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PubMed1998

Visual processing impairment and risk of motor vehicle crash among older adults.

CONTEXT: Motor vehicle crash risk in older drivers has been associated with visual acuity loss, but only weakly so, suggesting other factors contribute. The useful field of view is a measure that reflects decline in visual sensory function, slowed visual processing speed, and impaired visual attention skills. OBJECTIVE: To identify whether measures of visual processing ability, including the useful field of view test, are associated with crash involvement by older drivers. DESIGN: Prospective cohort study with 3 years of follow-up, 1990-1993. SETTING: Ophthalmology clinic assessment of community-based sample. PATIENTS: A total of 294 drivers aged 55 to 87 years at enrollment. MAIN OUTCOME MEASURE: Motor vehicle crash occurrence. RESULTS: Older drivers with a 40% or greater impairment in the useful field of view were 2.2 times (95% confidence interval, 1.2-4.1) more likely to incur a crash during 3 years of follow-up, after adjusting for age, sex, race, chronic medical conditions, mental status, and days driven per week. This association was primarily mediated by difficulty in dividing attention under brief target durations. CONCLUSION: Reduction in the useful field of view increases crash risk in older drivers. Given the relatively high prevalence of visual processing impairment among the elderly, visual dysfunction and eye disease deserve further examination as causes of motor vehicle crashes and injury.

Accidents, Traffic↗
PubMed1990

Blood alcohol testing of motor vehicle crash admissions at a regional trauma unit.

Motor vehicle crashes remain a leading cause of death and injury in the industrialized world. Alcohol consumption is implicated as a major factor in fatal motor vehicle crashes (MVCs), but only poor estimates of blood alcohol concentrations among nonfatally injured crash victims are available. A 3-year study was undertaken at a Regional Trauma Unit to determine the demographics, injury severity, and alcohol positivity of motor vehicle crash victims. Between August 1, 1986 and July 31, 1989, 825 motor vehicle crash victims were available for study; 368 drivers were admitted to the unit within a period of 4 hours. Of 715 patients tested for alcohol, 31.0% were positive. A total of 333 drivers were tested for blood alcohol; 128 (38.4%) were positive. The mean blood alcohol concentration (BAC) at admission for the drivers was 145.6 mg/100 ml; the estimated mean BAC at crash was 180.9 mg/100 ml. The mean age of BAC positive drivers was 31.4 years, compared to a mean age in the BAC negative drivers of 35.2 years (p less than 0.02). Male patients represented 76.6% of the drivers, yet represented 83.6% of the BAC positive drivers (p less than 0.05). There was a marked seasonal variation in BAC positivity, with 46.1% of drivers positive during the summer months. Alcohol appears to be a significant factor in nonfatal MVCs.

Accidents, Traffic↗
PubMed1997

Migraine: a risk factor for motor vehicle driver injury?

To test the hypothesis that migraine is associated with motor vehicle driver injury, data collected from 10,529 individuals on personal history of migraine and motor vehicle injury were analysed cross-sectionally. In multiple logistic regression analyses, the adjusted odds ratio for motor vehicle driver injury associated with migraine was 2.3 [95% confidence interval (CI) 1.9-2.7]. After excluding those who also had a history of head injury, the odds ratio was 1.5 (95% CI: 1.2-2.0). These results suggest that migraine may be associated with a 50% increase in the risk of motor vehicle driver injury and that in this population may account for as many as one in every 20 motor vehicle driver injuries. These findings require confirmation in prospective studies of motor vehicle driver injuries.

Accidents, Traffic↗
PubMed2003

Responsibility of drivers, by age and gender, for motor-vehicle crash deaths.

PROBLEM: Motor-vehicle crash rate comparisons by age and gender usually are based on the extent to which drivers in a particular age/gender category are themselves injured or involved in crashes (e.g., the number of 20-year-old females in crashes). Basing comparisons instead on the extent to which drivers in various age/gender groups are responsible for deaths (including themselves) in their crashes is more revealing of their overall contribution to the problem. METHODS: Data from the Fatality Analysis Reporting System (FARS, 1996-2000) were used in the analysis, which was based on crashes that involved one or two vehicles only. Drivers in fatal single-vehicle crashes were assumed to have responsibility for the crash. In fatal two-vehicle crashes, driver operator errors reported by police were used to assign crash responsibility. RESULTS: When all crashes were considered, both the youngest and oldest drivers were most likely to be responsible for deaths in their crashes. In two-vehicle crashes, the oldest drivers were more likely than young drivers to be responsible. Young males were more likely than young females to be responsible for crash deaths, whereas females in their 50s and older were more likely than same-age males to be responsible. In terms of responsibility for deaths per licensed driver, young drivers, especially males, had the highest rates because of their high involvement rates and high responsibility rates. The majority of deaths for which young drivers were responsible occurred to people other than themselves, especially passengers in their vehicles, whereas the bulk of the deaths for which older drivers were responsible were their own. DISCUSSION: The results highlight the contribution of young drivers to the motor-vehicle crash problem, the need for measures such as passenger restrictions in graduated licensing systems, and the need for vehicle modifications to better protect older occupants.

Accidents, Traffic↗
PubMed2004

Motor vehicle deaths in Hong Kong: opportunities for improvement.

OBJECTIVE: This study was undertaken to describe the epidemiology of motor vehicle mortality in Hong Kong, and to assess its impact on trauma service delivery. SETTING: Hong Kong has an area of 1,072 km2 and a population of 6,800,000. There were 500,000 registered vehicles in 2001. METHODS: All motor vehicle deaths must be reported to the coroner in Hong Kong. A manual retrospective review of all coroner case notes involving motor vehicles for 2001 was performed. RESULTS: The review identified 165 cases involving 111 male and 54 female patients. Elderly cases were predominant, with 37% of the cases involving individuals older than 60 years. Most of the cases involved pedestrians (59%), and half of these pedestrians had experienced collisions with public light buses and trucks. Alcohol was not commonly involved, and when it was, it was isolated to the group 20 to 40 years of age. Most individuals died of major head injury alone or multiple injuries. There were very few major vessel injuries, and these included 13 aortic transections. DISCUSSION: Hong Kong has a very low motor vehicle death rate relative to its population (2.4 per 100,000), but the rate is less impressive when it is related to motor vehicle registrations (33 per 100,000 vehicles). The low incidence of motor vehicle trauma has implications for trauma service delivery in terms of trauma expertise and specialization. Despite the low incidence of trauma, there still are opportunities for prevention, especially in relation to elderly pedestrians and public light buses.

Abdominal Injuries↗
PubMed2006

Psychiatric morbidity following motor vehicle crashes: a pilot study from India.

BACKGROUND: Motor vehicle crashes can result in significant posttraumatic psychiatric morbidity. While the psychological impact of major disasters has been extensively studied in developing nations, psychological distress resulting from personal disasters such as road traffic crashes is sadly lacking. METHOD: Thirty inpatients who had been involved in a motor vehicle crash, either as a driver, passenger, or pedestrian, were assessed for psychiatric morbidity using the Hospital Anxiety and Depression Scale and the Impact of Events Scale. We also studied the influence of various sociodemographic factors and peritraumatic emotional experiences on the development of psychological symptoms. RESULTS: Of the 30 patients, 57% had anxiety or depressive symptoms, 30% had an anxiety or depressive disorder, and 20% had posttraumatic stress disorder. It was also observed that peritraumatic emotions seemed to determine the type and severity of psychiatric symptoms that patients experienced. CONCLUSIONS: This study found that more than half of the victims of motor vehicle crashes in the sample suffered from some form of psychiatric morbidity. With rising industrialization and motorization in developing countries, the number of victims of motor vehicle crashes is bound to increase. Adequate attention to psychiatric interventions in the provision of emergency and trauma services could help prevent significant disability.

Accidents, Traffic↗
PubMed1997

[Observation on surface characters of particles emitted from gasoline and diesel motor vehicle].

Surface compositions and morphological features of particles emitted from gasoline and diesel motor vehicle in Taiyuan were observed by scanning electron microscopy equipped with an energy dispersive X-ray spectrometer. The results showed that the surface of particles from gasoline motor vehicle contained larger amount of lead, amounting to 22.5% (average) among 15 elements measured; whereas the particles from diesel motor vehicle contained less lead, amounting to only 8%. But the size from diesel motor vehicle particle was smaller than those from gasoline motor vehicle, < or = 2 microns particles amounted to 73% and 62% of the total particles, respectively. The shapes of particles were irregular, with rough multiple-porous surface. The morphological features of particles from both motor vehicles were similar.

Particle Size↗
PubMedDate not supplied

Preparing and presenting an introductory course on motor vehicle injury.

Health professionals are key to any progress in reducing motor vehicle injury and death, yet they have been slow to recognize their role in this important area. One factor contributing to this problem has been the absence of courses on motor vehicle injury from the curriculums of the health professions schools. A comprehensive course on motor vehicle injury and death was developed, presented, and evaluated at the University of Illinois at Chicago School of Public Health. The major course objectives were for students to (a) comprehend that highway injury is a major public health problem, (b) understand that this problem can be mitigated by proven public health techniques, and (c) understand and be able to implement multidisciplinary solutions. It was hoped that students would champion the prevention of motor vehicle injuries as a high priority for public health agencies and other professional and community organizations. The course has now been presented twice. A teaching guide was prepared and was reviewed by faculty at 13 schools of public health. This guide discusses practical aspects of introducing and implementing this type of course, overall course objectives, specific learning objectives, a model curriculum (with suggested readings) for nine topic areas, materials from which transparencies or slides could be made, and a geographic listing of resource persons. The objectives for the guide were for it to be a practical model for a motor vehicle injury course and to acquaint health professions faculty with the resources available to them for course development, as well as with a network of professionals who are willing to aid them in their efforts. The guide is not a programmed learning text or a collection of canned lectures, but rather it is intended to provide a framework and encouragement to those at other institutions who seek to develop such a course.

Accidents, Traffic↗
PubMedDate not supplied

Particulate air pollution from motor vehicles: a putative proallergic hazard?

Air pollution generated from motor vehicle exhaust has become a major cause for scientific and public concern worldwide over recent years. The rapid and marked increase in the motor vehicle traffic and its associated emissions in urban areas have paralleled a sharp increase in the prevalence of allergic diseases such as asthma and rhinitis. Epidemiological studies have demonstrated a strong association between people living in close proximity to roads with high traffic density and increased allergic symptoms, reduced lung function and increased sensitization to common aeroallergens. Several laboratory-based studies have demonstrated that pollutants emitted from motor vehicles can induce allergic inflammation and increase airway hyperresponsiveness, which may provide an underlying mechanism for the increasing prevalence of allergic diseases. Although the detrimental effects of air pollution on human health have been brought to public attention, it appears that less attention has been given to the potential role of road traffic fumes in the induction of the allergic state. Legislators should consider pollutants emitted from motor vehicle exhausts as a potential pro-allergic hazard, before making important changes in environmental policy.

Humans↗
PubMed2003

Characterization of fatal occupational versus nonoccupational motor vehicle collisions in Kentucky (1998-2000).

Motor vehicle collisions (MVCs) are the leading cause of occupational fatalities in Kentucky as well as in the nation. The characteristics of and contributing factors for occupational versus nonoccupational MVC fatalities in the Commonwealth of Kentucky were examined from 1998 to 2000. Semi trucks were most frequently involved in fatal occupational MVCs, and passenger cars were most frequently involved in nonoccupational MVCs. More than half of the decedent drivers resided outside of Kentucky. The percentage of occupational fatalities occurring on a four-lane highway was double the percentage observed for nonoccupational MVC fatalities. In addition, an increased proportion of occupational MVC deaths occurred on limited access highways compared to nonoccupational fatalities. When human factors contributing to these fatal incidents were examined, the two primary human factors involved in occupational motor vehicle fatalities were driver distraction/inattention and falling asleep, whereas unsafe speed and alcohol were the primary human factors contributing to a nonoccupational fatality. These results suggest that semi drivers traveling on four-lane highways are more at risk for a fatal occupational injury in Kentucky. Therefore, additional epidemiological studies are needed to further examine human factors, the nature of the Kentucky highway system, and trucking controls (e.g., weigh station hours of operation) within the Kentucky transportation industry.

Accidents, Occupational↗
PubMed1998

Effect of impact and injury characteristics on post-motor vehicle accident temporomandibular disorders.

OBJECTIVES: The objective of this study was to assess the potential effects of motor vehicle accident impact and injury characteristics on post-motor vehicle accident temporomandibular disorders in terms of presenting signs and symptoms, diagnoses, treatment regimens, and outcomes. STUDY DESIGN: A retrospective chart review of 50 patients with post-motor vehicle accident temporomandibular disorders from a private oral medicine practice was undertaken. Various demographic data and data related to temporomandibular disorders and motor vehicle accident impact and injury characteristics were collected. Chi-square and Fisher exact tests and multiple regression analyses were performed. RESULTS: Patients involved in front-end collisions or motor vehicle accidents resulting in severe vehicle damage reported more direct orofacial injury. However, those in rear-end collisions or accidents resulting in minimal vehicle damage required more treatment. Direct head or orofacial injury was therefore not a prognostic indicator. From multiple regression analyses, indicators of a poorer prognosis were minimal vehicle damage, lack of headrest use, driver position, and settlement of insurance claim. CONCLUSIONS: In this patients group several prognostic indicators for patients with post-motor vehicle accident temporomandibular disorders were identified; these indicators may influence the management approach for this patient population.

Accidents, Traffic↗
PubMed1996

Analysis of Hispanic motor vehicle trauma victims in Illinois, 1991-1992.

OBJECTIVE: 1) To develop a profile of Hispanic motor vehicle trauma victims in Illinois, 2) to ascertain whether differences exist between Hispanic and general-Illinois-population motor vehicle trauma victims, and 3) to identify potential target areas for future injury intervention programs. METHODS: A retrospective analysis of Illinois motor vehicle trauma patients admitted from July 1991 to June 1992 was made. Participants were motor vehicle trauma victims (drivers and passengers) who presented to one of 73 level I or level II trauma centers throughout Illinois and were entered into the Illinois Trauma Registry (ITR) from July 1, 1991, through June 30, 1992. RESULTS: Of the 12,299 motor vehicle trauma victims in the ITR, 771 (6.3%) were Hispanic, 8,979 (73.0%) were white, 1,115 (9.1%) were black, and 1,434 (11.6%) were other. When compared with the other racial groups, the group of Hispanic victims were younger (25.2 vs 33.2 years), had higher male predominance (72.8% vs 60.9%), and had the lowest rate of safety equipment/occupant restraint use (21.7% vs 34.7%). A high alcohol use rate (30.7%) and high mean serum ethanol levels (44 mmol/L; 0.2 mg%) were noted. When contrasted with other racial/ethnic groups, the Hispanic victims had lower Injury Severity Scale scores (p < 0.001), but mean hospital charges tended to be higher, with fewer alternative sources of payment (p < 0.001). CONCLUSION: Using age-adjusted data from the ITR, Hispanic motor vehicle trauma victim features differ significantly from those of other racial groups. Effective health maintenance and injury prevention strategies should address the basis for these differences.

Accident Prevention↗
PubMedDate not supplied

Preliminary evaluation of wheelchair occupant restraint system usage in motor vehicles.

Individuals using wheeled mobility devices (WMDs) often use them as motor vehicle seats during transportation. Wheelchair occupant restraint systems (WORSs), consisting of upper torso and pelvic restraints, are usually mounted to the structure of transit vehicles to secure individuals within their wheelchair seats. This preliminary study attempts to evaluate the use and satisfaction of currently installed vehicle-mounted WORSs for individuals using WMD as seats in motor vehicles. A survey was conducted among 33 adults who use their WMD to travel in motor vehicles. Results from the survey showed that upper torso and pelvic restraints installed in private vehicles are quick, comfortable, and easy to use. However, WORS installed in mass transit and paratransit are often uncomfortable to wear, difficult to reach, and time-consuming to use. This preliminary study documents the growing need for developing alternative WORS that are safe, comfortable, and that allow independent usage for wheelchair occupants while traveling in a motor vehicle.

Accident Prevention↗
PubMed1992

Fracture patterns and mechanisms in pedestrian motor-vehicle trauma: the ipsilateral dyad.

Pedestrians struck by motor vehicles have the highest mortality and morbidity rates of all motor-vehicle traumas. Fracture patterns and mechanisms were reviewed in a retrospective study of 115 consecutive patients. The most common fracture was tibia-fibula (39 patients), followed by pelvic (35 patients) and femur fractures (31 patients). A majority (90%) of long-bone fractures were the result of a direct-blow mechanism, and pelvic fractures were caused usually by lateral-compressive forces. Unstable pelvic and femur fractures both correlated with mortality (p less than 0.05), whereas tibia-fibula fractures (open or closed) did not. The triad of head, pelvis, and knee injuries traditionally associated with pedestrian motor-vehicle accident (MVA) victims was not found to occur with any statistical significance in this study group. Several characteristic fracture patterns were discovered: femur fractures associated with an accompanying pelvic fracture, and the ipsilateral dyad, an upper- and lower-extremity fracture on the same side, were found to occur with statistical significance (p less than 0.05). A lower extremity fracture warrants particularly close attention to the examination of the corresponding upper extremity, and a femur fracture should alert the clinician to the possibility of pelvic injury. The ipsilateral dyad has not been described previously in the literature and should be appreciated by physicians evaluating and treating pedestrian MVA victims.

Accidents, Traffic↗
PubMed2003

A small area study of motor vehicle crash fatalities in Alberta, Canada.

This study examined the small area variation in motor vehicle crash fatality rates in the province of Alberta, Canada. Motor vehicle crash fatality rates per 100000 population (1995-1997, inclusive) were determined for five geographic areas in the province. The rates showed substantial, statistically significant variation across areas, with fatality rates lowest in the urban areas of Calgary and Edmonton, and highest in the rural areas (south, central, and northern Alberta). Examination of area-level predictors-population density, impaired driving citation rates, education level, unemployment levels, and ethnicity-showed that population density and impaired driving rates were associated with motor vehicle crash fatality rates. There was a five-fold difference in annual motor vehicle crash fatality rates between rural (22.9/100000) and urban areas (4.4/100000), whereas annual impaired driving rates were around 1.8% in rural areas, compared with 0.6% in urban areas. Because of multicollinearity problems, it was not possible to estimate a multivariable Poisson regression model. In conclusion, rural areas in the province of Alberta demonstrate a significantly higher motor vehicle crash fatality rate, compared with urban areas.

Accidents, Traffic↗
PubMed2004

Motor vehicle fatalities among men in the U.S. Army from 1980 to 1997.

This retrospective cohort study compared trends in motor vehicle occupant fatalities among men in the Army with men in the civilian U.S. population. Motor vehicle fatality rates from 1980 to 1997 indicated both groups showed declines in fatality rates. The overall age-adjusted motor vehicle fatality rate for 17- to 44-year-old males in the Army fell from 40.8 to 20.6 per 100,000, a 49.5% decline. In the U.S. population, the rate dropped from 38.1 to 23.3 per 100,000 for a 38.8% decline. Deaths from motor vehicle crashes fell by almost 50% in the Army during the study period; however, motor vehicle crashes remain the leading cause of death for the Army. U.S. military policies and law enforcement have the potential to make even further gains in reducing motor vehicle crashes and injuries among military personnel.

Accidents, Traffic↗
PubMed1988

Occupational motor vehicle injury morbidity among municipal employees.

Injury related to motor vehicle use among Baltimore City employees was examined throughout a 34-month period. Among an average of 30,000 municipal employees; representing 7% of the total Baltimore work force, almost 2% of all city employees were injured by motor vehicles each year. Twelve percent of all injuries and 16% of the injury costs were attributable to motor vehicles. In the police department, 43% of all costs were vehicle-related. Compared with other departments, the rate of motor vehicle-related injury was more than 4 times as high in the department of public works and twice as high in the police and fire departments. Injuries related to police cars and department of public works trucks occurred at an annual rate of more than 14 per 100 vehicles. Detailed review of injuries that occurred in 1984 suggests the need for greater seat belt use, built-in crash protection, and designs to reduce falls from trucks.

Accidents, Traffic↗
PubMed2002

Motor vehicle restraints: primary versus secondary enforcement and ethnicity.

BACKGROUND: Efforts to increase motor vehicle restraint use have been broadly based rather than focused on specific populations. Identifying specific issues, including populations with low restraint use, can help target educational campaigns. Previous studies have reported differences in restraint use by ethnicity. This study was performed to determine whether differences exist in motor vehicle restraint use by ethnicity and whether these differences are altered by the presence of primary versus secondary restraint laws. METHODS: Data were collected on motor vehicle crash victims admitted to two Level I trauma centers from October 1, 1997, through March 31, 1998; one in a state with primary restraint enforcement (motorist can be stopped for the restraint violation), the other with a secondary restraint law (restraint violation may be enforced if the motorist is stopped for another violation). Data were obtained concurrently with hospitalization and entered into computerized trauma registry databases. RESULTS: Restraint use in all motor vehicle crash victims was significantly different between the primary and secondary enforcement states (58% vs. 37%, p < 0.001). Additionally, restraint use varied markedly by ethnicity in the secondary enforcement state (Caucasian, 42%; vs. African-American, 21%, and Hispanic, 26%, p < 0.02, chi(2)). Comparison of restraint use in primary versus secondary enforcement states demonstrated significantly increased restraint use in all ethnic groups (p < 0.01). CONCLUSION: In a state with secondary enforcement laws, restraint use varied significantly with ethnicity. Restraint use was markedly increased in all ethnic groups by the presence of a primary enforcement law. Implementation and enforcement of primary restraint laws is essential to improving motor vehicle restraint use. Educational campaigns to increase restraint use need to target specific populations.

Accidents, Traffic↗