Increases in crash involvement and fatalities among motor vehicle occupants younger than 5 years old

OBJECTIVE: To determine whether increased exposure as car occupants could be a major contributor to increases observed in deaths of young children in car crashes. DESIGN AND SETTING: Crash data from police reports for Maryland, Michigan, Pennsylvania, and Washington for various years from 1982 through 1990 were examined to compare annual age mix of injured and uninjured occupants in crashes involving at least two passenger vehicles. Aggregate national data from the Fatal Accident Reporting System were also examined over the same time period and compared to population estimates for children younger than 5 years old to assess temporal trends in number of occupants in this age group who were involved in motor vehicle crashes in which a fatality occurred in fatal crashes and the number of them killed in passenger vehicles. RESULTS: In regression analyses for each state, the number of car occupants younger than 5 involved in crashes increased during the years studied; their percentage among nondriver occupants involved also increased. At a national level, similar analyses showed increases in the number of occupants younger than 5 involved in crashes in which a fatality occurred. CONCLUSIONS: Despite overall increases in the use of restraint devices (ie, both child safety seats and adult restraints), fatalities among restrained children have increased. Given that exposures to crash environments are increasing, clinicians need be aware of the importance of child restraints as a means of reducing the likelihood of injury.     

Injury pattern and severity in lateral motor vehicle collisions: a Canadian experience

OBJECTIVE: To determine the pattern and severity of injury and the outcome of front seat motor vehicle occupants after lateral impact crashes. DESIGN: Retrospective review undertaken in a Regional Trauma Unit (Sunnybrook Health Science Centre). MATERIALS AND METHODS: Review of seriously injured front seat motor vehicle occupants admitted to a Regional Trauma Unit over a 46-month period (September 15, 1989, to July 15, 1993) for whom vehicle crash information and occupant seat belt use were known. MEASUREMENTS AND MAIN RESULTS: Three hundred forty-eight front seat vehicle occupants were available for study; one hundred forty-one (41%) were involved in a lateral impact motor vehicle crash. Driver side lateral crashes (57%) were more common than passenger side impacts. Victims of lateral impact crashes had a significantly higher mean Injury Severity Score (25 compared with 20 for nonlateral crashes: p < 0.05), and the direction of impact was strongly associated with injury severity (p < 0.05). Lateral impact crashes resulted in substantially more significant chest (p < 0.01) and intra-abdominal (p < 0.0001) injuries. Type of injury was significantly different between the lateral and nonlateral impact groups for facial, chest, abdominal, and musculoskeletal injuries. CONCLUSIONS: The direction of impact in motor vehicle crashes is strongly associated with the pattern and severity of organ injuries. Further attention to automobile safety design is necessary to better protect occupants involved in lateral impact crashes.     

Motor vehicle fatalities in the United States construction industry

Photographs (study 1) or line-drawing representations (study 2) of posed facial expressions and a list of emotion words (happiness, surprise, fear, disgust, anger, sadness, neutral) were presented to two groups of observers who were asked to match the photographs or line drawings, respectively, with the emotion categories provided. A multidimensional-scaling procedure was applied to the judgment data. Two dimensions were revealed; pleasantness--unpleasantness and upper-face--lower-face dominance. Furthermore, the similarity shown by the two-dimensional structures derived first from the judgments of photographs and second from the line drawings suggests that line drawings are a viable alternative to photographs in facial-expression research.     

Injuries in restrained motor vehicle accident victims

Passenger restraints reduce fatalities and serious injuries. Restraint systems alter the distribution of injuries seen in accident victims, and they cause a number of injuries. The distribution of injuries is dependent on the type of restraint. Automatic motorized shoulder belts are being used without the accompanying manual lap belt. This greatly reduces the effectiveness of the system and is equal to the two-point shoulder belt of the 1960s. Airbag injuries include abrasions to the face, neck, and chest; minor burns to the upper extremities; and chemical keratitis. Airbags have been shown to reduce injuries overall, especially when used in conjunction with a lap and shoulder belt. Elderly patients incur more rib and sternal fractures due to seat belts than do younger patients. Nevertheless, restraint systems are effective at reducing serious internal injuries in this population. Children who are too large for child safety seats but too small for adult seat belts are at increased risk for injury. Improvement in restraint systems for children in this age range is recommended. All pregnant women should be encouraged to wear seat belts because they reduce maternal injuries, and there is no evidence that they increase the risk of fetal loss. In view of the injury reduction associated with passenger restraint systems, emergency physicians should emphasize to their patients the importance of wearing seat belts.     

Isradipine in arterial hypertension in motor vehicle drivers

The study covered influence of Isradipine (2.5 mg administered twice daily during 6 weeks) on blood circulation in the heart and occupationally important functions and traits among 30 drivers having mild and moderate arterial hypertension (AH). Systolic and diastolic pressure demonstrate reliable decrease in all the examinees with mild AH and in 93.8% of the examinees with moderate AH. Isradipine proved to influence positively decrease of hypertensive reactions and subclinical myocardial ischemia. Isradipine presented statistically significant improvement of the studied psychophysiologic parameters (quickness of latent and motor visual reaction, number of errors in color choice, exactness in following the mobile object). Thus, all above enables to recommend Isradipine (Lomir) as effective and safe method correcting arterial hypertension in drivers.     

机电设备图纸管理信息系统

针对大中型矿山机电设备图纸管理的状况和当前计算机应用的发展趋势,提出了网络化图纸管理信息系统的思路,介绍了开发研究的基本框架。采用了可视化程序设计的方法,将图纸的输入、编辑、修改、管理集成在一个统一的环境中,实现了资源共享及人机对话,最大限度地利用了图纸资源,方便了基层职工的操作应用,对于相关企业机电设备的科学管理具有一定的借鉴意义。     

Epidemiology of motor vehicle crash-related serious eye injuries

The Eye Injury Registry of Alabama has been collecting epidemiologic, treatment, final outcome, and rehabilitation information on serious ocular trauma since 1982. By December 31, 1989, 150 motor vehicle crash-related eye injuries had been registered. This is the largest series of motor vehicle crash-related serious eye injuries reported. The mean age of those injured was 29 years; 61% were between 16 and 35 years of age, and 73% were males. Ten individuals (7%) suffered bilateral eye injuries. The retina was injured in 47% of eyes. The initial visual acuity was 19/200 or worse (legal blindness) in 47% of eyes. Of eyes with at least 3 months of follow-up, 63% had worse than 20/200 initial visual acuity and 41% remained legally blind. Twelve percent of eyes required removal. Possibly due to the large number of blunt ruptures, motor vehicle crash-related eye trauma carries a particularly unfavorable treatment prognosis. Prevention of these injuries is therefore of extraordinary importance.     

Prospective countywide evaluation of the effects of motor vehicle safety device use on hospital resource use and injury severity

Stress echocardiography is increasingly used for the assessment of coronary artery disease and is valuable in the treatment of patients with known disease as well. Although several studies are available on the accuracy of stress echocardiography in the detection of coronary artery disease and evaluation of its severity, studies on the use of this technique for evaluation of prognosis are just now emerging. Over the past decade, few studies have investigated its prognostic value in different patient populations. The versatility and advantage of stress echocardiography lie in the fact that it provides information on both resting ventricular function and stress-induced ischemia, two important determinants of cardiac events. Exercise echocardiography with the bicycle or posttreadmill approach is used in subjects who can exercise and provides important additional prognostic data from physiologic exercise variables. In patients unable to exercise, pharmacologic stress echocardiography with dobutamine or vasodilators is used. Stress echocardiography has been shown to identify different populations of patients at risk of cardiac events, including those with stable or suspected coronary artery disease, those with acute myocardial infarction, and those scheduled for major noncardiac surgery. In the early postinfarct setting, exercise and vasodilator stress have been used more often, whereas dobutamine echocardiography has been used predominantly at low doses for the assessment of residual myocardial viability. This review focuses on recently published investigations evaluating the prognostic effect of stress echocardiography in patients with stable coronary artery disease or acute myocardial infarction.     

Extensive fetal intrathoracic injuries sustained in a motor vehicle accident

Motor vehicle accidents are the primary nonobstetric cause of maternal and subsequent fetal mortality. We present a case in which blunt abdominal trauma sustained by a pregnant woman in a motor vehicle accident caused extensive intrathoracic fetal injuries consisting of bilateral hemothorax, severe bilateral interstitial pulmonary hemorrhages, hemopericardium, and subepicardial hemorrhages, in addition to fetal cranial injuries. To the best of our knowledge, this is the first report of fetal intrathoracic injuries sustained with blunt maternal trauma. The underlying mechanism of intrathoracic trauma was thought to be similar to that of blast injury with transmission of excessive hydrostatic forces throughout the amniotic fluid with severe impact on the elastic fetal chest. This case supports the concept of in utero blast injury to the fetus as a possible cause for fetal soft tissue trauma associated with blunt trauma to the maternal abdomen.     

Medical conditions and the risk of motor vehicle crashes in men

BACKGROUND: The appropriateness of laparoscopic colon resection (LCR) as treatment for malignancy has been questioned. METHODS: From 1992 to 1997, 91 patients were entered into a prospective study of LCR for cancer. Clinical, pathologic, and economic parameters of LCR were compared in a cohort of patients matched for age, tumor stage, and type of colectomy who underwent open colon resection (OCR) during the same time period. RESULTS: With a median follow-up of 26 months, there were no significant differences in survival rate for patients in the LCR, converted colon resection, and OCR groups. There were no port-site recurrences and the number of lymph nodes harvested was similar among the procedures. Hospital stay was significantly shorter if laparoscopic resection was successful. Total hospital costs were similar for LCR and OCR; however, the costs were significantly higher for converted colon resection. CONCLUSIONS: LCR is a sound oncologic procedure that can be performed with costs similar to OCR.     

Mechanisms of progressive glomerular injury in membranous nephropathy

Glomerular function and structure were serially evaluated in 15 patients with membranous nephropathy who exhibited relapsing nephrosis and chronic depression of GFR. GFR declined from 56+/-8 (mean+/-SEM) at onset to 31+/-4 ml/min per 1.73 m2 after a 2- to 5-yr period of observation (P < 0.05). An analysis of filtration dynamics suggested persistent elevation of net ultrafiltration pressure. To examine a possible role for declining intrinsic glomerular filtration capacity as the basis for the observed hypofiltration, glomeruli in the baseline and a repeat biopsy (performed after a median of 28 mo) were subjected to morphometric analysis and mathematical modeling. Analysis of the baseline biopsy revealed a reduction in filtration slit frequency and thickening of the glomerular basement membrane, lowering computed hydraulic permeability by 66% compared with normal kidney donors. In contrast, filtration surface area was increased by 37% as a result of glomerular hypertrophy. The repeat biopsy revealed persistent depression of hydraulic permeability, primarily owing to foot process broadening. An additional finding was a decrease in filtration surface area from baseline in patent glomeruli, possibly due to encroachment on the capillary lumen of an increasingly widened basement membrane. Also, a striking increase in the prevalence of global glomerulosclerosis from 7+/-2% to 23+/-4% was found between the two biopsies, suggesting a significant loss of functioning nephrons. It is concluded that hypofiltration in membranous nephropathy is the consequence of a biphasic loss of glomerular ultrafiltration capacity, initially owing to impaired hydraulic permeability that is later exacerbated by a superimposed loss of functioning glomeruli and of filtration surface area.     

Traumatic brain injury and posttraumatic stress disorder: a preliminary investigation of neuropsychological test results in PTSD secondary to motor vehicle accidents

In the present investigation involvement of endothelial-derived reactive oxygen species (ROS) and their interaction with nitric oxide (NO), during norepinephrine (NE)-induced contraction of rat aortic rings was studied. NE (1x10(-10) M to 1x10(-5) M) caused concentration-dependent contractio n of the endothelium intact aortic rings. In the presence of hydroxyl radical scavengers, histidine (1x10(-3) M), mannitol (3x10(-3) M), dimethyl sulfoxide (50x10(-3) M) or thiourea (1x10(-3) m), superoxide dismutase (superoxide radical scavenger, SOD 10 or 100 U ml-1) or catalase (hydrogen peroxide inactivator 3, 10, or 100 U ml-1) the concentration-response curve of NE was shifted towards the right. Interestingly, in NG-nitro-l-arginine methyl ester (L-NAME) (1x10(-5) M, a NO synthase inhibitor) pretreated rings, NE-induced contractions were not inhibited by SOD or extracellular hydroxyl radical scavengers (mannitol and histidine). However, in these rings NE-induced contractions were found to be attenuated by endogenous hydroxyl radical scavengers (thiourea and DMSO) or catalase. In the endothelium denuded rings no significant effect of these scavengers on NE-induced contractions was observed. These results thus indicate the involvement of endothelium-derived hydrogen peroxide, superoxide and hydroxyl radicals in the NE-induced contractions. In addition, endothelial NO interacts with the ROS generated during rat aortic ring contractions.     

Patterns of injury in belted and unbelted individuals presenting to a trauma center after motor vehicle crash: seat belt syndrome revisited

STUDY OBJECTIVE: Investigators have described a "seat belt syndrome" consisting variously of injuries to the lumbar or cervical spine, abdominal contents, or all 3. In this study we sought to identify these and any other patterns of injury associated with seat belt use in patients who presented to a trauma center after a motor vehicle crash. METHODS: The charts of all patients involved in motor vehicle crashes who presented as trauma alerts to the study institution between January 1, 1991, and December 31, 1993, were retrospectively reviewed for data regarding belt use and 35 specific injuries in 7 body regions. We calculated the positive likelihood ratio of injury between belted and unbelted patients, along with 95% confidence intervals. RESULTS: We identified 1,124 patients involved in motor vehicle crashes. Of these subjects, 376 were belted and 544 unbelted; in 204 belt status was unknown. Belted patients were more likely to have sustained sternal fracture than were unbelted patients (4% versus .7%; positive likelihood ratio, 1.97; 95% confidence interval, 1.09 to 3.29) but were less likely to have sustained head injury (30.6% versus 46.0%; positive likelihood ratio, .67; 95% confidence interval, .53 to .83). We noted no statistically significant differences in the rates of other specific injuries, including cervical and lumbar fractures and the need for abdominal surgery. CONCLUSION: Severe injuries of all types occur in both belted and unbelted individuals involved in motor vehicle crashes who present to a typical trauma center. With the exception of sternal fractures, injuries previously associated with the seat belt syndrome occurred in similar proportions of belted and unbelted patients. Head injuries were less frequent. Seat belt use cannot serve as a discriminator for specific injury. A diligent search of all body regions is indicated in both belted and unbelted patients.