Illegal road crossing behavior of pedestrians at overpass locations: Factors affecting gap acceptance,crossing times and overpass use

The aim of designing overpasses is to provide safe road crossings for pedestrians by helping them to avoid conflicts with motor vehicles. However, the number of pedestrians who do not use overpasses to cross the road is very high. An observational survey of illegal road crossings was conducted at four overpass locations in Izmir, Turkey to determine the crossing time, crossing speed of the pedestrians and their distance and time gap perception for safe road-crossing within 25 m of the overpasses in both directions. Crossing time is the time needed for a pedestrian to cross a particular road. Time gap is strongly related with safety margin. If a pedestrian chooses a larger time gap, then the arrival time of the oncoming vehicle to the crossing point of the pedestrian increases thus, the possibility of a collision decreases. Each overpass was observed on weekdays during peak afternoon (12.30–13.30) and evening hours (17.00–18.00). At all overpass locations 454 illegal crossings were observed. ANOVA results revealed that age had a significant effect both on safety margin and crossing time. During the observations a survey was conducted among pedestrians who completed their crossings either using the overpass or at street level within 25 m of the overpass (n = 231). Factors affecting the crossing choice of pedestrians were specified in the surveys. The major part of the respondents (71.7%) indicated that time saving was the main reason for crossing at street level. Pedestrians’ crossing speeds were extracted from the video recordings to observe the effect of speed limit on pedestrian behavior. As a result, at locations where the speed limit was 70 km/h, pedestrians’ average crossing speed was found to be 1.60 m/s and 1.73 m/s while at locations where the speed limit was 50 km/h, pedestrians’ average crossing speed was found to be 1.04 m/s and 0.97 m/s. This shows that pedestrians feel safer while crossing when the vehicle speed is low.     

Pedestrian signalization and the risk of pedestrian-motor vehicle collisions in Lima,Peru

Safe walking environments are essential for protecting pedestrians and promoting physical activity. In Peru, pedestrians comprise over three-quarters of road fatality victims. Pedestrian signalization plays an important role managing pedestrian and vehicle traffic and may help improve pedestrian safety. We examined the relationship between pedestrian-motor vehicle collisions and the presence of visible traffic signals, pedestrian signals, and signal timing to determine whether these countermeasures improved pedestrian safety. A matched case-control design was used where the units of study were crossing locations. We randomly sampled 97 control-matched collisions (weighted N = 1134) at intersections occurring from October, 2010 to January, 2011 in Lima. Each case-control pair was matched on proximity, street classification, and number of lanes. Sites were visited between February, 2011 and September, 2011. Each analysis accounted for sampling weight and matching and was adjusted for vehicle and pedestrian traffic flow, crossing width, and mean vehicle speed. Collisions were more common where a phased pedestrian signal (green or red-light signal) was present compared to no signalization (odds ratio [OR] 8.88, 95% Confidence Interval [CI] 1.32–59.6). A longer pedestrian-specific signal duration was associated with collision risk (OR 5.31, 95% CI 1.02–9.60 per 15-s interval). Collisions occurred more commonly in the presence of any signalization visible to pedestrians or pedestrian-specific signalization, though these associations were not statistically significant. Signalization efforts were not associated with lower risk for pedestrians; rather, they were associated with an increased risk of pedestrian-vehicle collisions.     

Urban crash-related child pedestrian injury incidence and characteristics associated with injury severity

Objective

Describe age-based urban pedestrian versus auto crash characteristics and identify crash characteristics associated with injury severity.

Materials and methods

Secondary analysis of the 2004–2010 National Highway and Traffic Safety Administration database for Illinois. All persons in Chicago crashes with age data who were listed as pedestrians (n = 7175 child age ≤19 yo, n = 16,398 adult age ≥20 yo) were included. Incidence and crash characteristics were analyzed by age groups and year. Main outcome measures were incidence, crash setting, and injury severity. Multivariate logistic regression analysis was performed to estimate injury severity by crash characteristics.

Results

Overall incidence was higher for child (146.6 per 100,000) versus adult (117.3 per 100,000) pedestrians but case fatality rate was lower (0.7% for children, 1.7% for adults). Child but not adult pedestrian injury incidence declined over time (trend test p < 0.0001 for <5 yo, 5–9 yo, and 10–14 yo; p < 0.05 for 15–19 yo, p = 0.96 for ≥20 yo). Most crashes for both children and adults took place during optimal driving conditions. Injuries were more frequent during warmer months for younger age groups compared to older (χ²p < 0.001). Midblock crashes increased as age decreased (p < 0.0001 for trend). Most crashes occurred at sites with sub-optimal traffic controls but varied by age (p < 0.0001 for trend). Crashes were more likely to be during daylight on dry roads in clear weather conditions for younger age groups compared to older (χ²p < 0.001). Daylight was associated with less severe injury (child OR 0.93, 95% CI 0.87–0.98; adult OR 0.90, 95% CI 0.87–0.93).

Conclusion

The incidence of urban pedestrian crashes declined over time for child subgroups but not for adults. The setting of pedestrian crashes in Chicago today varies by age but is similar to that seen in other urban locales previously. Injuries for all age groups tend to be less severe during daylight conditions. Age-based prevention efforts may prove beneficial.     

The culpability of drivers killed in New Zealand road crashes and their use of alcohol and other drugs

Over a period of five years, blood samples were taken from 1046 drivers killed as a result of a motor vehicle crash on New Zealand roads. These were analysed for the presence of alcohol and a range of both illicit drugs and psychoactive medicinal drugs. Driver culpability was determined for all crashes. The control group of drug- and alcohol-free drivers comprised 52.2% of the study population. Drivers positive for psychoactive drugs were more likely to be culpable (odds ratio (OR) 3.5, confidence interval (CI) 95% 2.4–5.2) than the control group. Driver culpability exhibited the expected positive association with alcohol use (OR 13.7, 95% CI 4.3–44) and with combined alcohol and cannabis use (OR 6.9, 95% CI 3.0–16). There was only a weak positive association between cannabis use (with no other drug) and culpability (OR 1.3, CI 95% 0.8–2.3). Furthermore, the OR for drivers with blood tetrahydrocannabinol (THC) concentrations greater than 5 ng/mL was lower (OR 1.0, CI 95% 0.4–2.4) than drivers with blood THC concentrations less than 2 ng/mL (OR 3.1, CI 95% 0.9–10). This is inconsistent with results reported by other studies where a significant increase in crash risk was found with blood THC levels greater than 5 ng/mL. In this study, there were very few drivers who had used a single drug, other than cannabis or alcohol. Therefore, from this study, it is not possible to comment on any relationship between opioid, stimulant or sedative drug use and an increased risk of being killed in a crash for the drivers using these drugs. The results from a multivariate analysis indicate that driver gender, age group and licence status, (P = 0.022, P = 0.016, P = 0.026, respectively), the type of vehicle being driven (P = 0.013), the number of vehicles in the crash (P < 0.001), the blood alcohol concentration of the driver (P < 0.001) and the use of any drug other than alcohol and cannabis (P = 0.044), are all independently associated with culpability.     

Not just a rural occurrence: Differences in agricultural equipment crash characteristics by rural–urban crash site and proximity to town

Purpose

Although approximately one-third of agricultural equipment-related crashes occur near town, these crashes are thought to be a rural problem. This analysis examines differences between agricultural equipment-related crashes by their urban–rural distribution and distance from a town.

Methods

Agricultural equipment crashes were collected from nine Midwest Departments of Transportation (2005–2008). Crash zip code was assigned as urban or rural (large, small and isolated) using Rural–Urban Commuting Areas. Crash proximity to a town was estimated with ArcGIS. Multivariable logistic regression was used to estimate the odds of crashing in an urban versus rural zip codes and across rural gradients. ANOVA analysis estimated mean distance (miles) from a crash site to a town.

Findings

Over four years, 4444 crashes involved agricultural equipment. About 30% of crashes occurred in urban zip codes. Urban crashes were more likely to be non-collisions (aOR = 1.69[1.24–2.30]), involve ≥2 vehicles (2 vehicles: aOR = 1.58[1.14–2.20], 3+ vehicles: aOR = 1.68[0.98–2.88]), occur in a town (aOR = 2.06[1.73–2.45]) and within one mile of a town (aOR = 1.65[1.40–1.95]) than rural crashes. The proportion of crashes within a town differed significantly across rural gradients (P < 0.0001). Small rural crashes, compared to isolated rural crashes, were 1.98 (95%CI[1.28–3.06]) times more likely to be non-collisions. The distance from the crash to town differed significantly by the urban-rural distribution (P < 0.0001).

Conclusions

Crashes with agricultural equipment are unexpectedly common in urban areas and near towns and cities. Education among all roadway users, increased visibility of agricultural equipment and the development of complete rural roads are needed to increase road safety and prevent agricultural equipment-related crashes.     

Impaired vigilance and increased accident rate in public transport operators is associated with sleep disorders

Objectives

Sleep disturbances can impair alertness and neurocognitive performance and increase the risk of falling asleep at the wheel. We investigated the prevalence of sleep disorders among public transport operators (PTOs) and assessed the interventional effects on hypersomnolence and neurocognitive function in those diagnosed with obstructive sleep apnea (OSA).

Methods

Overnight polygraphy and questionnaire data from 101 volunteers (72 males, median age 48 range [22–64] years, 87 PTOs) employed at the Gothenburg Public Transportation Company were assessed. Treatment was offered in cases with newly detected OSA. Daytime sleep episodes and neurocognitive function were assessed before and after intervention.

Results

At baseline, symptoms of daytime hypersomnolence, insomnia, restless legs syndrome as well as objectively assessed OSA (apnea hypopnea index (AHI, determined by polygraphic recording) = 17[5–46] n/h) were highly present in 26, 24, 10 and 22%, respectively. A history of work related traffic accident was more prevalent in patients with OSA (59%) compared to those without (37%, p < 0.08). In the intervention group (n = 12) OSA treatment reduced AHI by −23 [−81 to −5] n/h (p = 0.002), determined by polysomnography. Reduction of OSA was associated with a significant reduction of subjective sleepiness and blood pressure. Measures of daytime sleep propensity (microsleep episodes from 9 [0–20.5] to 0 [0–12.5], p < 0.01) and missed responses during performance tests were greatly reduced, indices of sustained attention improved.

Conclusions

PTOs had a high prevalence of sleep disorders, particularly OSA, which demonstrated a higher prevalence of work related accidents. Elimination of OSA led to significant subjective and objective improvements in daytime function. Our findings argue for greater awareness of sleep disorders and associated impacts on daytime function in public transport drivers.     

Formulas for risk of failure

The concept of stress strength inference plays an important role in modeling problems with respect to engineering fracture mechanics, see, e.g. [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20] and [21]. The risk of failure of a system can be expressed by the probability R = Pr(X₂ < X₁), where X₁ and X₂ are some random variables representing the stress and the strength experienced by the system. In this note, we derive a comprehensive collection of formulas for R by assuming the most commonly known models for X₁ and X₂. We feel that this work could serve as a useful reference for engineering fracture mechanics.     

MMSE as a predictor of on-road driving performance in community dwelling older drivers

Screening tools such as the MMSE have been used extensively in driving research studies to determine mild cognitive impairment or dementia. While some studies have shown the MMSE to correlate with driving performance, few studies have shown the predictive validity of the MMSE in determining on-road performance. In a sample of 168 community dwelling older adults, including 20 with Parkinson's disease (PD), the primary objective was to determine the validity of the MMSE to predict pass/fail outcomes of an on-road driving test using receiver operating characteristics curves. The area under the curve (AUC), an index of discriminability, for the total sample was .654, 95% CI = 0.536–0.772, p = .009. Meanwhile, the AUC for the PD group was 0.791, 95% CI = 0.587–0.996, p = .036. The total sample showed statistically significant yet poor predictive validity. However, the PD group showed statistically significant and good predictive validity of the MMSE to predict pass/fail outcomes on the road test, but caution is warranted as the confidence intervals are wide (due to small sample) and the positive and negative predictive values are less than desirable due to the associated error. The findings show that using the current cut-off point of ≤24 on the MMSE is not adequately sensitive to predict on-road performance in both community dwelling older drivers and in drivers with PD. This study offers strong evidence to support the current best practice of not using the MMSE in isolation to predict on-road performance.     

Reliability of simulator driving tool for evaluation of sleepiness,fatigue and driving performance

Study objective

To compare the impact of extended wakefulness (i.e., sleepiness) and prolonged driving (i.e., fatigue) at the wheel in simulated versus real-life driving conditions.

Design

Participants drove on an INRETS-MSIS SIM2 simulator in a research laboratory or an open French highway during 3 nocturnal driving sessions. A dose–response design of duration of nocturnal driving was used: a 2 h short driving session (3–5 AM), a 4 h intermediate driving session (1–5 AM) and an 8 h long driving session (9 PM–5 AM).

Participants

Two groups of healthy male drivers (20 for simulated driving and 14 drivers for real driving; mean age ± SD = 22.3 ± 1.6 years), free of sleep disorders.

Measurements

Number of inappropriate line crossings, self-rated fatigue and sleepiness were recorded in the last hour of driving sessions to control the effects of prior waking time and time of day.

Results

Compared to the daytime reference session, both simulated and real driving performance were affected by a short nocturnal driving session (P < .05 and P < .001, respectively). Extension of nocturnal driving duration affected simulated performance nonlinearly and more severely than that of real driving (P < .001).Compared to the daytime reference session, short nocturnal simulated and real driving sessions increased self-perceived fatigue and sleepiness. Real and simulated driving conditions had an identical impact on fatigue and sleepiness during extended periods of nocturnal driving.

Conclusions

In healthy subjects, the INRETS-MSIS SIM2 simulator appropriately measures driving impairment in terms of inappropriate line crossings related to extended wakefulness but has limitations to measure the impact of extended driving on drivers’ performance.     

Effects of mobile Internet use on college student pedestrian injury risk

Background

College-age individuals have the highest incidence of pedestrian injuries of any age cohort. One factor that might contribute to elevated pedestrian injuries among this age group is injuries incurred while crossing streets distracted by mobile devices.

Objectives

Examine whether young adult pedestrian safety is compromised while crossing a virtual pedestrian street while distracted using the Internet on a mobile “smartphone.”

Method

A within-subjects design was implemented with 92 young adults. Participants crossed a virtual pedestrian street 20 times, half the time while undistracted and half while completing an email-driven “scavenger hunt” to answer mundane questions using mobile Internet on their cell phones. Six measures of pedestrian behavior were assessed during crossings. Participants also reported typical patterns of street crossing and mobile Internet use.

Results

Participants reported using mobile Internet with great frequency in daily life, including while walking across streets. In the virtual street environment, pedestrian behavior was greatly altered and generally more risky when participants were distracted by Internet use. While distracted, participants waited longer to cross the street (F = 42.37), missed more safe opportunities to cross (F = 42.63), took longer to initiate crossing when a safe gap was available (F = 53.03), looked left and right less often (F = 124.68), spent more time looking away from the road (F = 1959.78), and were more likely to be hit or almost hit by an oncoming vehicle (F = 29.54; all ps < 0.01). Results were retained after controlling for randomized order; participant gender, age, and ethnicity; and both pedestrian habits and mobile Internet experience.

Conclusion

Pedestrian behavior was influenced, and generally considerably riskier, when participants were simultaneously using mobile Internet and crossing the street than when crossing the street with no distraction. This finding reinforces the need for increased awareness concerning the risks of distracted pedestrian behavior.     

Specific sleepiness symptoms are indicators of performance impairment during sleep deprivation

Drivers are not always aware that they are becoming impaired as a result of sleepiness. Using specific symptoms of sleepiness might assist with recognition of drowsiness related impairment and help drivers judge whether they are safe to drive a vehicle, however this has not been evaluated. In this study, 20 healthy volunteer professional drivers completed two randomized sessions in the laboratory – one under 24 h of acute sleep deprivation, and one with alcohol. The Psychomotor Vigilance Task (PVT) and a 30 min simulated driving task (AusEdTM) were performed every 3–4 h in the sleep deprivation session, and at a BAC of 0.00% and 0.05% in the alcohol session, while electroencephalography (EEG) and eye movements were recorded. After each test session, drivers completed the Karolinska Sleepiness Scale (KSS) and the Sleepiness Symptoms Questionnaire (SSQ), which includes eight specific sleepiness and driving performance symptoms. A second baseline session was completed on a separate day by the professional drivers and in an additional 20 non-professional drivers for test–retest reliability. There was moderate test–retest agreement on the SSQ (r = 0.59). Significant correlations were identified between individual sleepiness symptoms and the KSS score (r values 0.50–0.74, p < 0.01 for all symptoms). The frequency of all SSQ items increased during sleep deprivation (χ² values of 28.4–80.2, p < 0.01 for all symptoms) and symptoms were related to increased subjective sleepiness and performance deterioration. The symptoms “struggling to keep your eyes open”, “difficulty maintaining correct speed”, “reactions were slow” and “head dropping down” were most closely related to increased alpha and theta activity on EEG (r values 0.49–0.59, p < 0.001) and “nodding off to sleep” and “struggling to keep your eyes open” were related to slow eye movements (r values 0.67 and 0.64, p < 0.001). Symptoms related to visual disturbance and impaired driving performance were most accurate at detecting severely impaired driving performance (AUC on ROC curve of 0.86–0.91 for detecting change in lateral lane position greater than the change at a BAC of 0.05%). Individual sleepiness symptoms are related to impairment during acute sleep deprivation and might be able to assist drivers in recognizing their own sleepiness and ability to drive safely.     

Modeling motivation and habit in driving behavior under lifetime driver's license revocation

The purpose of the present study was to verify the motivational factors underlying the theory of planned behavior (TPB) predicting the driving behavior of lifetime driving license revoked offenders. Of a total of 639 drivers whose licenses had been permanently revoked, 544 offenders completed a questionnaire constructed to measure attitudes toward behaviors, subjective norms, perceived behavioral control, behavioral intentions (the key constructs of the TPB), and previous driving habit strength. The finding of the study revealed that an offenders’ driving behavior after a lifetime license revocation was significantly correlated to behavioral intention (R = 0.60, p < 0.01), perceived behavioral control (R = 0.61, p < 0.01), previous driving habit (R = 0.44, p < 0.01), and attitude (R = 0.41, p < 0.01). There was no evidence that subjective norms including road regulation, society ethics, and people important to offenders had an influence on driving behavior (R = 0.03). Low driving habit strength offenders are motivated to drive because of behavioral intention, whereas strong driving habit strength offenders are motivated to drive because of perceived behavioral control. Previous driving habit strength is a moderator in the intention–behavior relationship. The model appeared successful when previous habits were weak, but less successful when previous habits were strong.     

Exploring the impact of a dedicated streetcar right-of-way on pedestrian motor vehicle collisions: A quasi experimental design

Background and Objectives

The frequency of pedestrian collisions is strongly influenced by the built environment, including road width, street connectivity and public transit design. In 2010, 2159 pedestrian collisions were reported in the City of Toronto, Canada with 20 fatalities. Previous studies have reported that streetcars operating in mixed traffic pose safety risks to pedestrians; however, few studies evaluate the effects on pedestrian-motor vehicle collisions (PMVC). The objective of this study was to examine changes in the rate and spatial patterning of PMVC, pre to post right-of-way (ROW) installation of the St. Clair Avenue West streetcar in the City of Toronto, Canada.

Methods

A quasi-experimental design was used to evaluate changes in PMVC rate, following implementation of a streetcar ROW. Collision data were extracted from all police-reported PMVC, complied and verified by the City of Toronto, from January 1, 2000 to December 31, 2011. A zero-inflated Poisson regression analysis estimated the change in PMVC, pre to post ROW. Age and injury severity were also examined. Changes in the spatial pattern of collisions were examined by applying the G function to describe the proportion of collision events that shared a nearest neighbor distance less than or equal to a threshold distance.

Results

A total of 23,607 PMVC occurred on roadways during the study period; 441 occurring on St. Clair Ave, 153 during the period of analysis. There was a 48% decrease in the rate of collisions on St. Clair [Incidence rate ratio (IRR) = 0.52, 95% CI: 0.37–0.74], post ROW installation. There were also decreases noted for children (IRR = 0.13, 95% CI: 0.04–0.44), adults (IRR = 0.61, 95% CI: 0.38–0.97), and minor injuries (IRR = 0.56, 95% CI: 0.40–0.80). Spatial analyses indicated increased dispersion of collision events across each redeveloped route segment following the changes in ROW design.

Conclusions/Implications

Construction of a raised ROW operating on St. Clair Ave. was associated with a reduction in the rate of collisions. Differences in pre- and post collision spatial structure indicated changes in collision locations. Results from this study suggest that a streetcar ROW may be a safer alternative for pedestrians compared to a mixed traffic streetcar route and should be considered by city planners where appropriate to the street environment.     

Knowledge and practice of childhood motor vehicle restraint use in Nova Scotia: Phase II

Objective

To examine changes to knowledge and practice of childhood motor vehicle restraint (CMVR) use in Nova Scotia after the implementation of stricter car seat and new booster seat (BS) legislation in 2007.

Methods

A random telephone survey of households (at least one child <12 years) was performed in 2004 and 2010. Logistic regression determined variables independently associated with correct knowledge and/or practice of CMVR use.

Results

Families were surveyed in the pre- (N = 426 families, 728 children) and post- (N = 453 families, 723 children) legislative periods. Reported appropriate use of forward-facing car seats (FFCSs) and BSs increased significantly (74–92% and 58–95%, respectively). After adjusting for covariates, the post-law period remained a significant predictor of increased knowledge of when to graduate to a BS or a seat belt alone (SB) (OR:1.4(95% CI:1.0–2.0) and 1.9(1.4–2.7), respectively), which was significantly associated with correct use. The strongest independent predictor of the correct use of FFCSs and BSs was the post-law period (OR:14(3.0–68) and 43(17–114), respectively). With regards to rear-facing car seats (RFCSs), new legislation and associated social marketing on graduating from a rear-facing car seat was not associated with increases in correct practice.

Conclusions

Legislation, combined with social marketing at the time of introduction, is an effective means to educate parents on when to graduate from a FFCS and the importance of BSs while also influencing parents to use them, though not for RFCS graduation. The known protective effect of BSs dictates the need for all regions in Canada to adopt comprehensive BS legislation.     

Functional declines as predictors of risky street-crossing decisions in older pedestrians

The experiment investigated the extent to which risky street-crossing decisions by older pedestrians can be explained by declines in functional abilities. Sixteen young (age 20–35), 17 younger-old (age 60–67), and 18 older-old (age 70–84) participants carried out a street-crossing task in a simulated two-way road environment and took a battery of tests assessing perceptual, cognitive, and motor abilities. Older-old pedestrians were more likely than young and younger-old participants to make decisions that would have led to collisions with approaching cars, especially when traffic coming from two directions was approaching at a high speed. Regression analyses identified several functional performance measures as predictors of these dangerous choices. Walking speed, which determined the time needed to cross, was shown to play the most important role. Time-to-arrival estimate, which informed the pedestrians about the time available for crossing, was found to be the second most predictive factor. Visual processing speed and visual attention abilities assessed via the UFOV^® Test also came into play, allowing participants to focus their attention on the relevant available information and to make timely, correct decisions. Attention shifting was the fourth significant predictor, allowing pedestrians to adapt their crossing strategy to the oncoming road-traffic information. The results suggest that the greater risk of being involved in a collision as age increases calls for a multi-dimensional explanation combining age-related physical, perceptual, and cognitive performance declines. These findings have implications for improving older pedestrians’ safety in terms of speed limits, road design, and training.     

Health status recovery at one year in children injured in a road accident: A cohort study

Despite the frequency of traumatic injuries due to road accidents and potential importance of identifying children at risk of impaired recovery one year after a road accident, there is a lack of data on long-term recovery of health status, except in children with severe traumatic brain injury. The aim of the present study was to evaluate predictive factors of recovery in children one year after road traffic injuries. The prospective cohort study was composed of children aged <16 years, admitted to public or private sector hospitals in the Rhône administrative area of France following a road accident. Recovery of health status one year after the accident and information concerning quality of life and the consequences of the accident for the child or family 1 year after the accident were collected by questionnaire, usually completed by the parents. Victims were in majority male (64.6%) and had mild or moderate injuries (81.9% with Maximum Abbreviated Injury Scale (M-AIS) <3). One year after the accident, 75.0% of the mild-to-moderate and 34.8% of the severe cases estimated health status as fully recovered. After adjustment, severity score (M-AIS ≥ 3) and lower limb injury (AIS > 1) were associated with incomplete recovery of health status: weighted odds ratio (OR_w), 4.3 [95% confidence interval (95% CI), 1.3–14.6] and OR_w, 6.5 [95% CI, 1.9–21.7], respectively. Recovery status correlated significantly with quality of life physical scores (r = 0.46), especially body pain (r = 0.48) and role/social–physical (r = 0.50) and, to a lesser extent, quality of life psychosocial scores (r = 0.21). In a cohort of children injured in a road accident, those with high injury severity score and those with lower limb injuries are less likely to recover full health status by 1 year. Impaired health status was associated with a lower physical quality of life score at 1 year.     

Ambulance transport rates after motor vehicle collision for older vs. younger adults: A population-based study

Older adults are at greater risk than younger adults for life-threatening injury after motor vehicle collision (MVC). Among those with life-threatening injury, older adults are also at greater risk of not being transported by emergency medical services (EMS) to an emergency department. Despite the greater risk of serious injury and non-transportation among older adults, little is known about the relationship between patient age and EMS transportation rates for individuals experiencing MVC. We describe transport rates across the age-span for adults seen by EMS after experiencing MVC using data reported to the North Carolina Department of Motor Vehicles between 2008 and 2011. Of all adults aged 18 years and older experiencing MVC and seen by EMS (n = 484,310), 36.3% (n = 175,768) were transported to an emergency department. Rates of transport for individuals seen by EMS after MVC increased only a small amount with increasing patient age. After adjusting for potential confounders of the relationship between patient age and the decision to transport (patient gender, patient race, air bag deployment, patient trapped or ejected, and injury severity), transport rates were: age 18–64 = 36.0% (95% confidence interval [CI], 35.9–36.2%); age 65–74 = 36.6% (95% CI, 36.0–37.1%); age 75–84 = 37.3% (95% CI, 36.5–38.1%), and age 85–94 = 38.2% (95% CI, 36.7–39.8%). In North Carolina between 2008 and 2011, the transportation rate was only slightly higher for older adults than for younger adults, and most older adults experiencing MVC and seen by EMS were not transported to the emergency department. These findings have implications for efforts to improve the sensitivity of criteria used by EMS to determine the need for transport for older adults experiencing MVC.     

Alcohol- or drug-use disorders and motor vehicle accident mortality: A retrospective cohort study

A large body of research has linked alcohol consumption and motor vehicle accidents (MVAs), but far fewer studies have estimated the risk of MVA fatality among drug users. Our study addresses this gap. We identified cohorts of individuals hospitalized in California from 1990 to 2005 with ICD-9 diagnoses of methamphetamine- (n = 74,170), alcohol- (n = 592,406), opioids- (n = 68,066), cannabis- (n = 47,048), cocaine- (n = 48,949), or polydrug-related disorders (n = 411,175), and these groups were followed for up to 16 years. Age-, sex-, and race-adjusted standardized mortality rates (SMRs) for deaths due to MVAs were generated in relation to the California general population. Standardized MVA mortality ratios were elevated across all drug cohorts: alcohol (4.5, 95% CI, 4.1–4.9), cocaine (3.8, 95% CI, 2.3–5.3), opioids (2.8, 95% CI, 2.1–3.5), methamphetamine (2.6, 95% CI, 2–3.1), cannabis (2.3, 95% CI, 1.5–3.2) and polydrug (2.6, 95% CI, 2.4–2.9). Males and females had similar MVA SMRs. Our large, population-based study found elevated risk of MVA mortality across all cohorts of individuals with alcohol- or drug-use disorders. Given that illicit drug users are often unaware of or misperceive the impacts of drug use on safe driving, it may be important for health-service or public-health interventions to address such biases and improve road safety.     

Trends in head injuries associated with mandatory bicycle helmet legislation targeting children and adolescents

Background

Bicycling related head injuries (HIs) can be severe. Helmet use reduces head injury risk; however, there are few controlled studies of the effect of helmet legislation. We conducted this study to investigate changes in HIs after bicycle helmet legislation targeting those <18 in Alberta, Canada in 2002.

Methods

Bicyclist and pedestrian (control) HI rates and HIs as a proportion of all injuries were compared for the three years (1999–2001) before and four years (2003–2006) after bicycle helmet legislation in three age groups (children: <13, adolescents: 13–17, and adults: 18+).

Results

There were 41,270 ED visits and 2782 hospitalizations for bicyclists and 9836 ED visits and 2029 hospitalizations for pedestrians (excluding the legislation year 2002). The rate of ED HIs declined for child bicyclists and child pedestrians, while the rate of non-HIs declined in adult bicyclists and child pedestrians. The rate of hospitalized HIs declined in child bicyclists and all ages of pedestrians while non-HI rates declined for child and adult pedestrians. Non-HI rates for adolescent and adult bicyclists increased. After adjusting for sex and location, the proportion of ED bicycle HIs declined by 9% (APR = 0.91; 95% CI: 0.86, 0.95) in children, was unchanged among adolescents and increased in adults (APR = 1.08; 95% CI: 1.01, 1.15). The proportion of bicycle HI related hospitalizations decreased by 30% (APR = 0.70; 95% CI: 0.55, 0.90) in children, 36% (APR = 0.64; 95% CI: 0.49, 0.84) in adolescents and 24% (APR = 0.76; 95% CI: 0.63, 0.91) in adults. There were no observed changes in the proportion of pedestrian HIs resulting in ED visits or hospitalizations.

Interpretation

Our data indicate significant declines in the proportion of child bicyclist ED HIs and child, adolescent and adult bicyclist HI hospitalizations. This is in contrast to no significant trends in the proportion of ED or hospitalized HIs among pedestrians and the unexpected increases in the proportion of ED HIs for adult bicyclists. Comparing bicyclist and pedestrian trends in the proportion of child and adolescent HIs suggests a bicycle helmet legislation effect.     

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.