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PubMed2006

Postmortem radiology of fatal hemorrhage: measurements of cross-sectional areas of major blood vessels and volumes of aorta and spleen on MDCT and volumes of heart chambers on MRI.

OBJECTIVE: Autopsy determination of fatal hemorrhage as the cause of death is often a difficult diagnosis in forensic medicine. No quantitative system for accurately measuring the blood volume in a corpse has been developed. MATERIALS AND METHODS: This article describes the measurement and evaluation of the cross-sectional areas of major blood vessels, of the diameter of the right pulmonary artery, of the volumes of thoracic aorta and spleen on MDCT, and of the volumes of heart chambers on MRI in 65 autopsy-verified cases of fatal hemorrhage or no fatal hemorrhage. RESULTS: Most cases with a cause of death of "fatal hemorrhage" had collapsed vessels. The finding of a collapsed superior vena cava, main pulmonary artery, or right pulmonary artery was 100% specific for fatal hemorrhage. The mean volumes of the thoracic aorta and of each of the heart chambers and the mean cross-sectional areas of all vessels except the inferior vena cava and abdominal aorta were significantly smaller in fatal hemorrhage than in no fatal hemorrhage. CONCLUSION: For the quantitative differentiation of fatal hemorrhage from other causes of death, we propose a three-step algorithm with measurements of the diameter of the right pulmonary artery, the cross-sectional area of the main pulmonary artery, and the volume of the right atrium (specificity, 100%; sensitivity, 95%). However, this algorithm must be corroborated in a prospective study, which would eliminate the limitations of this study. Quantitative postmortem cross-sectional imaging might become a reliable objective method to assess the question of fatal hemorrhage in forensic medicine.

Adolescent↗

PubMed1990

Differences in reported car weight between fatality and registration data files.

Two national-level data sources are commonly used together to estimate and compare fatality rates by car weight. The weight of each car in a fatal crash is available on the automated files of the National Highway Traffic Safety Administration's Fatal Accident Reporting System; weight is derived by interpreting the Vehicle Identification Number of each car using a computer algorithm developed and maintained by R. L. Polk & Co. Counts of cars in use, by weight, are available on R. L. Polk & Co.'s National Vehicle Population Profile files; weights are coded from information in state vehicle registration files. However, it appears that there are systematic differences in car weight coding that complicate the use of these two sources together for calculating fatality rates (fatalities per registered car). Overall, the registration data appear to describe a car (of a particular make, model, and model year) as about one hundred pounds heavier than that car is described in the fatality data. The effect is to bias the comparison of fatalities per registered vehicle against lighter cars. Failure to consider this difference can lead to very misleading results. For example, the uncorrected data produce an estimate that the number of occupant fatalities per registered minicompact car (those under 1,950 pounds) was five times the rate in the largest cars (those weighing at least 3,950 pounds). Correcting for differences in car weight reporting produces estimates that the fatality rate in minicompact cars was twice that in the largest cars. Differences by car weight remain, but they are much less than would be concluded from the biased comparison.

Accident Prevention↗

PubMed1989

[Fatal pulmonary thromboembolism: is its incidence increasing or diminishing? Analysis of 178 cases from 1971 to 1988].

A retrospective study was undertaken on 178 cases (6.9% out of 2569 autopsies) of fatal pulmonary thromboembolism, 86 males and 92 females, aged 28-87 years (mean age = 71 +/- 13), in whom pulmonary emboli were found at autopsies, performed from 1971 to 1988. Fatal pulmonary thromboemboli means that no other cause of death was found at autopsy, and emboli occluded at least 2 lobar arteries. In 43 cases (24.2%) the fatal pulmonary thromboembolism developed after surgery. Considering the percentage of the cases of fatal pulmonary thromboembolism on the number of autopsies performed every year, the incidence of this disease increased throughout the period under study. There is a significant difference in incidence of fatal pulmonary thromboembolism in the autopsies in years 1971-79 in comparison with the years 1980-88. In fact the fatal pulmonary thromboembolism cases are 5.1% from 1340 autopsies in the period 1971-79, and 8.9% from 1229 autopsies in the period 1980-88. This increase in incidence is due mainly to the fatal pulmonary thromboembolism in the medical patients (from 3.2% to 7.5%) while the postoperative cases show a slight decrease, from 1.9% to 1.4%. The mean age of patients with fatal pulmonary thromboembolism increases in the second period considered. Age and medical treatment are the most important risk factors. In spite of the increasing age of the population and the increased use of major surgery, there is a tendency to constant or decreased incidence of fatal pulmonary thromboembolism, at least in surgical patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

[Fatal occupational accidents in Lombardy].

All fatal occupational accidents compensated in Lombardy from 1984 to 1989 were analyzed (1259 cases): significant differences between geographical distribution of fatal occupational accidents and workers were observed. Males accounted for about 95% of fatalities; an excess of cases was shown in both young and elderly workers. Death was the consequence of injuries involving most frequently the head, thorax and spinal cord. An excess of fatalities was observed in agriculture and, at a lower level, in manufacturing industries; small enterprises were involved in approximately 25% of fatalities occurring in the manufacturing industries and services. Employers were the victims of fatal accidents in 50% of cases in agriculture and in 70% of cases in craft industries. Construction, agriculture and transport accounted for about 50% of all fatalities. About 50% of fatal occupational accidents were related to vehicle use: the victim was the driver in the majority of cases, sometimes the victim was run over by a vehicle or fell from a vehicle. The results agree with some previous observations (e.g.: sex and age distribution; construction, agriculture and transport as working activities at high accident risk); but some original observations have emerged, in particular about the frequency of employers as victims and the role of vehicles in the genesis of fatal occupational accidents. If further studies confirm these latter observations, important developments could follow in preventive action design and implementation.

Accidents, Occupational↗

PubMed1998

Factors associated with fatalities and injuries from hot-air balloon crashes.

CONTEXT: Despite the increased popularity of hot-air balloon flight, data on injuries and fatalities associated with hot-air balloon crashes are limited. OBJECTIVE: To determine factors associated with injury and death in hot-air balloon crashes. DESIGN: Retrospective review of data collected from reports and investigations by the Civil Aeronautics Board and the National Transportation Safety Board. STUDY SUBJECTS: Individuals involved in US hot-air balloon crashes from 1964 to 1995. MAIN OUTCOME MEASURES: Total number of crashes and factors associated with fatality or serious injury. RESULTS: From 1964 to 1995, a total of 495 hot-air balloon crashes involving 1533 persons were reported and included 92 fatalities and 384 serious injuries. Pilot error or incapacitation was determined subjectively by crash investigators to contribute to 85.1% of the crashes. In univariate analysis, collision with the ground was the most significant predictor of a fatality or serious injury (P<.001), and power-line contact was the most significant predictor of fatality (P<.001). In multiple logistic regression, only the type of object struck by a balloon predicted a fatal crash or a fatality or serious injury. CONCLUSIONS: Although a number of factors likely contribute to increased severity of hot-air balloon crashes, the object struck during a crash is most predictive of fatality or serious injury. Preventive efforts are needed to decrease future injuries.

Accidents, Aviation↗

PubMed1998

Parametric likelihoods for multiple non-fatal competing risks and death.

Clinical trials of fatal diseases often focus on one or more non-fatal events, in addition to survival, both to characterize morbidity and to improve survival estimates. Three statistical complications are that the time to each non-fatal event and subsequent residual survival may be either positively or negatively associated, the times to death with or without an antecedent event often have very different distributions, and death may censor some of the non-fatal event times. Consequently, the overall survival time distribution is a mixture of the distributions corresponding to the possible antecedent non-fatal events. These conditions violate the usual assumptions underlying many statistical methods for analysing multivariate time-to-event data. In this paper, we consider a general parametric model for multiple non-fatal competing risks and death. The model accounts for positive or negative association between the time of each non-fatal event and subsequent survival while accommodating covariates and the usual administrative censoring. Each event time distribution is specified marginally by a three-parameter generalized odds rate model, and the time of each non-fatal event and subsequent residual survival are combined under a bivariate generalized von Morgenstern distribution. The approach is illustrated by application to two data sets from clinical trials in colon cancer and acute leukaemia.

Carcinoma↗

PubMed1985

Fatality risk for belted drivers versus car mass.

This study was performed to determine how the likelihood of a belted driver being killed in a single car crash depends on the mass of the car. This was done by applying the pedestrian fatality exposure approach to the subset of fatalities in the Fatal Accident Reporting System (FARS) for which the driver was coded as using a shoulder belt and/or a lap belt. Combining the 1975 through 1982 data provided a sufficiently large population of belted drivers to perform the analysis. In the exposure approach used, the number of car drivers killed in single car crashes is divided by the number of nonoccupant fatalities (pedestrians or motorcyclists) associated with the same group of cars. The ratio is interpreted to reflect the physical effect of car mass, essentially independent of driver behavior effects. In the present application, car mass effects for belted drivers were determined by considering the number of belted drivers killed divided by the number of nonoccupants killed in crashes involving cars whose drivers were coded in the FARS files as being belted. Because the belt use of surviving drivers is, to some extent, self-reported, it is considered that the data given in the report should be not used to estimate the effectiveness of seat belts in preventing fatalities. The results are presented as graphical and analytical comparisons of fatality likelihood versus car mass for belted and unbelted drivers. It is concluded that the effect of car mass on relative driver fatality likelihood is essentially the same for belted and unbelted drivers (for example, the present analysis gives that a belted driver in a 900 kg car is 2.3 times as likely to be killed in a single car crash as is the belted driver in an 1800 kg car. The corresponding ratio determined here for unbelted drivers is 2.4). As a consequence of this conclusion, the relative effectiveness of seat belts in preventing driver fatalities is similar for cars of different masses.

Accidents, Traffic↗

PubMed1990

An analysis of fatal bicycle accidents in Victoria (Australia) with a special reference to nighttime accidents.

This paper examines the fatal bicycle accidents which occurred in the period 1981-1984 in Victoria with particular emphasis on nighttime fatalities. The examination provides information on aspects of accident location, environment, problem type, time, and cyclist characteristics. The relationship between actual accidents and cyclists perceived collision danger is also investigated. The characteristics of fatal bicycle accidents are different to those of overall "casualty" accidents. A difference also exists between day and night, and between metropolitan and nonmetropolitan fatal accidents. In the metropolitan area, adult cyclists over 17 years were over-involved in fatal accidents. The proportion of cyclists involved in fatalities at night increases with increase in age. Almost 80% of nighttime accidents occurred on links on arterial roads, and the majority in the high speed limit zones (75 kph and over). A greater proportion of accidents was initiated by cyclists. In 90% of nighttime cyclist fatalities the cyclist was hit from the rear, compared with 40% in daytime. Inadequacy of bicycle and street lighting was found to be an important factor in nighttime fatalities.

Accidents↗

PubMed1993

Survey of fatalities from skin testing and immunotherapy 1985-1989.

BACKGROUND: The Committee on Allergen Standardization of the American Academy of Allergy and Immunology (AAAI) began a study of fatalities associated with skin testing and immunotherapy in an effort to identify risk factors and to ascertain whether any additional precautions are required to prevent and treat serious reactions. METHODS: Questionnaire data was obtained from members of the AAAI and the American College of Allergy and Immunology, regarding 17 fatalities associated with immunotherapy for the years 1985 to 1989. In this period, no fatalities were reported with skin testing. The mean age of patients who died was 36.0 years (range: 10 to 77 years), and 69% were female. Of the patients who died, 76% had asthma, and most were reported to have had factors associated with severity (i.e., lability, required steroids, and/or prior hospitalizations). The only patient who had rhinitis alone had cardiovascular disease and was receiving a beta-blocker. High sensitivity by skin test or RAST was reported by 71%, and 36% reported prior systemic reactions. Sixty-five percent of the patients were undergoing build-up therapy. Fatalities involved use of allergen doses between 1:1 million to 1:10 wt/vol. Other factors associated with fatalities were: changing to a new vial of extract, 5; dosing error or inappropriate dose adjustment, 5; allergen season, 5; symptomatic before injection, 4; not waiting after injection, 2; and home injection, 1. Onset of anaphylaxis occurred within 20 minutes in eleven patients, within 20 to 30 minutes in one, and after more than 30 minutes in one. In eleven cases the cause of death was associated with respiratory compromise. These data reinforce the need for special precautions in treating high-risk patients with asthma. The annual fatality rate from administration of allergenic extracts in the United States remains very low: 1 fatality per 2 million doses, but additional educational efforts to further reduce the fatality rate are needed.

Academies and Institutes↗

PubMed2005

Traffic fatalities and economic growth.

This paper examines the relationship between traffic fatality risk and per capita income and uses it to forecast traffic fatalities by geographic region. Equations for the road death rate (fatalities/population) and its components--the rate of motorization (vehicles/population) and fatalities per vehicle (F/V)--are estimated using panel data from 1963 to 1999 for 88 countries. The natural logarithm of F/P, V/P, and F/V are expressed as spline (piecewise linear) functions of the logarithm of real per capita GDP (measured in 1985 international prices). Region-specific time trends during the period 1963-1999 are modeled in linear and log-linear form. These models are used to project traffic fatalities and the stock of motor vehicles to 2020. The per capita income at which traffic fatality risk (fatalities/population) begins to decline is 8600 US dollars (1985 international dollars) when separate time trends are used for each geographic region. This turning point is driven by the rate of decline in fatalities/vehicles as income rises since vehicles/population, while increasing with income at a decreasing rate, never declines with economic growth. Projections of future traffic fatalities suggest that the global road death toll will grow by approximately 66% over the next twenty years. This number, however, reflects divergent rates of change in different parts of the world: a decline in fatalities in high-income countries of approximately 28% versus an increase in fatalities of almost 92% in China and 147% in India. The road death rate is projected to rise to approximately 2 per 10,000 persons in developing countries by 2020, while it will fall to less than 1 per 10,000 in high-income countries.

Accidents, Traffic↗

PubMed2005

Fatalities in Swedish skydiving.

Exact risk patterns in skydiving fatalities are not well known, but incomplete world injury data indicate that many are preventable. A comprehensive national material for Sweden of 37 skydiving fatalities 1964-2003 were reviewed to identify risk factors. In relation to jump volume, the period 1994-2003 had a fatality rate 11 times lower than 1964-1973. Student skydivers had the highest risk of fatal outcome, often caused by instability in freefall leading to unstable parachute activation with subsequent line entanglement, or parachute activation failure. Unintentional water landings also contributed to student fatality, with life jacket malfunctions, neglect to use life jackets, and automatic reserve parachute activation devices activated by water as aggravating factors. One-third of all fatalities had an inflated and operational parachute at some point prior to injury. A drastic worldwide increase in fatal landing incidents with fast wing parachutes during the 1990s did not occur in Sweden. Every fourth fatality caused by rapid deceleration against ground or water survived impact and died during transports or in hospitals. Rescue units and health care providers can improve management of skydiving incidents from knowledge about the incident and injury mechanisms we have described, and the skydiving community can target risk factors in preventive safety work.

Accidents, Aviation↗

PubMed2006

EMS helicopter crashes: what influences fatal outcome?

STUDY OBJECTIVE: In recent years, air transport of patients has been associated with disproportionate increases in crashes and deaths. We identify factors related to fatal outcome in air medical helicopter crashes and suggest preventive measures. METHODS: This was a retrospective study using National Transportation Safety Board records for helicopter emergency medical services (EMS) crashes between January 1, 1983, and April 30, 2005. The main outcome measure was the percentage of air medical crashes resulting in 1 or more deaths. RESULTS: There were 182 helicopter EMS crashes during the 22.3-year study period; 39% were fatal. One hundred eighty-four occupants died: 45% of the 44 patients and 32% of the 513 crewmembers. Fifty-six percent of crashes in darkness were fatal compared with 24% of crashes not in darkness. Seventy-seven percent of crashes in instrument meteorological conditions were fatal compared with 31% in visual conditions. Thirty-nine percent of all deaths occurred in crashes with postcrash fires; 76% of crashes with postcrash fire were fatal compared with 29% of other crashes. Multivariate logistic regression revealed that controlling for other factors, the odds of fatal outcome was increased by postcrash fire (odds ratio [OR] 16.1; 95% confidence interval [CI] 5.0 to 51.5], bad weather (OR 8.0; 95% CI 2.4 to 26.0), and darkness (OR 3.2; 95% CI 1.3 to 7.9). CONCLUSION: Fatalities after helicopter EMS crashes are associated especially with postcrash fire and with crashes that occur in darkness or bad weather and can be addressed with improved crashworthiness and measures to reduce flights in hazardous conditions. Further studies will be necessary to determine which changes will decrease the fatal crash rate and which are cost effective.

Accidents, Aviation↗

PubMed2006

Learning from tragedy: a survey of child and adolescent restraint fatalities.

OBJECTIVE: This descriptive study examines 45 child and adolescent fatalities related to restraints in residential (institutional) placements in the United States from 1993 to 2003. METHOD: The study team used common Internet search engines as its primary case discovery strategy to determine the frequency and the nature of the fatalities, as well as the characteristics of the children and the adolescents involved. RESULTS: Male children and adolescents were over-represented in the study sample. Thirty-eight of the fatalities occurred during or after a physical restraint, and 7 fatalities occurred during the use of mechanical restraints. Twenty-eight of the deaths occurred in a prone restraint. In 25 of the fatalities, asphyxia was the cause of death. CONCLUSION: In the 23 cases in this study where information is available, none of the child behaviors or conditions that prompted the restraint would meet the standard of danger to self or others: the commonly accepted criteria for the use of a restraint. The study points to deficiencies in fatality reporting, recommends reporting fatalities to established state child fatality review boards, and reinforces that restraints be governed by strict protocol and monitoring. The study also urges caution to policymakers in substituting or changing restraint procedures based on the incomplete data reported in this study.

Accidents↗

PubMed2004

Fatal intoxications in a Swedish forensic autopsy material during 1992-2002.

Compilations of substances detected in fatal intoxications are important in order to observe changes in intoxication patterns, to monitor effects of preventive work and to discover new trends in drug usage. The aim of the present study was to describe the current pattern of substances detected in fatal intoxications in Sweden. Fatal intoxications investigated at the Department of Forensic Chemistry, Linköping, Sweden, during 1992-2002, were analysed. All suicides, uncertain cases and accidents where the cause of death were fatal intoxications (ICD-9: E950, E980 and E859) were included and substances detected in more than 50 fatal intoxications (in femoral blood) were listed. For each substance, a cut off value was set, above which concentrations were considered toxic. Fatal intoxications were detected by forensic-chemical analyses in 12% (6998/60,314) of the forensic autopsies during the study period. Among the suicides, an average of 3.8 substances were detected per case, the corresponding figure for uncertain cases and accidents were 3.5 and 4.1 substances, respectively. Ethanol was by far the most frequently detected substance, detected in 43% (3039) of the fatal intoxications, of which 32% (960) had toxic concentrations, followed by propoxyphene, detected in 27% (1863) of the fatal intoxications of which 74% (1370) had toxic concentrations. The number of cases where ethanol and propoxyphene were detected decreased during the study period. Moreover, other CNS-active drugs such as antidepressants, analgesics and anxiolytics were also frequently detected. The drugs with high proportions of cases with toxic concentrations detected were propoxyphene, amitriptyline, zolpidem, carisoprodol, alprazolam, thioridazine, methadone and ketobemidone. Selective serotonin reuptake inhibitors (SSRI) and tricyclic antidepressants (TCA) were detected in 12% (833) and 10% (665), respectively. A significantly (P <0.001) higher proportion of cases where TCA were detected had toxic concentrations when compared with cases where SSRI were detected (64% versus 31%).

Adolescent↗

PubMed2004

Case-fatality rates for myocardial infarction declined in Denmark and Sweden during 1987-1999.

OBJECTIVE: To evaluate trends in prognosis after acute myocardial infarction (AMI) between Denmark and Sweden using routinely collected data and different case-fatality measures. STUDY DESIGN AND SETTING: We compared three case-fatality measures during 1987-1999 using national registries in Denmark and Sweden, and extended these measures with underlying deaths of ischemic heart disease and sudden deaths of unknown cause. RESULTS: Changed coding practice distorted trends of case fatality rates during the day of the event. In general, Denmark had higher case-fatality rates, but trends in hospital-based rates were very similar, except for men 35-64 years old; Denmark declined more steeply. Short- and long-term prognosis improved considerably: the odds ratios for case fatality during days 1-28 for 1999 vs. 1987 were 0.48 among men in Denmark (women 0.58) and 0.53 among men in Sweden (women 0.55) and the odds ratios for case fatality during days 29-365 for 1999 vs. 1987 were 0.56 among men in Denmark (women 0.65) and 0.66 among men in Sweden (women 0.67). CONCLUSION: Short- and long-term prognosis improved considerably during 1987-1999 in Denmark and Sweden. Case fatality during the day of the event is epidemiologically important, but less certain than case-fatality measures defined after the day of the event when comparing countries.

Adult↗

PubMed2006

Fatal crashes involving young unlicensed drivers in the U.S.

INTRODUCTION: Young unlicensed drivers' involvement in fatal crashes is a recurrent problem in the United States. METHODS: This descriptive study extracted cross-sectional data on fatal crashes from the Fatality Analysis Reporting System from 1998 to 2002. Young unlicensed driver fatal crashes are examined by age, gender, and region. RESULTS: There were 2,452 young unlicensed driver fatal crashes representing 10.8% of all young drivers' fatal crashes. By age, 72.5% are over 15 years, males are involved in 74.5%, and southern and western states have a higher percent of young unlicensed driver fatal crashes. CONCLUSIONS: Subgroups of young people based on their age, gender, and region are over-represented in fatal crashes as unlicensed drivers. Further studies are needed to investigate the context and factors of young unlicensed drivers, essential to tailor interventions. IMPACT ON INDUSTRY: Young unlicensed drivers circumvent the established licensing process and pose a serious threat to themselves and other road users.

Accidents, Traffic↗

PubMed2001

New evidence concerning fatal crashes of passenger vehicles before and after adding antilock braking systems.

Fatal crash rates for passenger cars and vans were compared for the last model year before four-wheel antilock brakes were introduced and the first model year for which antilock brakes were standard equipment. A prior study, based on fatal crash experience through 1995, reported that vehicle models with antilock brakes were more likely than identical but 1-year-earlier models to be involved in crashes fatal to their own occupants, but were less likely to be involved in crashes fatal to occupants of other vehicles. Overall, there was no significant effect of antilocks on the likelihood of fatal crashes. Similar analyses, based on fatal crash experience during 1996-98, yielded very different results. During 1996-98, vehicles with antilock brakes were again less likely than earlier models to be involved in crashes fatal to occupants of other vehicles, but they were no longer overinvolved in crashes fatal to their own occupants.

Accidents, Traffic↗

PubMed2002

Predicting seat belt use in fatal motor vehicle crashes from observation surveys of belt use.

There is a large difference between the rates of observed seat belt use by the general public and belt use by motor vehicle occupants who are fatally injured in crashes. Seat belt use rates of fatally injured occupants, as reported in the Fatality Analysis Reporting System (FARS), are much lower than the use rates found in observation surveys conducted by the states. A series of mathematical models describing the empirical relationship between FARS and observed rates were explored. The initial model was a 'straw man' and used two simplifying assumptions: (a) belt users and nonusers are equally likely to be involved in 'potentially fatal collisions', and (b) belts are 45% effective in preventing deaths. The model was examined by comparing each state's FARS use rate with the predicted rate. The model did not fit the state data points even when possible biases in the data were controlled. We next examined the assumptions in the model. Changing the seat belt effectiveness parameter provided a reasonable fit, but required an assumption that seat belts are 67% effective in preventing fatalities. The inclusion of a risk coefficient for non-belted occupants also provided a reasonable fit between the model and data. A variable risk model produced the best fit with the data. The major finding was that a model consistent with the data can be obtained by incorporating the assumption that nonusers of seat belts have a higher risk of involvement in potentially fatal collisions than do seat belt users. It was concluded that unbelted occupants are over-represented in fatal collisions for two reasons: (a) because of a greater chance of involvement in potentially fatal collisions in the first place, and (b) because they are not afforded the protection of seat belts when a collision does occur.

Accidents, Traffic↗