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PubMed1996

[A comparison of asthma deaths and near-fatal asthma attacks].

This study compares the characteristics of fatal asthma patients and those of near-fatal asthma patients who had experienced severe life threatening attacks. Data from 67 fatal asthma patients and 80 near-fatal asthma patients were analyzed. The mean age of fatal asthma cases were older than near-fatal asthma cases, 51.9 yrs and 44.3 yrs, respectively. Similarities of the two cases were seen in sex, type of asthma and severity of asthma. The experiences of previous life-threatening asthma did not differ in both groups (43.3% of fatal vs 40.0% of near-fatal). From the viewpoint of type of development of severe exacerbation, rapid exacerbation was more frequent in fatal cases than near-fatal cases, but acute exacerbation after unstable asthma was more in near-fatal asthma. Seventy-six percent of all asthma deaths occurred at home or on the way to the emergency department. The rate of delay of receiving medical care was significantly higher in fatal cases (72%) than near-fatal cases (26%). There was no significant difference in the frequency of medical management before fatal or near-fatal episode such as oxygen therapy, mechanical ventilation. Use of ambulance, visiting emergency department, previous hospitalization between the two groups. The profile of fatal cases was almost same to that of near-fatal cases except delay of receiving medical care. In conclusion, the analysis of near-fatal cases was very important to make clear the causes of asthma death.

Adult↗

PubMed2002

Occupational fatalities in emergency medical services: a hidden crisis.

STUDY OBJECTIVE: We estimate the occupational fatality rate among emergency medical services (EMS) personnel in the United States. METHODS: We undertook descriptive epidemiology of occupational fatalities among EMS providers. Analysis was conducted by using data from 3 independent fatality databases: the Census of Fatal Occupational Injuries (1992 to 1997), the National EMS Memorial Service (1992 to 1997), and the National Highway Traffic Safety Administration's Fatality Analysis Reporting System (1994 to 1997). These rates were compared with the occupational fatality rates of police and firefighters and with the rate of all employed persons in the United States. RESULTS: The Census of Fatal Occupational Injuries database documented 91 EMS provider occupational fatalities. The National EMS Memorial Service database contained 70 fatalities, and the Fatality Analysis Reporting System identified 8 ground-transportation EMS occupational fatalities. There was also wide variation in fatality counts by cause of injury. Using the highest cause-specific count from each of the databases, we estimate that there were at least 67 ground transportation-related fatalities, 19 air ambulance crash fatalities, 13 deaths resulting from cardiovascular incidents, 10 homicides, and 5 other causes, resulting in 114 EMS worker fatalities during these 6 years. We estimated a rate of 12.7 fatalities per 100,000 EMS workers annually, which compares with 14.2 for police, 16.5 for firefighters, and a national average of 5.0 during the same time period. CONCLUSION: This study identifies an occupational fatality rate for EMS workers that exceeds that of the general population and is comparable with that of other emergency public service workers.

Accidents, Occupational↗

PubMed2004

Elderly licensure laws and motor vehicle fatalities.

CONTEXT: Little is known about how state-level driver licensure laws, such as in-person renewal, vision tests, road tests, and the frequency of license renewal relate to the older driver traffic fatality rate. OBJECTIVE: To determine whether state driver's license renewal policies are associated with the fatality rate among elderly drivers. DESIGN, SETTING, AND POPULATION: Retrospective, longitudinal study conducted January 1990 through December 2000 of all fatal crashes in the contiguous United States identified in the Fatality Analysis Reporting System, which involved either an older (ages 65-74 years, 75-84 years, and > or =85 years) or middle-aged (ages 25-64 years) driver. Two regression approaches were used to study the effect of state laws mandating in-person renewal, vision tests, road tests, and frequency of license renewal on driver fatalities, controlling for state-level factors including the number of licensed elderly drivers, primary and secondary seatbelt laws, maximum speed limit laws, blood alcohol level of 0.08, and administrative license revocation drinking and driving laws, per capita income, and unemployment rate. The first regression approach examined only elderly driver fatalities and the second approach examined daytime elderly driver fatalities and used daytime fatalities among middle-aged drivers as a general control for unobserved variation across states and over time. MAIN OUTCOME MEASURES: Older driver fatalities and older and middle-aged daytime driver fatalities. RESULTS: Among individuals aged 85 years or older, there were a total of 4605 driver fatalities and 4179 daytime driver fatalities during the study period. For this age cohort, after controlling for middle-aged daytime driver deaths, states with in-person license renewal were associated with a lower driver fatality rate (incident rate ratio [RR], 0.83; 95% confidence interval [CI], 0.72-0.96). This was the only policy related to older drivers that was significantly associated with a lower fatality risk across both regression models. Thus, state-mandated vision tests, road tests, more frequent license renewal, and in-person renewal (for individuals aged 65-74 years and 75-84 years) were not found to be independently associated with the fatality rate among older drivers in the 2 models. CONCLUSIONS: In-person license renewal was related to a significantly lower fatality rate among the oldest old drivers. More stringent state licensure policies such as vision tests, road tests, and more frequent license renewal cycles were not independently associated with additional benefits.

Accidents, Traffic↗

PubMedDate not supplied

Characteristics of fatal ambulance crashes during emergency and non-emergency operation.

OBJECTIVE: To analyze the characteristics of fatal ambulance crashes to assist emergency medical services (EMS) directors in objectively developing their EMS system's policy governing ambulance operations. HYPOTHESIS: No difference exists between the characteristics of fatal ambulance crashes during emergency and nonemergency use. DESIGN: Retrospective, cross-sectional, comparative analysis of ambulance crashes resulting in fatalities reported to the Fatal Accident Reporting System (FARS) from 1987 to 1990. METHODS: Twenty variables, representing characteristics of fatal ambulance crashes, were selected from the National Highway Traffic Administration FARS Codebook and were evaluated using tests of significance for categorical data grouped by emergency use and nonemergency use. Crash variable categories examined included demographics, accident configuration, accident severity, vehicle description, and ambulance operator action. RESULTS: During the four-year study period, 109 fatal ambulance crashes occurred producing 126 deaths. Four states, New York, Michigan, California, and North Carolina, accounted for 37.5% of all fatal crashes. Seventy-five fatal crashes (69%) occurred during emergency use (EU) and 34 fatal crashes (31%) occurred during nonemergency use (NEU). The total number of fatal crashes varied in a downward trend (1987:32; 1988:24; 1989:28; 1990:25). The number of fatal EU crashes also varied in a downward trend (1987:28; 1988:16; 1989:19; 1990:12), while the number of fatal NEU crashes increased each year [1987:4; 1988:8; 1989:9; 1990:13](p = .016). Most EU fatal crashes occurred between 1200 h and 1800 h (p = .009). Most NEU fatal crashes occurred during times when light conditions were poor (p = .003). When a violation was charged to the ambulance driver (17 cited), the vehicle was more likely to be in EU (p = .056). No statistically significant differences between EU and NEU were identified by: 1) day of week; 2) season; 3) atmospheric conditions; 4) roadway surface type; 5) roadway surface condition; 6) speed limit; 7) roadway alignment; 8) relationship to junction; 9) manner of collision; 10) year manufactured; 11) vehicle role; 12) vehicle maneuver; 13) manner leaving scene; 14) extent of deformation; 15) violations charged; or 16) number of persons killed in accident. CONCLUSION: Few characteristics differentiate between fatal ambulance crashes during EU and NEU. The difference between EU and NEU were statistically significant in only three out of the 20 variables examined: 1) year occurred; 2) time of day; and 3) light condition. These data provide few objective measures that may be used to develop ambulance operation policies to decrease fatal ambulance crashes.

Accidents, Traffic↗

PubMed2003

Motor vehicle crash fatalities by race/ethnicity in Arizona, 1990-96.

OBJECTIVE: To compare rates of motor vehicle crash (MVC) fatalities among different race/ethnic groups in urban and rural Arizona. METHOD: Using the Fatality Analysis Reporting System and the National Center for Health Statistics Multiple Cause of Death file, MVC fatalities in Arizona from 1990-96 inclusive were classified by gender, race/ethnicity, and urban or rural residence. Age adjusted rates of total, occupant, pedestrian, and alcohol related fatalities were calculated. The total MVC fatality rate for each race/ethnic group was then adjusted for proportion of rural residence. RESULTS: Compared with non-Hispanic whites (NHWs), American Indians had raised relative risks for MVC fatality in all gender and residence subgroups. Hispanic females and rural Hispanic males had lower relative risks, as did rural African-American men. Raised relative risks for American Indian men and women included all subgroups: total, occupant, pedestrian, and alcohol related. Hispanic and African-American men both had raised relative risks of pedestrian related fatalities, and Hispanic men had a slightly higher relative risk while Hispanic women had a lower relative risks, for alcohol related fatality. Hispanic men and women and African-American men had lower occupant fatality rates. Close to half (45%) of the excess MVC fatality among American Indians can be attributed to residence in rural areas, where MVC fatality rates are higher. There were 1.85 occupants in crashes involving NHW deaths compared with 2.51 for Hispanics and 2.71 for American Indians (p<0.001). The proportion of occupants not using a seatbelt was higher in Hispanics and American Indians in both urban and rural areas. CONCLUSION: The major disparity in MVC fatality in Arizona is among American Indians. The higher MVC fatality rates among American Indians occur in all age groups, in both urban and rural areas, and among occupants and pedestrians. Rural residence, lower rates of seatbelt use, higher rates of alcohol related crashes, a greater number of occupants, and higher rates of pedestrian deaths all contribute to the American Indian MVC fatality disparity. High rates of pedestrian fatality occur in men in all three race/ethnic minorities in Arizona and among American Indian women. In contrast to other studies, African-Americans and Hispanics did not have raised total MVC fatality rates and compared to NHWs actually had lower rates in the rural areas of the state.

Accidents, Traffic↗

PubMed2004

Twelve-year survey of fatal reactions to allergen injections and skin testing: 1990-2001.

BACKGROUND: Fatal reactions associated with skin testing and injection immunotherapy have not been surveyed in North America since 1989. OBJECTIVE: A survey of fatal reactions related to skin testing and immunotherapy and of near-fatal immunotherapy reactions that transpired from 1990 through 2001 was conducted among member practices of the American Academy of Allergy, Asthma and Immunology. METHODS: A short survey of fatal reactions was sent to all American Academy of Allergy, Asthma and Immunology physicians, and an 87-item follow-up detailed questionnaire was sent to those reporting fatal reactions. RESULTS: Of 2404 members, 646 (25%) responded to the short survey. There were 20 fatal immunotherapy reactions that were directly reported and 21 indirectly reported cases by local physicians. There were 273 (42% of the responding sample) reports of near-fatal reactions. It was estimated that fatal reactions occurred every 1 per 2.5 million injections, with an average of 3.4 deaths per year. One fatality was confirmed after skin prick testing with multiple food allergens. Of 17 fatal deaths described in long questionnaires, 15 were in asthmatic patients, the majority of whose symptoms were not optimally controlled. Three reactions occurred in a medically unsupervised setting. None were receiving beta-blockers, and one was taking an angiotensin-converting enzyme inhibitor. Most fatal reactions (59%) occurred with maintenance allergen doses. The onset of 3 reactions began more than 30 minutes after injections, with a significant delay in starting epinephrine. Epinephrine was not administered in 3 other fatal reactors. CONCLUSIONS: Fatal reactions to immunotherapy injections occurred at similar rates reported in previous surveys. Certain clinical practices have improved (ie, exclusion of beta-blockers), and dosing errors were infrequent. Fatal reactions to immunotherapy often occur in settings inappropriate for optimal treatment of anaphylaxis. Strict adherence to practice guidelines might prevent or minimize future fatal reactions.

Asthma↗

PubMed2006

Field data: distributions and costs of road-traffic fatalities in South Africa.

BACKGROUND: Road-traffic crashes and fatalities constitute major social and economic issues in South Africa. They are a major cause of morbidity and mortality comparable to HIV/AIDS, homicides, and some chronic diseases. METHODS: Road-traffic accident data for the year 2003 obtained from the Department of Transport, Pretoria, South Africa were used for this study. The valuation of the costs of road-traffic crashes and fatalities in South Africa is based on the gross output or human capital approach. RESULTS: 10,197 fatal road crashes and 12,353 fatalities were reported during the study period. More than 50% of the fatal road crashes and fatalities occurred in only three out of 11 provinces. The Northern Cape, which is the least populated province, had the highest fatal road crashes per 100,000 population and fatalities per 100,000 population. The number of road-traffic fatalities in the rural areas was 2.7 times that in the urban areas. The total costs of the road-traffic fatalities which was about R 8 billion (>US$ 1 billion) is about 0.6% of the country's nominal GDP for 2003. 60% of the cases and costs of road-traffic fatalities involved persons aged 20-39 years, although this age group is only 27% of the country's population. The rural areas accounted for 73% and the urban areas 27% of the total costs of fatal road-traffic crashes. CONCLUSION: Those living in the rural areas of the South African society and those aged 20-49 years constitute high-risk groups of road-traffic crashes and fatalities. They are also responsible for most of the attendant costs of fatal crashes and fatalities in the country.

Accidents, Traffic↗

PubMed2006

Risk of fatality and causes of death of Thoroughbred horses associated with racing in Victoria, Australia: 1989-2004.

REASONS FOR PERFORMING STUDY: Determining the risk of fatality of Thoroughbred horses while racing is essential to assess the impact of intervention measures designed to minimise such fatalities. OBJECTIVES: To measure the risk of racehorse fatality in jump and flat starts on racecourses in Victoria, Australia, over a 15 year period and to determine proportional mortality rates for specific causes of death. METHODS: All fatalities of Thoroughbred horses that occurred during or within 24 h of a race were identified from a database. The risk of a start resulting in a racehorse fatality in all races and within flat and jump races, proportional mortality rates, population attributable risk, population attributable fraction and risk ratios were calculated along with 95% confidence intervals. Poisson regression was also performed to estimate risk ratios. RESULTS: There were 514 fatalities over the 15 year period; 316 in flat races and 198 in jump races. The risk of fatality was 0.44 per 1000 flat starts and 8.3 per 1000 jump starts (18.9 x greater). The risk of fatality on city tracks was 1.1 per 1000 starts whereas on country tracks it was 0.57 per 1000 starts. Of the 316 fatalities in flat races, 73.4% were due to limb injury, 2.5% to cranial or vertebral injury and 19.0% were sudden deaths. Of the 198 fatalities in jump races, 68.7% were due to limb injury, 16.2% to cranial or vertebral injury and 3.5% were sudden deaths. The risk of fatality in flat starts increased between 1989 and 2004 but the risk in jump starts remained unchanged over the 15 year period. CONCLUSIONS: The risk of fatality in flat starts was lower in Victoria than North America and the UK but the risk in jump starts was greater. Catastrophic limb injury was the major reason for racehorse fatality in Victoria but there was a larger percentage of sudden deaths than has been reported overseas. The risk of fatality in jump starts remained constant over the study period despite jump racing reviews that recommended changes to hurdle and steeple races to improve safety. POTENTIAL RELEVANCE: This study provides important benchmarks for the racing industry to monitor racetrack fatalities and evaluate intervention strategies.

Animals↗

PubMed2005

The strength of graduated drivers license programs and fatalities among teen drivers and passengers.

OBJECTIVES: The purpose of this study is to investigate the effects of differentially stringent graduated drivers license programs on teen driver fatalities, day-time and night-time teen driver fatalities, fatalities of teen drivers with passengers present, and fatalities among teen passengers. METHODS: The study uses 1992-2002 data on motor vehicle fatalities among 15-17-year-old drivers from the Fatality Analysis Reporting System to identify the effects of "good", "fair", and "marginal" GDL programs based upon designations by the Insurance Institute for Highway Safety. Analysis is conducted using conditional negative binomial regressions with fixed effects. RESULTS: "Good" programs reduce total fatalities among young drivers by 19.4% (c.i. -33.0%, -5.9%). "Fair" programs reduce night-time young driver fatalities by 12.6% (c.i. -23.9%, -1.2%), but have no effect on day-time fatalities. "Marginal" programs had no statistically meaningful effect on driver fatalities. All three types of programs reduced teen passenger fatalities, but the effects of limitations on the number of passengers appear to have had only minimal effects in reducing fatalities among young drivers themselves. CONCLUSIONS: Stronger GDL programs are more effective than weaker programs in reducing teenage motor vehicle fatalities.

Accidents, Traffic↗

PubMedDate not supplied

Stroke case fatality in Denmark from 1977 to 1992: the Copenhagen City Heart Study.

BACKGROUND AND PURPOSE: Stroke mortality rates have decreased in Denmark but little is known about the reasons for these changes. One possible explanation is decreased case-fatality, and the aim of the present investigation was to study trends in case-fatality for first-ever stroke in a large population-based cohort study in Copenhagen, Denmark. SUBJECTS AND METHODS: The Copenhagen City Heart Study comprised 19,698 inhabitants in Copenhagen, Denmark. Linkage to two national registers enabled identification of all subjects irrespective of participation in the study examinations. Follow-up in the present study was from January 1, 1977 to December 31, 1992. Case fatality after 7 days, 28 days, 1 year and 1 year in 28-day survivors was assessed for first-ever stroke. Uniform identification and validation methods made it possible to estimate trends in case-fatality. The World Health Organization's definition of stroke was used, and stroke was categorized into either unspecified stroke, ischemic infarction, intracerebral hemorrhage, or subarachnoid hemorrhage. The effect of time was estimated by means of multiple logistic regression analyses adjusting for gender, age at onset and type of stroke. RESULTS: A total of 1,213 strokes occurred during the study period from 1977 to 1992 in the study population. The case-fatality was highest during the first 28 days, and especially the initial 7 days; thereafter a steady state was reached. From the period 1977-1980 to the period 1989-1992 case-fatality did not change in analyses of 7-day case-fatality odds ratio (OR) = 1.14 (95% confidence interval, CI: 0.98-1.33), or of 28-day case-fatality OR = 1.06 (95% CI: 0.92-1.20), or of 1-year case-fatality OR = 0.95 (95% CI: 0.84-1.07). In the 1-year case-fatality, including only 28-day survivors, a significant decrease was found OR = 0.81 (95% CI: 0.67-0.97). Men had a significantly lower 7-day case-fatality than women; OR = 0.73 (95% CI: 0.52-0.99), but the difference attenuated in subsequent analyses and did not remain statistically significant. CONCLUSION: During the period 1977-1992, the 1-year case-fatality decreased in stroke patients who survived the initial 28 days, whereas no changes were observed in 7-day, 28-day and 1-year case-fatality.

Adult↗

PubMed1994

The effect of the 1992 California motorcycle helmet use law on motorcycle crash fatalities and injuries.

OBJECTIVE: To determine the effects of the California motorcycle helmet use law on statewide fatalities and a large sample of nonfatal injuries before and after law implementation. DESIGN: Police reports and death certificates were collected for motorcycle crash fatalities in California for 1991 (prelaw) and 1992 (postlaw). Official counts of registered motorcycles provided a statewide basis for exposure to a motorcycle crash. Autopsy results were collected for fatalities in 11 counties. Hospital records were reviewed for nonfatal injuries in 28 hospitals in 10 of the 11 counties. Police reports were linked to injury data for the riders. SUBJECTS AND PATIENTS: A total of 850 fatalities and injury data for 547 fatally injured riders and 3252 nonfatally injured patients. MAIN OUTCOME MEASURES: Changes in number and rates among statewide fatalities were estimated. The number and pattern of head injuries in fatally and nonfatally injured motorcycle riders were evaluated. RESULTS: After implementation of the helmet use law, statewide motorcycle crash fatalities decreased by 37.5%, from 523 fatalities in 1991 to 327 in 1992, more than 37%, and an estimated 92 to 122 fatalities were prevented. Motorcycle fatality rates were reduced by 26.5%, from 70.1 per 100,000 registered motorcycles in 1991 to 51.5 per 100,000 in 1992. Head injuries decreased significantly among both fatally and nonfatally injured motorcyclists. CONCLUSION: Enactment of an unrestricted helmet law significantly reduces the incidence of motorcycle crash fatalities and the number and severity of head injuries.

Accidents, Traffic↗

PubMed1994

The association of alcohol and night driving with fatal snowmobile trauma: a case-control study.

STUDY OBJECTIVE: To investigate the association of alcohol use and night driving with traumatic snowmobile fatalities. DESIGN: Case-control study. PARTICIPANTS: Traumatic deaths occurring while driving a snowmobile during the years 1985 to 1990 were reviewed. A sample of 1989 to 1990 fatal motor vehicle driver and motorcycle driver accidents were used as controls. Records were obtained from the provincial coroner. RESULTS: One hundred eight snowmobile fatalities, 432 motor vehicle fatalities, and 108 motorcycle fatalities were included. Young men (mean age, 30 years) made up the snowmobile fatalities population, with weekend fatalities predominating (67%). Snowmobile fatalities were associated with use during times of suboptimal lighting (crude odds ratio, 1.9 [95% confidence interval, 1.1-3.3]; P < .01). Blood alcohol concentration exceeded provincial limits in 64% of cases. When snowmobile fatalities were adjusted for occurrence during suboptimal lighting conditions, only alcohol use was associated independently with fatal outcome (adjusted odds ratio, 4.3 [95% confidence interval, 2.5-7.0]; P < .0001). CONCLUSION: Drivers in snowmobile fatalities are associated with an approximately fourfold greater use of alcohol than are age- and sex-matched drivers in automobile and motorcycle fatalities. Preventive strategies should be targeted at reducing the use of alcohol while snowmobile driving in young men.

Accident Prevention↗

PubMed2004

Pulmonary embolism associated with combined oral contraceptives: reporting incidences and potential risk factors for a fatal outcome.

BACKGROUND: It is established that combined oral contraceptive (COC) treatment increases the risk of a pulmonary embolism (PE), but specific risk factors for a fatal outcome from a PE remain to be determined. This study aimed to identify such risk factors, and to calculate the reporting rates of fatal and non-fatal PE. METHODS: Cases of suspected PE during treatment with COCs reported to the Swedish Adverse Drug Reactions Advisory Committee (SADRAC) between 1965 and 2001 were included. Medical records were scrutinized for potential risk factors for a venous thromboembolism (VTE). Annual sales data were obtained from the National Corporation of Pharmacies. RESULTS: A total of 248 cases of a suspected PE were reported; 207 non-fatal and 41 fatal. A VTE was verified in all fatal, and in 83.5% of non-fatal cases. The presence of nausea or abdominal pain, an age >35 years, concomitant treatment with other drugs which may increase the VTE risk, vein or lymph vessel malformation, and a deep vein thrombosis above the knee level were positively associated with a fatal outcome. Chest pain and previous COC use were negatively associated with a fatal outcome. The reporting rate of a PE with a verified VTE was 1.72 (95% confidence interval 1.47-2.00) cases per 100 000 treatment years, and of a fatal PE 0.25 (95% confidence interval 0.16-0.37) cases per 100 000 treatment years. CONCLUSION: Several specific potential risk factors for a fatal outcome from a COC-induced PE were identified. Recognition of these in combination with a high suspicion of VTE in COC users may reduce the risk of a fatal outcome.

Adult↗

PubMed1993

Coronary heart disease case fatality in four countries. A community study. The Acute Myocardial Infarction Register Teams of Auckland, Augsburg, Bremen, FINMONICA, Newcastle, and Perth.

BACKGROUND: Community-based registers participating in the MONICA Project of the World Health Organization show markedly different attack and death rates of coronary heart disease. This variation is a function of both the incidence and case fatality occurring within countries. The contribution of case fatality to the international variation in coronary heart disease mortality rates is not well understood. METHODS AND RESULTS: The register data from eight study populations--Augsburg and Bremen in Germany, Auckland in New Zealand, Perth and Newcastle in Australia, and North Karelia, Kuopio, and Turku/Loimaa in Finland--were compared. All patients with definite myocardial infarction or coronary death aged 35 to 64 years occurring in the study populations in 1985 through 1989 are the basis for the case fatality calculations by different definitions: 28-day case fatality for all cases, for hospitalized cases, and for hospitalized 24-hour survivors; out-of-hospital case fatality; and 24-hour case fatality for hospitalized cases. Differences in case fatality were much smaller than differences in attack and mortality rates in these populations. About two thirds of deaths occurred before the patients reached a hospital. The 28-day case fatality ranged from 37% for men in Perth to 58% for women in Augsburg. Among those who reached the hospital alive, 28-day case fatality was 13% to 27% for men and 20% to 35% for women. In those who survived 24 hours from the onset of symptoms, 28-day case fatality was 8% to 17% for men and 12% to 26% for women. CONCLUSIONS: Differences in case fatality were not associated with differences in coronary mortality rates between these populations. As most deaths occurred before reaching a hospital, opportunities for reducing case fatality through improved hospital care are limited. This emphasizes the primary role of prevention in reducing coronary death rates.

Adult↗

PubMed2003

Brain injury-related fatalities in American football, 1945-1999.

OBJECTIVE: Brain injuries have been the most common direct cause of death among American football players since the annual recording of football-related deaths began in 1931. This study examines the 55-year experience with brain injury-related fatalities in American football from 1945 to 1999, including not only the incidence but also the cause of death in discrete 5-year spans to focus on the variables that have either increased or decreased fatalities. In addition, we describe the types of injuries that have occurred, the activities in which the players were engaged at the time of injury, the level of play involved, and whether the injuries occurred during games or in practice sessions. METHODS: Data were collected nationwide regarding football fatalities in all organized football programs in public schools and in college, professional, and youth programs by conducting personal interviews and eliciting responses to questionnaires. The information collected included demographic data about the injured player, equipment data, injury type and body part involved, and pertinent information regarding the exact circumstances of the accident. RESULTS: We found that a total of 497 brain injury-related fatalities occurred among American football players during the period from 1945 through 1999. The causes of death were brain injuries in 69% of the cases, cervical spine injuries in 16%, and other injuries in 15%. Subdural hematoma was the type of injury associated with the majority (429, 86%) of brain injury-related fatalities. A majority (61%) of the brain injury-related fatalities occurred during participation in football games, and 75% of these were high school players. It should be noted that the number of high school football players is far greater (more than 1 million) than the number of either college (approximately 75,000) or professional (approximately 2000) players. The most frequent on-field activity involved when players sustained their fatal injuries was either tackling or being tackled (35%). CONCLUSION: Brain injury-related fatalities accounted for 69% of all football fatalities from 1945 through 1999. The greatest number and percentage of brain injury-related fatalities occurred during the 5-year span from 1965 through 1969, and the smallest number and percentage occurred during the 2 decades from 1975 through 1994. Most brain injury-related fatalities involved a subdural hematoma sustained by high school football players while either tackling or being tackled in a game. In the 2 decades from 1975 through 1994, there was a dramatic reduction in these fatalities, and the preventive measures that have received most of the credit are 1) the 1976 rule change that prohibits initial contact with the head and face when blocking and tackling and 2) the National Operating Committee on Standards for Athletic Equipment helmet standard, which went into effect in colleges in 1978 and in high schools in 1980.

Adolescent↗

PubMed2003

Fatal injuries to teenage construction workers in the US.

BACKGROUND: The construction industry is second only to agriculture in the annual number of fatal injuries in workers less than 18 years of age. We examined fatal injury reports for youth and adult workers to determine risk factors for injury and applicability of existing child labor regulations. METHODS: The US Occupational Safety & Health Administration (OSHA) investigation data for fatal work injuries from 1984 through 1998 were reviewed with respect to type of event, employer characteristics, and apparent violations of existing child labor laws under the Fair Labor Standards Act (FLSA). We also examined whether the employer met exemption criteria for federal enforcement of child labor or OSHA regulations. RESULTS: The fatality rate for teenage construction workers age 19 and younger was 12.1 per 100,000 per year, slightly less than for adult workers. Teenage workers who were fatally injured were more likely than adults to have been employed at non-union construction firms (odds ratio (OR) = 4.96, P < 0.05), firms with fewer than 11 employees (OR = 1.72, P < 0.05), and their employers were more likely to have been cited by OSHA for safety violations (OR = 1.66, P < 0.05) than for firms which were investigated because of a fatality in an adult worker. Fatalities in teenagers were more likely to occur in special construction trades such as roofing. Among fatalities in workers less than 18 years of age, approximately one-half (49%) of the 76 fatal injuries were in apparent violation of existing child labor regulations. We estimated that in 41 of the 76 cases (54%) the employer's gross annual income exceeded the $500,000 threshold for federal enforcement of child labor laws. Only 28 of 76 cases (37%) were at construction firms with 11 or more employees, which are subject to routine OSHA inspections. CONCLUSIONS: Fatal injuries in teenage construction workers differed from those in adults in that they were more likely to be at small, non-union firms of which a substantial proportion were exempt from federal enforcement of child labor laws and from routine OSHA inspections. Safety programs for young construction workers should include small, non-union construction firms and those in special construction trades such as roofing. We did not identify specific areas for new regulation but the number of fatalities reviewed was small.

Accidents, Occupational↗

PubMed1990

The fraction of traffic fatalities attributable to alcohol.

The vast literature on alcohol's effect on traffic safety does not contain even a moderately satisfactory answer to one of the most basic questions, namely "What is the fraction of all traffic fatalities attributable to alcohol use?" A published estimate of 23.7% based on an erroneous calculation has been widely quoted. This paper combines 1987 Fatal Accident Reporting System (FARS) data from 26 states that recorded blood alcohol concentrations for over 84% of fatally injured drivers with published estimates on how alcohol affects crash risk. By categorizing all traffic fatalities as either nonoccupants of vehicles, or occupants killed in single-vehicle, two-vehicle or three-or-more-vehicle crashes, and developing calculation procedures appropriate for each category, the fraction of all fatalities due to alcohol was inferred. The main finding was that eliminating alcohol would reduce traffic fatalities by (47 +/- 4)%. It was also concluded that alcohol use changes from 1982 to 1987 have reduced traffic fatalities by 12% (6,400 fatalities), which helps explain the absence of the fatality increase predicted because of a buoyant economy. Reducing the fraction of fatalities due to alcohol from the 1987 value of 47% to 42% (say) would reduce all traffic fatalities by 8%.

Accidents, Traffic↗

PubMed1993

Determinants of near fatality in acute severe asthma.

PURPOSE: The data extrapolated from cases of acute severe asthma that narrowly miss being fatal may prove valuable in the identification of the factors implicated in mortality. The purpose of this study was, therefore, to identify determinants of near fatality in patients with acute severe asthma. PATIENTS AND METHODS: We studied 81 patients with acute severe asthma in whom mechanical ventilation was required. Near fatality was defined as the occurrence of respiratory arrest and/or coma necessitating emergency tracheal intubation and resuscitation. In the cases that were not regarded as near fatal, tracheal intubation was performed electively because of deteriorating arterial blood gas values and/or the anticipation of exhaustion. Various continuous and categorical variables were compared in these two groups of patients. Patients with a hyperacute attack (period from onset of attack to mechanical ventilation less than 3 hours) were specifically sought and studied to determine the impact of such a course on near fatality. RESULTS: The "attack duration" (period from onset of attack to mechanical ventilation) was an important determinant of near fatality and of the subsequent clinical course. It was shorter in the group with a near-fatal episode (p < 0.03), and hyperacute attacks were uniformly near fatal. The attack duration correlated positively with the duration of the requirement for mechanical ventilation (p < 0.01). A longer attack duration was associated with an increased likelihood of the occurrence of major atelectasis (p < 0.01). There was no evidence of a relationship between near fatality and the side effects of bronchodilators as regards hypokalemia, arrhythmias, or cardiotoxicity. There was evidence of considerable under-treatment in the patient population as a whole, particularly in regard to the use of corticosteroids. CONCLUSIONS: A short attack duration is associated with an increased risk of near fatality in acute severe asthma. This is particularly evident in hyperacute attacks. Hyperacute attacks resolve rapidly once bronchodilator therapy has been instituted, suggesting that smooth muscle spasm is the predominant pathogenetic mechanism. The importance of routine anti-inflammatory therapy in mild to moderate asthma requires re-emphasis but, in addition, all patients should be provided with, and educated in the use of, bronchodilator rescue therapy, which should be available at all times. Despite current trends, the use of regular, prophylactic bronchodilator therapy in strict conjunction with anti-inflammatory agents may still be indicated. There is little evidence in the present data obtained from near-fatal cases to support the concept that cardiotoxicity related to bronchodilators contributes significantly to mortality from asthma.

Acute Disease↗