Pedestrian Car Accident Research Articles

Early management for traumatic benign paroxysmal positional vertigo in traumatically injured patients

ObjectivesThe purpose of this study was to identify the clinical features of posttraumatic benign paroxysmal positional vertigo (t-BPPV) in traumatically injured patients, investigating the effectiveness of the early diagnosis and management including canalith repositioning procedures (CRPs). Patients and methodsThe subjects of the present study were 74 patients who were hospitalized in the Trauma Center, Ajou University Hospital. We investigated the relationship between injury mechanisms and t-BPPV. Patients with t-BPPV were categorized into mild (typical BPPV) and severe (bilateral, recurrent, or persistent) types. ResultsOf the 74 patients, 41 were diagnosed with t-BPPV. Nineteen were mild and 22 were severe types. ‘A fall’ (36%) and ‘pedestrian car accident’ (32%) were common as the injury mechanisms provoking severe t-BPPV. In the severe t-BPPV group, they were hospitalized longer (as median value, 20 days in the severe group vs. 10 days in the mild group, P = 0.004), stayed longer in intensive care unit (3 days vs. 0 days, P = 0.016), and needed more days until the BPPV management (13.5 days vs. 6 days, P = 0.021). Major trauma (the Injury Severity Score >15) patients had a longer time to implementation of the first CRPs (10 days in major trauma and 3 days in minor trauma patients, P = 0.019). ConclusionsSeverity of trauma and longer duration of ICU treatment were factors delaying BPPV management. This delay could negatively affect the progress of t-BPPV. Diagnostic and therapeutic maneuvers including CRPs should be performed as early as possible, even in severely injured patients.

Legg-Calvé-Perthes disease following Ender nail fixation of a pediatric femoral fracture.

Introduction and importanceLegg–Calvé–Perthes disease (LCPD) sometimes occur in children, however it is difficult to diagnose it at the early stage especially in the cases there are no complaints of symptoms. Femoral shaft fractures in children cause various complications such as leg-length discrepancy, nonunion and malunion, refracture, and osteonecrosis of the femoral head. We presented a rare case in which a pediatric patient developed LCPD after femoral shaft fracture.Case presentationA healthy 8-year-old boy sustained a left femoral diaphyseal fracture following a pedestrian car accident. Fixation was achieved using retrograde Ender nails; bone union was confirmed at 3 months postoperatively, and the Ender nails were removed at 8 months postoperatively without any problems. Unfortunately, the morphological change of the ipsilateral femoral head and subtle symptoms were missed until the femoral head collapsed. LCPD was successfully treated with intertrochanteric varus osteotomy, which achieved a good clinical result.Clinical discussionAlthough the reason for the ipsilateral LCPD after the femoral shaft fracture is unclear, this case highlights the need for close postoperative follow-up of pediatric femoral fractures resulting from high-energy trauma to prevent the misdiagnosis of this coincidental complication.ConclusionThis case report describes a missed ipsilateral LCPD after a femoral diaphyseal fracture caused by high-energy trauma. Close postoperative follow-up with a detailed assessment and vigilant interpretation of postoperative radiography is imperative to avoid delayed/missed diagnosis of conditions for which early management may provide better outcomes.

Injury of Corticostriatal Tract between the Striatum and the Premotor Area in a Patient with Traumatic Brain Injury

Objectives: We investigated injury of corticostriatal (CStr) tract in patient with mild traumatic brain injury (mTBI), which was demonstrated by DTT. Method: A 44-year-old female with no previous history of neurological, physical, or psychiatric illness had suffered from head trauma resulting from a pedestrian car accident. She complained that could not quickly move the left hand with her intension. After three month’s administration, her slowness movement of left hand recovered rapidly to the point that she was able to extend all fingers quickly. Results: On DTT configuration, the integrity of the left CStr tract was well-preserved, however the right CStr tract showed narrowing and partial tearing in the subcortical white matter on a DTT at 25 months after onset. Conclusion: Injury of the right CStr tract was demonstrated in a patient who developed mild motor control problems following mild TBI. We believe that the evaluation of the CStr tract from the secondary motor area for patients who showed unexplained motor control problem is necessary.

Coincidence of Ipsilateral Humeral Shaft, Monteggia and Both Bone Fractures; A Floating Elbow with Significant Recovery

The coincidence of forearm and humeral shaft fractures results in a “floating elbow” injury necessitating surgical open reduction and internal fixation of all fractures to allocate for maintenance of elbow joint suitable motion and minimizing stiffness. Here we introduce a case of an ipsilateral humeral shaft fracture and Monteggia and both bone fracture with terrible triad open fracture from a pedestrian car accident (PCA) to his right upper extremity.

Observation results on pedestrian-vehicle interactions at non-signalized intersections towards simulation

The modelling and simulation of pedestrian-vehicle interactions is an open challenge for both research and practical computational solutions aiming at supporting urban/traffic decision makers and managers. The social cost of pedestrian-car accidents pushes the development of more effective and expressive computational models and simulation systems, integrating analytical knowledge, data and experience about pedestrian-vehicle interactions. The paper presents the results of a significant data gathering campaign focused on the considered phenomenon and aimed at supporting the extension and calibration of an existing model. A video-recorded naturalistic observation was executed in an area of the City of Milan (Italy) characterized by a significant presence of elderly inhabitants and by a high number of road accidents involving pedestrians in the past years. The achieved results include both macroscopic and microscopic indicators about pedestrian-vehicle interactions at the observed non-signalized intersection, with reference to: (i) traffic volumes; (ii) Level of Service; (iii) drivers compliance to pedestrians right of way on zebra crossing; (iv) age-driven pedestrian crossing behaviour, focusing on motor skills (speeds and trajectories) and decision making (accepted time gap to cross). Since elderlies represent one of the most vulnerable pedestrians in terms of road accidents, data analysis is focused on comparing results among two samples composed of adults and aged pedestrians. Results showed that crossing behaviour is characterized by three main phases: approaching, appraising (evaluation of the distance and speed of oncoming vehicles) and crossing. Moreover, results showed a significant difference in the crossing behaviour of adult and elderly pedestrians. The final objective of the research is to support the development of a microscopic agent-based tool for simulating pedestrian-vehicle interactions at non-signalized crosswalks.

Grouping of body areas affected in traffic accidents. A cohort study

BackgroundTraffic accidents are considered a public health problem and, according to the World Health Organization, currently is the eighth cause of death in the world. Specifically, pedestrians, cyclists and motorcyclists contribute half of the fatalities. Adequate clinical management in accordance with aggregation patterns of the body areas involved, as well as the characteristics of the accident, will help to reduce mortality and disability in this population. MethodsSecondary data analysis of a cohort of patients involved in traffic accidents and admitted to the emergency room (ER) of a high complexity hospital in Medellín, Colombia. They were over 15 years of age, had two or more injuries in different areas of the body and had a hospital stay of more than 24h after admission. A cluster analysis was performed, using Ward's method and the linfinity similarity measure, to obtain clusters of body areas most commonly affected depending on the type of vehicle and the type of victim. ResultsAmong 2445 patients with traffic accidents, 34% (n=836) were admitted into the Intensive Care Unit (ICU) and the overall hospital mortality rate was 8% (n=201). More than 50% of the patients were motorcycle riders but mortality was higher in pedestrian-car accidents (16%, n=34). The clusters show efficient performance to separate the population depending on the severity of their injuries. Pedestrians had the highest mortality after having accidents with cars and they also had the highest number of body parts clustered, mainly on head and abdomen areas. ConclusionsExploring the cluster patterns of injuries and body areas affected in traffic accidents allow to establish anatomical groups defined by the type of accident and the type of vehicle. This classification system will accelerate and prioritize ER-care for these population groups, helping to provide better health care services and to rationalize available resources.

Assessment of Maxillofacial Trauma in Emergency Department

Background: Maxillofacial trauma is one of the most common traumas with many complications and disabilities. Recognition of the trauma-related mechanisms is the key to early diagnosis and treatment. Objectives: The current study was aimed at assessing maxillofacial trauma in emergency department. Methods: The current cross sectional study was performed on 406 patients with maxillofacial trauma recruited from the emergency department (ED) of Shariati and Imam Khomeini hospitals from January 2014 to March 2015. Demographic data, etiology and mechanism of trauma as well as the type of maxillofacial fractures were recorded by the emergency medicine (EM) residents. Maxillofacial fractures, diagnosed by the computed tomography (CT) scan, were reported by the ED attending radiologist. Results: The current study evaluated 406 patients, 106 females (26.1%) and 300 males (73.9%), with maxillofacial trauma and the mean age of 29.95 ± 15.82 years. The leading causes of maxillofacial trauma were the road traffic accidents (RTA) (50.2%), followed by falling (20.0%) and assault (17.3%). Maxillofacial fractures were detected in 137 patients (33.7%) and mandibular fractures were the most common site (71.5%). The mean age of males was significantly higher than that of females. Some causes of maxillofacial trauma, such as assault and occupational accidents, were significantly common in males than females. The risk of maxillofacial fractures was significantly higher in the traumas caused by pedestrian-car accidents followed by falling and assault. Conclusions: In the current study population, the patterns of underlying causes of maxillofacial traumas were similar to other types of traumas mainly affected by socioeconomic status of the society. RTA was the main cause of maxillofacial trauma and males were affected more than females. Most of the current study patients were in the 3rd and 4th decades of life. Mandible was the site mostly involved in MF fractures.

Damage Control Orthopedics in Multitrauma Patients: A Pediatric Case Presentation and Literature Review

Introduction: A multiple long-bone shaft fracture is associated with developing systemic complications and increased morbidity and mortality. Optimal timing for surgery of polytrauma patients according to damage control orthopedics principles is crucial. Case Presentation: We present a 5-year-old boy referred after a pedestrian car accident with right femoral shaft fractures, a left distal femur fracture, and a left tibial fracture. The patient was classified as a borderline state according to the orthopedic trauma team and was managed accordingly. Conclusions: An article review is presented that signifies the potential benefits of delays in operativemultitrauma fracture fixation, particularly for patients in a borderline state.

Carotid artery thrombosis and cerebral infarction after multiple traumas

Carotid artery thrombosis and concomitant brain infarction after blunt trauma are rare conditions. We report a 34-year-old woman with multiple traumas due to pedestrian car accident. At the time of initial visiting, she was somnolent and her Glasgow coma scale (GCS) score was 14. Initial vital signs (V/S) and brain computed tomography (CT) scan were normal. One day after admission to the emergency observation unit, GCS improved to 15 but right-sided hemiparesis occurred. Magnetic resonance imaging (MRI) showed brain infarction and Doppler sonography indicated internal carotid artery thrombosis. She was admitted in the Neurosurgery ward and underwent anticoagulant therapy. With appropriate treatment, the patient’s condition improved after 5 days of admission and she was discharged on oral warfarin treatment and close follow up. Although there is no ideal treatment for traumatic internal carotid artery thrombosis, it seems that in most cases anticoagulation therapy is the preferred method of treatment but in some patients surgical or endovascular revascularization is indicated.

Appearance of a neural bypass between injured cingulum and brainstem cholinergic nuclei of a patient with traumatic brain injury on follow-up diffusion tensor tractography images.

Appearance of a neural bypass between injured cingulum and brainstem cholinergic nuclei of a patient with traumatic brain injury on follow-up diffusion tensor tractography images.

Injury of the spinothalamic tract in a patient with mild traumatic brain injury: Diffusion tensor tractography study

To report on a patient found to have injury of the spinothalamic tract on diffusion tensor tractography following traumatic brain injury. A 29-year-old male patient with head trauma resulting from a pedestrian car accident presented with pain in multiple areas (both subscapular areas, posterior head and neck, both upper trapezius areas, and the right arm and leg). His pain had not improved with various types of conservative management. Evaluations (conventional brain magnetic resonance imaging, electromyography, and whole spine magnetic resonance imaging), performed 2 years after the head trauma, did not reveal any specific abnormality. Fibromyalgia and myofascial pain syndrome were ruled out by physical examination. Injuries of the spinothalamic tracts in both hemispheres were observed on diffusion tensor imaging in terms of the configuration (thinning) and diffusion tensor tractography parameters (decreased fractional anisotropy or tract volume). Some of the pain in the trunk and extremities in this patient could be ascribed to central pain caused by injury of both spinothalamic tracts. We conclude that diffusion tensor tractography provides a useful means of detecting injury of the spinothalamic tract in patients with traumatic brain injury.

Traffic Signal Design and Simulation for Vulnerable Road Users Safety and Bus Preemption

Mostly, pedestrian car accidents occurred at a signalized interaction is because pedestrians cannot across the intersection safely within the green light. From the viewpoint of pedestrian, there might have two reasons. The first one is pedestrians cannot speed up to across the intersection, such as the elders. The other reason is pedestrians do not sense that the signal phase is going to change and their right-of-way is going to be lost. Developing signal logic to protect pedestrian, who is crossing an intersection is the first purpose of this study. In addition, to improve the reliability and reduce delay of public transportation service is the second purpose. Therefore, bus preemption is also considered in the designed signal logic. In this study, the traffic data of the intersection of Chong-Qing North Road and Min-Zu West Road, Taipei, Taiwan, is employed to calibrate and validate the signal logic by simulation. VISSIM 5.20, which is a microscopic traffic simulation software, is employed to simulate the signal logic. From the simulated results, the signal logic presented in this study can protect pedestrians crossing the intersection successfully. The design of bus preemption can reduce the average delay. However, the pedestrian safety and bus preemption signal will influence the average delay of cars largely. Thus, whether applying the pedestrian safety and bus preemption signal logic to an intersection or not should be evaluated carefully.

Analyzing pedestrian head injury to design pedestrian-friendly hoods

Head injuries are a major cause of fatalities in pedestrian-car accidents. The HIC (Head Injury Criterion) value, a measure of the fatality risk of a head injury, is calculated from the acceleration of the head’s center of gravity (henceforth, head center) resulting from a head impact. The pedestrian’s head does not impact the hood at a direction normal to the hood’s surface. The direction of motion of the head center may change extremely rapidly upon impact, and normal acceleration may also significantly contribute to the resultant acceleration of the head center. Therefore, pedestrian head protection studies should consider how normal acceleration contributes to the resultant acceleration of the head center. It is necessary to control the resultant acceleration of the head center to produce an optimal characteristic pulse. This study analyzes the composition and variations of the head’s acceleration in head-to-hood impacts, focusing on exactly how the normal and tangential components of the acceleration contribute to the resultant acceleration of the head center. This study also considers how structural design parameters affect each component of the resultant acceleration. Methods to control the resultant acceleration of the head center to produce an optimal characteristic pulse can be proposed based on the results of this study. The analytical models and the results of this study contribute to efforts to design vehicle hoods and pave the way for developing pedestrian protection technologies.

Traumatic Acute Epidural Hematoma in Children

Objective: The aim of this study is to investigate the clinical characteristics of acute epidural hematoma (AEDH) in children and to report our experience in recent years. Methods: A series of 48 patients below the age of 15 years treated for AEDH at our institution between August 1999 and August 2008 was analyzed in detail. All patients were divided into three groups according to age to identify any age-dependent clinical characteristics. Group A comprised 7 infants aged 0 to 3 years, group B 28 children aged 4 to 9 years, and group C 13 children aged 10 to 15 years. We reviewed retrospectively medical records and analyzed clinical status and radiological findings including age, causes of injury, initial Glasgow coma scale (GCS) or Modified GCS, location of hematoma, conservative or surgical treatment, and Glasgow outcome scale (GOS). Results: Thirty-two patients were male and 16 patients were female. The most frequent cause of trauma was pedestrian car accident, followed by fall, and slip. Initial GCS was mild (13-15) in 39 children, moderate (9-12) in 5, and severe head trauma (3-8) in 4. The location of the hematoma was frontal in 11 children, parieto-occipital in 23, temporal in 8, and posterior cranial fossa in 6. There was statistically significant correlation between initial GCS and GOS (p<0.05). Conclusion: Pediatric AEDH presents both age related and atypical features when compared with AEDH in adults. In selected cases, prompt surgical evacuation of the hematoma results in an excellent outcome. Operative treatment of AEDH has few difficulties for a surgeon with neurosurgical training. The outcome was found to be predominantly affected by the initial neurological status. (J Kor Neurotraumatol Soc 2009;5:11-15)

Comprehensive approach to increased pedestrian safety in pedestrian—car accidents

At the Ford Forschungszentrum Aachen a finite element pedestrian humanoid model for use in pedestrian accident simulations was constructed in LS-DYNA3D. Validation of the humanoid model shows the ability to predict fractures and to examine the influence on injuries and injury reduction. The pedestrian accident simulation models can predict general injury mechanisms (shear, bending and fracture) by virtue of the construction philosophy and are thus capable of being used as vehicle engineering development tools. To improve further the understanding of the kinematics of pedestrian accidents and to optimize the computer simulation program it is necessary to collect a set of highly detailed real-world data. At present such data are either unavailable or not sufficiently accurate for this purpose. To meet these targets the In-Depth Medical Pedestrian Accident Investigation and Reconstruction Study has been established.

Extension block secondary to partial anterior cruciate ligament tear on the femoral attachment of the posterolateral bundle

Purpose: The purpose of this investigation was to prove that a partial tear of the anterior cruciate ligament (ACL) at the femoral attachment of the posterolateral bundle can result in mechanical knee locking and trigger the injury mechanism of an isolated ACL injury. Type of Study: Case series. Methods: From February 1993 through June 1999, 19 cases of knee locking with observation of a torn ACL, confirmed under arthroscopy, were investigated. Patients’ ages ranged from 22 to 54 years. The causes of injury were sporting activities in 14 patients (8 skiing, 4 soccer, and 2 badminton); slipping and falling in 2 cases; a pedestrian car accident in 2 cases; and an unknown low-velocity injury in 1 case. Results: On physical examination, each patient indicated that the chief complaint was knee pain; all had a locked knee at 5° to 20° of full extension and 4 cases showed a locked knee at full flexion. Of the 19 cases, Lachman testing was positive in 3. With respect to intra-articular injuries, 3 patients had a tear in the medial meniscus and 1 had a tear in the lateral meniscus. The average time span between arthroscopy examinations was 3 months with a range of 1 to 10 months. Arthroscopic diagnosis and treatment were performed and meniscal tear was ruled out as the cause of locking in all patients. Conclusions: The mechanisms of injury for isolated ACL were knee hyperextension and internal rotation of lower extremity brought on especially by a low-velocity injury. The partial ACL tears were found on the femoral attachment site of the posterolateral bundle. The torn segment of the ACL was interposed between the lateral femoral condyle and the lateral tibial condyle and acted as a mechanical obstruction, giving rise to the locking symptom. In all 19 cases, the torn portion of the ACL was excised under arthroscopy and the locked knees were treated properly.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 3 (March), 2002: pp 227–231

Clues in pedestrian-vehicle collisions and their significance for reconstruction of accidents

Investigations of clues in 87 fatal pedestrian-car accidents which took place with erect posture of the body are reported. Traces of paint proved to be most important clues transferred from the vehicle to the pedestrian's clothing. They derived from the outer paint layer of the collision sites at the front of the vehicle and occurred in 49% of the cases investigated. As has been shown by light and scanning electron microscopic investigations, there is intensive contact between the textile fibers and the paint traces which can be explained by action of heat in the collision. The higher the collision speed, the more readily paint is rubbed off. Because traces of rubbed off paint mark the site of the vehicle impact and indicate the color of the vehicle, they have a high evidence value for reconstruction of the accident. This also applies to traces of molten plastic material as well as to rubbed off chrome and rubber. In contrast to the prevalent view, paint splitters are unsuitable for determining the impact direction. Textile microtraces, traces of blood, hair and tissue occur as transferred clues from the pedestrian to the vehicle. These clues do not permit any statements with regard to the impact direction. They must be evaluated in connection with the remaining clues and the injuries.

Excess mortality from traffic accidents among elderly pedestrians living in the inner city.

Age-specific death rates for pedestrian-car accidents among the populations living in four contiguous areas of a large city, one being the downtown area and the others gradually more removed from it, were compared. The rates are highest downtown and decrease progressively in the outlying areas, the absolute differences between areas being largest above age 65. These data suggest that pedestrian accident prevention efforts should take into account the specific needs of the elderly living in the inner city.