Incidence Of Motor Vehicle Accidents Research Articles

Risk of Motor Vehicle Accidents in Obstructive Sleep Apnea: Comparative Analysis of CPAP Versus Surgery.

To compare the incidence of motor vehicle accidents (MVAs) among patients with obstructive sleep apnea (OSA) undergoing continuous positive airway pressure (CPAP) therapy and sleep surgery. Retrospective cohort study using the TriNetX national clinical database. Analysis of a nationwide patient cohort. The database was queried for patients with OSA (International Classification of Diseases, 10th Revision: G47.33) treated with CPAP (Current Procedural Terminology [CPT]: 94660), sleep surgery (CPT: 42145, 64568, 64582), or no treatment. Sleep surgeries included uvulopalatopharyngoplasty and hypoglossal nerve stimulation. 1:1 Propensity score matching (PSM) ensured cohort comparability by age, sex, and race. MVA incidence rates were analyzed, along with a subanalysis of OSA-related comorbidities as a surrogate of OSA severity. A total of 2,832,437 patients with OSA were identified. Patients with OSA undergoing sleep surgery demonstrated a significantly lower incidence of MVAs (3.403%) compared to the OSA + CPAP cohort (6.072%) and the no-treatment group (4.662%). The odds ratio (OR) for MVA incidence in the no-treatment group compared to the OSA + sleep surgery cohort was 1.214 (95% confidence interval [CI]: 1.060-1.391, P = .0051). The OR in the OSA + sleep surgery cohort compared to the CPAP cohort was 0.545 (95% CI: 0.480-0.618, P < .0001). Patients with OSA who experienced MVAs were more likely to have comorbidities such as hypertension, diabetes, and heart failure following the accident. Sleep surgery significantly reduces the risk of MVAs in patients with OSA compared to CPAP and no treatment. In appropriate candidates, surgery should be considered to mitigate personal and public health risks associated with OSA.

Descriptive analysis of road traffic accidents in children aged 0-2 years

Aims: This study aims to investigate road traffic accidents (RTAs) involving infants and toddlers, defined as children from birth to 2 years old, focusing specifically on their epidemiology and outcomes. Methods: A retrospective, single-center, observational, and cross-sectional study was conducted in the Emergency Department of a university-affiliated training and research hospital. Data were collected from July 1, 2019, to January 1, 2024. Results: During the study period, 659 cases involved pediatric RTAs patients (individuals under 17 years old), with 41 cases specifically concerning infants and toddlers. These patients had a mean age of 12.98 ± 5.64 months, and 27 (65.9%) were boys. The median Pediatric Trauma Score for was 9 (range: 5-12) while the median pGCS score was 15 (range: 14-15). Motor vehicle accidents were the leading cause of injuries, accounting for 92.6% of cases, followed by motorcycle accidents (4.8%) and pedestrian-vehicle collisions (2.6%). Hospitalized patients exhibited various injuries, including femur fractures, subdural hematoma, orbital roof fracture, scalp hematomas, and lung contusion. Surgical intervention was required in only one case for a femur shaft fracture. Fortunately, no in-hospital deaths occurred among the study participants. Conclusion: This study underscores the importance of adult supervision to prevent RTAs and emphasizes the critical need for strict enforcement of child passenger safety laws to reduce the incidence of motor vehicle accidents involving infants and toddlers.

A novel universal medial approach for difficult posteromedial tibial plateau fractures: a prospective case series

Background: Tibial plateau fractures are considered to be one of the most common fractures with an increasing incidence of motor vehicle accidents. Posteromedial fracture, in particular, is considered a more challenging case. Combination of posteromedial fragment fracture with central articular depression or medial condyle fracture make it much more difficult to reduce and adequately fix the fractured fragments. The aims of this study were to describe a new extensile medial approach for the management of different types of tibial plateau fractures with posteromedial fragments and to evaluate results using this approach. Methods: Between January 2015 and January 2017, 15 patients with Schatzker IV, V, or VI fractures, in combination with a posteromedial fragment, were operated for open reduction of the fracture with restoration of the articular surface alignment. Fixation was done by double plate osteosynthesis. Complete healing time and knee-function scores were recorded in the follow-up period. Results: The average age of patients was 41.8 yr; the mean follow-up period was 30 mo. One patient had superficial wound dehiscence and was treated conservatively. No patients with knee instability or loss of reduction were reported. Conclusions: The posteromedial approach offers a very good access to view, reduce, and fix difficult posteromedial fractures together with comminuted tibial plateau fractures without the need for dissection of the neurovascular bundle in the fossa or soft-tissue injury. Level of Evidence: Level IV.

Motor Vehicle Accident Risk after Methadone Use: A Population-Based Study

Background: Opioid dependence, a major global public health concern, can be alleviated through methadone maintenance treatment (MMT). However, MMT possibly increases motor vehicle accident risk. The aim of this study was to determine motor vehicle accident risk in MMT users. Methods: We performed preliminary estimation of motor vehicle accident incidence rates in Taiwan. In this population-based retrospective cohort study with frequency-matched controls, adult opiate users receiving MMT and not receiving MMT (control) were identified at a 1:2 ratio by linking data from several nationwide administrative registry databases. All individuals were followed for motor vehicle accident events. Data were adjusted for potential covariates and assessed using Kaplan–Meier and Cox proportional hazard model analyses. Findings: From 2009 to 2016, the crude incidence rate of motor vehicle accidents was the lowest in the general adult population, followed by that in adult opiate users, and it was the highest in adults receiving MMT. Among opiate users, motor vehicle accident incidence rates were significantly higher in those receiving MMT than in those not receiving MMT (adjusted hazard ratio [aHR] 2.75, 95% CI 1.87–4.04; p<0.001). Kaplan–Meier curves of the incidence of motor vehicle accidents differed significantly between groups (log-rank test p<0.001), with a significant decline during the first 90 days of follow-up. Rural area residents had a higher motor vehicle accident risk than did urban area residents (aHR 1.56, 95% CI 1.05–2.32; p=0.029). Interpretation: Drivers receiving MMT have an increased motor vehicle accident risk, particularly during the first 90 days of MMT. These findings should be considered for motor vehicle accident prevention in opiate users receiving MMT. Funding Taiwan Food and Drug Administration. Funding Statement: This study was supported by 2 grants from the Taiwan Food and Drug Administration (TFDA) (MOHW106-FDA-D-114-000671 and MOHW107-FDA-D-114-000636). Declaration of Interests: Authors have no potential conflicts of interest to disclose. Ethics Approval Statement: The study was approved by the Institutional Review Boards (TSMH IRB No.: 17-010-B1 and 18-049-B); the need for written informed consent was waived because we used deidentified information from the databases.

Are cardiac patients in Saudi Arabia provided adequate instructions when they should not drive?

ABSTRACTObjective:Driving capability can be significantly affected by different heath disorders; cardiovascular diseases (CVDs) should be considered when assessing patients for medical fitness to drive (MFTD). The aim of this study was to evaluate the awareness of Saudi patients about driving recommendations and to assess the incidence of motor vehicle accidents (MVAs) among cardiac patients.Materials and Methods:We conducted a cross-sectional survey-based study. Male patients diagnosed with CVDs and who were visiting outpatient departments were invited to complete a questionnaire regarding their awareness of driving recommendations. Patients’ demographics, clinical diagnosis, echocardiography parameters, and time-to-CVD diagnosis were all obtained from the patients’ medical records. Women were excluded because it was illegal for women to drive in Saudi Arabia during the study period.Results:In total, 800 men were included, with a mean age of 54 ± 12 years. Driving counseling had been provided to 241 participants (30%). Of these, 207 (25%) were advised not to drive for a period of between one week and six months. Five percent of the patients had a history of MVAs during the follow-up period of 6.2 ± 4 years. We found that the presence of a dyspnea ≥2, according to the New York Heart Association (NYHA), and a history of loss of consciousness (syncope/pre-syncope) were significantly associated with accidents (46% vs. 20%, P < 0.0001 and 41% vs. 10%, P < 0.0001, respectively).Conclusion:Patient–physician discussion about MFTD was only performed with 30% of the patients with CVDs in Saudi Arabia. Dyspnea NYHA class ≥2 or a prior history of syncope were significantly associated with the incidence of MVAs.

EU questionnaire to screen for obstructive sleep apnoea validated in Slovakia.

Obstructive sleep apnoea syndrome (OSAS) associated with daytime sleepiness (DS) contributes to a higher incidence of motor vehicle accidents. Validation of fitness to drive in driving license applicants, with special concern regarding OSAS accompanied by excessive DS, became mandatory under new EU legislation in January 2016. The aim of the study was to translate and validate the recommended questionnaire to screen for OSAS (Q-OSAS) in the Slovak population. No data on any Q-OSAS validation has previously been published. The translated Q-OSAS was administered to 311 Slovak patients prior to a planned overnight polysomnography. The diagnostic accuracy of the Q-OSAS in OSAS with an apnoea-hypopnoea index of 15 or more/h of sleep was evaluated by calculating the area under the ROC curve. The sensitivity and specificity of the cut-off at 10 points for the Q-OSAS was 57% and 67%, respectively, with an increase of sensitivity and a decrease of specificity with a lowering of the cut-off values. Excluding the Epworth Sleepiness Scale (ESS) score from the final statistics yielded the best sensitivity (77%), specificity (50%), and an area under the ROC curve (0.637) for the cut-off value of 8 points (an equivalent of 10 points with the full version of the Q-OSAS). The Q-OSAS is an appropriate screening tool to facilitate the screening of subjects potentially at risk from moderate and severe OSAS. A modified two-step interpretation of the Q-OSAS in Slovakia yielded the best sensitivity, and in the future could promote evaluation of sleepiness in sleep and wake disorders other than OSAS for fitness to drive.

Emergency Medical Service System in the Kingdom of Saudi Arabia

Acute healthcare delivery system in Kingdom of Saudi Arabia starts up from the prehospital/ preclinical scenario in a village level and extents up to quaternary care medical, through state of the art emergency medical services. These quaternary care hospitals, located in urban areas, are considered the last referral points for the patients from nearby cities and states. As the incidence of motor vehicle accidents in Saudi Arabia have increased in recent years, the role of emergency medical care becomes vital in saving precious lives. The emergency services infrastructure needs professional adequacy for timely provision of quality care to critical patients is considered as the main agenda all over. This review looks in to the past, present and future perspective of emergency medical services in Kingdom of Saudi Arabia.

Brachial plexus injuries in adults: evaluation and diagnostic approach.

The increased incidence of motor vehicle accidents during the past century has been associated with a significant increase in brachial plexus injuries. New imaging studies are currently available for the evaluation of brachial plexus injuries. Myelography, CT myelography, and magnetic resonance imaging (MRI) are indicated in the evaluation of brachial plexus. Moreover, a series of specialized electrodiagnostic and nerve conduction studies in association with the clinical findings during the neurologic examination can provide information regarding the location of the lesion, the severity of trauma, and expected clinical outcome. Improvements in diagnostic approaches and microsurgical techniques have dramatically changed the prognosis and functional outcome of these types of injuries.

134. Texting While Driving Among High School Students in the United States: Analysis of 2011 Data From the National Youth Risk Behavior Survey (YRBS)

Motor vehicle fatalities are the single greatest cause of death in teenagers, and texting while driving (TWD) significantly increases the incidence of motor vehicle accidents. There are currently no systematic analyses examining high-risk behaviors that may predict TWD. Using national data from the CDC's 2011 Youth Risk Behavior Survey, our objectives were to: describe the prevalence of TWD among high school students, determine the high-risk behaviors that predict TWD, and analyze the effectiveness of state laws prohibiting TWD.

Motor vehicle accidents during pregnancy: a population‐based study

This population-based cohort study of more than 600,000 Australian women describes the incidence of motor vehicle accidents (MVA) during pregnancy and the immediate and subsequent pregnancy outcomes. In this study, 3.5 women per 1000 maternities were admitted to hospital following an MVA. Immediate delivery was uncommon: 0.4% at <20 weeks of gestation and 3.5% at ≥ 20 weeks of gestation. Outcomes for those giving birth immediately were poor, with increased risk of antepartum haemorrhage, preterm birth, caesarean section and perinatal death. In contrast, women who remained undelivered following an MVA (96%) had similar pregnancy outcomes to women not involved in MVAs, and can be reassured.

Current management of pelvic fractures

Abstract Pelvic fractures are common injuries seen by the orthopedic surgeon especially in our region which has the highest incidence of motor vehicle accidents. The management of these injuries involve taking care of both the life-threatening aspect and also the more commonly neglected long-term morbidity part of the injury. Many new methods of managing such injuries have emerged in the recent times and proper knowledge of the current protocols of managing such injuries is essential. Care should be taken not only to prevent the mortality associated with this injury but also to manage the fracture in a way to prevent the morbidities which may ensue.

Motor vehicle accidents, suicides, and assaults in epilepsy

The goal of our study was to compare the incidence of motor vehicle accidents (MVA), attempted or completed suicides, and injuries inflicted by others between individuals with and without epilepsy. Individuals with and without epilepsy were identified using linked administrative databases between 1996 and 2003 in a Canadian health region with a 1.4 million population. We used a validated epilepsy case definition: anyone who had 2 physician claims, one hospitalization, or one emergency room visit coded with an International Classification of Diseases (ICD)-9-CM or ICD-10 epilepsy code any time during a 2-year period. Four subjects without epilepsy were matched to one patient with epilepsy by age (within 1 year) and sex. The incidence of MVAs, attempted or completed suicides, and inflicted injuries was assessed in 2003-2004. Outcomes were adjusted using the Elixhauser comorbidity index. A total of 10,240 individuals with epilepsy and 40,960 individuals without epilepsy were identified. Mean age was 39.0 ± 21.3 years (range 0.12-99.4) and 48.5% were female. One-year odds ratios before and after adjustment for comorbidity were 1.83 (95% confidence interval [CI] 1.33-2.54) and 1.38 (95% CI 0.97-1.96) for MVAs, 4.32 (95% CI 2.79-6.69) and 1.32 (95% CI 0.81-2.15) for attempted or completed suicides, and 3.54 (95% CI 2.66-4.72) and 1.46 (95% CI 1.04-2.03) for injuries inflicted by others. In this cohort-controlled population-based study, once important medical and psychiatric comorbidities were adjusted for, people with epilepsy were not more likely to attempt suicide or experience MVAs, but were still more likely to be assaulted compared to those without epilepsy.

Obstructive sleep apnea: Not just a sleep disorder

Obstructive sleep apnea (OSA) has long been recognized as a disorder characterized by snoring and frequent cessations of breathing resulting in fragmentation of sleep, which eventually leads to cumulative sleep debt in affected patients. Until two decades ago, snoring and apneas drew attention mainly as a social curiosity and sleep apnea was not thought of as a serious disorder with multisystem involvement. Impairment of quality of work and high incidence of motor vehicle accidents associated with OSA were recognized toward the end of the last century. Since the turn of this millennium physicians have become increasingly aware of the various cardiovascular complications, metabolic disturbances, and neuropsychologic deficits. It has become very clear in the last decade that patients with OSA have a high recurrence of atrial fibrillation after elective cardioversion if their sleep apnea is not treated with continuous positive airway pressure (CPAP). Poor control of diabetes mellitus and resistant hypertension in the setting of OSA has also been recognized and significant progress in our understanding in this area has been accomplished. Unless physicians include sleep in their system review, many cases will go undiagnosed, which will eventually result in cardiovascular complications. Patients are also not readily forthcoming with the symptoms of sleep apnea, as they often assume that symptoms, such as snoring and daytime sleepiness, are not something serious to be discussed with their physician. In this review, the characteristics, the pathophysiology, and epidemiology of OSA are discussed. Furthermore, the mechanisms by which OSA affects the cardiovascular, endocrine, and metabolic functions have been explored.

Obstructive Sleep Apnea (OSA) and Excessive Sleepiness Associated with OSA: Recognition in the Primary Care Setting

Obstructive sleep apnea (OSA) is a common and debilitating condition characterized by recurrent episodes of upper airway obstruction, resulting in intermittent occurrence of apnea–hypopnea. Clinical features include snoring or disturbed sleep, reduced concentration and memory, mood disorders, and excessive sleepiness (ES). Left undiagnosed and untreated, OSA may have detrimental consequences, including cardiovascular (CV) morbidity and mortality, decreased health-related quality of life, and increased incidence of motor vehicle accidents. As most individuals affected by OSA will initially present in the primary care setting, primary care physicians have the opportunity to recognize the condition and refer patients for treatment when necessary. Management of the condition should include lifestyle changes and continuous positive airway pressure (CPAP) treatment if required. Wakefulness-promoting agents may be considered if ES persists despite CPAP. Effective intervention for OSA not only provides symptomatic benefits, but also improves hypertension and reduces the risk for fatal and nonfatal CV events associated with the condition.

An increased risk of road traffic accidents after prescriptions of lithium or valproate?

Studies have shown that lithium may cause psychomotor and cognitive impairment and impose an increased risk of traffic accidents. The antiepileptic drug valproate is also used as a mood stabilizer, but the impact on traffic safety has not been studied. The objective of the present study was to examine whether the use of lithium or valproate increased the risk of being involved in traffic accidents. Between April 2004 and September 2006, information on prescriptions, road accidents and emigrations/deaths was obtained from three Norwegian population-based registries. Data on people between the ages 18-70 (3.1 million) were linked. Exposure consisted of receiving prescriptions for either lithium or valproate. Standardized incidence ratios (SIRs) were calculated by comparing the incidence of motor vehicle accidents during time exposed with the incidence over the time not exposed. Lithium was studied separately from valproate. During the study period, 20,494 road accidents occurred including 36 while exposed to lithium and 31 while exposed to valproate. The overall accident risk was neither increased after having received prescriptions for lithium (SIR 1.3; 95%CI: 0.9-1.8), nor after having received a prescription for valproate (SIR 0.9; 0.6-1.3). The exception was a three-fold increase in risk for younger female drivers exposed to lithium. We found no increase in the traffic accident risk after being exposed to lithium or valproate, except for young female drivers on lithium. This may be because these drugs carry no increased risk or because patients exposed to these drugs refrain from driving.

Paediatric traumatic brain injury in South Africa: some thoughts and considerations

Purpose: This paper endeavours to describe the socio-political and economic backdrop to the assessment and management of traumatic brain injury (TBI) in children in South Africa.Outcomes: The argument put forward is that huge disparities in socio-economic status, diverse socio-cultural influences, and widely differing educational systems and educational attainment which characterize the country's population, render the management of TBI different from approaches adopted in developed countries. The main causes of TBI can be attributed to the high rates of violence in the country, as well as an inordinately high incidence of motor vehicle accidents. Compensation through existing national legislative and insurance agencies is unavailable to most of the population, and markedly insufficient in many cases. The access to medical care and rehabilitation is inadequate for the majority of South African children, although there are valiant efforts on the part of professionals working within the primary health care model to provide the support to the children and their families not offered by existing educational and school structures.Conclusion: The impact of the HIV/AIDS pandemic on the clinical picture of children and their families is profound and guides many of the decisions that are made by health care professionals. Given this bleak scenario, a re-focus on the strengths of existing structures and the creation of new possibilities is suggested as a positive and constructive approach to prevention, rehabilitation, and education.

Obstructive sleep apnea, inflammation, and cardiopulmonary disease.

Obstructive sleep apnea (OSA) occurs commonly in the U.S. population and is seen in both obese as well as non-obese individuals. OSA is a disease characterized by periodic upper airway collapse during sleep, which then results in either apnea, hypopnea, or both. The disorder leads to a variety of medical complications. Neuropsychiatric complications include daytime somnolence, cognitive dysfunction, and depression. Increased incidence of motor vehicle accidents has been documented in these patients and probably reflects disordered reflex mechanisms or excessive somnolence. More importantly, vascular disorders such as hypertension, stroke, congestive cardiac failure, arrhythmias, and atherosclerosis occur frequently in these patients. The lungs may be affected by pulmonary hypertension and worsening of asthma. Recent data from several laboratories demonstrate that obstructive sleep apnea is characterized by an inflammatory response. Cytokines are elaborated during the hypoxemic episodes leading to inflammatory responses as marked clinically by elevated C-reactive protein (CRP). As elevated CRP levels are considered markers of the acute phase response and characterize progression of vascular injury in coronary artery disease, it is likely that obstructive sleep apnea could lead to worsening of vasculopathy. Moreover, as inflammatory mechanisms regulate bronchial asthma, it is also likely that cytokines and superoxide radicals generated during hypoxemic episodes could exacerbate reactive airway disease. Patients with Cough, Obstructive sleep apnea, Rhinosinusitis, and Esophageal reflux clustered together can be categorized by the acronym, "CORE", syndrome. The purpose of this manuscript is to review the inflammatory responses that occur in patients with obstructive sleep apnea and relate them to the occurrence of cardiopulmonary disease.

Childhood injuries in the European Union: can epidemiology contribute to their control?

An average of 6000 children (0-14-y-old) died every year from injuries in the European Union during the last decade. Although the trends are overall favorable, injuries continue to represent the leading cause of death in this age group. The aim of this paper is to present childhood-injury-related public health issues and consider possible remedies of contemporary epidemiologic methods as applied to injury epidemiology and prevention. It has been estimated that half of the lives lost to childhood injuries could have been saved if all European Union countries matched the accomplishments of the country with the lowest mortality rate in each injury category. There is no specific pattern of association between Gross Domestic Product and incidence of motor-vehicle accidents by category of road user, whereas fatality from motor-vehicle accidents seems to be inversely, strongly and significantly related to Gross Domestic Product. The ongoing development of large injury databases in the European Union is a prerequisite for understanding the complex interactions that lead to a childhood injury. Moreover, possible remedies for overcoming the genuine problems associated with the application of traditional epidemiologic methods to the investigation of the frequently transient in nature causes of injuries should be considered.

WIDENING OF THE MEDIASTINUM FOLLOWING A STERNAL FRACTURE

SUMMARYSternal fractures, once thought of as uncommon, occur with increasing frequency, parallelling the incidence of motor vehicle accidents. A fractured sternum can produce a widening of the mediastinum even in the absence of an aortic injury. The Advanced Trauma Life Support course teaches that a widening of the mediastinum after blunt chest injury is an indication for aortography. In this case report we recommend computerised axial tomography (CT) scan of the chest as the investigation of choice in the non‐hypotensive patient who has sustained a fractured sternum after a blunt chest trauma, and who has widening of the mediastinum on the chest X‐ray, with no other radiological features suggesting traumatic aortic rupture.

Impaired driving performance in shiftworkers: The role of the circadian system in a multifactorial model

A substantial and growing percentage of the U.S. work force now works on a rotating shift schedule. The repeated changes in sleep-wake, meal and work times inherent in such schedules conflict with the dictates of the internal biological clock and have adverse consequences for the health of the shiftworker population. An important consequence of this conflict is impaired performance, both on and off the job, as indexed by the increased incidence of motor vehicle accidents in shift workers. In this paper we report the results of a survey administered to rotating shift and straight day workers at a manufacturing plant in the eastern U.S. This survey documents an increased incidence of motor vehicle accidents or "near misses" in which sleepiness was implicated as a cause by the respondent. Complaints of poor sleep and increased sleepiness were also significantly more common in shiftworkers than day workers. Last, shiftworkers reported higher caffeine and alcohol consumption, and were more likely to use alcohol as a sleep aid. Although causal links cannot be established using these associative observations alone, previously reported experience with alteration of shift schedules, improvement of levels of alertness, and reduction in adverse performance outcomes corroborate the possibility of a causal link and suggest potential interventions.