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PubMed2002

Restraint use and injury patterns among children involved in motor vehicle collisions.

BACKGROUND: Motor vehicle collisions are the leading cause of death among children older than 1 year. Use of appropriate restraint systems is associated with reductions in morbidity and mortality in this age group. No studies have evaluated the association between specific injury patterns and restraint use among children. The purpose of this study was to evaluate differences in risks of injuries in different body regions according to restraint use among children 0 to 11 years of age. 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 collisions. Information on occupant (seating position, restraint use), collision (change in velocity, vehicle intrusion), and outcome characteristics was evaluated. Risks of injuries in different body regions (Abbreviated Injury Scale, 1990 Revision score > or = 2) were calculated and compared according to restraint use. RESULTS: Between 1995 and 1999, there were approximately 1.5 million children 0 to 11 years of age involved in police-reported tow-away MVCs who met the inclusion criteria for this study. Compared with unrestrained children, properly restrained children had significantly lower overall injury risk (risk ratio [RR], 0.37); significant risk reductions were also observed for injuries to the head (RR, 0.18), thorax (RR, 0.35), and lower extremities (RR, 0.26), and mortality (RR, 0.26). Significant risk reductions were not noted when comparing improperly restrained children with unrestrained children. CONCLUSION: Proper restraint use among children is associated with lower risk of injury. Educational initiatives should focus not only on encouraging restraint use but also on ensuring that parents know the appropriate age-dependent restraint method and how to use it properly.

Accidents, Traffic↗
PubMed1996

Alcohol, central nervous system injury, and time to death in fatal motor vehicle crashes.

OBJECTIVES: Motor vehicle crash (MVC) studies have found that alcohol (ALC) is associated with increased mortality and decreased time to death (TTD). Clinical and experimental data suggest that ALC potentiates central nervous system injury (CNSI). We hypothesize that ALC-intoxicated, MVC fatalities with CNSI are more likely to die in the immediate postinjury period than are sober victims with CNSI. Methods; DESIGN: A retrospective cohort of 401 MVC fatalities from four Michigan counties for the time period 1985 to 1991 was studied. MEASUREMENTS: Medical examiner records were reviewed to determine age, blood alcohol concentration (BAC), and TTD. Injury severity was calculated with the Abbreviated injury Scale (1985 version). Anatomical profile scores and G scores were also calculated and used to identify CNSI subjects. ANALYSIS: chi 2 and Student's t test were used, and odds ratios with 0.95 confidence intervals (CIs) were calculated. RESULTS: ALC(+) cases (BAC > or = 100 mg/dl) (n = 99) were significantly younger and more frequently had TTD < 1 hr than ALC(-) cases (n = 233): odds ratio 1.62[0.95 CI (1.02 to 2.58)]. Overall, CNSI cases (n = 297) were significantly younger and had fewer thoracic injuries, but did not have significantly shorter TTD, compared with non-CNSI cases. However, ALC(+) CNSI cases (n = 77) were over twice as likely to have TTD < 1 hr ¿odds ratio 2.04 [0.95 CI (1.13 to 3.70)]¿. For ALC(+) isolated CNSI cases, the odds ratio for TTD < 1 hr, compared with nonisolated CNSI cases was 8.25 (0.95; CI 0.66 to 102.5). Injury Severity Score, anatomical profile, and G scores were not significantly different for ALC(+) CNSI cases, compared with ALC(-) CNSI cases, whether isolated or nonisolated. CONCLUSIONS: These data suggest that alcohol intoxication is associated with increased frequency of early death in MVC victims with CNSI, despite there being no detectable difference in anatomical injury scoring.

Accidents, Traffic↗
PubMed2002

Characteristics of pregnant women in motor vehicle crashes.

OBJECTIVES: Motor vehicle crashes are the leading cause of hospitalized trauma during pregnancy. Maternal injury puts the fetus at great risk, yet little is known about the incidence, risks, and characteristics of pregnant women in crashes. SETTING AND METHODS: Police reported crashes were analyzed from the National Automotive Sampling System Crashworthiness Data System. Since 1995, this system recorded pregnancy/trimester status. Pregnant and non-pregnant women 15-39 years of age were compared by age, driver status, seat belt use, and treatment. Belt use and seating position were examined by trimester. RESULTS: There were 427 pregnant occupants identified (weighted n=32 810, 2.6%, SE 12 585, rate 13/1000 person years). The mean age was 24.9 compared with 24.8 years (pregnant v non-pregnant). Cases were distributed by trimester as follows: first 29.8%, second 36.4%, and third 33.8%. Pregnant women were drivers 70% of the time compared with 71% for non-pregnant women. No belt use was 14% compared with 13% (pregnant v non-pregnant). Mean injury severity was lower for pregnant women but they were more likely to transported or hospitalized. Improper belt use decreased after the first trimester and there was little change in driver proportion by trimester. Third trimester hospitalization rates increased. CONCLUSIONS: Pregnant occupants in crashes have similar profiles of restraint use, driver status, and seat position but different treatment indicators compared to non-pregnant occupants. Trimester status has relatively little impact on crash risk, seating position or restraint use. Undercounting of pregnant cases was possible, even so, 1% of all births were reported to be involved in utero in crashes. Little research has focused on developmental outcomes to infants and children previously involved in exposure to these crashes.

Accidents, Traffic↗
PubMed1977

Incidence of drugs and alcohol in fatally injured motor vehicle drivers.

All motor vehicle accident fatalities occuring in Dallas County during a 1 1/2-year period were studied to determine drug usage at the time of death. Blood samples obtained at autopsy or at the time of hospital admission were analyzed for the presence of drugs and alcohol. Of the drivers, 70% were positive for alcohol or drugs. Ethyl alcohol alone was detected in 52%, drugs in 9%, and both drugs and alcohol in another 9%. Seventy-six percent of the drivers determined to be at fault in their respective accidents had alcohol or drugs detected compared to 41% for not-at-fault drivers. The minor tranquilizer diazepam accounted for over half of all positive drug findings, while barbiturates, antihistamines, methaqualone, propoxyphene, and pentazocine were each detected in more than one instance.

Accidents, Traffic↗
PubMed1997

Geographic variations in mortality from motor vehicle crashes in Taiwan.

Mortality from motor vehicle crashes within five urbanization categories in Taiwan between 1981 and 1990 was investigated. Sex-specific standardized mortality ratios (SMRs) were calculated within each urbanization category for motor vehicle crash deaths. Most urban areas demonstrated lower SMRs for both males and females. In contrast, most rural areas exhibited higher SMRs for both males and females. Both males and females demonstrated a significant linear relationship between decreasing urbanization and increasing SMRs for motor vehicle crash mortality. A variety of factors may underlie the inverse correlation between SMRs for motor vehicle crashes and urbanization category. These data are most useful in generating hypotheses for further studies to define specific etiological factors operating within urbanization categories.

Accidents, Traffic↗
PubMed1987

Changing patterns in motor vehicle crash mortality: 1940-1980.

Overall motor vehicle mortality rates in the United States varied little between 1940 (26 deaths per 100,000 per year) and 1980 (23 deaths per 100,000 per year). However, the distribution of motor vehicle deaths by age, sex, and road user status has changed considerably. Among the elderly there has been a substantial increase in motor vehicle death rates. The result of these changes, and of the altered age structure of the population, is that the number of years of life lost to motor vehicle crash injury before age 70 has increased 84 percent between 1940 and 1980.

Accidents, Traffic↗
PubMed2003

Importance of early identification of methylenedioxymethamphetamine ('ecstasy') ingestion in victims of motor vehicle accidents.

The blood of motor vehicle accident victims is routinely screened upon their arrival at the emergency services mainly for alcohol, unless the suspicion of a specific compound arises. Two young men who sustained severe internal and orthopaedic injuries after a motor vehicle accident are described. The conscious patient denied their having used stupefacients, but toxicological analysis upon arrival at the operating room detected methylenedioxymethamphetamine, the metabolite methylenedioxyamphetamine and methamphetamine in their blood and urine specimens. Methylenedioxymethamphetamine concentrations in the clotted blood and in the urine ranged between 0.9-1.15 and 55-70 mg/l, respectively. Methylenedioxyamphetamine concentrations for both patients were less than 0.2 mg/l in the blood and 2.0-3.0 mg/l in the urine. Each had a blood methamphetamine concentration greater than 250 ng/ml. There was no trace of alcohol. Three days after their arrival at the hospital, acute liver insufficiency and mild rhabdomyolysis (serum glutamate-pyruvate transaminase/serum glutamic-oxaloacetic transaminase 1245/218 mU/ml, creatine phosphokinase 48 000 U/ml, respectively) were diagnosed in both patients. Appropriate treatment was administered in an intensive care area and both were discharged home several weeks later without sequelae. These findings suggest that in this era of the widespread abuse of 'ecstasy', concentrations of methylenedioxymethamphetamine, methylenedioxyamphetamine or metamphetamine should be sought routinely in motor vehicle accident victims admitted to emergency services with an altered state of consciousness so that the early monitoring of the potential development of organ pathology can be implemented.

Accidents, Traffic↗
PubMed2000

Self-reported risk-taking behaviors and hospitalization for motor vehicle injury among active duty army personnel.

BACKGROUND: Motor vehicle crashes are a leading cause of injury in the Army. Behaviors increasing risk for motor vehicle crashes are also prevalent, but research has not linked these behaviors directly to injury outcomes (e.g., hospitalizations). METHODS: To evaluate the relationship between behavior and motor vehicle crash injuries, 99, 981 Army personnel who completed Health Risk Appraisal surveys in 1992 were followed for up to 6 years. Cox proportional hazards modeling was used to evaluate speeding, seat belt use, drinking patterns, and demographics. RESULTS: A total of 429 soldiers were hospitalized for motor vehicle injury. Unadjusted analyses revealed that heavy drinking, drinking and driving, speeding, low seat belt use, younger age, minority race/ethnicity, and enlisted rank were significantly associated with motor vehicle injury, but neither smoking nor gender was. Multivariate models showed a significant trend of increasing injury risk with younger ages. Soldiers under age 21 were injured almost five times more often than those over age 40 (HR 4.89, 2.56-9.33). Also associated with risk for hospitalizations were minority race (HR 1.78, 1.46-2.18), heaviest drinkers versus abstainers (HR 1.81, 1.11-2.94), and seat belt use of 50% or less versus 100% (HR 1.40, 1.07-1.85). Although nonsignificant, there was evidence of an age-drinking interaction where the difference in injury risk between those older and those younger than 21 was greatest at low alcohol consumption levels. CONCLUSIONS: Modifiable risk factors associated with motor vehicle injuries include heavy drinking and low seat belt use. Programs targeting these behaviors that meet the needs of young and minority soldiers are needed. The high density of young, at-risk soldiers residing in base housing may provide a unique opportunity for a residential intervention program.

Accidents, Traffic↗
PubMed2000

Motor vehicle crashes in Pakistan: the emerging epidemic.

SETTING: Motor vehicle injuries are increasingly being recognized as a growing public health issue in the developing world. Pakistan is a developing country in South Asia where motor vehicle use has increased since independence in 1947. OBJECTIVE: This paper explores the magnitude and impact of injuries from motor vehicle crashes in Pakistan. METHODS: An exhaustive review of published and gray literature, together with a detailed analysis of government data from 1956. RESULTS: The data indicate a persistent increase in the numbers of motor vehicle crashes, injuries, and fatalities. Changes in the reporting of rates are important to note in evaluating the data. Commercial vehicles contribute disproportionately to these motor vehicle injuries. CONCLUSIONS: There is a need to further the recognition of injuries as a public health issue in this country. Specific exploration of the epidemiological data; intersectoral collaboration between health, law, police and transport; and the development of appropriate information systems, will contribute to an appropriate response by Pakistan.

Accidents, Traffic↗
PubMed1999

Motor vehicle safety: current concepts and challenges for emergency physicians.

Motor vehicle travel is the primary means of transportation in the United States, providing freedom in travel and enterprise for many people. Motor vehicle crashes are the leading cause of death for the young and contribute to a high degree of morbidity and mortality for all ages. Motor vehicle crashes produce an enormous burden for society in terms of suffering, disability, death, and costs. Motor vehicle crash injury prevention is developing as a focused discipline to implement proven interventions involving technology and behavior known to prevent or reduce the severity of motor vehicle crash injury. Emergency physicians have an important role in advocating motor vehicle safety and injury prevention, both in the emergency department and within the community.

Accidents, Traffic↗
PubMed1988

Patterns of high-speed impact injuries in motor vehicle occupants.

Trauma from high-speed motor vehicle accidents is a leading cause of death and disability. Most of these injuries could be prevented if the driver and occupants of motor vehicles wore seatbelts or used other restraining devices. The injuries produced when an unrestrained occupant of a motor vehicle is ejected from that vehicle or impacts on a hostile surface at high speed occur in a reproducible pattern. The types of injuries sustained by drivers and front seat passengers are different and specific enough to allow one to identify drivers and passengers with confidence. Because of severe life-threatening injuries to the central nervous system, and thoracic and abdominal viscera, other serious injuries may be overlooked. Knowledge of the mechanism of injury and the role of the victim (i.e., driver or passenger) should lead to the prompt radiographic evaluation of all areas at risk. Our findings are based on a study of 250 drivers and 250 front seat passengers involved in motor vehicle accidents. We found distinct common injury patterns and radiographic findings in drivers and front seat passengers.

Abdominal Injuries↗
PubMedDate not supplied

Motor vehicle traffic accident mortality in Canada, 1921-1984.

The analysis of motor vehicle traffic accident mortality through the use of cross-sectional and secular death rates indicates that motor vehicle traffic accident death rates increased over all age and sex groups from 1921 to 1970. Each generation, defined as a birth cohort, experienced successively higher motor vehicle traffic accident mortality rates until the 1970s. The most striking increase occurred among youths 15-24 years of age. Motor vehicle traffic accidents were responsible for 518,488 hospital days in Canadian hospitals in 1981-82. Approximately 47% of the days involved youths below the age of 25. Among youths in the 15-24 age group, about 30% of the hospital separations attributable to motor vehicle traffic accidents involved head injuries. Between 1970 and 1984, motor vehicle traffic accident mortality rates declined in all age groups. The possible reasons for the decline and the current pattern of motor vehicle traffic accident mortality are discussed in terms of the implications for hospital utilization and the prevalence of disability.

Accidents, Traffic↗
PubMed2005

Student drivers: a study of fatal motor vehicle crashes involving 16-year-old drivers.

STUDY OBJECTIVE: Motor vehicle crashes are the leading cause of death for US teenagers, accounting for 40% of fatalities. The purpose of this study was to compare novice (aged 16 years) and experienced (aged 25 to 49 years) drivers involved in fatal motor vehicle crashes with respect to crash characteristics and driver behaviors. METHODS: This cross-sectional study of fatal motor vehicle crashes in Colorado used data from the Fatality Analysis Reporting System (1995 to 2001). Driver and crash variables were compared in the 2 age groups using separate logistic regression models, adjusted for sex, geographic locale, and year. RESULTS: Two thousand four hundred twenty fatal motor vehicle crashes were included; 158 fatalities (6.5%) were novice drivers. Novice drivers were more likely to have been speeding (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.34 to 3.08); driving recklessly (OR 4.78, 95% CI 3.31 to 6.92); charged with a traffic violation (OR 3.08, 95% CI 2.20 to 4.31); in a single-vehicle (OR 1.84, 95% CI 1.32 to 2.57), rollover (OR 1.36, 95% CI 0.97 to 1.91) or run-off-the-road (OR 1.54, 95% CI 1.03 to 2.30) crash; and carrying 2 (OR 4.52, 95% CI 2.75 to 7.41) or more (OR 4.07, 95% CI 2.49 to 6.55) passengers. Safety belt nonuse was high for novice (48%) and experienced (42%) drivers (OR 1.19, 95% CI 0.86 to 1.67). Novice drivers had older cars (mean difference 1.5 years, 95% CI 0.37 to 2.57 years). Novice drivers were less likely to be involved in crashes caused by alcohol (OR 0.24, 95% CI 0.14 to 0.41) or adverse weather (OR 0.37, 95% CI 0.19 to 0.75) and to be driving a sport utility vehicle (OR 0.62, 95% CI 0.39 to 0.97). CONCLUSION: Fatal motor vehicle crashes involving novice drivers are characterized by speeding, recklessness, single-vehicle and rollover crashes, and traffic law violations, suggesting that novice drivers bear considerable responsibility for their fatal crashes. Moreover, almost half of 16-year-old drivers involved in fatal motor vehicle crashes were not wearing their safety belts. These data may prove useful in strengthening graduated licensing laws and in improving drivers' education courses and public safety campaigns.

Accidents, Traffic↗
PubMed1980

Injury-vehicle correlations in the investigation of motor vehicle accidents.

The type and extent of medical investigation of traffic fatalities vary greatly in different areas of the United States. By participating in the investigation of automobile accidents the medical examiner or coroner has a unique opportunity to gain knowledge that is applicable to motor vehicle safety programs, medical and law enforcement education, and the safety performance of vehicles in actual crashes.

Accidents, Traffic↗
PubMed2001

Predictors of hazardous child seating behavior in fatal motor vehicle crashes: 1990 to 1998.

OBJECTIVE: Motor vehicle crashes are the leading cause of death in children ages 5 to 14. Children seated in the front seats of vehicles are at increased risk of death and injury in crashes, particularly in vehicles with passenger-side air bags. This study identifies factors associated with the seating of children in the front seats of vehicles involved in fatal crashes between 1990 and 1998. METHODS: Using 1990 to 1998 data from the Fatal Analysis Reporting System, a US census of motor vehicle crashes involving a fatality, multivariable logistic regression was used to model the association between child seating behavior and vehicle, driver, and occupant characteristics. RESULTS: The proportion of vehicles carrying children in the front declined from 42% to 31% over the 9-year period. Controlling for driver and vehicle characteristics, the risk of front-seating declined between 1990 and 1998, and this risk was smaller in vehicles carrying only younger children (</=6 years) than in those carrying older children. In the 3 years after the introduction of dual air bags into a significant proportion of the passenger fleet in late 1995, dual air bags were associated with fewer children being seated in the front seat. By the end of 1998, traveling in a vehicle with dual air bags and only children age 6 or younger was associated with a 95% lower chance of a child being seated in the front (odds ratio = 0.05; 95% confidence interval: 0.04-0.08). An important factor in safer seating position was the presence of multiple passengers, especially an older one, and children were at higher risk of front-seating when they traveled alone with the driver. CONCLUSIONS: The 1990s saw a decline in front-seating of children in vehicles involved in fatal crashes among all types of vehicles and drivers. Although this trend is encouraging, children ages 6 to 12 and children traveling alone with the driver remain at higher risk of being seated in the front. These traveling situations should be targeted for behavioral safety interventions to improve child motor vehicle safety.

Accidents, Traffic↗
PubMed1999

Organ injuries associated with femoral fractures: implications for severity of injury in motor vehicle collisions.

OBJECTIVE: To determine if motor vehicle collisions (MVCs) resulting in femoral fractures were associated with a different injury severity and pattern of injury compared with crashes in which victims did not sustain femoral fractures. METHODS: Retrospective review of seriously injured motor vehicle occupants admitted to a regional trauma unit (Hamilton General Hospital) during a 69-month period (April 1991 to December 1996) for whom detailed crash details were known. RESULTS: Data for 733 motor vehicle occupants with Injury Severity Scores greater than 12 were available; 112 occupants (15.3%) sustained femoral fractures, and 621 occupants (84.7%) did not sustain femoral fractures. Victims with femoral fractures had a significantly higher mean Injury Severity Score (29.4 compared with 25.3 for non-femoral fracture group; p<0.001). The femoral fracture group had a higher incidence of bowel (p<0.012) and hemopneumothorax (p<0.02) injuries as well as an increased incidence of upper and lower extremity (p<0.001) and pelvic (p<0.05) fractures. CONCLUSION: The presence of a femoral fracture is strongly associated with the pattern and severity of injuries sustained by occupants in MVCs. A high index of suspicion is warranted in identifying associated organ injuries in MVC victims with concomitant femoral fractures.

Accidents, Traffic↗
PubMed1997

Suicide by gunshot while driving a motor vehicle. Two additional cases.

Suicide by means of a motor vehicle occurs more frequently than is generally realized, and may be difficult to prove. Suicide by other means while driving a motor vehicle is far less frequent. Only two cases of suicide by gunshot while driving an automobile have been previously, and recently, reported. The author reports two additional cases of suicide by gunshot while driving a motor vehicle. Each case was a young man who had been suffering from depression; who obtained a firearm apparently for the express purpose of committing suicide; and who shot himself while driving a motor vehicle on an Interstate highway. Contrary to the usual finding in a series of suicides, three of the four cases now reported each left a suicide note or notes. What is apparently a fatal single-vehicle-single-occupant vehicular mishap may in fact be a suicide at the wheel by other means. What is apparently suicide by means of motor vehicle may in fact be an attempt to disguise homicide. Medicolegal offices are urged to routinely perform complete autopsies in fatal single-vehicle-single-occupant vehicular mishaps so that cause and manner of death may be documented without question.

Accidents, Traffic↗
PubMed2005

High school off-campus lunch policies and adolescent motor vehicle crash risks.

PURPOSE: To examine differences in motor vehicle crash involvement for teenagers in communities with and without school policies enabling teens to drive off campus during lunchtime. METHODS: Comparison of lunchtime motor vehicle crashes involving teen drivers in two North Carolina counties having open-lunch policies with a third county without an open-lunch policy. We also compare crash rates during the before-school period and at all times of the day in the three counties. Data were analyzed by computing rate ratios of teens' involvement in a crash during the three time periods and comparing them among the three counties. RESULTS: Crash rates over the lunch hours were significantly higher for teenagers in the counties with open-lunch policies, despite these counties having no elevated crash risk during other time periods. This resulted in a relative risk of lunchtime crash involvement of 3.10 and 2.98 (95% CI 1.97-4.89 and 1.87-4.74, respectively) compared with the county without an open-lunch policy. Number of vehicle occupants also increased during the lunch hours in the counties with open-lunch policies. CONCLUSIONS: Open-lunch policies contribute to motor vehicle crashes in teenagers and encourage a situation where there are multiple occupants per vehicle, a known risk factor for teenage motor vehicle crashes.

Accidents, Traffic↗