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Objective: E-scooter use has grown rapidly in the United States. Its rise in popularity has coincided with the promotion of cycling in many cities, but more needs to be known about how these transportation modes compare to determine if cycling should serve as an appropriate benchmark for policy decisions and safety expectations regarding e-scooters.Methods: We examined characteristics of adults seeking treatment in a Washington, DC, emergency department (ED) for injuries associated with riding e-scooters during 2019 (n = 99) or bicycles during 2015-2017 (n = 337).Results: E-scooter incidents less frequently involved moving vehicles (13.1% vs. 37.7%) or occurred on roads (24.5% vs. 50.7%) than cycling incidents. A smaller proportion of injured e-scooter riders were ages 30-49 (32.3% vs. 48.4%) and a larger proportion were 50 and older (34.3% vs. 22.6%) or female (45.5% vs. 29.1%). Distal lower extremity injuries were more common among e-scooter riders (13.1% vs. 3.0%; RR, 2.76; 95% CI, 1.79-3.54), and injuries to the proximal upper extremity (9.1% vs. 20.5%; RR, 0.49; 95% CI, 0.24-0.92) or chest, abdomen, and spine (3.0% vs. 14.0%; RR, 0.24; 95% CI, 0.07-0.70) were less common. Head injury rates were similar, but e-scooter riders more often experienced concussion with loss of consciousness (4.0% vs. 0.6%; RR, 3.03; 95% CI, 1.20-4.09) and were far less likely to wear helmets (2.0% vs. 66.4%). Estimated ED presentation rates per million miles traveled citywide were higher among e-scooter riders than cyclists (RR, 3.76; 95% CI, 3.08-4.59).Conclusions: E-scooters and bicycles are both popular forms of micromobility, but the characteristics of riders injured on them, the ways in which they become injured, and the types of injuries they sustain differ substantially. E-scooter rider injury rates, though currently high, may decrease as they gain experience; however, if the number of new users continues to climb, they will persist in using the ED more often than cyclists per mile that they travel. [ABSTRACT FROM AUTHOR]

Objectives: Earlier research has shown that the rear row is safer for occupants in crashes than the front row, but there is evidence that improvements in front seat occupant protection in more recent vehicle model years have reduced the safety advantage of the rear seat versus the front seat. The study objective was to identify factors that contribute to serious and fatal injuries in belted rear seat occupants in frontal crashes in newer model year vehicles. Methods: A case series review of belted rear seat occupants who were seriously injured or killed in frontal crashes was conducted. Occupants in frontal crashes were eligible for inclusion if they were 6 years old or older and belted in the rear of a 2000 or newer model year passenger vehicle within 10 model years of the crash year. Crashes were identified using the 2004-2015 National Automotive Sampling System Crashworthiness Data System (NASS-CDS) and included all eligible occupants with at least one Abbreviated Injury Scale (AIS) 3 or greater injury. Using these same inclusion criteria but split into younger (6 to 12 years) and older (55+ years) cohorts, fatal crashes were identified in the 2014-2015 Fatality Analysis Reporting System (FARS) and then local police jurisdictions were contacted for complete crash records. Results: Detailed case series review was completed for 117 rear seat occupants: 36 with Maximum Abbreviated Injury Scale (MAIS) 3+ injuries in NASS-CDS and 81 fatalities identified in FARS. More than half of the injured and killed rear occupants were more severely injured than front seat occupants in the same crash. Serious chest injury, primarily caused by seat belt loading, was present in 22 of the injured occupants and 17 of the 37 fatalities with documented injuries. Nine injured occupants and 18 fatalities sustained serious head injury, primarily from contact with the vehicle interior or severe intrusion. For fatal cases, 12 crashes were considered unsurvivable due to a complete loss of occupant space. For cases considered survivable, intrusion was not a large contributor to fatality. Discussion: Rear seat occupants sustained serious and fatal injuries due to belt loading in crashes in which front seat occupants survived, suggesting a discrepancy in restraint performance between the front and rear rows. Restraint strategies that reduce loading to the chest should be considered, but there may be potential tradeoffs with increased head excursion, particularly in the absence of rear seat airbags. Any new restraint designs should consider the unique needs of the rear seat environment. [ABSTRACT FROM AUTHOR]

Objective: The Vision Zero initiative pursues the goal of eliminating all traffic fatalities and severe injuries. Today's advanced driver assistance systems (ADAS) are an important part of the strategy toward Vision Zero. In Germany in 2018 more than 26,000 people were killed or severely injured by traffic accidents on motorways and rural roads due to road accidents. Focusing on collision avoidance, a simulative evaluation can be the key to estimating the performance of state-of-the-art ADAS and identifying resulting potentials for system improvements and future systems. This project deals with the effectiveness assessment of a combination of ADAS for longitudinal and lateral intervention based on German accident data. Considered systems are adaptive cruise control (ACC), autonomous emergency braking (AEB), and lane keeping support (LKS). Methods: As an approach for benefit estimation of ADAS, the method of prospective effectiveness assessment is applied. Using the software rateEFFECT, a closed-loop simulation is performed on accident scenario data from the German In-Depth Accident Study (GIDAS) precrash matrix (PCM). To enable projection of results, the simulative assessment is amended with detailed single case studies of all treated cases without PCM data. Results: Three categories among today's accidents on German rural roads and motorways are reported in this study: Green, grey, and white spots. Green spots identify accidents that can be avoided by state-of-the-art ADAS ACC, AEB, and LKS. Grey spots contain scenarios that require minor system modifications, such as reducing the activation speed or increasing the steering torque. Scenarios in the white category cannot be addressed by state-of-the-art ADAS. Thus, which situations demand future systems are shown. The proportions of green, grey, and white spots are determined related to the considered data set and projected to the entire GIDAS. Conclusions: This article describes a systematic approach for assessing the effectiveness of ADAS using GIDAS PCM data to be able to project results to Germany. The closed-loop simulation run in rateEFFECT covers ACC, AEB, and LKS as well as relevant sensors for environment recognition and actuators for longitudinal and lateral vehicle control. Identification of green spots evaluates safety benefits of state-of-the-art level 0-2 functions as a baseline for further system improvements to address grey spots. Knowing which accidents could be avoided by standard ADAS helps focus the evolution of future driving functions on white spots and thus aim for Vision Zero. [ABSTRACT FROM AUTHOR]

Objective: Left turn across path with traffic from the opposite direction (LTAP/OD) is the second most frequent car-to-car intersection crash type after straight crossing path (SCP) in Germany and the United States. Intersection automated emergency braking (AEB) for passenger cars can address these crashes. This study investigates 2 implementation strategies of intersection AEB addressing LTAP/OD crashes: (1) only the turning car is equipped with an intersection AEB and (2) turning and straight-heading cars are equipped with an intersection AEB. For each strategy, the influence of a safety zone around the vehicles that should not be entered is evaluated in terms of accident avoidance, injury mitigation, and change in velocity (delta-V) of remaining accidents. Results are given as a function of market penetration. Methods: A total of 372 LTAP/OD crashes from the time series precrash matrix (PCM), a subsample of the German In-Depth Accident Study (GIDAS), were resimulated in the PRediction of Accident Evolution by Diversification of Influence factors in COmputer simulation (PRAEDICO) simulation framework. A Kudlich-Slibar rigid-body impact model and an injury risk curve derived from GIDAS were used to predict remaining moderate to fatal (Maximum Abbreviated Injury Scale [MAIS] 2 + F) injuries among car occupants. Results: With a safety zone of 0.2 m, when the turning vehicle only was equipped with an intersection AEB, 59% of the crashes were avoided at a 100% market penetration. With both vehicles equipped the percentage increased to 77%. MAIS 2 + F injured occupants were reduced by 60 and 76%, respectively. Considering both the turning and the straight-heading vehicles, the delta-V decreased strongly with market penetration in remaining left-side impacts but only slightly in remaining frontal and right-side impacts. Eliminating the safety zone substantially decreases effectiveness in all conditions. Conclusions: Implementation strategy and safety zone definition strongly influence the real-life performance of intersection AEB. AEB should be applied not only for the turning vehicle but also for the straight-going vehicle to benefit from the full potential. Situationally appropriate safety zone definitions, in line with human hazard perception, need more attention and are a key to balance true positive and false positive performance. Remaining delta-V does not decrease broadly; hence, there is no evidence that future LTAP/OD crashes will be generally of lower severity. This highlights the need for continuous development of in-crash protection. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the safety impacts of pedestrian countdown signals (PCSs) with and without pushbuttons based on pedestrian crashes and pedestrian injuries in Michigan.Methodology: This study used 10 years of intersection data-5 years before PCSs were installed and 5 years after they were installed-along with a comparison group, to evaluate the crash impacts of PCSs; at 107 intersections the PCS had a pushbutton and at 96 it did not. At these intersections, and at their comparison sites (where no PCS was installed), crash data (from 2004 to 2016) were examined, along with traffic and geometric characteristics, population, education, and poverty level data.Results: Intersections where PCSs with pushbuttons have been installed showed a 29% reduction in total pedestrian crashes and a 30% reduction in fatal/injury pedestrian crashes. Further, when considering only pedestrians age 65 and below, these respective reductions are 33 and 35%. Intersections with PCSs but without pushbuttons did not show any significant change in any type of pedestrian crash.Conclusions: Although the Manual on Uniform Traffic Control Devices (Federal Highway Administration [FHWA] 2009 ) requires the use of PCSs at new traffic signal installations, this study suggests a safety benefit of installing PCSs with pushbutton at signals where a PCS without a pushbutton is present. [ABSTRACT FROM AUTHOR]

Objective: Highly automated vehicle occupants will all be passengers and may be free to ride while in postures for which existing occupant safety systems such as seat belts and airbags were not originally designed. These occupants could therefore face increased risk of injury when a crash occurs. Given that current vehicles are capable of supporting a variety of occupant postures outside of the normal design position, such as reclined or turned passengers, an evaluation of current field data was performed to better understand the risks of being out of position.Methods: We investigated the frequency, demographics, and injury outcomes for out-of-position occupants using NASS-CDS. A matched analysis was performed to compare injury outcomes for out-of-position passengers with in-position drivers involved in similar crashes. Finally, case studies for out-of-position occupants were examined in the Crash Injury Research (CIREN) database.Results: Only 0.5% of occupants in NASS-CDS with a coded posture were out of position at the time of crash. Of the out-of-position occupants, being turned or seated sideways was almost as likely as being reclined. Out-of-position occupants were younger and less likely to be belted than their in-position counterparts. Analysis of the injury data indicated a trend that being out of position was associated with an elevated risk for serious injury. However, the number of out-of-position occupants was too small to provide a definitive or statistically significant conclusion on injury outcome.Conclusion: Though highly automated vehicles may eventually reduce the number of crashes and traffic fatalities in the future, there will be a transition period when these vehicles remain at risk from collisions with human-driven vehicles. These crashes could cause higher than anticipated rates of injury if occupants are less likely to be belted or tend to be in positions for which restraints are not optimized. This study highlights the need for future research on occupant response and countermeasure design for out-of-position occupants. [ABSTRACT FROM AUTHOR]

Objective: Emergency medical services (EMS) play a vital role in the postcrash effort to reduce fatalities by providing first aid treatment and transportation to medical facilities. This study aims to analyze the time required for crash reporting and EMS arrival in fatal traffic crashes and to explore the effects of EMS time on the traffic injury severity.Methods: The time required for EMS reporting, arrival, and transport to hospital was calculated by location type and roadway functional classification using 2016 Fatality Analysis Reporting System (FARS) data. Subsequently, an ordered probit model was developed to identify factors contributing to injury severity considering EMS time.Results: The average time for the crash-reporting duration is 5.38 min, the reporting-scene arrival interval is 10.52 min, and the scene-hospital interval is 34.72 min. The average crash reporting and reporting-scene arrival intervals were the longest on conventional roads in rural areas and the shortest on conventional roads in urban areas. The average scene-hospital interval was longest in conventional rural areas and the shortest on freeways/expressways in urban areas. The developed random effects ordered probit model shows that prolonged reporting-scene arrival and scene-hospital intervals result in more severe injuries. The result also presents that crash type, violation, age, location, lighting condition, and alcohol/drug involvement have significant effects on injury severity.Conclusions: The key findings from this study indicate that EMS times differ according to urban/rural location and road functional classification and that reporting-scene arrival and scene-hospital intervals have significant effects on injury severity along with various factors. It is expected that the findings from this study can be used to develop effective and practical strategic plans to minimize EMS reporting, arrival time, and transport to hospital and therefore decrease the traffic injury severity. [ABSTRACT FROM AUTHOR]

Objective: Road traffic accidents (RTAs) are the first cause of abdominopelvic injuries (APIs). The objective of this study was to describe the characteristics and severity of APIs due to traffic accidents in a large French trauma registry and to identify risk factors for API.Methods: All victims from the French Rhône registry of victims of RTAs were analyzed from 1996 to 2013. This registry contained data that were issued over a 20-year period from 245 medical departments, from prehospital care until re-adaptation, and forensic medicine departments. All APIs, defined as an injury between the diaphragm and the pelvic bone, were extracted and studied.Results: Among 162,695 victims, 10,165 had an API (6.7%). Accidents frequently involved young men and 2 cars. Mean Injury Severity Score (ISS) was 8.7. Mortality rate was 5.6%. Soft tissue injuries largely predominated (n = 6,388; 54.4% of patients). Overall, 2,322 victims had a pelvic bone injury. Internal abdominal organs were involved in 2,425 patients; the most frequent were the spleen, liver, and kidney. Wearing of the seat belt appeared to be a significant protective factor in API, including serious injuries. A partial analysis over the past 2 years among the most severe patients hospitalized in the intensive care unit indicated that nonoperative management was carried out in two thirds of the wounded. In uni- or multivariate analysis, sex, age, type of user, antagonist, time of occurrence, associated severe lesions, or wearing of the seat belt were statistically associated with the occurrence of API, highlighting a more dangerous user profile.Conclusions: Abdominopelvic injuries concern a minority of road traffic injuries, but they are responsible for significant mortality. Large solid organs are the most frequently affected. Women drivers wearing a seat belt and driving in town during the day appear to be more protected against API. [ABSTRACT FROM AUTHOR]

Purpose: This is a descriptive study of the incidence and risk for severe injury in single-impact and multi-impact crashes by belt use and crash type using NASS-CDS.Methods: 1997-2015 NASS-CDS data were used to determine the distribution of crashes by the number of impacts and severe injury (Maximum Abbreviated Injury Score [MAIS] 4+F) to >15-year-old nonejected drivers by seat belt use in 1997+ MY vehicles. It compares the risk for severe injury in a single impact and in crashes involving 2, 3, or 4+ impacts in the collision with a focus on a frontal crash followed by other impacts.Results: Most vehicle crashes involve a single impact (75.4% of 44,889,518 vehicles), followed by 2-impact crashes (19.6%), 3-impact crashes (5.0%) and 4+ impacts (2.6%). For lap-shoulder-belted drivers, the distribution of severe injury was 42.1% in a single impact, 29.3% in 2 impacts, 13.4% in 3 impacts, and 15.1% in 4+ impact crashes. The risk for a belted driver was 0.256 ± 0.031% in a single impact, 0.564 ± 0.079% in 2 impacts, 0.880 ± 0.125% in 3 impacts, and 2.121 ± 0.646% in 4+ impact. The increase in risk from a single crash to multi-impact collisions was statistically significant (P < .001). In a single impact, 53.8% of belted drivers were in a frontal crashes, 22.4% in side crashes, 20% in rear crashes, and 1.7% in rollover crashes. The risk for severe injury was highest in a rollover at 0.677 ± 0.250%, followed by near-side impact at 0.467 ± 0.084% and far-side impact at 0.237 ± 0.071%. Seat belt use was 82.4% effective in preventing severe injury (MAIS 4+F) in a rollover, 47.9% in a near-side impact, and 74.8% in a far-side impact. In 2-impact crashes with a belted driver, the most common sequence was a rear impact followed by a frontal crash at 1,843,506 (21.5%) with a risk for severe injury of 0.100 ± 0.058%. The second most common was a frontal impact followed by another frontal crash at 1,257,264 (14.7%) with a risk of 0.401 ± 0.057%. The risk was 0.658 ± 0.271% in a frontal impact followed by a rear impact. A near-side impact followed by a rear crash had the highest risk for severe injury at 2.073 ± 1.322%.Conclusions: Restraint systems are generally developed for a single crash or sled test. The risk for severe injury was significantly higher in 2-, 3-, and 4+-impact crashes than a single impact. The majority (57.9%) of severe injuries occurred in multi-impact crashes with belted drivers. The evaluation of restraint performance warrants additional study in multi-impact crashes. [ABSTRACT FROM AUTHOR]

Objective: The objective of this article was the construction of injury risk functions (IRFs) for front row occupants in oblique frontal crashes and a comparison to IRF of nonoblique frontal crashes from the same data set.Method: Crashes of modern vehicles from GIDAS (German In-Depth Accident Study) were used as the basis for the construction of a logistic injury risk model. Static deformation, measured via displaced voxels on the postcrash vehicles, was used to calculate the energy dissipated in the crash. This measure of accident severity was termed objective equivalent speed (oEES) because it does not depend on the accident reconstruction and thus eliminates reconstruction biases like impact direction and vehicle model year. Imputation from property damage cases was used to describe underrepresented low-severity crashes-a known shortcoming of GIDAS. Binary logistic regression was used to relate the stimuli (oEES) to the binary outcome variable (injured or not injured).Results: IRFs for the oblique frontal impact and nonoblique frontal impact were computed for the Maximum Abbreviated Injury Scale (MAIS) 2+ and 3+ levels for adults (18-64 years). For a given stimulus, the probability of injury for a belted driver was higher in oblique crashes than in nonoblique frontal crashes. For the 25% injury risk at MAIS 2+ level, the corresponding stimulus for oblique crashes was 40 km/h but it was 64 km/h for nonoblique frontal crashes.Conclusions: The risk of obtaining MAIS 2+ injuries is significantly higher in oblique crashes than in nonoblique crashes. In the real world, most MAIS 2+ injuries occur in an oEES range from 30 to 60 km/h. [ABSTRACT FROM AUTHOR]

Objective: Characterization of the severity of injury should account for both mortality and disability. The objective of this study was to develop a disability metric for thoracic injuries in motor vehicle crashes (MVCs) and compare the functional outcomes between the pediatric and adult populations.Methods: Disability risk (DR) was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank for the most frequently occurring Abbreviated Injury Scale (AIS) 2-5 thoracic injuries. Occupants with thoracic injury were classified as disabled or not disabled based on the FIM scale, and comparisons were made between the following age groups: pediatric, adult, middle-aged, and older occupants (ages 7-18, 19-45, 46-65, and 66+, respectively). For each age group, DR was calculated by dividing the number of patients who were disabled and sustained a given injury by the number of patients who sustained a given injury. To account for the effect of higher severity co-injuries, a maximum AIS adjusted DR (DRMAIS) was also calculated for each injury. DR and DRMAIS could range from 0 to 100% disability risk.Results: The mean DRMAIS for MVC thoracic injuries was 20% for pediatric occupants, 22% for adults, 29% for middle-aged adults, and 43% for older adults. Older adults possessed higher DRMAIS values for diaphragm laceration/rupture, heart laceration, hemo/pneumothorax, lung contusion/laceration, and rib and sternum fracture compared to the other age groups. The pediatric population possessed a higher DRMAIS value for flail chest compared to the other age groups.Conclusion: Older adults had significantly greater overall disability than each of the other age groups for thoracic injuries. The developed disability metrics are important in quantifying the significant burden of injuries and loss of quality life years. Such metrics can be used to better characterize severity of injury and further the understanding of age-related differences in injury outcomes, which can influence future age-specific modifications to AIS. [ABSTRACT FROM AUTHOR]

Purpose: This is a study that updates earlier research on the influence of a front passenger on the risk for severe driver injury in near-side and far-side impacts. It includes the effects of belt use by the driver and passenger, identifies body regions involved in driver injury, and identifies the sources for severe driver head injury.Methods: 1997-2015 NASS-CDS data were used to investigate the risk for Maximum Abbreviated Injury Scale (MAIS) 4 + F driver injury in near-side and far-side impacts by front passenger belt use and as a sole occupant in the driver seat. Side impacts were identified with GAD1 = L or R without rollover (rollover ≤ 0). Front-outboard occupants were included without ejection (ejection = 0). Injury severity was defined by MAIS and fatality (F) by TREATMNT = 1 or INJSEV = 4. Weighted data were determined. The risk for MAIS 4 + F was determined using the number of occupants with known injury status MAIS 0 + F. Standard errors were determined.Results: Overall, belted drivers had greater risks for severe injury in near-side than far-side impacts. As a sole driver, the risk was 0.969 ± 0.212% for near-side and 0.313 ± 0.069% for far-side impacts (P < .005). The driver's risk was 0.933 ± 0.430% with an unbelted passenger and 0.596 ± 0.144% with a belted passenger in near-side impacts. The risk was 2.17 times greater with an unbelted passenger (NS). The driver's risk was 0.782 ± 0.431% with an unbelted passenger and 0.361% ± 0.114% with a belted passenger in far-side impacts. The risk was 1.57 times greater with an unbelted passenger (P < .10). Seat belt use was 66 to 95% effective in preventing MAIS 4 + F injury in the driver. For belted drivers, the head and thorax were the leading body regions for Abbreviated Injury Scale (AIS) 4+ injury. For near-side impacts, the leading sources for AIS 4+ head injury were the left B-pillar, roof, and other vehicle. For far-side impacts, the leading sources were the other occupant, right interior, and roof (8.5%).Conclusions: Seat belt use by a passenger lowered the risk of severe driver injury in side impacts. The reduction was 54% in near-side impacts and 36% in far-side impacts. Belted drivers experienced mostly head and thoracic AIS 4+ injuries. Head injuries in the belted drivers were from contact with the side interior and the other occupant, even with a belted passenger. [ABSTRACT FROM AUTHOR]

Objective: The clinical evaluation of motor vehicle collision (MVC) victims is challenging and commonly relies on computed tomography (CT) to detect internal injuries. CT scans are financially expensive and each scan exposes the patient to additional ionizing radiation with an associated, albeit low, risk of cancer. Injury risk prediction based on regression modeling has been to be shown to be successful in estimating Injury Severity Scores (ISSs). The objective of this study was to (1) create risk models for internal injuries of occupants involved in MVCs based on CT body regions (head, neck, chest, abdomen/pelvis, cervical spine, thoracic spine, and lumbar spine) and (2) evaluate the performance of these risk prediction models to predict internal injury.Methods: All Abbreviated Injury Scale (AIS) 2008 injury codes were classified based on which CT body region would be necessary to scan in order to make the diagnosis. Cases were identified from the NASS-CDS. The NASS-CDS data set was queried for cases of adult occupants who sought medical care and for which key crash characteristics were all present. Forward stepwise logistic regression was performed on data from 2010-2014 to create models predicting risk of internal injury for each CT body region. Injury risk for each region was grouped into 5 levels: very low (<2%), low (2-5%), medium (5-10%), high (10-20%), and very high (20%). The models were then tested using weighted data from 2015 in order to determine whether injury rates fell within the predicted risk level.Results: The inclusion and exclusion criteria identified 5,477 cases in the NASS-CDS database. Cases from 2010-2014 were used for risk modeling (n = 4,826). Seven internal injury risk models were created based on the CT body regions using data from 2010-2014. These models were tested against data from 2015 (n = 651). In all CT body regions, the majority of occupants fell in the very low or low predicted injury rate groups, except for the head. On average, 57% of patients were classified as very low risk and 15% as low risk for each body region. In most cases the actual rate of injury was within the predicted injury risk range. The 95% confidence interval overlapped with predicting injury risk range in all cases.Conclusion: This study successfully demonstrated the ability for internal injury risk models to accurately identify occupants at low risk for internal injury in individual body regions. This represents a step towards incorporating telemetry data into a clinical tool to guide physicians in the use of CT for the evaluation of MVC victims. [ABSTRACT FROM AUTHOR]

Objective: The goal of the study was to develop experimental chest loading conditions that would cause up to Abbreviated Injury Scale (AIS) 2 chest injuries in elderly occupants in moderate-speed frontal crashes. The new set of experimental data was also intended to be used in the benchmark of existing thoracic injury criteria in lower-speed collision conditions.Methods: Six male elderly (age >63) postmortem human subjects (PMHS) were exposed to a 35 km/h (nominal) frontal sled impact. The test fixture consisted of a rigid seat, rigid footrest, and cable seat back. Two restraint conditions (A and B) were compared. Occupants were restrained by a force-limited (2.5 kN [A] and 2 kN [B]) seat belt and a preinflated (16 kPa [A] and 11 kPa [B]; airbag). Condition B also incorporated increased seat friction. Matching sled tests were carried out with the THOR-M dummy. Infra-red telescoping rod for the assessment of chest compression (IRTRACC) readings were used to compute chest injury risk. PMHSs were exposed to a posttest injury assessment. Tests were carried out in 2 stages, using the outcome of the first one combined with a parametric study using the THUMS model to adjust the test conditions in the second. All procedures were approved by the relevant ethics board.Results: Restraint condition A resulted in an unexpected high number of rib fractures (fx; 10, 14, 15 fx). Under condition B, the adjustment of the relative airbag/occupant position combined with a lower airbag pressure and lower seat belt load limit resulted in a reduced pelvic excursion (85 vs. 110 mm), increased torso pitch and a substantially lower number of rib fractures (1, 0, 4 fx) as intended.Conclusions: The predicted risk of rib fractures provided by the THOR dummy using the Cmax and PC Score injury criteria were lower than the actual injuries observed in the PMHS tests (especially in restraint condition A). However, the THOR dummy was capable of discriminating between the 2 restraint scenarios. Similar results were obtained in the parametric study with the THUMS model. [ABSTRACT FROM AUTHOR]

Objective: Some drivers involved in motor vehicle crashes across the United States may be identified as at risk of subsequent injury by a similar mechanism. The purpose of this study was to perform a national review of the risk factors for hospitalization for a new injury due to a subsequent motor vehicle crash. It was hypothesized that presenting to a different hospital after subsequent injury would result in worse patient outcomes when compared to presentation at the same hospital.Methods: The Nationwide Readmissions Database for 2010-2014 was queried for all inpatient hospitalizations with injury related to motor vehicle traffic. The primary patient outcome of interest was subsequent motor vehicle crash-related injury within 1 year. The secondary patient outcomes were different hospital subsequent injury presentation, higher Injury Severity Score (ISS), longer length of stay (LOS), and in-hospital death after subsequent injury. The analysis of secondary patient outcomes was performed only on patients who were reinjured. Univariable analysis was performed for each outcome using all variables during the index admission. Multivariable logistic regression was performed using all significant (P < .05) variables on univariate analysis. Results were weighted for national estimates.Results: During the study period, 1,008,991 patients were admitted for motor vehicle-related injury; 12,474 patients (1.2%) suffered a subsequent injury within 1 year. From the reinjured patients, 32.9% presented to a different hospital, 48.9% had a higher ISS, and 22.1% had a longer LOS. The in-hospital mortality rate after subsequent injury was 1.1%. Presentation to a different hospital for subsequent injury was associated with a longer LOS (odds ratio [OR] = 1.32; 95% confidence interval [CI], 1.20-1.45; P < .01) and a higher ISS (OR = 1.38; 95% CI, 1.27-1.49; P < .01). Motorcyclists were more likely to suffer subsequent injury (OR = 1.39; 95% CI, 1.32-1.46; P < .01) and motorcycle passengers were more likely to present to a different hospital with a subsequent injury (OR = 2.49; 95% CI, 1.73-3.59; P < .01). Alcohol abuse was associated with subsequent injury (OR = 1.12; 95% CI, 1.07-1.18; P < .01).Conclusions: Nearly a third of patients suffering subsequent motor vehicle crash-related injury after an initial motor vehicle crash in the United States present to a different hospital. These patients are more likely to suffer more severe injuries and longer hospitalizations due to their subsequent injury. Future efforts to prevent these injuries must consider the impact of this fragmentation of care and the implications for quality and cost improvements. [ABSTRACT FROM AUTHOR]

Objectives: With regard to the pediatric population involved in vehicle side impact collisions, epidemiologic data can be used to identify specific injury-producing conditions and offer possible safety technology effectiveness through population-based estimates. The objective of the current study was to perform a field data analysis to investigate injury patterns and sources of injury to 4- to 10-year-olds in side and oblique impacts to determine the potential effect of updated side impact regulations and airbag safety countermeasures.Methods: The NASS-CDS, years 1991 to 2014, was analyzed in the current study. The Abbreviated Injury Scale (AIS) 2005-Update 2008 was used to determine specific injuries and injury severities. Injury distributions were examined by body region as specified in the AIS dictionary and the Maximum AIS (MAIS). Children ages 4 to 10 were examined in this study. All occupant seating locations were investigated. Seating positions were designated by row and as either near side, middle, or far side. Side impacts with a principal direction of force (PDOF) between 2:00 and 4:00 as well as between 8:00 and 10:00 were included. Restraint use was documented only as restrained or unrestrained and not whether the restraint was being used properly. Injury distribution by MAIS, body region, and source of injury were documented. Analysis regarding occupant injury severity, body region injured, and injury source was performed by vehicle model year to determine the effect of updated side impact testing regulation and safety countermeasures. Because the aim of the study was to identify the most common injury patterns and sources, only unweighted data were analyzed.Results: Main results obtained from the current study with respect to 4- to 10-year-old child occupants in side impact were that a decrease was observed in frequency of MAIS 1-3 injuries; injuries to the head, face, and extremities; as well as injuries caused by child occupant interaction with the vehicle interior and seatback support structures in 1998 model year passenger cars and newer.Conclusions: Results from this study could be useful in design advances of pediatric anthropomorphic test devices, child restraints, as well as vehicles and their safety countermeasure systems. [ABSTRACT FROM AUTHOR]

Objective: Field data analyses often use either parametric or nonparametric means to describe the relationship between risk and various predictor variables. This study sought to evaluate a hybrid approach using semiconstrained multivariate nonlinear spline-based analysis.Methods: Data were compiled from NASS-CDS years 1998-2015, selecting belted occupants age 16+ in collisions with a principal direction of force (PDOF) from 10 o'clock to 2 o'clock. Outcome measures included the incidence of Maximum Abbreviated Injury Scale (MAIS) 3+ injury in general and Abbreviated Injury Scale (AIS) 3+ rib fracture injury. Multivariate logistic regression models were fit controlling for PDOF, ΔV, vehicle model year, collision year, occupant age, occupant body mass index (BMI), and other select factors. Within the logistic regression models, each of the continuous variables was modeled with a 4-knot spline. These were compared to models treating ΔV and BMI linearly.Results: A total of 29,667 occupants were observed from the query, representing approximately 13,608,398 occupants when weighted. Sixty percent of the AIS 3+ rib fracture cases occurred at ΔVs at or below 40 km/h. The median age for cases without AIS 3+ rib fracture was 34 years old. The median age for cases with AIS 3+ rib fracture was 62 years old. When modeled via nonlinear spline, the risk of MAIS 3+ injury in general and AIS 3+ rib fracture injury specifically exhibited a relationship with ΔV similar in shape to that observed in the linear model. In both cases, the spline model exhibited greater risk prediction over ΔVs from 25 to 50 km/h compared to the linear model (20-33% greater risk at ΔVs below 40 km/h) and less risk than the linear model at greater ΔVs. BMI exhibited a nonlinear, nonmonotonic relationship with both injury types studied. The risk tended to be a minimum at BMIs of 22-24 kg/m2, with an increase in risk at both higher and lower BMIs. For AIS 3+ rib fracture, the risk for a person with a BMI of 18 was approximately equal to the risk for a person with a BMI of 30, both being approximately 40% greater than the risk associated with a BMI of 24.Conclusions: Nonlinear multivariate regression methods have the potential to convey information about the risk-predictor relationship that cannot be captured through traditional linear modeling. These results suggest that traditional linear logistic regression models may underestimate the risk of AIS 3+ rib fracture injury in the ΔV range where they most frequently occur (below 50 km/h). Due to its nonmonotonic effect, traditional linear models may underestimate injury risk at both high and low BMIs. [ABSTRACT FROM AUTHOR]

Objective: The objective of this research was to compare the kinetics and predicted injury risks of the Hybrid III (HIII) and Test device for Human Occupant Restraint (THOR)-M necks during full-scale frontal sled tests under 3 safety restraint conditions: knee bolster (KB), knee bolster and steering wheel airbag (KB/SWAB), and knee bolster airbag and steering wheel airbag (KBAB/SWAB).Methods: Twelve sled tests were performed for the HIII and THOR-M, and 8 matched sled tests were performed using postmortem human surrogates (PMHSs). The tests were designed to match the 2012 Toyota Camry New Car Assessment Program (NCAP) full-scale crash test. Upper and lower neck forces and moments were collected from the HIII and THOR-M load cells. Inverse dynamics was used to calculate PMHS upper neck forces and moments from acceleration data until the time of head contact. The PMHSs experienced head contact with the SWAB before appreciable neck loading occurred. Therefore, PMHS neck forces and moments were only compared to the HIII and THOR-M for the KB condition. Neck injury risks were calculated for the HIII and THOR-M and were compared to the injuries observed for the PMHSs.Results: The HIII had greater upper and lower neck shear forces than the THOR-M, whereas both surrogates had similar upper and lower neck axial forces. The HIII also experienced greater peak upper neck bending moments than the THOR-M, which experienced negligible upper neck bending moments. Before head contact, the PMHSs experienced upper neck flexion, and the HIII experienced extension. The HIII and THOR-M injury risk curves predicted less than a 50% risk of an Abbreviated Injury Scale (AIS) 3+ injury. No AIS 3+ neck injuries were observed for the PMHS tests, but at least one AIS 2 injury was observed per condition.Conclusions: The results of this study showed that the HIII and THOR-M had different neck kinetics for these restraint conditions. In particular, the THOR-M experienced lower upper neck shear forces and bending moments. These differences are likely due to the very different neck designs of the anthropomorphic test dummies (ATDs), particularly the increased compliance of the THOR-M neck. Despite these differences, both ATDs still predicted a similar risk of AIS 3+ neck injury. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to analyze factors affecting the severity of mild whiplash-associated disorders (WADs) and to develop a predictive model to evaluate the presence of mild WAD in minor motor vehicle crashes (MVCs).Methods: We used the Korean In-Depth Accident Study (KIDAS) database, which collects data from 4 regional emergency centers, to obtain data from 2011 to 2017. The Collision Deformation Classification code was obtained as vehicle's damage information, and Abbreviated Injury Scale (AIS), Maximum Abbreviated Injury Scale (MAIS), and Injury Severity Score (ISS) were used as occupant's injury information. The degree of WAD was determined using the Quebec Task Force (QTF) classification, comprised of 5 stages (QTF 0-4), depending on the occupant's pain and the physician's findings. QTF 1 was defined as mild WAD, and we used QTF 0 to define those who were uninjured. For KIDAS data between 2011 and 2016, a logistic regression model was used to identify factors affecting the occurrence of mild WAD and a predictive model was constructed. Internal validity was estimated using random bootstrapping, and external validity was evaluated by applying 2017 KIDAS data. Of the 2,629 occupants in the KIDAS database from 2011 to 2016, after applying several exclusion conditions, 459 occupants were used to develop the predictive model. The external validity of the derived predictive model was assessed using the 13 MVC occupants from the 2017 KIDAS database meeting our inclusion criteria. Among the 137 MVC occupants from the 2017 KIDAS database for analysis of the external validity of the derived predictive model, the predictive model was verified for 13 MVC occupants.Results: Logistic regression analysis was used to derive a predictive model based on sex, age, body mass index, type of vehicle, belt status, seating row, crush type, and crush extent. This predictive model had an explanatory power of 65.5% to determine an actual QTF of 0 and 1 (c-statistics: 0.655). As a result of the external validity analysis of the predictive model using data from the 2017 KIDAS database (N = 13), sensitivity, specificity, and accuracy were 0.500, 0.857, and 0.692, respectively.Conclusions: Using the predictive model, the results of the external validity analysis showed low sensitivity but high specificity. This predictive model provided meaningful results, with a high success rate for determining no injury to an occupant. Given our study results, future research is needed to create a more accurate predictive model that includes relevant technical and sociological factors. [ABSTRACT FROM AUTHOR]

Objective: Although the Abbreviated Injury Scale (AIS) was initially developed in the mid-1960s for tracking injury in automotive and aircraft crashes, it has grown to become an internationally recognized scoring system for a variety of traumatic injuries. This shift in focus and advances in organized medical care, combined with feedback from field use and outcome analysis, have resulted in several AIS updates and revisions. This article demonstrates how AIS codes and severities have changed over the last 25 years and investigates the effects of those changes.Methods: Data from each version and update of the AIS dictionary (AIS 1990, AIS 1998, AIS 2005, AIS 2008, and AIS 2015) were analyzed for changes and shifts in injury descriptions, severities, and code counts.Results: The number of AIS codes has increased to improve coding specificity and reliability for a growing number of injury types. There has also been a shift in severities, mainly within the moderate (AIS 2) to severe (AIS 4) range. AIS 1990 was the first version to utilize the 6-digit predot identifier, to add modifiers for pediatric injury, and to substantially expand brain injury codes. AIS 1998 added coding rules and guidelines throughout the dictionary and integrated the Organ Injury Scale scores. The AIS 2005 dictionary added over 400 codes and made significant changes throughout. Fewer changes were made in the AIS 2008 update. AIS 2015 includes descriptions for tissue injuries with loss of soft tissue that do not qualify as amputations, a need identified in military injury analysis.Conclusions: Each updated version of AIS reflects improving medical care and new advances in understanding, measuring, and documenting injury. AIS changes over time reflect its international and cross-domain utilization for describing injury severity and set the standard for how the world now studies traumatic injury. [ABSTRACT FROM AUTHOR]

Objective: The objective of this research is 2-fold: to (a) model and identify critical road features (or locations) based on crash injury severity and compare it with crash frequency and (b) model and identify drivers who are more likely to contribute to crashes by road feature.Method: Crash data from 2011 to 2013 were obtained from the Highway Safety Information System (HSIS) for the state of North Carolina. Twenty-three different road features were considered, analyzed, and compared with each other as well as no road feature. A multinomial logit (MNL) model was developed and odds ratios were estimated to investigate the effect of road features on crash injury severity.Results: Among the many road features, underpass, end or beginning of a divided highway, and on-ramp terminal on crossroad are the top 3 critical road features. Intersection crashes are frequent but are not highly likely to result in severe injuries compared to critical road features. Roundabouts are least likely to result in both severe and moderate injuries. Female drivers are more likely to be involved in crashes at intersections (4-way and T) compared to male drivers. Adult drivers are more likely to be involved in crashes at underpasses. Older drivers are 1.6 times more likely to be involved in a crash at the end or beginning of a divided highway.Conclusions: The findings from this research help to identify critical road features that need to be given priority. As an example, additional advanced warning signs and providing enlarged or highly retroreflective signs that grab the attention of older drivers may help in making locations such as end or beginning of a divided highway much safer. Educating drivers about the necessary skill sets required at critical road features in addition to engineering solutions may further help them adopt safe driving behaviors on the road. [ABSTRACT FROM AUTHOR]

Objective: Although numerous research studies have reported high levels of error and misuse of child restraint systems (CRS) and booster seats in experimental and real-world scenarios, conclusions are limited because they provide little information regarding which installation issues pose the highest risk and thus should be targeted for change. Beneficial to legislating bodies and researchers alike would be a standardized, globally relevant assessment of the potential injury risk associated with more common forms of CRS and booster seat misuse, which could be applied with observed error frequency-for example, in car seat clinics or during prototype user testing-to better identify and characterize the installation issues of greatest risk to safety.Methods: A group of 8 leading world experts in CRS and injury biomechanics, who were members of an international child safety project, estimated the potential injury severity associated with common forms of CRS and booster seat misuse. These injury risk error severity score (ESS) ratings were compiled and compared to scores from previous research that had used a similar procedure but with fewer respondents. To illustrate their application, and as part of a larger study examining CRS and booster seat labeling requirements, the new standardized ESS ratings were applied to objective installation performance data from 26 adult participants who installed a convertible (rear- vs. forward-facing) CRS and booster seat in a vehicle, and a child test dummy in the CRS and booster seat, using labels that only just met minimal regulatory requirements. The outcome measure, the risk priority number (RPN), represented the composite scores of injury risk and observed installation error frequency.Results: Variability within the sample of ESS ratings in the present study was smaller than that generated in previous studies, indicating better agreement among experts on what constituted injury risk. Application of the new standardized ESS ratings to installation performance data revealed several areas of misuse of the CRS/booster seat associated with high potential injury risk.Conclusions: Collectively, findings indicate that standardized ESS ratings are useful for estimating injury risk potential associated with real-world CRS and booster seat installation errors. [ABSTRACT FROM AUTHOR]

Objectives: Truck vehicles (TVs) have a different structure and stiffness than non-TVs and are used commercially for transporting goods. This study aimed to analyze whether truck occupants have a greater risk of serious injury than those of other types of vehicles.Methods: Crash data were obtained from the Korean In-Depth Data Analysis Study (KIDAS) for calendar years 2011-2016. Vehicles involved in frontal crash were included and classified into TVs and non-TVs (passenger cars and sports utility vehicles). We compared the demographic characteristics and serious injuries by body region between the 2 groups and analyzed factors that contributed to the serious injury severity from frontal crashes.Results: The analysis was based on 884 occupants; 177 (20.0%) were in TVs and 707 (80.0%) were in non-TVs. Non-TVs had more frontal airbags deployments than TVs (50.9% vs. 3.4%, P <.01). TV occupants were 4.8 times more likely to have a serious lower extremity (LE) injury (adjusted odds ratio [AOR] = 4.820; 95% confidence interval [CI], 2.407-9.653) and 2.5 times to have a serious abdominal injury (AOR = 2.465; 95% CI, 1.108-5.487) compared to non-TV occupants.Conclusions: Truck occupants had more serious LE and abdominal injuries than those of other types of vehicles in frontal crashes. Structural improvement and legislative efforts to develop safety systems are necessary to improve the safety of truck occupants. [ABSTRACT FROM AUTHOR]

Objective: This is a descriptive study of the frequency and risk of occupant-to-occupant contact injury by crash type and occupant age. It focused on rear impacts because of a recent Senate inquiry.Methods: 1994-2013 NASS-CDS data were used to investigate the effects of occupant-to-occupant contact on the risk of serious-to-fatal injury (Abbreviated Injury Scale [AIS] 3+) by crash type and age group. NASS-CDS in-depth cases were analyzed to identify crash circumstances for AIS 3+ occupant-to-occupant contact injury in rear crashes.Results: Serious injury (AIS 3+) due to occupant-to-occupant contact was uncommon. It represented only 0.84% of all AIS 3+ injury for all age groups. The overall risk of AIS 3+ occupant-to-occupant contact injury was 0.042 ± 0.007%. The highest incidence was in side impacts (69.8%) followed by rollovers (22.9%). Occupant-to-occupant contact injury risk was lower in rear impacts than in other crash types, at 0.0078 ± 0.0054%. The highest risk of AIS 3+ injury with occupant-to-occupant was for the <9-year-old age group when compared to other age groups for all crash types. The risk was 0.051 ± 0.026%, representing 2.69% of all AIS 3+ injury in the <9-year-old age group. Only 4.2% of AIS 3+ occupant-to-occupant contact injury occurred to children <9 years old in rear impacts. The corresponding injury risk was lowest in rear impacts, at 0.014 ± 0.014%%, when compared to other crash types. The analysis of in-depth NASS-CDS cases of occupant-to-occupant contact injury in children< 9 years old involved in rear impacts identified very severe collisions in older model vehicles with deformation of the occupant compartment and yielding front seats as main factors for the contact injury. Front seat occupants injuring rear-seated children was not identified in the in-depth NASS-CDS cases.Conclusions: AIS 3+ occupant-to-occupant contact injury occurs primarily in side impacts and rollovers. Most contact injury is to adults (89.4% incidence). Occupant-to-occupant contact injury to children is rare in rear impacts. [ABSTRACT FROM AUTHOR]

Objective: It is well known that alcohol and drugs influence driving behavior by affecting the central nervous system, awareness, vision, and perception/reaction times, but the resulting effect on driver injuries in car crashes is not fully understood. The purpose of this study was to identify factors affecting the injury severities of unimpaired, alcohol-impaired, and drug-impaired drivers.Method: The current article applies a random parameters logit model to study the differences in injury severities among unimpaired, alcohol-impaired, and drug-impaired drivers. Using data from single-vehicle crashes in Cook County, Illinois, over a 9-year period from January 1, 2004, to December 31, 2012, separate models for unimpaired, alcohol-impaired, and drug-impaired drivers were estimated. A wide range of variables potentially affecting driver injury severity was considered, including roadway and environmental conditions, driver attributes, time and location of the crash, and crash-specific factors.Results: The estimation results show significant differences in the determinants of driver injury severities across groups of unimpaired, alcohol-impaired, and drug-impaired drivers. The findings also show that unimpaired drivers are understandably more responsive to variations in lighting, adverse weather, and road conditions, but these drivers also tend to have much more heterogeneity in their behavioral responses to these conditions, relative to impaired drivers. In addition, age and gender were found to be important determinants of injury severity, but the effects varied significantly across all drivers, particularly among alcohol-impaired drivers.Conclusions: The model estimation results show that statistically significant differences exist in driver injury severities among the unimpaired, alcohol-impaired, and drug-impaired driver groups considered. Specifically, we find that unimpaired drivers tend to have more heterogeneity in their injury outcomes in the presence potentially adverse weather and road surface conditions. This makes sense because one would expect unimpaired drivers to apply their full knowledge/judgment range to deal with these conditions, and the variability of this range across the driver population (with different driving experiences, etc.) should be great. In contrast, we find, for the most part, that alcohol-impaired and drug-impaired drivers have far less heterogeneity in the factors that affect injury severity, suggesting an equalizing effect resulting from the decision-impairing substance. [ABSTRACT FROM AUTHOR]

Objective: Though public transport vehicles are rarely involved in mass casualty accidents, when they are, the number of injuries and fatalities is usually high due to the high passenger capacity. Of the few studies that have been conducted on bus safety, the majority focused on vehicle safety features, road environmental factors, as well as driver characteristics. Nevertheless, few studies have attempted to investigate the underlying risk factors related to bus occupants. This article presents an investigation aimed at identifying the risk factors affecting injury severity of bus passengers with different movements.Method: Three different passenger movement types including standing, seated, and boarding/alighting were analyzed individually using classification and regression tree (CART) method based on publicly available accident database of Great Britain.Results: According to the results of exploratory analyses, passenger age and vehicle maneuver are associated with passenger injury severity in all 3 types of accidents. Moreover, the variable "skidding and overturning" is associated with injury severity of seated passengers and driver age is correlated with injury severity of standing and boarding/alighting passengers.Conclusions: The CART method shows its ability to identify and easily explain the complicated patterns affecting passenger injury severity. Several countermeasures to reduce bus passenger injury severity are recommended. [ABSTRACT FROM AUTHOR]

Objective: Traffic crashes result in a loss of life but also impact the quality of life and productivity of crash survivors. Given the importance of traffic crash outcomes, the issue has received attention from researchers and practitioners as well as government institutions, such as the European Commission (EC). Thus, to obtain detailed information on the injury type and severity of crash victims, hospital data have been proposed for use alongside police crash records. A new injury severity classification based on hospital data, called the maximum abbreviated injury scale (MAIS), was developed and recently adopted by the EC. This study provides an in-depth analysis of the factors that affect injury severity as classified by the MAIS score.Method: In this study, the MAIS score was derived from the International Classification of Diseases. The European Union adopted an MAIS score equal to or greater than 3 as the definition for a serious traffic crash injury. Gains are expected from using both police and hospital data because the injury severities of the victims are detailed by medical staff and the characteristics of the crash and the site of its occurrence are also provided. The data were obtained by linking police and hospital data sets from the Porto metropolitan area of Portugal over a 6-year period (2006-2011). A mixed logit model was used to understand the factors that contribute to the injury severity of traffic victims and to explore the impact of these factors on injury severity. A random parameter approach offers methodological flexibility to capture individual-specific heterogeneity. Additionally, to understand the importance of using a reliable injury severity scale, we compared MAIS with length of hospital stay (LHS), a classification used by several countries, including Portugal, to officially report injury severity. To do so, the same statistical technique was applied using the same variables to analyze their impact on the injury severity classified according to LHS.Results: This study showed the impact of variables, such as the presence of blood alcohol, the use of protection devices, the type of crash, and the site characteristics, on the injury severity classified according to the MAIS score. Additionally, the sex and age of the victims were analyzed as risk factors, showing that elderly and male road users are highly associated with MAIS 3+ injuries. The comparison between the marginal effects of the variables estimated by the MAIS and LHS models showed significant differences. In addition to the differences in the magnitude of impact of each variable, we found that the impact of the road environment variable was dependent on the injury severity classification.Conclusions: The differences in the effects of risk factors between the classifications highlight the importance of using a reliable classification of injury severity. Additionally, the relationship between LHS and MAIS levels is quite different among countries, supporting the previous conclusion that bias is expected in the assessment of risk factors if an injury severity classification other than MAIS is used. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to identify the characteristics related to crash and victim, as well as the after-effects/disabilities and consequences arising from traffic crashes occurring in the city of Rio Branco-Acre.Methods: This is an analytical descriptive cross-sectional study conducted in the City of Rio Branco-Acre. The study population consisted of 405 residents of the city who were victims of traffic crashes, of all age groups and genders, who were hospitalized for the first time as a result of the crash in public hospitals and the health system network, as recorded in the Hospital Information System, and who were discharged between January 1 and December 31, 2010. The data sources included hospital record consultations and active searches for the victims. Hierarchical logistic regression was performed to evaluate the factors associated with the after-effects.Results: The majority of the study population was motorcycle victims (68.6%), male, and young (20-39 years). Concerning the after-effects, the following were significantly associated: factors related to the presence of a postcrash activity limitation (odds ratio [OR] = 2.39; 95% confidence interval [CI], 2.39-6.76), length of hospital stay in days (OR = 1 03; 95% CI, 1.01-1.06), and surgical treatment (OR = 1.82; 95% CI, 1.03-3.21). Those who suffered damage to soft tissue and nerves or facial injury showed an odds ratio of 2 to 4 times of having an after-effect/disability, independent of the victim's personal attributes.Conclusion: The mechanism, such as the origin of the pattern of injuries, explains the exposure factors shown by each attribute of the victim and their characteristics. Many of the injuries were precursors to after-effects/disabilities, which, due to their nature and extent, result in the modification of the apparently healthy living standards of young victims who are routinely injured in traffic crashes. Therefore, public policies for prevention should be formulated, reformulated, and implemented, taking into account each attribute of the victims and their social conditions, because these are closely related to their habits and customs. This is a starting point for promoting changes to the current reality that traffic crashes present in the morbidity and mortality of the population. [ABSTRACT FROM AUTHOR]

Objective: Pedestrians are the most vulnerable road users due to the lack of mass, speed, and protection compared to other types of road users. Adverse weather conditions may reduce road friction and visibility and thus increase crash risk. There is limited evidence and considerable discrepancy with regard to impacts of weather conditions on injury severity in the literature. This article investigated factors affecting pedestrian injury severity level under different weather conditions based on a publicly available accident database in Great Britain.Method: Accident data from Great Britain that are publicly available through the STATS19 database were analyzed. Factors associated with pedestrian, driver, and environment were investigated using a novel approach that combines a classification and regression tree with random forest approach.Results: Significant severity predictors under fine weather conditions from the models included speed limits, pedestrian age, light conditions, and vehicle maneuver. Under adverse weather conditions, the significant predictors were pedestrian age, vehicle maneuver, and speed limit.Conclusions: Elderly pedestrians are associated with higher pedestrian injury severities. Higher speed limits increase pedestrian injury severity. Based on the research findings, recommendations are provided to improve pedestrian safety. [ABSTRACT FROM AUTHOR]

Objectives: The 2 objectives of this study are to (1) examine the rib and sternal fractures sustained by small stature elderly females in simulated frontal crashes and (2) determine how the findings are characterized by prior knowledge and field data.Methods: A test series was conducted to evaluate the response of 5 elderly (average age 76 years) female postmortem human subjects (PMHS), similar in mass and size to a 5th percentile female, in 30 km/h frontal sled tests. The subjects were restrained on a rigid planar seat by bilateral rigid knee bolsters, pelvic blocks, and a custom force-limited 3-point shoulder and lap belt. Posttest subject injury assessment included identifying rib cage fractures by means of a radiologist read of a posttest computed tomography (CT) and an autopsy. The data from a motion capture camera system were processed to provide chest deflection, defined as the movement of the sternum relative to the spine at the level of T8.  A complementary field data investigation involved querying the NASS-CDS database over the years 1997-2012. The targeted cases involved belted front seat small female passenger vehicle occupants over 40 years old who were injured in 25 to 35 km/h delta-V frontal crashes (11 to 1 o'clock).Results: Peak upper shoulder belt tension averaged 1,970 N (SD = 140 N) in the sled tests. For all subjects, the peak x-axis deflection was recorded at the sternum with an average of -44.5 mm or 25% of chest depth. The thoracic injury severity based on the number and distribution of rib fractures yielded 4 subjects coded as Abbreviated Injury Scale (AIS) 3 (serious) and one as AIS 5 (critical). The NASS-CDS field data investigation of small females identified 205 occupants who met the search criteria. Rib fractures were reported for 2.7% of the female occupants.Conclusions: The small elderly test subjects sustained a higher number of rib cage fractures than expected in what was intended to be a minimally injurious frontal crash test condition. Neither field studies nor prior laboratory frontal sled tests conducted with 50th percentile male PMHS predicted the injury severity observed. Although this was a limited study, the results justify further exploration of the risk of rib cage injury for small elderly female occupants. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to describe the nature and extent of current powered 2-wheeler (PTW) risk exposures in order to support future efforts to improve safety for this mode of transport.Methods: A cross-sectional analysis of the control arm of a population-based case-control study was conducted. The control sample was selected from 204 sites on public roads within 150 km of the city of Melbourne that were locations of recent serious injury motorcycle crashes. Traffic observations and measurements at each site were sampled for a mean of 2 h on the same type of day (weekday, Saturday, or Sunday) and within 1 h of the crash time. Photographs of passing riders during this observation period recorded data relating to characteristics of PTWs, age of riders, travel speed of PTWs and all vehicles, time gaps between vehicles, visibility, and protective clothing use.Results: Motorcycles and scooters represented 0.6% of all traffic (compared with 4% of all vehicle registrations). Riders were significantly more likely to have larger time gaps in front and behind when compared to other vehicles. The average travel speed of motorcycles was not significantly different than the traffic, but a significantly greater proportion were exceeding the speed limit when compared to other vehicles (6 vs. 3%, respectively). The age of registered owners of passing motorcycles was 42 years. Over half of riders were wearing dark clothing with no fluorescent or reflective surfaces. One third of motorcyclists had maximum coverage of motorcycle-specific protective clothing.Conclusions: A very low prevalence of motorcyclists combined with relatively higher rates of larger time gaps to other vehicles around motorcycles may help explain their overrepresentation in injury crashes where another vehicle fails to give way. An increased risk of injury in the event of a crash exists for a small but greater proportion of motorcyclists (compared to other vehicle types) who were exceeding the speed limit. An apparent shift toward older age of the active rider population may be reducing injury crash risk relative to exposure time. There is significant scope to improve the physical conspicuity of motorcyclists and the frequency of motorcycle specific protective clothing use. These results can be used to inform policy development and monitor progress of current and future road safety initiatives. [ABSTRACT FROM AUTHOR]

Background: The consequences of injuries in terms of disabilities and health burden are relevant for policy making. This article provides an overview of the current knowledge on this topic and discusses the health burden of serious road injuries in The Netherlands.Methods: The overview of current knowledge on disabilities following a road crash is based on a literature review. The health burden of serious road injuries is quantified in terms of years lived with disability (YLD), by combining incidence data from the Dutch hospital discharge register with information about temporary and lifelong disability.Results: Literature shows that road traffic injuries can have a major impact on victims' physical and psychological well-being and functioning. Reported proportions of people with disability vary between 11 and 80% depending on the type of casualties, time elapsed since the crash, and the health impacts considered. Together, all casualties involving serious injuries in The Netherlands in 2009 account for about 38,000 YLD, compared to 25,000 years of life lost (YLL) of fatalities. Ninety percent of the burden of injury is due to lifelong consequences that are experienced by 20% of all those seriously injured in road accidents. Lower leg injuries and head injuries represent a high share in the total burden of injury as have cyclists that are injured in a crash without a motorized vehicle. Pedestrians and powered 2-wheeler users show the highest burden of injury per casualty.Conclusion: Given their major impacts and contribution to health burden, road policy making should also be aimed at reducing the number of serious road injuries and limiting the resulting health impacts. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to examine the prevalence of sarcopenia (low muscle mass) and osteosarcopenia (low bone density and muscle mass) in older motor vehicle crash (MVC) occupants and the relationship of these musculoskeletal conditions with age, sex, and injury.Methods: Sarcopenia and osteopenia was assessed from abdominal computed tomography (CT) scans of 61 seriously injured MVC occupants over age 50 in the Crash Injury Research and Engineering Network (CIREN) database.Results: The prevalence was 43% for sarcopenia, 25% for osteopenia, and 15% for osteosarcopenia in the CIREN occupants. The Injury Severity Score (ISS) was higher in those with only sarcopenia (mean ± SE = 22.4 ± 2.3), followed by those with osteosarcopenia (17.9 ± 2.4) and only osteopenia (12.8 ± 1.5). More total fractures were observed in occupants with sarcopenia alone (7.6 ± 1.5) or osteosarcopenia (7.0 ± 2.1) compared to nonsarcopenic occupants with osteopenia (4.0 ± 2.5).Conclusions: Sarcopenia and osteosarcopenia may be associated with more serious injuries and fractures in MVCs. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to evaluate the proportion and characteristics of patients sustaining major trauma in road traffic crashes (RTCs) who could benefit from direct transportation to a trauma center (TC).Methods: Currently, there is no national classification of TC in Sweden. In this study, 7 university hospitals (UHs) in Sweden were selected to represent a TC level I or level II. These UHs have similar capabilities as the definition for level I and level II TC in the United States. Major trauma was defined as Injury Severity Score (ISS) > 15. A total of 117,730 patients who were transported by road or air ambulance were selected from the Swedish TRaffic Accident Data Acquisition (STRADA) database between 2007 to 2014. An analysis of the patient characteristics sustaining major trauma in comparison with patients sustaining minor trauma (ISS < 15) was conducted. Major trauma patients transported to a TC versus non-TC were further analysed with respect to injured body region and road user type.Results: Approximately 3% (n = 3, 411) of patients sustained major trauma. Thirty-eight percent of major trauma patients were transported to a TC, and 62% were transported to a non-TC. This results in large proportions of patients with Abbreviated Injury Scale (AIS) 3+ injuries being transported to a non-TC.  The number of AIS 3+ head injuries for major trauma patients transported to a TC versus non-TC were similar, whereas a larger number of AIS 3+ thorax injuries were present in the non-TC group. The non-TC major trauma patients had a higher probability of traveling in a car, truck, or bus and to be involved in a crash in a rural location.Conclusions: Our results show that the majority of RTC major trauma patients are transported to a non-TC. This may cause unnecessary morbidity and mortality. These findings can guide the development of improved prehospital treatment guidelines, protocols and decision support systems. [ABSTRACT FROM AUTHOR]

Background: Although numerous observational studies have demonstrated a protective effect of motorcycle helmets against head injury, the degree of protection against specific head injury types remains unclear. Experimental biomechanics studies involving cadavers, animals, and computer models have established that head injuries have varying etiologies. This retrospective cross-sectional study compared helmet protection against skull fracture, cerebral contusion, intracranial hemorrhage, and cerebral concussion in a consecutive series of motorcycle operators involved in recent traffic crashes in Kentucky.Methods: Police collision reports linked to hospital inpatient and emergency department (ED) claims were analyzed for the period 2008 to 2012. Motorcycle operators with known helmet use who were not killed at the crash scene were included in the study. Helmet use was ascertained from the police report. Skull fracture, cerebral contusion, intracranial hemorrhage, and cerebral concussion were identified from International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes on the claims records. The relative risks of each type of head injury for helmeted versus unprotected operators were estimated using generalized estimating equations.Results: Helmets offer substantial protection against skull fracture (relative risk [RR] = 0.31, 95% confidence interval [CI], 0.23, 0.34), cerebral contusion (RR = 0.29, 95% CI, 0.16, 0.53), and intracranial hemorrhage (RR = 0.47, 95% CI, 0.35, 0.63). The findings pertaining to uncomplicated concussion (RR = 0.80, 95% CI, 0.64, 1.01) were inconclusive. A modest protective effect (20% risk reduction) was suggested by the relative risk estimate, but the 95% confidence interval included the null value.Conclusions: Motorcycle helmets were associated with a 69% reduction in skull fractures, 71% reduction in cerebral contusion, and 53% reduction in intracranial hemorrhage. This study finds that current motorcycle helmets do not protect equally against all types of head injury. Efforts to improve rotational acceleration management in motorcycle helmets should be considered. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to develop a disability-based metric for motor vehicle crash (MVC) injuries, with a focus on head injuries, and compare the functional outcomes between the pediatric and adult populations.Methods: Disability risk (DR) was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank-Research Data System (NTDB-RDS) for the top 95% most frequently occurring Abbreviated Injury Scale (AIS) 3, 4, and 5 head injuries in NASS-CDS 2000-2011. Pediatric (ages 7-18), adult (19-45), middle-aged (46-65), and older adult (66+) patients with an FIM score available who were alive at discharge and had an AIS 3, 4, or 5 injury were included in the study. The NTDB-RDS contains a truncated form of the FIM instrument, including 3 items (self-feed, locomotion, and verbal expression), each graded on a scale of 1 (full functional dependence) to 4 (full functional independence). Patients within each age group were classified as disabled or not disabled based on the FIM scale. The DR was calculated for each age group by dividing the number of patients who sustained a specific injury and were disabled by the number of patients who sustained the specific injury. To account for the impact of more severe associated coinjuries, a maximum AIS (MAIS) adjusted DR (DRMAIS) was also calculated for each injury. DR and DRMAIS ranged from 0 (0% disability risk) to 1 (100% disability risk).Results: An analysis of the most frequent FIM components associated with disabling MVC head injuries revealed that disability across all 3 items (self-feed, locomotion, and expression) was the most frequent for pediatric and adult patients. Only locomotion was the most frequent for middle-aged and older adults. The mean DRMAIS for MVC head injuries was 35% for pediatric patients, 36% for adults, 38% for middle-aged adults, and 44% for older adults. Further analysis was conducted by grouping the head injuries into 8 groups based on the structure of injury and injury type. The pediatric population possessed higher DRMAIS values for brain stem injuries as well as loss of consciousness injuries. Older adults possessed higher DRMAIS values for contusion/hemorrhage injuries, epidural hemorrhage, intracerebral hemorrhage, skull fracture, and subdural/subarachnoid hemorrhage.Conclusion: At-risk populations such as pediatric and older adult patients possessed higher DRMAIS values for different head injuries. Disability in pediatric patients is critical due to loss of quality life years. Disability risk can supplement severity metrics to improve the ability of such metrics to discriminate the severity of different injuries that do not lead to death. Understanding of age-related differences in injury outcomes when compared to adults could inform future age-specific modifications to the AIS. [ABSTRACT FROM AUTHOR]

Objective: The functional capacity index (FCI) is designed to predict functional loss 12 months post-injury for each injury in the 2008 Abbreviated Injury Scale (AIS) manual on a scale from 0 (death) to 100 (full recovery), but FCI has never been validated. This study compared FCI predicted loss with patient-reported 12-month outcomes as measured through the Short Form 36 (SF-36) health assessment survey.Methods: Using follow-up data collected on 2,858 adult car crash occupants in the Crash Injury Research and Engineering Network (CIREN) database, we compared FCI predicted outcomes to occupants' Physical Component Summary (PCS) scores, which are weighted averages of the SF-36 items addressing physical function. Our analyses included descriptive statistics, plots of typical recovery patterns, and a mixed effects regression model that describes PCS as a function of FCI, demographics, comorbidities, and injury pattern while also adjusting for the occupants' pre-crash physical capabilities. We further examined injuries in patients who report a significant drop in PCS 12 months post-crash despite being predicted to fully recover.Results: At baseline, the CIREN population exhibited PCS scores similar to the overall population (mean = 51.1, SD = 10.3). Twelve months post-crash, occupants with predicted impairment (FCI < 100) report a substantial decrease in physical function, and those who were predicted to fully recover still report some, albeit less, impairment. In the multivariate mixed-effects regression model, FCI is a strongly significant (P-value <.0001) predictor of PCS, with each 1-point drop in FCI predicting a 0.27-point drop in PCS. Maximum AIS severities in the head, spine, and lower extremity body regions were also significantly associated with PCS (P-values <.05). Among occupants who were expected to fully recover but who report a significant drop in PCS at 12 months, spinal fractures without cord involvement account for 5 of the 10 most common AIS 2+ injuries.Conclusions: FCI was associated with 12-month outcomes but may not adequately describe the recovery from some head, spine, and lower extremity injuries. Some occupants who were expected to recover still report functional loss 12 months post-injury. [ABSTRACT FROM AUTHOR]

Background: The Abbreviated Injury Scale (AIS) is an anatomical-based coding system created by the Association for the Advancement of Automotive Medicine, utilized to classify and code injuries resulting from trauma, in order of severity. According to the latest version, all Thoraco-Lumbar Compression Fractures (TLCF), even without injury to other spine components and with >20% loss of height, were branded AIS 3 injuries, reflecting a serious threat to life or permanent disability. Advances in spine imaging, recent biomechanical studies, and long-term outcomes research offer the opportunity to consider these injuries differently.Objective: To re-evaluate the percent compression threshold of TLCF of the spine from motor vehicle crashes (MVC) for serious risk to life identified as surgical treatment, delineating a reliable cut-off for fracture severity and morbidity. Little national data considers degree of compression and provides adequate followup imaging to determine degree of compression, justifying this effort.Methods: Charts and radiographs of patients admitted to our institution due to vehicle crashes with isolated (vertebral body only) TLCF between 2008 and 2015 were reviewed. Data were collected on degree of compression, treatment, and long-term outcomes to determine the threshold of permanent injury. Vertebral bodies at the level of fracture were measured both anteriorly and posteriorly, and compared to adjacent segments; percentage compression was calculated.Results: 1470 patient records with diagnoses of spine trauma were reviewed; 695 isolated compression fractures were identified, of which 194 were in vehicle crashes and had adequate imaging and follow-up. Ages ranged from 19 to 82, with a male: female ratio of 60:40. No patient with vertebral body compression of less than 30% underwent surgery unless presenting with a neurological deficit. All 22 surgical patients demonstrated significant retropulsion of bone into the spinal canal. Five surgical patients suffered eight complications; there were no adverse outcomes in the nonsurgical group.Conclusions: These results are consistent with evolving clinical thinking, resulting in decreasing surgical incidence and orthosis use. Our data strongly suggests that isolated compression fractures in the absence of neurologic deficit or severe cord compression due to retropulsed bone are self-limiting. Therefore, the AIS scores for these common injuries could be reconsidered and reflect their relatively benign outlook. [ABSTRACT FROM AUTHOR]

Objective: The objective of this article is to present concussion assessment data for 30 male athletes prior to and after being involved in a large school bus crash. The athletes on the bus, all male and aged 14-18 years, were participants in their school's concussion management program that included baseline and postinjury testing using Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT).Methods: This case study described changes in concussion assessment scores for 30 male athletes following a primarily frontal school bus crash. Data from the school's concussion management program, including baseline test data and postinjury assessment data, were reviewed. Athletes who required multiple postinjury assessments by the program were identified as having had significant cognitive changes as a result of the bus crash.Results: Twenty-nine of 30 athletes were injured. One had lumbar compression fractures; others had various lacerations, abrasions, contusions, sprains, and nasal fractures. ImPACT data (postcrash) were available for all 30 athletes and 28 had available precrash baseline data. A total of 16 athletes (53.3%) had significant cognitive changes indicated by changes in their concussion assessment scores, some of which took months to improve.Conclusion: This case study highlights a unique opportunity to evaluate concussion assessment data from 30 male athletes involved in a high-speed school bus crash. Further, these data provide additional insight into assessing the effectiveness of current school bus occupant protection systems. [ABSTRACT FROM AUTHOR]

Objective: The State of Connecticut has a partial motorcycle helmet law, which has been linked to one of the lowest helmet compliance rates in the Northeast. We examine the clinical and financial impact of low motorcycle helmet use in the State of Connecticut.Methods: A retrospective cohort study comparing the outcomes between helmeted and nonhelmeted motorcycle crash victims over a 12.5-year period, from July 2, 2002, to December 31, 2013. All patients who were admitted to the hospital after a motorcycle crash were included in the study. Patients were stratified into helmeted and nonhelmeted cohorts. Group differences were compared using t-test or Wilcoxon rank test for continuous variables and chi-square test for dichotomous outcomes. Regression models were created to evaluate predictors of helmet use, alcohol and drugs as confounding variables, and factors that influenced hospital costs.Results: The registry included 986 eligible patients. Of this group, 335 (34%) were helmeted and 651 (66%) were nonhelmeted. Overall, nonhelmeted patients had a worse clinical presentation, with lower Glasgow Coma Scale (GCS; P <.01), higher Injury Severity Score (ISS; P <.01), higher incidence of loss of consciousness (LOC; P <.01), longer intensive care unit (ICU; P <.01) admissions, and higher incidence of head (P <.01) or face injuries (P <.01). Nonhelmeted patients were also twice as more likely to die from their injuries (P =.04, odds ratio [OR] = 1.89, 95% confidence interval [CI], 1.02-3.45). Financially, nonhelmeted patients incurred mean hospital costs of $18,458, whereas helmeted patients incurred $14,970 (P =.18). ISS, GCS, and ICU length of stay were significantly correlated with increased hospital costs (P <.01). Not using a helmet was a significant predictor of mortality (P =.04) after adjusting for alcohol/drug use and age.Conclusions: Helmet use is associated with lower injury severity and increased survival after a motorcycle crash. These outcomes remained consistent even after controlling for age and alcohol and drug use. The medical and financial impact of Connecticut's partial helmet law should be carefully evaluated to petition for increased education and enforcement of helmet use. [ABSTRACT FROM AUTHOR]

Objective: Powered 2-wheeled motor vehicles (PTWs) are one of the most vulnerable categories of road users. Bearing that fact in mind, we have researched the effects of individual and environmental factors on the severity and type of injuries of PTW users. The aim was to recognize the circumstances that cause these accidents and take some preventive actions that would improve the level of road safety for PTWs.Methods: In the period from 2001 to 2010, an analysis of 139 road accidents involving PTWs was made by the Faculty of Transport and Traffic Engineering in Belgrade. The effects of both individual (age, gender, etc.) and environmental factors (place of an accident, time of day, etc.) on the cause of accidents and severity and type of injuries of PTWs are reported in this article. Analyses of these effects were conducted using logistic regression, chi-square tests, and Pearson's correlation.Results: Factors such as categories of road users, pavement conditions, place of accident, age, and time of day have a statistically significant effect on PTW injuries, whereas other factors (gender, road type; that is, straight or curvy) do not. The article also defines the interdependence of the occurrence of particular injuries at certain speeds. The results show that if PTW users died of a head injury, these were usually concurrent with chest injuries, injuries to internal organs, and limb injuries.Conclusions: It has been shown that there is a high degree of influence of individual factors on the occurrence of accidents involving 2-wheelers (PTWs/bicycles) but with no statistically significant relation. Establishing the existence of such conditionalities enables identifying and defining factors that have an impact on the occurrence of traffic accidents involving bicyclists or PTWs. Such a link between individual factors and the occurrence of accidents makes it possible for system managers to take appropriate actions aimed at certain categories of 2-wheelers in order to reduce casualties in a particular area. The analysis showed that most of the road factors do not have a statistically significant effect on either category of 2-wheeler. Namely, the logistic regression analysis showed that there is a statistically significant effect of the place of accident on the occurrence of accidents involving bicyclists. [ABSTRACT FROM AUTHOR]

Introduction: Restraint systems (seat belts and airbags) are important tools that improve vehicle occupant safety during motor vehicle crashes (MVCs). We aimed to identify the pattern and impact of the utilization of passenger restraint systems on the outcomes of MVC victims in Qatar.Methods: A retrospective study was conducted for all admitted patients who sustained MVC-related injuries between March 2011 and March 2014 inclusive.Results: Out of 2,730 road traffic injury cases, 1,830 (67%) sustained MVC-related injuries, of whom 88% were young males, 70% were expatriates, and 53% were drivers. The use of seat belts and airbags was documented in 26 and 2.5% of cases, respectively. Unrestrained passengers had greater injury severity scores, longer hospital stays, and higher rates of pneumonia and mortality compared to restrained passengers (P = .001 for all). There were 311 (17%) ejected cases. Seat belt use was significantly lower and the mortality rate was 3-fold higher in the ejected group compared to the nonejected group (P = .001). The overall mortality was 8.3%. On multivariate regression analysis, predictors of not using a seat belt were being a front seat passenger, driver, or Qatari national and young age. Unrestrained males had a 3-fold increase in mortality in comparison to unrestrained females. The risk of severe injury (relative risk [RR] = 1.82, 95% confidence interval [CI], 1.49-2.26, P = .001) and death (RR = 4.13, 95% CI, 2.31-7.38, P = .001) was significantly greater among unrestrained passengers.Conclusion: The nonuse of seat belts is associated with worse outcomes during MVCs in Qatar. Our study highlights the lower rate of seat belt compliance in young car occupants that results in more severe injuries, longer hospital stays, and higher mortality rates. Therefore, we recommend more effective seat belt awareness and education campaigns, the enforcement of current seat belt laws, their extension to all vehicle occupants, and the adoption of proven interventions that will assure sustained behavioral changes toward improvements in seat belt use in Qatar. [ABSTRACT FROM AUTHOR]

Objective: Several studies have reported the benefits of motorcycle antilock braking systems (ABS) in reducing injury crashes, due to improved stability and braking performance. Both aspects may prevent crashes but may also reduce the crash severity when a collision occurs. However, it is still unknown to what extent the reductions in injury crashes with ABS may be due to a combination of these mechanisms.Methods: Swedish hospital and police reports (2003-2012) were used. The risk for permanent medical impairment (RPMI) was calculated, showing the risk of at least 1 or 10% permanent medical impairment. In total, 165 crashes involving ABS-equipped motorcycles were compared with 500 crashes with similar motorcycles without ABS. The analysis was performed in 3 steps. First, the reduction in emergency care visits with ABS was calculated using an induced exposure approach. Secondly, the injury mitigating effects of ABS were investigated. The mean RPMI 1+ and RPMI 10+ were analyzed for different crash types. The distributions of impairing injuries (PMI 1+) and severely impairing injuries (PMI 10+) were also analyzed. In the third step, the total reduction of PMI 1+ and PMI 10+ injured motorcyclists was calculated by combining the reductions found in the previous steps. An additional analysis of combined braking systems (CBS) together with ABS was also performed.Results: The results showed that emergency care visits were reduced by 47% with ABS. In the second step, it was found that the mean RPMI 1+ and RPMI 10+ with ABS were 15 and 37% lower, respectively. Finally, the third step showed that the total reductions in terms of crash avoidance and mitigation of PMI 1+ and PMI 10+ injured motorcyclists with ABS were 67 and 55%, respectively. However, PMI 1+ and PMI 10+ leg injuries were not reduced by ABS to the same extent. Indications were found suggesting that the benefits of ABS together with CBS may be greater than ABS alone.Conclusions: This article indicated that motorcycle ABS reduced impairing injuries, mostly due to fewer emergency care visits but also due to a reduction in crash severity. This may seem reasonable as the improved stability and braking performance provided by ABS could prevent some crashes but would also decrease crash severity if a collision still occurs. As suggested by previous studies, however, the lower extremities would be more exposed in a crash with ABS. It is recommended that future research should follow up these results with additional data. [ABSTRACT FROM AUTHOR]

Objective: With increasing traffic volume and urban development, increasing numbers of underground tunnels have been constructed to relieve conflict between strained land and heavy traffic. However, as more long tunnels are constructed, tunnel traffic safety is becoming increasingly serious. Thus, it is necessary to acquire their implications and impacts. This study examined 4,539 traffic accidents that have occurred in 14 Shanghai river-crossing tunnels for the period 2011-2012 and analyze the correlation between potential factors and accident injury severity.Methods: An ordered logit model was developed to examine the correlation between potential factors and accident injury severity.Results: Results show that increased injury severity is associated with male drivers, drivers aged 65 years or older, accident time from midnight to dawn, weekends, wet road surface, goods vehicles, 3 or more vehicles, 4 or more lanes, middle speed limits (50-79 km/h), zone 3, extra-long tunnels (over 3,000 m), and maximum longitudinal gradient.Conclusions: This article aims to provide useful information for engineers to develop interventions and countermeasures to improve tunnel safety in China. [ABSTRACT FROM AUTHOR]

Objectives: In order to improve motorcycle safety, this article examines the correlation between crash avoidance maneuvers and injury severity sustained by motorcyclists, under multiple precrash conditions.Method: Ten-year crash data for single-vehicle motorcycle crashes from the General Estimates Systems (GES) were analyzed, using partial proportional odds models (i.e., generalized ordered logit models).Results: The modeling results show that “braking (no lock-up)” is associated with a higher probability of increased severity, whereas “braking (lock-up)” is associated with a higher probability of decreased severity, under all precrash conditions. “Steering” is associated with a higher probability of reduced injury severity when other vehicles are encroaching, whereas it is correlated with high injury severity under other conditions. “Braking and steering” is significantly associated with a higher probability of low severity under “animal encounter and object presence,” whereas it is surprisingly correlated with high injury severity when motorcycles are traveling off the edge of the road. The results also show that a large number of motorcyclists did not perform any crash avoidance maneuvers or conducted crash avoidance maneuvers that are significantly associated with high injury severity.Conclusions: In general, this study suggests that precrash maneuvers are an important factor associated with motorcyclists' injury severity. To improve motorcycle safety, training/educational programs should be considered to improve safety awareness and adjust driving habits of motorcyclists. Antilock brakes and such systems are also promising, because they could effectively prevent brake lock-up and assist motorcyclists in maneuvering during critical conditions. This study also provides valuable information for the design of motorcycle training curriculum. [ABSTRACT FROM PUBLISHER]

Objective: Appropriate treatment at designated trauma centers (TCs) improves outcomes among injured children after motor vehicle crashes (MVCs). Advanced Automatic Crash Notification (AACN) has shown promise in improving triage to appropriate TCs. Pediatric-specific AACN algorithms have not yet been created. To create such an algorithm, it will be necessary to include some metric of development (age, height, or weight) as a covariate in the injury risk algorithm. This study sought to determine which marker of development should serve as a covariate in such an algorithm and to quantify injury risk at different levels of this metric.Methods: A retrospective review of occupants age < 19 years within the MVC data set NASS-CDS 2000-2011 was performed. R(2) values of logistic regression models using age, height, or weight to predict 18 key injury types were compared to determine which metric should be used as a covariate in a pediatric AACN algorithm. Clinical judgment, literature review, and chi-square analysis were used to create groupings of the chosen metric that would discriminate injury patterns. Adjusted odds of particular injury types at the different levels of this metric were calculated from logistic regression while controlling for gender, vehicle velocity change (delta V), belted status (optimal, suboptimal, or unrestrained), and crash mode (rollover, rear, frontal, near-side, or far-side).Results: NASS-CDS analysis produced 11,541 occupants age < 19 years with nonmissing data. Age, height, and weight were correlated with one another and with injury patterns. Age demonstrated the best predictive power in injury patterns and was categorized into bins of 0-4 years, 5-9 years, 10-14 years, and 15-18 years. Age was a significant predictor of all 18 injury types evaluated even when controlling for all other confounders and when controlling for age- and gender-specific body mass index (BMI) classifications. Adjusted odds of key injury types with respect to these age categorizations revealed that younger children were at increased odds of sustaining Abbreviated Injury Scale (AIS) 2+ and 3+ head injuries and AIS 3+ spinal injuries, whereas older children were at increased odds of sustaining thoracic fractures, AIS 3+ abdominal injuries, and AIS 2+ upper and lower extremity injuries.Conclusions: The injury patterns observed across developmental metrics in this study mirror those previously described among children with blunt trauma. This study identifies age as the metric best suited for use in a pediatric AACN algorithm and utilizes 12 years of data to provide quantifiable risks of particular injuries at different levels of this metric. This risk quantification will have important predictive purposes in a pediatric-specific AACN algorithm. [ABSTRACT FROM AUTHOR]

Objective:Previous studies on crash modeling at highway–rail grade crossings were aimed at exploring the factors that are likely to increase the crash frequencies at highway–rail grade crossings. In recent years, modeling driver's injury severity at highway–rail grade crossings has received interest. Because there were substantial differences among different weather conditions for driver's injury severity, this study attempts to explore the impact of weather influence on driver injury at highway–rail grade crossing. Method:Utilizing the most recent 10 years (2002–2011) of highway–rail grade crossing accident data, this study applied a mixed logit model to explore the determinants of driver injury severity under different weather conditions at highway–rail grade crossing. Results:Analysis results indicate that drivers' injury severity at highway–rail grade crossings is strongly different for different weather conditions. It was found that the factors significantly impacting driver injury severity at highway–rail grade crossings include motor vehicle speed, train speed, driver's age, gender, area type, lighting condition, highway pavement, traffic volume, and time of day. Conclusions:The findings of this study indicate that crashes are more prevalent if vehicle drivers are driving at high speed or the oncoming trains are high speed. Hence, a reduction in speed limit during inclement weather conditions could be particularly effective in moderating injury severity, allowing more reaction time for last-minute maneuvering and braking in moments before impacts. In addition, inclement weather-related crashes were more likely to occur in open areas and highway–rail grade crossings without pavement and lighting. Paved highway–rail grade crossings with installation of lights could be particularly effective in moderating injury severity. [ABSTRACT FROM PUBLISHER]

Purpose: This is a descriptive study of the annual incidence of brain injuries in motor vehicle crashes by type, seat belt use, and crash severity (delta V) using national accident data. The risk for concussion, diffuse axonal injury (DAI), and severe head injury was determined.Methods: 1994-2011 NASS-CDS was analyzed to estimate the number of brain injuries annually in nonejected adults involved in motor vehicle crashes. Crashes were grouped by front, side, rear, and rollover, and the effect of belt use was investigated. Light vehicles were included with model year 1994+. Head injuries were identified as concussion, DAI, severe head injury (Abbreviated Injury Scale [AIS] 4+), and skull fracture. The annual incidence, risk, and rate for different types of head injury were estimated with standard errors.Results: Motor vehicle crashes involved 33,191 ± 7,815 occupants with concussion, 5,665 ± 996 with AIS 4+ head injuries, 986 ± 446 with DAI, and 3,300 ± 531 with skull fracture annually. The risk was 1.64 ± 0.39% for concussion, 0.28 ± 0.05% for severe head injury (AIS 4+), 0.05 ± 0.02% for DAI, and 0.16 ± 0.03% for skull fracture in tow-away crashes. The risk for severe head injury (AIS 4+) was highest in rollovers (0.74 ± 0.16%) and lowest in rear impacts (0.17 ± 0.05%). Head injury risk depended on seat belt use, crash type, and crash severity (delta V). Seat belt use lowered the risk for AIS 4+ head injury by 74.8% and skull fracture by 73.2%.Conclusions: Concussions occur in about one out of 61 occupants in tow-away crashes. The risk was highest in rollover crashes (4.73 ± 1.09%) and it was reduced 69.2% by seat belt use. Severe brain injuries occurred less often and the risk was also reduced by seat belt use. [ABSTRACT FROM AUTHOR]