Traffic-related Injuries Research Articles

There and Back Again: Safety and Health on the Journey to School

* Abbreviations: AST — : active school transportation SRTS — : Safe Routes to School Active school transportation (AST) has been associated with children attaining more moderate-to-vigorous physical activity and a healthier BMI.1–3 Similar to Canadian children, US rates of AST declined from 48% in 1969 to 13% in 2009.4 There are many reasons for this decline, but parents report distance (62% of respondents), traffic-related injury (30%), and weather (19%) as the top 3 barriers.5 There are many benefits to AST. Children in developed countries are not sufficiently active and obesity remains a global threat.6 Families driving students to school represent 10% to 14% of US traffic during the morning commute,4 and often such trips are less than a half mile. Communities that have invested in infrastructure to promote walking or biking have shown increased property values, improved air quality, reduced urban heat injury, and greater social cohesion.7–9 In 2005, the US Congress established a Safe Routes to School (SRTS) program to improve safety on walking and bicycling routes to elementary and middle schools and to encourage travel between home and school using these modes.10 SRTS was … Address correspondence to Gilbert Chien Liu, MD, MS, Department of Pediatrics, University of Louisville, 571 S Floyd St, Suite 424, Louisville, KY 40202. E-mail: gcliu001{at}louisville.edu

Impact of road safety interventions on traffic-related occupational injuries in Spain, 2004–2010

ObjectivesTo evaluate the impact of road safety interventions, including the penalty point system (PPS) and the reformed Spanish penal code (RPC), on traffic-related occupational injuries in Spain. MethodsThe study design was an interrupted time-series with a comparison group. The study group had traffic-related, occupational injuries incurred during working and commuting hours; the comparison group had non-traffic-related injuries incurred at the work site. A negative binomial regression model was used to determine the relative risk (RR) of sustaining occupational injuries for the post-intervention periods compared to the non-intervention period. ResultsNon-fatal, traffic-related injuries did not significantly change after the PPS and RPC implementations, except for those occurred in commuting hours, which increased significantly after the PPS. On the other hand, after the RPC, fatal, traffic-related injuries decreased significantly during working hours (0.79; 95%CI 0.65 to 0.97) and commuting hours (RR: 0.63; 95%CI:0.56 to 0.72), although fatal, non-traffic-related injuries also decreased at the work site. ConclusionsRoad safety interventions did not clearly affect traffic-related occupational injuries in Spain. Specific occupational risk factors could influence the occurrence of those injuries.

Study on the Trend and Disease Burden of Injury Deaths in Chinese Population, 2004–2010

Injuries are a growing public health concern in China, accounting for more than 30% of all Person Years of Life Lost (PYLL) due to premature mortality. This study analyzes the trend and disease burden of injury deaths in Chinese population from 2004 to 2010, using data from the National Disease Surveillance Points (DSPs) system, as injury deaths are classified based on the International Classification of Disease-10th Revision (ICD-10). We observed that injury death accounted for nearly 10% of all deaths in China throughout the period 2004–2010, and the injury mortality rates were higher in males than those in females, and higher in rural areas than in urban areas. Traffic crashes (33.79–38.47% of all injury deaths) and suicides (16.20–22.01%) were the two leading causes of injury deaths. Alarmingly, suicide surpassed traffic crashes as the leading cause of injury mortality in rural females, yet adults aged 65 and older suffered the greatest number of fatal falls (20,701 deaths, 2004–2010). The burden of injury among men (72.11%) was about three times more than that of women's (28.89%). This study provides indispensible evidence that China Authority needs to improve the surveillance and deterrence of three major types of injuries: Traffic-related injury deaths should be targeted for injury prevention activities in all population, people aged 65+ should be encouraged to take individual fall precautions, and prevention of suicidal behavior in rural females should be another key priority for the government of China.

Traffic-related pedestrian injuries amongst expatriate workers in Qatar: a need for cross-cultural injury prevention programme

Qatar is a rapidly developing country in which expatriate workers constitute the majority of population. Also, Qatar is an example of right-sided road driving convention (RDC) country. The aim of our study is to analyse the traffic-related pedestrian injuries (TRPI) amongst expatriates in relation to RDC. A retrospective analysis of prospectively collected data of TRPI patients who were admitted to the only Level I trauma centre in Qatar between 2009 and 2011 was performed. Demographics, country of origin, time of injury, injury severity score (ISS), RDC, morbidity and mortality were analysed. Of the 4997 injured patients, 601 (12%) were pedestrians. Of these, 92% were expatriates. The mean age was 31.8 ± 17 and 64% of them were 18–45 years old. Mean ISS was higher in those who were injured on weekends (15.4 ± 10) in comparison to working days (13.5 ± 10) (p = 0.04). The overall mortality was 15%. Sixty-seven percent of those who died were from left RDC countries. Expatriate workers, originally from left RDC countries are disproportionately affected by TRPI. This group of injured patients requires focused injury prevention programmes that are culture and language appropriate.

What's new in emergencies, trauma and shock? studying traffic related injuries in India.

In urban India, cycle rickshaws are a significant mode of transport. Exact numbers are hard to obtain, but it is estimated that there are 2 million or more rickshaws on the road. Taken together, cycle rickshaws account for 6-8 billion passenger kilometer/year. Recent research analyzed the workload of cycle rickshaw pullers. The investigators concluded that pulling the cycle rickshaw is heavy to very heavy, which also corresponds to the subjective assessment of the participants. As known from other countries, pedestrians, cyclists, and other (motorized) two wheeled vehicle users are the most endangered road users to sustain accidents and corresponding serious injuries and death. Said this, rickshaw pullers as well as rickshaw users have to be categorized into this high-risk group. So far, little is known about injury pattern and characteristics of cycle rickshaw pullers or users. The study at hand presents new data of 84 patients, which were involved in a road traffic accident related to cycle rickshaws. A predominance of young men was evident with a peak between 20 years and 30 years of age. Crash characteristics were differentiated between single and multiple vehicle crashes. Interestingly, overturned vehicles were predominant in this group. The authors found an overload of the rickshaw in 28.5% which most likely contributes to that type of accidents with cycle rickshaws. In case of multiple vehicle crashes, the majority involved crashes with big vehicles like trucks. During hospital stay, three patients died from traumatic brain injury. Another study dealing with injuries from cycle rickshaw accidents was performed by Jaiswal et al. In their study, the majority of the participants were children or young adults. The majority of the injuries were soft-tissue injuries mostly due to the chain and the rear sprocket, but a number of fractures were also described. In summary, the authors described injuries related to rickshaws comparable to those of bicycles. The majority of patients travelled on rickshaws in a dangerous way, which also included overloaded rickshaws. The authors concluded that most of the rickshaw related injuries are preventable by restricting the number of persons travelling on cycle rickshaws and application of chain covers on new rickshaws. Another form of transport, which is popular in Asia including India, is the motorized rickshaw. Although, these vehicles reach higher traffic speeds, motorized rickshaws may serve to compare injury patterns and characteristics to those of cycle rickshaws. A study of Schmucker et al. analyzed these items in a prospective trial. In total, 60% of the reported accidents led to injuries of the rickshaw occupant. Of these the investigators were able to recruit a total of 139 patients including 82 injured motorized rickshaw occupants. Of these patients, 50% had multiple injuries and there was an alarming mortality of 12.2% in that group. This data demonstrates the need of further research to improve traffic safety in these road traffic users. To compare data of the mentioned studies to other countries, further studies are required, which also include the preclinical management. Particularly, the organization preclinical emergency medicine has to be described and should be analyzed. Based on these data including multivariate analyses, an international comparison to bicycle or motorcycle accidents might be supposable. Possibly, some implemented safety features out of the research performed in accident research units world-wide are transferable to cycle rickshaws in order to improve the safety of this mode of transport. Language: en

Endoscopically-assisted Intraoral Reduction and Fixation of a Subcondylar Fracture: A Report of Two Cases

The surgical reduction and plate fixation of a condylar fracture can lead to early recovery, but the extraoral approach might induce complications, such as facial nerve injury and the creation of visible scars. Recently, an endoscopically-assisted intraoral approach has been introduced to avoid these complications, and we performed this procedure in two cases with subcondylar fractures. Case 1: A 33-year-old female had subcondylar and mandibular body fractures due to a traffic-related injury. She had hearing loss and visual impairment. Case 2: An 84-year-old female had subcondylar and mandibular body fractures due to a traffic-related injury. She had dementia and delirium. Both patients had difficulty communicating, and surgical treatments were performed to enable early recovery. An endoscope with a 30-degree angle was used to visualize the condylar fracture through an intraoral incision. Titanium miniplates and screws were used to stabilize the fracture site with the help of a contra-angle drill and screwdriver. The intermaxillary fixation was released on the seventh and fifth postoperative days, respectively. This surgical procedure is minimally invasive and can lead to an early recovery, and so can be a useful method for treating condylar fractures, if the patients and indications are properly selected.

A Method for Linking Motor Vehicle Victim and Collision Data Collected by Multiple County Agencies

Objective: This study assessed roadside and bedside factors associated with early mortality following motor vehicle trauma. Methods: This retrospective cohort study evaluated motor vehicle crashes in Orange County Florida in 2009 that became medical examiner cases. Data from the Department of Highway Safety and Motor Vehicles (DHSMV), emergency medical services (EMS), a level I trauma center, and the medical examiner were integrated for the analysis. The primary outcome measure was early death, defined by death within 48 hours of a motor vehicle trauma. Both traditional and nontraditional predictors of early mortality were assessed. Results: The most significant factors associated with early mortality were as follows: (1) From autopsy: hemothorax (odds ratio [OR] = 8.26, 95% confidence interval [CI]: 1.83–37.3) and liver injury (OR = 4.26, 95% CI: 1.70–15.6); (2) from hospital data: systolic blood pressure (OR = 0.98, 95% CI: 0.96–0.99) and having cardiopulmonary resuscitation (CPR) performed in the emergency department (OR = 13.4, 95% CI: 1.51–118.72); and (3) from DHSMV: involvement of drugs and/or alcohol (OR = 4.27, 95% CI: 1.33–13.6), total fatalities (OR = 6.07, 95% CI: 1.57–23.5), speed of vehicle (OR = 1.06, 95% CI: 1.02–1.09), and number of lanes at the crash scene (OR = 1.58, 95% CI: 1.13–2.20). Conclusion: These results were made possible by integrating 4 distinct data sources. As future research in traffic-related injury moves toward prevention, it will be critical to evaluate new preventative strategies quickly and effectively. A unique number that is both patient and event specific that could be incorporated into each of these databases would make such integration seamless. Successful methods for linking data collected by the multiple agencies involved in motor vehicle collisions will ultimately provide invaluable information for medical personnel, researchers, engineers, planners, and policy makers at the local, state, and national levels to identify safety priorities to reduce crash-related injuries and fatalities.

Motorcycle Simulator Technology and Traffic-Related Injury Prevention: Global Health Potential

Road traffic related fatalities account for over 50% of the global deaths for individuals between ages 15 and 44 and ranks 11th in the cause of death for all age groups. It’s future impact is equally dismal: within the next decade road traffic related morbidity is projected to be the 6th leading contributor global fatalities and 3rd leading contributor to global Disability-Adjusted Life Years, disproportionately impacting the overall global burden of disease. However, national-level traffic safety intervention by global health organizations lacks programmed efforts to include vehicle simulation-based technologies as a key element of comprehensive national traffic safety programs. This is particularly true for two wheel vehicles in low and middle income countries (LMICs). Importantly, US resources in diplomacy settings are also subject to loss because of deployment into these risky settings, lack of adaptability to traffic cultures and systems locally, and limited skills training. The United States Marine Corps has utilized two wheel motorcycle simulation based technologies as part of a comprehensive education and training strategy to reduce fatalities and injuries amongst military personnel operating motorcycles off-duty. Positive experiences with motorcycle vehicle-simulator training program indicate further potential to validate impact on injury rates and efficacy of motorcycle simulator technology both for those assigned abroad and for relevant LMICs personnel. Other international professional and charitable organizations contending with similar risks abroad would also benefit from shared advances in traffic safety training utilizing motorcycle simulators. By improving traffic safety in these environments, health care resources can be shifted from expensive reactive, acute care trauma settings to investments in longer term public health infrastructures, medicines, and outreach.

Changing trends in maxillofacial trauma in Delhi and National Capital Region-multicentric retrospective study of 450 cases

World over annually 1 million people die and over 25 million are injured or disabled due to road traffic accidents. In India alone road mishaps are responsible for 78% of deaths due to accidents. Till two decades back road accidents were the tenth biggest killer which is projected to be fifth in near future and third up to 2020. Most analysts are unanimous that the rapid rise in traffic related injuries is due to major economic and demographic transition coupled with increasing urbanisation and materialisation.

Factors affecting hospital length of stay and hospital charges associated with road traffic-related injuries in Iran

BackgroundRoad traffic injuries (RTIs) are a substantial cause of mortality and disability globally. There is little published information regarding healthcare resource utilization following RTIs, especially in low and middle-income countries (LMICs). The aim of this study was to assess total hospital charges and length of stay (LOS) associated with RTIs in Iran and to explore the association with patients’ socio-demographic characteristics, insurance status and injury-related factors (e.g. type of road users and safety equipment).MethodThe study was based on the Iranian National Trauma Registry Database (INTRD), which includes data from 14 general hospitals in eight major cities in Iran, for the years 2000 to 2004. 8,356 patients with RTI admitted to the hospitals were included in the current study. The variables extracted for the analysis included total hospital charges and length of stay, age, gender, socio-economic and insurance status, injury characteristics, medical outcome and use of safety equipment among the patients. Univariable analysis using non-parametric methods and multivariable regression analysis were performed to identify the factors associated with total hospital charges and LOS.ResultsThe mean hospital charges for the patients were 1,115,819 IRR (SD=1,831,647 IRR, US$128 ± US$210). The mean LOS for the patients was 6.8 (SD =8 days). Older age, being a bicycle rider, higher injury severity and longer LOS were associated with higher hospital charges. Longer LOS was associated with being male, having lower education level, having a medical insurance, being pedestrian or motorcyclist, being a blue-collar worker and having more severe injuries. The reported use of safety equipment was very low and did not have significant effect on the hospital charges and LOS.ConclusionThe study demonstrated that the hospital charges and LOS associated with RTI varied by age, gender, socio-economic status, insurance status, injury characteristics and health outcomes of the patients. The results of the study provide information that can be of importance in the planning and design of road traffic injury control strategies.

Two-Vehicle Injury Severity Models Based on Integration of Pavement Management and Traffic Engineering Factors

Objective: The severity of traffic-related injuries has been studied by many researchers in recent decades. However, the evaluation of many factors is still in dispute and, until this point, few studies have taken into account pavement management factors as points of interest. The objective of this article is to evaluate the combined influences of pavement management factors and traditional traffic engineering factors on the injury severity of 2-vehicle crashes. Methods: This study examines 2-vehicle rear-end, sideswipe, and angle collisions that occurred on Tennessee state routes from 2004 to 2008. Both the traditional ordered probit (OP) model and Bayesian ordered probit (BOP) model with weak informative prior were fitted for each collision type. The performances of these models were evaluated based on the parameter estimates and deviances. Results: The results indicated that pavement management factors played identical roles in all 3 collision types. Pavement serviceability produces significant positive effects on the severity of injuries. The pavement distress index (PDI), rutting depth (RD), and rutting depth difference between right and left wheels (RD_df) were not significant in any of these 3 collision types. The effects of traffic engineering factors varied across collision types, except that a few were consistently significant in all 3 collision types, such as annual average daily traffic (AADT), rural–urban location, speed limit, peaking hour, and light condition. Conclusions: The findings of this study indicated that improved pavement quality does not necessarily lessen the severity of injuries when a 2-vehicle crash occurs. The effects of traffic engineering factors are not universal but vary by the type of crash. The study also found that the BOP model with a weak informative prior can be used as an alternative but was not superior to the traditional OP model in terms of overall performance.

The association between motor vehicle injuries and health-related quality of life: a longitudinal study of a population-based sample in the United States

As many as 3 million US residents are injured in traffic-related incidents every year leaving many victims with disabling conditions. To date, limited numbers of studies have examined the effects of traffic-related injuries on self-reported health. This study aims to examine the association between health-related quality of life (HRQOL) and traffic-related injuries longitudinally in a nationally representative sample of US adult population. This is a longitudinal study of adult participants (age ≥18) from seven panels (2000-2007) of the Medical Expenditure Panel Survey. The dependent variables included the physical and mental components of the SF-12, a measure of self-reported health. The outcome was assessed twice during the follow-up period: round 2 (~4-5months into the study) and round 4 (~18months into the study) for 62,298 individuals. Two methods estimate the association between traffic-related injuries and HRQOL: a within person change using paired tests and a between person change using multivariable regression adjusting for age, sex, income and educational level. Nine hundred and ninety-three participants reported traffic-related injuries during the follow-up period. Compared to their pre-crash HRQOL, these participants lost 2.7 of the physical component score while their mental component did not change. Adjusted results showed significant deficits in the physical component (-2.84, p value=<.001) but not the mental component (-0.07, p value=.83) of HRQOL after controlling for potential confounders. Traffic injuries were significantly associated with the physical component of HRQOL. These findings highlight the individual and societal burden associated with motor vehicle crash-related disability in the United States.

Understanding recovery in children following traffic-related injuries: Exploring acute traumatic stress reactions, child coping, and coping assistance

Millions of children incur potentially traumatic physical injuries every year. Most children recover well from their injury but many go on to develop persistent traumatic stress reactions. This study aimed to describe children's coping and coping assistance (i.e., the ways in which parents and peers help children cope) strategies and to explore the association between coping and acute stress reactions following an injury. Children (N = 243) rated their acute traumatic stress reactions within one month of injury and reported on coping and coping assistance six months later. Parents completed a measure of coping assistance at the six-month assessment. Children used an average of five to six coping strategies (out of 10), with wishful thinking, social support, and distraction endorsed most frequently. Child coping was associated with parent and peer coping assistance strategies. Significant acute stress reactions were related to subsequent child use of coping strategies (distraction, social withdrawal, problem-solving, blaming others) and to child report of parent use of distraction (as a coping assistance strategy). Findings suggest that children's acute stress reactions may influence their selection of coping and coping assistance strategies. To best inform interventions, research is needed to examine change in coping behaviors and coping assistance over time, including potential bidirectional relationships between trauma reactions and coping.

Age and traumatic chest injury: a 3-year observational study.

A quarter of trauma-related deaths are attributable to traumatic chest injury (TCI). To outline the pattern and outcome of TCI in a rapidly developing country among different age groups. We conducted a retrospective observational study for patients who sustained TCI and admitted between January 2008 and December 2010 to the Level I trauma center at Hamad General Hospital in Qatar. Patients were classified and analyzed in four age groups (group 1≤18, group 2 between 19-44, group 3 45-59, and group 4>60years). Multivariate regression analysis was performed for predictors of mortality. Of 5,118 cases admitted to the Section of Trauma Surgery, 1,355 (26.5%) had TCI (12, 67, 16, and 5% in groups 1-4, respectively), which was due to blunt trauma in 96% of cases. The overall mean age was 33±15years and males comprised 94% of cases. Children (≤18years of age) had more traffic-related injury, intubation, high Injury Severity Score (ISS) (19±12), and associated head and liver injuries in comparison to the other groups. The overall mortality rate was 13% (24, 11, 12, and 16% in groups 1-4, respectively). The death rate was higher in pedestrians, followed by motor vehicle crashes (MVCs) and fall-related injuries (24 vs. 13 vs. 7%, respectively, p=0.001). The highest mortality occurred within the first day (n=115, 65%). In comparison to old age, children were more likely to die early (on the first day) and the adult group died mostly within the first week of hospitalization. Independent predictors for mortality included associated head injury [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.48-3.62), ISS (OR 1.11, 95% CI 1.09-1.13), and age (OR 0.37, 95% CI 0.22-0.62). TCI is an alarming problem in Qatar, with a bimodal mortality curve. The highest mortality peak occurred in children, followed by old age. However, young males are the most exposed population. Regulatory efforts and strict enforcement of traffic laws would likely reduce morbidity and mortality.

Investigating the influence of curbs on single-vehicle crash injury severity utilizing zero-inflated ordered probit models

The severity of traffic-related injuries has been studied by many researchers in recent decades. However, previous research has seldom accounted for the effects of curbed outside shoulders on traffic-related injury severity. This study applies the zero-inflated ordered probit (ZIOP) model to evaluate the influences of curbed outside shoulders, speed limit change, as well as other traditional factors on the injury severity of single-vehicle crashes. Crash data from 2003 to 2007 in the Illinois Highway Safety Database were employed in this study.The ZIOP model assumes that injury severity comes from two distinct sources: injury propensity and injury severity when this crash falls into the injury prone category. The modeling results show that on one hand, single-vehicle crashes that occurring on roadways with curbed outside shoulders are more likely to be injury prone. On the other hand, the existence of a curb decreases the likelihood of severe injury if the crash was in the injury prone category. As a result, the marginal effect analysis implies that the presence of curbs is associated with a higher likelihood of no injury and minor injury involved crashes, but a lower likelihood of incapacitating injury and fatality involved crashes. In addition, in the presence of curbed outside shoulders, the change of speed limit adds no significant impact to the injury severity of single-vehicle crashes.Moreover, the modeling results also highlight some interesting effects caused by vehicle type, light and weather conditions, and drivers’ characteristics, as well as crash type and location. Through a comprehensive evaluation of the modeling results, the authors find that the ZIOP model performs well relative to the traditional ordered probit (OP) model, and can serve as an alternative in future studies of crash injury severity.

The built environment and the incidence of pedestrian and cyclist crashes

This study applied negative binomial regressions to understand how the characteristics of the built environment may affect the incidence of crashes involving pedestrians and cyclists. Arterial thoroughfares, big box stores and strip commercial uses were all associated with increased risk for pedestrians and cyclists alike. Unlike earlier studies on pedestrian and cyclist crash risk, however, this study hypothesized that it was the configuration of commercial and retail uses that mattered, rather than the uses themselves. To test this, this study included a variable indicating the number of pedestrian-scaled retail uses in a community in the models. Indeed, while strip commercial uses and big box stores were a safety problem, this variable had a negative, though statistically insignificant, effect on crash incidence, suggesting that road users were modifying their behavior in these environments in a manner that prevented these crashes from occurring. Further, although earlier studies have asserted that population density was a risk factor for pedestrians and cyclists, this study found it to have a positive but weak effect on total pedestrian crashes, and no statistically meaningful effect on pedestrian killed or severely injured (KSI) crashes, nor on total or KSI crashes involving cyclists. Finally, this study found that whereas four-leg intersections were associated with increased numbers of pedestrian and cyclist crashes, three-leg intersections had no effect, or even a negative effect on crash incidence involving pedestrians and cyclists. This finding suggests that three-leg intersections may be a desirable means for increasing local street connectivity for pedestrians and cyclists without simultaneously increasing their exposure to traffic related crashes, injuries or deaths.

Child and Youth Traffic-Related Injuries: Use of a Trauma Registry to Identify Priorities for Prevention in the United Arab Emirates

Objective: Traffic-related injuries are the main cause of death during childhood and youth in the United Arab Emirates (UAE), use of safety restraints by citizens is uncommon, rollovers are frequent, and current legislation does not protect rear-seat occupants. Because little was known about the circumstances of hospitalizations for traffic injuries to guide prevention, a trauma registry was used to assess causes and determinants for traffic-related injuries during childhood and youth (<19 years) and its value for prevention. Methods: One hundred ninety-three children and youth with traffic injuries were admitted for more than 24 h at surgical wards of the main trauma hospital in the Al-Ain region during a 36-month period (2003–2006). Injuries were analyzed by age, nationality, road user and vehicle types, severity, anatomical region, and the presence of head injury using Injury Severity Scores (ISS) and the Abbreviated Injury Scale (AIS). Results: Traffic injuries represented 40 percent (n = 193) of injuries to 0- to 19-year-olds, followed by falls (39 percent). Among 15- to 19-year-olds, who accounted for 46 percent of child and youth victims, the incidence was 150/100,000 person years, compared to an incidence of 15 to 51 for younger age groups. Overall, 53 percent were vehicle occupants, 23 percent were pedestrians, 14 percent were bicyclists, 6 percent were motorcyclists, with 4 percent other. The ratio of male-to-female victims was 6.7:1; for drivers it was 33:0; and for pedestrians, bicyclists, and motorcyclists it was between 10:1 and 12:1; injured females were mainly rear-seat passengers and the male: female ratio was 1.4:1. Seventy-one percent of pedestrians were ≤9 years old. Although the ratio of UAE children to foreign children was estimated at 0.7:1 in the community, 58 percent of the injured were UAE citizens. The ratio of injured UAE: non-UAE citizens was 1.4:1 overall but 5.6:1 for drivers and 4.5:1 for motorcyclists. Forty-one percent of citizens were injured in 4-wheel drive sport utility vehicles compared to 13 percent of non-citizens. Head injuries occurred in 68 percent of vehicle occupants and 51 percent of nonoccupants, with AIS ≥ 3 injuries in 23 percent of occupants and 26 percent of nonoccupants. Sixty-seven percent of rear occupants had head injuries. Conclusions: Male drivers and vulnerable road users were at an unusually high risk relative to females. A relatively high frequency of traffic-related head injuries among UAE children and youth, including rear-seat passengers and other vehicle occupants, suggests that considerable preventable morbidity is associated with nonuse of safety restraints and/or other factors such as excess speed and rollovers of 4-wheel drive vehicles. Trauma registries can be useful for prevention; inclusion of data on safety restraints and helmet use by road user type is essential.

Declining trend in the use of repeat computed tomography for trauma patients admitted to a level I trauma center for traffic-related injuries

ObjectiveTo evaluate the trend in utilization of repeat (i.e. ≥2) computed tomography (CT) and to compare utilization patterns across body regions for trauma patients admitted to a level I trauma center for traffic-related injuries (TRI). Materials and MethodsWe linked the Harborview Medical Center trauma registry (1996–2010) to the billing department data. We extracted the following variables: type and frequency of CTs performed, age, gender, race/ethnicity, insurance status, injury mechanism and severity, length of hospitalization, intensive care unit (ICU) admission and final disposition. TRIs were defined as motor vehicle collisions, motorcycle, bicycle and pedestrian-related injuries. Logistic regression was used to evaluate the association between utilization of different body region repeat (i.e. ≥2) CTs and year of admission, adjusting for patient and injury-related characteristics that could influence utilization patterns. ResultsA total of 28,431 patients were admitted for TRIs over the study period and 9499 (33%) received repeat CTs. From 1996 to 2010, the proportion of patients receiving repeat CTs decreased by 33%. Relative to 2000 and adjusting for other covariates, patients with TRIs admitted in 2010 had significantly lower odds of undergoing repeat head (OR=0.61; 95% CI: 0.49–0.76), pelvis (OR=0.37; 95% CI: 0.27–0.52), cervical spine (OR=0.23; 95% CI: 0.12–0.43), and maxillofacial CTs (OR=0.24; 95% CI: 0.10–0.57). However, they had higher odds of receiving repeat thoracic CTs (OR=1.86; 95% CI: 1.02–3.38). ConclusionA significant decrease in the utilization of repeat CTs was observed in trauma patients presenting with traffic-related injuries over a 15-year period.

Decarbonizing urban transport in European cities: four cases show possibly high co-benefits

Cities worldwide are increasingly becoming agents of climate change mitigation, while simultaneously aiming for other goals, such as improved accessibility and clean air. Based on stakeholder interviews and data analysis, we assess the current state of urban mobility in the four European cities of Barcelona, Malmö, Sofia and Freiburg. We then provide scenarios of increasingly ambitious policy packages, reducing greenhouse gas emissions from urban transport by up to 80% from 2010 to 2040. We find significant concurrent co-benefits in cleaner air, reduced noise ambience, fewer traffic-related injuries and deaths, more physical activity, less congestion and monetary fuel savings. Our scenarios suggest that non-motorized transport, especially bicycles, can occupy high modal shares, particularly in cities with less than 0.5 million inhabitants. We think that this kind of multi-criteria assessment of social costs and benefits is a useful complement to cost–benefit analysis of climate change mitigation measures.

Pedestrians: the daily underestimated victims on the road

Traffic-related pedestrian injuries (TRPI) are vulnerable to road users. In this study, we aimed to evaluate the demographic pattern of injury and outcome of TRPI. Patients with TRPI admitted between November 2007 and March 2010 to the only level 1 trauma centre in Qatar were included. A retrospective analysis was based on medical records and Emergency Medical Services run sheets. The spreadsheet included demographic data and pre-hospital transport, service admissions and injuries by system and mortality. Of 4077 patients who were admitted, 420 (10.3%) had TRPI. The mode of transportation included ambulances (91%), private vehicles (6%) and helicopters (3%). The direct dispositions were trauma intensive care units (38%), surgical wards (42%) and operating rooms (17%). Patients were classified according to Injury Severity Score (1–8 in 28%, 9–15 in 25%, 16–24 in 20% and 25–75 in 17% cases). Multisystem injuries were most characteristic. Of 804 injures, injury of extremities was predominant followed by head, thorax and abdomen. The overall mortality was 8%. Pedestrian injuries are a significant cause of serious trauma in Qatar. Motor vehicle/pedestrian interface contributes to this ongoing public health problem. Reducing pedestrian trauma requires recognition of the problem and implementing programmes to mitigate these largely preventable injuries.