Motor Vehicle Occupants Research Articles

Machine learning-based injury severity prediction of level 1 trauma center enrolled patients associated with car-to-car crashes in Korea

Injury prediction models enables to improve trauma outcomes for motor vehicle occupants in accurate decision-making and early transport to appropriate trauma centers. This study aims to investigate the injury severity prediction (ISP) capability in machine-learning analytics based on five-different regional Level 1 trauma center enrolled patients in Korea. We study car crash-related injury data of 1417 patients enrolled in the Korea In-Depth Accident Study database from January 2011 to April 2021. Severe injury classification was defined using an Injury Severity Score of 15 or greater. A planar crash was considered by excluding rollovers to compromise an accurate prediction. Furthermore, dissimilarities of the collision partner component based on vehicle segmentation were assumed for crash incompatibility. To handle class-imbalanced clinical datasets, we used four data-sampling techniques (i.e., class-weighting, resampling, synthetic minority oversampling, and adaptive synthetic sampling). Machine-learning analytics based on logistic regression, extreme gradient boosting (XGBoost), and a multilayer perceptron model were used for the evaluations. Each model was executed using five-fold cross-validation to solve overfitting consistent with the hyperparameters tuned to improve model performance. The area under the receiver operating characteristic curve of 0.896. Additionally, the present ISP model showed an under-triage rate of 6.1%. The Delta-V, age, and Principal ~ were significant predictors. The results demonstrated that the data-balanced XGBoost model achieved a reliable performance on injury severity classification of emergency department patients. This finding considers ISP model selection, which affected prediction performance based on overall predictor variables.

Motor Vehicle Crash and Hospital Charges in Front- and Rear-Seated Restrained and Unrestrained Adult Motor Vehicle Occupants.

There are reports that historically higher mortality observed for front- compared to rear-seated adult motor vehicle (MV) occupants has narrowed. Vast improvements have been made in strengthening laws and restraint use in front-, but not rear-seated occupants suggesting there may be value in expanding the science on rear-seat safety. Methods. A linked 2016–2017 hospital and MV crash data set, the Crash Outcomes Data Evaluation System (CODES), was used to compare characteristics of front-seated (n = 115,939) and rear-seated (n = 5729) adults aged 18 years and older involved in a MV crash in New York State (NYS). A primary enforced seat belt law existed for front-seated, but not rear-seated occupants. Statistical analysis employed SAS 9.4. Results. Compared to front-seated occupants, those rear-seated were more likely to be unrestrained (21.2% vs. 4.3%, p < 0.0001) and to have more moderate-to-severe injury/death (11.9% vs. 11.3%, p < 0.0001). Compared to restrained rear-seated occupants, unrestrained rear-seated occupants had higher moderate-to-severe injury/death (21.5% vs. 7.5%, p < 0.0001) and 4-fold higher hospitalization. More than 95% of ejections were unrestrained and had 7-fold higher medical charges. Unrestrained occupants’ hospital stays were longer, charges and societal financial costs higher. Conclusions. These findings extend the science of rear-seat safety in seriously injured rear-seated occupants, document increased medical charges and support the need to educate consumers and policy makers on the health and financial risks of adults riding unrestrained in the rear seat. The lack of restraint use in adult rear-seated motor vehicle occupants consumes scarce health care dollars for treatment of this serious, but largely preventable injury.

The association between beverage-specific alcohol consumption and mortality among road users in Russia, 1965–2019

A vast body of literature suggests a relationship between alcohol consumption and road traffic fatalities. Despite an impressive downward trend in road traffic fatalities in Russia, the death rate is still unacceptably high. Far fewer studies have differentiated the association by road users and types of alcoholic beverages. This population-based study aims to estimate the associations of total and beverage-specific alcohol per capita (15+) consumption (APC) based on official alcohol sales statistics and road traffic mortality using police data on the number of deaths by road users. The study covers the period 1965–2019. We employed a first-order difference linear regression model with robust and autocorrelation consistent standard errors, controlling for a level of motorisation. To examine the possible evolution of the phenomenon, we repeated models separately for three consecutive periods (1965–1984, 1985–2002, 2003–2019). The findings suggest that an annual 1-litre increase in APC (in litres of pure alcohol) associated with a corresponding increase in the death rates (per 100,000 inhabitants) of both unprotected road users and motor vehicle occupants by about 0.3 (p < 0.01) and 0.4 (p < 0.05), respectively. A beverage-specific analysis for 1965–2019 revealed a positive and significant association between mortality of pedestrians and cyclists and the consumption of strong alcoholic beverages (p < 0.05) as well as mortality of drivers and passengers and the consumption of weaker alcoholic beverages, primarily beer (p < 0.01). Various road safety strategies should be applied to prevent road traffic fatalities of road users.

The safety of wheelchair occupants in motor vehicles

Ensuring the free movement of disabled people, including the use of vehicles, is a fundamental right. Therefore, efforts should be made to draw up standards regulating both organisational and technical aspects related to the construction and testing of wheelchairs. The main purpose of the paper is a review the literature related to wheelchair transport safety and the current standards for wheelchair crash testing Wheelchair users must securely and safely attach their wheelchair to the vehicle when travelling. The most common methods include securing with a four-belt system or using docking systems. Docking systems allow the disabled person to restrain the wheelchair themselves. Their main limitation is the lack of standardisation. Issues related to in-vehicle wheelchair design and testing are mainly described in international ISO standards and, in the US, in ANSI standards. Not all wheelchairs are crash tested. Before using wheelchairs, it should be checked if they can be mounted in a car. An important issue is education of wheelchair users and their carers on proper wheelchair securing. Even when wheelchairs are effectively secured, occupants in wheelchairs could be seriously and fatally injured because of improperly used and positioned belt restraints.

What is counted counts: An innovative linkage of police, hospital, and spatial data for transportation injury prevention

Introduction: Growing research indicates transportation injury surveillance using police collision reporting alone underrepresents injury to vulnerable groups, including pedestrians, cyclists, and people of color. This reflects differing reporting patterns and non-clinicians’ challenge in accurately evaluating injury severity. To our knowledge, San Francisco is the first U.S. city to link and map hospital and police injury data. Analysis of linked data injury patterns informs interventions supporting traffic fatality and injury prevention goals. Methods: Injury and fatality records 2013–2015 were collected from San Francisco Police, Emergency Medical Services (EMS), Medical Examiner, and Zuckerberg San Francisco General Hospital (ZSFG). Probabilistic linkage was conducted using LinkSolv9.0 on match variables collision/admission time, name, birthdate, sex, travel mode, and geographic collision location. Results: From 2013-2015, this study identified 17,000+ transportation-related injuries on public roadways in San Francisco. Twenty-six percent (n = 4,415) appeared in both police and ZSFG sources. Linked injury records represent 39% of police records (N = 11,403) and 43% of hospital records (N = 10,223). Among hospital records, 34% of cyclist, 38% of motor vehicle occupant, 61% of pedestrian, and 54% of motorcyclist records linked with a police record. Linkage rate varied by travel mode even after controlling for injury severity. Transportation-injured ZSFG-treated patients lacking police reports were more often cyclists, male, Hispanic or Black, and less often occupants of motor vehicles compared to those with injuries captured only in police reports. Conclusions: Incorporating hospital and EMS spatial data into injury surveillance systems historically reliant on police reports offers trifold benefits. First, linkage captures injuries absent in police data, adding data on populations empirically vulnerable to injury. Second, it improves injury severity assessment. Finally, linked data better informs and targets interventions serving injury-burdened populations and road users, advancing transportation injury prevention. Practical applications: Linkage closes data gaps, improving ability to quantify injury and develop evidence-based interventions for vulnerable groups.

Validating the danger of vehicular protective devices and bowel injury

IntroductionProtective devices such as seat belts and airbags have improved the safety of motor vehicle occupants, but limited data suggest they may be associated with increased blunt bowel (small bowel or colon) injuries (BI). Unfortunately, this risk is unquantified. MethodsWe analyzed the National Trauma Data Bank (2017-2019) using ICD-10 codes to identify adult motor vehicle occupants with BI who underwent surgical repair. We used logistic regression modeling to compare the risk of undergoing surgical repair for BI after using a protective device. ResultsOf 2,848,592 injured patients, 475,546 (16.7%) were motor vehicle occupants. Only 1.2% (n = 5627/475,546) of patients underwent a bowel repair or resection. Using a seat belt only was associated with an adjusted OR of 2.09 (95% CI 1.91, 2.28) for undergoing a bowel repair/resection when adjusting for Injury Severity Score (ISS) and age. Airbag deployment without a seat belt had an adjusted OR of 1.46 (95% CI 1.31, 1.62), while both devices combined conferred an OR of 3.27 (95% CI 3.02, 3.54). However, using a seat belt was protective against death with an OR of 0.50 (95% CI 0.48, 0.53), adjusted for age, sex, Charlson Comorbidity Score, and ISS. ConclusionSeat belts and airbags are essential public health safety interventions and protect against death in motor vehicle-associated injuries. However, patients involved in MVCs with airbag deployment or while wearing a seat belt are at an increased risk of bowel injury requiring surgery compared to unrestrained patients, despite these events being relatively uncommon.

The burden of road traffic accident-related trauma to orthopaedic healthcare and resource utilisation at a South African tertiary hospital: a cost analysis study

BACKGROUND: Road traffic accidents (RTAs), the second commonest cause of trauma in South Africa (SA), are on the rise. It is therefore important to study and understand the burden of RTA-related injuries on our orthopaedic healthcare and healthcare in general, in order to devise new prevention strategies to minimise the number of RTAs METHODS: A retrospective analysis of data from orthopaedic trauma intake records was done for patients admitted with RTA-related injuries to the orthopaedic department at a South African tertiary hospital between February 2019 and January 2020. Hospital records and the PAC (picture archiving and communication) system were analysed for radiological studies done. The Uniform Patient Fee Schedule (UPFS) was analysed for individual costing of all variables being studied RESULTS: There were 642 patients seen and managed with RTA-related injuries included in this study. Seventy-one per cent of them were males, with an average age of 35 years. The majority (76.2%) were motor vehicle occupants, whereas 17% were pedestrians. Seventeen per cent of them had polytrauma. Four hundred and sixty-two (76%) patients required some form of surgical intervention and spent an average of 171 minutes in theatre per procedure. Ten per cent of these patients required ICU/HCU admission for an average of 13 days. The total length of hospital stay was an average of 21.8 days. The majority of patients (67%) had some form of orthopaedic implant inserted, with an average of 1.3 implants per patient. The average cost per patient was R92 737.39. The major cost drivers were hospital stay, ICU/HCU stay, implant cost, radiological studies and theatre utilisation, respectively CONCLUSION: Management of RTA-related trauma puts a significant burden on orthopaedic healthcare management and resource utilisation. While we may not be able to directly influence other contributing factors to high costs, reducing the use of temporary external fixators may help reduce the cost of managing RTA victims These findings provide scientific data which will help support the implementation of preventative measures aimed at minimising the numbers of RTAs we see on our roads, thereby minimising the burden this puts on our healthcare system. Level of evidence: Level 3

Epidemiological Study of Road Traffic Accidents in Japan during 2010-2019

The study aimed to determine epidemiological characteristics of road traffic accidents in Japan during the year 2010-2019. A cross-sectional descriptive study depended on a retrospective analysis of road traffic accident data that were obtained from the National Police Agency (NPA) for the years 2010 – 2019 in Japan. The relationship of road traffic accident consequences as dependent variables with age, road user type, helmet, and seatbelt use as independent variables during the studied years was analyzed with Chi-square test. The case fatality rate has been declining every year from 3.88 in 2010 to 2.54 per 100,000 persons. More than half of fatality cases have occurred among the elderly. There was a statistically significant relationship between road user type and accident severities. 36.21% fatality occurred in pedestrians. Otherwise, 27.61% of motor vehicle occupants were dominant in serious injury cases and 66.87% in slight injury cases. Most of the casualties revealed for fatality cases were in the head, whereas the leg part was dominant in serious injury cases and the neck region was raised in slight injuries. There was a significant relationship between the use of helmets and seat belt use with casualties of road traffic accidents. There was a declined trend of road traffic accidents in Japan during 10 years of study. The result of the epidemiological study could be a valid consideration for the design of road safety policy in the future.

Comparison of physical and psychological health outcomes for motorcyclists and other road users after land transport crashes: an inception cohort study

BackgroundSerious injuries and fatalities among vulnerable road users on two wheeled motorised vehicles have increased across Australia and internationally in the past decade yet fallen for motor vehicle occupants. Almost half of all reported motorcycle injury crashes cause serious injury or death, nearly double that of motor vehicle police-reported crashes. This study explores associations with sociodemographic and pre-injury health characteristics and health outcomes after a road traffic injury; aiming to compare motorcyclists with other road users and inform recovery care.MethodsAn inception cohort study recruited 1854 individuals aged > 17 years, injured following land-transport crashes in New South Wales, Australia (July 2013–November 2016). Interviews conducted at baseline, 6-and 12-months post-injury elicited demographic, socioeconomic, and self-reported health conditions.ResultsPrimary analysis involved 1854 participants who were recruited at baseline as three distinct road user groups; 628 (33.9%) motorcyclists, 927 (50%) vehicle occupants and 299 (16.1%) bicyclists. At baseline, injury patterns differed significantly between road user groups; motorcyclists were more than twice as likely to sustain lower extremity injury (p < 0.001); to have more severe injury severity scores (p < 0.001) and longer hospital stays versus vs vehicle occupants and bicyclists (< 0.001) across these measures. Injured motorcyclists were predominantly male (88.1%, p < 0.001), were younger on average (38 years) than bicyclists (41.5 years), had lower income and education levels, and poorer pre-injury physical health than other road user groups. Despite these differences, at 12 months post-injury motorcyclists had better physical health (SF12-PCS 2.07 (0.77, 3.36), p = 0.002) and reported lower pain scores (− 0.51 (− 0.83, − 0.2), p < 0.001) than vehicle occupants. Motorcyclists displayed less evidence of psychological distress than vehicle occupants, but more than bicyclists across several measures used.ConclusionsRoad user types differ in important characteristics, including pre-injury health status and recovery after injury. As vulnerable road users experiencing transport crash and considering their higher initial injury severity, the degree of recovery among motorcyclists compared with other user types is remarkable and unexplained. Health and recovery outcomes after land-transport crashes is least favourable among vehicle occupants despite their higher levels of protection in a crash. This information is valuable for targeting early intervention strategies by road user type during the post-crash care phase, to improve long-term recovery.

Pedestrian mortality in Russia: a continuous decline over the last 25 years?

Using different data sources (HCoD, IRTAD, UNECE statistical database, police data), our research shows that the significant excess of pedestrian mortality over motor vehicle occupant mortality in 1988-1999 in Russia, according to RusFMD, is an abnormal phenomenon that most likely never occurred. Police data is preferable for assessing mortality levels by road user types in Russia. According to Russian police data, pedestrian mortality never exceeded motor vehicle occupant mortality. The steady decline of pedestrian mortality began in 2003, not in 1993, as vital statistics show. In 2008, pedestrian mortality for the first time reached the minimum level of the Soviet period. After significant fluctuations, motor vehicle occupant mortality dropped to the level of the early 1970s only in 2015-2017. The use of vital statistics is possible if it is necessary to differentiate road traffic mortality by sex, age, and type of settlements. Categorisation by road user types should be done with caution, using the following data sources: HCoD data from 1988 and RusFMD data from 1970 to 1988 and after 1999. It is suggested that difficulties in analysing long-term mortality by road user types based on vital statistics may occur in post-Soviet countries, where the Soviet abridged classification of causes of death (SC) was used. The prevalence of deaths coded by unspecified V-codes (V89) should also be considered.

Development and validation of a risk-adjustment model for mortality and hospital length of stay for trauma patients: a prospective registry-based study in Australia

ObjectivesAdequate risk adjustment for factors beyond the control of the healthcare system contributes to the process of transparent and equitable benchmarking of trauma outcomes. Current risk adjustment models are not...

Keeping Safe on Australian Roads: Overview of Key Determinants of Risky Driving, Passenger Injury, and Fatalities for Indigenous Populations.

Social and cultural barriers associated with inequitable access to driver licensing and associated road safety education, as well as socioeconomic issues that preclude ongoing vehicle maintenance and registration, result in unsafe in-car behaviours such as passenger overcrowding. This in turn is associated with improper seatbelt usage, noncompliance with child restraint mandates, and driver distraction. For example, in Australia, where seatbelt use is mandatory, Indigenous road users are three times less likely to wear seatbelts than non-Indigenous road users. This is associated with a disproportionately high fatality rate for Indigenous drivers and passengers; 21% of Indigenous motor-vehicle occupants killed on Australian roads were not wearing a seatbelt at the time of impact. In addition, inequitable access to driver licensing instruction due to financial and cultural barriers results in Indigenous learner drivers having limited access to qualified mentors and instructors. A consequent lack of road safety instruction results in a normalising of risky driving behaviours, perpetuated through successive generations of drivers. Moreover, culturally biased driver instruction manuals, which are contextualised within an English written-language learning framework, fail to accommodate the learning needs of Indigenous peoples who may encounter difficulties with English literacy. This results in difficulty understanding the fundamental road rules, which in turn makes it difficult for young drivers to develop and sustain safe in-car behaviours. This paper considers the literature regarding road safety for Indigenous road users and critically evaluates strategies and policies that have been advanced to protect Indigenous drivers. Novel solutions to increasing road safety rule compliance are proposed, particularly in relation to passenger safety, which are uniquely embedded within Indigenous ways of knowing, being, and doing. Safe driving practices have crucial health and social implications for Indigenous communities by allowing more Indigenous people to participate in work and education opportunities, access healthcare, maintain cultural commitments, and engage with families and friends, qualities which are essential for ongoing health and wellbeing.

Differences in rural and urban drivers’ attitudes and beliefs about seat belts

In the United States, a disproportionate number of motor vehicle crash fatalities occur in rural areas. While many factors likely contribute to the discrepancy between fatality rates in rural and urban areas, prior studies suggest that rural drivers may be more likely to engage in risky driving behaviors like seat belt non-use. Although having favorable attitudes or beliefs about seat belts increases the likelihood of wearing them, few studies have investigated the possibility that lower rates of seat belt use in rural areas may result from a greater prevalence of unfavorable seat belt attitudes and beliefs—one part of a distinct rural “traffic safety culture.” In the current study, we analyzed responses from the 2016 Motor Vehicle Occupant Safety Survey (MVOSS) to test the hypotheses that rural drivers are more likely than urban drivers to hold unfavorable attitudes and beliefs about seat belts, and that these unfavorable attitudes and beliefs predict lower self-reported seat belt use. We found that rural and urban drivers differed significantly on several seat belt attitudes and beliefs and that these differences persisted after controlling for possible demographic differences between rural and urban drivers. We also found that drivers who hold less favorable attitudes and beliefs were less likely to always wear their seat belts. However, even after accounting for demographic factors and differences in attitudes and beliefs, rural drivers continued to be less likely to report full-time seat belt use than urban drivers. Our findings suggest that rural drivers should be treated as a distinct market segment for seat belt messaging and public awareness campaigns, and that interventions designed to change the unfavorable attitudes and beliefs about seat belts held by rural drivers may help reduce the disparity between rural and urban traffic fatality rates.

Road traffic injury mortality and morbidity by country development status, 2011-2017

PurposeThis research examined road traffic injury mortality and morbidity disparities across of country development status, and discussed the possibility of reducing country disparities by various actions to accelerate the pace of achieving Sustainable Development Goals target 3.6 – to halve the number of global deaths and injuries from road traffic accidents by 2020. MethodsData for road traffic mortality, morbidity, and socio-demographic index (SDI) were extracted by country from the estimates of the Global Burden of Disease study, and the implementation of the three types of national actions (legislation, prioritized vehicle safety standards, and trauma-related post-crash care service) were extracted from the Global Status Report on Road Safety by World Health Organization. We fitted joinpoint regression analysis to identify and quantify the significant rate changes from 2011 to 2017. ResultsAge-adjusted road traffic mortality decreased substantially for all the five SDI categories from 2011 to 2017 (by 7.52%–16.08%). Age-adjusted road traffic mortality decreased significantly as SDI increased in the study time period, while age-adjusted morbidity generally increased as SDI increased. Subgroup analysis by road user yielded similar results, but with two major differences during the study period of 2011 to 2017: (1) pedestrians in the high SDI countries experienced the lowest mortality (1.68–1.90 per 100,000 population) and morbidity (110.45–112.72 per 100,000 population for incidence and 487.48–491.24 per 100,000 population for prevalence), and (2) motor vehicle occupants in the high SDI countries had the lowest mortality (4.07–4.50 per 100,000 population) but the highest morbidity (428.74–467.78 per 100,000 population for incidence and 1025.70–1116.60 per 100,000 population for prevalence). Implementation of the three types of national actions remained nearly unchanged in all five SDI categories from 2011 to 2017 and was consistently stronger in the higher SDI countries than in the lower SDI countries. Lower income nations comprise the heaviest burden of global road traffic injuries and deaths. ConclusionGlobal road traffic deaths would decrease substantially if the large mortality disparities across country development status were reduced through full implementation of proven national actions including legislation and law enforcement, prioritized vehicle safety standards and trauma-related post-crash care services.

Utilizing Frequency and Severity of Injury to Identify Injury Prevention Priorities in the Community.

Trauma centers are charged with identifying injury prevention priorities in the community. Hospitals frequently use system and regional injury data based on frequency of injury mechanisms to establish injury prevention priorities. This study was conducted to provide insight into how the Injury Prevention Priority Score (IPPS) can be utilized to prioritize injury prevention activities with considerations of both frequency and severity of injury. This descriptive study utilizes a retrospective review of 6,824 patients 15 years and older at one Level I trauma center between July 1, 2014, and June 30, 2019. A previously described and validated IPPS was calculated for injury mechanisms to compare the overall trauma burden for each cause. The IPPS is presented as a T-score with a mean of 50 and a standard deviation of 10. In this sample, most injuries (57.1%) occur to those 65 years or older, and the most common injuries are from a fall (66.5%) or were from a motor vehicle occupant (13.3%). The fall group had an average severity of injury, but the frequency was five times higher than the next highest group. The pedestrian and firearm groups had the highest severity, and their IPPSs were the second and third highest. Injury priorities should not be based on frequency of injury alone. Use of the IPPS provides additional objective data regarding injury prevention priorities in the community. The IPPS has most commonly been used to evaluate pediatric injury prevention needs but effectively evaluates injury prevention needs throughout the lifespan.

Epidemiology of Fatal Road Traffic Accidents: A Six Year Retrospective Study in the Medico legal Centre of a Tertiary Care Health Set Up in Western Maharashtra

Road Traffic Accident (RTA) is a public health concern globally. Rapid urbanisation and increase in thenumber of motor vehicles, lack of discipline and violation of traffic regulations has led to a rapid rise inthe deaths in vulnerable road users. A retrospective study was undertaken in the autopsy centre of a tertiarycare hospital to observe the pattern and trends of deaths between 2013-2018 due to RTAs. Out of 248 RTAcases analysed in this study, 75.4% were male and 24.6% were female. The most vulnerable age group was21-40 years in both two-wheeler and four-wheeler accidents while in pedestrians it was 41-50 years. Highrate of accidents was seen during summer in afternoon in cases of pedestrians as well as motor vehicleoccupants and in the evening after 6 PM in two-wheeler motorcyclists. Observation of the pattern of headinjuries showed fracture of the skull was a common occurrence in two and four-wheeler accidents whereasa greater number of pedestrians reported no skull fracture. Non helmet users suffered higher mortality in theage group of 21-30 years. Subdural haemorrhage caused maximum deaths in two-wheeler motorcyclists andpedestrians while sub arachnoid haemorrhage was seen in four-wheeler accidents. Our study agreed with theWHO report of 2018 and various other studies from India and abroad. Increased number of fatalities wasfound to occur at a particular time of the day with seasonal preference. Two-wheeler motorcyclists withouta helmet suffered maximum deaths. Real time analysis of data in various parts of the country would help inensuring safe road user practices.

Severe traffic injuries in the Helsinki Trauma Registry between 2009–2018

ObjectiveThe European Union (EU) has adopted the Vision Zero and Safe System approach to eliminate deaths and serious traffic injuries on European roads by 2050. Detailed information on serious injuries, injury mechanisms and consequences are needed. The aim of this study was to describe and compare by injury mechanism the demographics, injuries, injury severity, and treatment of seriously injured road traffic trauma patients. Material and methodsWe analysed data on severe traffic injury trauma patients aged ≥16 years of the Helsinki Trauma Registry (HTR) covering the years 2009−2018. The variables analysed were basic patient demographics, injury mechanism, Abbreviated Injury Scale (AIS) codes, injured body regions, patient Injury Severity Score (ISS) and New Injury Severity Score (NISS) values, NISS groups (NISS 16−24 and NISS ≥25), AIS 3+ injuries, trauma bay and 30-day mortality, length of stay (LOS) at ICU and in hospital, surgeries performed, pre-injury classification, and intention of injury. ResultsA total of 1 063 traffic injury patients were analysed; 38.6% were motor vehicle occupants, 28.5% motorcyclists or moped drivers, 17.2% bicyclists, and 15.7% pedestrians. The mean age of patients was 44.3 years (SD 20.2). Median ISS score was 22 and median NISS score was 27. Both scores were highest in pedestrians. Among all patients, total hospital LOS was 12 517 days (median 9) and total ICU LOS was 6 311 days (median 5). The most common AIS 3+ injuries according to ISS body regions were chest injuries (60%) and head or neck injuries (43.7%). Chest injuries occurred more frequently in motorcyclists and motor vehicle occupants, whereas head or neck injuries were most common among bicyclists and pedestrians. ConclusionsSeverely injured pedestrians and bicyclists were older and they had higher mortality than motorcyclists and motor vehicle occupants. According to NISS, the overall severity was highest among pedestrians followed by bicyclists. However, the both median ICU LOS and hospital LOS were highest for pedestrians but lowest for bicyclists. The most common AIS 3+ injuries were chest and head or neck injuries. To specify effective injury prevention measures, hospital data should be complemented with information on the circumstances of the accident.

Modeling severities of motorcycle crashes using random parameters

One of the critical areas of road safety is motorcycle safety. Motorcyclists are more vulnerable to injuries than occupants of other motor vehicles when involved in crashes. Researchers have studied the relationships between motorcycle crash severity and crash contributing factors. They are crash characteristics, roadway geometric design features, traffic characteristics, socio-demographics and environmental conditions. However, few researchers considered unobserved heterogeneity effects when modeling motorcycle crash injury severities, let alone interaction effects. In this research, motorcycle crashes in Wyoming that occurred from 2008 to 2017 were analyzed. Specifically, the injury severities of single motorcycle crashes and multiple vehicle crashes involving motorcycles were modeled. The response was whether the motorcycle crash incurred an incapacitating injury or fatality or not. The binary logistic regression and mixed binary logistic regression modeling structures were implemented. The mixed models revealed effects that otherwise would have been undisclosed in the binary logistic regression models’ results. According to the results of single motorcycle crashes, the majority of motorcycle-animal crashes and of motorcycle-barrier crashes were likely to be severe relative to other single motorcycle crashes. It was also found that horizontal curves increased the risk of severe injuries. Young riders were found to be less at risk of being gravely injured in single motorcycle crashes than older riders as well. Furthermore, riding under the influence and high posted speed limits increased the odds of severe crashes regardless of whether the crashes were single motorcycle crashes or multiple vehicle crashes involving motorcycles. Additionally, the mixed models uncovered interaction effects and unobserved effects pertaining to speed limits. • Severities of motorcycle crashes in Wyoming were modeled using logistic regression. • Random parameters were incorporated in the modeling. • Latent effects were inferred regarding crash types and roadway factors. • Recommendations were made to reduce motorcycle crash severity.

Motor Vehicle Crash Characteristics That Are Predictive of High Acuity Patients: An Analysis of Linked Ambulance and Crash Data

Background Motor vehicle crashes (MVCs) comprise a significant component of emergency medical service workload. Due to the potential for life-threatening injuries, ambulances are often dispatched at the highest priority to MVCs. However, previous research has shown that only a small proportion of high-priority ambulance responses to MVCs encounter high acuity patients. Alternative methods for triaging patients over the phone are required to reduce the burden of over-triage. One method is to use information readily available at the scene (e.g. whether a person was a motorcyclist, ejection status or whether an airbag deployed) as potential predictors of high acuity. Methods: A retrospective cohort study was conducted of all MVC patients in Perth attended by St John Western Australia between 2014 and 2016. Ambulance data was linked with Police crash data. The outcome variable of interest was patient acuity, where high acuity was defined as where a patient (1) died on-scene or (2) was transported by ambulance on priority one (lights & sirens) from the scene to hospital. Crash characteristics that are predictive of high acuity patients were identified by estimating crude odds ratios and 95% confidence intervals. Results: Of the 18,917 MVC patients attended by SJ-WA paramedics, 6.4% were classified as high acuity patients. The odds of being a high acuity patient was greater for vulnerable road users (motorcyclists, pedestrians and cyclists) than for motor vehicle occupants (OR 3.19, 95% CI, 2.80–3.64). A ‘not ambulant patient’ (one identified by paramedics as unable to walk or having an injury incompatible with being able to walk) had 15 times the odds of being high acuity than ambulant patients (OR 15.34, 95% CI, 11.48–20.49). Those who were trapped in a vehicle compared to those not trapped (OR 4.68, 95% CI, 3.95–5.54); and those who were ejected (both partial and full) from the vehicle compared to those not ejected (OR 6.49, 95% CI, 4.62–9.12) had higher odds of being high acuity patients. Discussion: There were two important findings from this study: (1) few MVC patients were deemed to be high acuity; and (2) several crash scene characteristics were strong predictors of high acuity patients.

Comparison of the epidemiology and injury profile among injured patients involved in special purpose vehicle-related incidents in South Korea

Injuries caused by mobile machinery or special purpose vehicles (SPVs) can lead to high socio-medical cost and fatality. In this descriptive study, we compared the epidemiology and injury profile of injured patients involved in SPVs-related incidents. We analyzed a nationwide database of SPV-related injured patients between January 2011 and December 2016. Injured patients were classified into three groups: pedestrian, motor vehicle occupant (MVO), and SPV operator groups. Of 1,419 cases, the highest number of SPV-related injured patients were found in the age group 40–59 years (671 cases, 47.3%) and at transport area (771 cases, 54.3%). The injury was most severe in the SPV operator group. The lower extremities were the most common fracture site, and intrathoracic injury was the most common visceral regions for SPV-related injured patients. SPV operator could lead to fatal intrathoracic injuries.