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PubMed2003

[An epidemiological study of 2,353 patients injured in motor vehicle accidents].

OBJECTIVE: To investigate the clinical conditions of the in-patients with motor-vehicle injury and survey the distribution features of the injuries. METHODS: The clinical records of 2,353 patients with motor-vehicle injuries who were hospitalized in a hospital in Shaoyang City of Hunan Province, China, within the period from 1997 to 2001, were collected and surveyed. The patients were diagnosed according to International Classification of Diseases-9th Revision (ICD-9) codes and statistical analysis was performed in an attempt to define the injury features of this cohort of patients. RESULTS: The patients with motor-vehicle injuries took up a fraction 3.16% of the total in-patients treated in this hospital (74,368) within the defined period, with a male to female ratio of 2.37:1.00. Subjects in the age range of 15 to 44 years were most likely to be involved in the accidents (55.9%), and in terms of occupation, farmers who lived outside the urban regions had the highest ratio in the total injured patients (34.0%). In the motor-vehicle accidents, the major injuries occurred in the head, usually with moderate severity when admitted into hospital (69.9%). CONCLUSION: Traffic accident is a crucial public health issue that severely affects the life quality of the wounded. Effective legislation and regulations should therefore be instituted, and relevant health education program be launched to control and prevent the occurrence of these accidents.

Accidents, Traffic↗
PubMed2001

Intoxicated motor vehicle passengers: an overlooked at-risk population.

HYPOTHESES: Intoxicated motor vehicle passengers are similar to intoxicated drivers in recurrent health care encounters and risk of death for 5 years after injury. Intoxicated passengers have a greater risk of death than population controls. DESIGN: Historical cohort study. SETTING: University-based level I trauma center. PARTICIPANTS: Motor vehicle crash victims admitted to a level I trauma center in 1993. MAIN OUTCOME MEASURES: Recurrent hospitalization, emergency department visits, survival analysis, and standardized mortality ratios for 5 years following injury. RESULTS: More than one quarter of intoxicated passengers and drivers had recurrent hospitalizations and emergency department visits. Intoxicated occupants were more likely to return to the hospital and the emergency department than nonintoxicated controls (odds ratios, 2.0 and 2.7, respectively). Intoxicated passengers were at increased risk of dying compared with nonintoxicated occupants (P = .008) and with the general population (standardized mortality ratio = 5.8). Intoxicated occupants were more likely to die an alcohol-related death (P< .001). CONCLUSIONS: Intoxicated passengers injured in a motor vehicle crash are similar to intoxicated drivers in recurrent hospitalizations and emergency department visits. Intoxicated passengers have an increased mortality rate in the 5 years following injury.

Accidents, Traffic↗
PubMed2006

Severity of alcohol-related motor vehicle crashes in British Columbia: case - control study.

The objective of the present study was to compare the injury severity and vehicle damage severity rates of alcohol-related crashes with rates of non-alcohol-related crashes in British Columbia (BC). Injury severity rates and vehicle damage severity rates were taken from 2002 Insurance Corporation of British Columbia traffic collision data. The data were computed in order to compare the differences in injury severity and vehicle damage severity rates of alcohol-related vs. non-alcohol-related motor vehicle crashes. Case - control methods were used in this study to analyse the risk of alcohol-related crashes compared to non-alcohol-related crashes in BC. Odds ratios (OR) and 95% CI were calculated to estimate relative risks. In the case - control analysis, the risk of fatal collision was increased for those drinking and driving compared with those driving sober (OR 4.70; 95% CI 3.15 - 7.01). Risk of injury collision was increased for those drinking and driving compared with those driving sober (OR 1.32; 95% CI 1.19 - 1.37). Importantly, the risk of vehicle damage severity was increased for those drinking and driving compared with those driving sober (write-off vehicle OR 4.24; 95% CI 3.70 - 4.86, severely damaged vehicles OR 1.98; 95% CI 1.77 - 2.21). The study reinforces existing literature to suggest that current evidence is sufficient to show an increased risk of injury and fatality to drivers and occupants in alcohol-related crashes. This paper not only emphasizes this well-known relationship, but also such consequences as increased vehicle damage severity. The connection between drinking and severity of motor vehicle crashes is popularly believed and has now received substantial scientific support. There is strong justification for injury prevention experts and policy-makers to step up motor vehicle crash injury prevention advocacy by implementing evidence-based policies to reduce rates of alcohol-impaired driving in the province of BC. Most unintentional injuries in BC are related to motor vehicle crashes. Significant improvements can be made in these statistics by: increasing the use of occupant protection (safety belt and child restraint seats); reducing alcohol-related injuries through multiple strategies including corrections in the physical environment, extensive enforcement of drinking and driving laws and health promotion/education.

Accidents, Traffic↗
PubMed1989

Regional variation in motor vehicle accident reporting: findings from Massachusetts.

Differences in motor vehicle crash reporting may affect geographic comparisons of motor vehicle crash rates. Substantial differences have been reported between nations and, within the United States, between states, but little is known about more localized differences. Data from Massachusetts' 45 largest municipalities indicate substantial local variation in the percentage of reported injury-producing crashes for which a police report is available, from fewer than 20% in the lowest decile to more than 85% in the highest. For a given municipality, the percentage of crashes with police reports in 1979 was highly predictive of the percentage with police reports in 1983.

Accidents, Traffic↗
PubMed1989

Injury and cost comparison of restrained and unrestrained motor vehicle crash victims.

The use of active motor vehicle restraints is a topic of current public and legislative debate. To better define the effects of restraint systems on injury severity, the following study was undertaken. Parametric statistical tests were used for data analyses. For a 6-month period beginning February 1, 1987, all motor vehicle crash victims treated in the emergency unit were entered into the study (n = 613). There were 290 unrestrained subjects (UR), 254 restrained subjects (R), and 69 were excluded because restraint usage information was unobtainable. Unrestrained victims were younger (mean age, UR = 28, R = 32; p less than 0.05), and were more often male (UR = 65%, R = 51%; p less than 0.05). Hospitalization was more frequently required for unrestrained crash victims (UR = 59%, R = 26%; p less than 0.05). Length of hospital stay (LOS), including ICU confinement, was also extended (mean LOS, UR = 13, R = 10), but this difference did not reach statistical significance. Injury Severity Scores (ISS) and Abbreviated Injury Scales (AIS) were tabulated and compared. Mean ISS was significantly higher for unrestrained victims (UR = 8.28, R = 4.44; p less than 0.05), and a higher proportion of unrestrained victims had scores greater than 15 (UR = 20%, R = 7%; p less than 0.05). Mean AIS was higher in all regions, although the difference did not consistently reach statistical significance.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Traffic↗
PubMed1994

Motor vehicle occupant injuries in New Zealand children, 1981-90.

AIM: To determine the incidence of motor vehicle occupant injuries in New Zealand children and to consider future directions for prevention. METHODS: The Ministry of Health's national mortality and morbidity files for the years 1981-1990 were examined to identify all deaths and hospital discharges for motor vehicle occupant injuries in children between the ages of 0-14 years. RESULTS: Over the 10 year period, there was an average of 26 deaths and 433 hospitalisations annually. Fatality rates were highest for the age group 0-2 years, whereas hospitalisation rates were highest for those aged 3-4 years. Although mortality rates were similar for Maori and nonMaori children, the hospitalisation rate for Maori children was more than three times that for nonMaori children. No significant trends in either fatality or hospitalisation rates were evident. DISCUSSION: Motor vehicle occupant injury is an important public health problem in New Zealand children. Reductions in the numbers of motor vehicle occupant deaths and hospitalisations will require not only legislative changes aimed at increasing restraint use, but also the development of strategies to ensure compliance with the legislation. The identification of barriers to the use of child restraints is likely to facilitate the development of effective strategies aimed at increasing occupant restraint use.

Accidents, Traffic↗
PubMed2001

Pedestrians who required admission to hospital after collisions with motor vehicles in Sweden from 1987 to 1994.

OBJECTIVES: To report the incidence, range of injury, medical consequences, and mortality of pedestrians in collisions with motor vehicles in Sweden. DESIGN: Retrospective case study. SETTING: The Swedish Hospital Discharge Register (SHDR). SUBJECTS: 8684 pedestrians in collisions with motor vehicles had a total of 12,036 episodes treated in Swedish hospitals from 1987-1994. INTERVENTIONS: Statistical analysis of the Register. MAIN OUTCOME MEASURES: Incidence of pedestrians in collisions with motor vehicles in Sweden, mortality, range of injuries, and medical consequences. RESULTS: From 1987 to the end of 1994, a total of 8684 pedestrians were admitted to Swedish hospitals after collisions with motor vehicles. A mean of 17.6 persons were admitted/100,000 population/year. In all there were 12,036 admissions of injured pedestrians. There were 4593 men (53%) and 4091 women (47%), with a median age of 47 (range 1-100) years. The annual incidence of injured pedestrians (both men and women) decreased significantly during this period. Injuries to the extremities were commonest (39% fractures), followed by injuries to the head and neck (34%). The total number of deaths in our series of patients was 444 (5%). Of these, more than half had head injuries, 22% had fractures, and 5% abdominal or thoracic injuries. CONCLUSION: The number of pedestrians in collisions with motor vehicles is low in Sweden. Injuries to the extremities were commonest, followed by injuries to the head and neck. Old people were most likely to be injured and 5% of the patients treated in hospital died.

Accidents, Traffic↗
PubMed2005

Temporal factors in motor vehicle crash deaths.

OBJECTIVE: To summarize fatal motor vehicle crash deaths in the United States by time of day, day of week, month, and season, and to determine why some days of the year tend to experience a relatively high number of deaths. METHOD: Crash deaths were identified and categorized using the Fatality Analysis Reporting System. Days of the year with relatively high crash deaths were compared to the two days that occurred exactly one week before and one week after. RESULTS: On average, motor vehicle crashes in the United States result in more than 100 deaths per day, but there is much day-to-day variability. During 1986-2002 the single day fatality count ranged from a low of 45 to a high of 252. Summer and fall months experience more crash deaths than winter and spring, largely due to increased vehicle travel. July 4 (Independence Day) has more crash deaths on average than any other day of the year, with a relatively high number of deaths involving alcohol. January 1 (New Year's Day) has more pedestrian crash deaths on average, plus it has the fifth largest number of deaths per day overall, also due to alcohol impairment. On other days the high numbers of deaths are likely due to increases in holiday or recreational travel. CONCLUSION: Every day of the year results in many crash deaths, but certain days stand out as particularly risky. The temporal and geographic spread of crash deaths, as well as the view of driving as a routine task, inures the public to this continuing problem. Innovative strategies are needed both to raise awareness and to work toward a solution.

Accidents, Traffic↗
PubMed1987

Injury patterns in motor vehicle fatalities.

A retrospective pilot study of motor vehicle incident fatalities was conducted to determine what relationships exist between injuries received by deceased drivers, passengers, and a control population of pedestrians, and some of the environmental factors existing at the time of the incident. A number of correlations were established between the types and locations of injuries received, seat belt use, position of the injured party, and so forth. A study of this type, if performed on a large enough population, could lead to predictive models for the determination of position of the victims within a motor vehicle at the time of a fatal crash, based on a unique clustering of injuries.

Abdominal Injuries↗
PubMed1993

Undiagnosed post-traumatic stress disorder following motor vehicle accidents.

OBJECTIVES: To determine the pattern of emergence of post-traumatic stress disorder (PTSD) among motor vehicle accident victims and to examine the influence of PTSD on subsequent levels of disability. DESIGN: A longitudinal study of motor vehicle accident victims one month and 18 months after the accident. SUBJECTS: Twenty-four motor vehicle accident victims admitted by the trauma team at the Royal Adelaide Hospital. A 52% response rate was achieved. MAIN OUTCOME MEASURES: Post-traumatic stress disorder as diagnosed by the Diagnostic Interview Schedule and disability as measured with the Sickness Impact Profile. RESULTS: Eighteen months after their accidents, six of the 24 subjects had clinically significant PTSD and one was considered borderline. None had been previously diagnosed or treated. The group with PTSD had higher scores on all measures of psychological distress one month after the accident and were more likely to use immature psychological defences. There was no association between physical outcome (measured with the modified Glasgow Outcome Scale) at six months and subsequent diagnosis of PTSD. However, the group with PTSD had higher levels of disability on assessment with the Sickness Impact Profile, particularly in the domain of social functioning. The results suggest PTSD was associated with work-related dysfunction equal to that associated with severe physical handicap. CONCLUSION: The data from this pilot study suggest that PTSD after motor vehicle accidents is an important cause of disability, which may also become the focus for damages in litigation. Thus, there is a need for further investigation of the early patterns of distress and to design preventive programs for victims of road accidents.

Accidents, Traffic↗
PubMed1990

Acquired maxillofacial defects from motor vehicle accidents: statistics and prosthodontic considerations.

Trauma from motor vehicle accidents is one of the leading causes of death in the United States; moreover, the costs related to personal harm are only second to cancer. Head and neck injuries predominate and involve contact with the vehicle's interior (80%), contact with the vehicle's exterior (12%), or noncontact with the vehicle (8%). The patient with maxillofacial defects resulting from motor vehicle accident will have numerous soft tissue and hard tissue injuries ranging from neurologic involvement to fractures and/or avulsions of the temporomandibular joint, maxillae, mandible, teeth, and supporting structures. Tooth avulsions, pulpitis, and fractures without pulpitis have been found in a 4:2:1 ratio. The prosthodontist plays an important team role by anticipating the increased functional demands that may be placed on the required prostheses and by anticipating the preprosthetic procedures and counseling that may be necessary to assist in the total treatment.

Abbreviated Injury Scale↗
PubMed2000

Performance of persons with juvenile-onset amputation in driving motor vehicles.

OBJECTIVE: To study the driving of motor vehicles by persons with juvenile-onset amputation and to compare the percentage of drivers among them with that found in the general population. DESIGN: A follow-up study of subjects who were younger than 18 years of age at amputation and who underwent one-sided amputation, covering the period 1976 to 1996. SETTING: The Prosthesis Service of the Asturias Central Hospital, Spain. SUBJECTS: A total of 236 juvenile amputee patients. RESULTS: The percentage of women with amputations who drive is lower than that of their male counterparts (p<.05). The percentage of drivers with upper limb amputations is greater than that of drivers with amputation of the lower limb (p<.05). Motor vehicle adaptations were used more frequently by people with upper limb amputations (p<.05). The ability to drive was not affected by the etiology or the side of amputation, or by the use of a prosthesis. The level of amputation affected driving ability in cases of amputation of the lower limb, but not in those of amputation of the upper limb. CONCLUSION: The percentage of persons with juvenile-onset amputation who drive (47.4%) is similar to that found in the general population (40.8%), and the use of a prosthesis does not have any influence on the capacity to drive a car--89.2% of drivers and 93.5% of nondrivers used a prosthesis.

Adult↗
PubMed2002

Impact of cataract surgery on motor vehicle crash involvement by older adults.

CONTEXT: Motor vehicle crash risk in older drivers is elevated in those with cataract, a condition that impairs vision and is present in half of adults aged 65 years or older. OBJECTIVE: To determine the impact of cataract surgery on the crash risk for older adults in the years following surgery, compared with that of older adults who have cataract but who elect to not have surgery. DESIGN, SETTING, AND PATIENTS: Prospective cohort study of 277 patients with cataract, aged 55 to 84 years at enrollment, who were recruited from 12 eye clinics in Alabama from October 1994 through March 1996, with 4 to 6 years of follow-up (to March 1999). MAIN OUTCOME MEASURE: Police-reported motor vehicle crash occurrence involving patients who elected to have surgery compared with those who did not. RESULTS: Comparing the cataract surgery group (n = 174) with the no surgery group (n = 103), the rate ratio for crash involvement was 0.47 (95% confidence interval, 0.23-0.94), adjusting for race and baseline visual acuity and contrast sensitivity. The absolute rate reduction associated with cataract surgery was 4.74 crashes per million miles of travel. CONCLUSIONS: In our sample, patients with cataract who underwent cataract surgery and intraocular lens implantation had half the rate of crash involvement during the follow-up period compared with cataract patients who did not undergo surgery. Cataract surgery thus may have a previously undocumented benefit for older driver safety, reducing subsequent crash rate.

Accidents, Traffic↗
PubMed2006

The employer costs of motor vehicle crashes.

The latest published estimate of the cost of US motor vehicle crashes to employers is for 1989. This study estimates annual employer costs in 1998-2000. Incidence was estimated with occupational injury data and motor vehicle crash data for 1998-2000. Employer costs were estimated from Federal estimates of crash costs by source of payment using data on the percentage of varied payment streams (e.g. health insurance, sick leave) paid by employers. Motor vehicle crash injuries on and off the job cost employers almost $60 billion annually, including $16.3 billion in fringe benefit costs; $25.2 billion in property damage, workplace disruption and other non-fringe costs; and $18.4 billion in wage-risk premiums. Traffic safety programmes can reduce the fringe benefit bill without reducing the benefits offered to employees. Eliminating alcohol-impaired and unrestrained driving would save employers $15.2 billion annually.

Accidents, Traffic↗
PubMed1998

Benzodiazepine use and motor vehicle accidents. Systematic review of reported association.

OBJECTIVE: To examine the relationship between benzodiazepine (BZD) use and motor vehicle accidents (MVAs). DATA SOURCES: MEDLINE was searched from 1980 to 1997 using the key words traffic accidents or motor vehicle accidents and benzodiazepines (and alternative terms and outcomes) in English, German, French, or Italian. STUDY SELECTION: Case-control studies of BZDs and MVAs; police or emergency studies of BZD use among travelers; driving tests with subjects taking BZDs. Outcomes were impaired driving, accidents; mortality; postaccident medical attention, emergency ward care, or hospitalization. Quality criteria were whether all driving BZD users and non-users had an equal chance of entering the study; whether medication dosage and timing were ascertained; whether all kilometres driven by BZD users and non-users were studied; whether all types of accidents were ascertained; and whether medical conditions were controlled for. SYNTHESIS: In case-control studies, the odds ratios for mortality and emergency medical treatment ranged from 1.45 to 2.4 in relation to time of use and quantity of drug taken. In police and emergency ward studies, BZD use was a factor in 1% to 65% of accidents (usually 5% to 10%). In two studies where subjects had blood alcohol concentrations less than the legal limit, BZDs were found in 43% and 65% of subjects. In one study with controls, 5% of drivers and 2% of controls in accidents had used BZDs. CONCLUSIONS: Case-control studies suggest using BZDs approximately doubles the risk of motor vehicle accidents. The risk for drivers older than 65 of being involved in reported motor vehicle collisions is higher when they take longer-acting and larger quantities of BZDs.

Accidents, Traffic↗
PubMed2000

Motor vehicle crash characteristics and medical outcomes among older drivers in Utah, 1992-1995.

STUDY OBJECTIVE: We sought to compare the characteristics and medical outcomes of motor vehicle crashes for drivers 70 years and older with those of drivers between the ages of 30 and 39 years. METHODS: We probabilistically linked statewide motor vehicle crash and hospital discharge data between the years of 1992 and 1995 for the state of Utah. We calculated the odds of older drivers exhibiting certain motor vehicle crash characteristics compared with younger drivers. Adjusting for nighttime crash, high-speed crash, and seatbelt use, we calculated the odds of an older driver being killed or hospitalized compared with those of a younger driver. RESULTS: During the study years, there were 14,466 drivers older than 69 years and 68,706 drivers between the ages of 30 and 39 years involved in motor vehicle crashes in Utah. Older drivers were less likely to have crashes involving drug or alcohol use (odds ratio [OR] 0.1; 95% confidence interval [CI] 0.1 to 0.2) and less likely to have crashes at high speed (OR 0.6; 95% CI 0.6 to 0.7). Although older drivers were no more likely to have a crash involving a right-hand turn (OR 1.0; 95% CI 0.9 to 1.1) than younger drivers, they were over twice as likely to have a crash involving a left-hand turn (OR 2.3; 95% CI 2.2 to 2.5). Also, older drivers were more likely to be killed or hospitalized than younger drivers (OR, 3.5; P <.001). Among belted drivers, an older driver was nearly 7 times more likely to be killed or hospitalized than a younger driver (OR 6. 9; 95% CI 5.4 to 8.9). CONCLUSION: Older drivers do have distinctive motor vehicle crash patterns. Interventions must be taken to reduce the number of left-hand turn crashes involving older drivers. In addition, further research is needed to design, implement, and evaluate countermeasures that may enable older drivers to continue driving while keeping public safety in the forefront.

Accidents, Traffic↗
PubMedDate not supplied

EMS providers do not accurately note motor-vehicle crash patients with positive serum alcohol concentrations.

INTRODUCTION: Alcohol use is associated with many motor-vehicle crashes and may increase the severity of injury. Because alcohol use also may mask injury, prehospital emergency care providers (PHECPs) may make inaccurate assessments. To assess and triage crash victims accurately, PHECPs must identify recent alcohol use. STUDY OBJECTIVE: This study examines the accuracy of PHECPs in identifying motor-vehicle crash victims who had positive serum alcohol concentrations. DESIGN: Retrospective cohort study. POPULATION: Included in the study were motor-vehicle crash victims more than 17 years of age who were conveyed directly to a university medical center emergency department by ground ambulance (n = 372). TIME PERIOD: 15 July 1990 to 15 July 1991. METHODS: Data sources included ambulance report forms and hospital records. Variables that were abstracted included the Revised Trauma Score (RTS), the PHECPs' impression of alcohol use, and serum alcohol concentrations. Sensitivity, specificity, predictive-value positive, predictive-value negative, and 0.95 confidence intervals (0.95 CI) were calculated for the PHECPs' ability to identify patients with a serum alcohol concentration > 0. The relationship between the RTS and the impressions of alcohol use was analyzed with chi-square testing: a p-value of < 0.05 was considered statistically significant. CONCLUSION: This study suggests that PHECPs cannot accurately identify crash victims with positive serum alcohol concentrations. Selection bias and retrospective design are significant limitations of this study. Future studies should develop and evaluate methods to improve PHECPs' accuracy in assessing alcohol use in motor-vehicle crash victims.

Accidents, Traffic↗
PubMed1991

Cessation of driving and unsafe motor vehicle operation by dementia patients.

We surveyed 522 consecutive patients from a dementia clinic to assess duration of driving after disease onset and instances of unsafe motor vehicle operation in the preceding 6 months. Among the 333 patients licensed to drive at the onset of dementia, the median duration of driving after onset was 28.6 months. Patients with a clinical diagnosis of Alzheimer's disease drove significantly longer than those with other dementia syndromes. Of the 93 patients still driving at the time of the survey, approximately one third were reported to have had at least one form of unsafe motor vehicle operation in the past 6 months, including 21 patients with motor vehicle accidents. Motor vehicle accidents were associated with use of prescription medications with sedative properties and with lower subjective ratings of the patient's driving ability by the informant.

Accidents, Traffic↗