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Fatal cervical spinal injuries in road traffic accidents.

The present study analyses fatal road traffic accidents involving private cars and vans in Finland during the period 1972-1982, in which an injury to the cervical spine was the main cause of death. The material consists of 289 victims; this being 10.5 per cent of all the fatalities in this category of road traffic accidents. Front seat and rear seat passengers seem to have an equal risk of sustaining a fatal cervical spinal injury. However, front seat passengers have a significantly greater chance (P less than 0.001) of having fatal cervical spinal injuries than the drivers. Of the victims 21.1 per cent had worn safety belts but there was no statistical difference between those who did and those who did not wear safety belts. Increasing age seems to increase the risk of fatal cervical spinal injuries. Patients between 16 and 25 years of age had the lowest risk and patients over the age of 60 had the highest risk of sustaining a fatal cervical spinal injury (P less than 0.001). In 48.1 per cent of the cases, the victims were multiply injured and this is similar to other main causes of death in road traffic accidents. Wearers of safety belts had significantly (P less than 0.001) more multiple injuries. Of the patients who died of cervical injury, only 8.8 per cent survived transportation to hospital and 1.4 per cent survived longer than 24 hours. A direct blow was the most common mechanism of the cervical injury (47.1 per cent) and deceleration was found in 13.1 per cent of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Traffic↗

Firearms fatalities in Denmark 1970-1979.

In the 10-year period from 1970 to 1979 933 firearm fatalities occurred in Denmark which represent an increase of 45% during a little more than 10 years. Eighty-eight per cent were suicides, 8% homicides, and 4% accidents. Accidental shootings have decreased from 8% to 4% and the fall seems to be a result of fewer accidents in connection with hunting, probably due to a more restrictive legislation about hunting. An increasing share of the total number of deaths, now responsible for 57% of the fatalities, are by shotgun. There has been a remarkable increase in the use of sawn-off long barreled weapons. Still considering the marked increase of firearm fatalities, fatal shootings are of very limited importance in Denmark, especially homicidal shootings of which there are 2-3 per year. Shotguns are at the present time the only procurable dangerous weapons which have led to an increased share of the total firearm fatalities. Restrictions in the use of shotguns during hunting seem to have had positive effects on the reduction of hunting accidents. As mentioned above, the most valuable method of bringing the firearm fatalities under further control seems to be increased control over the procurement and possession of shotguns.

Accidents↗

Temporal distribution of motorcyclist injuries and risk of fatalities in relation to age, helmet use, and riding while intoxicated in Khon Kaen, Thailand.

This study investigated the temporal distribution of risky behaviors among injured motorcyclists, that is, riding unhelmeted or while intoxicated, and showed how they are associated with risk of fatal injuries. Data of motorcyclists injured in Khon Kaen municipality in northeastern Thailand and transferred to Khon Kaen Regional Hospital were obtained from the trauma registry system of the hospital. Case fatalities were compared by time of day, age group, helmet use, and alcohol intoxication. Unhelmeted riding peaked late in the evening and riding while intoxicated peaked around midnight. Both were associated with increased fatality risk after stratification by time of day; the odds ratios were 3.49 (95% confidence interval (CI) = 1.48-9.36) and 3.01 (CI = 1.71-5.19), respectively. Nighttime injuries were not significantly associated with increased fatality risk after stratification by helmet use or alcohol intoxication. Unhelmeted driving was prevalent and associated with higher fatality risk among younger drivers, whereas intoxicated driving was less prevalent among teens but associated with increased risk among those aged 20-39 years. This study shows that riding unhelmeted or while intoxicated can explain the increased fatality risk at night, suggesting that safety education or enforcements should be targeted at specific age groups and appropriate times.

Accidents, Traffic↗

Crossing county lines: the impact of crash location and driver's residence on motor vehicle crash fatality.

INTRODUCTION: Studies have demonstrated that the fatality risk for motor vehicle crashes (MVCs) is higher in rural than urban areas. The purpose of this study was to quantify the risk of a fatal outcome associated with a crash by the urban/rural classification of the driver's county of residence and the county of crash before and after adjusting for potentially confounding factors. METHODS: County of crash and driver's county of residence were classified as urban or rural for 514,648 Utah crash participants. Multivariate regression analysis was used to assess the impact of rural versus urban crash location on fatality outcomes for both urban and rural drivers. RESULTS: Before adjusting for confounding factors the relative risk of fatality in a rural versus urban crash was 9.7 (95% CI: 8.0-11.7) for urban drivers and their passengers compared to 1.8 (95% CI: 1.3-2.6) for rural residents. Adjustment for behavioral, road, and crash characteristics reduced risk estimates to 2.8 (95% CI: 2.2-3.5) and 1.2 (95% CI: 0.8-1.7), respectively. CONCLUSION: Urban and rural drivers may have distinct risk factors for MVC fatality in rural areas. Interventions to reduce the risk of fatality in rural areas should evaluate the needs of both urban and rural drivers.

Accidents, Traffic↗

Trocar-associated injuries and fatalities: an analysis of 1399 reports to the FDA.

Laparoscopic trocars, medical devices used to gain access into the abdominal cavity, are the most common device named in malpractice injury claims associated with laparoscopic procedures. As part of its ongoing adverse event reporting program, the U.S. Food and Drug Administration (FDA) requires manufacturers and user facilities to file a report whenever a device was or may have been a factor in a death or serious injury. The FDA collects data from these reports in its Manufacturer and User Facility Device Experience (MAUDE) database. This study presents an analysis of fatality and injury data on laparoscopic trocars found in MAUDE reports received from January 1, 1997, through June 30, 2002, including 31 fatal injury cases and 1353 reports on nonfatal injuries. Cholecystectomy was the procedure most frequently associated with both fatal and nonfatal trocar injuries. Most fatalities involved vascular injuries. All fatality reports that identified the trocar design involved either a shielded trocar (which has a retractable shield that covers the trocar blade before and after insertion to help protect abdominal and pelvic organs from inadvertent puncture) or an optical trocar (which allows laparoscopists to view the cutting tip as it penetrates the tissues). Narrative comments cited surgical technique, device problems, and patient characteristics as contributing factors. Among nonfatal injuries, a change in surgical management such as additional surgical procedure--primarily laparotomy--prolonged surgery, or aborted surgery was reported most frequently for vascular and hollow viscus injuries. Many reports did not identify the device model, surgical procedure, or event timing, limiting Food and Drug Administration (FDA) and manufacturer investigations into whether the device contributed to the event. The most common manufacturer conclusions indicated the trocar was not returned, and no conclusions could be drawn about the trocar's contribution to the event. Fatalities occur with procedures in which shielded trocars and optical trocars are used. Further study is needed to evaluate the high proportion of reports associated with laparoscopic cholecystectomy. Laparoscopists should retain for evaluation any devices implicated in patient injuries and should ensure that detailed information on adverse events is provided in adverse event reports to the FDA. The FDA's Manufacturer and User Facility Device Experience (MAUDE) database can be a valuable source for information on adverse outcomes associated with medical devices and, given an understanding of its limitation, provides researchers with a viable adjunct to published literature and litigation surveys for obtaining this information.

Adolescent↗

Factors related to seat belt use among fatally injured teenage drivers.

PROBLEM: In the United States, teenage drivers have a higher crash risk and lower observed seat belt use than other age groups. METHOD: Seat belt use was examined for teenage (16-19 years) drivers who were fatally injured in traffic crashes occurring in the United States during the years 1995-2000. Vehicle, driver, and crash factors potentially related to belt use were examined. State differences in belt use rates among fatally injured teenage drivers were related to states' observed belt use rates for all ages and other state-level variables. RESULTS: During 1995-2000, mean belt use was 36% among fatally injured teenage drivers and 23% among fatally injured teenage passengers. One of the strongest predictors of higher belt use for both drivers and passengers was whether the crash occurred in a state with a primary seat belt law. Belt use rates for 1995-2000 for fatally injured teenage drivers ranged from 20% or less in six states to more than 60% in two states. States with the highest use rates were those with strong primary belt use laws and those with high rates of observed belt use for all ages. Lower belt use among fatally injured teenage drivers was associated with increasing age; male drivers; drivers of SUVs, vans, or pickup trucks rather than cars; older vehicles; crashes occurring late at night; crashes occurring on rural roadways; single vehicle crashes; and drivers with BACs of 0.10 or higher. Teenage driver belt use declined as the number of teenage passengers increased, but increased in the presence of at least one passenger 30 years or older. IMPACT ON TRAFFIC SAFETY: It is suggested that to increase teenage belt use, states should enact strong primary belt use laws and mount highly publicized efforts to enforce these laws. Graduated driver licensing systems should incorporate strong provisions that require seat belt use by teenage drivers and passengers.

Accidents, Traffic↗

Quantitative morphometry of granular 'dot-like' ubiquitin-immunoreactivity in the crus cerebri in asphyxiation and fire fatalities.

In the central nervous system (CNS), a variety of ubiquitinated structures have been reported, usually as pathological alterations of the brain related to degenerative diseases or aging. However, previous studies showed an increase in the ubiquitin (Ub)-immunoreactive intranuclear inclusion of the pigmented neurons of the substantia nigra in the midbrain in asphyxiation and fire fatalities in the adult subjects. The aim of the present study was to examine granular 'dot-like' Ub-immunoreactivity in the crus cerebri (cortico-spinal tracts) in related fatalities (over 35 years of age, n=169), including fatal asphyxiation (n=27), drownings (n=14), fire fatalities (n=60), and control groups (n=68). Dot-like Ub-immunoreactivity was clearly observed in the descending tract of the crus cerebri. Morphometric analysis of the positive granular area (dot-like Ub-area) showed a higher value in strangulation and fire fatalities and a lower value in hemorrhagic and head injury deaths, as was observed for the inclusion-type neuronal Ub-positivity. However, there was a difference between those markers: a low value was seen for the inclusion-type neuronal Ub-positivity in hanging and drownings, and a difference in the dot-like Ub-area was detected between fire fatalities with lower and higher COHb levels. Our findings suggested the possible usefulness of these markers for examination of CNS stress responses in traumas, at least in middle-aged and elderly victims and a partial difference in stress reaction between the cortico-spinal tracts and dopaminergic neurons.

Adult↗

Fatal traumatic brain injury, West Virginia, 1989-1998.

OBJECTIVE: The objective of this study was to describe fatal cases of traumatic brain injury (TBI) among West Virginia residents. METHODS: The authors analyzed data from the National Center for Health Statistics Multiple Cause of Death tapes for the period 1989-1998. They compared West Virginia's annualized average TBI death rate with the rates of other states and with the rate among U.S. residents for the same period. U.S. Bureau of Census population estimates were used as denominators. RESULTS: A total of 4,416 TBI deaths occurred in West Virginia in 1989-1998, for an annual average death rate of 23.6 per 100,000 population. From 1989 to 1998, TBI death rates declined 5% (p=0.4042). Seventy-five percent (n=3,315) of fatalities occurred among men. Adults > or =65 years of age accounted for the highest percentage of fatal injuries (n=1,135). The leading external causes of fatal TBI were: firearm-related (39% of reported fatalities), motor vehicles-related (34%), and fall-related (10%). Firearm-related TBI became the leading cause of TBI fatalities in 1991, surpassing motor vehicle-related TBI. Seventy-five percent of firearm-related TBI deaths were suicides (n=1,302). West Virginia's TBI death rate (23.6 per 100,000) was higher than the national rate (20.6 per 100,000). In 23 states, the average TBI death rates over the 10-year period were higher than West Virginia's. Whereas modest declines in TBI death rates occurred for motor vehicle-related and firearm-related causes in West Virginia, a concomitant 38% increase occurred in the fall-related TBI death rate during the decade. CONCLUSION: Data presented in this report can be used to develop targeted prevention programs in West Virginia.

Accidental Falls↗

Risk factors for fatal road traffic accidents in Udine, Italy.

In the Province of Udine, Northeast Italy, mortality from road accidents is 37% higher than in the country as a whole. To identify the major risk factors for fatal crashes in this area, we analyzed the Police reports of 10,320 road traffic accidents that occurred from 1991 to 1996. Logistic regression was used to evaluate the association of characteristics of drivers and accidents with accident severity. The risk of involvement in fatal rather than non-fatal accidents was lower among females than among males (odds ratio (OR) = 0.65; 95% confidence interval (95% CI), 0.53-0.80). Compared with subjects < 30 years of age, subjects aged > or = 65 had a significantly increased risk of fatal injury as pedestrians (OR = 10.87; 95% CI, 4.45-26.54), car drivers (OR = 1.85; 95% CI, 1.08-3.18), moped riders (OR = 3.53; 95% CI, 1.42-8.78), and bicycle riders (OR = 7.72; 95% CI, 2.56-23.29). In accidents that occurred from 1:00 to 5:00 h the risk of death was higher than from 6:00 to 11:00 h among pedestrians (OR = 8.88; 95% CI, 2.58-30.52), car drivers (OR = 4.95; 95% CI, 3.09-7.95), motorcycle riders (OR = 13.44; 95%CI, 2.54-71.05) and moped riders (OR = 8.76; 95% CI, 2.42-31.69). Risk of death among pedestrians, car drivers, moped, and bicycle riders was also significantly increased on roads outside the urban center. Driver's injury was strongly associated with lack of use of seat belts (OR = 13.27; 95% CI, 9.39-18.74, for fatal injury; OR = 2.49; 95% CI, 2.17-2.86, for non-fatal injury). Simple interventions focused on protecting the weakest road users and based on law enforcement, behavioral change and environmental modification might result in reducing the significant excess of road traffic accident mortality found in the study area.

Accidents, Traffic↗

International comparison of costs of a fatal casualty of road accidents in 1990 and 1999.

The purpose of this study is to assemble information of costs per fatal casualty in traffic accidents, adopted by authorities in different countries. analyse and compare these figures as well as the methods used for estimating these values. A questionnaire was sent to 19 countries from which 11 gave information on cost per fatality and methods of valuation. The costs per fatality, usually defined as direct and indirect costs plus a value of safety per se, are compared both between countries and over time, 1990 and 1999, for each country. The average cost per fatality has increased between 1990 and 1999 (fixed prices) due to both changes in the methodology and changes of valuations. Great Britain, New Zealand, Sweden and the US conduct own willingness-to-pay (WTP) surveys, while the Netherlands and Norway make reviews of these studies. In Finland, the cost per fatality is a combination of the value of lost productivity and the cost of care for an institutionalised disabled person. In Australia, Austria, Germany and Switzerland, the cost per fatality is estimated as a value of lost productivity and an addition of a human cost based on compensation payments or insurance payments. Estimates from recently conducted WTP surveys or meta-analyses are considered in Austria, Finland and Sweden, however, not yet adopted as official values for use in road traffic planning.

Accidents, Traffic↗

The role of ambient light level in fatal crashes: inferences from daylight saving time transitions.

The purpose of this study was to estimate the size of the influence of ambient light level on fatal pedestrian and vehicle crashes in three scenarios. The scenarios were: fatal pedestrian crashes at intersections, fatal pedestrian crashes on dark rural roads, and fatal single-vehicle run-off-road crashes on dark, curved roads. Each scenario's sensitivity to light level was evaluated by comparing the number of fatal crashes across changes to and from daylight saving time, within daily time periods in which an abrupt change in light level occurs relative to official clock time. The analyses included 11 years of fatal crashes in the United States, between 1987 and 1997. Scenarios involving pedestrians were most sensitive to light level, in some cases showing up to seven times more risk at night over daytime. In contrast, single-vehicle run-off-road crashes showed little difference between light and dark time periods, suggesting factors other than light level play the dominant role in these crashes. These results are discussed in the context of the possible safety improvements offered by new developments in adaptive vehicle headlighting.

Accidents, Traffic↗

A small area study of motor vehicle crash fatalities in Alberta, Canada.

This study examined the small area variation in motor vehicle crash fatality rates in the province of Alberta, Canada. Motor vehicle crash fatality rates per 100000 population (1995-1997, inclusive) were determined for five geographic areas in the province. The rates showed substantial, statistically significant variation across areas, with fatality rates lowest in the urban areas of Calgary and Edmonton, and highest in the rural areas (south, central, and northern Alberta). Examination of area-level predictors-population density, impaired driving citation rates, education level, unemployment levels, and ethnicity-showed that population density and impaired driving rates were associated with motor vehicle crash fatality rates. There was a five-fold difference in annual motor vehicle crash fatality rates between rural (22.9/100000) and urban areas (4.4/100000), whereas annual impaired driving rates were around 1.8% in rural areas, compared with 0.6% in urban areas. Because of multicollinearity problems, it was not possible to estimate a multivariable Poisson regression model. In conclusion, rural areas in the province of Alberta demonstrate a significantly higher motor vehicle crash fatality rate, compared with urban areas.

Accidents, Traffic↗

Estimating transport fatality risk from past accident data.

This paper examines the statistical properties of estimates of fatal accident rates, mean fatalities per accident, and fatality rates when these estimates are based on past accident data. The statistical properties are illustrated by two long-term transport fatal accident datasets from Great Britain, the principal one for railways and the other for roads, chosen to provide a statistical contrast. In both modes, the accident rates have fallen substantially over the long term. Two statistical estimates of current accident and fatality rates are presented for each dataset, one based only on recent data and the other based on estimates of long-term trends. The trend-based estimate is preferred for train accidents because this makes maximum use of the limited and variable data; the recent data are preferred for road accidents because this avoids unnecessary dependence on modelling the trends. For train accidents, the estimated fatality rate based on past accidents is compared with an estimate produced by the railway industry using a risk model. The statistical estimate is less than half the industry's estimate, and the paper concludes that the statistical estimate is to be preferred.

Accidents↗

Fatal crashes of passenger vehicles before and after adding antilock braking systems.

Fatal crash rates of 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. Vehicles selected for analysis had no other significant design changes between the model years being compared, and the model years with and without antilocks were no more than two years apart. The overall fatal crash rates were similar for the two model years. However, the vehicles with antilocks were significantly more likely to be involved in crashes fatal to their own occupants, particularly single-vehicle crashes. Conversely, antilock vehicles were less likely to be involved in crashes fatal to occupants of other vehicles or nonoccupants (pedestrians, bicyclists). Overall, antilock brakes appear to have had little effect on fatal crash involvement. Further study is needed to better understand why fatality risk has increased for occupants of antilock vehicles.

Accidents, Traffic↗

Analysis of circumstances and injuries in 217 pedestrian traffic fatalities.

We performed a retrospective analysis of 217 pedestrian traffic fatalities in Seattle, WA, U.S.A. that occurred over a six-year period using medical examiner records with essentially all of the deaths examined by autopsy. The annual pedestrian fatality rate for the county averaged 2.0/100,000 for all ages and both sexes, and the age-specific rate varied from 1.0/100,000 for the 22-34 year age group to 1.5/100,000 for children under seven years and 7.0/100,000 for ages 70 years and older. Males had a 50% higher rate than females. Fatal accidents were most common during December and January and during the evening hours. Wednesday had the greatest number of accidents leading to death, 79% higher than the Saturday weekend rate. Of those tested, 24% had ethanol in their blood. 66% of the fatal injuries occurred on city or residential streets, and 29% occurred on major thoroughfares. A single urban highway accounted for 12% of pedestrian fatalities and represented a particularly hazardous traffic environment. Fatal head injuries and severe chest injuries were present in 73% of cases; injuries involving multiple sites were present in 60%. There were few significant differences in the extent of injuries with respect to vehicle speed or type of vehicle. Head injuries were much less common in the oldest age group, probably because elderly pedestrians were more vulnerable to death from less severe trunk and extremity injuries. Severe chest injury was the most important predictor of death occurring at the scene.

Accidents, Traffic↗

A photograph-based study of the incidence of fatal truck underride crashes in Indiana.

Photographs were used to estimate the incidence of fatal crashes in which passenger vehicles underrode the fronts, sides and rears of large trucks in Indiana during 1993. The photographs were obtained for 98 of the 107 eligible fatal crashes between large trucks and passenger vehicles in 1993. A protocol was developed to judge the presence and extent of underride, the presence of intrusion into the passenger vehicle compartment, and the likelihood of death or serious injury if underride had been prevented. The incidence of fatal underride was compared with the incidence reported in the Fatality Analysis Reporting System (FARS), a census of fatal crashes on public roads in the U.S.A. For the same 107 fatal large truck-passenger vehicle crashes, the incidence of underride reported in FARS was much lower than in the photograph-based study: 6 versus 63%. Photographs contain details absent from police reports, the primary data source for FARS, and thus enable more complete identification of underride crashes. Preventing underride would have substantially reduced the likelihood of death or serious injury in ca 20% of the underride crashes.

Accident Prevention↗

Residence location of drivers involved in fatal crashes.

Traffic safety researchers have long known that the majority of fatal crashes occur on rural roads, but it is not clear whether these crashes involve people who live in rural areas or residents of urban areas traveling on rural roads. 'Geodemographic' market-research tools allow determination of the urbanization of drivers' residence locations from their postal 'zip code.' Using data from the 1988-1992 files of the Fatal Accident Reporting System (FARS) maintained by the National Highway Traffic Safety Administration (NHTSA), this study determined the residence location of several subgroups of drivers involved in fatal crashes. Not only did the majority of fatal crashes occur in rural areas, but the majority of fatal crashes involved rural and small-town residents and the majority of the rural and small-town residents involved in fatal crashes were traveling on rural roads.

Accidents, Traffic↗

An inter-regional comparison: fatal crashes in the southeastern and non-southeastern United States: preliminary findings.

The southeastern United States, particularly those states representing the National Highway Traffic Safety Administration's and Federal Highway Administration's Region IV, have consistently had among the highest number of fatal crashes and fatal crash rates compared to the other five regions in the US. These states--Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee, are suspected of sharing traits in common that lead to their systematically poor crash record. Inter-regional and intra-regional comparisons, such as the comparison between southeastern and non-southeastern states, raises interesting and challenging research questions that are applicable to similar comparisons. First, is there a sound practical and theoretical justification supporting an inter-regional comparison framework? Second, is there a way to construct a meaningful statistical hypothesis and test to determine whether one region, which is comprised of numerous entities, suffers from a characteristically better or worse crash record? This paper addresses each of these questions. After providing a brief summary of the Southeast's safety record, we discuss the issues pro and con surrounding inter-regional comparisons, illustrating the statistical strategy for such an analysis approach. Then, a simple generalizable statistical procedure is used for testing the hypothesis that southeastern states have a poorer crash record than non-southeastern states. Finally, we explore possible relationships between safety belt use, roadway functional class, vehicle miles of travel, and driver age on fatal crash occurrence. The data used in the analyses are from the Fatal Analysis Reporting System (FARS), primarily data compiled for 1995. The analysis suggests that regional differences in fatal crashes may indeed exist, that these differences are related in part to seat-belt use, VMT by functional classification, and speed limit differences, and that more detailed studies are needed to quantify the effect of these and other factors. The approach developed here lends insight as to where future in-depth studies may reveal causal factors of fatal crashes, and illustrates the relative safety performance records of US regions.

Accidents, Traffic↗