Motor Vehicle-related Crashes Research Articles

Effectiveness of child restraint legislation to reduce motor vehicle related serious injuries and fatalities: A national interrupted time series analysis

Children that are unrestrained while travelling in a motor vehicle are more vulnerable to serious injury and death. The greatest levels of crash protection are achieved when children use the most age or size appropriate form of restraint. In this study, we aimed to examine the effectiveness of the introduction of age-appropriate child restraint legislation on serious and fatal injury in five Australian states and territories. For this interrupted time series analysis, we used a segmented regression method to assess the association between the implementation of child-restraint legislation and motor-vehicle related serious injuries and fatalities using data obtained from transport authorities in each jurisdiction. We estimated the change in annual rates after the implementation of legislation with the number of motor-vehicle accidents resulting in fatalities or serious injuries as the outcome, and the total number of injuries (minor, serious and fatal) as an offset in the model. We identified 10882 motor-vehicle related crashes resulting in fatalities (n = 188), serious injuries (n = 1730) and minor injuries (n = 8964). In NSW and VIC, the rate ratio was statistically significant and positive, indicating an increase in the rate of serious injuries and fatalities in the period post-legislation compared to the period prior to legislation. In all other states and territories, we did not find a statistically significant effect of legislation Road safety programs incorporating interventions targeted at increasing awareness of optimal restraint practices, strengthened enforcement and measures to improve the affordability of restraints are needed to support legislation.

Effectiveness of Child Restraint Legislation to Reduce Motor Vehicle Related Serious Injuries and Fatalities: A National Interrupted Time Series Analysis

Background: Children that are unrestrained while travelling in a motor vehicle are more vulnerable to serious injury and death. The greatest levels of crash protection are achieved when children use the most age or size appropriate form of restraint. In this study, we aimed to examine the effectiveness of the introduction of age-appropriate child restraint legislation on serious and fatal injury in five Australian states and territories. Methods: For this interrupted time series analysis, we used a segmented regression method to assess the association between the implementation of child-restraint legislation and motor-vehicle related serious injuries and fatalities using data obtained from transport authorities in each jurisdiction. We estimated the change in annual rates after the implementation of legislation with the number of motor-vehicle accidents resulting in fatalities or serious injuries as the outcome, and the total number of injuries (minor, serious and fatal) as an offset in the model. Findings: We identified 10882 motor-vehicle related crashes resulting in fatalities (n=188), serious injuries (n=1730) and minor injuries (n=8964). In NSW and VIC, the rate ratio was statistically significant and positive, indicating an increase in the rate of serious injuries and fatalities in the period post-legislation compared to the period prior to legislation. In all other states and territories, we did not find a statistically significant effect of legislation. Interpretation: Road safety programs incorporating interventions targeted at increasing awareness of optimal restraint practices, strengthened enforcement and measures to improve the affordability of restraints are needed to support legislation. Funding Statement: The George Institute for Global Health. Declaration of Interests: The authors state: None declared. Ethics Approval Statement: The authors declare: Ethics committee approval was not needed as the data was de-identified, publicly accessible government data.

Review of Tribal Transportation Safety

For more than a decade, the proportion of American Indians and Alaskan Natives killed in motor vehicle–related crashes (per population of 100,000) has been much higher than that of other ethnic groups in the United States. Between 1975 and 2002, the number of fatal motor vehicle crashes increased by 52.5% on Indian reservations, while the number declined by 2.2% nationally. Seat belt underuse, child seat restraint underuse, and operation of a motor vehicle under the influence of alcohol have been identified as key concerns for tribal transportation safety during various tribal safety summits and in the published literature. Without detailed data, identifying specific risk factors and developing effective solutions (as well as securing federal and state funding for safety programs) is difficult. This report summarizes the information available on crashes in tribal communities to generate a fact-based understanding of the status of transportation safety within these communities. Gaps in crash data and a study procedure to overcome these gaps are discussed to understand and work better to improve transportation safety on tribal lands. Results showed that readily available information could provide only a broad overview of the status of tribal transportation safety. For the major transportation safety concerns within a tribal community to be identified and addressed, data need to be obtained at the community level. For crash patterns and best practices to be identified, information should be aggregated from tribes that have successfully established a data collection procedure and have implemented safety programs.

Commentary: Alcohol and Motor Vehicle–Related Crashes—Driver Attitudes Need Further Intervention

Commentary: Alcohol and Motor Vehicle–Related Crashes—Driver Attitudes Need Further Intervention

33. Traffic Injury Prevention Program

In Texas (1999), teen crashes accounted for 76% of all teen deaths caused by unintentional injuries. More than 20% of persons injured in a motor vehicle–related event were between the ages of 15 and 24 years old. The purpose of this project is to reduce the incidence of teen motor vehicle–related crashes by providing an injury prevention field trip program to teens (TIPP). Prehospital, hospital, and law enforcement are core components of the program. The message is proactive and positive in addressing driving safely and being aware of the lifetime impact of driving under the influence–related motor vehicle crashes. Students receive a teen drinking/driving crash scenario with hands-on education from EMS and the Fire Department in the extrication/resuscitation of victims from a wrecked vehicle. The participants escort “patients” to the trauma rooms for the resuscitation. The resuscitation is conducted in “real-life” simulation with nurses and physicians describing the patient's injuries and treatment. The patient is taken to the burn unit where students learn about the burn treatment requirements. Physical appearance is significant to teens and this portion of the program gives impact on self-perception. To learn the long-term effects of drinking and driving, participants hear from physical therapists about the treatment of spinal cord injuries and other debilitating injuries. The day ends with an open discussion that is shared with survivors of traumatic injuries whose lives were impacted as a result. The theory behind TIPP is that by exposing teens to a traumatic scenario, the imprint of the sights, sounds, and the odors are recorded in the teen's experience and can become powerful stimuli (toward injury prevention and behavioral change) in the future. TIPP has been presented 15 times to approximately 1000 students. A pretest, posttest, and evaluation tool is administered. The subjects tested were between the ages of 16 and 18 years. Subjects (95%) scored less than 100% on the pretest. However, these same subjects scored above 95% on the posttest, demonstrating increased comprehension of the dangers of drinking and driving. The evaluation tools reveal that students were affected with “real-life” hands-on participation in the resuscitation of crash victims and by the “real-life” discussions with survivors who sustained (preventable) injuries. A multidisciplinary and collaborative effort from different agencies is recommended, that is, hospital, prehospital, fire, and police. The main challenge for this program's success is in obtaining adequate funding for work force to track, evaluate, and measure the outcomes.

Practical Safety Tool for Local Low-Volume Rural Roads: The Road Safety Audit Review

Practical tools for improving transportation safety are needed worldwide. It has been estimated that motor vehicle–related crashes account for more than 1 million fatalities each year, and the number of serious injuries far exceeds fatalities. Local and low-volume roads are significantly overrepresented in crash statistics. Globally, the road safety audit (RSA) concept has been recognized as an effective tool in identifying and reducing the crash potential of roadways when used to analyze the safety aspects of project plans and designs before completion. In the local rural road arena, many safety issues are associated with existing roadway networks. Many of these networks have developed over time with little or no planning or design. There is a critical need for a practical tool that focuses on the safety of the existing as-built local road network. The RSA review (RSAR) process has been developed for this purpose, giving specific recognition to the functionality of the road being evaluated for safety issues. Significant numbers of safety improvements are needed, and practical approaches to address these needs are crucial. The RSAR tool has the potential to be particularly beneficial to local governments in systematically addressing safety deficiencies on existing rural road networks. In addition, it is a proactive safety tool that has the potential to protect agencies from tort liability since it establishes a record of the organization’s safety agenda. An RSAR methodology that can be adapted by local agencies is presented. A case study illustrating the application of this process is included. Also highlighted is a local rural training program that has been presented in several states for county applications. The focus is on U.S. county applications, but it is recognized that the process has utility for other agencies and has application in other countries. The necessity for training as a key component in the development of a sustainable safety program is emphasized.

Fetal Deaths Related to Maternal Injury

Injury during pregnancy is an acknowledged cause of negative fetal outcomes, but, unfortunately, even the most severe outcome, fetal/neonatal death, is systematically excluded from US injury surveillance programs. This study therefore sought to determine rates of traumatic fetal death reported in state fetal death registries and to clarify some of the epidemiological aspects of these events. Fetal death certificates were available for 1995 through 1997 from 16 states, accounting for approximately 15,000 registered fetal deaths each year and for 55% of live US births. The 240 traumatic fetal deaths found in the 3-year review period represented 3.7 per 100,000 live births per year. The figure ranged from 0 to 6.5 in various states. Trauma accounted for 5.4 of every 1000 fetal deaths. Gestational age averaged 29.4 weeks. Deaths from traumatic fetal injury were most frequent at maternal ages of 15 to 19 years and declined with advancing maternal age. Maternal race was not a significant factor. Eighty-two percent of deaths resulted from motor vehicle-related crashes. Placental injury was described in 42% of cases. When the delivery mode was known, cesarean delivery accounted for 46% of births. Maternal mortality was 11%. Nearly two thirds of maternal deaths whose cause was specified were caused by motor vehicle-related injuries. Motor vehicle crashes are the major cause of fetal deaths related to maternal injury. It is hoped that improved tracking of fatal traumatic fetal injuries will prompt efforts to reduce the risk of injury to both the mother and fetus. Research on nonfatal fetal outcomes might also prove helpful.

Early functional outcome in children with pelvic fractures

Background/Purpose: Although the mortality, morbidity, and spectrum of associated injuries in children with pelvic fractures have been extensively studied, little is known about the functional outcomes in these patients. The authors examined retrospectively functional independence measurement (FIM) at discharge in children with pelvic fractures to determine how it should influence their management protocol. Methods: The authors reviewed the records of all patients who sustained pelvic fractures between 1993 and 1998 in the trauma registry of a level I pediatric trauma center. Patients were stratified according to demographics, type of pelvic fracture, functional independence measurement, and discharge disposition. Fractures graded 1, 2, or 3 were defined as stable, whereas grade 4 fractures were deemed unstable. Results: A total of 88 children sustained pelvic fractures. Seventy-four percent had stable fractures, whereas 26% sustained unstable fractures. There was no difference in age or sex between the groups; boys were more commonly injured than girls. Motor vehicle-related crashes accounted for most injuries. The mean injury severity score (ISS) for patients with a stable fracture was 17 ± 14 and 20 ± 13 for unstable fractures. There was no difference in overall hospitalization nor intensive care unit stay between the unstable and stable fracture patients. Eighty percent of the patients with unstable and 52% of the patients with stable pelvic fractures were dependent based on locomotion, and similar proportions were seen for the transfer category. Conclusions: Short-term function appears to be significantly impaired in a high percentage of children with stable and unstable pelvic fractures. Therefore, aggressive rehabilitation should be instituted early in all children with pelvic fractures to achieve optimal functional outcome. J Pediatr Surg 35:1002-1005. Copyright © 2000 by W.B. Saunders Company.

Effects of high school driver education on motor vehicle crashes, violations, and licensure

Objective: We sought evidence in the research literature to determine if (1) high school–aged persons who enroll in a driver education course have fewer motor vehicle–related crashes or violations, or are more likely to obtain a drivers license, than those who do not enroll in driver education courses, and (2) the availability of high school driver education courses is associated with lower community rates of motor vehicle crashes among young drivers. Methods: To be included, a study must: (1) assess the effects of driver education courses or legislation for high school–aged persons; (2) present non-self-reported data for at least one of the following outcome measures: driver licensure rates, motor vehicle–related violations, or crashes; (3) include some form of no intervention comparison group; (4) adequately control for potentially confounding variables; and (5) randomly assign participants to control or treatment groups, if a controlled trial. Results: Nine studies met our inclusion criteria. Based on these studies, there is no convincing evidence that high school driver education reduces motor vehicle crash involvement rates for young drivers, either at the individual or community level. In fact, by providing an opportunity for early licensure, there is evidence that these courses are associated with higher crash involvement rates for young drivers. Conclusions: Although few driver education curricula have been carefully evaluated, in the absence of evidence that driver education reduces crash involvement rates for young persons, schools and communities should consider other ways to reduce motor vehicle–related deaths in this population, such as graduated licensing.

Pediatric amputation injuries: etiology, cost, and outcome.

To provide a comprehensive profile of amputation injuries in children and adolescents. A retrospective case series. All patients 18 years old or less, admitted to the regional Level I trauma center hospital with a traumatic amputation injury over a 10-year period (74 patients, 77 extremities) were included in the study. Etiology and mechanism of injury, length of hospital stay, number of surgeries and procedures, presence of infection, final outcome of injury (amputation vs. salvage), anatomic location of final outcome, and total charges were recorded for each patient. There were 47 injuries to the upper extremity, and 30 to the lower extremity. The average length of stay was 11.3 days, with a mean of 4.3 procedures in 2.3 surgeries and average charges of $22,015. Twenty-two percent of the injuries were caused by power lawn mowers; all of these patients had amputations. Motor vehicle related crashes accounted for 16% of all injuries; 77% of these ultimately had amputations. Gunshot wounds had the highest mean length of hospital stay, surgery days, number of procedures, and charges. Out of 32 extremities that were revascularized for attempted salvage, 27 were successful (84%), all in the upper extremity, and all but one were digits. Injuries caused by a sharp mechanism with a smaller area of involvement are more likely to be successfully salvaged with revascularization, regardless of ischemic time. Long-term follow-up is needed to evaluate final functional and psychosocial outcome. Lawn mowers represent a serious hazard to children, and should be addressed through changes in engineering and parent education.

Patterns of alcohol use and the risk of drinking and driving among US high school students.

Approximately one third of deaths among persons aged 15 to 24 years are the result of motor vehicle-related crashes. Data from a national sample of US high school students were used to assess patterns of alcohol use among adolescents in relation to the risk of drinking and driving. Prevalence and odds ratios were calculated for drinking and driving associated with patterns of alcohol use. Drinking and driving increased with increasing frequency of alcohol use and binge drinking and when alcohol was used in addition to other drugs. Efforts to reduce drinking and driving among adolescents should address underage drinking that is frequent or heavy.