Vehicle Collision Injuries Research Articles

Self-Reported Motor Vehicle Injury Prevention Strategies, Risky Driving Behaviours, and Subsequent Motor Vehicle Injuries: Analysis of Canadian National Population Health Survey

The purpose of this study was to examine self-reported motor vehicle injury prevention strategies, speeding and impaired driving, and the effects of speeding and impaired driving on subsequent motor vehicle collision injuries, using the Canadian National Population Health Survey (NPHS). Strategies commonly reported were preventing impaired drivers from driving, using designated drivers, and requiring passengers to use seatbelts. Yet a substantial minority, particularly young males, reported engaging in risky driving behaviours such as speeding and impaired driving. Self-reported speeders and impaired drivers had significantly higher odds of reporting injuries from subsequent motor vehicle collisions. Specifically, those who reported sometimes/rarely or never obeying the speed limits were two and a half times more likely to report a subsequent motor vehicle injury, while those who reported impaired driving one or more times in the past 12 months were two times more likely to report a subsequent motor vehicle injury. These findings support the need for continued focus on speeding, drinking and driving, and other risky driving behaviours to reduce collisions in Canada.

Self-Reported Motor Vehicle Injury Prevention Strategies, Risky Driving Behaviours, and Subsequent Motor Vehicle Injuries: Analysis of Canadian National Population Health Survey

The purpose of this study was to examine self-reported motor vehicle injury prevention strategies, speeding and impaired driving, and the effects of speeding and impaired driving on subsequent motor vehicle collision injuries, using the Canadian National Population Health Survey (NPHS). Strategies commonly reported were preventing impaired drivers from driving, using designated drivers, and requiring passengers to use seatbelts. Yet a substantial minority, particularly young males, reported engaging in risky driving behaviours such as speeding and impaired driving. Self-reported speeders and impaired drivers had significantly higher odds of reporting injuries from subsequent motor vehicle collisions. Specifically, those who reported sometimes/rarely or never obeying the speed limits were two and a half times more likely to report a subsequent motor vehicle injury, while those who reported impaired driving one or more times in the past 12 months were two times more likely to report a subsequent motor vehicle injury. These findings support the need for continued focus on speeding, drinking and driving, and other risky driving behaviours to reduce collisions in Canada.

A Chronic Posterolateral Knee and Patella Dislocation: Case Report

Knee dislocations are uncommon as isolated orthopaedic injuries, but their prevalence is increased in the setting of high-energy multiple trauma. In these circumstances, it is important for the orthopaedic clinician to recognize and appropriately treat the knee dislocation in parallel with other significant injuries. We report the case of an 18-year-old woman who was involved in a motor vehicle collision and sustained multiple injuries in addition to a posterolateral knee dislocation. An attempt at reduction was made in the initial trauma setting, and the patient was medically stabilized. She was discharged from the hospital in a splint with orthopaedic follow-up and presented 3 months after injury with an unreduced posterolateral dislocation. A single-stage operation was performed with reduction and stabilization of the knee. Postoperatively, the patient has done well and regained significant range of motion.

The effects of health status, distress, alcohol and medicinal drug use on subsequent motor vehicle injuries

Objective The purpose of this study was to examine the effects of health factors and substance use on subsequent motor vehicle collision (MVC) injuries of three different age groups, using the longitudinal dataset from the Canadian National Population Health Survey (NPHS) for the years 1994–2002. Methods Path analysis technique was used to determine the relations between MVC injury and four risk factors: binge drinking; health status; distress; and medication use. The three demographic variables, age at ‘baseline’, sex, and immigration status were added into the model as control variables. Three age groups were examined: young = 12–29.9; middle-aged = 30–59.9 and old = 60–85 years of age. The total sample size was 16,093. Results A lower percentage of males, older persons, immigrants, and non-binge drinkers reported a subsequent MVC injury, as did respondents reporting better health and lower distress scores. Medication use was associated with higher subsequent MVC injuries. Path analysis found that among younger individuals, the variable binge drinking, was the only significant risk factor associated with subsequent injuries. In contrast, among middle-aged individuals, the variable medication use, was the only statistically significant risk factor for subsequent injuries. No variables were significant risk factors of injuries for older individuals. Conclusions Various demographic and risk factors were found to influence injuries among a nationally representative sample of Canadians. Reported binge drinking among young individuals and medication use among middle-aged individuals were found to be risk factors for subsequent MVC injury. These findings support the need for continued focus on alcohol, drugs and traffic safety.

Predictors of Motor Vehicle Collision Injuries Among a Nationally Representative Sample of Canadians

Objective. The purpose of this study was to examine predictors of subsequent motor vehicle collision injuries, with a particular focus on health-related variables, using the longitudinal dataset from the Canadian National Population Health Survey (NPHS) for the years 1994–2002. Methods. Multiple logistic regression analysis was used to determine the relations between motor vehicle collision injury and four risk factors: binge drinking, health status, distress, and medication use. Age and sex were included as control variables. The total sample size was 14,529. Results. A higher percentage of females and younger persons reported a motor vehicle collision injury. Binge drinkers, respondents with poor health, respondents with distress, and respondents reported using two or more medications reported a higher percentage of subsequent injuries. Logistic regression analysis found that persons with poorer health status and persons who used more medications had higher odds of motor vehicle injuries. Only one statistically significant interaction effect was found: alcohol bingeing and medication use. Conclusions. Among a nationally representative sample of Canadians, various demographic and risk factors predict subsequent injuries. Given that this number represents a considerable economic burden, this study underscores the need for continued research and countermeasures on alcohol, drugs, and driving.

A comparison of self-reported motor vehicle collision injuries compared with official collision data: An analysis of age and sex trends using the Canadian National Population Health Survey and Transport Canada data

Objective The purpose of this study was to compare the age and sex trends of motor vehicle collision injuries between a nationally representative self-report survey and official police motor vehicle collision report data. To do this, population-based estimates of motor vehicle collision injuries were established using data from the National Population Health Survey (NPHS), a prospective, population-based, longitudinal survey that was compared to Transport Canada's official motor vehicle collision report statistics. Methods Aggregated mean data (1994–1996) were compared for seven age groups (15–19, 20–24, 25–34, 35–44, 45–54, 55–64, and 65+) from both data sets. Results No significant differences were found between males’ and females’ MVC injuries for any age category in the NPHS. A comparison of the NPHS and Transport Canada data found two small (significant) within-sex differences between the data sets, but overall, the analysis largely revealed similar trends for self-reported injury for all age categories and sex. Conclusions The results indicate that the incidence of injuries based on self-report data in a nationally representative sample is similar to official sources of reporting and are thus a valid indicator or motor vehicle collision injury incidence. The results also confirm that injury trends differ from fatality trends.

Poster 121: Bell’s Palsy Following Zygoma Fracture and Repair: A Case Report

Setting: Inpatient rehabilitation unit. Patient: A 63-yoear-old woman. Case Description: A patient with a medical history of multiple sclerosis was involved in a motor vehicle collision and sustained multiple injuries. Assessment/Results: Computed tomography revealed a subarachnoid hemorrhage and multiple fractures, including those of the right clavicle, right zygoma, right sphenoid, and the right anterolateral wall of the maxillary sinus. The patient underwent open reduction and internal fixation of the right zygoma.

Maxillofacial injuries in moose-motor vehicle collisions versus other high-speed motor vehicle collisions

Maxillofacial injuries in moose-motor vehicle collisions versus other high-speed motor vehicle collisions

Frequency of maxillofacial injuries in all-terrain vehicle collisions

Purpose We sought to evaluate the frequency and distribution of maxillofacial injuries associated with all-terrain vehicle (ATV) collisions and to compare this with patients involved in motorcycle accidents over the same 5-year period at the University of Alabama at Birmingham. Patients and methods The records of all patients involved in ATV collisions who were admitted to the University of Alabama at Birmingham Trauma Center from January 1998 to January 2003 were reviewed. Age, gender, mechanism of injury, length of stay, Glasgow Coma Scale (GCS) score, maxillofacial injuries, Injury Severity Score (ISS), and maxillofacial Abbreviated Injury Scale (AIS) score were the factors considered for the study. These variables were also analyzed for patients involved in motorcycle collisions who sustained maxillofacial trauma. Results There were a total of 72 ATV collisions; 23 patients (32%) sustained maxillofacial injuries. The mean age was 31, and there were 59 males (82%) and 13 females (18%). The most common mechanism of injury was an ATV rollover. The warmer seasons and weekend days had the highest frequency of ATV trauma. Of the 23 patients who sustained maxillofacial injuries, the average maxillofacial AIS score was 2. The length of stay and GCS score were 8 days and 12, respectively, compared to 5 days and 15 in the nonmaxillofacial injury group. The most common maxillofacial fracture seen was a zygomaticomaxillary complex fracture (n = 8), followed by mandibular fractures (n = 6), and orbital floor blowout fractures (n = 5). Eighty-three percent of patients with maxillofacial injuries required an operative intervention during their hospitalization. The distribution of maxillofacial fractures in the ATV group was similar to that of an equivalent motorcycle group, but the frequency for the ATV group was higher (32% versus 8%). The length of stay for the motorcycle group was 11 days versus 8 days for the ATV group. The GCS scores, maxillofacial AIS scores, and ISS were similar between the 2 groups (12, 2, and 18, respectively). In patients who sustained maxillofacial fractures, neurologic injuries were the most frequent concomitant injury in the ATV group, whereas orthopedic injuries occurred more often in the motorcycle group. Conclusions Maxillofacial injuries are common findings in ATV collisions. ATV patients with maxillofacial fractures have more neurologic impairment at admission and longer hospitalizations than patients sustaining motorcycle injuries. There needs to be an increase in the public health effort to educate individuals about the dangers of ATVs and to provide proper safety guidelines before the purchase of a vehicle.

Proportion of injured alcohol-impaired drivers subsequently convicted of an impaired driving criminal code offence in British Columbia

Alcohol is a frequent contributing factor to motor vehicle collision injuries. Our objective was to determine the proportion of intoxicated drivers hospitalized following motor vehicle crashes who were subsequently convicted of an impaired driving criminal code offence. We reviewed British Columbia Trauma Registry records from Jan. 1, 1992, to Mar. 31, 2000, and identified drivers of motor vehicles who were hospitalized for treatment of crash-related injuries. Patient identifiers were then used to link with the Insurance Corporation of British Columbia's (ICBC) contraventions database and the ICBC Traffic Accident System collisions database. Of 6067 patients identified in the Trauma Registry, 4042 had not been administered a blood ethanol test, 209 had no driver's licence match in the relevant databases and 119 died, leaving 1697 eligible patients. Mean age was 34 years, and 79.6% were male. The average Injury Severity Score was 20, the average hospital stay was 14 days and, among ethanol-positive patients, the mean ethanol level was 34.0 mmol/L (156.4 mg/dL). In patients with levels >17.3 mmol/L, the police had listed ethanol as a contributing factor in 70.6% of cases. Despite this, only 11.0% were convicted of impaired driving and 8.4% of another criminal offence; 10.7% received a 24-hour roadside prohibition, 3.9% received a 90-day administrative driving prohibition and 25.0% were convicted of a contravention of the Motor Vehicle Act. Forty-one percent were not convicted of any offence at all. Intoxicated drivers in British Columbia requiring hospitalization as a result of alcohol-related motor vehicle crashes are seldom convicted of impaired driving or other criminal code offences.

Intensive Care Unit Outcome of Vehicle-Related Injury in Elderly Trauma Patients

Vehicle-related trauma is a common mechanism of injury in elderly (age > or = 65 years) trauma patients. Several hospital-based studies have shown that patients with pedestrian injury have a higher mortality compared with those with motor vehicle collision (MVC) injury partially because of older patients found in the former group. In addition the injury patterns also differ significantly between these two mechanisms of vehicle-related trauma. The purpose of the present study is to compare the demographics, injury severity, injury patterns, and outcomes of elderly patients with pedestrian injury admitted to a surgical intensive care unit (SICU) of a Level I trauma center between January 1, 1994 and December 31, 2000 with those admitted with MVC injury. During the study period there were 187 elderly patients admitted to the surgical intensive care unit with vehicle-related injury. Fifty-one per cent of the patients had MVC injury. Patients were divided into two groups based on their mechanisms of injury (pedestrian vs MVC) for comparison. There was no difference in the mean age and gender between the two groups. Injury Severity Score, admission Simplified Acute Physiology Score, and mortality were significantly higher in the pedestrian group compared with the MVC group. Using logistic regression analysis three factors were found to be independently predictive of mortality: Simplified Acute Physiology Score, intracranial hemorrhage with mass effect on CT scan, and cardiac complications.

Patterns and mechanisms of pedestrian injuries induced by vehicles with flat-front shape

To clarify the difference between flat-front vehicles and bonnet-front vehicles with regard to the patterns and mechanisms of vehicle-induced pedestrian injuries, we investigated 101 cases of pedestrians who were struck by the front of a vehicle. There were 33 flat-front vehicle collision cases and 68 bonnet-front vehicle collision cases. The frequency of chest injuries in flat-front vehicle collisions (30.3%) was significantly higher than that in bonnet-front vehicle collisions (11.8%). Lower leg fractures were more common in bonnet-front vehicle collisions than in flat-front vehicle collisions. Although head injuries were common in both cases, the mechanisms of these injuries differed. The pedestrians who were struck by flat-front vehicles tended to sustain more severe injuries at lower impact speeds. All of these results stem from the difference in the front shape of the two types of vehicle. Pedestrians who are struck by the front of flat-front vehicles receive the impact force to the trunk, particularly the chest, at the initial impact and are thrown out forward after the impact, because the front of these vehicles is perpendicular to the road.

Hospital charges to injured drinking drivers in Washington State: 1989–1993

The Washington State Patrol Crash Database and computerized hospitalization records for 1989–1993 were used to determine total hospital charges billed for motor vehicle collision injuries to drivers whose crash reports contained any indication of alcohol use. In this population-based study, total hospital charges were summed, and mean charges and lengths of stay were computed within alcohol use and insurance coverage status categories in an attempt to evaluate the hospital charges billed to public funding and private insurance. Of the total hospital charges for drivers with injuries from motor vehicle collisions for which a police-reported indicator of alcohol use status was available, 43% (U.S.$64.8 million) were for drivers who reportedly had been drinking. At the time of discharge, Medicaid was identified as the payor for 47% of these hospitalizations. The mean hospital charge billed per collision was greater for drinking (U.S.$18 258) than nondrinking drivers (U.S.$14 181). Drinking drivers also had longer hospital stays, even after adjustment for patient age, gender and injury severity. During this time in Washington state, the average annual amount billed at discharge for initial inpatient care of injuries to drivers who reportedly had been drinking at the time of the motor vehicle collision was U.S.$13 million. This includes only the amount assessed by the hospital at the time of discharge for treatment of the initial injury and does not include other related medical charges for rehabilitation or outpatient care, or for doctors' or laboratory fees. As increasing pressures of managed and capitated care lead to a shift of financial risk from the federal government and insurers to states and providers, the financial burden of specific, potentially preventable conditions such as this will receive greater attention.

Treating Patients Involved in MVA

I was very much interested to see a book review, published in January 1997, of Motor Vehicle Collision Injuries: Mechanisms, Diagnosis and Management (Nordhoff LS, ed). Since completing my master's degree in biomechanical trauma, I have become aware of the fact that, although physical therapists treat many patients who have been involved in motor vehicle accidents (MVAs), many physical therapists are not familiar with impact biomechanics and its implications for patient care. Through better understanding of mechanisms of injury and analysis of force patterns at impact, physical therapists can be more effective in taking a focused history with consideration of impact mechanics, improve their evaluation skills when dealing with patients involved in MVAs, be a much better informed expert witness in a court of law, and assure patients that physical therapists are knowledgeable in the area of MVAs.

Medical conditions and motor vehicle collision injuries in older adults.

To determine whether medical conditions that can impair sensory, cognitive, or motor function increase the risk of injury due to motor vehicle collision in older drivers. Case-control study. Group Health Cooperative of Puget Sound, a large prepaid health plan. Group Health members age 65 or older who were licensed drivers in 5 counties. Cases were injured while driving during 1987 or 1988. Controls were matched to cases on age, gender, and county of residence but experienced no such injury during the study years. The outcome was injury requiring medical care due to a police-investigated motor vehicle collision. Risk factors evaluated included selected medical conditions active within the previous 3 years, as determined from the medical record. Injury risk was 2.6-fold higher in older diabetic drivers (95% CI: 1.4-4.7), especially those treated with insulin (odds ratio [OR] = 5.8, 95% CI: 1.2-28.7) or oral hypoglycemic agents (OR = 3.1, 95% CI: 0.9-11.0), those with diabetes for over 5 years (OR = 3.9, 95% CI: 1.7-8.7), and those with both diabetes and coronary heart disease (OR = 8.0, 95% CI: 1.7-37.7). Increases were also found for older drivers with coronary artery disease (OR = 1.4), depression (OR = 1.7), alcohol abuse (OR = 2.1), or falls (OR = 1.4), but these associations could easily have arisen by chance. Counseling about driving risks may be warranted for certain elderly diabetic drivers. Further research is needed to determine whether transient hypoglycemia or long-term complications explain these effects.

Motor vehicle collision injuries and sensory impairments of older drivers.

To determine whether ocular disease, impaired vision, or diminished hearing might increase the risk of motor vehicle collision injuries in older drivers, we conducted a population-based case-control study at a large Health Maintenance Organization (HMO). All study subjects were HMO members who were licensed drivers age 65 or over. Cases were drivers treated for injuries sustained in a police-reported collision that occurred in 1987 or 1988. Controls were drivers who experienced no such injury during the study years and were matched to cases by age, sex, and county of residence. We found no clear evidence that ocular diseases or impaired visual acuity, as customarily recorded in the medical record, increased the risk of an injury collision. Although there was no significant association between impaired hearing and injury collision, we found that subjects who used hearing aids while driving had about twice the risk of others (adjusted RR 2.1; 95% CI 1.2-3.8). We conclude that mild reductions in static visual acuity have little effect on the risk of injury collisions for older drivers. Moreover, the types of vision tests needed to identify elderly drivers at increased risk are not those that are generally administered during routine optometry examinations or at the time of licence renewal. Further research is needed to verify a possible increase in risk among elderly drivers using hearing aids.

The incidence and prognostic significance of radiological abnormalities in soft tissue injuries to the cervical spine.

The radiographs and initial clinical findings of 73 patients who had sustained trauma to the cervical spine without bony injury in vehicle collisions were reviewed. The patients were also re-examined clinically two years after the injury. Forty eight (65.8%) had abnormal radiographs at presentation--prevertebral soft tissue swelling in 15 (20.6%), degenerative changes in 15 (20.6%), and an angular deformity between two adjacent vertebral bodies in 27 (37.0%). Prevertebral soft tissue swelling was found to have no significance with respect to clinical outcome and showed no association with the presence of an angular deformity. Degenerative changes are associated with a poor prognosis. The presence of an angular deformity was found to carry a good prognosis in this group of patients. The exact mode of injury is not associated with any specific radiographic appearance except that "roll overs" and side collisions are more likely to cause angulation in the cervical spine.

Fatal injuries in vehicle collisions

Fatal injuries in vehicle collisions