Motor Vehicle Passengers Research Articles

Research on the Liability Identification of "Open Door Killing" Traffic Accidents

In legal practice, there is a great dispute about the liability identification of the "open door killing" accident. Often, the division of responsibility involves multiple parties, including the driver of the motor vehicle, the passenger of the vehicle, and possibly third parties. Therefore, this paper aims to propose a more reasonable liability division and compensation scheme through the analysis of the existing theories. First of all, this paper discusses three legal theories: subjective co-theory, objective co-theory and compromise theory. The subjective joint theory holds that the accident liability should be distributed according to the subjective faults of each party. The objective common theory focuses on the objective behavior and result of the parties in the accident. The compromise theory tries to find a balance between the first two, taking into account both subjective negligence and objective results. Combining these three theories, this paper proposes that in the "open-door killing" accident, the main body of responsibility should include motor vehicle driver and passenger. The driver of a motor vehicle should be responsible for ensuring safety after stopping, while the passenger should ensure that there is no traffic or pedestrians before driving. In addition, this paper also puts forward the shared responsibility of the duty of care, and believes that drivers and passengers should pay attention to the surrounding traffic environment to prevent possible accidents. Finally, this paper discusses the problem of identifying the accident in the accident. In determining whether an accident is an accident, consideration should be given to the degree of control over the accident by the parties. If both the driver and the passenger had sufficient ability to anticipate and prevent an accident, then the accident should not be considered an accident. Through the above analysis, this paper aims to provide a more comprehensive and fair perspective to guide the identification of liability and liability for compensation in practice. It is hoped that through this way, the traffic accidents caused by passengers' driving doors can be fundamentally reduced and the overall safety of road traffic can be improved.

Proposal for nationwide registration of injuries or fatalities in wheelchair user motor vehicle passengers in Japan.

One consequence of population aging is an increase in the number of older wheelchair users. They often board the motor vehicle from the rear for moving. Recently, wheelchair user vehicle passengers have involved in motor vehicle collisions and died. A three-point seatbelt does not adequately fit most wheelchair user passengers because of the way that the wheelchair is constructed. Therefore, owing to the movement of the body immediately after the collision, the wheelchair user passengers attacked their body to the interior of the vehicle or suffered from the intrusion of the lap belt into the abdomen, subsequently suffered from severe head, chest or abdominal injuries. According to the review of all fatal motor vehicle collisions in Shiga Prefecture, Japan, which has a population of approximately 1.4 million, from 2017 to 2022, the rate of wheelchair users in fatal motor vehicle passenger increased from 3.6% in 2017 to 2019 to 7.8% in 2020 to 2022. Therefore, there is a risk that substantial numbers of wheelchair user passengers involved in motor vehicle collisions will die. However, in Japan, there are no official statistics on the involvement of wheelchair user passengers in motor vehicle collisions. Therefore, we propose a nationwide registration of injuries and fatalities in wheelchair user passengers. Investigating the mechanisms of injury in wheelchair user passengers would contribute to the development of safety measures, especially for restraint systems. Established preventive measure would contribute to the decrease of fatally or severely injured motor vehicle collision passengers.

Predictive Factors of the Fatality of Motor Vehicle Passengers Involved in Far-Side Lateral Collisions: A National Crash Database Study.

Although the risks faced by passengers in near-side lateral collisions are understood, and despite the presence of side airbags for injury prevention, passengers involved in far-side lateral collisions also suffer serious and fatal injuries. The objective of this study was to determine the independent predictive factors of fatality of motor vehicle passengers involved in far-side lateral collisions. Using 2010 records from the National Automotive Sampling System/Crashworthiness Data System (NASS/CDS), we selected 86 fatal and 325 non-fatal passengers with an Abbreviated Injury Scale (AIS) score of 2 or more. The background and injury severity of the passengers and collision characteristics were compared between the two groups. In a multivariable logistic regression analysis, variables independently associated with fatalities were female sex (Ref, male) (odds ratio [OR], 0.396), age (OR, 1.029), body mass index (OR, 1.057), total delta-V (OR, 1.031), head AIS score (OR, 1.679), chest AIS score (OR, 1.330), and abdomen AIS score (OR, 1.294). This is the first report to determine factors affecting fatality in passengers involved in far-side lateral collisions. Improving the safety of the vehicle interior, such as by including additional seatbelt systems or a side airbag that deploys between seats, might help to avoid fatalities, and reduce injury severity.

Increased CT Use and No Change in Injury Severity among Child Motor Vehicle Victims: A National Trauma Database Study in Japan.

The number of fatalities associated with traffic accidents has been declining owing to improvements in vehicle safety performance and changes in the law. However, injuries in children can lead to social and economic losses. We examined 10-year changes in the characteristics of traffic trauma among pediatric motor vehicle passengers by analyzing data from the Japan Trauma Data Bank (JTDB). Among the 36,715 injured motor vehicle passengers under the age of 15 years who were registered in the JTDB from 2004 to 2019, we compared the groups injured during 2004-2007 (n = 94) and 2017-2019 (n = 203). Physiologically, the 2004-2007 group had a lower body temperature and Glasgow Coma Scale score as well as a higher mortality. Anatomical severity was higher in the 2004-2007 group for the head, face, and neck, according to the Abbreviated Injury Scale. In terms of treatment, only craniotomy as a primary surgery was significantly lower in the 2017-2019 group. The 2017-2019 group had significantly higher rates of receiving whole-body computed tomography (CT). Because the rate of performing CT has increased, with no changes in the injury severities of the trunk and extremities, limiting the number of CT examinations is suggested for pediatric motor vehicle passengers involved in road traffic collisions. The severity of trunk and extremity injuries has not improved in more than 10 years; further preventive measures for these injuries should be considered.

Profile of Road Traffic Accident Cases Attending in Combined Military Hospital Ramu, Cox’s Bazar

Background: A Road Traffic Accident (RTA) is any injury due to crashes originating from, terminating with or involving a vehicle partially or fully on a public road. It is one of the leading causes of global disease burden. Road traffic accidents, injuries and fatalities are causing great concern to the community in Bangladesh. To find out the characteristics of road traffic accident cases attending in Combined Military Hospital Ramu, this research work was planned.
 Materials and methods: This descriptive cross-sectional study was conducted at Combined Military Hospital Ramu.All the road traffic accident victims attending at Medical Inspection room (MI Room) of CMH Ramu from April 2019 to September 2019 irrespective of age and sex . All the victims entered in the ‘special event statement register’. There were 119 Road Traffic Accident victims enlisted and selected by purposive type of sampling technique.
 Results: Mean age of the respondents was 28.77 ± 5.14 years. Out of 119 respondents, majority (26.9%) were in the age group of 31-40 years. Among the victims, 99.2% were motorized accident. Majority (33.6%) were due to Bus or Minibus accident, 43.8% victims were motor vehicle passenger. The highest 49.6% victims were passenger, followed by 31.9% were pedestrian. Regarding pattern of injury, majority 39.5% victims sustained Laceration and Cut injury. Majority of the accident (50.9%) happened in the main road, 33.6% happened during Noon (1000-1400 hrs) time, followed by 27.7% at afternoon (1400-1800 hrs) time.
 Conclusion: Among the victims, most of them were male and majority of them were within the active age group. Most of accidents by motorized vehicles by Bus or minibus. Pedestrians and motor vehicle passengers were most vulnerable. Cut injury and Laceration were the most common type of injury. Main roads were the commonest site and accident occurred more during the day.
 IAHS Medical Journal Vol 4(2), December 2021; 12-16

Child Restraint Use and Seating Position of Child Passengers in Motor Vehicles and Their Correlations: Application of a Random-Effects Bivariate Probit Model

Motor vehicle crashes are a leading cause of death and injury for children aged under 8 years. In the U.S.A., while some states are showing increases in the proportion of child restraint device use, only around half of child passengers aged from 4 to 7 years are being properly restrained. This study was undertaken to identify the factors contributing to the proper child restraint use and child passenger’s seating position through the direct observation surveys of more than 10,000 child passengers in 2015 and 2018 in Michigan. A bivariate probit model with random effects was developed to identify simultaneously the contributing factors for the proper restraint use and seating position of child passengers, accounting for the unobserved heterogeneity in the data. The bivariate framework is able to account for the correlation of the two dependent variables in the study. The results show that the two dependent variables are positively correlated, and this correlation is strongly significant. The key factors simultaneously influencing proper child restraint use and appropriate seating position of the child passenger include the age of the child, the number of child passengers in the vehicle, driver belt use, driver gender, age, and race, vehicle type, stratum, weather, and the time of the day and week. However, factors such as county-specific population, income, and education, and the type of location did not have any significant association with either child restraint use or the seating position of the child passenger.

Prevention of severe injuries of child passengers in motor vehicle accidents: is re-boarding sufficient?

PurposeThe purpose of this study was to evaluate whether prolonged re-boarding of restraint children in motor vehicle accidents is sufficient to prevent severe injury.MethodsData acquisition was performed using the Trauma Register DGU® (TR-DGU) in the time period from 2010 to 2019 of seriously injured children (AIS 2 +) aged 0–5 years as motor vehicle passengers (MVP). Primarily treated and transferred patients where included.ResultsThe study group included 727 of 2030 (35.8%) children, who were severely injured (AIS 2 +) in road traffic accidents, among them 268 (13.2%) as MVPs in the age groups: 0–1 years (42.5%), 2–3 years (26.1%) and 4–5 years (31.3%). The pattern of severe injury was head/brain (56.0%), thoracic (42.2%), abdominal (13.1%), fractures (extremities and pelvis, 52.6%) and spine/severe whiplash (19.8%). The 0–1-year-old MVPs showed the significantly highest proportion of brain injuries with Glasgow Coma Score (GCS) < 8 and severe injury to the spine. The 2–3-year-olds showed the significantly highest proportion of fractures especially the lower extremity and highest proportion of cervical spine injuries of all spine injuries, while the 4–5-year-olds, the significantly highest proportion of abdominal injury and second highest proportion of cervical spine injury of all spine injuries. MVPs of the 0–1-year-old and 2–3-year-old groups showed a higher median Injury Severity Score (ISS) of 21.5 and 22.1 points than the older children (17.0 points). They also suffered an AIS-6-injury significantly more often (9 of 21) of spine (p = 0.001). Especially the cervical spine was significantly more often involved. Passengers at the age of 0–1 years were treated with cardiopulmonary resuscitation (CPR) three times as often as older children in the prehospital setting and twice as often at admission in the Trauma Resuscitation Unit (TRU). Their survival rate was 7 out of 8 (0–1 years), 1 out of 6 (2–3 years) and 1 out of 4 (4–5 years).ConclusionAlthough the younger MVPs are restraint in a re-boarding position, severe injury to the spine and head occurred more often, while older children as front-faced positioned MVPs suffered from significantly higher rates of abdominal and more often severe facial injury. Our data show, that it is more important to properly restrain children in their adequate car seats (i-size-Norm) and additionally consider the age-related physiological and anatomical specific risks of injury as well as co-factors in road traffic accidents, than only prolonging the re-boarding position over the age of 15 months as a single method.

Factors Affecting Death and Severe Injury in Child Motor Vehicle Passengers.

Saving children from motor vehicle collisions is a high priority because the injury rate among motor vehicle passengers has been increasing in Japan. This study aimed to examine the factors that influence death and serious injury in child motor vehicle passengers to establish effective preventive measures. To identify these factors, we performed a retrospective study using a nationwide medical database. The data of child motor vehicle passengers younger than 15 years (n = 1084) were obtained from the Japanese Trauma Data Bank, registered from 2004 to 2019. Physiological variables, outcomes, and injury severity were compared between fatal and non-fatal patients and between those with and without severe injuries. Multivariate logistic regression analysis was performed to determine factors affecting fatality and severe injury. The Glasgow Coma Scale score (odds ratio (OR): 1.964), body temperature (OR: 2.578), and the Abbreviated Injury Scale score of the head (OR: 0.287) were identified as independent predictors of a non-fatal outcome. Systolic blood pressure (OR: 1.012), the Glasgow Coma Scale score (OR: 0.705), and Focused Assessment with Sonography for Trauma positivity (OR: 3.236) were identified as independent predictors of having severe injury. Decreasing the severity of head injury is the highest priority for child motor vehicle passengers to prevent fatality and severe injury.

Characteristics of Road Traffic Accident Cases Reported in a Tertiary Military Hospital

Introduction: Road traffic accidents (RTA) are the eighth leading cause of death globally, and the leading cause of death in Bangladesh. The road safety situation in Bangladesh has been deteriorating with increasing number of road accident deaths, largely as direct consequences of rapid growth in population, motorization, urbanization and lack of investment in road safety.&#x0D; Objectives: To describe the injury characteristics of road traffic accidents cases that reported at Combined Military Hospital (CMH), Dhaka.&#x0D; Materials and Methods: This descriptive cross-sectional hospital based study was conducted on all the RTA cases reported to medical inspection room CMH, Dhaka from 01 March to 30 June 2010. A total of 126 RTA victims irrespective of age and sex were included, data were collected by face to face interview using a pre-tested questionnaire.&#x0D; Results: A total of 126 road traffic accident victims both sexes were studied. The majority of the study subjects were men 103 (81.7%) and most of them were in 31-40 years group (27%), Muslims (98.41%) were the majority. In our study regarding educational qualification of RTA victims most of them were SSC qualified (44’4%) and primary level (15.1%). Military services holder (45.2%) was the majority of road traffic crash victims. Bus/Minibus (32.5%) was responsible for the majority of road traffic crashes and motor vehicle passengers (42.9%) were main victims. Laceration &amp; cut injury were (38.1%) and multiple injury (18.3%) were the most common injury. Main roads (49.2%) were the commonest site of the accidents. Regarding place of occurrence main roads 62 (49.2%) was the most common site and noon 41 (32.5%) was the most common time of occurrence of accidents.&#x0D; Conclusion: Road traffic crashes constitute a major public health problem in our setting and contribute significantly to unacceptably high morbidity and mortality. Urgent preventive measures targeting at reducing the occurrence of road traffic crashes is necessary to reduce the morbidity and mortality resulting from these injuries. Early recognition and prompt treatment of road traffic injuries is essential for optimal patient outcome.&#x0D; JAFMC Bangladesh. Vol 15, No 2 (December) 2019: 213-217

Sociodemographic Profile among the Victims of Road Traffic Accident Reported in a Tertiary Level Hospital: A Cross Sectional Observation

Introduction: Road traffic accident is an unbaiting concern of health security issues to the community in Bangladesh. Every individual RTA contributes a tragic social impact due to its morbidity or mortality associated to each family.&#x0D; Objectives: To assess the sociodemographic profile among the victims of RTA.&#x0D; Material and Methods: This cross sectional study was conducted in 2010 among purposively selected 126 victims of road traffic accident reported to the medical inspection room of Combined Military Hospital Dhaka.Data were collected by a structured questionnaire through the review of medical records of the patients.&#x0D; Results: More than half (53.2%) of the respondents were in the age group of 21-40 years and 44.4% were educated up to SSC level. Majority of them (8 1 .7%) were Male and 45.23.8% were from military service. About 27.3% of RTA occurred by truck/covered van/Bus/ minibus which was followed by Jeep/car/microbus and pickup (35.7%) and 44.4% of the affected respondents were from motor vehicle passengers which was followed by pedestrian (37.3%). Majority ofthe patients experienced laceration and cut injuiy (38.1%) which was equally followed by abrasion and fracture (15.9%). Statistically significant (p&lt;0.05) association revealed between education with role of affected personand occupation with morbidity pattern.&#x0D; Conclusion: As the victims of RTA are mainly male in active and productive period of life, so this group should be motivated.&#x0D; AKMMC J 2020; 11(2) : 102-106

Prevalence of speeding and associated factors in four Mexican cities

BackgroundSpeeding is responsible for countless traffic collisions and road traffic injuries (RTIs) around the world. It threatens the lives of passengers in motor vehicles as well as the safety of...

Pediatric road traffic injuries in Qatar: Evidence for a developmental stage approach to road safety.

Road traffic injuries are the leading cause of death in Qatar but their epidemiology in children has not been fully described. This paper will describe the epidemiology of pediatric road traffic injuries (pRTIs) in Qatar, in order to understand the relationships among risk factors, mechanisms of injury, use of safety equipment, and according to child developmental stages.The primary sample for this study was drawn from all pRTIs (0–18 years) from January 2010 to December 2012—motor vehicle occupants, passengers and drivers, pedestrians, cyclists, motorcyclists, and all-terrain vehicle (ATV) drivers and passengers—seen at the trauma registry of the Hamad Trauma Center, the national Level I Trauma Referral Center of Qatar.During those two years, the Trauma Center attended to 4864 patients, 443 (9.1%) of whom were pRTIs, 83% were male, and 71% were non-Qatari. Only 1.2% of injured passengers and drivers were restrained. All fatalities were passengers or drivers; the overall mortality rate was 3.4%. The motor vehicle crash (MVC) mortality rate was 6.2%, with the longest mean length of hospital stay 10.5 days and highest Intensive Care Unit (ICU) admission rate 35.7%. Older adolescents (15–18 years) comprised 56.4% of total MVC mortality. One-in-four (25%) pedestrian victims was Qatari. They had the lowest mean Injury Severity Score (9.6); 73% were nine years or younger. ATV victims had a 27% ICU admission rate; 48.4% were 10–14 years old. Older adolescents made up only 17% of the pediatric population of Qatar, yet 40% of pRTI victims and 80% of pRTI deaths. Forty-two percent of injured older adolescents were drivers, with half (21%) of those underage.There are clear and distinct age and mechanism-specific patterns of pRTIs among children in Qatar that must be used to guide road safety policy and program formulation for underage pedestrians and drivers. Proven interventions that increase seatbelt and child restraint use and graduated driver licensing must be considered.

Assessment of Caregiver-Targeted Interventions for Use of Motor Vehicle Passenger Safety Systems for Children

Caregiver-targeted interventions to improve the use of child restraint systems (CRS) in motor vehicles are common and heterogeneous in their implementation. The effectiveness of these interventions is unknown. To quantify the effects of caregiver-targeted interventions using meta-analytic methods, assess the quality of published studies, and assess for publication bias. PubMed and PsychINFO (January 1, 2004, to April 1, 2019) were searched for English-language studies using a list of search terms. The search and screening process was completed between May 25, 2018, and April 1, 2019. Studies met inclusion criteria if they included a caregiver-targeted intervention that focused on increasing CRS use for children (age, ≤9 years) and report the use of CRS before and after the intervention. Cochrane and PRISMA guidelines were used for the meta-analysis and risk-of-bias review. Information was extracted on intervention type, setting, implementation, and attributes of the study independently between 2 coders. Data were pooled from independent samples, with 1 outcome measure from each intervention implementation or study. This study was an exploratory random-effects meta-analysis. Unadjusted odds ratios were calculated using the sample size and the observed number of children in incorrect or correct restraints in motor vehicles before and after the intervention to determine the odds of incorrect CRS use after completing an intervention. Setting, measurement method, randomization, use of vouchers, and types of restraint were tested as moderators. A funnel plot was used to assess for publication bias. Of 1240 potential articles, 51 were deemed eligible for screening and 10 (8238 participants total) were included in the meta-analysis. Caregiver-targeted interventions were associated with a reduction in the number of children not riding in a CRS (odds ratio, 0.51; 95% CI, 0.36-0.71; P < .001). Variance in the averaged effect size was driven by self-report methods (when removed from analyses, I2 = 61.8%; R2 change = 26.3; P = .02) and hospital settings (when removed from analyses, I2 = 70.7%; R2 change = 17.4; P = .002). Risk of bias was high in most studies; however, there was low evidence for publication bias. In this meta-analysis, caregiver-targeted interventions were associated with a reduction in the number of children not riding in a CRS in motor vehicles; however, the methodological rigor of intervention studies should be enhanced.

Fatal road transport crashes among Australian residential aged care facility residents.

To examine fatal road transport crashes of residential aged care facility (RACF) residents to determine crash characteristics and risk factors. A cross-sectional study of a retrospective national cohort of RACF resident deaths notified to Australian coroners. death occurred between 1 July 2000 and 30 June 2013; mechanism classified as 'transport injury event'; and completed coronial investigation. Descriptive statistical analyses were conducted on crash characteristics and risk factors. Thirty-eight deaths met the inclusion criteria. Median age of deceased RACF residents was 84years, and gender was equally distributed. Men were most frequently pedestrians (n = 14, 37%), and women were most frequently motor vehicle passengers (n = 14, 37%). Road user factors contributed to two-thirds of crashes (n = 25, 66%), with 'failure to yield' (n = 17, 45%) most frequent. Reducing fatal crashes of RACF residents requires effective road safety strategies and public awareness of risks for this increasing and vulnerable population.

Trends in child passenger safety practices in Indiana from 2009-2015

Objective: This study reviews trends in rear facing direction, top tether use, booster seat use and seating position for children 12 years or younger among motor vehicle passengers in Indiana. Methods: This is an observational, cross-sectional survey of drivers transporting children 15 years and younger collected at 25 convenience locations randomly selected in Indiana during summers 2009-2015. Observations were conducted by Certified Child Passenger Safety Technicians (CPST). ). As the driver completed a written survey collecting demographic data on …

Trends in child passenger safety practices in Indiana from 2009 to 2015

ABSTRACTObjective: This study reviews trends in rear-facing direction, top tether use, booster seat use, and seating position for children 12 years or younger among motor vehicle passengers in Indiana.Methods: This is an observational, cross-sectional survey of drivers transporting children 15 years and younger collected at 25 convenience locations randomly selected in Indiana during summers of 2009–2015. Observations were conducted by certified child passenger safety technicians (CPST). As the driver completed a written survey collecting demographic data on the driver, the CPST recorded the child demographic data, vehicle seating location, the type of restraint, direction the car safety seat (CSS) was facing, and use of the CSS harness or safety belt as appropriate. Data were analyzed for infants and toddlers younger than 24 months, children in forward-facing CSS, booster seat use, and seating position for children 12 years or younger.Results: During the study period, 4,876 drivers were queried, and 7,725 children 15 years and younger were observed in motor vehicles. Between 2009 and 2015, 1,115 infants and toddlers (age birth to 23 months) were observed in motor vehicles. For infants <1 year, rear-facing increased from 84% to 91%. During the study years the greatest increase in rear facing was for toddlers age 12–17 months (12–61%). Rear facing for those from 18–23 months did not significantly change. Of the 1,653 vehicles observed with a forward-facing car seat, using either the seat belt system or lower anchors, an average of 27% had the top tether attached. For installations of forward-facing seats using the lower anchor, 66% employed the top tether. Among children age 4–7 years observed booster seat use decreased from 72% to 65% during the observation period. Finally, for vehicle seating position, in our sample, more than 85% of children 12 years or younger were seated in a rear seat vehicle position. Unfortunately, 31% of 8- to 12-year-old children were observed in the front seat.Conclusions: Overall, these trends demonstrate an improvement in child passenger safety practices among Indiana drivers. However, this study illuminates areas to improve child passenger safety, such as rear facing for toddlers 18 to 23 months, increasing top tether use, booster seat use, and an emphasis on rear seat position for children 8 to 12 years. This information can be used by primary care providers and child passenger safety technicians and other child passenger safety advocates to develop counseling points and targeted educational campaigns.

Road traffic accidents in children: the 'what', 'how' and 'why'.

Road traffic accidents (RTAs) in Singapore involving children were evaluated, with particular focus on the epidemiology, surrounding circumstances and outcomes of these accidents. Key factors associated with worse prognosis were identified. We proposed some measures that may be implemented to reduce the frequency and severity of such accidents. This was a retrospective study of RTAs involving children aged 0-16 years who presented to the Children's Emergency at KK Women's and Children's Hospital, Singapore, from January 2011 to June 2014. Data was obtained from the National Trauma Registry and analysed in tiers based on the Injury Severity Score (ISS). A total of 1,243 accidents were reviewed. RTA victims included motor vehicle passengers (60.4%), pedestrians (28.5%), cyclists (9.9%) and motorcycle pillion riders (1.2%). The disposition of emergency department (ED) patients was consistent with RTA severity. For serious RTAs, pedestrians accounted for 63.6% and 57.7% of Tier 1 (ISS > 15) and Tier 2 (ISS 9-15) presentations, respectively. Overall use of restraints was worryingly low (36.7%). Not restraining increased the risk of serious RTAs by 8.4 times. Young age, high ISS and low Glasgow Coma Scale score predicted a longer duration of intensive care unit stay. The importance of restraints for motor vehicle passengers or helmets for motorcycle pillion riders and cyclists in reducing morbidity requires emphasis. Suggestions for future prevention and intervention include road safety education, regulation of protective restraints, use of speed enforcement devices and creation of transport policies that minimise kerbside parking.

Trends in traumatic brain injury mortality in China, 2006-2013: A population-based longitudinal study.

BackgroundTraumatic brain injury (TBI) is a significant global public health problem, but has received minimal attention from researchers and policy-makers in low- and middle-income countries (LMICs). Epidemiological evidence of TBI morbidity and mortality is absent at the national level for most LMICs, including China. Using data from China’s Disease Surveillance Points (DSPs) system, we conducted a population-based longitudinal analysis to examine TBI mortality, and mortality differences by sex, age group, location (urban/rural), and external cause of injury, from 1 January 2006 to 31 December 2013 in China.Method and findingsMortality data came from the national DSPs system of China, which has coded deaths using the International Classification of Diseases–10th Revision (ICD-10) since 2004. Crude and age-standardized mortality with 95% CIs were estimated using the census population in 2010 as a reference population. The Cochran–Armitage trend test was used to examine the significance of trends in mortality from 2006 to 2013. Negative binomial models were used to examine the associations of TBI mortality with location, sex, and age group. Subgroup analysis was performed by external cause of TBI. We found the following: (1) Age-adjusted TBI mortality increased from 13.23 per 100,000 population in 2006 to 17.06 per 100,000 population in 2008 and then began to fall slightly. In 2013, age-adjusted TBI mortality was 12.99 per 100,000 population (SE = 0.13). (2) Compared to females and urban residents, males and rural residents had higher TBI mortality risk, with adjusted mortality rate ratios of 2.57 and 1.71, respectively. TBI mortality increased substantially with older age. (3) Motor vehicle crashes and falls were the 2 leading causes of TBI mortality between 2006 and 2013. TBI deaths from motor vehicle crashes in children aged 0–14 years and adults aged 65 years and older were most often in pedestrians, and motorcyclists were the first or second leading category of road user for the other age groups. (4) TBI mortality attributed to motor vehicle crashes increased for pedestrians and motorcyclists in all 7 age groups from 2006 to 2013. Our analysis was limited by the availability and quality of data in the DSPs dataset, including lack of injury-related socio-economic factors, policy factors, and individual and behavioral factors. The dataset also may be incomplete in TBI death recording or contain misclassification of mortality data.ConclusionsTBI constitutes a serious public health threat in China. Further studies should explore the reasons for the particularly high risk of TBI mortality among particular populations, as well as the reasons for recent increases in certain subgroups, and should develop solutions to address these challenges. Interventions proven to work in other cultures should be introduced and implemented nationwide. Examples of these in the domain of motor vehicle crashes include policy change and enforcement of laws concerning helmet use for motorcyclists and bicyclists, car seat and booster seat use for child motor vehicle passengers, speed limit and drunk driving laws, and alcohol ignition interlock use. Examples to prevent falls, especially among elderly individuals, include exercise programs, home modification to reduce fall risk, and multifaceted interventions to prevent falls in all age groups.

Road traffic injuries among children and adolescents in Singapore – Who is at greatest risk?

IntroductionPediatric road traffic injuries remain a significant cause of death and disability in many countries in Asia, despite the implementation of road traffic safety laws. We aim to describe the injuries, the use of restraints among road users, and risk factors associated with severe injuries for children in Singapore. MethodsWe performed a retrospective chart review of road traffic injuries presenting to the only two pediatric tertiary care hospitals in Singapore, from January 2012 to April 2016. We included children <16years old presenting to the emergency departments within 24h after injury (pedestrian, bicycle, motorcycle, motor vehicle). We calculated the frequencies for specific injury mechanisms, injury severity scores (ISS), and in-hospital outcomes of severe injuries (death, urgent resuscitation and emergent surgery). We performed a multivariate logistic regression to determine risk factors associated with severe injury. ResultsThere were 2468 patients during the study period. The mean age was 7.9 years (SD 4.7); 60.1% of road injuries involved motor vehicle occupants (1483/2468). Most bicyclist/motorcyclists were not wearing helmets (70.0%, 245/350) and 51.1% of motor vehicle passengers (758/1483) were not restrained. Compared to motor vehicle passengers, pedestrians (adjusted OR 2.38, 95% CI 1.41–3.99), bicyclists (adjusted OR 2.12, 95% CI 1.04–4.32) and motorcyclists (adjusted OR 6.09, 95% CI 2.04–18.24) were more likely to sustain severe injuries. ConclusionChild pedestrians, bicyclists and motorcyclists are especially vulnerable for severe injures. Further injury prevention efforts must focus on the enforcement of legislation to protect these high-risk groups.

Scale Forecast Method for Regional Highway Network Based on BPNN-MOP

Abstract The forecast of the scale of highway network is of great importance in the planning of regional highway network. This paper is to seek a hybrid method to improve the accuracy and reliability of scale-forecast and obtain the optimal hierarchical structure of highway network in Hangzhou in the Year 2015, 2020 and 2025. Firstly, drawbacks of traditional scale-forecast methods of highway network and advantages of the combinative forecast method which embraces BP neural network (BPNN) and Markov chain are illustrated. Then, a novel prediction method which is based on BPNN and Markov chain with the consideration of five elements, including GDP, total population, the number of civil motor vehicle ownership, passenger capacity and volume of freight traffic is proposed. After that, a multi-objective programming (MOP) model is established to obtain the optimum technical grade structure of highway network. Thirdly, with the Program for the 13th Five-Year Development Plan of Highway Transportation in Hangzhou, the scale of highway and its optimal hierarchical structure in the year of 2015, 2020 and 2025 is obtained. Finally, the results show that the accuracy and reliability of the forecast method are improved, and the model proves to be of both theoretical and practical significance.