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Seat belts and child restraint systems (CRS) are important in-car safety components capable of preventing serious injuries and death in the event of a car crash. Low rates of seat belt and CRS use persist globally, particularly in the Kingdom of Saudi Arabia (KSA). In an effort to better understand and subsequently improve seat belt and CRS use rates, this study analyzed the factors influencing seat belt and CRS use behavior in the Eastern Province (EP) of KSA, including the connection between seat belt and CRS use and road traffic crash experience. This cross-sectional study was based on a survey of 3,421 male and female participants regarding their seat belt and CRS use behavior. Respondents were classified into four CRS use categories: cautious , helplessly negligent , ignorantly negligent , and deliberately negligent. Chi-squared tests were used to determine significant associations among seat belt use, seat belt belief, prior crash experience, CRS use, and demographic variables. Multinomial nominal logistic regression was used to estimate the odds ratios for classification in one of the three negligent vs. cautious CRS use categories as a function of demographic variables, prior road traffic crash experience, and belief in and use of seat belts. Results of this study indicated a modest improvement in the rate of seat belt use in KSA's EP, however, a significant proportion of respondents reported only sometimes or never using their seat belt. A significant proportion of respondents were also classified in one of the three negligent CRS use categories. Respondents who reported using a seat belt sometimes or never were 2.67, 2.60, and 3.48 times more likely to be categorized as deliberately negligent , ignorantly negligent , or helplessly negligent in their CRS use, respectively, than respondents who reported always using their seat belts. Respondents who reported being previously involved in a car crash or a near crash were also more likely to be classified in one of the three negligent CRS use categories than respondents who reported no prior road traffic crash experience. Previous involvement in a car crash was also found to be associated with lower seat belt and CRS use rates. These findings suggest a need for increased seat belt law enforcement by the KSA's Traffic Police Department, as well as additional seat belt and CRS use awareness campaigns targeting individuals with prior road traffic crash experience by the KSA's Ministry of Communications through the Road Transport Department. This study can serve as a reference for future studies that aim to understand the factors and implications related to seat belt use and belief, CRS use, and road traffic crash experience. [ABSTRACT FROM AUTHOR]

Background/Aim: Centrofacial fractures resulting from high-impact violence can be considered mild traumatic brain injuries. Given the complexities and associated risks, a comprehensive examination of these fractures is warranted. These fractures are increasingly prevalent among young adult patients and are commonly associated with road traffic accidents. In the literature, only a few studies have focused on this particular type of facial bone lesion. In Ivory Coast, no studies have been conducted on these fractures, which highlights the importance of our research aimed at describing the epidemiological and anatomicalclinical characteristics of centrofacial fractures in the stomatology and maxillofacial surgery department of the Cocody Teaching Hospital. Methods: This descriptive cross-sectional study was conducted in the Stomatology and Maxillofacial Surgery Department of the Cocody University Hospital Center from January 2016 to December 2020. Results: The prevalence of these fractures was 24.20%, with a predominance of male subjects. The age group most affected was 20 to 40 years old, accounting for 70.96% of cases, and most patients resided in Abidjan (59%). All socio-economic categories were represented, with a higher proportion of individuals in liberal professions (91.4%). Road traffic accidents involving two-wheeled vehicles were the primary cause of these fractures (76.8%), with the most common injury site being the naso-ethmoido-maxillo-frontoorbital complex (NEMFOC) (32.5%). Conclusion: The epidemiological characteristics of centrofacial fractures associated with two-wheeled vehicles in the Abidjan metropolis of Côte d'Ivoire suggest the need for increased accountability among motor vehicle drivers and stricter enforcement of traffic laws. [ABSTRACT FROM AUTHOR]

Background: Urban trauma centers reported increased substance use among individuals injured in motor vehicle collisions (MVC) after the start of the COVID-19 pandemic. Little is known about individuals admitted to rural trauma centers during this time. This study's purpose was to describe substance use trends before and during the pandemic among individuals injured in MVC and treated at a rural Level-1 trauma center in West Virginia. Methods: A cross-sectional analysis was performed using patients' medical records. The study population included individuals ≥ 18 years of age who received treatment for a motor vehicle-related injury between September 1, 2018, and September 30, 2021, and were tested for drugs and alcohol upon admittance. The pre-COVID-19 period was defined as September 1, 2018–March 15, 2020. The COVID-19 period was March 16, 2020–September 30, 2021. The primary dependent variable was the patients' drug test results. The primary independent variable was the time period. The data were analyzed using Chi-square tests, logistic regression, and proportional odds models. Results: During this time, 1465 patients received treatment. On average, patients were 45 years ± 20 of age and male (57%). During COVID-19, 17% of patients tested positive for alcohol and 58% tested positive for non-alcohol drugs. After adjusting for patients' sex and age, the number of drugs that patients tested positive for was 31% higher during COVID-19 (aOR 1.31; 95% CI 1.08, 1.58). The proportion of patients testing positive for cannabinoids (p = 0.05), opioids (p = 0.001), and stimulants (p = 0.010) increased from pre-COVID-19 to COVID-19 periods. Conclusions: Drug and alcohol use increased among trauma patients admitted to a rural trauma center during COVID-19. Significant increases were seen in the number of drugs and for cannabinoids, opioids, and stimulants. [ABSTRACT FROM AUTHOR]

Background and Aims: Sobriety checkpoints are an effective strategy to reduce alcohol‐impaired driving, motor vehicle crashes, injuries and fatalities. The aim of this study was to identify the geographic extent over which individual sobriety checkpoints affect alcohol‐impaired driving. Design, Setting, Participants: Spatial ecological panel analysis using geolocated breath test data from the Queensland Police Service, Australia, for January 2012 to June 2018. Data were aggregated over 338 weeks within 528 Statistical Area level 2 (SA2) units (n = 178 464 SA2‐weeks) and 84 Statistical Area level 3 (SA3) units (n = 28 392 SA3‐weeks). SA2 units in Queensland contain a mean population of 8883.5 (SD = 55 018.3) and encompass 468.9 roadway kilometers (SD = 1490.0); SA3 units contain a mean population of 57 201.6 (SD = 29521.6) and encompass 2936.0 roadway kilometers (SD = 7025.0). Measurements Independent measures were the density of sobriety checkpoints conducted per 500 roadway kilometers within local and spatially adjacent space–time units. The dependent measure was the rate of tests that detected breath alcohol concentration (a proxy for blood alcohol concentration [BAC]) greater than the legal maximum value of 0.05% for fully licensed drivers in Queensland. Bayesian hierarchical spatial negative binomial models‐related sobriety checkpoints to the rate of breath tests with BAC ≥ 0.05% within and between space–time units. Findings One additional sobriety checkpoint conducted per 500 roadway kilometers was associated with 2.5% reduction in the rate of breath tests with BAC ≥ 0.05% within local SA2 units (incidence rate ratio [IRR] = 0.975; 95% credibility interval (CrI): 0.973–0.978), and with 5.5% reduction in the rate of breath tests with BAC ≥ 0.05% within local SA3 units (IRR = 0.945; 95%CrI: 0.937–0.953). Associations were attenuated towards null in spatially adjacent units and in temporally lagged units (e.g. SA3‐weeks; adjacent lagged 1 week: IRR = 0.969; 95%CrI: 0.937–1.003). Conclusions: Individual sobriety checkpoints appear to be associated with reductions in nearby alcohol‐impaired driving. Relationships decay after approximately 1 week and beyond local areas containing approximately 60 000 residents and 3000 kilometers of roadway. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Macedonian Journal for Criminal Law & Criminology is the property of Macedonian Association for Criminal Law & Criminology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The first steam-powered vehicle is attributed to Ferdinand Verbiest in China made in 1672 for the Kangxi Emperor. The first recorded automobile death was Mary Ward in Ireland who was thrown from a steam-powered car and fell under its wheels in 1869. The first person killed in the United States is recorded as Henry Bliss in New York City on Wednesday, September 13, 1899. As the automobile became popular among all groups of humans, motor vehicle crashes became the major cause of death and disability among children and adolescents. Research initially focused on the physical trauma that motor vehicle accidents or crashes induced, but eventually the psychological toll of motor vehicle crashes (MVCs) in the pediatric population became appreciated. This discussion reflects on how this occurred taking the entire 20th century to be acknowledged by researchers, clinicians, parents, and the general society. [ABSTRACT FROM AUTHOR]

The motor vehicle crash is the main cause of death and destruction in children and adolescents. One of the major psychological consequences to those who survive a motor vehicle crash (MCV) is post-traumatic stress disorder (PTSD). This discussion considers the future of research in this field that may also involve the use of artificial intelligence in control of motor vehicles that will take human error out of motor vehicle operation. It is important to consider all means in lowering the death and destruction faced by our children and adolescents on the killing fields of the roads in the United States and the world. [ABSTRACT FROM AUTHOR]

This review considers the teenage driver and the high risk of injury as well as death that these young drivers represent for themselves and others because of automobile crashes in the United States and around the world. Research suggests that half a million teenagers will die as motor vehicle drivers or passengers in the 21st century, that 35 million adolescents will be injured as drivers in the 21st century, and untold millions of car passengers are at risk of death and/or injury when exposed to teenage drivers in this century. Reasons for the high prevalence of motor vehicle crashes with injuries and deaths are considered as well as measures that have been instituted over the past few decades to improve this situation. From a viewpoint of prospicience, it is hoped that more preventive measures along with more research will help to reverse this tragic trend in the 21st century [ABSTRACT FROM AUTHOR]

Motor vehicle crashes (MVCs) comprise a significant component of emergency medical service workload. Due to the potential for life-threatening injuries, ambulances are often dispatched at the highest priority to MVCs. However, previous research has shown that only a small proportion of high-priority ambulance responses to MVCs encounter high acuity patients. Alternative methods for triaging patients over the phone are required to reduce the burden of over-triage. One method is to use information readily available at the scene (e.g. whether a person was a motorcyclist, ejection status or whether an airbag deployed) as potential predictors of high acuity. Methods: A retrospective cohort study was conducted of all MVC patients in Perth attended by St John Western Australia between 2014 and 2016. Ambulance data was linked with Police crash data. The outcome variable of interest was patient acuity, where high acuity was defined as where a patient (1) died on-scene or (2) was transported by ambulance on priority one (lights & sirens) from the scene to hospital. Crash characteristics that are predictive of high acuity patients were identified by estimating crude odds ratios and 95% confidence intervals. Results: Of the 18,917 MVC patients attended by SJ-WA paramedics, 6.4% were classified as high acuity patients. The odds of being a high acuity patient was greater for vulnerable road users (motorcyclists, pedestrians and cyclists) than for motor vehicle occupants (OR 3.19, 95% CI, 2.80–3.64). A 'not ambulant patient' (one identified by paramedics as unable to walk or having an injury incompatible with being able to walk) had 15 times the odds of being high acuity than ambulant patients (OR 15.34, 95% CI, 11.48–20.49). Those who were trapped in a vehicle compared to those not trapped (OR 4.68, 95% CI, 3.95–5.54); and those who were ejected (both partial and full) from the vehicle compared to those not ejected (OR 6.49, 95% CI, 4.62–9.12) had higher odds of being high acuity patients. Discussion: There were two important findings from this study: (1) few MVC patients were deemed to be high acuity; and (2) several crash scene characteristics were strong predictors of high acuity patients. [ABSTRACT FROM AUTHOR]

Objective: Sobriety checkpoints have strong empirical and theoretical support as an intervention to reduce alcohol‐involved motor vehicle crashes. The purpose of this study was to examine whether checkpoint size (the number of police officers) and checkpoint duration (the amount of time in operation) affect associations between individual checkpoints and subsequent alcohol‐related crash incidence. Method: Queensland Police Service provided latitude–longitude coordinates and date and time data for all breath tests that occurred in Brisbane, Australia, from January 2012 to June 2018. We applied hierarchical cluster analysis to the latitude–longitude coordinates for breath tests, identifying checkpoints as clusters of ≥25 breath tests conducted by ≥3 breath testing devices over a duration of 3 to 8 hours. Generalized linear autoregressive moving average (GLARMA) models related counts of alcohol‐involved motor vehicle crashes to the number of checkpoints conducted per week, as well as 1 week prior and 2 weeks prior. Results: A total of 3420 alcohol‐related crashes occurred and 2069 checkpoints were conducted in Brisbane over the 6.5‐year (339‐week) study period. On average, checkpoints included a mean of 266.0 breath tests (SD = 216.3), 16.4 devices (SD = 13.7), and were 286.3 minutes in duration (SD = 104.2). Each 10 additional checkpoints were associated with a 12% decrease in crash incidence at a lag of 1 week (IRR = 0.88; 95%CI: 0.80, 0.97). We detected no differential associations according to checkpoint size or duration. Conclusions: Sobriety checkpoints are associated with fewer alcohol‐related motor vehicle crashes for around 1 week. Checkpoint size and duration do not appear to affect this relationship. [ABSTRACT FROM AUTHOR]

WHO mortality statistics overlook land motor-vehicle accident (LMVA)-related drowning. The aim of the study was to provide an overview of the prevalence and trends of fatal LMVA-related drowning in Finland, plus the main crash settings, victims' demographic characteristics, and contributing factors leading to such deaths. A descriptive, retrospective, population-based study of drowning deaths associated with LMVA among Finnish residents of all ages, 1971–2013. LMVA-related drownings and applicable variables were extracted from the Statistics Finland (SF) mortality database by cross-analysis of ICD injury- and external cause-of-death codes. During the study period, 538 LMVAs leading to drowning occurred among Finnish residents (2.5/1 000 000/year; 4.9% of all unintentional drownings, 3.7% of all LMVA). Three main settings, ones responsible for over 95% of LMVA-related drownings, were recognized: traffic vehicle accidents involving a passenger car; non-traffic vehicle accident involving a snowmobile; and non-traffic accidents involving agricultural, industrial, or construction vehicles. Alcohol use was a contributing factor for death in > 40% of the victims, whereas severe injuries were reported in less than 6%. Because transport safety is crucial to prevent any vehicle entering the water, placing LMVA-related drowning in the category of transport accidents is warranted. Once the vehicle becomes submersed, however, prevention measures to avoid death by drowning remains decisive. [ABSTRACT FROM AUTHOR]

Objectives This study aimed to characterize the population prevalence of pain and mental health problems postinjury and to identify risk factors that could improve service delivery to optimize recovery of at-risk patients. Methods This population-based registry cohort study included 5,350 adult survivors of transport-related major trauma injuries from the Victorian State Trauma Registry. Outcome profiles were generated separately for pain and mental health outcomes using the "pain or discomfort" and "anxiety or depression" items of the EuroQol Five Dimensions Three-Level questionnaire at six, 12, and 24 months postinjury. Profiles were "resilient" (no problems at every follow-up), "recovered" (problems at six- and/or 12-month follow-up that later resolved), "worsening" (problems at 12 and/or 24 months after no problems at six and/or 12 months), and "persistent" (problems at every follow-up). Results Most participants had persistent (pain/discomfort, N = 2,171, 39.7%; anxiety/depression, N = 1,428, 26.2%) and resilient profiles (pain/discomfort, N = 1,220, 22.3%; anxiety/depression, N = 2,055, 37.7%), followed by recovered (pain/discomfort, N = 1,116, 20.4%; anxiety/depression, N = 1,025, 18.8%) and worsening profiles (pain/discomfort, N = 956, 17.5%; anxiety/depression, N = 948, 17.4%). Adjusted multinomial logistic regressions showed increased risk of problems (persistent, worsening, or resolved) vs no problems (resilient) in relation to female sex, middle age, neighborhood disadvantage, pre-injury unemployment, pre-injury disability, and spinal cord injury. People living in rural areas, motorcyclists, pedal cyclists, and people with head, chest, and abdominal injuries had lower risk of problems. Discussion Targeted interventions delivered to people with the risk factors identified may help to attenuate the severity and impact of pain and mental health problems after transport injury. [ABSTRACT FROM AUTHOR]

Introduction: Trauma related to car accidents are among the most common type of trauma. The purpose of this study was to investigate the two-year road accidents of Maragheh-Hashtroud in terms of causes and factors lead to accidents. Method: This is a retrospective descriptive study. Sample size includes all patients with traffic accident in 2017 and 2018 consecutive years hospitalized in Amiralmomenin Hospital of Maragheh, Iran. Convenient Sampling was done. Data were analyzed using SPSS version 19. Result: 150 injured cases were investigated. Accidents occur more often in young people and men. Failure to pay attention to traffic rules and attention and concentration disorder is the most important cause of accidents. Conclusion: The human factor is the most important cause of traffic accidents, which occurs mostly due to non-observance of traffic rules and drowsiness. [ABSTRACT FROM AUTHOR]

Objective: Non‐fatal injuries sustained from animal–vehicle collisions are a globally under‐recognised road safety issue, with limited data on these crash types. The present study aimed to quantify the number and causes of major trauma events resulting from animal–vehicle collisions. Methods: The study was a retrospective analysis of major trauma cases occurring in Victoria, Australia, between 2007 and 2016, using data from the population‐based Victorian State Trauma Registry. To identify animal–vehicle collisions, Victorian State Trauma Registry injury codes were combined with text‐mining of the text description of the injury event. Results: Over the 10 year period, there were 152 major trauma patients who were admitted to Victorian trauma‐receiving hospitals due to vehicle collisions with animals. The crude population‐based incidence rate for animal–vehicle collisions increased by 6.7% per year (incidence rate ratio 1.07; 95% confidence interval 1.01–1.13; P = 0.02). Conclusion: Development of systematic recording methods of animal–vehicle collisions will improve reporting of these crash types to assist future studies in implementing effective countermeasures. [ABSTRACT FROM AUTHOR]

Background: The cervical spine region can be especially vulnerable to concurrent injury in concussion, with research suggesting that females may be at greater risk due to their weaker and anatomically distinct necks. The main objective of our research was to study sex differences in the rate of neck injury comorbidity across the life span among patients with a concussion diagnosis in the emergency department (ED) setting, by cause of injury (motor vehicle collisions [MVC] and sports). Materials and Methods: All patients with a first concussion-related ED visit between fiscal years 2002/2003 and 2011/2012 (inclusive) in Ontario were identified in population-based health administrative data using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Canada (ICD-10-CA) codes. Age-dependent odds ratios of comorbid neck injury for sex were estimated using polynomial multivariable logistic regression models, adjusting for sociodemographic characteristics. Results: Females with a concussion had significantly higher odds of sustaining a comorbid neck injury between the ages of 5–49 years for all concussion-related ED visits, 15–49 years for MVC-related concussion ED visits, and 10–39 years for sports-related concussion ED visits, holding all other covariates in the model constant. Conclusions: These results support the consideration of increased screening for comorbid neck injuries, particularly for females, to allow for early intervention. Furthermore, the increased risk of comorbid neck injury in females with a concussion-related ED visit was age-dependent, with the interaction between sex and age following a nonlinear trend. As such, future studies on concussions should consider linear and nonlinear sex and age interactions. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to compare the outcomes of trauma patients who were injured in a motor vehicle crash and tested positive for alcohol upon hospital arrival versus those who tested negative.Methods: Study data came from the US National Trauma Data Bank (2007-2010). Any blood alcohol concentration (BAC) found at or above the legal limit (≥0.08 g/dL) was considered "alcohol positive", and if no alcohol was identified through testing, the patient was considered "alcohol negative". Patients' demographics including age > = 14, race, gender, drug test results, systolic blood pressure, heart rate, injury severity score (ISS), and Glasgow Coma Scale (GCS) were included in the study. Propensity score and exact pair matching were performed between the groups using baseline characteristics.Results: From a total of 88,794 patients, 30.9% tested positive and 69.1% tested negative for alcohol. There were significant differences found between the groups regarding age, gender, race, and GCS (all p < 0.001) as well as a significantly higher in-hospital mortality rate (3.5% vs. 2.7%, p < 0.001) and median time to patient expiration (4 vs. 3 days, p < 0.001) in the alcohol negative group. After running both matching scenarios, there was no evidence of a significant difference seen in the rates of in-hospital mortality or the median time to patient expiration between the alcohol groups in either matched comparison.Conclusion: Patients who tested positive for alcohol following a traumatic motor vehicle crash showed no significant increase in in-hospital mortality or time to expiration when compared to propensity score and exact matched patients who tested negative for alcohol. [ABSTRACT FROM AUTHOR]

Background: Unintentional injury is the leading cause of death in children and adolescents. Injuries occurring during boating and recreational water sports are poorly described in the literature. Herein, we compare injuries from water sports to those resulting from motor vehicle collisions, which are better described in existing literature.Methods: A retrospective review of 1935 consecutive pediatric trauma patients, as defined by age < 18 years, admitted to a single level-1 pediatric trauma center between January 2000 and August 2013 was performed. Patients were divided into two cohorts based on the mechanism of injury: water sports injury (WSI) or motor vehicle collision (MVC). Demographics, injury descriptors, and outcomes were reviewed for each patient. Categorical variables were compared by Chi square or Fisher's exact test, and continuous by t test or Mann-Whitney U test. Parametric data are reported as mean ± standard deviation and nonparametric as median (interquartile range). Significance was set at alpha level 0.05.Results: A total of 18 pediatric patients were admitted for WSI and 615 for MVC during the study period. Among those with WSI, mean age was 12 ± 4 years, mean Injury Severity Score (ISS) was 11 ± 10, and mean Revised Trauma Score (RTS) was 7.841(IQR 6.055-7.841). 44% of WSI occurred by personal watercraft (Jet Ski, WaveRunner), 39% by boat, and 17% by other means (e.g., diving, tubing, kite surfing). Overall, the most common WSI included skin/soft-tissue lacerations (59%), head injury/concussion (33%), tendon/ligament lacerations (28%), and extremity fractures (28%). Compared to 615 patients admitted for MVC, age, sex, race, Glasgow Coma Scale, ISS, RTS, spleen and liver laceration rates, neurosurgical consultation, ICU admission, ICU and total length of stay, and mortality were similar. Patients with WSI were more likely to be tourists (44% vs. 5%, p < 0.001). Those with WSI showed a significantly higher requirement for any surgical intervention (61% vs. 15%, p = 0.001). The rate of open fracture (28% vs. 6%, p = 0.006) and, subsequently, orthopedic procedures (39% vs. 17%, p = 0.027) were also higher in the WSI group.Conclusion: Overall, water sports injuries are similar in in-hospital mortality to motor vehicle collisions. They are more likely to result in penetrating trauma and more likely to require surgical intervention. Primary and secondary prevention strategies should specifically target personal watercraft usage and tourist populations. [ABSTRACT FROM AUTHOR]

Highlights • Sled tests using a short-height pregnant woman crash test dummy. • Shoulder belt compressed the neck in a rear seat. • Complex head and neck movements were observed. • Correct belt path may prevent serious neck injuries in a rear seat passenger. Abstract Introduction When considering seat belt contacts to the neck in pregnant woman of shorter height sitting in the rear seat of a vehicle, subsequent injuries after a collision must be understood in the context of both maternal and fetal outcomes. To determine likely injuries to a pregnant woman sitting in the rear seat, we determined the kinematics of a "pregnant" crash test dummy by measuring neck compression forces and biomechanical parameters acting on the head and neck. Methods Sled tests using a shorter-height pregnant woman crash test dummy (Maternal Anthropometric Measurement Apparatus, ver. 2B) were performed at the HYGE sled test facility representing full frontal impact at target velocities of 29 km/h and 48 km/h. Kinematics of the dummy and biomechanical parameters of the head, neck, and chest were measured. Pressure to the neck was measured using Prescale (Fujifilm, Tokyo, Japan). Results During frontal collision tests, the shoulder belt compressed the neck at a pressure >12.8 MPa, even during the low-velocity impact. In addition to neck flexion, right side bending and the head and chest moving in opposite directions were observed, with maximum differences of 42.4 mm at high velocity and 33.7 mm at low velocity. Conclusions This study provides data on the kinematics of pregnant women of short height sitting in the rear seat during a frontal collision using a pregnant woman crash test dummy. The knowledge gathered from this study should be useful for determining pregnant women passengers' kinematics at the time of collision and evaluating the relationship between the vehicle collision and fetal outcomes. [ABSTRACT FROM AUTHOR]

Introduction Teens beginning to drive independently are at significant increased risk of motor-vehicle crashes relative to their other life stages. There is, however, little guidance for parents as to how best to supervise learning to drive. Method This study sought to undertake an informed approach to development and implementation of a Parent Guide . We included a multi-stage development process, using theory, findings from a Delphi-study of young driver traffic-safety experts, and parent focus groups. This process informed the development of a Guide that was then evaluated for feasibility and acceptability, comparing a group that received the Guide with a control group of parent and teen dyads. Both members of the dyads were surveyed at baseline, again at the approximate time teens would be licensed to drive independently (post-test), and again three months later. Results We found no difference in the proportion of teens who became licensed between those given the new Guide and control teens (who received the state-developed booklet); that is the Guide did not appear to promote or delay licensure. Teens in the Guide group reported that their parents were more likely to use the provided resource compared with control teens. Responses indicated that the Parent Guide was favorably viewed, that it was easy to use, and that the logging of hours was a useful inclusion. Parents noted that the Guide helped them manage their stress, provided strategies to keep calm, and helped with planning practice. In contrast, control parents noted that their booklet helped explain rules. Among licensed teens there was no significant difference in self-reported risky driving at the three-month follow-up. We discuss the challenges in providing motivation for parents to move beyond a set number of practice hours to provide diversity of driving practice. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Pediatric Emergency & Intensive Care Medicine / Çocuk Acil ve Voğun Bakım Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction Motor-vehicle crashes are a leading cause of death among children in the United States, and almost one-fourth of all trips by school-aged children are trips to and from school. This study sought to determine how children (5–18 years) travel to and from school and, among those living ≤ 1 mile of school, to explore the role of school bus service eligibility on school travel mode. Methods We used national 2012 survey data to determine prevalence of usual school travel mode, stratified by distance from school. For those living ≤ 1 mile of school, multivariable regression was conducted to assess the association between bus service eligibility and walking or bicycling. Results Almost half (46.6%) of all children rode in passenger vehicles (PV) to school and 41.8% did so for the trip home. Results were similar among those living ≤ 1 mile (48.1%, PV to school; 41.3%, PV to home). Among those living ≤ 1 mile, 21.9% and 28.4% of children walked or bicycled to and from school, respectively. Ineligibility for school bus service was strongly associated with walking or bicycling to school [adjusted prevalence ratio (aPR: 5.36; p < 0.001)] and from school (aPR: 5.36; p < 0.001). Conclusions Regardless of distance from school, passenger vehicles were a common mode of travel. For children who live close to school, the role that school bus service eligibility plays in walking or bicycling deserves further consideration. Practical applications Given the large proportion of children who use passenger vehicles for school travel, effective interventions can be adopted to increase proper child restraint and seat belt use and reduce crash risks among teen drivers. Better understanding of conditions under which bus service is offered to children who live close to school could inform efforts to improve pedestrian and bicyclist safety for school travel. [ABSTRACT FROM AUTHOR]

Problem Motor-vehicle crashes were the second leading cause of injury death for adults aged 65–84 years in 2014. Some older drivers choose to self-regulate their driving to maintain mobility while reducing driving risk, yet the process remains poorly understood. Methods Data from 729 older adults (aged ≥ 60 years) who joined an older adult ride service program between April 1, 2010 and November 8, 2013 were analyzed to define and describe classes of driving self-regulation. Latent class analysis was employed to characterize older adult driving self-regulation classes using driving frequency and avoidance of seven driving situations. Logistic regression was used to explore associations between characteristics affecting mobility and self-regulation class. Results Three classes were identified (low, medium, and high self-regulation). High self-regulating participants reported the highest proportion of always avoiding seven risky driving situations and the lowest driving frequency followed by medium and low self-regulators. Those who were female, aged 80 years or older, visually impaired, assistive device users, and those with special health needs were more likely to be high self-regulating compared with low self-regulating. Conclusions and practical applications Avoidance of certain driving situations and weekly driving frequency are valid indicators for describing driving self-regulation classes in older adults. Understanding the unique characteristics and mobility limitations of each class can guide optimal transportation strategies for older adults. [ABSTRACT FROM AUTHOR]

Introduction Nearly half of 8–12 year-old tweens killed in car crashes every year in the US are completely unrestrained, and the majority sit in the front seat. The purpose of this study was to develop and evaluate a school-based program targeting increased safety restraint and back-seat use among tweens. Design and setting The multi-component school-wide program was evaluated via a pre-post control-group design in four public elementary schools in an economically disadvantaged, multi-ethnic urban community in southeastern Virginia. Study schools had 1184 students enrolled in third through sixth grades. Intervention The Make it Click Initiative was developed with input from student focus groups, surveys, and school personnel. Grounded in social cognitive theory and principles of behavioral psychology, the participative education program included: (a) competition to achieve a high rate of students buckled in the back; (b) a creativity contest with entries illustrating a car safety theme; (c) a series of parent education flyers; (d) car safety assignments that support state learning objectives; (e) a safety-themed play; (f) teacher newsletters; and (g) educational presentations. Main outcome measures Behavioral observations ( N = 762) of children’s restraint and back seat use. Results Make it Click intervention schools’ observed safety belt use increased from 31.9% to 67.9%, and students in intervention schools were 3.3 times more likely to wear their belts at follow-up than students in control schools, X 2 (1) = 19.72, p < 0.001. Further, increases in belt use were maintained in study observations longer than those resulting from the highly publicized national Click it or Ticket enforcement program. Significant differences were not observed in back seat use. Conclusions The program resulted in significant improvements in observed safety belt use that outlasted results observed locally from the national high visibility enforcement program alone. Theory-driven participative education programs can improve the safety practices of school-age children. [ABSTRACT FROM AUTHOR]

Problem Motor-vehicle crashes are a leading cause of death for American Indian/Alaska Natives (AI/AN) including AI/AN children. Child safety seats prevent injury and death among children in a motor-vehicle crash, yet use is low among AI/AN children. Methods To increase the use of child safety seats (CSS; car seats and booster seats), five tribal communities implemented evidence-based strategies from the Guide to Community Preventive Services during 2010–2014. Increased CSS use was evaluated through direct observational surveys and CSS event data. CSS events are used to check the installation, use, and safety of CSS and new CSS can be provided. Results CSS use increased in all five programs (ranging from 6% to 40%). Four out of five programs exceeded their goals for increased use. Among the five communities, a total of 91 CSS events occurred resulting in 1417 CSS checked or provided. Conclusions and practical applications Evidence-based child passenger safety interventions are both feasible in and transferable to tribal communities. [ABSTRACT FROM AUTHOR]

In 2013, the National Transportation Safety Board advised lawmakers in the United States to reduce the legal limit of blood alcohol content (BAC) from 0.08% to 0.05%. The purpose of this research was to evaluate the rationale for reducing the legal limit of BAC to 0.05% through analysis of the relationship between BAC and injury severity. A correlational study was conducted on patients with positive BAC involved in a motor vehicular collision. Retrospective review of 446 trauma patients (aged 18–80 years) injured in a vehicular collision routinely screened for BAC was conducted. Two groups were compared: Group 1, patients with nonzero blood alcohol concentration ( n = 101); and Group 2, patients with zero blood alcohol ( n = 345). Standard statistical analyses were utilized. A total of 101 patients (23%) had a detectable BAC on admission. Patients with a detectable BAC were younger (33 and 44 years) and more likely to be male (27% and 16%). There was no statistically significant association between both injury severity score (ISS) and BAC or between ISS and age. There was no significant correlation between higher BAC and a higher ISS. Positive BAC alone may not affect ISS, but the potential for risk-taking behaviors by drivers under the influence may increase injury severity. [ABSTRACT FROM AUTHOR]

Background: This study examines spatial relationships between alcohol outlet density and the incidence of alcohol-related crashes. The few prior studies conducted in this area used relatively large spatial units; here we use highly resolved units from Melbourne, Australia (Statistical Area level 1 [SA1] units: mean land area=0.5 km(2); SD=2.2 km(2)), in order to assess different micro-scale spatial relationships for on- and off-premise outlets.Methods: Bayesian conditional autoregressive Poisson models were used to assess cross-sectional relationships of three-year counts of alcohol-related crashes (2010-2012) attended by Ambulance Victoria paramedics to densities of bars, restaurants, and off-premise outlets controlling for other land use, demographic and roadway characteristics.Results: Alcohol-related crashes were not related to bar density within local SA1 units, but were positively related to bar density in adjacent SA1 units. Alcohol-related crashes were negatively related to off-premise outlet density in local SA1 units.Conclusions: Examined in one metropolitan area using small spatial units, bar density is related to greater crash risk in surrounding areas. Observed negative relationships for off-premise outlets may be because the origins and destinations of alcohol-affected journeys are in distal locations relative to outlets. [ABSTRACT FROM AUTHOR]

Objective: To determine details of road traffic suicides in Switzerland between 2000 and 2010 and to look at our results in relation to studies from other countries.Methods: Retrospective data analysis of road traffic suicides extracted from the database of all suicides investigated by Swiss institutes of forensic medicine between 2000 and 2010 using a standardized assessment sheet.Results: Out of 4,885 suicides in Switzerland, we identified 76 cases (1.56%) of road traffic suicide. Twenty-three cases had to be excluded because, although the forensic medical experts suspected suicide, they could not establish it for sure. That left 53 cases (1.02% of all suicides), mostly unmarried men, who were on average 9 years younger than the study population as a whole. Most collided with other vehicles, mainly other cars, and usually on main highways or country roads. In most cases, the cause of death was multiple injuries. Other persons were killed 4 times more often than with other suicide methods. Toxicology screening was performed significantly more frequently than with other methods but more often proved negative. Acute psychiatric problems were commonly assumed to be the underlying reasons. Suicide notes were left by only 20%, a lower proportion than in the study population as a whole.Conclusions: Road traffic suicides account for approximately 1% of all suicide methods used in Switzerland, although unclassifiable cases indicate that the rate might be higher. Every road traffic crash should therefore be routinely investigated by an interdisciplinary team and suicide should be considered as the possible cause. [ABSTRACT FROM AUTHOR]

• Research on co-presence of opioids and alcohol and road safety outcomes is scarce. • Up to 30% of opioid-positive people in a crash were also positive for alcohol. • Studies show a rise in the prevalence of opioid use among fatally injured drivers. • Existing evidence suggests combining the two substances presents an elevated risk. • Novel designs can better inform risk of opioids and alcohol simultaneously present. Connections between substance use, impairment, and road safety have been frequently researched. Yet, little is known about how simultaneous use of opioids and alcohol affects road safety outcomes, which is an increasingly critical link within the current landscape of the substance use environment and public health. Lack of this understanding is partly due to testing complications and data limitations. We define polysubstance use here as alcohol and opioids consumed together or within a small-time window such that both are present in the system. This polysubstance use is on the rise and produces greater health risks than when the substances are consumed separately. Given the increasing rate of opioid use, high prevalence of alcohol use, and dangers of polysubstance use, we aim to synthesize literature on the prevalence and impact of this polysubstance on road safety-related outcomes. We performed a systematic review of studies published between 1974 and 2020 that examined opioid and alcohol use exposures and road safety-related outcomes. Out of 644 initial findings, 20 studies were included in this review. Outcomes included motor vehicle crash injuries, deaths, or driver culpability; suspected driving under the influence; and simulated driving performance. Evidence from multiple sources showed a significant rise, approximately 1% to 7%, in the prevalence of opioids among fatally injured drivers in the U.S. from 1995 to 2016. Information published on the simultaneous presence of opioids and alcohol in people involved in crashes was scarce. The limited available findings point toward an overlap where up to 30% of opioid-positive people involved in a crash were also positive for alcohol. Studies also suggest a possibly elevated risk presented by this polysubstance use relative to the substances used alone, though the majority of identified studies did not estimate this association. The synthesized research indicates that alcohol and opioid use is not uncommon and may be increasing among people involved in adverse driving events. More research and better data are needed to improve estimates of association with road traffic-related outcomes, potentially improving substance testing in current surveillance systems or using linked data sets and other novel data sources to improve estimates. [ABSTRACT FROM AUTHOR]

Introduction Seat belt use reduces the risk of injuries and fatalities among motor vehicle occupants in a crash, but belt use in rear seating positions is consistently lower than front seating positions. Knowledge is limited concerning factors associated with seat belt use among adult rear seat passengers. Methods Data from the 2012 ConsumerStyles survey were used to calculate weighted percentages of self-reported rear seat belt use by demographic characteristics and type of rear seat belt use enforcement. Multivariable regression was used to calculate prevalence ratios for rear seat belt use, adjusting for person-, household- and geographic-level demographic variables as well as for type of seat belt law in place in the state. Results Rear seat belt use varied by age, race, geographic region, metropolitan status, and type of enforcement. Multivariable regression showed that respondents living in states with primary (Adjusted Prevalence Ratio (APR): 1.23) and secondary (APR: 1.11) rear seat belt use enforcement laws were significantly more likely to report always wearing a seat belt in the rear seat compared with those living in a state with no rear seat belt use enforcement law. Conclusions and practical applications Several factors were associated with self-reported seat belt use in rear seating positions. Evidence suggests that primary enforcement covering all seating positions is an effective intervention that can be employed to increase seat belt use and in turn prevent motor vehicle injuries to rear-seated occupants. [ABSTRACT FROM AUTHOR]

Background: Road traffic injuries (RTIs) are a major public health concern in Libya. In the light of the armed conflict in Libya that broke out on February 2011 and the subsequent instability, the rate and pattern of RTIs was studied. Methods: RTI patient data were gathered from Al-Jalaa hospital, the main trauma center in Benghazi, from 2010 to 2011. Various parameters [i.e. age, gender, nationality, method of entry, receiving department, intensive care unit (ICU) admission, duration of stay, method of discharge, and fatalities] were compared with data from the previous year (2010), and statistical analyses were performed (t-test, chi-square, and Poisson regression). Results: During the conflict period, 15.8% (n=2,221) of hospital admissions were RTIs, that is, a rate of 6.08 RTI cases per day, levels not seen for 5 years (t=-5.719, p<0.001). The presence of armed conflict was found to have caused a significant 28% decrease in the trend of RTIs over the previous 10 years (B=-0.327, CI=-0.38 - -0.28, p<0.001). February and March, the peak period of active combat in Benghazi, witnessed the lowest number of RTIs during the conflict period. The average age of an RTI decreased to 28.35±16.3 years (t=-7.257, p<0.001) with significantly more males (84.1%, n=1,755) being affected (χ2=4.595, p=0.032, df=1). There was an increase in the proportion of younger aged patients (from 0 to 29 years) (χ2=29.874, p<0.001, df=8). More patients required admission to the ICU (χ2=36.808, p<0.001, df=8), and the mortality of an RTI increased to 5.2% (n=116) (χ2=48.882, p<0.001, df=6). Conclusions: There were fewer RTIs during the conflict period; however, those that occurred had higher morbidity and mortality. The profile of an RTI victims also changed to an increased prominence of young males and motorcyclists. Further research is required to propose and analyze possible interventions. [ABSTRACT FROM AUTHOR]

Objective The implementation of the compulsory wearing of seat belts (SBs) for children and improvements in child restraint systems have reduced the number of deaths and severe injuries among children involved in motor vehicle (MV) collisions (MVCs). Establishing the characteristics predictive of such injuries may provide the basis for targeted safety campaigns and lead to a further reduction in mortality and morbidity among children involved in MVCs. This study performed a multidisciplinary investigation among child occupants involved in MVCs to elucidate injury mechanisms, evaluate the safety measures used and determine the characteristics that are predictive of injury. Methods A prospective study was conducted of all child occupants aged <16 years involved in severe MVCs in south-eastern Norway during 2009–2013. The exterior and interior of the MVs were investigated and the injured children were medically examined. Supplementary information was obtained from witnesses, the crash victims, police reports, medical records and reconstructions. Each case was reviewed by a multidisciplinary team to assess the mechanism of injury. Results In total, 158 child occupants involved in 100 MVCs were investigated, of which 27 (17%) exhibited Abbreviated Injury Scale (AIS) scores of 2+ injuries and 15 (9%) exhibited AIS 3+ injuries. None of the children died. Of those with AIS 2+ injuries ( n = 27), 89% ( n = 24) were involved in frontal impact collisions and 11% (3/27) were involved in side impacts. Multivariate analysis revealed that restraint misuse, age, the prevailing lighting conditions and Δ V were all independently correlated with AIS 2+ injuries. Safety errors were found in 74% (20/27) of those with AIS 2+ injuries and 93% (14/15) of those with AIS 3+ injuries. The most common safety error was misuse of restraints, and in particular loose and/or improperly positioned SBs. Conclusion The risk of injury among child occupants is significantly higher when the child occupants are exposed to safety errors within the interior of the vehicle. Future campaigns should focus on the prevention of restraint misuse and unsecured objects in the passenger compartment or boot. [ABSTRACT FROM AUTHOR]

Introduction Traffic-related injuries are a major cause of premature death in developing countries. Saudi Arabia has struggled with high rates of traffic-related deaths for decades, yet little is known about health outcomes of motor vehicle victims seeking medical care. This study aims to develop and validate a model to predict in-hospital death among patients admitted to a large-urban trauma centre in Saudi Arabia for treatment following traffic-related crashes. Methods The analysis used data from King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia. During the study period 2001–2010, 5325 patients met the inclusion criteria of being injured in traffic crashes and seen in the Emergency Department (ED) and/or admitted to the hospital. Backward stepwise logistic regression, with in-hospital death as the outcome, was performed. Variables with p < 0.05 were included in the final model. The Bayesian Information Criterion (BIC) was employed to identify the most parsimonious model. Model discrimination was evaluated by the C -statistic and calibration by the Hosmer–Lemeshow Goodness of Fit statistic. Bootstrapping was used to assess overestimation of model performance and obtain a corrected C -statistic. Results 457 (8.5%) patients died at some time during their treatment in the ED or hospital. Older age, the Triage-Revised Trauma Scale (T-RTS), and Injury Severity Score were independent risk factors for in-hospital death: T-RTS was best modelled with linear and quadratic terms to capture a flattening of the relationship to death in the more severe range. The model showed excellent discrimination ( C -statistic = 0.96) and calibration (H–L statistic 4.29 [ p > 0.05]). Internal bootstrap validation gave similar results ( C -statistic = 0.96). Conclusions The proposed model can predict in-hospital death accurately. It can facilitate the triage process among injured patients, and identify unexpected deaths in order to address potential pitfalls in the care process. Conversely, by identifying high-risk patients, strategies can be developed to improve trauma care for these patients and reduce case-fatality. This is the first study to develop and validate a model to predict traffic-related mortality in a developing country. Future studies from developing countries can use this study as a reference for case fatality achievable for different risk profiles at a well-equipped trauma centre. [ABSTRACT FROM AUTHOR]

Aim To explore the relationship between injury risk among child occupants involved in motor vehicle collisions according to the age of the vehicle driver. Methods The National Automotive Sampling System Crashworthiness Data System 2000-2009 ( n = 10 797) was used to identify demographic, vehicle-, collision- and injury-related characteristics among motor vehicle collision occupants ≤15 years of age. The association between the age of the driver (older vs. younger, defined as individuals <50 years of age vs. individuals ≥50 years of age, respectively) and injury occurrence was estimated using logistic regression adjusting for the potentially confounding effect of occupant, vehicle and collision characteristics. Results Of the child occupants in motor vehicle collisions, 2.9% were driving with an older driver, and approximately 2.9% were injured while driving with a younger driver (odds ratio 1.03; 95% confidence interval 0.55-1.91). After adjusting for child occupant age, gender, restraint use, seat position and vehicle type, there remained no significant association between the age of the driver (older vs. younger) and the risk of injury (odds ratio 0.92; 95% confidence interval 0.49-1.74). Conclusions These findings add to the body of literature indicating no difference in injury risk found among children when considering the age of the driver. Research is needed to ascertain the association and further evaluate characteristics more specific to the relationship being explored in this study. [ABSTRACT FROM AUTHOR]

Objective. To determine whether emergency physicians (EPs) and prehospital emergency medical services (EMS) personnel differ in their assessment of motor vehicle crash (MVC) severity and the potential for serious injury when viewing crash scene photographs. Methods. Attending and resident EPs, paramedics, and emergency medical technicians (EMTs) from a single emergency medicine system used a web-based survey platform to rate the severity of 100 crash photographs on a 10-point Likert scale (Crash Score) and the potential for serious injury on a 0-100% scale (Injury Score). Serious injury was defined as skull fracture or intracranial bleeding, spine fracture or spinal cord injury, intrathoracic or intraabdominal injury, or long bone fracture. Crash and Injury Scores were stratified into EP and paramedic/EMT (EMS) groups and the mean score was calculated for each photo. Spearman rank correlation coefficients with 95% confidence intervals (95% CI) and Bland-Altman plots were constructed to assess agreement. Secondary analyses were performed after categorizing data into quartiles based on participants' estimations of MVC severity. Results. A total of 54 attending and 53 resident EPs, 156 paramedics, and 34 EMTs were invited to participate in the survey. Of these, 39 (72%) attending and 46 (87%) resident EPs, 107 (69%) paramedics, and 17 (50%) EMTs completed the survey. A total of 183 (88%) surveys were completed in full. The overall Crash Score correlation coefficient between EPs and EMS was 0.98 (95% CI, 0.97-0.99). The Crash Score correlation coefficients for each quartile were 0.86 (0.57-0.97), 0.93 (0.85-0.96), 0.58 (0.16-0.85), and 0.88 (0.66-0.97), respectively. The overall Injury Score correlation coefficient between EPs and EMS was 0.98 (0.88-0.97). The Injury Score correlation coefficients for each quartile were 0.94 (0.48-0.91), 0.76 (0.50-0.92), 0.80 (0.69-1.00), and 0.94 (0.57-0.97), respectively. Conclusion. Although overall agreement between EPs and EMS personnel was excellent, differences in estimation of crash severity and potential for injury were identified among crashes estimated to be moderate in severity. [ABSTRACT FROM AUTHOR]

The issue of passive safety of pregnant women travelling by car has been discussed. The pregnant woman's body has been considered as a complex dynamic system subject to various impacts that take place during a car ride. In the field of motorization, much attention is paid (and rightly so) to the issue of safety of pregnant women travelling by car in consideration of road accidents. Motor vehicle accidents are the most important cause of death of pregnant women, according to data published by the National Highway Traffic Safety Administration (NHTSA). In the USA, about 130 000 pregnant women being in the second half of their pregnancy are annually involved in motor vehicle accidents. In this paper, some example solutions have been presented that are to improve the passive safety of riding in a motor car, including those proposed to minimize the injuries that may be sustained in result of an accident. The issue of the possible negative effects of a road accident or collision on a pregnant woman has also been raised. The application of virtual techniques has been discussed and examples of modelling a pregnant woman have been shown. Some research results concerning the deceleration values that might be dangerous for pregnant women have been given, with reference having been made to statistical data on fatal accidents. [ABSTRACT FROM AUTHOR]

Objective:Legislation is an effective strategy for reducing road-related fatalities and injuries. Public opinion can be an impetus for passing new laws and can affect the success of their implementation, but little is known about the current state of public opinion toward existing and proposed road-related policies in the United States. This review describes the scope and results of research on public support for state- and local-level evidence-based motor vehicle– and bicycle-related policies. We identify gaps in our understanding of public support for these policies. Methods:Published U.S. literature and all reports from the NHTSA from the past decade (2003–2012) were searched for data on opinions about existing or proposed policies related to motor vehicle or bicycle injury prevention. Twenty-six studies fulfilled the inclusion criteria. In all, studies reported public opinion about 7 injury prevention topic areas: all-terrain vehicles (n= 1), automated enforcement with red light and speed cameras (n= 5), distracted driving (n= 4), drinking and driving (n= 5), graduated driver licensing (n= 7), helmets (n= 7), and seat belts (n= 4). Twenty-three studies focused only on one topic, and 3 sought public opinion about multiple topic areas. Results:The studies revealed generally high levels of support for injury prevention policies in all topic areas. Fifteen studies collected information from national samples, and only 7 studies reported data from the state (n= 5) or local (n= 2) level. Conclusions:There is a relatively small evidence base on public opinion related to motor vehicle– and bicycle-related evidence-based policies; even less is less known for state- or county-specific policies. The findings of this review suggest that the public's opinion toward injury prevention legislation is generally favorable. This information can be used to communicate with the media and policy makers to reinforce the need for effective policy solutions to continuing motor vehicle injury problems. More research is needed to understand the perspectives of those who do not hold favorable opinions, to understand opinions toward local or state-level policies, and to monitor trends in public opinion over time. Supplemental materials are available for this article. Go to the publisher's online edition ofTraffic Injury Preventionto view the supplemental file. [ABSTRACT FROM AUTHOR]

Highlights: [•] Disparities in crash survival may be partly due to differences in EMS quality and response times. [•] Survival analysis can consider EMS effects as time-varying covariates. [•] Survival analysis is complicated by uncertainty in determining exact time of death. [•] Analytic difficulties can be managed using interval censoring and an imputation method. [•] Rural/urban survival disparity appears mostly unrelated to EMS quality or response times. [ABSTRACT FROM AUTHOR]

The paper presents the methodology for expert investigation of traffic accidents involving running over pedestrians. This methodology is aimed at determining the availability of any technical possibility for a motor vehicle driver, driving at a particular speed, to avoid hitting the pedestrian in a particular situation. Furthermore, the paper presents the analysis of different investigation methods and the description of investigation procedures. Various patterns of the path of the motor vehicle and the pedestrian travel before the accident are described, providing a deeper insight into the peculiarities of investigation of each particular pattern. The description is supported by the case study, illustrating the investigation of a specific traffic accident, involving actual hitting of a pedestrian. The methodology presented may be successfully used for investigating traffic accidents by experts. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Children aged 8- to 12-years-old (“tweens”) are at high risk for crash injury, and motor vehicle crashes are their leading cause of death. Method: Data are presented from behavioral observations (N =243), surveys (N =677), and focus groups (N =26) conducted with tweens attending four urban elementary schools in Virginia. The populations assessed were predominantly Black (77.9%) and economically disadvantaged (61.9%). Results: Focus groups revealed a number of inconsistencies in and misconceptions about safety practices. Among the 677 tweens who completed anonymous surveys, the majority (58.1%) reported wearing their seat belts “not very much at all” or “never.” Many students (47.8%) reported usually sitting in the front seat or sitting in the front and back seats equally. This is despite the fact that most (92.0%) knew that the back seat was the safest place to sit. Of the 243 tweens observed in vehicles, 65.0% were unrestrained and 60.1% were seated in the front passenger seat. Impact on Industry: Findings of this study shed light on the great disparity between the national rates for child safety practices and those of children living in an economically disadvantaged urban school district. Additional intervention programs that are culturally appropriate and specifically target this age group are needed. [Copyright &y& Elsevier]

Driving simulator performance was examined in Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) Veterans to objectively evaluate driving abilities among this cohort who self-report poorer driving safety post-deployment. OIF/OEF Veterans (n = 25) and age- and education-matched civilian controls (n = 25) participated in a 30 min driving simulator assessment that measured the frequency of minor, moderate, and severe driving errors. Frequency of errors in specific content domains (speed regulation, positioning, and signaling) was also calculated. All participants answered questions about number of lifetime traffic “warnings,” moving violation tickets, and accidents. Veterans completed the Posttraumatic Stress Disorder (PTSD) Checklist–Military Version. On the driving simulator assessment, Veterans committed more minor, moderate, severe, and speeding errors and reported poorer lifetime driving records than the civilian control group. Exploratory analyses revealed an association between increasing errors on the driving simulator with increasing symptoms of PTSD, although statistically this correlation did not reach significance. These findings suggest that Veterans perform more poorly on an objective evaluation of driving safety and that the presence of PTSD could be associated with worse performance on this standardized driving simulator assessment. [ABSTRACT FROM AUTHOR]

Highlights: [•] North Carolina has a relatively high pregnant driver crash risk (12.6 per 1000 pregnant women). [•] Crash risks were especially elevated among pregnant women who were young, black, moderately educated, or unmarried. [•] Pregnant women were at lower risk of being drivers in crashes during the last few weeks of pregnancy. [•] More states could adopt pregnancy-related crash surveillance systems by utilizing record linkage procedures. [•] More research is needed to quantify pregnant women's driving frequency and patterns. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: The purpose of this research is to describe the leading circumstances of military vehicle crashes to guide prioritization and implementation of crash avoidance and/or warning technologies. Methods: A descriptive study using narrative text analysis on 3,944 military vehicle crash narratives. Crash data on drivers, from 2001 to 2006, were assembled from the U.S. Army Combat Readiness/Safety Center. Reviewers collected information on the circumstances of crashes and determined if vehicle technology could have prevented the crash. Results: Nearly 98% of the crashes were nonfatal; 63% occurred in the U.S. and 24% in Iraq. Among crash events where the direction of the impact was recorded, 32% were to the front of the vehicle and 16% involved a vehicle being rear-ended. Rollovers were mentioned in 20% of the narratives. Technology was determined to have the potential to prevent 26% of the crashes, with the forward collision warning system, rear end collision avoidance, emergency brake assistance, and rollover stability control system likely to have the greatest impacts. Conclusions: Some technologies available for civilian vehicles may prevent certain military crash circumstances. Impact on Industry: The results of this research are significant in light of ongoing global military operations that rely on military vehicles. Improving the preventive technology featured on military vehicles may be an effective strategy to reduce the occurrence of military crashes. [Copyright &y& Elsevier]

Abstract: This study estimates the risk of severe injury or death for pedestrians struck by vehicles using data from a study of crashes that occurred in the United States in years 1994–1998 and involved a pedestrian struck by a forward-moving car, light truck, van, or sport utility vehicle. The data were weighted to correct for oversampling of pedestrians who were severely injured or killed. Logistic regression was used to adjust for potential confounding related to pedestrian and vehicle characteristics. Risks were standardized to represent the average risk for a pedestrian struck by a car or light truck in the United States in years 2007–2009. Results show that the average risk of a struck pedestrian sustaining an injury of Abbreviated Injury Scale 4 or greater severity reaches 10% at an impact speed of 17.1miles per hour (mph), 25% at 24.9mph, 50% at 33.0mph, 75% at 40.8mph, and 90% at 48.1mph. The average risk of death reaches 10% at an impact speed of 24.1mph, 25% at 32.5mph, 50% at 40.6mph, 75% at 48.0mph, and 90% at 54.6mph. Risks varied by age. For example, the average risk of death for a 70-year-old pedestrian struck at any given speed was similar to the average risk of death for a 30-year-old pedestrian struck at a speed 11.8mph faster. [Copyright &y& Elsevier]

BACKGROUND: Most trauma centers incorporate mechanistic criteria (MC) into their algorithm for trauma team activation (TTA). We hypothesized that characteristics of the crash are less reliable than restraint status in predicting significant injury and the need for TTA. METHODS: We identified 271 patients (age, <15 y) admitted with a diagnosis of motor vehicle crash. Mechanistic criteria and restraint status of each patient were recorded. Both MC and MC plus restraint status were evaluated as separate measures for appropriately predicting TTA based on treatment outcomes and injury scores RESULTS: Improper restraint alone predicted a need for TTA with an odds ratios of 2.69 (P = .002). MC plus improper restraint predicted the need for TTA with an odds ratio of 2.52 (P = .002). In contrast, the odds ratio when using MC alone was 1.65 (P = .16). When the 5 MC were evaluated individually as predictive of TTA, ejection, death of occupant, and intrusion more than 18 inches were statistically significant CONCLUSIONS: Improper restraint is an independent predictor of necessitating TTA in this single- institution study. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To describe trends in transport mortality for a range of common transport types in Australia over a 30-year period (1975–1977 to 2005–2007). Methods: Mortality data on all-cause and transport-related causes of death were supplied by the Australian Institute of Health and Welfare (AIHW). Mortality rates, expected number of deaths and probabilities of death were compared for three time periods: 1975–1977, 1990–1992 and 2005–2007. Results: There were significant decreasing trends between 1975–1977 and 2005–2007 in all-cause and most other transport mortality types for both men and women. There were significant reductions in the contribution of transport-related mortality to all-cause mortality; however the difference in mortality between men and women (higher for men) changed little over the evaluated period. Conclusions: Between 1975–1977 and 2005–2007 there were marked reductions in key causes of transport-related mortality amongst Australian adults, and the reductions in transport-related mortality exceeded reductions in all-cause mortality. The reductions could be attributed to better preventive measures and improved medical treatment for people involved in transport crashes. Although there is scope for further improvement, the reductions are evidence of a success in the prevention of crashes and the medical treatment of crash victims. [Copyright &y& Elsevier]

Abstract: There are now more than 200 million licensed drivers, who drive an average of 13,000 miles per year on 4 million miles of roads. In 2010 crashes resulted in nearly 33,000 deaths and millions of nonfatal injuries. This article describes the Injury Center''s response to this public health threat from our beginnings as a small Center in 1992, current motor vehicle injury prevention priorities, and emerging road safety issues that will need attention in the future. [Copyright &y& Elsevier]

Objective: Around the world, a substantial proportion of motor vehicle crash deaths are recognized as “hidden” suicides. This project sought to progress understandings of drivers who used a motor vehicle to die by suicide in Queensland, Australia, during the period 1990 to 2007. Methods: Data for this study were derived from the Queensland Suicide Register and forensic crash investigation case records. Analysis focused on life circumstances and events preceding the death, physical and mental illnesses, past suicidality, and indication of suicide intent (e.g., suicide notes or statements). Results: Compared to cases using other methods, confirmed driver suicides were more likely to be males aged between 25 and 44 years who were employed at the time of death. A large proportion of driver suicides had consumed alcohol immediately prior to the crash and experienced a number of life events, including relationship conflict, legal or criminal issues, and financial problems. Conclusion: These exploratory results indicate the need to educate crash investigators about the characteristics of those who use a motor vehicle to die. Improving the information available on the mental and physical health and background life-related factors of crash victims can help coroners and researchers determine whether these deaths were intentional. Further investigation is needed in order to formulate intervention strategies for those who may be vulnerable to driver suicide. [ABSTRACT FROM AUTHOR]