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PubMed2003

Heat-induced immunoreactivity of tau protein in neocortical neurons of fire fatalities.

Tau protein is the main component of neurofibrillary tangles of Alzheimer's disease (AD). Immunohistochemistry of tau protein is useful in the diagnosis of AD but produces diffuse staining of neocortical neurons in fire fatalities. To learn the cause of this phenomenon, we examined the temporal neocortex of 13 fire fatalities and 9 fatalities unrelated to fire. The diffuse tau immunoreactive neurons were observed in 10 fire fatalities with heat coagulation of the cerebrum. Diffuse staining was not found in the three fire fatalities without heat coagulation of the cerebrum or in fatalities unrelated to fire. The immunoreactivity progressively increased as a function of the degree of cerebral heat coagulation. These results demonstrate that diffuse tau immunoreactivity of neocortical neurons is a post-mortem phenomenon caused by prolonged exposure of the head to intense heat. Forensic pathologists should consider this phenomenon when they diagnose AD in fire fatalities.

Aged↗

PubMed1986

Double pair comparison--a new method to determine how occupant characteristics affect fatality risk in traffic crashes.

A new method to determine how occupant characteristics affect fatality risk in traffic crashes is developed. The method, which uses data from the Fatal Accident Reporting System (FARS), focuses on two occupants, a "subject" occupant and an "other" occupant. The probabilities of a fatality to the subject occupant when that occupant has one of two characteristics are compared. The other occupant serves essentially a normalizing, or exposure estimating, role. The method uses only fatality frequency data--no external exposure information is required, and it is relatively free from uncertain assumptions. It has wide applicability; examples of potential applications include investigating car occupant fatality risk as a function of sex, age, alcohol use or motorcyclist fatality risk as a function of helmet use. The first application is to determining the effectiveness of safety belts in preventing car occupant fatalities, as described in the paper following this paper.

Accidents, Traffic↗

PubMed1989

Relative fatality risk in different seating positions versus car model year.

Fatality risk of drivers compared to right-front passengers is examined vs. car model year (MY) using Fatal Accident Reporting System (FARS) data for 1975 through 1986. Confounding effects are removed by comparing unrestrained occupants matched in sex and age (to within three years). MY greater than or equal to 1968 cars, which complied with Federal Motor Vehicle Standard 203 (impact protection for the driver) and FMVSS 204 (rearward column displacement), are compared to MY less than or equal to 1966 cars, which did not comply with these standards. It is found that, compared to right-front passengers in the same cars, drivers had higher relative fatality risks in MY greater than or equal to 1968 cars and lower relative fatality risks in MY less than or equal to 1966 cars. Because there are so few fatal frontal crash data for MY 1966 and MY 1968 cars, definitive conclusions regarding the effectiveness of FMVSS 203 and 204 in reducing driver fatalities are not possible. However, our analysis, together with the assumption that right-front-passenger fatality risk was the same in 1966 and 1968 MY cars, does suggest that a previous 12% effectiveness estimate is more likely to be high than low.

Accidents, Traffic↗

PubMed1989

Potential fatality reductions through eliminating occupant ejection from cars.

The percent of occupant fatalities preventable by eliminating ejection is calculated using Fatal Accident Reporting System (FARS) data for 1975 through 1986. The calculation requires estimates of two quantities. First, the fraction of all fatally injured occupants who were ejected; this is obtained directly from the FARS data. Second, the probability that an ejected occupant was killed compared to the probability that the occupant would have been killed in a similar crash in the absence of ejection; this quantity is estimated using the double pair comparison method, and its dependence on occupant age and sex and on car mass and model year is examined. High precision estimates of the reduction in fatalities that would result from eliminating ejection as functions of these same variables are thereby obtained. These estimates depend on assuming that whatever method is used to prevent ejection would cause the formerly ejected occupant to acquire the same fatality risk as a nonejected occupant in a similar crash; the study does not address how to prevent ejection. It is concluded that ejection elimination would decrease fatalities to unrestrained car occupants by 18 +/- 1%. The fatality reductions are independent of car seating position (19%, 19%, 17%, 16%, 19%, and 18% for drivers, middle front, right front, left rear, middle rear, and right rear passengers, respectively); they decrease with driver age, from 25% at age 18 years to 7% at 70 years; they decrease with increasing mass, but remained relatively independent of car model year since the early 1970s, being somewhat higher for earlier model years.

Accidents, Traffic↗

PubMed1994

The connection between risky driving and involvement in fatal accidents.

The connection between risky driving and involvement in fatal accidents was investigated in two studies using two data sets. The first study compared the recorded offenses of 615 drivers involved in fatal accidents with a sample of drivers randomly selected from driver records. The second study compared the recorded offenses of 143 drivers stopped by the police for risky driving with the prior records of control drivers stopped at the same locations. The drives involved in fatal accidents and the drivers stopped for risky driving had violated traffic regulations more often than other drivers. Those responsible for causing fatal accidents as well as involved but nonculpable drivers had previously been convicted of traffic offenses more often than other drivers. Among the fatal-accident drivers, those involved in running-off-the-road accidents had accumulated the largest number of traffic offenses. There appears to be a particular link between the age and the prior offense rate of the two risk groups. For under-35-year-olds, the offense rate (offenses/million kilometers) of those stopped for risky driving and those involved in fatal accidents were about the same. For over-35-year-olds, the drivers stopped for risky driving had accumulated many times more speeding offenses than those involved in fatal accidents. Unlike the other groups the offense rate of those stopped for risky driving does not decrease with age.

Accidents, Traffic↗

PubMed1983

Fatal child abuse in Georgia: the epidemiology of severe physical child abuse.

Decisions about the occurrence of child abuse are increasingly difficult to make because concepts of what qualifies as reportable child abuse may be broadening. We examined this question by comparing 51 fatal child abuse cases occurring in Georgia between July 1975 and December 1979 to non-fatal cases and to the Georgia population. Overall rates of fatal child abuse were higher for male perpetrators compared with female and black perpetrators compared with white. However, the latter finding varied with economic and geographic status. The highest child abuse fatality rates were found in poor, rural, white families (3.3/100,000 children) and in poor, urban, black families (2.4/100,000 children). Risk factors for fatal abuse included early childhood (RR 6:1), parental teenage childbearing (RR 4:1), and low socioeconomic status. These characteristics were similar to those of the severe child abuse cases noted in the early child abuse literature. Non-fatal cases did not clearly share these risk factors. Severe abuse, here represented by fatal cases, is a distinct subset of reported child abuse, but characteristics associated with it are frequently attributed to all reportable child abuse. Medical personnel should be aware that they cannot rely on the presence or absence of these characteristics in screening for risk of reportable child abuse. Child abuse research should use restricted, stated case definitions. When intervention and prevention programs are being organized, they should not generalize research findings to all forms of child abuse.

Adolescent↗

PubMed1989

Fatal maltreatment by mothers: a proposed framework.

This paper proposes a framework for understanding fatal maltreatment by mothers based on an in-depth study of incarcerated women. Despite its extreme outcome, fatal maltreatment is not homogeneous. While the specifics of each case varied, the circumstances leading to the fatality followed a similar progression. The framework is characterized by a recurrent pattern of abuse culminating in the fatality. All of the women had abused the deceased child prior to the fatality. The women provided warning signals to professionals and to members of their personal networks (kin, friends, neighbors) by alerting them to the abusive incidents. The fatal incident was not a one-time assault, but the exit point of a continuing pattern of abusive interactions that was maintained by the woman's ability to explain, rationalize, and minimize the abuse to herself and to her network. Future research efforts must be directed beyond the fatal incident to the circumstances leading up to it. Intervention and education must be aimed beyond biological parents to the wider network and community.

Child↗

PubMed2006

Work-related maritime fatalities.

All maritime fatalities investigated by Coroners that occurred in Australia from 1992 to 1998 inclusive have been collated, coded and recorded in the Australian Boating Injury Database: Fatal Injury (ABID:FI). This article focuses on the work-related maritime fatalities recorded in the database. Over the period 1992-1998 there were 74 fatalities involving people who were working for income at the time of the incident: 46 commercial fishermen, 12 seamen involved in the transport of cargo and 16 miscellaneous workers. The fatality rate of commercial fishermen has declined substantially in Australia over recent years. The main contributing factors were: hazardous conditions; an error of judgement; unsafe work practices; and failure to wear a personal flotation device (PFD) in circumstances where, in the opinion of the Coroners, it would have saved life. Hazardous conditions were much more of a factor in fishermen deaths than in other maritime deaths. Most vessels involved had an insufficient number of PFDs for the number of crew on board. The Australian fatal injury database should be updated with the details of recent fatalities in order to further monitor safety performance, causal factors and prevention measures in the maritime industry in Australia. Attention should be focused on reducing alcohol use and increasing PFD availability and usage. In order to continue to improve safety, it is essential that a constructive dialogue is maintained with industry sources, informed by independent research and up-to-date information.

Accidents, Occupational↗

PubMed2005

Suspected drug-induced liver fatalities reported to the WHO database.

BACKGROUND: World Health Organisation drug monitoring started in 1968. No systematic investigation has been carried out using this database of adverse drug reactions with liver injury associated with fatalities. METHODS: All reports of suspected hepatic adverse drug reactions with a fatal outcome received by the WHO Collaborating Centre for International Drug Monitoring in Uppsala Sweden from 1968 to 2003 were screened. Only those drugs associated with at least 50 suspected cases were analysed. RESULTS: A total of 4,690 reports of suspected drug-induced liver injury associated with fatal outcome were found in the database. The median age of the patients was 45 years and 50.4% were females. A total of 21 drugs were suspected to have caused at least 50 fatalities each. Among these 1,808 adverse drug reactions, the reporting country in 1,598 (88.3%) of the cases was the United States. The most common drugs associated with fatalities were acetaminophen, troglitazone, valproate, stavudine, halothane, lamivudine, didanosine, amiodarone, nevirapine and sulfamethoxazole/trimethoprim. The most common drug types found were analgesics, drugs against human immunodeficiency virus, anticonvulsants and antibacterial drugs. CONCLUSIONS: A wide range of different drugs were suspected to have caused fatal liver injury. Analgesics, drugs against infectious diseases and anticonvulsants were the drug types most commonly associated with fatalities.

Analgesics↗

PubMed2004

Possible factors contributing to the postmortem lung weight in fire fatalities.

The aim of the present study was to examine the factors that contribute to the postmortem lung weight in acute fire fatalities (n=149) including those with lower (<60%) and higher (>60%) blood carboxyhemoglobin (COHb) levels (n=94 and 55, respectively). The control groups consisted of acute myocardial infarction/ischemia (AMI, n=99) and mechanical asphyxiation (n=85). For all cases (n=333), the lung and heart weights were independent of the postmortem time (4.5-72 h) and charring of the body. The combined weight of both lobes of the lung showed a significant gender difference (males>females, P<0.001), negative regression with respect to age (R=0.167, P<0.01) and positive regression with respect to heart weight (R=0.316, P<0.001). The gender difference was also significant for each cause of death even after being corrected using body height measurements. When the lung-heart weight ratio was estimated to diminish the influence of possible cardiogenic factors, the gender difference was insignificant for each cause of death among the non-elderly (<60 years of age). However, for elderly fire fatalities (>60 years of age), there was a gender difference (males>females) for the lower COHb group (P<0.05) and higher COHb group (P<0.001). A significant age-dependent difference (non-elderly>elderly) in the lung-heart weight ratio was observed for fire fatalities with a lower COHb and AMI among males and for fire fatalities with a higher COHb among females. Such gender- and/or age-dependent influences were not significant for fatal mechanical asphyxiation. These findings suggest that a person's heart weight may be a possible contributory factor to an increase in the lung weight in acute death, and that gender- and/or age-dependent susceptibilities may be additional factors that contribute to fire fatalities and AMI. In addition, elderly females appear to be most susceptible among fire casualties, and extreme cardiomegaly may also be a potential fatal risk factor.

Adolescent↗

PubMed2005

Impact of case fatality on the seasonality of suicidal behaviour.

A number of differences exist between the seasonality of suicide and suicidal behaviour. Case fatality is one index of the relationship between these phenomena. The purpose of this study was to use contemporaneous data to examine the impact of case fatality on the seasonality of suicidal behaviour. All deliberate self-harm (ICD9 E950-58) hospitalisations (DSH) and deaths (suicide) for 1984-93 were extracted from the Western Australia case register (N=22 883). Case fatality was calculated by method of suicide. Data were arranged in time series by standardised month according to case fatality; sex and age and analysed using spectral analysis. We found that DSH involving low case fatal methods is seasonal with a spring peak (95% confidence interval). The explained variance of the seasonal rhythm increases with age. Suicide involving high case fatal methods is not seasonal. The increase in DSH seasonality with age may be related to a parallel increase in case fatality.

Adolescent↗

PubMed2002

Comparison of two fatal occupational injury surveillance systems in the United States.

INTRODUCTION: Using different methods, two national systems compile fatal occupational injury data in the United States: the National Institute for Occupational Safety and Health (NIOSH) National Traumatic Occupational Fatalities (NTOF) surveillance system, and the Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI). The NTOF uses only death certificates, while CFOI uses multiple sources for case ascertainment. METHODS: Through overall and case-by-case comparisons, this study compares these systems and evaluates counts for the nation and by state for worker and case characteristics. RESULTS: From 1992 through 1994, NTOF reported an average of 84% of the number of traumatic occupational fatalities reported in CFOI. This percentage changed somewhat when a case-by-case comparison was conducted--88% of the NTOF cases were matched directly to the CFOI cases. Although CFOI captured a larger number of fatalities annually, the additional fatalities did not follow a discernable pattern. IMPACT ON INDUSTRY: By understanding the distribution of fatalities, targeted efforts to reduce them will benefit all industries.

Accidents, Occupational↗

PubMed2003

[Myocardial infarction. Population case-fatality in seven Spanish autonomous communities: the IBERICA Study].

BACKGROUND AND OBJECTIVE: The magnitude of the problem of myocardial infarction (MI) is better understood by assessing the population case-fatality than by analyzing only the number of patients attending hospitals. PATIENTS AND METHOD: Our data come from the IBERICA Study (Investigation, Specific Search and Registry of Acute Myocardial Ischemic Syndrome). Twenty eight-day MI population case-fatality is described in the population aged 25 to 74 years during 1997 and 1998 in the following Spanish autonomous communities: Castilla-La Mancha (Toledo and Albacete), Catalonia (Girona), Valencia Community (Valencia), Balearic Islands (Majorca), Murcia, Navarra and Basque Country. The relationship between case-fatality and other variables such as sex, age and geographic area is also analyzed. RESULTS: A total of 10,660 MI cases were registered, 4,106 of whom died within the period of 28 days following the onset of symptoms (38.5%; CI 95%, 37.6-39.4%). The overall case-fatality was 37.0% (CI 95%, 35.9-38.0%) in men and 44.3% (CI 95%, 42.3-46.4%) in women. Death occurred out of hospitals in 2,869 (69.9%) cases. An increased case-fatality in women was associated with a higher in-hospital case-fatality (45% higher than men). The proportion of patients who died before reaching a hospital was similar in both genders. Classical symptoms of MI were more common among men than women (82.7% vs. 77.6%, p < 0,001). The interval between symptoms' onset and hospitalization was 30 minute longer among hospitalized women as compared with men (p < 0,001). CONCLUSIONS: Population MI case-fatality is high in the seven Spanish autonomous communities studied. Approximately 2 out of 3 deaths occur without patients being able to reach a hospital. These results emphasize the importance of primary and secondary prevention measures and the necessity to design ready-access systems to defibrillation and resuscitation manoeuvres for patients with cardiopulmonary arrest.

Adult↗

PubMed1998

Trends in nonfatal and fatal firearm-related injury rates in the United States, 1985-1995.

STUDY OBJECTIVE: To characterize trends in annual estimates of nonfatal firearm-related injuries treated in US hospital emergency departments and to compare trends in quarterly rates of such injuries with those of firearm-related fatalities in the US population. METHODS: Data on nonfatal firearm-related injuries were obtained from the National Electronic Injury Surveillance System (NEISS) by review of medical records for June 1, 1992, through May 31, 1995. Data on firearm-related fatalities were obtained from the National Vital Statistics System for January 1, 1985, through December 31, 1995. NEISS comprises 91 hospitals that represent a stratified probability sample of all hospitals in the United States and its territories that have at least six beds and provide 24-hour emergency service. The main outcome measures were numbers, percentages, and quarterly population rates for nonfatal and fatal firearm-related injuries. RESULTS: An estimated 288,538 nonfatal firearm-related injuries (95% confidence interval [CI], 169,776 to 407,300) were treated in EDs during the 3-year study period. The annual number of non-fatal firearm-related injuries increased from 99,025 for June 1992 through May 1993 (95% CI, 58,266 to 139,784) to 101,669 for June 1993 through May 1994 (95% CI, 59,822 to 143,516), then decreased to 87,844 for June 1994 through May 1995 (95% CI, 51,687 to 124,001). Before the third quarter of 1993, quarterly nonfatal and fatal firearm-related injury rates in the total US population and quarterly nonfatal firearm assaultive injury and firearm homicide rates for males aged 15 to 24 years were observed to be on the rise. Since then, these rates have significantly declined. CONCLUSION: Analysis of national trends indicates that non-fatal and fatal firearm-related injuries are declining in the United States, although the rate of firearm-related deaths remains high, especially among males aged 15 to 24 years, in relation to other leading causes of injury death. An assessment of factors responsible for the decline in firearm-related injuries is needed to design further prevention efforts.

Adolescent↗

PubMed1997

In-hospital case-fatality of aged patients with hip fracture in Catalonia, Spain.

Hip fracture case-fatality in patients aged 65 years or older was studied in patients admitted to acute care hospitals in Catalonia over a 1-year period. 1222 femoral neck fractures and 1648 pertrochanteric fractures were identified. Women (76.9%) were most frequently and significantly older than men. Average age in pertrochanteric fracture was significantly higher than cervical fracture. The overall in-hospital case-fatality rate was 6.8%. Male gender, advanced age, pertrochanteric fracture and conservative management were associated with a significantly higher case-fatality rate. Multivariate logistic regression analyses demonstrated that previously seen associations showed univariate analysis. However, because interaction was observed, association within fracture and case-fatality was studied separately by gender. Men with pertrochanteric fracture showed the greatest association for in-hospital case-fatality (OR: 3.3; 95% CI: 2-5.5) compared with women with femoral neck fractures. In models with in-hospital case-fatality or no autonomy at discharge or in-hospital case-fatality or no autonomy at discharge or readmission as dependent variables, the odds ratio of death for conservative management of hip fracture were 3.7 (95% CI: 2.3-6) and 3.1 (95% CI: 1.9-4.9), respectively. This information should be taken into consideration for further analyses for long-term outcome and resource consumption by patients with hip fracture.

Age Factors↗

PubMed2002

Exploratory spatial analysis of pilot fatality rates in general aviation crashes using geographic information systems.

Geographic information systems and exploratory spatial analysis were used to describe the geographic characteristics of pilot fatality rates in 1983-1998 general aviation crashes within the continental United States. The authors plotted crash sites on a digital map; rates were computed at regular grid intersections and then interpolated by using geographic information systems. A test for significance was performed by using Monte Carlo simulations. Further analysis compared low-, medium-, and high-rate areas in relation to pilot characteristics, aircraft type, and crash circumstance. Of the 14,051 general aviation crashes studied, 31% were fatal. Seventy-four geographic areas were categorized as having low fatality rates and 53 as having high fatality rates. High-fatality-rate areas tended to be mountainous, such as the Rocky Mountains and the Appalachian region, whereas low-rate areas were relatively flat, such as the Great Plains. Further analysis comparing low-, medium-, and high-fatality-rate areas revealed that crashes in high-fatality-rate areas were more likely than crashes in other areas to have occurred under instrument meteorologic conditions and to involve aircraft fire. This study demonstrates that geographic information systems are a valuable tool for injury prevention and aviation safety research.

Accidents, Aviation↗

PubMed1993

The role of alcohol in work-related fatal accidents in Australia 1982-1984.

This paper describes the role of detectable blood alcohol in fatal work injuries. An attempt was made to identify all work-related fatalities that occurred throughout Australia in the period 1982-1984. A research team examined coroners' records and classified 1737 fatal injury cases as being work-related according to study definitions. The following were also extracted from data in coroners' records: (i) whether or not the description of the fatal event indicated that inebriation was likely to have been a factor; (ii) whether or not there was documentation of blood alcohol concentration (BAC), and if so, what it was. The likelihood of inebriation was assessed without knowledge of the victim's BAC. In 1030 (59 per cent) of the 1737 fatal work injury cases, a BAC determination was documented. Zero levels were detected in 867 fatalities (84 per cent), and 163 cases (16 per cent) had non-zero BAC. In the latter group the median BAC was 104 mg%. Sixty-five per cent of measurable BAC cases had BAC greater than 50 mg%. Fatality risk in the non-zero BAC group relative to that of the zero BAC group was elevated for the following factors: marital status--single (risk ratio (RR) = 1.7, 95 per cent confidence interval (CI) 1.1-2.8) or separated/divorced (RR = 2.4, CI 1.5-3.8); occupation as manager, executive or administrator (RR = 2.5, CI 1.5-5.8); and commuting (RR = 1.6, CI 1.2-2.0).(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Occupational↗

PubMedDate not supplied

Thermal burn fatalities in the workplace, United States, 1992 to 1999.

The purpose of this study was to present the epidemiology of thermal burn fatalities in the workplace in the United States between 1992 and 1999. Data on fatal thermal burn injuries in the United States between 1992 through 1999 were obtained from the Bureau of Labor Statistics Census of Fatal Occupational Injuries. Between 1992 and 1999, 1,189 fatal thermal burns occurred in the workplace (0.11 deaths/100,000 workers per year). Mortality increased with age, with those over 65 years of age having the greatest rate of death (0.20/100,000). Workers in the mining industry and transportation and public utilities had the highest rates of fatal thermal burns. Occupational categories with the highest rates included "extractive occupations" (eg, miners, explosives workers) and "transportation and material movers" (eg, truck drivers). The specific occupations with the highest rates were airplane pilots and navigators, furnace, kiln, and oven operators, and firefighters. Most decedents were operating vehicles or involved in "other transportation operations" at the time of the incident. The majority of injurious incidents occurred on "industrial premises" or the "street and highway." Efforts to prevent fatal occupational thermal burn injuries should focus on older workers and those in occupations with frequent exposure to potential sources of thermal injury. Further study of nonfatal thermal burns in the workplace is needed because patterns of fatal burn injury may not reflect patterns of occupational burn injury overall.

Accidents, Occupational↗