Motorcycle crashes in New Zealand resulting in death and hospitalisation. I: Introduction methods and overview

Motorcycle crashes: attitudes of the motorcyclists regarding riders' experience and safety measures

Motorcycle injuries constitute a major but neglected emerging public health problem in developing countries and contribute significantly to the overall road traffic injuries. The aims of this work were to study the attitudes and practices of the motorcyclists regarding training and safety measures, and to determine some underlying factors of motorcycle crashes. This cross sectional hospital based study was conducted on all injured conscious motorcyclists who were admitted to the emergency department at Benha University Hospital, Benha City, Qalubia governorate, Egypt from December 2012 up to December 2013. The data were collected using a standard interview questionnaire which included four main sections; personal data, data about the rider's experience and training, safety issues and data about the crash the motorcyclist involved in. The questionnaire was completed by 246 motorcyclists. Of these, 67.5% did not have a motor cycle license and friends/family were the source of training for 56.9% of them. There were highly significant associations between the source of training and age, education, occupation and marital status (P < 0.001 for all). Correctly positioning the motorcycle according to road conditions, making one visible to other road users and the proper maintenance of the motorcycle were the most commonly reported safety measures. Inattentive mode, suffering stress on the day of the accident, not paying attention to distances or to the regulations, not being familiar with the road of the accident and not using the protection system were some of the underlying factors of motorcycle accidents.

Motorcycle-related spinal injury: crash characteristics

This study presents an analysis of crash characteristics of motorcyclists who sustained spinal injuries in motorcycle crashes. The aim of the study is to identify the salient crash characteristics that would help explain spinal injury risks for motorcyclists. Data were retrospectively collected from police case reports that were archived at MIROS from year 2005 to 2007. The data were categorized into two subcategories; the first group was motorcycle crashes with spinal injury (case) and the second group was motorcycle crashes without spinal injury (control). A total of 363 motorcyclists with spinal injury and 873 motorcyclists without spinal injury were identified and analyzed. Descriptive analysis and multivariate analysis were performed in order to determine the odds of each characteristic in contributing to spinal injury. Single vehicle crash, collision with fixed objects and crash configuration were found to have significant influence on motorcyclists in sustaining spinal injury (p<0.05). Although relatively few than other impact configurations, the rear-end impacted motorcyclist shows the highest risk of spinal injury. Helmets have helped to reduce head injury but they did not seem to offer corresponding protection for the spine in the study. With a growing number of young motorcyclists, further efforts are needed to find effective measures to help reduce the crash incidents and severity of spinal injury. In sum, the study provides some insights on some vital crash characteristics associated with spinal injury that can be further investigated to determine the appropriate counter-measures and prevention strategies to reduce spinal injury.

Variations in car crash-related hospitalization costs amongst young adults in New South Wales, Australia

BACKGROUND

This study aims to examine factors associated with variation in crash-related hospitalization costs for young adults in New South Wales (NSW), Australia with a particular focus on types of vehicle occupant, rurality of residence and socioeconomic status (SES).

METHODS

Data on patients aged 17-25 years, admitted to public hospitals due to a crash during July 2000-June 2007 were extracted from the NSW Health Admission Collection database. The hospitalization cost of each admission was calculated based on published charges for specific Australian Refined-Diagnosis Related Groups (AR-DRG). Multivariable analyses using generalized estimating equations were used to estimate costs by vehicle occupant type (driver, passenger and other occupants), rurality of residence (urban, regional and rural areas) and SES (low, moderate and high SES areas).

RESULTS

During 2000-2007, there were 11,892 crash-related hospitalizations involving young adults, aged 17-25 years, in NSW. These cost the health sector about A$87.6 million or on average, A$7363 per hospitalization (mean length of stay (LOS) 5.3 days). Compared to drivers, passengers had significantly longer LOS (<0.01) as well as higher hospitalization costs (p = 0.04). Regional and rural young adults had significantly longer LOS and higher hospitalization costs compared to urban young adults (p<0.05). Compared with young adults from high SES areas, young adults from moderate SES areas had significantly higher costs (p = 0.02), whilst the higher costs for young adults of low SES areas was borderline significant (p = 0.06), although differences in LOS by SES were not significant.

CONCLUSION

Annually, young adults' crashes in NSW were estimated to cost the health sector at least A$14.6 million between 2001 and 2007. The higher hospitalization costs and LOS for young adults living in regional and rural vs. urban areas, and those living in moderate and low SES vs. high SES areas partly reflects the severity of these crashes and challenges for treatment. Based on these findings, a strong economic argument can be made for targeting prevention strategies to young people living in rural and low SES areas. The area variations in costs also suggest some scope for policy makers to consider potentially more efficient ways of targeting both treatment and preventative programmes.

Motor vehicle trauma: analysis of injury profiles by road-user category

BACKGROUND

Vehicle accidents in Greece are among the leading causes of death and the primary one in young people. The mechanism of injury influences the patterns of injury in victims of vehicle accidents.

OBJECTIVE

Identification and analysis of injury profiles of motor-vehicle trauma patients in a Greek level I trauma centre, by road-user category.

PATIENTS AND METHODS

The trauma registry data of Herakleion University Hospital of adult trauma patients admitted to the hospital after a vehicle accident between 1997 and 2000 were retrospectively examined. Patients were grouped based on the mechanism of injury into three road-user categories: car occupants, motorcyclists, and pedestrians.

RESULTS

Of 730 consecutive patients, 444 were motorcyclists (60.8%), 209 were car occupants (28.7%), and 77 were pedestrians (10.5%). Young men constituted the majority of injured motorcyclists whereas older patients (p = 0.0001) and women (p = 0.0001) represented a substantial proportion of the injured pedestrians. With regard to the spectrum of injuries in the groups, craniocerebral injuries were significantly more frequent in motorcyclists and pedestrians (p = 0.0001); abdominal (p = 0.009) and spinal cord trauma (p = 0.007) in car occupants; and pelvic injuries (p = 0.0001) in pedestrians. Although the car occupants had the highest Injury Severity Score (ISS) (p = 0.04), the pedestrians had the poorest outcome with substantially higher mortality (p = 0.007) than the other two groups.

CONCLUSIONS

The results reveal a clear association between different road-user categories and age and sex incidence patterns, as well as outcomes and injury profiles. Recognition of these features would be useful in designing effective prevention strategies and in comprehensive prehospital and inhospital treatment of motor-vehicle trauma patients.

The effect of crash experience on changes in risk taking among urban and rural young people

A 20-month prospective study was conducted to investigate the effect of motorcycle crash experience on changes in risk taking among 2514 urban and 2304 rural students in Taiwan. Risk taking was assessed using a 14-item self-administered questionnaire at the beginning and end of the study. A risk-taking score for each student at the initial and the last follow-up assessments was generated from adding up points across all 14 items. For exposure variables, the study documented past motorcycle crash history at the initial assessment and collected detailed information about any motorcycle crash involvement that occurred during the study period. A general linear mixed model was applied to assess the effects of prior and recent crash involvements on the path of risk-taking behavior. The results show that at the initial assessment, students with crash experience had higher risk-taking levels than those without crash experience. However, crash experience, irregardless of whether it was measured in terms of crash history prior to the study, crash frequency, time elapsed since the last crash, or crash severity, did not significantly change the risk-taking path among students, even though its effect differed between urban and rural areas.

Prevalence and patterns of foot injuries following motorcycle trauma

OBJECTIVES

To determine the prevalence and patterns of foot injuries following motorcycle trauma.

DESIGN

Prospective.

SETTING

Yorkshire Region Trauma Units (Level 1 trauma centers with trauma research).

PATIENTS

Individuals injured in motorcycle road traffic accidents between January 1993 and December 1999.

OUTCOME MEASUREMENTS

Patient demographics, protective devices (helmet) use, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), clinical details, therapeutic interventions, resuscitation requirements, duration of hospital stay, mortality, and type of foot injuries sustained.

RESULTS

The parent population of 1239 contained 53 (4.3%) foot-injured motorcyclists (49 men) with a mean age of 31.7 years (range 18-79 years). Fifty-two were drivers and one was a rear-seat passenger. Mean ISS was 6.9 (range 4-33), significantly lower than the parent population mean of 34.98 (range 9-75) (P = 0.001). Mean GCS was 14.7 (range 13-15). The motorcyclists' injuries included 26 metatarsal fractures (49.1%), 14 talar fractures (26.4%), 7 os calcis fractures (13.2%), and 6 toe fractures (11.3%). Associated foot injuries included three partial foot amputations, four Lisfranc dislocations, three cases of foot compartment syndrome (two crush injuries with no fracture, one open fourth metatarsal fracture with associated Lisfranc dislocation). Forty-six motorcyclists had more than one foot injury. Associated injuries included 22 ankle fractures (41.5%), 15 tibial fractures (28.3%), 6 femoral fractures (11.3%), 5 pelvic ring fractures (9.4%), 23 upper limb injuries (43.4%), and 3 cases of chest trauma (5.7%). No one sustained abdominal trauma or head injury compared with the parent population. All patients required operative stabilization of foot fractures, including their associated injuries. Mean hospital stay was 10.9 days (range 1-35 days). In the parent population, there were 71 deaths (6.0%), whereas there was only 1 death (1.9%) in the foot-injured group (with fractures including open book pelvic, T6-8, unilateral open femur, tibial, ankle, and metatarsal) with an ISS 33, who died of multiorgan dysfunction syndrome. At final follow-up, all patients underwent radiologic and clinical assessment of foot injuries. Forty-three patients returned to their previous occupation and level of mobility. Ten of the more significantly injured patients had to modify their occupation from manual to sedentary-type jobs due to their foot injuries. We noted a pattern of complex ipsilateral foot and limb injury in nine patients, which we postulate was due to the actual mechanism of contact with the road surface.

CONCLUSION

Motorcycle accidents continue to be a source of severe injury, especially to the foot. The most common foot injury is a metatarsal fracture; however, there must be a high index of suspicion for associated injuries. Although these injuries are associated with a low mortality rate, they require prompt assessment and treatment to limit long-term morbidity and disability. The difference in foot injury pattern and mortality between the parent population and our series, among other factors, potentially may be influenced by the actual mechanism of contact with the road surface and the modifying action of the foot during the accident.

Effect of Italy's motorcycle helmet law on traumatic brain injuries

OBJECTIVES

To evaluate the impact of a revised Italian motorcycle-moped-scooter helmet law on crash brain injuries.

DESIGN

A pre-post law evaluation of helmet use and traumatic brain injury (TBI) occurrence from 1999 to 2001.

SETTING

Romagna region, northeastern Italy, with a 2000 resident population of 983 534 persons.

PARTICIPANTS

Motorcycle-moped rider survey for helmet use compliance and all residents in the region admitted to the Division of Neurosurgery of the Maurizio Bufalini Hospital in Cesena, Italy for TBI.

OUTCOME MEASURES

Helmet use compliance and change in TBI admissions and type(s) of brain lesions.

RESULTS

Helmet use increased from an average of less than 20% to over 96%. A comparison of TBI incidence in the Romagna region shows that there was no significant variation before and after introduction of the revised helmet law, except for TBI admissions for motorcycle-moped crashes where a 66% decrease was observed. In the same area TBI admissions by age group showed that motorcycle mopeds riders aged 14-60 years sustained significantly fewer TBIs. The rate of TBI admissions to neurosurgery decreased by over 31% and epidural hematomas almost completely disappeared in crash injured moped riders.

CONCLUSIONS

The revised Italian mandatory helmet law, with police enforcement, is an effective measure for TBI prevention at all ages.

A longitudinal study of risk factors for motorcycle crashes among junior college students in Taiwan

A cohort of 4729 junior college students in an urban and a rural area in Taiwan was followed up for a period of 20 months. Students' characteristics, including riding exposures, as well as human, vehicular, and environmental factors were collected using one initial and three follow-up questionnaires. The Anderson-Gill (AG) multiplicative intensity model was used to determine the risk of a motorcycle crash over time while also allowing for the modeling of multiple events. The average response rate for the four assessments was 92%. The adjusted relative hazard (RH) for students living in the rural as opposed to the urban area for crashes was 1.67 at the beginning of the study but decreased to 0.66 by the end. Past motorcycle crash history, number of riding days, average riding distance, risk-taking level, alcohol consumption, and traffic violations were all significantly associated with an increased risk of being involved in a crash. Conversely, increasing age, riding experience, and automobile licensure were related to a decreased risk of crashing. Furthermore, helmet use was not independently related to the risk of crashing. In conclusion, a high-risk group predisposed to involvement in a motorcycle crash, including both non-injury and injury-related crashes, can be identified using selected risk factors for crash prevention among young riders.

Head injury mechanisms in helmet-protected motorcyclists: prospective multicenter study

BACKGROUND

In a prospective study, three research groups at Hannover (H) and Munich (M) in Germany and Glasgow (G) in the United Kingdom collected data from motorcycle crashes between July 1996 and July 1998 to investigate head injury mechanisms in helmet-protected motorcyclists.

METHODS

The head lesions of motorcyclists with Abbreviated Injury Score-Head (AISHead) 2+ injuries and/or helmet impact were classified into direct force effect (DFE) and indirect force effect (IFE) lesions. The effecting forces and the force consequences were analyzed in detail.

RESULTS

Two-hundred twenty-six motorcyclists (H, n = 115; M, n = 56; and G, n = 55) were included. Collision opponents were cars (57.8%), trucks (8.0%), pedestrians (2.3%), bicycles (1.4%), two-wheel motor vehicles (0.8%), and others (4.2%). In 25.4% no other moving object was involved. The mean impact speed was 55 km/h (range, 0-120 km/h) and correlated with AISHead. Seventy-six (33%) motorcyclists had no head injury, 21% (n = 48) AISHead 1, and 46% (n = 103) AISHead 2+. Four hundred nine head lesions were further classified: 36.9% DFE and 63.1% IFE. Lesions included 20.5% bone, 51.3% brain, and 28.1% skin. The most frequent brain lesions were subdural hematomas (22.4%, n = 47) and subarachnoid hematomas (25.2%, n = 53). Lesions of skin or bone were mainly DFE lesions, whereas brain lesions were mostly IFE lesions.

CONCLUSION

A modification of the design of the helmet shell may have a preventative effect on DFE lesions, which are caused by a high amount of direct force transfer. Acceleration or deceleration forces induce IFE lesions, particularly rotation, which is an important and underestimated factor. The reduction of the effecting forces and the kinetic consequences should be a goal for future motorcycle helmet generations.

Psychological and social predictors of motorcycle use by young adult males in New Zealand

Motorcycle riding is a significant cause of serious injuries to young males. Little is known about the psychological and social characteristics of these riders, despite such knowledge being potentially important for the targeting of appropriate injury prevention interventions. Using problem-behaviour theory to broadly guide and structure the research, the present study focused on identifying predictors of motorcycle riding. Previous research investigating differences between riders and non-riders has tended to be inconclusive, methodologically limited, and lacking in explicit theoretical foundations. The present research was based on the birth cohort enrolled in the Dunedin Multidisciplinary Health and Development Study (DMHDS), a comprehensive New Zealand longitudinal study of health, development, attitudes, and behaviours. Logistic regression models were built using prior measures of health risk behaviour, other psychological and social factors, and motorcycle riding history as potential predictors of any motorcycle use at the age of 18 years. The strongest predictors were early motorcycle riding, including illegal on-road driving at age 13 (OR 4.0; 95% CI 1.7, 9.1), below average reading skills (OR 2.4; 95% CI 1.3, 4.6) and fighting in a public place at age 15 (OR 2.9; 95% CI 1.2, 6.9). It was of particular interest that this profile tended to fit less well those subgroups of riders with greatest exposure to on-road motorcycle driving. Although based on small numbers, this finding was consistent with earlier cross-sectional research that linked casual and unlicensed driving with less protective motorcycling opinions and behaviours. Some implications for injury prevention and public policies regarding motorcycling are discussed. In particular, stricter enforcement of present licensing regulations and stronger penalties for their violation could help to reduce the number of less responsible riders.

The risky and protective motorcycling opinions and behaviours of young on-road motorcyclists in New Zealand

This research documented the frequency of protective and risky motorcycling opinions and behaviours and investigated whether these opinions and behaviours were more frequently expressed by licensed than unlicensed riders and by riders with high rather than low exposure to motorcycling. Areas where there was scope for improvement were identified to help guide the promotion of protective strategies. As part of a broader study of a birth cohort, 217 18 year old motorcyclists were administered a motorcycling computer questionnaire. Evidence of positive protective opinions was found, but there was considerable scope for behavioural improvements. While 92% had worn a helmet, optimal protection was reported less frequently for other body areas: most often for the feet (54%), hands (47%) and upper body (35%) and least often for the legs (8%). Most (87%) riders considered conspicuity increased safety, 68% favoured mandatory day-time headlight use, and 66% used dipped headlights in day-time. While 55% favoured mandatory wearing of high-visibility clothing, only 15% of day-time and 20% of night-time riders reported doing this. During the past month, 16% had driven within two hours of drinking alcohol and 6% when too tired to be fully in control. Overall, 22% had been penalized for a motorcycle driving offence, most often speeding. While 46% said they agreed with the Graduated Driver Licensing System (GDLS), most licensed under that system reported breaking licence conditions and most were not apprehended. Licensed motorcyclists were significantly more likely than the unlicensed to favour mandatory day-time headlight usage, report using dipped headlights in day-time, and wear better protection for the head, upper body and hands, but were also more likely to report drinking and driving and traffic convictions--probably because of their greater exposure. Other, non-significant, results were in the same direction, except that fewer licensed than unlicensed riders were in favour of mandatory high visibility clothing or the GDLS. A similar pattern of more protective attitudes and behaviours was found for high rather than low exposure riders, though it was generally weaker, and high exposure was associated with drinking and driving, driving while tired and traffic convictions. The issues of representativeness and reliability are discussed and some implications for public policies towards motorcycling by young people are considered. Further research is recommended in order to determine which are the best predictors of motorcycling opinions and behaviours: personal characteristics, the formal training associated with licensure, or exposure to motorcycling.

Disablement resulting from motorcycle crashes

This retrospective study describes the nature and severity of disablement resulting from motorcycle crashes (both traffic and non-traffic). Two hundred and fifty motorcycle crash victims were randomly selected from the total population of motorcycle crash victims (n = 1510) who had received compensation for disablement in the year ending 31 March 1990. Information on the nature and extent of disablement was obtained from official accident compensation files and coded according to the International Classification of Impairments, Disabilities, and Handicaps. Extremity injuries predominated, especially to the lower limb. The majority of these were fractures. Most commonly impairments occurred in the areas of 'skeletal', 'disfiguring' and 'generalized' impairment. Mechanical impairment of a limb was reported in 68% of cases, often with associated disfigurement. Disability mostly involved problems with locomotion and problems coping with physical stresses at work. Occupational handicap was the most common handicap reported, with mobility handicap the next most common. The shortcomings of this study included its retrospective design and the variable quality of the information on disablement. It was most likely, though, that these factors contributed to an underestimation of disablement in the study group.

New Zealand's Injury Prevention Research Unit: reducing sport and recreational injury

The Injury Prevention Research Unit was established in 1990 to reduce the incidence, severity and consequences of injury. Research into sport and recreational injury is one of five major areas of research being undertaken. National data sources have been used to estimate the overall size of the problem and to describe the nature and circumstances of injury associated with a variety of sport and recreational activities. Analytical studies are now being undertaken to identify significant risk and protective factors. Research activity is being directed toward the development, implementation and evaluation of preventive measures.

Motorcycle crashes resulting in death and hospitalisation. II: Traffic crashes

This is the second paper in a series of three that describe the epidemiology of motorcycle crashes in New Zealand that result in death and hospitalisation. The first paper presented an overview of all motorcycle crashes. This paper focuses on traffic crashes. The source of the fatality data was national mortality data files for the years 1978 to 1987 inclusive. The source of the hospitalisation data was the 1988 national morbidity file which records all public hospital discharges in New Zealand. For the period 1978 to 1987, 1,175 fatalities were identified resulting in a mortality rate of 3.5 per 100,000 persons per year. Males aged 15-19 and 20-24 had very high rates (25.2 and 26.4, respectively), especially labourers (40.0) and forestry workers (32). Maori and non-Maori had similar rates. The majority (63%) of the deaths were attributable to a collision with another motor vehicle. During 1988 2,222 motorcyclists were hospitalised giving an incidence rate of 68.1 per 100,000 persons per year. Males aged 15-19 and 20-24 had very high rates (409 and 416, respectively), especially labourers (355). Maori had a higher morbidity rate than non-Maori (99 versus 61). The most common (40%) crash was a collision with another motor vehicle. The most common sites of injury were the lower limb (43%) and head (23%). Collision crashes were more likely to result in lower limb injury, be more severe, and result in longer stays in hospital.