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Motor-vehicle collisions involving animals can result in both personal injury and property damage. In the United States, deer are a common hazard to motor vehicles and their occupants (1). This report, based on police records submitted to the Kentucky Transportation Cabinet from 1987 through 1989, characterizes motor-vehicle collisions with deer in Kentucky.
BACKGROUND: Motor vehicles are a leading cause of injury on and off the job. METHODS: To describe the occurrence of fatal motor vehicle crashes in the working-age population, a case-control study was conducted among persons 15-64 years old who died in 1986 or 1987 in any of 20 states reporting death certificate occupational data to the National Center for Health Statistics. Cases were occupants of motor vehicles (excluding motorcycles) who died of injuries sustained in a crash (E810-E825, 9th revision International Classification of Diseases), and controls died of any other cause. RESULTS: Transportation-related occupations had more than the expected number of deaths for men (odds ratio = 1.6, 95% confidence interval = 1.4-1.9) and women (odds ratio = 2.1, 95% confidence interval = 1.0-4.5), as did managerial occupations (odds ratio = 1.3 and 1.7, 95% confidence interval = 1.1-1.5 and 1.3-2.2 for men and women, respectively). Men in mining and oil drilling occupations and the wholesale trade industry also had excess crash deaths. Among women, additional excesses were observed among professional specialists and in several groups with few deaths, including agriculture, construction, and the military, whereas homemakers had markedly fewer vehicle crash deaths than expected. CONCLUSIONS: These findings encourage further investigation of this important safety hazard, but also call attention to a need for more detailed studies and improved data.
One hundred and sixty victims of motor vehicle accidents presenting to Auckland Hospital were evaluated to determine patterns of injury, overall injury severity, and outcome. Motor vehicle occupants comprised 51% of the group, pedestrians 28% and motorcyclists 21%. Mortality was 7.4%, 20% and 2.9% respectively for these three groups. The mean injury severity score was 19. Head and external injuries were common, each occurring in over 60% of all patients. In motorcyclists however, head injuries were less common (47%) (p less than 0.05) and facial injuries occurred in only 9% compared to 23% (p = ns) of the other two injury groups. Overall, severe chest or abdominal injury was present in only 16% of patients but these injuries occurred in 58% of those patients with severe head injury and extremity fractures (p less than 0.001). In motor vehicle occupants the combination of severe head injury and lower extremity fracture was associated with severe chest or abdominal injury in 8/9 patients. The patterns of injury identified here may be helpful in triaging patients to appropriate care facilities.
Injuries due to falls from moving motor vehicles have received relatively little attention from the research community. Injury events of this type in New Zealand were examined using national injury mortality and hospitalisation data from the New Zealand National Health Statistics Centre (NHSC). Also used were data obtained from the New Zealand Post Motor Registration Centre and from coroner's investigation reports held by the Department of Justice. Fifty-six fatal falls from moving motor vehicles occurred during the period 1977-1986 (0.18 per 100,000 population per year). The average age of fatalities was 23. The total potential years of life lost due to these fatalities was 2,696, or an average of 48 years per person. Thirty-nine persons (70%) fell while riding on the exterior of a vehicle. None of the 56 fatalities was using a belt restraint when he/she fell. Four hundred and twenty-three admissions to hospital occurred during 1986 and 1987 (6.5 per 100,000 persons per year). The average age of those hospitalised was 18. Incidence rates were highest in the 0-4, 15-19, and 20-24 year age groups. In the case of both deaths and hospitalisations, the incidence rate for males was approximately double the rate for females. In addition, the rate of falls (per unit registered motor vehicle) from trucks was significantly higher than the rate of falls from cars. Means of preventing falls from motor vehicles are discussed.
OBJECTIVES: To determine whether providing child motor vehicle safety recommendations on computerized discharge instructions (CDIs) were useful to parents and modified their use of child-restraint devices (CRDs). METHODS: The subjects were guardians of children seen in an urban pediatric emergency department (ED). An intervention group was given computerized ED discharge instructions that included the National Highway Traffic Safety Administration recommendations for motor vehicle CRDs. A control group was given CDIs without the recommendations. All subjects were subsequently called within four days of the ED visit and asked questions about their knowledge and use of CRDs. They also were queried if the recommendations affected their knowledge or changed their behavior. RESULTS: There were 52 subjects in the control group and 58 in the intervention group. Fifty-seven percent of the intervention group remembered reading a safety tip (p < 0.001, 95% confidence interval [CI] = 0.32 to 0.62), and 82% of that subset correctly identified it pertaining to motor vehicle safety. Forty-five percent (n = 33) of those who remembered the safety recommendation in the intervention group supported it being educational (p = 0.067, 95% CI = 0.28 to 0.64). Ten percent of the subjects in the intervention group said the CDIs changed their behavior regarding buckling-up their child, compared with 0% of the control group (p = 0.473, 95% CI = 0.05 to 0.32). CONCLUSIONS: Including CRD information on CDIs is a convenient method of educating guardians of patients about motor vehicle safety in a pediatric ED setting. The data suggest that parents find it educational and a smaller subgroup change their behaviors after receiving them.
Pedestrians account for 14% of all motor-vehicle-related deaths and approximately 3% of all motor-vehicle-related injuries in the United States. In 1992, a total of 5546 pedestrians were killed as a result of motor-vehicle crashes, and 96,000 suffered nonfatal injuries. Because of the effects of alcohol on attention, perception, vision, judgment, and motor control, intoxicated pedestrians are at increased risk for unintentional injury. Although alcohol consumption by pedestrians is an important contributing factor to motor-vehicle crashes in which pedestrians are injured, characteristics of intoxicated pedestrians who are killed as a result of such crashes have not been well defined. This report uses data from the National Highway Traffic Safety Administration's (NHTSA) Fatal Accident Reporting System for 1982-1992 to characterize intoxicated pedestrians aged > 14 years who were killed as a result of motor-vehicle-related crashes.
BACKGROUND: Although there have been numerous strategies to prevent motor vehicle collisions and their subsequent injuries, few have been effective in preventing motor vehicle injury claims. In this paper, we examine the role of legislation and compensation system in altering injury claim incidence. METHODS: The population base for our natural experiment was all Saskatchewan, Manitoba, British Columbia and Quebec residents who submitted personal injury claims to their respective motor vehicle insurance provider from 1990 to 1999. The provinces of Saskatchewan and Manitoba switched from Tort to pure No-Fault insurance on January 1, 1995 and on March 1, 1994 respectively. British Columbia maintained tort insurance and Quebec maintained pure no-fault insurance throughout the entire 10-year period. RESULTS: The conversion from tort insurance to pure no-fault motor vehicle insurance resulted in a five-year 31% (RR = 0.69; 95% CI 0.68-0.70) reduction in total injury claims per 100,000 residents in Saskatchewan and a five-year 43% (RR = 0.57; 95% CI 0.56-0.58) reduction in Manitoba. At the same time, the province of British Columbia retained tort insurance and had a five-year 5% reduction (RR = 0.95; 95% CI 0.94-0.99). Quebec, which retained pure no-fault throughout the entire 10-year period, had less than one third of the injury claims per 100,000 residents than the tort province of British Columbia. INTERPRETATION: The conversion from tort to pure no-fault legislation has a large influence in reducing motor vehicle injury claim incidence in Canada. Legislative system and injury compensation scheme have an observable impact on injury claim incidence and can therefore have significant impact on the health care system.
BACKGROUND: Pedestrian versus motor vehicle accidents are associated with substantial morbidity and mortality. Previous studies have examined pedestrian injury profiles on an individual hospital basis and have been limited by small patient populations. The objective of this study was to examine the demographics and injury profiles of pedestrian versus motor vehicle accidents in a large trauma system. STUDY DESIGN: Five thousand pedestrians injured by motor vehicles whose records were entered in a centralized county trauma database were reviewed retrospectively over 3 years. Patients were grouped by age: pediatric (less than 15 years), adult (15 to 65 years), and elderly (older than 65 years). The main outcome measures included mortality, hospital stay, ICU stay, Injury Severity Score, Glasgow Coma Scale, Revised Trauma Score, level of residual disability, and payer source. RESULTS: The pediatric group represented 38.1% of the study population, adults 53.9%, and the elderly 8.0%. Mortality was highest among the elderly (27.8%), followed by adults (8.1%) and children (3.1%). Overall, the pediatric group had the lowest Injury Severity Score (6.8 +/- 0.2, mean +/- SEM), the highest Revised Trauma Score (7.5 +/- 0.9), and the highest Glasgow Coma Scale (13.9+/-0.1). Hospital stay (4.9+/-0.2 days) and ICU stay (4.6 +/- 0.3 days) were also shortest in this age group. Among all patients, injuries included musculoskeletal (34.3%), head and neck (30.0%), external (24.4%), abdomen and pelvis (3.9%), chest (2.4%), spine (1.8%), and other (3.2%). Operations were required in 11%: orthopaedic (67%), thoracic (2%), abdominal (11%), neurosurgical or head (6%), and other (14%). At the time of discharge, 78% of patients had a temporary disability, 4% had a permanent handicap, and only 16% were functioning at preadmission capacity. Among those with identifiable payer sources, 45% were state or federal, 25% were cash or self-pay, 18% of patients belonged to an HMO or had a group carrier, and 12% were from other sources. CONCLUSIONS: This study contributes the largest database reported on motor vehicle versus pedestrian accidents and finds that these accidents are common in a large urban trauma system. Hospital stay, Injury Severity Score, Revised Trauma Score, Glasgow Coma Scale, and the mortality rate worsen with age. The high mortality rate among the elderly indicates the need for more aggressive and effective prevention efforts.
BACKGROUND: Motor vehicle crashes are the most common cause of acetabular fractures, which have been associated with significant morbidity and mortality. METHODS: To date, medical and collision information has been collected on 83 acetabular fracture patients treated at the University of Alabama at Birmingham's Level I trauma center. The fractures were grouped according to the Judet-Letournel classification scheme and investigated for correlation with age, sex, vehicle type, impact direction, and seat-belt use. RESULTS: The database included 41 women and 42 men with a combined average age of 32.8 years. Femoral shaft axis loading fractures correlated significantly with male sex, trucks, and frontal impacts. Greater trochanter loading fractures occurred statistically more frequently in side impacts. Women received a significant higher percentage of off-axis loading fractures, which were associated more in angled frontal impacts. CONCLUSION: Acetabular fracture type strongly correlated with impact direction, supporting the fracture mechanisms proposed by Judet and Letournel.
The 1988 Alternative Motor Fuels Act and the 1990 Clean Air Act Amendments require examination of the potential to favorably influence air quality by changing the composition of motor vehicle fuels. Motor vehicle tailpipe and evaporative emissions were characterized using laboratory simulations of roadway driving conditions and a variety of vehicle-fuel technologies (reformulated gasoline (RFG), methanol (M85), ethanol (E85), and natural gas (CNG)). Speciated organic compound (with Carter MIR ozone potential), CO, and NO(x) emission rates and fuel economy were characterized. The Carter MIR ozone potential of combined Federal Test Procedure (FTP) tailpipe and evaporative emissions was reduced more than 90% with CNG relative to RFG, M85, and E85 fuels. FTP toxic compound emissions (benzene, formaldehyde, acetaldehyde, and 1,3-butadiene) were greater with M85 and E85 fuels than with RFG fuel, and less with CNG fuel than RFG fuel. The most abundant toxic compound was benzene with RFG fuel, formaldehyde with M85 fuel, and acetaldehyde with E85 fuel. FTP MPG fuel economies were reduced with M85 and E85 fuels relative to RFG fuel, consistent with their lower BTU/gal. Energy efficiencies (BTU/mi) were improved with all the alternative fuels relative to RFG. Carter MIR ozone potential was generally reduced with the alternative fuels relative to RFG fuel under REP05 (high speeds and acceleration rates) driving conditions (most significantly with CNG). Toxic aldehyde emissions were reduced under REP05 conditions relative to FTP conditions with all the tested fuels, and toxic benzene emissions were elevated under high acceleration conditions.
In Taiwan, motor vehicle fatalities have increased significantly in the past two decades and are now a leading cause of mortality, especially among younger age groups. In this paper, we review vital statistics and hospital morbidity data to provide an overview of the problem of motor vehicle injuries in Taiwan and make several suggestions for improving injury surveillance.
STUDY OBJECTIVE: The identification of risk factors for recurrent motor vehicle crashes is the basis for prevention, but few studies have been published on predictors of recurrence. Our objective is to determine the main variables predicting recurrent crashes in subjects attending an emergency department (ED) for injuries after motor vehicle crash. METHODS: During a 5-year follow-up period, we studied 2,354 consecutive adult subjects treated in the ED after a motor vehicle crash in 1998. The variables of the original event were tested for predicting recurrence in a Cox proportional hazard model. RESULTS: During follow-up, 390 of 2,325 (16.8%) survivors were treated for injury after a new crash. The overall event rate was 34 per 1,000 subject-years. Four variables (age < or =32 years, male sex, nighttime crash, and blood alcohol concentration >50 mg/dL) were identified as independent predictors of recurrent crash. After adjustment for sex, age, and nighttime, alcohol was the leading predictor (relative risk 3.73; 95% confidence interval 3.00 to 4.64). In the presence of the 4 variables, the recurrence rate was as high as 145 (117 to 175) events per 1,000 subject-years, and alcohol per se accounted for more than 75% of events. In the absence of the 4 variables, the rate was as low as 11 (7 to 17) events per 1,000 subject-years. CONCLUSION: Alcohol was the most powerful behavioral factor predicting recurrent events in subjects treated in an ED for injury after motor vehicle crash, along with young age, male sex, and nighttime.
OBJECTIVES: In a cohort of 21,816 Brazilian steelworkers we found mortality from motor-vehicle injury was twice that in the State population. A nested case-control study was therefore undertaken to investigate possible socio-demographic, medical and occupational risk factors for this increased risk. METHODS: Cases were defined as all steelworkers in the cohort who died of motor-vehicle injury during employment in the period 1977-1992. For each case, four controls were selected at random from workers in the cohort who were employed at the time of death of the case, and who were born in the same year as the case. Data on socio-demographic factors, and medical and occupational histories were obtained from personnel, industrial hygiene and medical records, and the relation of these factors to risk of motor-vehicle injury was analysed using conditional logistic regression. RESULTS: In a multivariate analysis, the risk of death from motor-vehicle injury was independently associated with being unmarried (odds ratio [OR] compared to married = 3.21, 95% confidence interval [CI]: 1.84-5.59), having a hearing defect (OR = 2.28, 95% CI: 1.10-4.74) and exposure to moderate (OR = 1.71, 95% CI: 1.03-2.83) or high (OR = 2.00, 95% CI: 1.18-3.39) levels of noise at work. The risk of fatal motor-vehicle injury increased with intensity of occupational noise exposure (P = 0.004). CONCLUSIONS: The raised risk of motor-vehicle injury death associated with single marital status is likely to relate to selective factors in the types of individual who remain single, and behaviours associated with being unmarried. The raised risks in relation to hearing defects and exposure to occupational noise, factors that do not appear to have been examined previously, imply that occupational noise exposures might be a cause of fatal motor-vehicle accidents outside the workplace. This finding may have widespread public health consequences since high levels of noise in the workplace and occupationally acquired hearing deficits are prevalent in several occupations. Further investigation is needed to confirm the associated and its mechanisms and, if it is causal, to develop preventive strategies.
Motor vehicle injuries are a major harmful side effect of industrialization. We examine this relationship in a rapidly industrializing country, Taiwan, using Potential Productive Years of Life Lost (PPYLL) analysis, and suggest ways that the injury toll of industrialization might be mitigated. We also compare Taiwan to the US, Hungary, Korea, and Chile. Taiwan has a higher PPYLL per 100,000 population due to motor vehicle injury (530/100,000) than cardiac disease, cancer, or strokes. Twenty-five years ago, more PPYLL was due to cancer, strokes, cardiac disease, and tuberculosis than to motor vehicle injuries (106/100,000). Taiwan's PPYLL rate is much greater than three other industrializing countries--Chile, Korea, and Hungary--and twice that of the US. Explanations for the dramatic rise in motor vehicle injury deaths in Taiwan may be high use of motorcycles, lack of motorcycle helmets, increase in alcohol use, high care density, and road and vehicle safety design problems.
Motor vehicle occupant deaths of US children aged 0 to 12 years were analyzed. Surprisingly, the death rate is highest for children less than 6 months old: 9.0/100,000, dropping to 4.5/100,000 for 1-year-olds and about 3/100,000 for children aged 6 to 12. The second and third months of age are a period of especially high risk. More attention should therefore be focused on protecting infants from injury and death resulting from motor vehicle crashes.
This retrospective cohort study evaluated the risk of adverse pregnancy outcomes following motor vehicle crashes during pregnancy. The authors assessed outcomes of pregnant women hospitalized for motor vehicle crashes in Washington State from 1989 to 2001 (n = 582). They used the Injury Severity Score (ISS) to classify 84 severely injured (ISS > or =9), 309 non-severely injured (ISS 1-8), and 189 uninjured (ISS 0) pregnant women and compared them with pregnant women who had not been hospitalized for a motor vehicle crash (n = 17,274). Of pregnant women in motor vehicle crashes, 82.9% were hospitalized and discharged without delivering, and 17.1% delivered at hospitalization. Compared with women not in motor vehicle crashes, severely and non-severely injured women were at increased risk of placental abruption and cesarean delivery, and their infants were at increased risk of respiratory distress syndrome and fetal death. Uninjured women were also at increased risk of preterm labor (relative risk = 7.9, 95% confidence interval: 6.4, 9.8) and placental abruption (relative risk = 6.6, 95% confidence interval: 3.9, 11.2) compared with women not in motor vehicle crashes. Pregnant women hospitalized following motor vehicle crashes are at increased risk of adverse pregnancy outcomes, regardless of the presence or severity of injuries.
Carbon monoxide (CO) is a colorless, odorless, toxic gas that is a product of incomplete combustion. Motor vehicles, heaters, and appliances that use carbon-based fuels are the main sources of this poison. Most fatal unintentional CO poisonings associated with motor vehicles are preventable and can result from differing mechanisms of exposure; 1) operation of a motor vehicle with a damaged or malfunctioning exhaust system and an inadequately ventilated passenger compartment, 2) operation of a motor vehicle in an enclosed space (e.g., a garage) with inadequate ventilation, and 3) use of auxiliary fuel-burning heaters inside a passenger compartment or in a camper. This report describes the investigation of deaths associated with multiple motor-vehicle-related CO poisonings in Colorado on November 3, 1996, summarizes a review of such deaths in New Mexico during 1980-1995, and presents geographic and seasonal patterns in national death rates for 1979-1992. These findings indicate that deaths from motor-vehicle-related unintentional CO poisonings increase during winter months and that death rates from CO poisoning in stationary motor vehicles are highest in states with colder average winter temperatures.
OBJECTIVES: We sought to estimate motor vehicle passenger restraint use among Northwest American Indian children 8 years old or younger and to determine factors associated with using proper (i.e., age and weight appropriate) passenger restraint systems. METHODS: We surveyed vehicles driven by members of 6 tribes in Idaho, Oregon, and Washington. Associations between proper restraint and child, driver, and vehicle characteristics were analyzed using logistic regression for clustered data. RESULTS: We observed 775 children traveling in 574 vehicles; 41% were unrestrained. Proper restraint ranged from 63% among infant seat-eligible children to 11% among booster seat-eligible children and was associated with younger child's age (odds ratio (OR) per year = 0.60; 95% confidence interval (CI) = 0.48, 0.75), seating location (OR front vs rear=0.27; 95% CI=0.16, 0.44), driver seat belt use (OR=2.39; 95% CI=1.51, 3.80), and relationship (OR for nonparent vs parent=0.28; 95% CI=0.14, 0.58). More than half of drivers felt children could use an adult seat belt earlier than recommended guidelines, and 63% did not correctly identify whether their tribe had child safety seat laws. CONCLUSIONS: Children in these communities are inadequately restrained. Restraint use was exceedingly low among booster-eligible children and children riding with unrestrained adults. Interventions emphasizing appropriate restraint use and enforcement of passenger safety laws could reduce the risk of injury or death in motor vehicle accidents.