Traffic Injuries Research Articles

How Vulnerable Are the Elderly in Road Traffic-Autopsy Study?

The aim of this study was to analyze characteristic and pattern of road traffic injuries in this special aging group, as well to examine the relevance of certain injuries or risk factors to outliving the injuries. This epidemiological, analytical, retrospective, autopsy study investigated the road traffic deaths for period between 2001 and 2022. The subjects were divided into two age groups, elderly (65 years and older) and middle aged (16-64 years old). We included 213 (32%) elderly participants out of all 665 RTA subjects who died from sustained injuries or complications of the injuries. The majority of elderly subjects (61%) were pedestrians, and elderly participants in RTA were more likely to survive the injuries. The most common injuries among the elderly in all group of participants were chest injuries 81% (and among them, rib fractures were present in 76%). Cranio-cerebral injury is the most common cause of death in RTA subjects, singular (45%) or in combination with other causes. In the group of elderly RTA subjects complication of injury is represented in 36 subjects (17%), while as cause of death is represented in 22 subjects (10%). Elderly are less likely to have positive BAC, and even in cases when BAC was increased, the levels were on the lower scale. More effort should be made to enhance road safety for elderly pedestrians, especially considering the expected rapid growth in the elderly population.

A novel framework for crash frequency prediction: Geographic support vector regression based on agent-based activity models in Greater Melbourne

The field of spatial analysis in traffic crash studies can often enhance predictive performance by addressing the inherent spatial dependence and heterogeneity in crash data. This research introduces the Geographical Support Vector Regression (GSVR) framework, which incorporates generated distance matrices, to assess spatial variations and evaluate the influence of a wide range of factors, including traffic, infrastructure, socio-demographic, travel demand, and land use, on the incidence of total and fatal-or-serious injury (FSI) crashes across Greater Melbourne’s zones. Utilizing data from the Melbourne Activity-Based Model (MABM), the study examines 50 indicators related to peak hour traffic and various commuting modes, offering a detailed analysis of the multifaceted factors affecting road safety. The study shows that active transportation modes such as walking and cycling emerge as significant indicators, reflecting a disparity in safety that heightens the vulnerability of these road users. In contrast, car commuting, while a consistent factor in crash risks, has a comparatively lower impact, pointing to an inherent imbalance in the road environment. This could be interpreted as an unequal distribution of risk and safety measures among different types of road users, where the infrastructure and policies may not adequately address the needs and vulnerabilities of pedestrians and cyclists compared to those of car drivers. Public transportation generally offers safer travel, yet associated risks near train stations and tram stops in city center areas cannot be overlooked. Tram stops profoundly affect total crashes in these areas, while intersection counts more significantly impact FSI crashes in the broader metropolitan area. The study also uncovers the contrasting roles of land use mix in influencing FSI versus total crashes. The proposed framework presents an approach for dynamically extracting distance matrices of varying sizes tailored to the specific dataset, providing a fresh method to incorporate spatial impacts into the development of machine learning models. Additionally, the framework extends a feature selection technique to enhance machine learning models that typically lack comprehensive feature selection capabilities.

An evaluation of front seat distance from rear facing child restraint systems in prevention of injury in frontal crash tests

Objectives Elevated head injury incidence in infants compared to toddlers involved as occupants in motor vehicle crashes has been demonstrated in multiple population-representative crash databases. Further, experimental studies have revealed a potential injury mechanism via impact between a rear-facing, CRS-restrained child and the back of the vehicle seat or console on the row in front of the CRS. Subsequently, experimental studies have suggested that bracing the CRS against the seat immediately in front of the CRS could mitigate head injury, but also indicated that more research was necessary. Thus, we investigated the effect of bracing against the front seat, as well as distance from the front seat with rear-facing infant carriers and rear-facing convertibles, with a focus on changes to measured head, neck and chest injury metrics in rear facing CRSs. Further, we examined the effect of using the infant carrier with and without a base on these injury metrics. Methods 34 frontal sled tests at 30 or 35 mph were conducted using a simulated rear-row vehicle seat and structure representing the front seatback. A Q1.5 anthropomorphic test device (ATD) was placed in a single make/model LATCH-affixed rear-facing convertible or single make/model infant carrier; infant carrier without base was affixed with lap and shoulder belt. To evaluate the effect of bracing and distance, tests were conducted with a 300, 140, 70, or 15 mm gap between the CRS seatback and the front seatback, or a touching (0 mm) or braced (-20 mm) condition. Bayesian regression models quantified the effects of various predictors and model uncertainty. Results For tests with the convertible CRS, no head contact was observed between the head and the front vehicle seatback. For the infant carrier, head contact occurred at both 70 and 140 mm distances but not the other distances. On average, the −20, 0, or 15 mm distances yielded a 60% reduction in head injury criterion with 15 millisecond window (HIC15), and a 60% to 80% reduction in neck tension, compared to the 70 and 140 mm distances; chest acceleration also decreased for the convertible seat only. In the case of both carriers and convertibles, each mm of distance the CRS moves away from the front seatback up to 70 mm, adds 5.3 HIC15 points (95% Credible Interval (CrI):[4.6, 6.2]), and 3.5 Newtons (95% CrI: [2.2, 4.8]) of neck tension, on average. Conclusions Placing a rear facing CRS, both convertibles and infant carriers, against or close to the seatback of the seat immediately in front of the CRS reduces head and tensile neck injury criteria in ATDs. The amount of gap between the front seat and the rear facing CRS is strongly and positively correlated with HIC for both convertibles and infant carriers. RF infant carriers with and without a base yield comparable injury metrics and kinematics when touching or nearly touching the back of the front vehicle seatback.

Estimating occupation-related crashes in light and medium size vehicles in Kentucky: A text mining and data linkage approach

Occupational motor vehicle (OMV) crashes are a leading cause of occupation-related injury and fatality in the United States. Statewide crash databases provide a good source for identifying crashes involving large commercial vehicles but are less optimal for identifying OMV crashes involving light or medium vehicles. This has led to an underestimation of OMV crash counts across states and an incomplete picture of the magnitude of the problem. The goal of this study was to develop and pilot a systematic process for identifying OMV crashes in light and medium vehicles using both state crash and health-related surveillance databases. A two-fold process was developed that included: 1) a machine learning approach for mining crash narratives and 2) a deterministic data linkage effort with crash state data and workers compensation (WC) claims records and emergency medical service (EMS) data, independently. Overall, the combined process identified 5,302 OMV crashes in light and medium vehicles within one year’s worth of crash data. Findings suggest the inclusion of multi-method approaches and multiple data sources can be implemented and used to improve OMV crash surveillance in the United States.

Network-level crash risk analysis using large-scale geometry features

Road traffic crashes are common occurrences that create substantial losses and hazards to society. A complex interaction of components, including drivers, vehicles, roads, and the environment, can impact the causes of these crashes. Due to its complexity, crash identification, and prediction research over large-scale areas faces several obstacles, including high costs and challenging data collecting. This study offers a method for large-scale road network crash risk identification based on open-source data, given that roadways’ horizontal and vertical geometric alignment is crucial in highway traffic crashes. This methodology includes a comprehensive technique for feature extraction from horizontal curves (H-curves) and vertical curves (V-curves) and a novel way of combining the XGBoost model’s attributes with the Harris Hawks Optimization (HHO) algorithm—referred to as the HHO-XGBoost model. Using this model on the road geometry-crash risk dataset developed specifically for this study, the HHO approach adaptively identifies the optimal set of XGBoost hyperparameters and yields favorable outcomes. This study creates a three-dimensional road geometry database that may be utilized for various road infrastructure management, operation, and safety in addition to completing a tiered risk analysis of “region-road-segment” for large-scale road networks. It also offers direction on using swarm intelligence algorithms in integrated learning models.

Injury mortality in South Africa: a 2009 and 2017 comparison to track progress to meeting sustainable development goal targets

ABSTRACT Background Injuries, often preventable, prompted urgent action within the United Nations’ 2030 Agenda for Sustainable Development Goals (SDGs) to improve global health. South Africa (SA) has high rates of injury mortality, but accurate reporting of official national data is hindered by death misclassification. Objective Two nationally representative surveys for 2009 and 2017 are utilised to assess SA’s progress towards SDG targets for violence and road traffic injuries, alongside changes in suicide and under-5 mortality rates for childhood injuries, and compare these estimates with those of the Global Burden of Disease for SA. Methods The surveys utilised multi-stage, stratified cluster sampling from eight provinces, with mortuaries as primary sampling units. Post-mortem files for non-natural deaths were reviewed, with additional data from the Western Cape. Age-standardised rates, 95% confidence intervals (CIs), and incidence rate ratios (IRRs) were calculated for manner of death rate comparisons and for age groups. Results The all-injury age-standardised mortality rate decreased significantly between 2009 and 2017. Homicide and transport remained the leading causes of injury deaths, with a significant 31% decrease in road traffic mortality (IRR = 0.69), from 36.1 to 25.0 per 100 000 population. Conclusions Despite a reduction in SA’s road traffic mortality rate, challenges to achieve targets related to young and novice drivers and male homicide persist. Achieving SA’s injury mortality SDG targets requires comprehensive evaluations of programmes addressing road safety, violence reduction, and mental well-being. In the absence of reliable routine data, survey data allow to accurately assess the country’s SDG progress through commitment to evidence-based policymaking.

External Fixation of Tibial Shaft Fractures in Cameroon-Central Africa

<i>Introduction: </i>Open Tibial Shaft Fractures (TSF) are the most commonly encountered injury type in Cameroon. External fixation, relatively unfamiliar in Cameroon, helps prevent its complications. <i>Objectives:</i> The objective of this study was to evaluate the outcomes of the treatment of TSF using external fixation in Cameroon. <i>Materials and Methods:</i> Patients operated at Laquintinie and Edea Regional Hospital (ERH) with an external fixator (EF) for TSF were followed up from 2018 to 2022. Circumstances of the trauma, anatomo-clinical lesions, types of management, complications, and duration of fixator maintenance were assessed. <i>Results:</i> 161 EFs were placed on 144 patients. Of these, 93 (64.6%) were aged between 20 and 49 years with a sex ratio of 2.5/1. Motorcycle crashes were involved in 68.2% of patients. The fracture involved the middle third in 61 patients (37.9%). It was oblique in 57 patients (35.4%). The injuries were open in 126 (78.3%) cases. The average length of hospital stay was 36.2 days. 122 fractures (75.8%) healed within the expected time, and 21 cases (13.0%) of delayed union were observed. Bone infection was noted in 24 patients (14.9%). The outcome was deemed excellent and good in 122 cases (84.8%). <i>Conclusion:</i> External fixation is effective in managing TSF and is recommended for wider use in Cameroon.

Frequency of Injuries and Deaths Due to Traffic Accidents Caused by the Driver, Bishkek

Road traffic injuries due to the severity of their adverse consequences are one of the priority health problems both in the Kyrgyz Republic and around the world. In Bishkek, the most common causes of traffic accidents caused by the driver were violations of the rules of maneuvering, violation of the rules for the passage of a pedestrian, crossing, non-observance of the rules of priority of travel, road signs, signals, speeding, driving into the oncoming lane, double overtaking, driving while intoxicated, non-observance of distance. However, it should be taken into account that for reasons such as violation of maneuvering rules (2.5 times), violations of the rules of passage of a pedestrian, crossing (2.9 times), non-compliance with the rules of priority of passage (1.6), disobedience to road signs, signals (2.9 times), driving into the oncoming lane, double overtaking (1.8 times), drunk driving (1.7 times), non-compliance with the distance (3.0 times), violation of the rules for passing inspection, use, reception (3.2 times), the frequency of injuries increased. In general, in Bishkek, for the period from 2016 to 2022, 549 people died from road accidents, of which 418 (76.1%) were caused by the driver of passenger vehicles. The highest proportion, both in general and through the fault of the driver of passenger vehicles, was made up of those who died from traffic accidents due to violation of maneuvering rules, violation of pedestrian, crossing, speeding.

The Impact of Climate Change on Road Traffic Crashes in Ghana.

Despite the substantial injuries and fatalities from Road Traffic Crashes (RTCs), evidence of climate change's impact on RTCs in Ghana is lacking. This study assessed the impact of climate change on RTCs in Ghana by combining quantitative (Mann-Kendall trend tests, Continuous Wavelet Transform analysis, causal inference analysis) and qualitative (15 key stakeholder interviews) methods. The quantitative analysis employed monthly rainfall and temperature data (1991-2021) alongside RTC data (1998-2021) across 10 regions. While rainfall trends varied regionally, the wet season (April through mid-October) showed a strong link to crash severity for all regions across Ghana. Wavelet analysis showed higher crash severity in the wet season within every 2-8 months period in a particular annual year during the study period. Causal inference analysis revealed rainfall's stronger influence (3.59%) on fatal crashes during the wet season compared to temperature (0.04%). Key stakeholder interviews highlighted perceived changes in temperature and intense rainfall patterns affecting RTCs, especially during rainy seasons suggesting an association between increased rainfall and crash severity. These findings emphasize the multifaceted role of climate change on road safety and the need to address weather-specific risks.

Epidemiology of geriatric orthopaedic injuries in a tertiary hospital in southwestern Nigeria

Life expectancy in sub-Saharan Africa (SSA) has increased owing to economic growth and improvements in medical care. An increased representation of older people among orthopaedic trauma victims is a significant consequence of population ageing, as shown in previous studies, including few in SSA. This retrospective review in Nigeria aims to corroborate previous studies and highlight the emergence of geriatric orthopaedic trauma (GOT) as a public health concern in SSA. Among 241 orthopaedic trauma in-patients aged ≥ 60, the mortality rate was 3.7%. They made up 21.2% of adult orthopaedic trauma admissions. The incidence of GOT increased steadily over the five-year study period with a spike during COVID-19 lockdown. Males constituted 51%. Mean age was 72.5 years (range, 60–105 years). Mean distance to the hospital was 35.8 km and 50.6% lived farther than 10 km. The main causes of injury were falls (50.6%) and traffic crashes (48.1%). Fractures were the predominant (91.7%) injuries. Univariate analyses revealed significant differences along age and gender stratifications. Longer distance to the hospital significantly delayed presentation. The study supports previous studies and shows that GOT is evolving as a public health concern in SSA. The 2030 Sustainable Development agenda is apt to stem the trend.

Child vulnerable road user crash injury severity

Road traffic crashes (RTC) are the main cause of mortality, morbidity, and disability for children globally as well as in the United Arab Emirates (UAE). Although vehicle occupants usually account for the majority of children involved in RTC in developed countries and in the UAE, injuries sustained by child vulnerable road users (VRUs) are usually more severe due to their lack of protection compared to child occupants. Such injuries are known to result in long-term suffering for children including disabilities in some cases, thereby posing a severe public health burden and economic losses to the population. However, despite the severity of injuries to child VRUs involved in RTC, studies in the UAE have mostly focused on vehicle occupants for both children and adults. To the best of our knowledge, this is the first dedicated study on child VRU RTC injuries in the UAE. Additionally, the UAE government is promoting an active transportation policy among children in a bid to curb childhood obesity. Hence, this study examined the factors contributing to RTC injury severity for child VRUs in the UAE. The results of this study will help in enhancing the safety outcomes of child VRU RTC injuries as well as providing policy recommendations for safe active transport among children in the country.

Identifying the causal effects of driver distraction on hazardous actions at intersections based on propensity score weighting

Distracted driving is a threat to traffic safety that can result in more traffic crashes. Although previous studies have been conducted to explore the relationship between driver distraction and hazardous driving actions, few studies are available to identify the causation between them. Thus, the study intended to evaluate the causal effects of distraction on hazardous driving actions at intersections based on the crash data extracted from the Crash Report Sampling System (2021–2022). The multinomial logit model was employed to reveal the factors contributing to driver distraction. Then, propensity score weighting was adopted to balance the factor distributions between distraction and non-distraction cases to identify the causal effects on hazardous actions. Results indicated that 1) the propensity of distraction is relevant to factors such as the driver’s age, gender, vehicle type, speed limit, area, weather, and light condition, 2) driver distraction can significantly increase the probability of risky actions including speeding, running red lights, failing to obey stop signs, failing to yield, following too closely, and 3) the causal effects show great diversity for different distraction types. The findings serve to understand the influence mechanism of distraction on specific crash risks and develop countermeasures to reduce distraction and hazardous driving actions.

Rethinking cycling safety: The role of gender in cyclist crash injury severity outcomes

Given the ongoing climate crisis and the need for environmentally friendly communities, there has been an increasing interest in sustainable mobility solutions such as cycling. This study seeks to incorporate an equitable component to studying cycling safety and uses one full year’s data of 4,457 single bicycle-single motor vehicle crashes that took place in 2022 in the state of Florida to estimate a series of random parameters multinomial logit models with heterogeneity in the means and variances to capture gender differences in outcome severities. A comparison of advanced statistical models such as unconstrained and partially constrained approaches, that were previously employed in the literature to test for temporal stability, is undertaken in a new application. A partially constrained model is estimated to best identify gender specific factors and argue the need to evaluate and promote safety of female and male cyclists separately. The study finds substantial differences between how the contributing factors and crash circumstances impact the crash injury severity of women and men cyclists. It evaluates factors such as age, location, cyclist behavior, weather, and road design as well as performs out-of-sample simulation to gain additional insights. The findings of this research emphasize the need for targeted approaches in designing our cities and policy making that account for the collective differences in behavior and experience of women and men cyclists.

Changes in Traffic Jams and Injuries Impact on Acceptability of Automated Vehicles: A Strong Curvilinear Relation with no signs of Loss Aversion.

We investigate whether the acceptance of autonomous trucks as a function of their impact on traffic jams and injury rates are affected by loss aversion and diminishing sensitivity as described in prospect theory. In an online survey (N = 447), we presented randomised sets of values the replacement of human truck drivers would have on traffic jams and injuries. Adjusting for loss aversion provides no additional explained variance in the model, but adjusting for diminishing sensitivity does.

Prevalence of Urogenital Injury following Road Accident: A Systematic Review.

Trauma complications have been one of the most serious public health concerns worldwide. In most reports, urogenital injuries (UGIs) are seen in approximately 10% of adult traumatic patients and less than 3% of children with multiple/severe trauma to the abdomen or pelvis. Traffic accidents are the most common cause of UGIs. The purpose of this study is to systematically determine the prevalence and types of UGIs after car accidents. The search strategy was aimed at finding relevant studies in October 2023. No restrictions on language or date were applied. The following criteria were considered eligibility criteria: reporting at least one epidemiological aspect of UGIs in people with road traffic injury (RTI) and a separate epidemiological analysis of RTIs in UGI (we also included those articles that pointed out all RTIs but separately mentioned UGIs). Two experts assessed the reporting quality of articles using standardized critical appraisal instruments from the Joanna Briggs Institute. Statistical analysis for this study was conducted using the CMA statistical software version 3.2.0. A total of 1,466,024 cases following RTIs through 107 studies were included in our review. Of these, 29 studies were related to children (20,036), and the others reported RTIs in adults (1,445,988). The total prevalence was 4.7%, and car accidents were responsible in 36 studies, followed by motorcycle accidents in 25, bicycles in 17 studies, and automobile-pedestrian collisions in 23 related studies. In subgroup analysis based on the damaged organ, the rate of bladder injury was 3.5%. This rate was 5.3% for kidneys. This systematic review and meta-analysis found that the prevalence of UGI following RTIs was 4.7%, with car accidents being the most common cause. UGIs were more prevalent in adults than in children, and bladder and kidney injuries were the most commonly reported types. The prevalence of UGI varied by country and study design.

Long-Term Effects of a Multi-Component Community-Level Intervention to Reduce Single Vehicle Nighttime Crashes: Follow up Findings from a 24-Community Randomized Trial.

This follow up study examines whether a multi-component, high-visibility alcohol enforcement intervention implemented in 12 California cities had long-term effects on alcohol-related motor vehicle crashes beyond the time period of the original study. Previous results indicated a significant reduction in single vehicle nighttime (SVN) crashes among 15 to 30-year-olds in intervention cities relative to controls (Saltz et al., 2021). A randomized trial was conducted with 24 randomly chosen California cities from 2012 to 2017 to evaluate a multi-component intervention to reduce excessive drinking and driving while impaired among adolescents and young adults. Twelve of the cities were randomly assigned to the intervention condition and implemented high-visibility alcohol enforcement operations and other components from April 2013 to March 2016. Multi-level negative binomial regression analyses were conducted with motor vehicle crash data from 2010 to 2021 to examine whether single vehicle nighttime (SVN) crashes among 15 to 30-year-olds decreased in intervention cities relative to controls after the multi-component intervention was implemented. Analyses controlled for community sociodemographic characteristics, the overall time trend, the COVID pandemic, and pre-intervention levels of SVN crashes and adjusted for correlation of repeated observations within cities over time. Regression analyses indicated a significantly lower level of monthly SVN crashes among 15-to-30-year-olds in intervention cities during post-intervention months through 2021 relative to control cities [Event Rate Ratio (95%CI) = 0.88 (0.79, 0.98), p<.05] when controlling for community sociodemographic characteristics, the overall time trend, COVID, and pre-intervention levels of SVN crashes. Study findings suggest that a multi-component, high-visibility alcohol enforcement intervention can have long-term effects on alcohol-related motor vehicle crashes and related injuries and fatalities among adolescent and young adult drivers.

Aggression of electric bike riders in China: comparisons of the Cycling Anger Expression Inventory toward drivers, pedestrians, and other riders

ABSTRACT Electric bikes (e-bikes) account for an unexpected proportion of traffic crash injuries and deaths in China. There is an urgent need to study the factors influencing the aggressive behaviours of e-bike riders and reduce their potential involvement in crashes. In addition, aggression varies when directed at different types of road users, particularly when expressed by vulnerable groups. This study aimed to validate the Cycling Anger Expression Inventory (CAX) for e-bikers and explore whether the expression of aggression in e-bikers differs depending on the recipients, such as drivers, pedestrians, or other riders. The analysis examined the aggression specificity of e-bikers by employing tests of measurement invariance (MI). These findings indicate that adaptive/constructive expression has emerged as a mainstream strategy for managing e-biker anger. E-bikers exhibited the highest levels of aggression toward drivers. These results provide a strong basis for the prevention and intervention of aggression and accidents among Chinese e-bikers.

Post‐road traffic injury experiences and challenges faced by college students: A qualitative study in Madurai district, Tamil Nadu, India

AbstractRoad traffic injuries (RTIs) are a pressing public health concern in India, leading to a rise in injury‐related deaths, hospitalizations, and disabilities. India accounts for a significant portion of the world's fatal traffic accidents, with two‐wheelers being involved in the majority of these accidents. The impact of non‐fatal injuries on individuals extends beyond the bodily consequences of the injury and includes both the physical and psychological dimensions of the injury. The literature indicates the need for policy cascades and implementation framework for the prevention of road traffic injury. This study aimed to investigate the post‐RTI experiences and challenges faced by college students who experienced road traffic injury during their college life by using a qualitative research approach in Madurai district, Tamil Nadu, India. The study found that college students who experienced RTIs faced a wide range of physical, emotional, and social difficulties. The study highlights the need for a more comprehensive and holistic approach to RTI prevention that takes into account the complex interplay of individual, environmental, and societal factors that contribute to RTIs. The study also underscores the urgent need to improve the quality and availability of healthcare and rehabilitation services for RTI survivors.

Direct Fetal Head Injury after Maternal Motor Vehicle Crash

Direct Fetal Head Injury after Maternal Motor Vehicle Crash

Prehospital Care for Road Traffic Injury Victims

Abstract Introduction: Prehospital capabilities are inadequately developed to meet the growing needs for emergency care in most low- and middle-income countries. This study aims to describe the prehospital care received by the road traffic injury (RTI) victims presenting to a level I Trauma Care Center in Central Kerala, India. Methods: This was a hospital-based prospective observational study, which included consecutive victims of RTI attending the emergency department within 24-h of the event. A structured interview schedule was developed for collecting the data on various domains and the patients were followed up for their duration of hospital stay. Results: A total of 920 RTI victims, were included in this study. Two percent (17/920) of first responders had some sort of training in trauma care whereas the rest were untrained. The time taken to get any help at the scene after an RTI was 8 ± 12.9 min (95% confidence interval [CI] 7.16–8.84) and for first medical contact 25 ± 16 min (95% CI 24–26). No attempt at field stabilization occurred in any case. Three percent (26/920) had received some form of prehospital care, like arrest of hemorrhage using a compression bandage and splinting of the fractured limb with a wooden plank. None of the patients received supplemental oxygen, airway management, or cervical spine immobilization at the site of the accident or en route to the hospital. Conclusion: A lack of an organized prehospital care system results in minimal care before hospital admission. Urgent establishment of ambulance services and structured prehospital care tailored to our health-care system is imperative.