Motor vehicle inspection and motor vehicle accident mortality.
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Accidents, Traffic↗
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The prevention of injury secondary to motor vehicle accidents.
Motor vehicle accidents are a common cause of death for all age groups but are the most serious threat to life for patients aged one to 34 years. Major progress has been made in reducing these losses through improved highway design, improved laws, adjudication of laws controlling the drunk driver, and the advent of vehicle safety design standards. A federal law enacted in 1966 established the National Highway Traffic Safety Administration (NHTSA) and the Federal Motor Vehicle Safety Standards (FMVSS). Motor vehicles, particularly passenger cars, now provide effective protection for occupants because of vehicle safety design features required by the FMVSS. Safety belts are the single most effective safety device available and are required equipment in virtually all motor vehicles sold in the United States. Passive protection for nonusers of safety belts is rapidly improving with the availability of air bags and automatic belt systems, improved windshields, steering wheels, dashboards, and seats, and other vehicle crashworthiness features. Motorcyclists, bicyclists, and pedestrians are also provided with improved protection because of the FMVSS.
Accidents, Traffic↗
Injuries associated with mandible fractures sustained in motor vehicle collisions.
Motor vehicle collisions are second only to altercations as the most common cause of mandible fractures. This article details in a retrospectively studied group the incidence of isolated mandible fractures and associated injuries in patients who were involved in motor vehicle collisions. This group consisted of 148 patients with mandible fractures listed in the University of Mississippi's trauma registry during the past 5 years. In almost all patients, associated injuries occurred with mandible fractures that were caused by motor vehicle collisions, with an incidence of 99.3 percent. Facial and head lacerations and facial fractures were the leading associated injuries, occurring in more than half of the patients who had a mandible fracture. Closed head injury is the major life-threatening associated injury and cause of mortality. The life-threatening injuries occurred in 64.8 percent of patients in this study. The mortality rate in this group of patients was 8.1 percent. These data suggest that mandible fractures from motor vehicle collisions should never be viewed as an isolated injury but rather as part of a spectrum of significant and sometimes life-threatening injuries that require thorough trauma evaluation at the time of presentation.
Accidents, Traffic↗
Extensive fetal intrathoracic injuries sustained in a motor vehicle accident.
Motor vehicle accidents are the primary nonobstetric cause of maternal and subsequent fetal mortality. We present a case in which blunt abdominal trauma sustained by a pregnant woman in a motor vehicle accident caused extensive intrathoracic fetal injuries consisting of bilateral hemothorax, severe bilateral interstitial pulmonary hemorrhages, hemopericardium, and subepicardial hemorrhages, in addition to fetal cranial injuries. To the best of our knowledge, this is the first report of fetal intrathoracic injuries sustained with blunt maternal trauma. The underlying mechanism of intrathoracic trauma was thought to be similar to that of blast injury with transmission of excessive hydrostatic forces throughout the amniotic fluid with severe impact on the elastic fetal chest. This case supports the concept of in utero blast injury to the fetus as a possible cause for fetal soft tissue trauma associated with blunt trauma to the maternal abdomen.
Accidents, Traffic↗
Seat belt use before and after motor vehicle trauma.
BACKGROUND: Motor vehicle crashes cause significant morbidity and mortality annually. Seat belt use has partially been associated with a decreased risk of morbidity and mortality among those involved in motor vehicle crashes. Persons injured in motor vehicle crashes and not wearing seat belts have an increased risk of admission to trauma centers for motor vehicle crash-related injury. The purpose of this study was to measure changes in seat belt use after discharge among patients admitted to a Level I trauma center for injuries sustained in motor vehicle crashes. METHODS: Patients admitted to a Level I trauma center for injuries sustained in motor vehicle crashes during 1998 were eligible for participation. A telephone interview was conducted with a random sample of 136 eligible patients regarding patterns of seat belt use before and after their collision. Demographic data and clinical characteristics were also collected. The frequency of seat belt use before and after crash involvement was compared for all patients and stratified by age, gender, race, and Injury Severity Score (ISS). RESULTS: Slightly over half (54%) of patients reported "always" wearing a seat belt before their collision compared with 85% afterward. Younger age groups, male subjects, and whites had the largest increases in the frequency of seat belt use after collision (45%, 37%, and 44% increases, respectively). With respect to injury severity, the largest increase in the frequency of seat belt use was among those with ISS of 15 to 25 (82% increase). Significant concordance between patient- and emergency medical service-reported use of seat belts was observed. Among subjects reported by emergency medical service personnel to have been restrained, nearly 90% reported belt use at the time of the telephone interview. The most frequently cited occasion for failure to use seat belts (30%) was when taking short trips. Other reported reasons were forgetting to fasten belts (29%), discomfort (10%), being in a rush (8%), riding in the back seat (4%), and that seat belts were unnecessary when riding with a good driver (3%). CONCLUSION: Involvement in a motor vehicle crash results in increased seat belt use. Prevention efforts should be directed toward those patients who report infrequent use. Patient "converts" to seat belt use after collisions may be useful in public awareness and prevention campaigns.
Accidents, Traffic↗
Elemental investigation of some Egyptian vehicle motor alloys using neutron activation analysis.
Six samples of different Egyptian motor vehicle alloys have been investigated by neutron activation analysis to estimate the concentrations of their elemental constituents, which affect their quality. A single high resolution hyper-pure germanium HPGe gamma-ray detector and a multichannel analyzer are used to collect the gamma-ray spectra. A HPGe-HPGe coincidence spectrometer was also used to confirm the identity of certain peaks. Thirteen trace elements (Sc, Cr, Fe, Co, Zn, Sn, Sb, La, Sm, Eu, Hf, Pt and Au) were observed in the spectra and their concentrations were determined. A comparative study on the element concentrations for the six samples is given.
Journal Article↗
Matching fatal accident reporting system cases with National Center for Health Statistics motor vehicle deaths.
Motor vehicle traffic fatalities in the United States are described by two major data sources, the Fatal Accident Reporting System (FARS) and the National Center for Health Statistics Multiple Cause of Death data (NCHS). Certain data, such as the age and sex of the fatality, are reported by both sources. However, each source contains data absent from the other. For example, only the FARS describes the precise circumstances of injury, and only the NCHS identifies the anatomic injuries listed on the death certificate. Thus, it would be useful to have a single file that offers for each case all of the data provided in each of the separate files. Creation of such a file is impeded by the fact that neither file contains personal identifiers for the cases listed. The present paper describes a method of matching cases from the two files based on simultaneous agreement of several variables common to both files (age, sex, date of death, role in the crash, and state in which the injury occurred). Using this method, 85% of the FARS cases can be uniquely matched with a case in the NCHS data.
Accidents, Traffic↗
Assessing technologies for preventing injuries in motor vehicle crashes.
Motor vehicle crashes are a leading cause of morbidity and mortality. In the Haddon matrix, crashes are divided into three phases and factors affecting each phase. In the context of this matrix, the effectiveness, use, and legislation of safety belts and airbags are discussed, using process, injury, and economic outcome measures.
Accidents, Traffic↗
Fractures of the mandible in motor vehicle accidents.
Motor vehicle accidents are a common cause of fractures of the mandible and are the most common cause of serious and multiple fractures. The usual mechanism of injury is outlined. The common fractures that occur are through the anterior alveolar process, condylar necks, or edentulous areas of the body and symphysis. There is high incidence of other injuries associated with jaw fractures in these patients. Treatment of the mandibular fracture must wait until the patient's general condition is stabilized. Obstruction of the airway demands emergency treatment by keeping the tongue forward and repeated suction of blood and mucus from the mouth and nasopharynx. Emergency tracheostomy is rarely necessary because of mandibular fractures. The methods for immobilizing a fractured jaw are outlined. The majority of accident victims are young and therefore have teeth. When there are teeth that occlude immobilization of the mandible must include intermaxillary fixation by wiring the teeth into occlusion. Interosseus wiring is used to support unstable fragments. Intramedullary Kirschner wires are a simple and effective method for immobilizing fractures through the body and symphysis of edentulous patients.
Accidents, Traffic↗
Upper cervical trauma in motor vehicle collisions.
Motor vehicle collisions can cause a variety of injuries in pedestrians and vehicle occupants. Fatal and nonfatal trauma to the upper cervical spine, that is, atlanto-occipital junction, atlas and axis, can be part of this spectrum. Certain distinctive injuries (for example, "hangman's fracture") which occur result from the unique anatomic structure of this area and the various disruptive forces such as extension, distraction (tension), compression (axial loading), shear, and inertia generated during collision. Correlation of autopsy findings or radiological information of these cervical injuries or both with scene investigation can be informative not only in the determination of morbidity and mortality, but also in the assessment of injury mechanisms and improvements in occupant protection.
Accidents, Traffic↗
Pedestrian injury. The next motor vehicle injury challenge.
Motor vehicle injuries are the leading causes of death and disability in childhood after age 1 year. Educational efforts by physicians and public policy have focused on the protection of motor vehicle occupants. However, fatal pedestrian injuries are more common than fatal occupant injuries in preschool and school-aged children. The importance of pedestrian injury as a cause of early childhood morbidity and mortality is likely to become even clearer in the coming years as passenger injury rates decline. Existing patterns and trends in pedestrian injury statistics are poorly understood. The development of effective strategies for injury prevention requires greater understanding of how and why pedestrian injuries occur. Improved knowledge is needed that concerns the roles of environmental, psychosocial, medical, and behavioral factors in child pedestrian injury. Multidisciplinary accident investigation, which involves physicians, traffic engineers, psychologists, and social scientists, is most likely to provide the information needed to develop candidate educational and environmental strategies for study. Prevention of child pedestrian injury is a challenge that has not yet been addressed by pediatricians or policymakers. Pediatricians can promote and direct a national focus on this area that has been understudied by researchers, public health officials, and policymakers.
Accidents, Traffic↗
[Driving a vehicle--driving a motor vehicle, a necessary differentiation for proven limit of alcohol-induced absolute driving incapacity].
There are special cases of vehicle driving, such as driving or moving a certain type of vehicle without an engine as part of the division of labour. These cause distinguishing problems in the area of paragraphs 21, 24, 25 StVG and 44, 69, 69 b, 315 c, 316 StGB with consequences for the type and extent of the proof of dangerous driving due to alcohol. From the jurisdiction so far published on this topic, relevant limiting criteria will be summarised and clearly laid out.
Alcohol Drinking↗
An unexpected fetal outcome following a severe maternal motor vehicle accident.
BACKGROUND: Maternal motor vehicle injury occurs commonly and can cause serious fetal injury. Optimum pregnancy management at the time of maternal presentation following trauma requires reliable methods of fetal assessment. In this report, we present a case in which currently accepted methods of fetal assessment initially failed to demonstrate catastrophic fetal brain injury following a maternal motor vehicle accident. CASE: A 28-year-old primigravida woman at 27 weeks' gestation was in a pedestrian motor vehicle accident, suffering a closed head injury and multiple fractures. Initial fetal assessment included cardiotocographic monitoring for 24 hours fetal ultrasound, both of which were normal, as was a biophysical profile done on the fifth day after the accident. These were repeated at intervals, but definite evidence of fetal brain injury was not seen until unilateral ventricular dilatation was documented on ultrasound at 35 weeks' gestation. Postnatal imaging showed microcephaly, hydrocephalus ex vacuo, and multiple hemispheric hypodensities, likely representing post-traumatic hemorrhages with secondary infarction. At the age of 4 years, the child is cortically blind, epileptic, and quadriparetic. CONCLUSION: This pregnancy outcome was unexpectedly poor despite the reassuring initial assessment. We caution that these methods may not provide accurate early fetal assessment, especially when fetal brain stem function is spared.
Accidents, Traffic↗
A survey of motor vehicle burn accidents in children: report of 45 cases.
The association of burns with motor vehicles was reviewed from the records of 1,532 children treated at the Galveston Shriners Burns Institute since 1966. Forty-five children were burned in or about a motor vehicle. The most common causes were gasoline spillage in moving vehicle accidents, and small children playing with matches unattended in a stationary vehicle. Motor vehicle burn patients had more serious and larger burns than in the general burn population. Of the 34 children burned within the confined space of a motor vehicle, 94% suffered face and/or hand burns. There was a high incidence of respiratory problems. In the moving motor-vehicle fire accident group there were 13 major injuries seen in 17 patients. Of the total motor vehicle occupancy in 38 separate accidents, 19 people died and 66 were hospitalized at the SBI or elsewhere.
Accidents, Traffic↗
The relationship between acute stress disorder and posttraumatic stress disorder: a prospective evaluation of motor vehicle accident survivors.
Motor vehicle accident survivors (n = 92) were assessed for acute stress disorder (ASD) within 1 month of the trauma and reassessed (n = 71) for posttraumatic stress disorder (PTSD) 6 months posttrauma. ASD was diagnosed in 13% of participants, and a further 21% had subclinical levels of ASD. At follow-up, 78% of ASD participants and 60% of subclinical ASD participants met criteria for PTSD. The strong predictive power of acute numbing, depersonalization, a sense of relieving the trauma, and motor restlessness, in contrast to the low to moderate predictive power of other symptoms, indicates that only a subset of ASD symptoms is strongly related to the development of chronic PTSD. Although these findings support the use of the ASD diagnosis, they suggest that the dissociative and arousal clusters may require revision.
Accidents, Traffic↗
Historical changes in motor vehicle death rates among the elderly.
Motor vehicle death rates among the elderly decreased substantially between 1940 and 1980, while the number of registered motor vehicles in the United States increased fourfold and death rates from motor vehicle injury changed little for the entire population. The annual death rate per 100,000 males aged 75-79 declined from 120 in 1940 to 41 in 1980. Much of the decrease can be attributed to reduced pedestrian deaths. Rates for other elderly age and sex groups showed similar patterns but the rates were lower and the changes smaller. Displaying age-specific motor vehicle death rates by birth cohort provides a graphic demonstration that these death rates have decreased markedly for all age groups 60 and older. Implications and possible causes of this decrease are discussed.
Accidents, Traffic↗
Suicide by motor vehicle.
Five suicides by motor vehicle drivers are reported. Possible frequency of such incidents and methods for their investigation, as well as patterns and characteristics of suicidal behavior, are discussed. Published reports of suicide by motor vehicle are scarce. Proven cases should be reported by medical examiners and coroners to help establish the patterns of such deaths.
Adult↗
Childhood motor vehicle occupant injuries.
Motor vehicle occupant trauma is the major cause of mortality among the pediatric population. The mortality rate for adolescents is approximately 10 times that of the younger age groups. Despite enactment of child passenger safety laws in all states and mandatory seat belt use laws in two thirds of the states, mortality rates have not decreased to the extent expected. Additional interventions targeted at the adolescent driver, substance use and driving, and improved occupant protection for all children will be required to further decrease occupant trauma. Lack of comprehensive trauma data is a major roadblock to the calculation of morbidity and disability rates.
Accident Prevention↗