The burden of road trauma due to other people's drinking

The purpose of this study was to estimate the burden of road traffic injury due to alcohol consumption by someone other than the injured party. We estimated the number and proportion of these traffic deaths and non-fatal traffic injuries, and the associated social costs, for a five-year period (2003–2007) in New Zealand. We found that more than 40% of alcohol-related crash injuries in New Zealand are suffered by people who have not themselves been drinking. While the rate of road traffic injuries and the involvement of alcohol peak amongst young adults, so too does the proportion of all road traffic crash injuries that are due to other people's drinking, reaching one in five in the 15–19-year age group. Most innocent victims are car passengers, and this includes almost all children who are injured by drink driving. For a large majority of the children injured, the driver affected by alcohol is the driver of their own car. Using official cost figures, alcohol-related injuries to innocent victims cost the country more than half a billion dollars per year.     

A system for measuring the severity of temporary and permanent disability after injury

500 patients have been questioned about activities of daily living and mobility 4 and 26 weeks after injury in order to assess the extent of temporary and permanent disability following minor and major trauma. Only those who sustained single injuries have been assessed, resulting in a relatively small number of serious injuries in the sample. In other respects, the population is representative of the daytime attendance at a busy emergency department. Most patients sustained injuries with an Abbreviated Injury Scale (AIS) of 1 or 2 (96%); it is clear that the AIS is unable to distinguish between most small injuries. Assessment was by interview. Although subjective, this has produced results that have face validity and discriminate between a wide variety of injuries. The methodology may be useful in the development of a "disability score," but much more data will be required before this can be achieved.     

Comparison of injury mortality risk in motor vehicle crash versus other etiologies

The mortality risk ratio (MRR), a measure of the proportion of people who died that sustained a given injury, is reported to be among the most powerful discriminators of mortality following trauma. The primary aim was to determine whether mechanistic differences exist and are quantifiable when comparing MRR-based injury severity across two broadly defined etiologies (motor vehicle crash (MVC) versus non-MVC) for the clarification of important injury types that have some room for improvement by emergency treatment and vehicle design. All International Classification of Diseases, 9th revision (ICD-9) coded injuries in the National Trauma Data Bank (NTDB) database were stratified into MVC and non-MVC groups and the MRR for each injury was computed within each group. Injuries were classified as 11 different types for MRR comparison between etiologies. Overall, MRRs for specific injuries were 10–18% lower for MVC compared to non-MVC etiologies. MVCs however produced much higher mean MRRs for crushing injuries (0.184 versus 0.072) and internal injuries to the thorax, abdomen, and pelvis (0.200 versus 0.169). Non-MVCs produced much higher MRRs for intracranial injuries (0.199 versus 0.250). Analysis of the top 95% most frequent MVC injuries revealed higher MVC MRR values for 78% of the injuries with MRR ratios indicating an average 50% increase in a given injury's MRR when MVC was the etiology. Addressing the large differences in MRR in between etiologies for identical injuries could provide a reduction in fatalities and may be important to patient triage and vehicle safety design.     

Characteristics of motor vehicle accidents resulting in spinal cord injury

The majority of cases of spinal cord injury (SCI) occur during car crashes. Yet, relatively little is known about the precise accident factors involved. The present study investigated 30 cases of SCI in automobile drivers that occurred in a series of 91 spinal cord injuries. A matched control group was also studied. SCI drivers were not different from controls in terms of mortality, number of rollover crashes, alcohol use, citations for contributing human factors, nighttime accidents, or unfavorable weather and road conditions. However, SCI drivers less frequently used restraints. Results are discussed in terms of preventive measures, specifically, those concerning restraint use, alcohol use, and driving behavior.     

Snowmobiling: characteristics of owners,patterns of use and injuries2

Snowmobilers injured in northern Vermont during the 1971–1972 and 1972–1973 seasons were compared with uninjured snowmobilers from the same communities. Lack of familiarity with the machine or the environment was an important factor in injury events. Among injured adults there was overrepresentation of persons who had been drinking, who have higher horsepower machines which they use at faster speeds, who drive greater highway mileage, and who have an excess of previous snowmobile injuries, highway crashes, and traffic citations. The vehicle itself appeared to contribute to the occurrence or severity of injury in at least half of the events, and there is urgent need to improve upon the stability, lighting, energy attenuation capacity, and other features of the snowmobile. Gross inadequacies of emergency care were identified, including use of alcohol after injury, delay in seeking care and general absence of first aid, including only rare splinting for fractures. Finally, when the injured arrived at the hospital some of them were lectured and berated because their injuries had involved a form of recreation not to the liking of a few members of the hospital staff.     

Variations of alcohol impairment in different types, causes and contexts of injuries: results of emergency room studies from 16 countries

OBJECTIVE: The purpose of this paper is to document alcohol impairment (based on a blood alcohol content (BAC) of at least 80 mg%) for different types, causes and location contexts of injuries. DESIGN AND SETTING: Data from 45 studies with 11,536 injury patients were merged to determine variations in the percent of alcohol impairment among injury patients. In each study, emergency room (ER) injury patients were given a short interview on the circumstances of their injury and BAC was measured. RESULTS: Injury severity, measured by number of body regions injured was significantly associated with BACs over 80 mg%. The highest percentage of injury type to involve alcohol was head injury/concussion. In terms of causes of injuries, patients with alcohol impairment were significantly more likely to be involved in violence than any other cause (i.e., vehicle, falling, poisoning or burns). Finally, injuries occurring at a bar or restaurant were significantly more likely to involve alcohol impairment than any other setting. CONCLUSIONS: The results demonstrate considerable variation in the circumstances where alcohol is involved in injuries. These results may be useful for the development of prevention initiatives.     

Karate injuries in children and adolescents

OBJECTIVES: To identify risk factors for injury and to establish safety guidelines for children in Uechi-Ryu karate. DESIGN: A 1-year retrospective survey of injuries. SETTING: A private karate school (Uechi-Ryu style) in Plymouth, MA. PATIENTS: A total of 68 athletes (age 6-16 years; mean age 10 years) who participated in karate during the 1995-1996 season. INTERVENTIONS: None. MAIN OUTCOME MEASURES: The presence or absence of injury, with grading of injuries as major, moderate or minor. The types of injuries and body region involved were also analyzed. RESULTS: Twenty eight percent of athletes sustained at least one injury. All injuries were minor, with no time off from training required. The injuries consisted primarily of bruises (11 of 19). Other injuries included mild sprains or strains (5 of 19) and having their 'wind knocked out' (3 of 19). Most injuries were localized to the extremities. Logistic regression analysis identified risk factors for injury. Risk of injury increased with number of years of training (odds ratio 2.95; 95% confidence interval 1.81-4.82; P<0.0001), number of hours per week (odds ratio 2.12; CI 1.15-4.21; P = 0.016) and rank, specifically brown belt versus lower belts (odds ratio 6.56; CI 2.02-21.26; P = 0.006). CONCLUSIONS: Karate is a relatively safe sport for children and adolescents when properly taught. Risk of injury increases with experience; therefore, greater supervision is required of higher ranks. Injury increases with weekly training; however, 3 h a week or less appears to be associated with a low risk of significant injury in this age group.     

Adolescent involvement in anti-social and delinquent behaviours: Predicting future injury risk

The purpose of this study was to challenge the broadly based focus of injury prevention strategies towards concern with the needs of young adolescents who engage in multiple anti-social and delinquent behaviours. Five hundred and forty 13–14-year olds reported on injuries and truancy, violence, illegal road behaviours, drug, and alcohol use. Engagement in these behaviours was found to contribute to the likelihood of an injury. Those engaging in the most anti-social and delinquent behaviours were around five times more likely to report medically-treated injuries in the past three months. Their likelihood of future injury was 1.8 times more likely when they were followed up three months later. The engagement in multiple delinquent and illegal behaviours thus significantly increased the likelihood of injury and identifies a particularly vulnerable group. The findings also suggest that reaching these young people represents a key target for change strategies in injury prevention programs.     

Pediatric lumbar Chance fractures in British Columbia: chart review and analysis of the use of shoulder restraints in MVAs

Chance fractures of the skeletally immature spine classically occur in frontal motor vehicle accidents (MVAs) when the occupants are restrained by a lap belt only and undergo traumatic hyperflexion of the torso during the impact. We retrospectively examined all MVA-related Chance fractures at British Columbia's Children's Hospital since 1986, by collecting injury and seat-belt use information from chart data and imaging studies. Twenty-six patients were included in the study, 14 wore a lap belt only, seven wore a three-point restraint properly, and five were reportedly misusing the shoulder portion of a three-point restraint. The subjects ranged in age from 3 to 16 with a mean age of 10.6 years. Eleven of the 26 (42%) patients sustained abdominal viscera injuries, seven of the 26 patients suffered neurologic injury (spinal cord and/or spinal nerve injury) associated with their spinal fracture, with two cases of complete paralysis, and there was a 38% incidence of head injury. Concomitant injuries (i.e. to the head, abdomen and abdominal contents) tended to be mitigated by the presence of a properly worn shoulder restraint. This leads to the conclusion that Chance fractures can be sustained even when the occupant is using a shoulder belt to restrain their torso. The mechanism responsible for this is unknown. This may indicate that Chance fractures can be caused by a lesser degree of torso hyperflexion than previously thought. Alternatively, we also speculate that Chance fractures can occur while the torso is restrained by the shoulder belt if the hips submarine beneath the lap belt and the torso experiences hyperflexion secondary to forward excursion of the pelvis and legs during the collision. Future work is necessary to confirm these mechanisms and to find ways to prevent them. These studies will need to use computational or experimental child surrogates that can sit in a slouched posture and submarine during a collision.     

Exploring factors contributing to injury severity at freeway merging and diverging locations in Ohio

Identifying factors that affect crash injury severity and understanding how these factors affect injury severity is critical in planning and implementing highway safety improvement programs. Factors such as driver-related, traffic-related, environment-related and geometric design-related were considered when developing statistical models to predict the effects of these factors on the severity of injuries sustained from motor vehicle crashes at merging and diverging locations. Police-reported crash data at selected freeway merging and diverging areas in the state of Ohio were used for the development of the models. A generalized ordinal logit model also known as partial proportional odds model was applied to identify significant factors increasing the likelihood of one of the five KABCO scale of injury severity: no injuries, possible/invisible injuries, non-incapacitating injuries, incapacitating injuries, or fatal injuries. The results of this study show that semi-truck related crashes, higher number of lanes on freeways, higher number of lanes on ramps, speeding related crashes, and alcohol related crashes tend to increase the likelihood of sustaining severe injuries at freeway merging locations. In addition, females and older persons are more likely to sustain severe injuries especially at freeway merge locations. Alcohol related crashes, speeding related crashes, angle-type collisions, and lane-ramp configuration type D significantly increase the likelihood of severe injury crashes at diverging areas. Poor lighting condition tends to increase non-incapacitating injuries at diverging areas only. Moreover, adverse weather condition increases the likelihood of no-injury and fatal injuries at merging areas only and adverse road conditions tend to increase a range of injury severity levels from possible/invisible injuries to incapacitating injuries at merging areas only.     

The economic burden of injury: Health care and productivity costs of injuries in the Netherlands

BackgroundDetailed information on health care costs and productivity costs for the whole spectrum of injuries is lacking. We measured the total costs of injuries by external-cause, injury groupings, age and sex.MethodInjury patients visiting an Emergency Department in the Netherlands were included. Health service use and work absenteeism were estimated with national database data and a prospective follow-up study. Health care costs (direct costs) and productivity costs (indirect costs) were determined using the incidence-based Dutch Cost of Injury Model.ResultsTotal costs of injuries were €3.5 billion annually (€210/capita and €4300/patient); €2.0 billion healthcare costs and €1.5 billion productivity costs. Home and leisure injury subcategory falls caused 41% of total costs. Traffic injury was prominent in the 15–54 age group, mainly due to bicycle injuries. Sports injuries, in special football/soccer injuries, resulted in high costs in the 15–24 age group. Although costs per patient were comparable between males and females, health care costs were higher in females, whereas males have more than twice as high productivity costs. Health care costs were highest for hip fractures (€20,000/patient). Extremity fractures had high costs due to high incidences and high productivity costs per patient.ConclusionOur detailed cost model identified known risk groups, such as elderly females with hip fractures resulting from falls, as well as less obvious important high risk groups, such as young children falling from furniture, young males who sustained football/soccer injuries and bicycle injuries among all ages. This information is essential to assess additional priority areas for prevention.     

The relationship between face or skull fractures and cervical spine and spinal cord injuries: a review of 13,834 patients.

A state trauma registry database containing 13,834 patients was evaluated to determine the relationship among 1,062 skull fractures, 1,329 facial fractures, 339 cervical spine injuries, and 299 spinal cord injuries. Categories studied were all trauma patients, motor vehicle crashes, automobile crashes (drivers, passengers, unknown), and belted and unbelted victims. Odds ratios calculated demonstrated that patients with skull and/or facial fractures did not have a higher likelihood of cervical spine or spinal cord injury as has been suggested. The lack of a relationship emphasizes the need for a greater vigilance for cervical spine and spinal cord injury in the group without facial or skull fractures. It appears that the pathological biomechanical forces causing each injury are a reflection of the different multiple forces associated with motor vehicle trauma.     

Pedestrian injuries in eight European countries: An analysis of hospital discharge data

Out of the 50,000 yearly road traffic deaths in the European Union (formed by 27 European countries and commonly designated as EU-27), some 8500 are pedestrians. While some studies focus on the increased risk for pedestrian mortality compared to other road users, there is a dearth of information on injury patterns that could be used to prioritize injury prevention measures. Hospital discharge data from eight European countries have been used in this study. Injury information from 10,341 pedestrians sustaining 19,424 injuries has been analyzed. Data have been augmented with Abbreviated Injury Scale, Functional Capacity Index and Injury Severity Score codes, and have been categorized into the Barell Matrix. Fractures (51.1%, 50.3-51.8) and internal injuries (21.3%, 20.7-21.9) are the most frequently found in the data; however, blood vessel injuries and internal injuries are the ones associated with the highest risk of death. Head and lower extremities account for 26% of the injuries each, being spinal and thoracic injuries those showing the highest threat to life risk. Hip and lower extremities injuries are the most frequent cause of functional limitation 1 year after discharge. Due to its intrinsic importance, different injury causation mechanisms for head injuries have been analyzed. Though current standards and regulations consider Head Injury Criterion (HIC) as the only tool to assess the risk of injuries to the head, real world injury data show that only 12.1% (11.0-13.2) of these injuries can be attributed to a pure translational mechanism and therefore susceptible to be predicted by HIC. Design of prevention strategies, particularly from the engineering point of view, should benefit from this information.     

Injury prediction in a side impact crash using human body model simulation

Background

Improved understanding of the occupant loading conditions in real world crashes is critical for injury prevention and new vehicle design. The purpose of this study was to develop a robust methodology to reconstruct injuries sustained in real world crashes using vehicle and human body finite element models.

Methods

A real world near-side impact crash was selected from the Crash Injury Research and Engineering Network (CIREN) database. An average sedan was struck at approximately the B-pillar with a 290 degree principal direction of force by a lightweight pickup truck, resulting in a maximum crush of 45 cm and a crash reconstruction derived Delta-V of 28 kph. The belted 73-year-old midsized female driver sustained severe thoracic injuries, serious brain injuries, moderate abdominal injuries, and no pelvic injury. Vehicle finite element models were selected to reconstruct the crash. The bullet vehicle parameters were heuristically optimized to match the crush profile of the simulated struck vehicle and the case vehicle. The Total Human Model for Safety (THUMS) midsized male finite element model of the human body was used to represent the case occupant and reconstruct her injuries using the head injury criterion (HIC), half deflection, thoracic trauma index (TTI), and pelvic force to predict injury risk. A variation study was conducted to evaluate the robustness of the injury predictions by varying the bullet vehicle parameters.

Results

The THUMS thoracic injury metrics resulted in a calculated risk exceeding 90% for AIS3+ injuries and 70% risk of AIS4+ injuries, consistent with her thoracic injury outcome. The THUMS model predicted seven rib fractures compared to the case occupant's 11 rib fractures, which are both AIS3 injuries. The pelvic injury risk for AIS2+ and AIS3+ injuries were 37% and 2.6%, respectively, consistent with the absence of pelvic injury. The THUMS injury prediction metrics were most sensitive to bullet vehicle location. The maximum 95% confidence interval width for the mean injury metrics was only 5% demonstrating high confidence in the THUMS injury prediction.

Conclusions

This study demonstrates a variation study methodology in which human body models can be reliably used to robustly predict injury probability consistent with real world crash injury outcome.     

Crash characteristics and injuries of victims impaired by alcohol versus illicit drugs

Alcohol has long been associated with injury, but the relationship between other drugs and injury is less clear. Blood samples from 894 patients presenting to two Emergency Departments for treatment of motor vehicle injury sustained in passenger cars, station wagons, vans and pickup trucks, were tested for alcohol and other drugs. Results were related to demographic characteristics, including prior history of alcohol and drug use; crash characteristics; and injury characteristics. Alcohol was associated with more severe crashes, but other drugs, in the absence of alcohol, were not. The crashes involving drugs but no alcohol were very similar to those involving neither alcohol nor drugs.     

Assessing the relative risk of severe injury in automotive crashes for older female occupants

A logistic regression model was used in the prediction of injury severity for individuals who are involved in a vehicular crash. The model identified females and older occupants (segmented by age 55-74, and 75 and older) as having a significantly higher risk of severe injuries in a crash. Further, interactions of older females with other factors, such as occupant seat position, crash type, and environmental factors were also shown to significantly impact the relative risk of a severe injury. This study revealed that females 75 years and older had the lowest odds of injury among all female occupants studied (OR=1.16) while females between 55 and 74 years old have higher risk of severe injuries (OR=1.74). All older females (55 and older) were at greater risk for head-on, side-impact and rear-end collisions. Seatbelt use reduced severe injuries for females in this age group, but not to the same extent as the rest of the population studied. Additionally, crashes in severe weather, which were less likely to result in severe injuries for the general population, increased the risk of severe injuries to females that were 55 and older. Among occupants of light trucks, sport utility vehicles and vans, older females were less likely than others to be severely injured. In this case, older females appear better off in vehicles which are larger and protect better in severe crashes. This research demonstrates that circumstances surrounding a crash greatly impact the severity of injuries sustained by older female occupants.     

Thoracic and lumbar spinal impact tolerance

INTRODUCTION: Thoracolumbar injuries resulting from motor vehicle accidents, falls, and assaults have a high risk of morbidity and mortality. However, there are no biomechanically based standards that address this problem. METHODS: This study used four cadaveric porcine specimens as a model for direct spinal impact injuries to humans to determine an appropriate injury tolerance value. The anthropometric parameters of these specimens are compared with values found in a large human cadaveric dataset. Each specimen was subjected to five impacts on the dorsal surface of the lower thorax and abdomen. RESULTS: The injuries ranged from mild spinous process fractures to endplate fractures with anterior longitudinal ligament (ALL) transactions with a maximum AIS=3. The average peak reaction force for the thoracic failure tests was 4720+/-1340 N, and the average peak reaction force for the lumbar failure tests was 4650+/-1590 N. DISCUSSION: When scaled to human values using anthropometric parameters determined in this study, the force at which there is a 50% risk of injury is 10,200+/-3900 N. This value favorably compares to that found in the existing literature on isolated vertebral segments. SUMMARY: After demonstrating that the porcine model can be used as a spinal impact model for the human, the resulting injury risk value can be used in determining new standards for human injury risk or in guiding the design of safety equipment for the back.     

Epidemiology of moderate-to-severe injury patterns observed in rollover crashes

BackgroundPrevious epidemiological studies have highlighted the high risk of injury to the head, thorax, and cervical spine in rollover crashes. However, such results provide limited information on whole-body injury distribution and multiple region injury patterns necessary for the improvement and prioritization of rollover-focused injury countermeasures.MethodsSampled cases representing approximately 133,000 U.S. adult occupants involved in rollover crashes (between 1995 and 2013) sustaining moderate-to-severe injuries were selected from the National Automotive Sampling System Crashworthiness Data System database. A retrospective cohort study, based on a survey of population-based data, was used to identify relevant whole body injury patterns.ResultsAmong belted occupants injured in rollover crashes, 79.2% sustained injuries to only one body region. The three most frequently injured (AIS2+) body regions were head (42.1%), upper extremity (28.0%), and thorax (27.1%). The most frequent multi-region injury pattern involved the head and upper extremity, but this pattern only accounted for 2.3% of all of occupants with moderate or worse injuries.ConclusionsThe results indicated that for rollover-dominated crashes, the frequently observed injury patterns involved isolated body regions. In contrast, multi-region injury patterns are more frequently observed in rollovers with significant planar impacts. Identification of region-specific injury patterns in pure rollover crashes is essential for clarifying injury mitigation targets and developing whole-body injury metrics specifically applicable to rollovers.     

ER visits predict premature death among teenagers

Background

The purpose of this study was to investigate if teenagers visiting an emergency room because of injury have an increased risk of premature death ahead and, if so, identify possible risk factors and suggest preventive measures.

Methods

In January 2010, the personal identity numbers of 12,812 teenagers who had visited the emergency room at the University Hospital in Umeå, Sweden, during 1993 through 2006 because of injury were checked against the National Cause of Death Register in Sweden. Standardised mortality ratio and confidence intervals were calculated. For the unnatural deaths that took place in Sweden, the police report, autopsy protocol, and hospital records, if present, were studied.

Results

Thirty-eight fatalities were included giving a standardised mortality ratio of 1.44 (95% CI: 1.02–1.98). A majority of the decedents were males (n = 32, 84%) and the median age at the time of death was 21 years. Twenty-three deaths were caused by unintentional injuries and ten by intentional injuries (all suicides), while five deaths were categorised as undetermined whether intentional or not. Seventy-four percent tested positive for either alcohol or drugs or a combination at the post mortem examination. Nine males and one female committed suicide, five tested positive for alcohol (one also for drugs), while four tested negative at the post mortem examination. One died abroad and in this case we lack information on alcohol and drugs.

Conclusion

Teenagers visiting an emergency room due to injury experience an increased risk of premature death by unnatural cause and those at risk are especially males. The use of alcohol and drugs often seems to contribute to their untimely deaths. Identifying those at risk when they visit the emergency room for an injury and to take preventive actions at this stage could be a way to reduce the number of fatalities.