Death In Motor Vehicle Accidents Research Articles

Enhanced Pothole Detection Using YOLOv8 Nano

With over 50 million cars sold annually and over 1.3 million motor vehicle accident deaths worldwide each year, road safety is an urgent concern. It is critical to address driving behavior in countries like India, which contributes 11% of all traffic fatalities worldwide. This study uses YOLOv8, a state-of- the-art deep learning model, to improve pothole identification, hence improving road safety. Our technology achieves a detection accuracy of over 90% by utilizing YOLOv8, which considerably lowers the likelihood of accidents caused by potholes. Moreover, our method has exceptional scalability, processing more than thirty frames per second, which makes it appropriate for real- time implementation in a variety of road conditions. Through rigorous experimentation and analysis, we showcase the potential of our system to revolutionize road safety measures by proactively addressing pothole-related hazards. Index Terms—Pothole detection, YOLOv8, Deep learning, Object detection, Real-time detection, Road safety.

The impact of recreational cannabis markets on motor vehicle accident, suicide, and opioid overdose fatalities

In the U.S., an increasing number of states are legalizing regulated commercial markets for recreational cannabis, which allows private industry to produce, distribute, and sell marijuana to those 21 and older. The health impacts of these markets are not fully understood. Preliminary evidence suggests recreational markets may be associated with increased use among adults, which indicates there may be downstream health impacts on outcomes related to cannabis use. Three causes of death that are linked to cannabis use are motor vehicle accidents, suicide, and opioid overdose. Drawing on data from U.S. death certificates from 2009 to 2019, we conducted a difference-in-differences analysis to estimate the impact of recreational markets on fatalities from motor vehicle accidents, suicide, and opioid overdose in seven states: Colorado, Washington, Oregon, Alaska, Nevada, California, and Massachusetts. States with comprehensive medical cannabis programs with similar pre-trends in deaths were used as comparisons. For each outcome, a pooled estimate was generated with a meta-analysis using random effects models. The results revealed substantial increases in crash fatalities in Colorado, Oregon, Alaska, and California of 16%, 22%, 20%, and 14%, respectively. Based on estimates from all seven states, recreational markets were associated with a 10% increase in motor vehicle accident deaths, on average. This study found no evidence that recreational markets impacted suicides. Most states saw a relative reduction in opioid overdose death that ranged between 3 and 28%. On average, recreational markets were associated with an 11% reduction in opioid overdose fatalities.

Do opioid prescriptions lead to fatal car crashes?

Widespread opioid misuse suggests a potential for increased fatal car crashes. However, opioid use may not necessarily lead to additional crashes if drivers respond to opioid prevalence by substituting away from more inebriating intoxicants like alcohol. Combining data on local opioid prescription rates and car crashes from the Fatality Analysis and Reporting System, we use two-way fixed effects models to test the direction of the association between prescribing intensity and crash fatalities between 2007 and 2016. We estimate that a 10 percent increase in the local prescription rate is associated with a 1 percent increase in the number of driver deaths in motor vehicle accidents. The association is robust to several model specifications, and isolated to drivers most affected by the opioid crisis: males and 25 to 34 year-olds.

Lifetime Risk of Death From Firearm Injuries, Drug Overdoses, and Motor Vehicle Accidents in the United States

BackgroundNews media and policy makers frequently discuss deaths from firearms, drug overdoses, and motor vehicle accidents. However, this information is generally presented as absolute numbers or annual rates. Cumulative lifetime risk may be an additional useful metric for understanding the impact of these causes of death. MethodsData on all-cause firearm, drug overdose, and motor vehicle accident deaths were obtained from the US Centers for Disease Control and Prevention (CDC) for the year 2018. Age-specific death rates were used to estimate the cumulative risk of firearm, drug overdose, and motor vehicle accident deaths from birth to age 85 after accounting for other causes of death. ResultsThe lifetime risk of death from firearms, drug overdoses, and motor vehicle accidents was 0.93% (95% confidence interval [CI], 0.92%-0.94%), 1.52% (95% CI, 1.51%-1.53%), and 0.92% (95% CI, 0.91%-0.93%), respectively. Black males had a 2.61% (95% CI, 2.55%-2.66%) lifetime risk of firearm death, indicating that 1 out of 38 black males will die from firearms if current death rates persist. Residents of West Virginia had a 3.54% lifetime risk of drug overdose death, equivalent to 1 out of every 28 residents dying from overdoses. ConclusionsThe lifetime risk of death from firearms, drug overdoses, and motor vehicle accidents is substantial and varies greatly across demographic subgroups and states.

The Weekend Effect

Introduction A US study suggested donation rates were poorer on weekends. We investigated the effect of day-of-week of donor referral on organ donation in Australia. We also investigated whether any weekend effect resulted in fewer referrals for donation on weekends compared to weekdays. Methods In Australia, potential donor referrals are made to a state-based Donation Service, who then simultaneously seek family consent for donation and assess the medical suitability of the referral for donation. Referrals do not proceed without family consent, or if deemed medically unsuitable. In Australia, organ retrieval occurs when utilisation is almost certain, hence discard rates are extremely low. We retrospectively reviewed all New South Wales referral logs from January 2010 to March 2016. Our outcomes were actual donation (when a referral proceeded to organ retrieval), family consent, and medical suitability. We used logistic regression with random effects adjusting for clustering of referral hospitals. We used mortality data from the Australian Institute of Health and Welfare to compare donation referrals to the background mortality rate by day of the week. We compared donor referrals to all-cause mortality, and specifically to motor vehicle accident (MVA) deaths, as these deaths more typically result in donor referrals. Results Of 2,832 potential donors referred for consideration, 603 (21%) became actual donors.Donation rates were higher for weekend compared to weekday referrals (24% vs. 20%), however this was not statistically significant (p=0.1). We found no evidence of reduced donation (adjusted OR: 1.10; 95% CI 0.88 – 1.38; p=0.4), consent (adjusted OR 1.14; 95% CI 0.88-1.48; p=0.3), or medical suitability (adjusted OR 1.26; 95% CI 0.98-1.62; p=0.07) among weekend referrals.While all-cause mortality was relatively uniform over the week, referrals appeared to drop on Saturdays and Sundays.MVA deaths were more common on weekends (Saturday and Sunday), while the number of referrals from MVA deaths was relatively stable over the week.Compared to all-cause mortality rates by day of the week, the rate of donor-referral on weekends was lower than during the week (p<0.001). We also found that MVA referrals were less common on weekends compared to all MVA deaths (24% vs. 35%; p=0.03). Conclusion There was no association between day-of-the-week or weekend referrals and actual donation, family consent, or medical suitability. Our study suggests the Australian organ donation process is operating consistently even during transient periods of diminished resource or higher caseload, typically experienced during the weekend. These results stand in contrast to the findings from the US. There was some indirect evidence that donor referrals may be more selective at weekends. Further research could explore different stages of the donation pathway (e.g. progression from donor-identification to referral, and progression from actual donation to transplantation)

Blunt Chest Trauma: A Radiologic Approach and Review

Blunt chest trauma, a frequent component of trauma admissions, is the second leading cause of death in motor-vehicle accidents. Additionally, it may be associated with significant morbidity in those who survive. Radiography, ultrasonography, and computed tomography (CT) have a widespread role in evaluating blunt chest trauma, importantly aiding in the diagnosis and management of injury. Herein, we discuss the most common salient injuries, imaging protocol considerations and imaging findings associated with acute blunt chest trauma.

History of Pelvi-Acetabular Fracture Treatment

Acetabular Fractures were treated conservatively before 1960. Robert Judet in 1960 started to treat displaced Acetabular Fractures Surgically. In the modern world of fast moving vehicular traffic, the Pelvic Fractures are the third most common cause of death in Motor Vehicle accidents. The associated injuries to the abdomen, chest, CNS and long bones as well as hemodynamic instability is frequently present Implementation of the ATLS protocol has helped in the early management of such patients but even during the ”golden hour” further decisions need to be taken regarding the surgical management (temporary or definitive) in order to improve survival rates in such patients. Acetabular Fixation can be delayed for a week after the index injury managing the life threatening injuries first. However they may have to be fixed as a damage control orthopedics when the Hemorrhage of pelvis fracture itself is a cause of the shock. Keywords: Acetabulum Fractures, Pelvis Fracture, treatment.

Trends in Socioeconomic Inequalities in Motor Vehicle Accident Deaths in the United States, 1995-2010.

Motor vehicle accident (MVA) mortality has been declining overall, but little is known about trends by socioeconomic position. We examined trends in education-related inequalities in US MVA death rates from 1995 to 2010. We used mortality data from the National Center for Health Statistics and population estimates from the Current Population Survey, and we calculated vehicle- and person-miles traveled using data from the National Household Travel Survey. We used negative binomial regression to estimate crude and age-, sex-, and race-adjusted mortality rates among adults aged 25 years or more. We found larger mortality decreases among the more highly educated and some evidence of mortality increases among the least educated. Adjusted death rates were 15.3 per 100,000 population (95% confidence interval (CI): 10.7, 19.9) higher at the bottom of the education distribution than at the top of the education distribution in 1995, increasing to 17.9 per 100,000 population (95% CI: 14.8, 21.0) by 2010. In relative terms, adjusted death rates were 2.4 (95% CI: 1.7, 3.0) times higher at the bottom of the education distribution than at the top in 1995, increasing to 4.3 times higher (95% CI: 3.4, 5.3) by 2010. Inequality increases were larger in terms of vehicle-miles traveled. Although overall MVA death rates declined during this period, socioeconomic differences in MVA mortality have persisted or worsened over time.

HealthViEWS: Mortality Study of Female US Vietnam Era Veterans, 1965-2010

We conducted a retrospective study among 4,734 women who served in the US military in Vietnam (Vietnam cohort), 2,062 women who served in countries near Vietnam (near-Vietnam cohort), and 5,313 nondeployed US military women (US cohort) to evaluate the associations of mortality outcomes with Vietnam War service. Veterans were identified from military records and followed for 40 years through December 31, 2010. Information on underlying causes of death was obtained from death certificates and the National Death Index. Based on 2,743 deaths, all 3 veteran cohorts had lower mortality risk from all causes combined and from several major causes, such as diabetes mellitus, heart disease, chronic obstructive pulmonary disease, and nervous system disease relative to comparable US women. However, excess deaths from motor vehicle accidents were observed in the Vietnam cohort (standardized mortality ratio = 3.67, 95% confidence interval (CI): 2.30, 5.56) and in the US cohort (standardized mortality ratio = 1.91, 95% CI: 1.02, 3.27). More than two-thirds of women in the study were military nurses. Nurses in the Vietnam cohort had a 2-fold higher risk of pancreatic cancer death (adjusted relative risk = 2.07, 95% CI: 1.00, 4.25) and an almost 5-fold higher risk of brain cancer death compared with nurses in the US cohort (adjusted relative risk = 4.61, 95% CI: 1.27, 16.83). Findings of all-cause and motor vehicle accident deaths among female Vietnam veterans were consistent with patterns of postwar mortality risk among other war veterans.

Obesity and seatbelt use: a fatal relationship

BackgroundSeatbelts significantly reduce the risk of death in motor vehicle accidents, but a certain number of individuals from some subgroups tend not to wear their seatbelts. ObjectivesIn this study, we hypothesized that obese drivers (in fatal crashes) were less likely to wear seatbelts than their normal-weight counterparts. MethodsA retrospective study was conducted on the drivers in motor vehicle crashes entered into the Fatality Analysis Reporting System database between 2003 and 2009. A number of precrash variables were found to be significantly associated with seatbelt use. These were entered into a multivariate logistic regression model using stepwise selection. Drivers were grouped into weight categories based on the World Health Organization definitions of obesity by body mass index. Seatbelt use was then examined by body mass index, adjusted for precrash variables that were significantly associated with seatbelt use. ResultsThe odds of seatbelt use for normal-weight individuals were found to be 67% higher than the odds of seatbelt use in the morbidly obese. The relationship of seatbelt use between the different weight groups and the morbidly obese is as follows (odds ratios [ORs] for each comparison are listed with 95% confidence limits [CL]): underweight vs morbidly obese (OR, 1.62; CL, 1.47-1.79), normal weight vs morbidly obese (OR, 1.67; CL, 1.54-1.81), overweight vs morbidly obese (OR, 1.60; CL, 1.48-1.74), slightly obese vs morbidly obese (OR, 1.40; CL, 1.29-1.52), and moderately obese vs morbidly obese (OR, 1.24; CL, 1.13-1.36). ConclusionSeatbelt use is significantly less likely in obese individuals compared with their normal-weight counterparts.

Bacterial flora of conjunctiva after death.

To evaluate the frequency of bacterial flora of conjunctiva after death (cadaver eyes) which will give information about the bacterial contamination of donor eyes, and the in-vitro sensitivity of isolated bacteria to the commonly used antibiotics in ophthalmic practice. Conjunctival swabs were taken from the cadavers (motor vehicle accident deaths and patients who died in the hospital), within 6h after death, and sent for culture and sensitivity test. Conjunctival swabs, taken from the healthy conjunctiva of patients admitted for cataract surgery, were sent for culture and sensitivity as controls (eyes in those of living status). The bacterial isolates were tested against the commonly used antibiotics (chloramphenicol, gentamicin, ciprofloxacin) in ophthalmology practice. Bacteria were isolated in 41 out of 100 conjunctival swabs (41%), taken from 50 cadavers (study group). Coagulase negative staphylococcus was the most common bacteria isolated (15%), followed by pseudomonas aeruginosa (5%). Gentamicin was effective against majority of the bacterial isolates (82%). Bacteria were isolated from 7 out of 100 conjunctival swabs taken as control group (eyes in living state). Coagulase negative staphylococcus was the most common organism (5%) isolated in control group; the others were staphylococcus aureus (1%) and beta hemolyticus streptococci (1%). Bacteria were isolated from 41% of the cadaver eyes. High percentage sensitivity of the bacterial isolates to gentamicin (82%) supports the practice of thorough irrigation of the eyes with gentamicin solution before starting the procedure of enucleation followed by immersion of the enucleated eyeballs in gentamycin solution, to prevent the bacterial contamination.

A 5-year Profile of Trauma Admissions to the Surgical Intensive Care Unit of a Tertiary Hospital in Singapore

This retrospective pilot study provides information on trauma admissions to the Surgical Intensive Care Unit (SICU) of a tertiary hospital in Singapore. The aim was to use the data collected to generate awareness and interest in this area. The authors also wish to use the information to advocate subsequent in-depth collection and analysis of data and the development of a Trauma Registry. As this was a pilot study, the data collected were by no means exhaustive and only descriptive analysis was applied. Trauma admissions to the SICU for the period between January 2001 and December 2005 were identified from the admissions logbook maintained in the unit. The physical case-notes or electronic-records for the identified cases were retrieved and the relevant data and parameters were entered into the data collection sheet. Descriptive analysis was applied to the data collected. A total of 503 cases over the 5-year period fulfilled our criteria. Motor vehicle accidents were the greatest contributor of trauma admissions to the SICU (53%). The length of stay (LOS) in the unit ranged from 1 to 59 days. The anatomical area most frequently injured was the head (68%). Out of the 132 mortalities, male patients accounted for 84%. Two-thirds (67%) of injury-related mortality occurred in young patients aged less than 45 years. Motor vehicle accidents accounted for nearly half (47%) of injury-related mortality. Motorcyclists accounted for almost half (46%) of motor vehicle accident deaths. The preponderance of young people involved in motor vehicle accidents with head injuries has a large impact on society and on the hospital workload. The authors hope that this pilot study will generate awareness and interest in the area of trauma injuries. They recommend that a nationwide trauma registry be established to look closer into this "disease", as other developed countries have done.

Mathematical models used in TBI

Event Abstract Back to Event Mathematical models used in TBI Svein Kleiven1* 1 KTH School of Technology and Health, Neuronic Engineering, Sweden In Sweden, head injuries causes about 78% of the deaths in motor vehicle accidents. The total annual rate of head injuries in Sweden over the last 14 years is also relatively constant. Thus, in spite of several national preventive strategies, there has not been an important impact on the total burden of head injury. Neurotrauma is the physical damage that results when the human skull and brain are suddenly subjected to intolerable levels of energy that is usually transmitted mechanically. Most of the research in the injury prevention area was initiated by the military aircraft industry in the sixties and seventies. Today the research is to a greater extent sponsored by the car manufacturing industry, partly as a result of the demands from the customers and the media. However, there is a long way to go before a complete understanding of the pathophysiological events following an accident is reached. This paper primarily focuses on summarizing current efforts, and to outline future strategies in human head injury modeling. Although the finite element (FE) modeling of the human head has been advancing over the past decades, it is still far from being able to explain all brain injury mechanisms and predict all types of impact injuries. However, using proper material characterization, correct boundary conditions and detailed geometric representation, a finite element model of the human head can provide us a powerful tool. A detailed and parameterized FE model of the adult human head is presented. It includes the scalp, skull, brain, meninges, cerebrospinal fluid (CSF), and eleven pairs of bridging veins. Separate representations of gray and white matter, and inclusion of the ventricles were also implemented. Non-linear and viscoelastic models are derived for the central nervous system (CNS) and meninges and the importance for injury prediction is outlined. The fluids were modelled using an Eulerian FE formulation, and constrains between fluids and solids were defined. Proposed injury measures for the CNS are also evaluated. Application of the FE head model to reconstructions of real head injury cases will also be discussed. Keywords: accident reconstruction, brain injury prevention, Finite Element Analysis, Traumatic Brain Injury Conference: Karolinska Institutet 200 years anniversary Symposium on Traumatic Injuries in the Nervous System, Stockholm, Sweden, 15 Sep - 16 Sep, 2010. Presentation Type: Presentation Topic: Traumatic Injuries in the Nervous System Citation: Kleiven S (2010). Mathematical models used in TBI. Front. Neurol. Conference Abstract: Karolinska Institutet 200 years anniversary Symposium on Traumatic Injuries in the Nervous System. doi: 10.3389/conf.fneur.2010.56.00012 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 07 Sep 2010; Published Online: 21 Sep 2010. * Correspondence: Dr. Svein Kleiven, KTH School of Technology and Health, Neuronic Engineering, Huddinge, Sweden, sveink@kth.se Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Svein Kleiven Google Svein Kleiven Google Scholar Svein Kleiven PubMed Svein Kleiven Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Mild neuritic changes are increased in the brains of fatally injured older motor vehicle drivers

Given the expected increase in the older population and driving in this age group, concerns have been raised about the safety of older drivers. People over 65 years are over-represented in motor vehicle fatalities when calculated by distance driven. They are also at risk of neurodegenerative diseases, such as Alzheimer's disease, that affect cognitive function. We have examined the brains of older drivers (15M:12F) who died as a result of a motor vehicle accident (MVA) to determine the extent of Alzheimer's disease-related neurofibrillary changes (neuritic plaques and neurofibrillary tangles), Lewy body pathology and cerebrovascular disease and compared them to a control group of older licenced drivers (23M:5F) who died of other causes. The prevalence of moderate or severe neuritic plaque pathology was less than expected for the general population of this age and there was no difference between the groups. However, mild neuritic plaque pathology was increased for MVA deaths compared to controls. There was no evidence of vascular dementia or dementia with Lewy bodies. The current mandatory age-related re-licencing procedures in NSW may contribute to the low percentage of drivers with severe pathology. Further research into the role of mild pathology in cognitive impairment and older drivers is warranted.

Trends in fatal motor vehicle accidents in Transkei region of South Africa

This paper aims to estimate the incidence of motor vehicle accident (MVA) related deaths and identify the factors associated with the causes of the high road death toll in Transkei region. A retrospective review and analysis was performed of all medico-legal autopsies (n=6181) between January 1993 and December 1999, of which 39% (1778/4525) were deaths as a result of MVAs. During the seven-year period (January 1993-December 1999), MVA deaths in Transkei region accounted for an average of 63 deaths per 100,000 population per year. It reached a peak of 80 deaths per 100,000 in 1997, and then slowly came down to 48 deaths per 100,000 in 1999. MVA deaths have come down from 39% (248) of all trauma-related deaths in 1993 to 29% (193) in 1999. The male/female ratio is 3.3:1; and 50% of victims were between 21 and 40 years of age. In conclusion, there are high motor vehicle accident-related deaths in Transkei region of South Africa.

Impact of timing of pelvic fixation on functional outcome

Pelvic fractures are the third most common cause of death in motor vehicle accidents. Recent improvements in mortality can be attributed to the progress made in modern critical care medicine, multidetector CT, ATLS principles, multidisciplinary protocols and early fracture stabilisation. Currently, the timing of pelvic fixation is often based on the haemodynamic status and response of the patient to resuscitation, the fracture pattern, the presence of associated injuries and the immuno-inflammatory status of the patient. The purpose of this review is to focus on the impact of timing of reconstruction of pelvic fractures on the functional outcome of the patients. Thirty seven scientific studies on the outcome of pelvic and acetabular injuries were reviewed. Four on pelvic ring fractures, and one study on pelvic and acetabular fractures met our second inclusion criterion of prospective or retrospective studies investigating the outcome after early or late pelvic and acetabular fixation. These five studies suggested early pelvic and acetabular fixation for optimal outcome but their main difference was the definition of the length in time of that early period. In polytrauma patients, the "damage control orthopaedics" principle should be applied for haemodynamic and skeletal stabilisation (and faecal diversion, if indicated in cases of open fractures of the pelvis). The definitive fixation should be performed after the fourth post-injury day, when the physiological state of the patient is conducive to surgery.

Restraint Use Among Northwest American Indian Children Traveling in Motor Vehicles

We sought to estimate motor vehicle passenger restraint use among Northwest American Indian children 8 years old or younger and to determine factors associated with using proper (i.e., age and weight appropriate) passenger restraint systems. We surveyed vehicles driven by members of 6 tribes in Idaho, Oregon, and Washington. Associations between proper restraint and child, driver, and vehicle characteristics were analyzed using logistic regression for clustered data. We observed 775 children traveling in 574 vehicles; 41% were unrestrained. Proper restraint ranged from 63% among infant seat-eligible children to 11% among booster seat-eligible children and was associated with younger child's age (odds ratio (OR) per year = 0.60; 95% confidence interval (CI) = 0.48, 0.75), seating location (OR front vs rear=0.27; 95% CI=0.16, 0.44), driver seat belt use (OR=2.39; 95% CI=1.51, 3.80), and relationship (OR for nonparent vs parent=0.28; 95% CI=0.14, 0.58). More than half of drivers felt children could use an adult seat belt earlier than recommended guidelines, and 63% did not correctly identify whether their tribe had child safety seat laws. Children in these communities are inadequately restrained. Restraint use was exceedingly low among booster-eligible children and children riding with unrestrained adults. Interventions emphasizing appropriate restraint use and enforcement of passenger safety laws could reduce the risk of injury or death in motor vehicle accidents.

Traumatic Rupture of the Aorta in Adolescence - Description of Two Cases

Aortic disruption is a well documented cause of death in motor vehicle accidents and falls from heights. These injuries also affect children. About 10 % who survive despite aortic injury could potentially be saved provided the diagnosis is established and surgical intervention is undertaken early enough. We present here 2 cases of adolescents aged 17 years, treated in our hospitals with different results. In the first case, timely diagnosis of aortic pseudoaneurysm could not be made, which resulted in its rupture and the death of the patient. In the other patient an early diagnosis of aortic injury was established already in the Emergency Department. The patient was then transferred for further surgical treatment which proved successful. Diagnosis of traumatic aortic rupture is impossible at the accident site and can also be missed in hospital. The symptoms of aortic rupture are not characteristic. The knowledge of the mechanism of injury is extremely important. The diagnosis is established based on chest X-ray, computed tomography, and transoesophageal echocardiography. In cases of doubt, aortography remains decisive in the identification of an aortic injury.

Endoluminal Stent Graft Repair of Traumatic Thoracic Aortic Pseudoaneurysm

Acute rupture of the thoracic aorta caused by blunt chest trauma is a life threatening injury accounting for up to 18% of deaths in motor vehicle accidents. The mechanism is attributed to the combination of sudden deceleration and the relative immobility of the thoracic aorta at the ligamentum arteriosum, the left subclavian artery and the intercostal arteries. Aortic disruptions occur just distal to the left subclavian artery in 97% of cases. Disruptions of the distal descending aorta are rare and occur less than 1% of the time. Death follows a bimodal distribution with most patients dying at the scene. However, approximately 15±20% of patients reach the hospital alive because of the preserved continuity of adventitia and mediastinal structures surrounding the injured aorta. Of those potentially curable patients, the overall mortality still remains as high as 30%. Covered stents have been selectively used in the treatment of chronic thoracic aneurysms and dissections but have only been anecdotally reported for the treatment of traumatic thoracic aortic pseudoaneurysms. We report a case of a patient with multisystem trauma with an unusual distal thoracic aortic injury treated successfully with endovascular grafting.

Upper airway occlusion by soil – an unusual cause of death in vehicle accidents

Upper airway obstruction by soil is a rare cause of death in motor vehicle accidents. Four cases were found in a search of the records of the Forensic Science Centre in Adelaide, South Australia over a twenty-year period from January 1982 to December 2001. Case 1: A 68-year-old male driver died from sand inhalation after he was trapped in his vehicle following an accident. His mouth and upper airway were packed with sand. Case 2: A 33-year-old male pedestrian died from smothering after he had been knocked over and had his head pressed face down into sandy soil by a vehicle wheel. Case 3: A 12-year-old male passenger died from soil inhalation after the vehicle in which he was travelling rolled over and filled with soil. His mouth and upper airway were packed with soil. In these cases the victims had been trapped with the face covered in fine, or loose, soil or sand. In Case 4 a 41-year-old male passenger was ejected from a vehicle. He died from blunt chest trauma exacerbated by occlusion of the mouth and nose by soil. Careful scene descriptions are required in the assessment of such cases, in addition to evaluation of the relative contribution of injuries and asphyxia to the fatal episode.