PubMed · 11791076
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Jeffrey A Hertz, Miren A Schinco, Eric R Frykberg. 2002. Extensive pneumocranium.. https://doi.org/10.1097/00005373-200201000-00036
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The association of helmet use with death in a motorcycle crash can be estimated using matched-pair cohort methods. By estimating effects among naturally matched pairs on the same motorcycle, one can account for potential confounding by motorcycle characteristics, crash characteristics, and other factors that may influence the outcome. The authors used Fatality Analysis Reporting System data, from 1980 through 1998, for motorcycles that crashed with two riders and either the driver or the passenger, or both, died. For their main analysis, the authors estimated the relative risk of death using conditional Poisson regression. The relative risk of death, accounting for the matching on motorcycle and adjusted for age, sex, and seat position, for a helmeted rider compared with an unhelmeted rider was 0.61 (95% confidence interval: 0.54, 0.70). The authors suggest that conditional Poisson regression is useful for the analysis of traffic crash data, where occupants are naturally matched in a vehicle and where crash-related confounders may be difficult or impossible to measure.
The paper presents final results of the studies concerning the usefulness of knee, ankle, hip, pelvis and neck injuries in reconstructing the circumstances of car-to-pedestrian accidents. Each type of injuries was evaluated with regard to possible reconstruction of the victim's position (upright or recumbent) at the moment of collision and in the upright hits-the side of the pedestrian's body hit. In each group, a chance of proper reconstruction of the pedestrian's location (which determined the frequency of injury pattern assumed as the typical one of a given position or impact side) and error risk (percentage of cases in which the injury pattern showed improper position or impact side) were calculated. These data were compared with similarly calculated possibilities of deducing based on the classical "bumper" injuries to soft tissues and "bending" fractures of the lower limb bone diaphyses. It was shown that the bone bruises within the knee epiphyses were very specific evidence for upright hits as they confirm the limb load by body mass at the moment of pathological dislocation of joint structures on impact. The evidential value of knee injuries was found to be similar to that of other "classical" methods based on bumper injuries or even higher in lateral and front hits. The injuries to the remaining structures were less frequently found and their correlation with the victim's position or impact side was lower. Nevertheless, once the whole complex of these injuries is taken into consideration the chances of proper reconstruction of the pedestrian-vehicle location increase and the risk of opinion error is minimized.
An unusual case of driving under the influence of the volatile anaesthetic enflurane is reported. A markedly affected anaesthetist was sniffing at an enflurane-moistened handkerchief before he crashed into a lorry at a red traffic light. In the blood sample enflurane (2.92 mg/l) as well as diclofenac (0.28 mg/l) and 4-aminophenazone (24.4 mg/l) were found. The way of driving and the accident and the deficiency symptoms could be explained by the central suppressing effects of enflurane. The physician was considered as impaired and not suitable to drive at the time of the incidence.