Motor Vehicle Crash Rates Research Articles

How the physical inactivity is affected by social-, economic- and physical-environmental factors: an exploratory study using the machine learning approach

ABSTRACT Previous studies have utilized regression models to investigate the impact of environmental factors on physical activity. However, such approaches are inadequate for data-driven analysis seeking to identify robust associations from the intricate and multi-variable interactions between physical activity and environmental factors. With the emergence of the concept of the exposome, which encompasses the totality of exposures, this paper explores machine learning models for predicting the percentage of physical inactivity in U.S. counties, while considering 28 social-, economic-, and physical-environmental factors. The aim of this study is to address the research gap and gain insight into the complex associations between environmental exposures and physical activity. Five machine learning models were tested, and the performances were compared to select the best classifier for further investigation. This study used data from the Behavioral Risk Factor Surveillance System (BRFSS) of the Centers for Disease Control and Prevention. The mean population of all counties was 102,841, and the mean percentage of population below 18 years was 22.3%. The partial dependence plot analysis indicated that only one feature – bachelor’s degree – exhibited a close-to-linear relationship with physical inactivity. Motor-vehicle crash death rate and mean temperature showed nonlinear and non-monotonic relationships with the predicted percentage of physical inactivity.

Analysis of the vibration caused by porting on the intake and exhaust channels of a 150 cc Kawasaki Ninja driver

Motorcycle vehicles are very popular because they are easy to maneuver and fast, so they are the most popular in various aspects of transportation in urban areas. However, motorbike drivers get tired easily. Acute fatigue, fatigue, chronic sleepiness, sleep disturbances, and heavy workloads have been associated with reduced performance in psychomotor tests and driving simulators and increased rates of motor vehicle crashes, injuries and deaths in certain populations. One that must be considered is the spread of vibrations originating from the piston motor. This is due to vibrations occurring in the work environment and distributed to the body of the workforce or objects in the workplace or work environment throughout the body in the form of mechanical vibrations originating from machines or mechanical equipment. Therefore, the purpose of this study will be to determine the effect of port placement on the intake and exhaust channels on vibrations throughout the body (Whole Body Vibration). Tissue resonance throughout the human body causes health problems. The standard or threshold value for the whole body vibration level that applies at the international level refers to ISO 2631. The test results on the driver’s arm with a rotational speed of 9900 rpm at the standard obtained a frequency of 6 Hz and an amplitude of 0.911137 mm/s2, after porting, the frequency is 7 Hz and the amplitude is 0.771992 mm/s2. Meanwhile, on the driver’s feet with a rotational speed of 9900 rpm, the standard obtained a frequency of 3 Hz and an amplitude of 12.0214 mm/s2, after porting a frequency of 3 Hz and an amplitude of 18.6765 mm/s2 was obtained. The results of this study can be concluded that the use of ports on motorbikes will cause riders to experience fatigue more quickly than standard motorbikes. Because the average ported has a greater amplitude than the standard conditions

Evaluation of motor vehicle crashes between scooter riders and car drivers after diagnosis of type 2 diabetes in Taiwan

BackgroundDespite the plausibility that diabetes may increase the risk of motor vehicle crashes (MVCs) due to various diabetes related complications and co-morbidity, findings from epidemiological studies on the relationship between diabetes and MVCs remained inclusive mainly due to heterogeneity in the study design and failure to complete consideration of potential confounders. This study re-visited this putative association with an improved study design. MethodThis study employed a controlled before–after study design and included 1,264,280 people aged 18–75 years with T2D newly diagnosed from 2009–2014 and an equal number of age-, sex-, and time-matched controls. The rate ratios (RRs) of vehicle type–specific incidence rates of MVCs in the 1 and 2 years before and after diabetes diagnosis (or the matched dates) were compared between the individuals with type 2 diabetes (T2D) and their matched controls. ResultsThe rate of MVCs increased slightly among people with T2D over 1 and 2 years following diabetes diagnosis, with RRs of 1.04 (95% confidence interval [CI]=1.02–1.07) and 1.11 (95% CI=1.09–1.13), respectively. These RRs were comparable to those obtained for controls (1.06 and 1.12, respectively). By contrast, the RRs of scooter crashes were significantly higher in the T2D group than in the control group during the 1 year (1.28 vs. 1.08, p < 0.001) and 2 years (1.32 vs. 1.08, p < 0.001) following diabetes diagnosis. Conclusion: T2D diagnosis was associated with a moderate but significant increase in the risk of MVCs among scooter drivers, but not among car drivers.

Pedestrian Safety Among High School Runners: A Case Series.

Participation in high school cross-country and track has increased over the last few decades. At the same time, the rate of pedestrian-involved motor vehicle crashes (MVCs) has also increased. In the context of organized sport, pedestrian safety among runners is often not highlighted, despite the risk of catastrophic injury. To describe incidents of pedestrian-involved MVCs involving student athletes captured by the National Center for Catastrophic Sport Injury Research (NCCSIR) at the University of North Carolina at Chapel Hill. Case series. Level 5. This study utilized surveillance data from the NCCSIR from 2011 to 2020. It presents descriptive statistics, including frequencies and percentages, detailed summaries, and a Haddon Matrix. There were 8 incidents involving 11 student athletes, resulting in 9 fatalities. Of these, 5 cases occurred in the afternoon or early evening, 4 occurred in the Fall, and 6 occurred in a rural area. Haddon Matrix analyses of case descriptions indicate schools should implement a runner safety program for all new runners and ensure that runner safety measures are included in emergency action plans. Runner-related MVCs are relatively rare, but tragic, incidents. Pedestrian safety measures should be incorporated into school-sponsored practices and training runs. Pedestrian safety should be incorporated into runner safety and injury prevention efforts.

Drowsy driving and teen motor vehicle crashes: Impact of changing school start times.

Motor vehicle crashes (MVC) are the second leading cause of death for adolescents in the United States, with drowsy driving a major contributing factor. Early school start times have been identified as a significant factor that reduces adolescent sleep duration, which in turn contributes to drowsy driving and MVC. This paper examined the longitudinal impact of delaying secondary school start times on self-reported student drowsy driving and teen MVC. Secondary school students (10thand 11thgrade, 51.7% female, 67.8% White) in the United Statescompleted annual surveys 1 year before and 2 years after implementation of later school start times (70-mindelay, n range 1642-2452 per year), reporting frequency of drowsy driving (less than once/week vs. at least once/week). Teen (16-18 years) MVC data from the Colorado Department of Transportation for the 2 yearsbefore and 2 yearsafter later start time implementation were compared for Arapahoe County (where start times changed) and neighboring Adams County and Douglas County (where start times did not change). With later start times, there was a significant drop in the percent of students who reported frequent drowsy driving (pre-change: 32.6%, post-change: 21.9%, follow-up: 22.8%). Weekday teen MVC rates went down in Arapahoe County (p = .04) during the school year, while no change or increases in MVC rates were seen in neighboring counties. Healthy school start times are important for adolescent health and safety, with study findings highlighting the downstream effects of increased sleep duration following a 70-min delay in secondary school start times on adolescent drowsy driving and teen MVC rates.

Novel use of a virtual driving assessment to classify driver skill at the time of licensure

Motor vehicle crash rates are highest immediately after licensure, and driver error is one of the leading causes. Yet, few studies have quantified driving skills at the time of licensure, making it difficult to identify at-risk drivers before independent driving. Using data from a virtual driving assessment implemented into the licensing workflow in Ohio, this study presents the first population-level study classifying degree of skill at the time of licensure and validating these against a measure of on-road performance: license exam outcomes. Principal component and cluster analysis of 33,249 virtual driving assessments identified 20 Skill Clusters that were then grouped into 4 major summary “Driving Classes”; i) No Issues (i.e. careful and skilled drivers); ii) Minor Issues (i.e. an average new driver with minor vehicle control skill deficits); iii) Major Issues (i.e. drivers with more control issues and who take more risks); and iv) Major Issues with Aggression (i.e. drivers with even more control issues and more reckless and risk-taking behavior). Category labels were determined based on patterns of VDA skill deficits alone (i.e. agnostic of the license examination outcome). These Skill Clusters and Driving Classes had different distributions by sex and age, reflecting age-related licensing policies (i.e. those under 18 and subject to GDL and driver education and training), and were differentially associated with subsequent performance on the on-road licensing examination (showing criterion validity). The No Issues and Minor Issues classes had lower than average odds of failing, and the other two more problematic Driving Classes had higher odds of failing. Thus, this study showed that license applicants can be classified based on their driving skills at the time of licensure. Future studies will validate these Skill Cluster classes in relation to their prediction of post-licensure crash outcomes.

Comment on "A National Survey of Motor Vehicle Crashes Among General Surgical Residents".

Comment on "A National Survey of Motor Vehicle Crashes Among General Surgical Residents".

Amending the heston stochastic volatility model to forecast local motor vehicle crash rates: A case study of Washington, D.C.

Modelling crash rates in an urban area requires a swathe of data regarding historical and prevailing traffic volumes and crash events and characteristics. Provided that the traffic volume of urban networks is largely defined by typical work and school commute patterns, crash rates can be determined with a reasonable degree of accuracy. However, this process becomes more complicated for an area that is frequently subject to peaks and troughs in traffic volume and crash events owing to exogenous events – for example, extreme weather – rather than typical commute patterns. One such area that is particularly exposed to exogenous events is Washington, D.C., which has seen a large rise in crash events between 2009 and 2020. In this study, we adopt a forecasting model that embeds heterogeneity and temporal instability in its estimates in order to improve upon forecasting models currently used in transportation and road safety research. Specifically, we introduce a stochastic volatility model that aims to capture the nuances associated with crash rates in Washington, D.C. We determine that this model can outperform conventional forecasting models, but it does not perform well in light of the unique travel patterns exhibited throughout the COVID-19 pandemic. Nevertheless, its adaptability to the idiosyncrasies of Washington, D.C. crash rates demonstrates its ability to accurately simulate localised crash rates processes, which can be further adapted in public policy contexts to form road safety targets.

Evaluation of motor vehicle crash rates during and after the COVID-19-associated stay-at-home order in Connecticut

IntroductionRecent research suggests that COVID-19 associated stay-at-home orders, or shelter-in-place orders, have impacted intra-and-interstate travel as well as motor vehicle crashes (crashes). We sought to further this research and to understand the impact of the stay-at-home order on crashes in the post order period in Connecticut. MethodsWe used a multiple-comparison group, interrupted time-series analysis design to compare crashes per 100 million vehicle miles traveled (VMT) per week in 2020 to the average of 2017–2019 from January 1-August 31. We stratified crash rate by severity and the number of vehicles involved. We modeled two interruption points reflecting the weeks Connecticut implemented (March 23rd, week 12) and rescinded (May 20th, week 20) its stay-at-home order. ResultsDuring the initial week of the stay-at-home order in Connecticut, there was an additional 28 single vehicle crashes compared to previous years (95% confidence interval (CI): [15.8, 36.8]). However, the increase at the order onset was not seen throughout the duration. Rescinding the stay-at-home order by and large did not result in an immediate increase in crash rates. Crash rates steadily returned to previous year averages during the post-stay-at-home period. Fatal crash rates were unaffected by the stay-at-home order and remained similar to previous year rates throughout the study duration. DiscussionThe initial onset of the stay-at-home order in Connecticut was associated with a sharp increase in the single vehicle crash rate but that increase was not sustained for the remainder of the stay-at-home order. Likely changes in driver characteristics during and after the order kept fatal crash rates similar to previous years.

634 Impact of Changing School Start Times on Drowsy Driving and Teen Motor Vehicle Crashes: A Longitudinal Examination

Abstract Introduction Early high school start times are associated with insufficient adolescent sleep, which in turn is associated with motor vehicle crashes [MVC]. This analysis examined the impact of a 70-minute delay in high school start times on student-reported drowsy driving and department of transportation MVC rates before and for 2 years after start time changes. Methods Self-reported sleep duration and drowsy driving data were drawn from a longitudinal study of changing high school start times (n=2099–4092/year) in the Cherry Creek School District (Arapahoe County [AC]). The Colorado Department of Transportation provided frequency/timing of weekday MVC data for teen (16–18 years) and adult drivers in AC and four neighboring counties in metro Denver (Other Counties [OC]). MVC rates per 1000 licensed drivers were calculated. Outcomes are reported for three school years: 2016–17 (pre-change), 2017–18 (post change), and 2018–19 (follow-up). Chi-square analyses examined drowsy driving frequency (at least once/week vs. less than once/week) by sufficient weeknight sleep duration (&amp;lt;8 hours vs. 8+ hours). Two-proportion z-tests compared MVC rates by county, as well as teens vs. adults. Results Compared to pre-change (29.3%), fewer students reported drowsy driving at post-change (20.3%) and follow-up (23.7%). Students who reported insufficient sleep also reported more frequent drowsy driving across all years (p’s&amp;lt;0.001 to 0.037). AC’s teen crash rate decreased from 78.9/1000 to 76.6/1000 post-change, with a further reduction to 68.7/1000 at follow-up. Pre-change crash rates did not differ between counties (p=0.444); however, they were significantly lower in AC vs. OC at both post-change (p=0.048) and follow-up (p=0.046). Adult crash rates remained consistent over three years in both counties. Morning crash rates per hour did not differ pre-change; at both post-change and follow-up OC’s morning crash rates peaked one hour earlier than AC’s (7:00-7:59am vs. 8:00-8:59am). Conclusion This study extends previous reports by finding that later school start times are associated with decreased drowsy driving and fewer teen motor vehicle crash rates for up to 2 years post-change. Early school start times is an important public policy that benefits adolescent sleep, health, and well-being through decreased drowsy driving and motor vehicle crashes. Support (if any) Robert Wood Johnson Foundation’s Evidence for Action Program

Cohort study of medical cannabis authorization and motor vehicle crash-related healthcare visits in 2014\u20132017 in Ontario, Canada

BackgroundWith increasing numbers of countries/jurisdictions legalizing cannabis, cannabis impaired driving has become a serious public health concern. Despite substantive research linking cannabis use with higher rates of motor vehicle crashes (MVC), there is an absence of conclusive evidence linking MVC risk with medical cannabis use. In fact, there is no clear understanding of the impact of medical cannabis use on short- and long-term motor vehicle-related healthcare visits. This study assesses the impact of medical cannabis authorization on motor vehicle-related health utilization visits (hospitalizations, ambulatory care, emergency department visits, etc) between 2014 and 2017 in Ontario, Canada.MethodsA matched cohort study was conducted on patients authorized to use medical cannabis and controls who did not receive authorization for medical cannabis – in Ontario, Canada. Overall, 29,153 adult patients were identified and subsequently linked to the administrative databases of the Ontario Ministry of Health, providing up to at least 6 months of longitudinal follow-up data following the initial medical cannabis consultation. Interrupted time series analyses was conducted to evaluate the change in rates of healthcare utilization as a result of MVC 6 months before and 6 months after medical cannabis authorization.ResultsOver the 6-month follow-up period, MVC-related visits in medical cannabis patients were 0.50 visits/10000 patients (p = 0.61) and − 0.31 visits/10000 patients (p = 0.64) for MVC-related visits in controls. Overall, authorization for medical cannabis was associated with an immediate decrease in MVC-related visits of − 2.42 visits/10000 patients (p = 0.014) followed by a statistically significant increased rate of MVC-related visits (+ 0.89 events/10,000 in those authorized medical cannabis) relative to controls in the period following their authorization(p = 0.0019). Overall, after accounting for both the immediate and trend effects, authorization for medical cannabis was associated with an increase of 2.92 events/10,000 (95%CI 0.64 to 5.19) over the entire follow-up period. This effect was largely driven by MVC-related emergency department visits (+ 0.80 events/10,000, p < 0.001).ConclusionsOverall, there was an association between medical cannabis authorization and healthcare utilization, at the population level, in Ontario, Canada. These findings have public health importance and patients and clinicians should be fully educated on the potential risks. Continued follow-up of medically authorized cannabis patients is warranted to fully comprehend long-term impact on motor vehicle crash risk.

The association between marijuana and motor vehicle crashes

IntroductionWe are just beginning to be able to detect the policy implications and public health effects of changes in marijuana laws and consumption in the United States on motor vehicle related fatalities. Most studies to date use classical regression methods to study these and are thus susceptible to both model and parameter uncertainty. This study examines the associations between marijuana and motor vehicle fatality rates taking these two issues of uncertainty into account using Bayesian sturdy-values, i.e., s-values. MethodThis study utilizes a new balanced panel dataset across all states and Washington, D.C. for the period 2010 to 2016 in the context of linear models using Bayesian s-values. It addresses the association between marijuana and alcohol consumption along with the legal environment across states and through time on crash fatalities. Other important factors such as the distractive influence of cell phones are studied. The s-value approach considers a vast number of model specifications and provides robust policy guidelines. ResultsA strong association between marijuana and alcohol use on motor vehicle crash rates is found. The statistical results are both substantial and robust, i.e., non-fragile. Other important variables include cell phone use, seat belt use, speed limit laws, and fleet modernization. ConclusionOur results have found strong evidence of a life-taking relationship between marijuana use and vehicle crashes. This suggests that policy makers recognize that legislation liberalizing marijuana use may have tragic ramifications regarding motor vehicle fatalities.

Driving Ability and Safety in Rheumatoid Arthritis: A Systematic Review.

To identify whether rheumatoid arthritis (RA) is associated with driving ability and/or the use of assistive devices or modifications to improve driving ability. We conducted a systematic literature review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines of RA and driving ability/adaptations by searching multiple databases from inception to April 2018. Eligible studies were original articles in the English language that had quantitative data regarding the study objective and at least 5 RA patients. Similar outcomes were extracted across studies and grouped into categories for review. Our search yielded 1,935 potential reports, of which 22 fulfilled eligibility criteria, totaling 6,285 RA patients. The prevalence of driving issues in RA was highly variable among the studies. Some of the shared themes addressed in these publications included RA in association with rates of motor vehicle crashes, self-reported driving difficulty, inability to drive, use of driving adaptations, use of assistance by other people for transport, and difficulty with general transportation. Despite variability among individual reports, driving difficulties and the use of driving adaptations are relatively common in individuals with RA. Given the central importance of automobile driving for the quality of life of RA patients, further investigations of driving ability and potential driving adaptations that can help overcome barriers to safe driving are needed.

Breast Hematoma: An Under-Recognized and Under-Reported Female-Specific Traumatic Injury and Its Clinical Significance.

Female-specific traumatic injury patterns have not been well researched and are potentially not well documented. Our aim was to examine the prevalence of breast hematomas (BHs) after blunt chest trauma, and to evaluate if there were risk factors associated with BH requiring intervention. A retrospective review from 2013 to 2018 was performed, identifying female patients ≥18 years sustaining blunt chest trauma. BH was defined as the presence of a collection of blood within the breast parenchyma, and clinically significant breast hematoma (CSBH) as BH requiring blood transfusion, surgical, or interventional radiology intervention. Univariate analysis was performed comparing CSBH with BH in terms of demographics, injury severity, antithrombotic agent use, and body mass index (BMI). Of 871 female patients meeting criteria, 59 (7%) had BH. Of these, 10 (17%) had CSBH (transfusion only, n = 3; angioembolization, n = 4; operation, n = 3). Compared to BH not requiring intervention, CSBH patients were older (mean age, 80 vs 69, P = .006), but had similar rates of motor vehicle crashes (90% vs 78%), seatbelt use (70% vs 71%), antiplatelet use (10% vs 12%), and anticoagulant use (10% vs 6%). Median Injury Severity Scores and median BMI (34 vs 34) were similar between the groups.

An examination of relationships between cannabis legalization and fatal motor vehicle and pedestrian-involved crashes

Objective While attention has been given to how legalization of recreational cannabis affects traffic crash rates, there was been limited research on how cannabis affects pedestrians involved in traffic crashes. This study examined the association between cannabis legalization (medical, recreational use, and recreational sales) and fatal motor vehicle crash rates (both pedestrian-involved and total fatal crashes). Methods We used crash data from the Fatality Analysis Reporting System (FARS) to calculate monthly rates of fatal motor vehicle crashes and fatal pedestrian-involved crashes per 100,000 people from 1991 to 2018. Changes in monthly crash rates in three states that had legalized cannabis (Colorado, Washington, and Oregon) were compared to matched control states using segmented regression with autoregressive terms. Results We found no significant differences in pedestrian-involved fatal motor vehicle crashes between legalized cannabis states and control states following medical or recreational cannabis legalization. Washington and Oregon saw immediate decreases in all fatal crashes (-4.15 and −6.60) following medical cannabis legalization. Colorado showed an increase in trend for all fatal crashes after recreational cannabis legalization and the beginning of sales (0.15 and 0.18 monthly fatal crashes per 100,000 people). Conclusions Overall findings do not suggest an elevated risk of total or pedestrian-involved fatal motor vehicle crashes associated with cannabis legalization.

Distracted Driving Laws and Motor Vehicle Crash Fatalities

Motor vehicle crashes (MVCs) continue to be the leading cause of death in youth 16 to 24 years old in the United States. Distracted driving has been shown to increase the risk of MVCs in all drivers, particularly teenagers. We aimed to determine the association between fatal MVC rates involving 16- to 19-year-old drivers and state distracted driving laws. We conducted a retrospective time series analysis of fatal MVCs in the United States involving drivers and passengers 16 to 19 years old from 2007 to 2017 using the Fatality Analysis Reporting System. Multivariable negative binomial regression analysis was performed to compare MVC rates across states on the basis of different types and strengths of distracted driving laws. There were 38 215 drivers 16 to 19 years old involved in fatal MVCs from 2007 to 2017. Incidence of fatal MVCs was highest for 19-year-old drivers (27.2 out of 100 000 19-year-old persons) and lowest for 16-year-olds (10.7 out of 100 000). States with primarily enforced texting bans had lower MVC fatality rates overall involving 16- to 19-year-old drivers (adjusted incidence rate ratio: 0.71; 95% confidence interval: 0.67-0.76). Texting bans and handheld bans for all drivers were associated with decreased MVC fatalities in all age groups. In the United States, primarily enforced distracted driving laws are associated with a lower incidence of fatal MVCs involving 16- to 19-year-old drivers. Bans on all handheld device use and texting bans for all drivers are associated with the greatest decrease in fatal MVCs. Adoption of universal handheld cellphone bans in all states may reduce the incidence of distracted driving and decrease MVC fatalities.

Motor Vehicle Crashes Involving a Bicycle Before and After Introduction of a Bike Share Program in Philadelphia, Pennsylvania, 2010-2018.

Objectives. To quantify the impact of a citywide bicycle share program on rates of motor vehicle collisions involving a bicycle.Methods. We conducted an interrupted time series analysis, using crash records from the Pennsylvania Department of Transportation for Philadelphia County from 2010 through 2018. We also calculated summary statistics to illustrate annual and monthly trends in rates of motor vehicle crashes involving a bicycle.Results. The baseline rate of bike events was 106% greater (95% confidence interval [CI] = 1.25, 3.38) at the time bicycle share was implemented compared with January 2010. Before bicycle share implementation, the rate of bicycle events decreased 1% (95% CI = 0.95, 1.03) annually. After the bicycle share program started, the rate of bicycle events decreased 13% (95% CI = 0.82, 0.94) annually.Conclusions. In the long term, programs that increase the number of bicycles on the road, such as bike share, may reduce rates of motor vehicle crashes involving a bicycle.

Working Memory Development and Motor Vehicle Crashes in Young Drivers

Adolescent drivers have the highest rate of motor vehicle crashes, and among equally novice drivers, crash risk is inversely age graded. Working memory (WM), crucial to driving hazard awareness, is also age graded, with ongoing development into late adolescence. Variability in WM capacity and growth trajectory positions WM as a candidate crash risk factor for study, clinical screening, and possible preventative intervention. To test the association between crashes and differential WM development. This prospective cohort study used data from a longitudinal cohort of 118 community youth in Philadelphia, Pennsylvania. Working memory and other risk factors were measured annually from age 11 to 13 years (prelicensure, in 2005) to 14 to 16 years (in 2009), and again at 18 to 20 years (in 2013). In 2015, a follow-up survey of driving experience identified 84 participants who had started driving. Latent growth curve modeling was used to examine the association between variability in the baseline (intercept) and developmental trajectory (slope) of WM and the crash outcome. Self-reported crashes were the primary outcome. Variability in the relative growth of WM development along with traits and behaviors associated with risky driving were assessed. Of 84 participants (39 [46%] male; mean [SD] age, 20.46 [1.09] years), 25 (29.8%) reported they had been involved in at least 1 crash. Controlling for other crash risk factors, the model indicated that variation in the linear slope of WM growth was inversely associated with reporting a crash (b = -6.41; SE = 2.64; P = .02). Crashes were also associated with reckless driving behavior (b = 0.40; SE = 0.18; P = .03). Variation in the intercept of WM was not associated with crashes (b = -0.245; SE = 0.67; P = .72). The results suggest that a relatively slower WM growth trajectory is associated with young driver crashes. Routine assessment of WM across adolescence may help to identify at-risk teen drivers and opportunities for providing adaptive interventions (eg, driving aids or training) that can address limitations in WM-related skills that are critical for safe driving.

Driver licensing and motor vehicle crash rates among young adults with amblyopia and unilateral vision impairment

This retrospective cohort study investigated whether unilateral vision impairment (UVI) or amblyopia are associated with driver licensing and crash risk among young adults. Electronic health records for New Jersey residents who were patients with the Children's Hospital of Philadelphia's healthcare network were linked to statewide driver licensing and crash data. We compared young adults with a diagnosis of UVI and/or amblyopia to peers without such a diagnosis. Young adults with UVI or amblyopia were less likely to acquire a driver's license than those without these conditions. However, among licensed drivers, the risk of a police-reported crash was similar in all three groups.

Trends and Outcomes of Pediatric Vascular Injuries in the United States: An Analysis of the National Trauma Data Bank

According to the Center for Disease Control and Prevention, trauma is the leading cause of death in children aged >1year in the United States (US). Although vascular injuries occur in only 0.6-1% of pediatric patients with trauma, they are a major mortality contributor. This study aims to examine epidemiology and outcomes after pediatric vascular injuries (PedVIs) in the US. The National Trauma Data Bank (2002-2012) was queried to identify children (0-16) with PedVIs. Patients were categorized based on their demographics, location, and mechanism and presenting trauma severity (injury severity score [ISS] and shock). Study was divided into two 5-year periods (P1: 2002-2006; P2: 2007-2012) to study the trends in pediatric vascular trauma presentation and outcomes (hospital death and extended length of stay [LOS >8days]) using adjusted analyses. Analyses were performed on 3,408 cases; who were male (73.7%) and Caucasian (52.8%) with a mean age of 10.5±4.5years. The Southern region of the US saw the highest increase in PedVIs (P2 versus P1: 38.3% vs. 25.0%, P<0.05). Blunt injuries constituted most of these injuries (57%). Firearm (36.9%) and motor vehicle crash (MVC) (34%) were the most common lethal mechanisms of injury. Despite the significant decrease in MVC rates (P2 versus P1: 17.4% vs. 22.6%, P<0.05), firearm rates were unchanged. Upper extremity injuries were the most common anatomically (34.9%). ISS and shock were significantly decreased during P2. Mortality occurred in 7.9% of patients, which significantly decreased (P2 versus P1: 6.3% vs. 10.9%, P<0.001) without a significant change in LOS. Odds of mortality decreased by 32% during P2 (P=0.08) and was independently associated with penetrating mechanism of injury (odds ratio [OR]: 1.97; 95% confidence interval [CI]: 1.22-3.19, P=0.006), shock at presentation (OR: 5.48; 95% CI: 3.55-8.46, P<0.001); ISS (OR: 1.08; 95% CI: 1.06-1.27, P<0.001), and Glasgow Coma Score<9 (OR: 11.21; 95% CI: 7.18-17.49, P<0.001). We observed a significant decrease in the overall severity of injury and in-hospital mortality concurrent with the observation of a significant decrease in the rates of pediatric MVC vascular injuries. Public health policies directed toward firearm safety may further decrease PedVIs and mortality among this vulnerable population.