The relationship between visibility aid use and motor vehicle related injuries among bicyclists presenting to emergency departments

Background

Little is known about the effectiveness of visibility aids (VAs; e.g., reflectors, lights, fluorescent clothing) in reducing the risk of a bicyclist–motor-vehicle (MV) collision.

Purpose

To determine if VAs reduce the risk of a bicyclist–MV collision.

Methods

Cases were bicyclists struck by a MV and assessed at Calgary and Edmonton, Alberta, Canada, emergency departments (EDs) from May 2008 to October 2010. Controls were bicyclists with non-MV injuries. Participants were interviewed about their personal and injury characteristics, including use of VAs. Injury information was collected from charts. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for VAs during daylight and dark conditions, and adjusted for confounders using logistic regression. Missing values were imputed using chained equations and adjusted OR estimates from the imputed data were calculated.

Results

There were 2403 injured bicyclists including 278 cases. After adjusting for age, sex, type of bicycling (commuting vs. recreational) and bicyclist speed, white compared with black (OR 0.52; 95% CI 0.28, 0.95), and bicyclist self-reported light compared with dark coloured (OR 0.67; 95% CI 0.49, 0.92) upper body clothing reduced the odds of a MV collision during daylight. After imputing missing values, white compared with black (OR 0.57; 95% CI: 0.32, 0.99) and bicyclist self-reported light compared with dark coloured (OR 0.71; 95% CI 0.52, 0.97) upper body clothing remained protective against MV collision in daylight conditions. During dark conditions, crude estimates indicated that reflective clothing or other items, red/orange/yellow front upper body clothing compared with black, fluorescent clothing, headlights and tail lights were estimated to increase the odds of a MV collision. An imputed adjusted analysis revealed that red/orange/yellow front upper body clothing colour (OR 4.11; 95% CI 1.06, 15.99) and tail lights (OR 2.54; 95% CI: 1.06, 6.07) remained the only significant risk factors for MV collisions. One or more visibility aids reduced the odds of a bicyclist MV collision resulting in hospitalization.

Conclusions

Bicyclist clothing choice may be important in reducing the risk of MV collision. The protective effect of visibility aids varies based on light conditions, and non-bicyclist risk factors also need to be considered.     

Factors affecting hospital charges and length of stay from teenage motor vehicle crash-related hospitalizations among United States teenagers, 2002-2007

Motor vehicle crashes are the leading cause of death for all teenagers, and each year a far greater number of teens are hospitalized with non-fatal injuries. This retrospective cohort study used the National Inpatient Sample data to examine hospitalizations from the years 2002 to 2007 for 15–18-year-old teenagers who had been admitted due to a motor vehicle crash. More than 23,000 teens were hospitalized for motor vehicle-related crash injuries each year, for a total of 139,880 over the 6-year period. Total hospital charges exceeded $1 billion almost every year, with a median hospital charge of more than $25,000. Older teens, boys, those with fractures, internal injuries or intracranial injuries, and Medicaid/Medicare as a payer were associated with higher hospital charges and longer lengths of stay. These high charges and hospitalization periods pose a significant burden on teens, their families, and the health care system.     

Regional mortality from motor vehicle traffic injury: relationships among place-of-occurrence, place-of-death, and place-of-residence

Regional mortality data, which are compiled according to place-of-residence of the decedent, are an important reference for regional health planning and resource allocation. However, it would be inappropriate to apply these data to studies of environmental risk factors if a large proportion of fatal motor vehicle traffic injuries (MVTI) in fact occur outside the resident county. The aim of this study was to determine the proportion and characteristics of residents of a rural area of Taiwan who died from MVTIs that occurred outside the county of residence. We also explored the relationships among the place-of-occurrence, place-of-death, and place-of-residence of these decedents. The families or neighbors of residents of Huatung Area (eastern Taiwan) who died from MVTIs in 1994 or 1995 were interviewed to identify the place-of-occurrence of the MVTI. Of the 882 Huatung Area residents who died as a result of an MVTI during the study period and for whom relevant data were available, the MVTI occurred outside the resident county in 207 (23%) cases. Residents whose MVTI occurred outside the county of residence were more likely to be youths (aged 15-24) or young adults (aged 25-44) and driving automobiles or trucks. Of the 866 cases in which the exact place was known, the place-of-occurrence and the place-of-death (recorded on the death certificate) were in the same county in 849 (98%). Because a high proportion of fatal MVTIs occurred outside the resident county, the mortality rate calculated according to place-of-residence does not accurately reflect the environmental risk factors in this area. The finding that the characteristics of those whose MVTI occurred outside the county differed from those decedents whose MVTI occurred within the county indicates that there are two target groups for prevention programs. In addition, at least in Huatung Area, the place-of-death recorded on the death certificate could serve as a surrogate for the place-of-occurrence in epidemiologic studies.     

The motorcyclist impact against a light vehicle: Epidemiological,accidentological and biomechanic analysis

This paper summarizes the results obtained within the framework of the French PROMOTO Project (PROtection of the MOTOrcyclist). The aim of this project was to analyze the impact between a motorcycle and a light vehicle from an epidemiological, accidentological and biomechanical point of view. The results have made it possible to outline the most frequent accident configurations such as the “turn on the left” and the most common injuries sustained by motorized two-wheelers (head and trunk). The biomechanic analysis has enabled a better understanding of the kinematics involved in an impact between a motorized two-wheeler and a light vehicle in various accident configurations (chronology and speed impact). While it is well known that motorcyclists frequently receive life threatening injuries to the head, spine and torso, this paper has been able to observe specific injury mechanisms such as pelvis impacts against the vehicle fuel tank and hyper-extension of the neck due to head impact on passenger cars.     

Predictors of injury among younger and older adults in fatal motor vehicle crashes

With 2003 Fatality Analysis Reporting System data, we examined relationships among predictors of motor vehicle injury/fatality outcomes for younger (35–54 years) and older (65 years and older) drivers. Using the Precede-Proceed Model of Health Promotion as an organizing framework, we classified variables into person, vehicle and environment domains and conducted a multinomial logistic regression.Significant risk factors for older driver injuries were impact crashes at 1–3 o’clock (OR = 1.65; CI: 1.05–2.59), 7–9 o’clock angles (OR = 2.59; CI = 1.45–4.63), and driving with one passenger (OR = 2.25; CI: 1.58–3.20). Previous other motor vehicle convictions were significantly associated with reduced risk of injury (OR = 0.55; CI = 0.34–0.90). The 7–9 o’clock angle (OR = 3.06; CI: 1.83–5.12), and driving in daylight hours were risk factors for fatality among older drivers.Many risk factors (e.g., female gender, non-seatbelt use, rollover crashes, and vehicle body type), and protective factors (e.g., number of lanes and non-airbag deployment) were relevant for younger and older drivers. Findings showed relevant factors for drivers from both age groups, with some pointing to older adults, and set the stage for further research to develop injury and fatality prevention programs.     

Understanding the effect of deployment on the risk of fatal motor vehicle crashes: a nested case-control study of fatalities in Gulf War era veterans, 1991-1995

Motor vehicle crashes (MVCs) are an important cause of morbidity and premature loss of life among military personnel during peacetime and particularly following combat. A nested case-control study of fatal MVC occurring between 1991 and 1995 was conducted in a cohort of Gulf War era veterans. Cases were validated MVC deaths in the Fatality Analysis Reporting System. Controls were selected using risk set sampling by gender and year of case ascertainment in a 10:1 ratio. Preliminary results, consistent with previous reports of increased fatal MVC risk among returning combat veterans, showed a crude odds ratio of 1.45 (95% confidence interval 1.27-1.65). Multivariable logistic regression modeling was used to identify important independent predictors, as well as to quantify the influence of deployment on a risk profile for fatal MVC. Because of significant interaction between deployment and inpatient diagnosis of substance abuse, the final model was stratified by deployment status. Results suggest that demographic, military, and behavioral characteristics of deployed healthy warriors are similar to the risk profile for fatal MVC. In addition to young, single, high school-educated, enlisted male personnel, those who served during times of ground combat, particularly in infantry, gun crews, or seamanship occupations, should be targeted for preventive interventions.     

Civil liability, criminal law, and other policies and alcohol-related motor vehicle fatalities in the United States: 1984-1995

This study examines the associations between alcohol policies and motor vehicle fatality rates from 1984 to 1995 in the United States. State policies and state characteristics variables were merged with motor vehicle fatality rates over an 11 year period and analyzed using minimum logit chi-square method and fixed effects to create a quasi time-series analysis. Laws allowing individuals to sue bars for the drunken behavior of their patrons were the policies most strongly associated with lower minor and adult fatality rates. The mandatory first offense fine was associated with lower minor fatality rates but not adult fatality rates, while minor and adult rates fell after administrative per se license suspension and anti-consumption laws for all vehicle occupants. Many other public policies evaluated were not associated with lower fatality rates.     

Off-highway vehicle parks: Combining environment,knowledge, and enforcement for all-terrain vehicle injury prevention

The number of off-highway vehicle (OHV) parks continues to grow to meet the recreational needs of ATV enthusiasts and the increasing popularity of the vehicle. Little is known about how OHV park regulations and enforcement affect ATV safety among their users. This study was designed to determine whether there were differences in crash mechanisms and/or compliance with ATV safety laws and regulations when comparing off-road ATV crashes inside and outside state OHV parks. Relative to outside the parks, a smaller percentage of park victims were under the age of sixteen, a lower percentage were passengers, and a dramatically higher percentage were helmeted. Mean injury severity scores were not different inside and outside the parks, but 5% of outside victims had severe brain injuries, as compared to no park victims. Overall, park victims exhibited better compliance with ATV safety laws and regulations and suffered less severe brain injury outcomes. However, park crashes involved more jump-related injuries, suggesting that additional approaches are needed to improve park safety. These findings support the hypothesis that riding environments with safety regulations and effective enforcement can promote safe behaviors and may prevent injuries.     

Prevalence of alcohol and drugs among Norwegian motor vehicle drivers: a roadside survey

The objective of the study was to determine the prevalence of alcohol, psychoactive medicinal drugs and illegal drugs among drivers in Norwegian road traffic. Drivers of motor vehicles were selected from April 2005 to April 2006 in the south-eastern part of Norway, surrounding, but not including the capital, Oslo. A stratified two-stage cluster sampling procedure was used. In the first stage, random road sites and time intervals were selected, and in the second stage, drivers were stopped by random at those sites and time intervals. Altogether about 12,000 drivers were asked to provide a sample of oral fluid (saliva) and answer a few questions. Samples of oral fluid were obtained from 88% of the drivers, of whom 30% were females and 70% males. The prevalence of each drug was estimated by a weighted average using weights adjusted for under- or over-sampling compared to traffic statistics. Alcohol or drugs were found in oral fluid samples of 4.5% of the drivers; alcohol in 0.4%, psychoactive medicinal drugs in 3.4%, and illegal drugs in 1.0%. Illegal drugs were found more frequently in samples from younger drivers, while psychoactive medicinal drugs were more frequently found in samples from older drivers. Psychoactive medicinal drugs were more prevalent among females than males, among drivers stopped on working days rather than weekends, and among those who reported annual driving distances less than 16,000km. The drugs found most frequently were zopiclone (1.4%), benzodiazepines (1.4%), codeine (0.8%), tetrahydrocannabinol (0.6%) and amphetamines (0.3%). Two or more drugs were found in 0.6% of the samples, corresponding to 15% of the drug-positive drivers.     

The association between sudden illness and motor vehicle crash mortality and injury among older drivers in NSW, Australia

This exploratory study aims to investigate the associations between sudden illness and the risk of motor vehicle crash-related mortalities and injuries among older drivers aged 60 or above. Information utilised in the study was obtained from police reports of all road traffic accidents that occurred on the roads between 1996 and 2000 in New South Wales, Australia. There were 409 older drivers involved in crashes after becoming ill suddenly. Among these the majority (62.1%) of crashes led to at least one occupant in the vehicle being killed or injured. There is a significant association between sudden illness and crash-related mortality and injury after adjusting for other risk factors. The risk of injury and death is increased by nearly six times (OR = 5.58, 95% CI = 4.54-6.85) for those who suffered a sudden illness while driving when compared to those non-sufferers. These results are discussed in the light of possible preventive strategies and the provision of risk assessment and safety counselling for older people.     

Race,Hispanic origin,and socioeconomic status in relation to motor vehicle occupant death rates and risk factors among adults

Black and Hispanic adults travel less in motor vehicles than whites but may be at greater risk when they do travel. Passenger vehicle occupant deaths per 10 million trips among persons ages 25-64 were computed by race, Hispanic origin, gender, and socioeconomic status (SES) using 1995 data from the Fatality Analysis Reporting System (FARS) and Nationwide Personal Transportation Survey. Educational level was used as the indicator of SES. Blacks, particularly black men, were at increased risk of dying relative to whites when traveling in motor vehicles (rate ratio (RR) for black men=1.48; 95% confidence interval (CI)=1.42-1.54). Hispanic men, but not Hispanic women, also had elevated occupant death rates, but their risk was less than that of black men (RR=1.26; 95% CI=1.20-1.31). SES was the strongest determinant of occupant deaths per unit of travel; RRs among those who had not completed high school were 3.52 (95% CI=3.39-3.65) for men and 2.79 (95% CI=2.69-2.91) for women, respectively. Whites without high school degrees had the highest death rates per 10 million trips. After adjustment for SES, the elevated risk of occupant fatalities persisted among black men and women, but not among Hispanic men. Seat belt use and alcohol-impaired driving were examined among fatally injured passenger vehicle drivers. Among those with no education beyond high school, higher percentages were reported as having high blood alcohol concentrations (BACs) or having not used belts. Reported belt use rates were lower among black men and women, even after controlling for SES, whereas Hispanic men and women had belt use rates similar to those of whites. High BACs were more common among Hispanic men, which appeared largely to be an effect of SES because most Hispanic men killed in crashes had not completed high school, the education level with the highest percentage that drove while impaired by alcohol. More effective public health efforts are needed to reduce occupant deaths among persons of lower SES, blacks, and Hispanics, including measures to increase use of seat belts and reduce alcohol-impaired driving.     

The Fatality Analysis Reporting System as a tool for investigating racial and ethnic determinants of motor vehicle crash fatalities

The Fatality Analysis Reporting System (FARS) is a Department of Transportation database in the public domain that contains detailed information about fatalities resulting from motor vehicle crashes on public roadways in the United States since 1975. However, data on race and Hispanic ethnicity were not collected by FARS until 1999. Since then, completeness of reported racial and ethnic information has varied from State to State. To assess utility of FARS for investigating race- and ethnicity-specific risk factors associated with motor vehicle crash mortality, we examined yearly national and State-specific reporting rates of race and Hispanic ethnicity for 168,863 motor vehicle crash fatalities from 1999 to 2002. In 1999, national reporting was 85% for race and 78% for Hispanic ethnicity. Over the 4-year study period, a significant linear increase in annual reporting for both race and Hispanic ethnicity was evident at the national level, as reporting by individual States improved over time. In 2002, national reporting rates reached 90% for race and 88% for Hispanic ethnicity. Our findings indicate that FARS has become a valuable resource for population-based studies of motor vehicle crash mortality disparities that exist among racial and ethnic subpopulations in the United States.     

Driving with pets and motor vehicle collision involvement among older drivers: A prospective population-based study

ObjectiveDistracted driving is a major cause of motor vehicle collision (MVC) involvement. Pets have been identified as potential distraction to drivers, particularly in the front. This type of distraction could be worse for those with impairment in the cognitive aspects of visual processing. The purpose of this study is to evaluate the association between driving with pets and rates of motor vehicle collision involvement in a cohort of older drivers.MethodsA three-year prospective study was conducted in a population-based sample of 2000 licensed drivers aged 70 years and older. At the baseline visit, a trained interviewer asked participants about pet ownership, whether they drive with pets, how frequently, and where the pet sits in the vehicle. Motor vehicle collision (MVC) involvement during the three-year study period was obtained from the Alabama Department of Public Safety. At-fault status was determined by the police officer who arrived on the scene. Participants were followed until the earliest of death, driving cessation, or end of the study period. Poisson regression was used to calculate crude and adjusted rate ratios (RR) examining the association between pet ownership, presence of a pet in a vehicle, frequency of driving with a pet, and location of the pet inside with vehicle with any and at-fault MVC involvement. We examined whether the associations differed by higher order visual processing impairment status, as measured by Useful Field of View, Trails B, and Motor-free Visual Perception Test.ResultsRates of crash involvement were similar for older adults who have ever driven with a pet compared to those who never drove with their pet (RR = 1.15, 95% CI 0.76–1.75). Drivers who reported always or sometimes driving with their pet had higher MVC rates compared to pet owners who never drive with a pet, but this association was not statistically significant (RR = 1.39, 95% CI 0.86–2.24). In terms of location, those reporting having a pet frequently ride in the front of the vehicle had similar rates of MVC involvement compared to those who did not drive with a pet in the front. A similar pattern of results was observed for at-fault MVCs. This association was not modified by visual processing impairment status.ConclusionThe current study demonstrates a positive but non-significant association between frequently driving with pets and MVC involvement. More research is needed, particularly on restraint use and whether the pet was in the car at the time of the crash, to help characterize the public safety benefit of regulations on driving with pets.     

Impaired driving and motor vehicle crashes among Swedish youth: an investigation into drivers' sociodemographic characteristics

Impaired driving is an important road safety problem, and the characteristics of drivers impaired by alcohol or drugs are relevant to targeted interventions. This study considers young drivers' sociodemographic attributes: age, sex, class of origin and educational attainment, based on a national cohort of young Swedish drivers (1988-2000) followed up in police registers for their first motor vehicle crash. Of all crashes reported for these drivers, 946 were where the driver was suspected of being under the influence of alcohol or other substances (corresponding to 6% of all first crashes). Impaired driving significantly increases the odds of severe and fatal injuries, regardless of sociodemographic attributes. Observed differences in the proportions of impaired drivers reveal significant excess risks among males, persons aged 18-19, those from households classified as "workers" and "others" (including, e.g. the long-term unemployed and those on long-term sick leave), and those with low educational attainment. Impaired driving is a risk factor in all sociodemographic strata among young people. Members of some groups are more likely to be found than others among impaired drivers on occasion of first motor vehicle crash.     

Traumatic brain injury,driver aggression and motor vehicle collisions in Canadian adults

ObjectiveThis study examines the associations between lifetime traumatic brain injury (TBI), driver aggression, and motor vehicle collisions among a population sample of adults who reside in the province of Ontario, Canada.MethodA cross-sectional sample of 3993 Ontario adults, aged 18–97 were surveyed by telephone in 2011 and 2012 as part of Center for Addiction and Mental Health’s ongoing representative survey of adult mental health and substance use in Canada. TBI was defined as trauma to the head that resulted in loss of consciousness for at least five minutes or overnight hospitalization.ResultsAn estimated 91% (95% CI: 90.0, 91.9) of individuals in this sample held a valid Ontario driver’s license at the time of testing. Among those, 16.7% reported a history of lifetime TBI and 83.3% reported no TBI. The prevalence of TBI was higher among men than women. Relative to licensed adults without TBI, adults with a history of TBI had significantly higher odds of engaging in serious driver aggression in the past 12 months, such as making threats to hurt another driver, passenger or their vehicle (AOR = 4.39). These individuals also reported significantly higher odds (AOR = 1.74) of being involved in a motor vehicle collision that resulted in hurting themselves, their passenger(s) or their vehicle.ConclusionThis is the first population-based study to demonstrate a relationship between a history of TBI and higher rates of serious driver aggression and collision involvement. Given the large proportion of adult drivers with a history of TBI, these individuals may account for a disproportion burden of all traffic safety problems. Whether the increased road safety risk of adults with a history of TBI is reflective of neurocognitive deficits or is merely evidence of a cluster of unsafe activities produced by a higher risk lifestyles requires further research attention.     

Comparison of factors influencing emergency department visits and hospitalization among drivers in work and nonwork-related motor vehicle crashes in Utah, 1999-2005

This study identified contributing factors in the occurrence of motor vehicle crashes (MVCs) and the severity of crashes according to work-related status in Utah. Analyses were based on probabilistically linked data involving police crash reports and hospital inpatient and emergency department (ED) records for the years1999–2005. Of 643,647 drivers involved in crashes, 73,437 (11.4%) went to the emergency department (ED) and 4989 (0.8%) were hospitalized. Of the drivers in crashes visiting the ED, 2330 (3.2%) were working at the time of the crash and of drivers in crashes who were hospitalized, 235 (4.7%) were working at the time of the crash. There was no significant difference between those working versus not working at the time of the crash in safety belt use (82% [53,947/66,188] for ED cases and 60% [2,489/4,176] for hospitalized cases) or fatigue (4% [2,697/70,536] for ED cases and 9% [450/4,824] for hospitalized cases) among drivers in crashes, but there was a significant difference with respect to alcohol drinking between workers versus nonworkers (ED: 1% [31/2,237] vs. 5% [3,455/68,299], P < 0.001; hospitalized: 3% [7/228] vs. 15% [673/4,596], P < 0.001). Of those attending the ED because of a crash, workers were significantly more likely to have broken bones, bleeding wounds, or to die. Of those hospitalized because of a crash, workers were significantly less likely to have caused the crash (65% [145/223] vs. 73% [3,315/4,566], P < 0.001). Yet although those drivers who were working at the time of the crash compared with those not working were less likely to have alcohol involved or to have caused the crash, there remains room for improvement among workers with respect to these factors, as well as safety belt use and fatigue.     

Crash and burn? Vehicle,collision, and driver factors that influence motor vehicle collision fires

A retrospective population-based case–control study was performed to determine the association between vehicle fires, and vehicle, collision, and driver factors on highways with a posted speed limit of at least 55 mph. Data were obtained from the Kentucky Collision Report Analysis for Safer Highways (CRASH) electronic files for 2000–2009 from the Kentucky State Police Records Sections. The results from the final multiple logistic regression show that large trucks were at a higher risk for a collision involving a fire than passenger vehicles and pickup trucks. When controlling for all other variables in the model, vehicles 6 years old and older, driving straight down the highway, and single vehicle collisions were also identified as factors that increase the risk of motor vehicle collision fires on roadways with a posted speed limit of ≥55 mph. Of the 2096 vehicles that caught fire, there were 632 (30%) non-fatally injured drivers and 224 (11%) fatally injured drivers. The results of this study have the potential to inform public health messages directed to the transportation industry, particularly semi truck drivers, in regard to fire risk.     

The association between price of regular-grade gasoline and injury and mortality rates among occupants involved in motorcycle- and automobile-related motor vehicle collisions

Motorcyclists have been reported to be more likely to die in a motor vehicle collision (MVC) than automobile occupants. With the recent increase in the pump price of gasoline, it has been reported that people are switching to motorcycles as main modes of transportation. This study evaluated the association between motor vehicle collision-related injury and mortality rates and increases in gasoline prices for occupants of automobiles and riders of motorcycles.There were an estimated 1,270,512 motorcycle MVC and 238,390,853 automobile MVC involved occupants in the U.S. from 1992 to 2007. Higher gasoline prices were associated with increased motorcycle-related injuries and deaths; however, this association no longer remained after accounting for changes in the number of registered vehicles.The current study observed that, while the number of injuries and fatalities in motorcycle-related MVCs increase with increasing gasoline price, rates remained largely unchanged. This suggests that the observed increase in motorcycle-related injuries and fatalities with increasing gasoline price is more a factor of the number of motorcycles on the road rather than operator characteristics.     

Crash costs by body part injured, fracture involvement, and threat-to-life severity. United States, 2000

This paper presents costs per US motor vehicle crash victim differentiated into many more diagnostic categories than prior estimates. These unit costs, which include the first keyed to the 1990 edition of Abbreviated Injury Scale (AIS) threat-to-life severity scores, are reported by body part, whether a fracture/dislocation was involved, and the maximum AIS score among the victim's injuries. This level of detail allows for a more accurate estimation of the social costs of motor vehicle crashes. It also allows for reliable analyses of interventions targeting narrow ranges of injuries. The paper updates the medical care data underlying the US crash costs from 1979 to 1986 to the mid 1990s and improves on prior productivity cost estimates. In addition to presenting the latest generation of crash victim costs, this paper analyzes the effects of applying injury costs classified by AIS code from the 1985 edition to injury incidence data coded with the 1990 edition of AIS. This long-standing practice results in inaccurate cost-benefit analyses that typically overestimate benefits. This problem is more acute when old published costs adjusted for inflation are used rather than the recent costs.