Fatally injured drivers in Norway 2005-2015-Trends in substance use and crash characteristics

Do crashed drivers need more drug testing? A retrospective analysis of blood samples from hospitalised post-crash drivers in New Zealand

Driving under the influence of alcohol and other drugs is a prominent safety concern in New Zealand and across the world. While alcohol testing is routinely performed for drivers involved in hospitalisation crashes, testing for other drugs is often not undertaken. The present study refers to 530 traffic crashes that occurred from October 2019 to January 2020 on New Zealand roads. The blood samples from 550 drivers who were injured in a crash and were admitted to a hospital (66% of all drivers involved in these crashes), previously tested for drugs and/or alcohol, were retested for a wider range of drugs. Alcohol above the applicable limit was found to be present in 38% of hospitalised drivers, while other drugs of interest were found in 47% of hospitalised drivers. Binary logistic regression was used to predict the presence of drugs of interest for a crashed driver using previous offence data. A driver having at least one prior drink and drug driving offence is 61% more likely to be positive for a drug of interest when involved in a crash. Similarly, a driver having at least one prior non-traffic drug offence is 4.7 times more likely to be positive for at least a drug of interest when involved in a crash. While the presence of a drug or drugs cannot be presumed to have played a role in the occurrence of the crash, this study has provided a unique and comprehensive picture of the presence of various drugs present in New Zealand drivers' blood. It is recommended to consider standardising drug testing on all blood specimens taken in relation to a serious injury or fatal crash. This procedure is not only of interest for information purposes but may importantly inform appropriate charging decisions.

Characteristics of crash-involved drink and drug car drivers and motorcyclists

OBJECTIVE

Drug driving is an issue of growing concern among Australian jurisdictions, including South Australia. In order to have an appropriate response to drug driving in regard to policy and enforcement, it is important to have sound knowledge about the patterns of drug use among motorists and the associated risks of this behavior.

METHOD

To this end, this study examined the characteristics of 1,277 hospitalized road users in South Australia in the years 2014 to 2017, with reference to whether or not they tested positive for alcohol or other drugs (the three drugs tested for according to the South Australian Road Traffic Act (1961): THC, methamphetamine, MDMA). This examination used a database combining hospital data, police-reported crash data, licensing information, and the result of alcohol and drug tests conducted by Forensic Science SA.

RESULTS

It was found that more motorists were positive for one or more of the three illicit drugs than for alcohol, reversing long established trends. Comparisons were made between alcohol and drug free motorists, alcohol positive motorists, drug positive motorists, and motorists positive for both drugs and alcohol, with drivers of cars and motorcyclists analyzed separately where possible. Findings include: that those combining drugs and alcohol only comprise a small proportion of hospitalized motorists; that drug drivers tend to be younger than other hospitalized motorists; that drivers are more likely to test positive to alcohol or methamphetamine, while motorcyclists are more likely to test positive to THC; motorists testing positive to drugs and/or alcohol tend to exhibit a range of other risky behaviors; and motorists testing positive to drugs and/or alcohol tend to sustain more severe injuries in the event of a crash.

CONCLUSIONS

Preventing drink and drug driving is important not only for reducing crash numbers but also injury severity in the event of a crash. Substance use differs by road user type and age, which has potential implications for enforcement practices.

Visualization and Analysis of Global Vision Zero Studies and Policy Orientation in China

As a policy that is widely used worldwide, Vision Zero is a long-term strategic goal for road safety in China. The aim of this paper is to examine the literature in the field of Vision Zero retrieved by the Web of Science (WOS) Core Collection database from 1997 to 2021 based on mapping knowledge domain (MKD) and bibliometric methods. In this paper, we analyzed the overall development level of Vision Zero at different stages using the statistical analysis of the distribution of literature years. Based on the analysis, four major research directions of Vision Zero are obtained through keywords co-occurrence analysis, including "Vision Zero in road safety", "vulnerable road users' risks", "effect of speed on severity", and "responsibility management for crashes". Furthermore, we explore the influence and development potential of each country and region of Vision Zero based on the number and citation frequency of the literature, and the distribution of time dimensions. Among the research topics, all countries and regions are clustered into four clusters, and the current status of Vision Zero for countries in the most influential clusters, which include Sweden, the United States, Australia, China, and Norway, have been presented. Finally, an analysis of road safety in China is carried out, which includes displaying the changes in the number of road accidents, fatalities, and serious injuries in China between 2009 and 2018, comparing the fatalities per 10,000 vehicles and the fatalities per 100,000 people between China and other countries, and describing China's strategic routes toward Vision Zero.

Characteristics, image findings and clinical outcome of moderate and severe traumatic brain injury among severely injured children: a population-based cohort study

PURPOSE

The aim of this study was to explore patient and injury characteristics, image findings, short-term clinical outcome and time trends of moderate and severe traumatic brain injury in severely injured children.

METHODS

This study is an observational cohort study based on prospectively collected data from an institutional trauma registry database covering all trauma patients in South West Norway. All paediatric patients registered in the database between 01.01.2004 and 31.12.2019 were included.

RESULTS

During the 16 years-study periods, 82 paediatric patients with moderate (n = 42) and severe (n = 40) traumatic brain injury were identified. Median age was 13.0 years, 45% were female and median Glasgow Coma Scale score at admission was 9.0. Cranial fractures were common image findings in both groups. Cerebral contusions (32%) and epidural hematomas (29%) were more commonly found in moderate traumatic brain injury; cerebral contusions (49%), diffuse axonal injury (31%) and cerebral oedema (46%) were more prominent in severe traumatic brain injury. All children with moderate traumatic brain injury survived and favourable outcome was registered in 98%. Overall mortality in the severe traumatic brain injury cohort was 38% (thereof 25% due to TBI) and only 38% had a favourable short-term outcome.

CONCLUSIONS

In this population-based study on paediatric trauma patients over a period of 16 years severe traumatic brain injury in children still had a considerably high mortality and a higher proportion of patients experienced an unfavourable clinical short-term outcome. Moderate traumatic brain injury resulted in favourable clinical outcome.

Alcohol and drug use among road users involved in fatal crashes in Norway

OBJECTIVE

To study the prevalence of alcohol and drugs in biological samples from drivers, motorcycle riders, bicyclists, and pedestrians involved in fatal road traffic crashes (RTCs) during 2016-2018 in Norway, both among fatally injured victims and those who survived fatal RTCs.

METHODS

Anonymous information was extracted from police data. No personal data were recorded.

RESULTS

There were 330 fatal RTCs with 349 killed road users and 384 survivors during the study period; this included 179 passengers who were excluded from the study. In total, 90% of the studied killed road users and 67% of the survivors were investigated for alcohol or drug use by analyzing biological samples. Alcohol or drugs in concentrations above the legal limits were detected in 21% of the analyzed samples. The proportion impaired by alcohol or drugs (blood alcohol concentrations equal to or greater than 0.05%, or drug concentrations above equivalent limits) was highest among killed bicyclists (43%), higher than among killed pedestrians (24%), car and van drivers (28%) and motorcyclists (20%), and significantly higher than among drivers who survived fatal crashes (4%).

CONCLUSIONS

Impairment due to use of alcohol or drugs was often a contributing factor among bicyclists, pedestrians and motor vehicle drivers who died in RTCs. Driving under the influence of alcohol or drugs was more often a contributing factor in cases where the motor vehicle driver was killed than in cases where the driver survived.

Alcohol and illicit drugs in drivers involved in road traffic crashes in Italy. An 8-year retrospective study

This study aims to investigate the prevalence of alcohol and drugs of abuse in Italian drivers involved in road traffic crashes between 2011 and 2018. Toxicological analyses were performed on the whole blood of 7593 injured drivers. Alcohol and illicit drugs, namely tetrahydrocannabinol (THC; cut-off 2ng/ml), cocaine (cut-off 10ng/ml), illicit opiates (cut-off 10ng/ml) and amphetamines (amphetamine, methamphetamine, MDMA, MDA; cut-off 20ng/ml) were investigated. The age and gender of the driver, the time of the crash (weekend/weekday and day/night), the road crash year and Blood Alcohol Concentration (BAC) were also considered. The 16.2% of samples tested positive for alcohol, 2.5% for cocaine, followed by opiates (2.0%), cannabinoids (1.5%), and amphetamines (0.5%). The overall prevalence of alcohol and drugs was lower than those reported in previous epidemiological studies of the DRUID project. The year 2011 showed the highest prevalence of drug-positive cases (24.1%), while the lowest prevalence was found in 2016 (16.8%), after the update of the Road Traffic Law (RTL) that increased punishments for driving under the influence. A progressive increase in the number of alcohol-positive female drivers was observed from 2011 to 2018, and the highest prevalence was found in the 26-35-year-old age range. Illicit drugs showed the highest overall prevalence in drivers <26 years of age but, if considering single drugs, cocaine and opiates were mostly found in subjects older than 36 years of age. A higher percentage of drug-positive drivers was found on weekend nights for alcohol and on both weekend and weekday nights for drugs. The types of drugs used by drivers did not change during the studied period.

Driver-related risk factors of fatal road traffic crashes associated with alcohol or drug impairment

Fatal road traffic crashes are often related to speeding, non-use of a seatbelt, and alcohol/drug-impaired driving. The aim of this study was to examine associations between driving under the influence of drugs and/or alcohol and driver-related risk factors that have been reported as significantly contributing causes of fatal road traffic crashes. The data were extracted from Norwegian road traffic crash registries and forensic toxicology databases. Drug/alcohol investigated car and van drivers and motorcycle riders fatally injured in road traffic crashes in Norway during 2005-2015 were included in this study (n = 772). Drug and alcohol concentrations corresponding to 0.5 g/kg alcohol in blood were used as the lower limits for categorising drivers/riders as impaired; 0.2 g/kg was the upper limit for being categorised as sober. Associations between driver-related risk factors and impairment from specific substance groups were calculated using multivariable logistic regression, adjusted for other substance groups, age, and sex, and were reported when the confidence intervals did not contain the value 1 or lower. Substances found in concentrations above the impairment limits were mainly alcohol (20%), medicinal drugs (10%: benzodiazepines, opioids, z-hypnotics), stimulants (5%: amphetamines, methylphenidate, and cocaine), and cannabis (4%: THC). The drug/alcohol-impaired drivers had compared to the sober drivers more often been speeding (68% versus 32%), not used a seatbelt (69% versus 30%), and been driving without a valid driver license (26% versus 1%). Logistic regression analysis showed that impairment from alcohol or stimulants (mainly amphetamines) was associated with all three risk factors, medicinal drugs with all except speeding, and impairment from cannabis (THC) with not having a valid driver license. Among motorcycle riders, drug/alcohol impairment was associated with not having a valid driver license and non-use of a helmet. At least one of the risk factors speeding, non-use of a seatbelt/helmet, and driving without a valid license were present among the vast majority of the drug/alcohol-impaired fatally injured drivers and riders, and also among more than half of the fatally injured sober drivers.