Risk Factors For Fatality Research Articles

Incidence of fatalities of road traffic accidents associated with alcohol consumption and the use of psychoactive drugs: A 7-year survey (2011-2017).

Driving under the influence of alcohol and/or psychoactive substances increases the risk of severe, even fatal motor vehicle accidents. The aim of this descriptive study was to present the impact of alcohol and/or psychoactive substances on fatal road traffic accidents (RTAs) during the period 2011-2017. For this purpose, the toxicological investigation reports from the Department of Forensic Medicine and Toxicology of the University of Athens were used. In total, 1,841 (32.2%) of the autopsies conducted by the Department of Forensic Medicine and Toxicology of the National and Kapodistrian University of Athens over a 7-year period (2011-2017) were victims of fatal RTAs. Blood and urine samples were collected and analyzed for the presence of alcohol and psychoactive substances. The results were classified according to sex, age, victim (car driver, motorcyclist, pedestrian, or passenger) and the date the accident occurred (day, month and year). In total, 40.7% of the RTA-related fatalities were associated with alcohol consumption, among which 20.3% were car drivers. Of these, 87.3% were male victims. A higher frequency of RTA-related fatalities associated with a blood alcohol concentration (BAC) >110 mg/dl was encountered in younger compared with older age groups. Psychoactive substances were detected in 348 (18.9%) of the victims (cannabis in 46.6% of these, benzodiazepines in 25.9%, opiates in 16.4% and cocaine in 11.1% of these). The percentage of the RTA-related victims that had consumed alcohol in combination with other psychoactive substances was 4.5%. On the whole, the findings of this study suggest that alcohol and psychoactive substances are probably risk factors for RTA-related fatalities.

Risk of suicide and repeat self-harm after hospital attendance for non-fatal self-harm in Sri Lanka: a cohort study

SummaryBackgroundEvidence from high income countries (HICs) suggests that individuals who present to hospital after self-harm are an important target for suicide prevention, but evidence from low and middle-income countries (LMICs) is lacking. We aimed to investigate the risk of repeat self-harm and suicide, and factors associated with these outcomes, in a large cohort of patients presenting to hospital with self-harm in rural Sri Lanka.MethodsIn this cohort study, hospital presentations for self-harm at 13 hospitals in a rural area of North Central Province (population 224 000), Sri Lanka, were followed up with a self-harm surveillance system, established as part of a community randomised trial, and based on data from all hospitals, coroners, and police stations in the study area. We estimated the risk of repeat non-fatal and fatal self-harm and risk factors for repetition with Kaplan-Meier methods and Cox proportional hazard models. Sociodemographic (age, sex, and socioeconomic position) and clinical (past self-harm and method of self-harm) characteristics investigated were drawn from a household survey in the study area and data recorded at the time of index hospital presentation. We included all individuals who had complete data for all variables in the study in our primary analysis.OutcomesBetween July 29, 2011, and May 12, 2016, we detected 3073 episodes of self-harm (fatal and non-fatal) in our surveillance system, of which 2532 (82·3%) were linked back to an individual in the baseline survey. After exclusion of 145 ineligible episodes, we analysed 2259 index episodes of self-harm. By use of survival models, the estimated risk of repeat self-harm (12 months: 3· 1%, 95% CI 2·4–3·9; 24 months: 5·2%, 4·3–6·4) and suicide (12 months: 0·6%, 0·4–1·1; 24 months: 0·8%, 0·5–1·3) in our study was considerably lower than that in HICs. A higher risk of repeat self-harm was observed in men than in women (fatal and non-fatal; hazard ratio 2·0, 95% CI 1·3–3·2; p=0·0021), in individuals aged 56 years and older compared with those aged 10–25 years (fatal; 16·1, 4·3–59·9; p=0·0027), and those who used methods other than poisoning in their index presentation (fatal and non-fatal; 3·9, 2·0–7·6; p=0·00027). We found no evidence of increased risk of repeat self-harm or suicide in those with a history of self-harm before the index episode.InterpretationAlthough people who self-harm are an important high-risk group, focusing suicide prevention efforts on those who self-harm might be somewhat less important in LMICs compared with HICs given the low risk of repeat self-harm and subsequent suicide death. Strategies that focus on other risk factors for suicide might be more effective in reducing suicide deaths in LMICs in south Asia. A better understanding of the low incidence of repeat self-harm is also needed, as this could contribute to prevention strategies in nations with a higher incidence of repetition and subsequent suicide death.FundingWellcome Trust.

Epidemiology of suicide in 10–19 years old in southern Iran, 2011–2016: A population-based study on 6720 cases

ObjectiveGlobally, suicide is the second leading cause of death among young people. Although completed suicide is rare before puberty, the incidence of adolescent suicide has increased significantly at the late ages of 10–19. Hence, this study investigates the adolescent suicide, aged 10–19, in southern Iran. MethodsIn this cross-sectional study, all data regarding the demographics, causes, methods, outcomes, past medical history of suicide attempts and suicide death were collected from the Mental Health and Suicide Surveillance Systems of Fars province between 2011 and 2016. ResultsOverall 6-year incidence rate of suicide attempts and death were 193.49/100,000 and 7.91/100,000, respectively. Case-fatality rate was 4.09%. During the period of 6 years, an increasing trend has been observed for both the rates of suicide attempt and death. Family conflicts were the major cause and medication overdose was the main method of suicides. After controlling the effects of confounders by logistic regression, male gender, living in the rural area and age are among the risk factors of fatality in suicide attempts. ConclusionsSuicide attempts and deaths have been increased in adolescents. Therefore, due to the vulnerability of this age group, we need to understand all components of suicide to educate families and to help policy makers.

Incidence, risk factors, clinical profile, and determinants (affecting outcome) of new onset acute kidney injury developing in critically Illpatients in pediatric intensive care unit of a tertiary hospital in middle India

Aim/Objectives: To study the incidence, clinical-profile of AKI developing in critically-ill children after admission to PICU, including its risk-factors and determinants affecting patient outcome. Material/Methods: This prospective observational study was conducted at a tertiary teaching hospital (Pt JNM Medical College Raipur, CG, India) over a study period of 12 months (August 2017-July 2018). Those patients who satisfied the inclusion-criteria of having critical-illness requiring PICU admission, age between 1month to 18 years,anddevelopingin-hospital AKI were enrolled; and after obtaining written informed-consent from parents, their basic demographic, clinical details and laboratory reports were entered from case records into predesigned proforma and then data was compiled in Microsoft Excel-Sheet. AKI staging was obtained using pRIFLE criteria (2007) and compared with renal-recovery and patient-survival. SPSS software (version 21) was used for data-analysis and p-value <0.05 was taken for statistical significance. Results: Out of total 1042 critically-ill children admitted during study-period, 103 developed new-onset AKI in PICU (overall incidence 9.8%). Among them, 96 patients died (93.2%cases). Maximum subjects developing in-hospital AKI had three major associated fatal risk-factors like refractory shock (80.5%), severe sepsis (68%) and MODS (62.1%). But only MODS (p=0.002) and refractory-shock (p=0.0001) showed significant association with fatal outcome. Maximum new-onset AKI cases developed within 3 days of PICU admission (62%). No statistically-significant association was observed between different AKI-stages and renal-recovery or patient-survival. Conclusion: Sepsis was common underlying risk-factor for new-onset AKI in critically-ill patients admitted in PICU, while association of MODS and/or refractory shock majorly determined poor survival-outcome.

Child welfare workers’ knowledge of risk factors for child maltreatment fatalities: a second multi-state assessment

ABSTRACT This paper reports results from a second study which examines the knowledge and training of child welfare professionals with regard to risk factors for fatal child maltreatment. This multi-state, online study (n = 619) shows that workers have gaps in their knowledge of risk factors for maltreatment-related deaths. The majority of workers had received training, but it had little impact on worker knowledge. Workers reported receiving a variety of trainings on risks for fatalities, with different sources, length of training, and foci. Workers who received training that focused on research-based risk factors had higher levels of knowledge than other workers.

Identifying Fatality Risk Factors for the Commercial Vehicle Driver Population

Commercial/large-truck fatal crash involvement by drivers of different age groups is a critical issue for the trucking industry. Escalating safety concerns related to these heavy vehicles serving the freight economy in the U.S. have an impact national freight reliability and economic growth. This study identifies major contributing factors leading to large-truck fatal crashes for four age groups of driver: &lt;30, 30–49, 50–65, and 65+. The analysis in this study is based on five years (2012–2016) of Fatality Analysis Reporting System data and provides an overall picture of risk factors in large-truck fatal crashes. In total, 30 variables were found to be significant in the logit models, indicating varying risks associated with large-truck drivers of these four age groups. Model results indicate different risk factors associated with driver characteristics, spatial and temporal characteristics, vehicle and vehicle maneuvering characteristics, and environmental conditions at the time of the crashes. Identifying the risk factors for different age groups of drivers is important so proper countermeasures can be implemented from the perspective of human factors (e.g., safe speed choice, fatigue), roadway engineering (e.g., design of roadside barriers, radius of ramps), enforcement (e.g., presence of law enforcement personnel at critical locations), and emergency medical attention in remote areas. Considering the aging of the truck driver population in the U.S. and around the world, the findings of this study are vital to understand better the importance of safety in relation to large-truck fatal crashes.

Competing Risks Model with Partially Step-Stress Accelerate Life Tests in Analyses Lifetime Chen Data under Type-II Censoring Scheme

Abstract The experiment design may need a stress level higher than use condition which is called accelerate life tests (ALTs). One of the most ALTs appears in different applications in the life testes experiment is partially step stress ALTs. Also, the experiment items is failure with several fatal risk factors, the only one is caused to failure which called competing risk model. In this paper, the partially step-stress ALTs based on Type-II censoring scheme is adopted under the different risk factors belong to Chen lifetime distributions. Under this assumption, we will estimate the model parameters of the different causes with the maximum likelihood method. The two, asymptotic distributions and the parametric bootstrap will be used to build each confidence interval of the model parameters. The precision results will be assessed through Monte Carlo simulation study.

An Epidemiological Study of Traumas Caused by Motorcycle Crashes in Shahid Rajaee Hospital, Shiraz, Iran in 2013 - 2016

Background: Road traffic injuries (RTIs) are one of the main causes of death and disability throughout the world. In this regard, motorcyclists constitute the most vulnerable groups. By investigating the epidemiological characteristics of motorcycle crashes, we can attain valuable information about research priorities. Objectives: We decided to conduct this study aiming at determining the epidemiological pattern of RTIs among motorcyclists in Shiraz in 2013 - 2016. Methods: In this cross-sectional study, we reviewed all information related to motorcycle crashes that took place in Shiraz from January 2013 to December 2016. The injured motorcyclists were classified according to their age, gender, the severity of the injury, injured region, length of hospital stay, hospital-acquired infections, and the outcomes. We also performed a logistic regression analysis to determine the risk factors for fatality in motorcycle crashes. Results: According to our results, from all motorcycle crashes, 13577 (91.5%) were related to men and 1258 (8.5%) to women. Furthermore, most injured motorcyclists were in the 15 - 29-year-old age group. Crashes mostly occurred on weekends and in warm seasons. A hospital stay of more than one month (OR = 4.93, CI: 2.32 - 10.46) and an ISS of 9 - 15 (OR = 7.56, CI: 3.68 - 15.56) were the most effective risk factors for motorcyclist fatality. Conclusions: According to the study, since most motorcycle crashes involved the youth, enforcing stricter laws and cultural developments towards correcting risky behaviors can be very important in reducing the rates of death and disability.

An Exploratory Analysis of Seven Child Welfare Workers who Confused SIDS with Child Maltreatment Fatalities: A Brief Research Report

Previous research shows that child welfare workers (CWWs) have low levels of knowledge of risk factors for child maltreatment fatalities. Further, these gaps in knowledge leave CWWs with misconceptions about causes of deaths and the characteristics of the perpetrators. This brief research report focuses on CWWs’ gaps in knowledge with regard to CMFs and sudden infant death syndrome (SIDS) and explores the socio-demographic characteristics of seven workers who confused fatal child maltreatment and SIDS. These workers were experienced professionals—who were in their middle-age, mid-career, and well-educated—and had been trained in how to recognize risk factors for CMFs. Implications for training and collaboration with other professionals are discussed, as well as the need for research to evaluate training efficacy.

Dengue Infection in Children: Clinical Profile and Outcome in Dhaka City

Dengue is a self-limiting acute mosquito born disease caused by Dengue virus. Dengue infections may be asymptomatic or can result in a wide spectrum of disease severity ranging from an influenza-like illness (Dengue fever) to the life-threatening Dengue hemorrhagic fever (DHF)/Dengue shock syndrome (DSS). We aimed to analyze the variation in clinical spectrum, outcome and possible risk factors for fatality among Dengue infected children. This was an observational study carried out over a period of one year involving 89 children up to 15 years of age. Upon clinical suspicion Dengue was confirmed by NS 1 antigen and/or Dengue antibody IgM, IgG. Positive Dengue cases were enrolled & interviewed and the information obtained related to the risk factors, clinical presentation, pattern of Dengue infection and outcome were documented in the pre-structured questionnaire. Among the 89 studied children the highest percentage (51.68%) was between 0-5 year and male female ratio was 1.2: 1. Mosquito net was not used by (74.15%) children and there was source of stagnant water in/near the house of (13.48%) children. Fever was present in (100%), rash in (48.31%), nausea/vomiting in (37.07%), headache in (12.35%), myalgia/arthralgia/backache (13.48%), retro orbital pain (1.12%) and abdominal pain in (23.59%) patient. Epistaxis was the commonest (70%) form of bleeding. CNS involvement was in the form of restlessness/irritability (19.10%), altered sensorium (2.24%) and convulsion. Pleural effusion was commoner than ascites; (25.84%) and (12.35%) respectively. Among the enrolled children Dengue fever was (74.15%), Dengue hemorrhagic fever (6.74%) and Dengue shock syndrome (19.10%). Two patients died out of 17 from Dengue shock syndrome which was (11.76%). World Health Organization (WHO) guideline based management should be applied in assessing and managing Dengue cases to reduce mortality rate. Public awareness should be widened to prevent Dengue.

Anaphylaxis in Children: Epidemiology, Risk Factors and Management.

Anaphylaxis is defined as a serious, generalized or systemic allergic reaction that is rapid in onset and may cause death. It is unpredictable and can be the result of various allergic triggers including food, insect venom and medication. The European Anaphylaxis Registry confirmed food as the major elicitor of anaphylaxis in children, specifically hen's egg, cow's milk and nuts. It has been reported that the incidence of anaphylaxis is on the rise. In the US, there is a continued trend of increasing food-induced anaphylaxis hospitalizations among children, which is supported by nationally representative data. Anaphylaxis can occur both in the home and outdoors and can be life-threatening, however, fatalities are a rare occurrence. A recent systematic review and meta-analysis reported that fatal food anaphylaxis is rarer than accidental death in the general population. Studies of fatal and near-fatal allergic reactions have identified potential risk factors for fatalities and have provided important information that may help minimize future risk. Following confirmation of the relevant allergen trigger, prevention of anaphylaxis is through strict avoidance of the allergen and optimal management of existing co-morbidities. The cornerstone in the successful management of anaphylaxis is early recognition of signs and symptoms and the prompt administration of intramuscular adrenaline. Patients and their families need to be well educated on how to manage potential anaphylactic reactions with training in the use of adrenaline auto-injectors and personalized emergency management plans. Healthcare professionals must be familiar with this clinical emergency and able to respond to anaphylaxis in a timely and appropriate manner.

Rural-Urban Differences in Risk Factors for Motor Vehicle Fatalities.

Purpose: To examine rural–urban differences in motor vehicle fatality (MVF) risk factors.Methods: We used 2017 County Health Rankings data to run stratified regression models to estimate county-level correlates of motor vehicle fatalities (MVFs) by rural and urban location.Results: Rural counties have higher rates of MVFs than urban counties (22 vs. 14 per 100,000, p<0.001). Physical inactivity and uninsurance were associated with higher rates of MVFs, as was having a more racially or ethnically concentrated population and larger percentages of younger or older adults.Conclusion: Interventions to reduce MVFs should take geographic location and population composition into account.

Epidemiology of Pedestrian–Motor Vehicle Fatalities and Injuries, 2006–2015

Pedestrian road safety remains a public health priority. The objective of this study is to describe trends in fatalities and injuries after pedestrian-motor vehicle collisions in the U.S. and identify associated risk factors for pedestrian fatalities. This is a cross-sectional study of U.S. pedestrian-motor vehicle collisions from 2006 to 2015 (performed in 2017). Pedestrian fatality and injury data were obtained from the National Highway Traffic Safety Administration's Fatality Analysis Reporting System and National Automotive Sampling System General Estimates System. Frequencies of fatalities, injuries, and associated characteristics were calculated. Multivariable logistic regression was performed for risk of fatality, controlling for demographic and crash-related factors. There were 47,789 pedestrian fatalities and 674,414 injuries during the 10-year study period. Fatality rates were highest among the elderly aged 85 years and older (2.95/100,000 population), whereas injury rates were highest for those aged 15-19 years (35.23/100,000 population). Predictors associated with increased risk for death include the following: male sex (AOR=1.36, 95% CI=1.15, 1.62), age ≥65 years (AOR=3.44, 95% CI=2.62, 4.50), alcohol involvement (AOR=2.63, 95% CI=1.88, 3.67), collisions after midnight (AOR=5.21, 95% CI=3.20, 8.49), at non-intersections (AOR=2.76, 95% CI=2.21, 3.45), and involving trucks (AOR=2.15, 95% CI=1.16, 3.97) and buses (AOR=5.82, 95% CI=3.67, 9.21). Potentially modifiable factors are associated with increased risk of death after pedestrian-motor vehicle collisions. Interventions including elder-friendly intersections and increasing visibility of pedestrians may aid in decreasing pedestrian injuries and deaths.

The epidemiology of respiratory syncytial virus: A retrospective review from Steve Biko Academic Hospital 2013 - 2016.

Background Respiratory syncytial virus (RSV) bronchiolitis is a seasonal disease that has an enormous burden on health systems across the world. RSV disease manifestations in children range from mild upper respiratory tract infections to severe lower respiratory tract infections, including pneumonia and bronchiolitis. In South Africa, the seasonality of RSV disease causing both upper and lower respiratory tract illness is well documented. Objectives To describe the incidence of RSV bronchiolitis among patients ≤24 months of age who presented to a tertiary institution with a diagnosed viral bronchiolitis over a 4-year period. Secondary aims included determining: (i) the risk factors for the development of RSV bronchiolitis; (ii) the fatality rates and risk factors associated with mortality; (iii) the correlation with c-reactive protein values and risk of comorbid bacterial infection; and (iv) the impact of seasonality on RSV incidence. Methods A retrospective chart-based analysis of laboratory-confirmed RSV cases in children ≤24 months, presenting to Steve Biko Academic Hospital from January 2013 to December 2016, was undertaken. Epidemiology, risk factors and local weather data were collected as part of the analysis. Results During the 4-year period, a total of 1 127 nasopharyngeal aspirates (NPAs) was collected. RSV was isolated from 162 NPAs by either immunofluorescence (84%) or polymerase chain reaction (16%). Of the 162 patients with RSV bronchiolitis, 131 (80.9%) had a known HIV status. Only 2 (1.5%) of the patients whose status was known were HIV-infected; 26 (19.8%) were HIV-exposed and confirmed negative; and 103 (78.6%) HIV-unexposed. Forty-nine patients (30.2%) with RSV required intensive care unit (ICU, either paediatric or neonatal) admission. Thirty-four (69.4%) of these were <6 months old. Prematurity (27.8%) and cardiac lesions (13%) were the most common risk factors for acquiring the disease identified in patients with RSV bronchiolitis. Conclusion RSV is still a commonly detected virus among infants who are admitted for bronchiolitis. Significant risk factors associated with admission due to RSV bronchiolitis were prematurity, being <6 months of age and congenital cardiac disease. Male gender and HIV status did not appear to increase the risk of RSV bronchiolitis. In fact, HIV seems to have a protective effect against specifically RSV bronchiolitis in children <2 years of age. Young babies, especially premature infants with RSV bronchiolitis, are at considerable risk of requiring ICU admission, which leads to a significant increase in admission costs.

Risk factors for race-day fatality in flat racing Thoroughbreds in Great Britain (2000 to 2013).

A key focus of the racing industry is to reduce the number of race-day events where horses die suddenly or are euthanased due to catastrophic injury. The objective of this study was therefore to determine risk factors for race-day fatalities in Thoroughbred racehorses, using a cohort of all horses participating in flat racing in Great Britain between 2000 and 2013. Horse-, race- and course-level data were collected and combined with all race-day fatalities, recorded by racecourse veterinarians in a central database. Associations between exposure variables and fatality were assessed using logistic regression analyses for (1) all starts in the dataset and (2) starts made on turf surfaces only. There were 806,764 starts in total, of which 548,571 were on turf surfaces. A total of 610 fatalities were recorded; 377 (61.8%) on turf. In both regression models, increased firmness of the going, increasing racing distance, increasing average horse performance, first year of racing and wearing eye cover for the first time all increased the odds of fatality. Generally, the odds of fatality also increased with increasing horse age whereas increasing number of previous starts reduced fatality odds. In the ‘all starts’ model, horses racing in an auction race were at 1.46 (95% confidence interval (CI) 1.06–2.01) times the odds of fatality compared with horses not racing in this race type. In the turf starts model, horses racing in Group 1 races were at 3.19 (95% CI 1.71–5.93) times the odds of fatality compared with horses not racing in this race type. Identification of novel risk factors including wearing eye cover and race type will help to inform strategies to further reduce the rate of fatality in flat racing horses, enhancing horse and jockey welfare and safety.

Understanding fatal older road user crash circumstances and risk factors

ABSTRACTObjective: This study used medicolegal data to investigate fatal older road user (ORU) crash circumstances and risk factors relating to four key components of the Safe System approach (e.g., roads and roadsides, vehicles, road users, and speeds) to identify areas of priority for targeted prevention activity.Methods: The Coroners Court of Victoria's Surveillance Database was searched to identify coronial records with at least one deceased ORU in the state of Victoria, Australia, for 2013–2014. Information relating to the ORU, crash characteristics and circumstances, and risk factors was extracted and analyzed.Results: The average rate of fatal ORU crashes per 100,000 population was 8.1 (95% confidence interval [CI] 6.0–10.2), which was more than double the average rate of fatal middle-aged road user crashes (3.6, 95% CI 2.5–4.6). There was a significant relationship between age group and deceased road user type (χ2(15, N = 226) = 3.56, p < 0.001). The proportion of deceased drivers decreased with age, whereas the proportion of deceased pedestrians increased with age. The majority of fatal ORU crashes involved a counterpart (another vehicle: 59.4%; fixed/stationary object: 25.4%), and occurred “on road” (87.0%), on roads that were paved (94.2%), dry (74.2%), and had light traffic volume (38.3%). Road user error was identified by the police and/or coroner for the majority of fatal ORU crashes (57.9%), with a significant proportion of deceased ORU deemed to have “misjudged” (40.9%) or “failed to yield” (37.9%).Conclusions: Road user error was the most significant risk factor identified in fatal ORU crashes, which suggests that there is a limited capacity of the Victorian road system to fully accommodate road user errors. Initiatives related to safer roads and roadsides, vehicles, and speed zones, as well as behavioral approaches, are key areas of priority for targeted activity to prevent fatal older road user crashes in the future.

Community-acquired methicillin-resistant Staphylococcus aureus infections: hospitalization and case fatality risk in 10 pediatric facilities in Argentina.

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are prevalent both in Argentina and worldwide, and they may have a severe clinical course. To estimate the hospitalization rate and case fatality risk factors of CA-MRSA infection. Cross-sectional, analytical study. All patients < 15 years old with community-acquired Staphylococcus aureus (CA-SA) infections admitted to 10 pediatric facilities between January 2012 and December 2014 were included. Out of 1141 patients with CA-SA, 904 (79.2%) had CA-MRSA. The rate of hospitalization of CA-MRSA cases (per 10 000 discharges) among patients < 5 years old was 27.6 in 2012, 35.2 in 2013, and 42.7 in 2014 (p = 0.0002). The 2-4-year-old group was the most affected one: 32.2, 49.4, and 54.4, respectively (p = 0.0057). The clinical presentations included skin and soft tissue infections: 66.2%, pneumonia: 11.5%, sepsis/bacteremia: 8.5%, osteomyelitis: 5.5%, arthritis: 5.2%, psoas abscess: 1.0%, pericarditis/endocarditis: 0.8%, meningitis: 0.6%, and other: 0.7%. In terms of antibiotic resistance, 11.1% had resistance to erythromycin; 8.4%, to gentamicin; and 0.6%, to trimethoprim-sulfamethoxazole. All strains were susceptible to vancomycin. The case fatality rate was 2.2% and associated risk factors were (odds ratio [95% confidence interval]) age > 8 years (2.78, 1.05-7.37), pneumonia (6.37, 2.3717.09), meningitis (19.53, 2.40-127.87), and sepsis/bacteremia (39.65, 11.94-145.55). The rate of CA-MRSA infection was high; the rate of hospitalization increased in the 2013-2014 period; the 2-4-year-old group was the most affected one. A higher case fatality risk was observed among patients > 8 years old and those with the clinical presentations of pneumonia, meningitis, and sepsis.

Comparison of risk factors for pedestrian fatality in urban and suburban traffic accidents

Background: The burden of traffic accidents on pedestrians is very high in Iran. Since the pattern of injury is different in urban and suburban accidents, this study was conducted to identify the risk factors associated with pedestrian mortality in urban and suburban traffic accidents in Tehran and Alborz Provinces. Materials and Methods: The data of all traffic accidents related to pedestrians in Tehran and Alborz Provinces were investigated from two databases of traffic police and forensic medicine. The effects of demographic variables (age and gender) and pedestrian position, time, accident location, and vehicle type on the outcome of pedestrian death were investigated. Multiple logistic regression was used to analyze the data. The significance level was considered 65 years compared to 15–24 years (odds ratio [OR]: 2.04, confidence interval [CI]: 1.26–3.3), (OR: 4.8, CI: 2.9–7.9), male gender (OR: 2.26, CI: 1.6–3.1), lighting condition at night compared to day (OR: 1.6, CI: 1.2–2.1), two-way not divided road versus one-way road (OR: 1.6, CI: 1.12–2.3), the status of day after holidays compared to normal days (OR: 1.53, CI: 1.09–2.14), type of vehicle such as heavy or semi-heavy and conventional or pickup versus motorcycles or bicycles (OR: 5.4, CI: 3.1–8.9) and (OR: 1.8, CI: 1.2–2.7) and pedestrian position at crossing the road from an unauthorized route compared to crossing the road from the authorized route (OR: 1.94, CI: 1.4–2.6) were significant on the fatality. Whereas in suburban accidents, there was a statistically significant correlation with pedestrian fatality only in two-way divided road compared to one-way (OR: 0.2, CI: 0.05–0.77). Conclusion: The present study showed that risk factors for pedestrian mortality are different in urban and suburban traffic accidents. It is necessary to take appropriate measures in urban and suburban areas to reduce the severity of injuries in pedestrians.

Risk factors for race-day fatality, distal limb fracture and epistaxis in Thoroughbreds racing on all-weather surfaces in Great Britain (2000 to 2013)

The incidence of race-day injuries in Great Britain (GB) is higher on all-weather (AW) surfaces than on turf. However, to date no studies have focused on identifying risk factors for injury specific to AW racing. Therefore, the objective of the current study was to determine risk factors for fatality, distal limb fracture (DLF) and episodes of epistaxis in flat racing Thoroughbreds racing on AW surfaces in GB. Data included all flat racing starts on AW surfaces (n=258,193) and race-day veterinary events recorded between 2000 and 2013. Information on additional course-level variables was gathered during face-to-face interviews with racecourse clerks. Horse-, race- and course-level risk factors for each outcome were assessed using mixed-effects multivariable logistic regression including horse as a random effect. A classification tree method was used to identify potential interaction terms for inclusion in the models. During the study period, there were 233 fatalities resulting in a fatality incidence of 0.90 per 1000 starts; 245 DLF with a resultant DLF incidence of 0.95 per 1000 starts and 410 episodes of epistaxis resulting in an epistaxis incidence of 1.59 per 1000 starts. Risk factors varied for each outcome, although some factors were similar across models including the going, racing intensity, horse age, age at first race start, horse and trainer performance variables. Generally, older horses and those that had started racing at an older age were at higher risk of an adverse outcome, albeit with an interaction between the two variables in the fatality model. Faster going increased the odds of epistaxis and DLF but not fatality. Increasing race distance increased the odds of fatality but reduced the odds of epistaxis. Epistaxis was associated with type of AW surface (Fibresand versus Polytrack®), but DLF and fatality were not. This study provides further evidence of the association between the risk of race-day injuries and fatalities and current age, age at first start, race distance, going and horse performance. These findings provide the racing industry with information to develop strategies to reduce the occurrence of race-day events on AW surfaces.

Using medico-legal data to investigate fatal older road user crash circumstances and risk factors

ABSTRACTObjective: This study used medico-legal data to investigate fatal older road user (ORU, aged 65 years and older) crash circumstances and risk factors relating to 4 key components of the Safe System approach (e.g., roads and roadsides, vehicles, road users, and speeds) to identify areas of priority for targeted prevention activity.Method: The Coroners' Court of Victoria's (CCOV) Surveillance Database was searched to identify and describe the frequency and rate per 100,000 population of fatal ORU crashes in the Australian state of Victoria for 2013–2014. Information relating to the deceased ORU, crash characteristics and circumstances, and risk factors was extracted and analyzed.Results: One hundred and thirty-eight unintentional fatal ORU crashes were identified in the CCOV Surveillance Database. Of these fatal ORU crashes, most involved older drivers (44%), followed by older pedestrians (32%), older passengers (17%), older pedal cyclists (4%), older motorcyclists (1%), and older mobility scooter users (1%). The average annual rate of fatal ORU crashes per 100,000 population was 8.1 (95% confidence interval [CI], 6.0–10.2). In terms of the crash characteristics and circumstances, most fatal ORU crashes involved a counterpart (98%), of which the majority were passenger cars (50%) or fixed/stationary objects (25%), including trees (46%) or embankments (23%). In addition, most fatal ORU crashes occurred close to home (73%), on-road (87%), on roads that were paved (94%), on roads with light traffic volume (37%), and during low-risk conditions: between 12 p.m. and 6 p.m. (44%), on weekdays (80%), during daylight (75%), and under dry/clear conditions (81%). Road user (RU) error was identified by the police and/or the coroner for the majority of fatal crashes (55%), with a significant proportion of deceased ORUs deemed to have failed to yield (54%) or misjudged (41%).Conclusions: RU error was the most significant factor identified in fatal ORU crashes, which suggests that there is a limited capacity of the road system to fully accommodate RU errors. Initiatives related to safer roads and roadsides, vehicles, speed zones, as well as behavioral approaches are key areas of priority for targeted activity to prevent fatal ORU crashes in the future.