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Background: Pediatric patients with any severity of traumatic intracranial hemorrhage (tICH) are often admitted to intensive care units (ICUs) for early detection of secondary injury. We hypothesize that there is a subset of these patients with mild injury and tICH for whom ICU care is unnecessary., Objectives: To quantify tICH frequency and describe disposition and to identify patients at low risk of inpatient critical care intervention (CCI)., Methods: We retrospectively reviewed patients aged 0 to 17 years with tICH at a single level I trauma center from 2008 to 2013. The CCI included mechanical ventilation, invasive monitoring, blood product transfusion, hyperosmolar therapy, and neurosurgery. Binary recursive partitioning analysis led to a clinical decision instrument classifying patients as low risk for CCI., Results: Of 296 tICH admissions without prior CCI in the field or emergency department, 29 had an inpatient CCI. The decision instrument classified patients as low risk for CCI when patients had absence of the following: midline shift, depressed skull fracture, unwitnessed/unknown mechanism, and other nonextremity injuries. This clinical decision instrument produced a high likelihood of excluding patients with CCI (sensitivity, 96.6%; 95% confidence interval, 82.2%-99.9%) from the low-risk group, with a negative likelihood ratio of 0.056 (95% confidence interval, -0.053-0.166). The decision instrument misclassified 1 patient with CCI into the low-risk group, but would have impacted disposition of 164 pediatric ICU admissions through 5 years (55% of the sample)., Conclusions: A subset of low-risk patients may not require ICU admission. The proposed decision rule identified low-risk children with tICH who may be observable outside an ICU, although this rule requires external validation before implementation.

Background: The growing proportion of older adults in Australia is predicted to comprise 23% of the population by 2030. Accordingly, an increasing number of older drivers and fatal crashes of these drivers could also be expected. While the cognitive and physiological limitations of ageing and their road safety implications have been widely documented, research has generally considered older drivers as a homogeneous group. Knowledge of age-related crash trends within the older driver group itself is currently limited., Objective: The aim of this research was to identify age-related differences in serious road crashes of older drivers. This was achieved by comparing crash characteristics between older and younger drivers and between sub-groups of older drivers. Particular attention was paid to serious crashes (crashes resulting in hospitalisation and fatalities) as they place the greatest burden on the Australian health system., Method: Using Queensland Crash data, a total of 191,709 crashes of all-aged drivers (17-80+) over a 9-year period were analysed. Crash patterns of drivers' aged 17-24, 25-39, 40-49, 50-59, 60-69, 70-79 and 80+ were compared in terms of crash severity (e.g., fatal), at fault levels, traffic control measures (e.g., stop signs) and road features (e.g., intersections). Crashes of older driver sub-groups (60-69, 70-79, 80+) were also compared to those of middle-aged drivers (40-49 and 50-59 combined, who were identified as the safest driving cohort) with respect to crash-related traffic control features and other factors (e.g., speed). Confounding factors including speed and crash nature (e.g., sideswipe) were controlled for., Results and Discussion: Results indicated that patterns of serious crashes, as a function of crash severity, at-fault levels, road conditions and traffic control measures, differed significantly between age groups. As a group, older drivers (60+) represented the greatest proportion of crashes resulting in fatalities and hospitalisation, as well as those involving uncontrolled intersections and failure to give way. The opposite was found for middle-aged drivers, although they had the highest proportion of alcohol and speed-related crashes when compared to older drivers. Among all older drivers, those aged 60-69 were least likely to be involved in or the cause of crashes, but most likely to crash at interchanges and as a result of driving while fatigued or after consuming alcohol. Drivers aged 70-79 represented a mid-range level of crash involvement and culpability, and were most likely to crash at stop and give way signs. Drivers aged 80 years and beyond were most likely to be seriously injured or killed in, and at-fault for, crashes, and had the greatest number of crashes at both conventional and circular intersections. Overall, our findings highlight the heterogeneity of older drivers' crash patterns and suggest that age-related differences must be considered in measures designed to improve older driver safety., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

This paper presents findings from the rural and remote road safety study, conducted in Queensland, Australia, from March 2004 till June 2007, and compares fatal crashes and non-fatal but serious crashes in respect of their environmental, vehicle and operator factors. During the study period there were 613 non-fatal crashes resulting in 684 hospitalised casualties and 119 fatal crashes resulting in 130 fatalities. Additional information from police sources was available on 103 fatal and 309 non-fatal serious crashes. Over three quarters of both fatal and hospitalised casualties were male and the median age in both groups was 34 years. Fatal crashes were more likely to involve speed, alcohol and violations of road rules and fatal crash victims were 2½ times more likely to be unrestrained inside the vehicle than non-fatal casualties, consistent with current international evidence. After controlling for human factors, vehicle and road conditions made a minimal contribution to the seriousness of the crash outcome. Targeted interventions to prevent fatalities on rural and remote roads should focus on reducing speed and drink driving and promoting seatbelt wearing., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Objective: To define characteristics of all-terrain vehicle (ATV) crashes occurring in north Queensland from March 2004 till June 2007 with the exploration of associated risk factors., Design: Descriptive analysis of ATV crash data collected by the Rural and Remote Road Safety Study., Setting: Rural and remote north Queensland., Participants: Forty-two ATV drivers and passengers aged 16 years or over hospitalised at Atherton, Cairns, Mount Isa or Townsville for at least 24 hours as a result of a vehicle crash., Main Outcome Measures: Demographics of participants, reason for travel, nature of crash, injuries sustained and risk factors associated with ATV crash., Results: The majority of casualties were men aged 16-64. Forty-one per cent of accidents occurred while performing agricultural tasks. Furthermore, 39% of casualties had less than one year's experience riding ATVs. Over half the casualties were not wearing a helmet at the time of the crash. Common injuries were head and neck and upper limb injuries. Rollovers tended to occur while performing agricultural tasks and most commonly resulted in multiple injuries., Conclusions: Considerable trauma results from ATV crashes in rural and remote north Queensland. These crashes are not included in most general vehicle crash data sets, as they are usually limited to events occurring on public roads. Minimal legislation and regulation currently applies to ATV use in agricultural, recreational and commercial settings. Legislation on safer design of ATVs and mandatory courses for riders is an essential part of addressing the burden of ATV crashes on rural and remote communities.

Each year in Australia many thousands of collisions occur between motor vehicles and animals, resulting in considerable vehicle repair costs, injury to persons, and loss of animal life. This paper reviews animal-related road crashes in Australia and presents data from the in-depth Rural and Remote Road Safety Study in North Queensland for serious casualties (n=33) resulting from direct impact with an animal or swerving to avoid an animal on public roads. These crash types accounted for 5.5% of all eligible on-road serious casualties in the study and, hence, are considered to be an important issue that requires particular attention within rural and remote areas. Kangaroos and wallabies were the predominant species involved in these crashes (44.8%). Consistent with international studies, night-time travel was found to be a significant risk factor when comparing animal-related crashes to other serious injury crashes in the study. There were also a significantly higher proportion of motorcyclists (51.7%) than other vehicle occupants involved in animal-related serious crashes compared to all other serious injury crashes. Data matching to official Government records found underreporting of animal-related crashes to be an issue of concern. These findings are discussed in terms of countermeasures suitable for the Australian context and the need for consistent crash reporting across jurisdictions.