risk factors for this type of injury comes largely from descriptive studies. This study is the first case-control study of risk factors for spinal cord injury specifically in car crashes. Cases of occupant spinal cord injury in South Australia were identified from the Australian Spinal Cord Injury Register (ASCIR) which provides full coverage of the adult population. The comparison group was other seriously injured car occupants. In single vehicle car crashes in the country, the likelihood of spinal cord injury was five times higher for occupants of non-sedan type cars compared with sedans. The likelihood of spinal cord injury was especially high in non-sedan type cars involved in rollover crashes; ten times higher than sedans. The implications of the findings for prevention are highlighted. Concern is expressed over the increasing proportion of four wheel drive passenger vehicles (sport utility vehicles) in the car fleet in Australia, and in the USA, as they are more prone to rollover.

Accidents, Traffic↗