Estimated potential death and disability averted with vehicle safety interventions, Association of Southeast Asian Nations

Objective

To evaluate road safety in member countries of the Association of Southeast Asian Nations and estimate the benefits that vehicle safety interventions would have in this group of countries.

Methods

We used a counterfactual analysis to assess the reduction in traffic deaths and disability-adjusted life years (DALYs) lost if eight proven vehicle safety technologies and motorcycle helmets were entirely in use in countries of the Association of Southeast Asian Nations. We modelled each technology using country-level incidence estimations of traffic injuries, and the prevalence and effectiveness of the technology to calculate the reduction in deaths and DALYs if the technology was fitted in the entire vehicle fleet.

Findings

The availability of electronic stability control, including the antilock braking systems, would provide the most benefits for all road users with estimates of 23.2% (sensitivity analysis range: 9.7-27.8) fewer deaths and 21.1% (9.5-28.1) fewer DALYs. Increased use of seatbelts was estimated to prevent 11.3% (8.11-4.9) of deaths and 10.3% (8.2-14.4) of DALYs. Appropriate and correct use of motorcycle helmets could result in 8.0% (3.3-12.9) fewer deaths and 8.9% (4.2-12.5) fewer DALYs.

Conclusion

Our findings show the potential of improved vehicle safety design and personal protective devices (seatbelts and helmets) to reduce traffic deaths and disabilities in the Association of Southeast Asian Nations. These improvements can be achieved by vehicle design regulations and creating consumer demand for safer vehicles and motorcycle helmets through mechanisms such as new car assessment programmes and other initiatives.

Comparison of injury severity scores (ISS) obtained by manual coding versus "Two-step conversion" from ICD-9-CM

Background

The International Classification of Diseases (ICD) is the standard diagnostic tool for classifying and coding diseases and injuries. The Abbreviated Injury Scale (AIS) is the most widely used injury severity scoring system. Although manual coding is considered the gold standard, it is sometimes unavailable or impractical. There have been many prior attempts to develop programs for the automated conversion of ICD rubrics into AIS codes.

Objective

To convert ICD, Ninth Revision, Clinical Modification (ICD-9-CM) codes into AIS 2005 (update 2008) codes via a derived map using a two-step process and, subsequently, to compare Injury Severity Score (ISS) resulting from said conversion with manually coded ISS values.

Methods

A cross-sectional retrospective study was designed in which medical records at the Hospital Universitario Marqués de Valdecilla of Cantabria (HUMV) and the Complejo Hospitalario of Navarra (CHN), both in Spain, were reviewed. Coding of injuries using AIS 2005 (update 2008) version was done manually by a certified AIS specialist and ISS values were calculated. ICD-9-CM codes were automatically converted into ISS values by another certified AIS specialist in a two-step process. ISS scores obtained from manual coding were compared to those obtained through this conversion process.

Results

The comparison of obtained through conversion versus manual ISS resulted in 396 concordant pairs (70.2%); the analysis of values according to ISS categories (ISS<9, ISS 9–15, ISS 16–24, ISS>24) showed 493 concordant pairs (87.4%). Regarding the criterion of “major trauma” patient (i.e., ISS> 15), 538 matching pairs (95.2%) were obtained. The conversion process resulted in underestimation of ISS in 112 cases (19.9%) and conversion was not possible in 136 cases (19%) for different reasons.

Conclusions

The process used in this study has proven to be a useful tool for selecting patients who meet the ISS>15 criterion for “major trauma”. Further research is needed to improve the conversion process.

Drugs, Substance Use Disorder and Driving: Intervention of Health Professionals in the Treatment of Addictions

Editorial of vol 27-3.

Implications of Functional Capacity Loss and Fatality for Vehicle Safety Prioritization

OBJECTIVE

We investigate the use of the Functional Capacity Index (FCI) as a tool for establishing vehicle safety priorities by comparing the life year burden of injuries to the burden of fatality in frontal and side automotive crashes. We demonstrate FCI's utility by investigating in detail the resulting disabling injuries and their life year costs.

METHODS

We selected occupants in the 2000-2013 NASS-CDS database involved in frontal and side crashes, merged their injuries with FCI, and then used the merged data to estimate each occupant's overall functional loss. Lifetime functional loss was assessed by combining this measure of impairment with the occupants' expected future life spans, estimated from the Social Security Administration's Actuarial Life Table.

RESULTS

Frontal crashes produce a large number of disabling injuries, particularly to the lower extremities. In our population, these crashes are estimated to account for approximately 400,000 life years lost to disability in comparison with 500,000 life years lost to fatality. Victims of side crashes experienced a higher rate of fatality but a significantly lower rate of disabling injury (0.3 vs. 1.0%), resulting in approximately 370,000 life years lost to fatality versus 50,000 life years lost to disability.

CONCLUSIONS

The burden of disabling injuries to car crash survivors should be considered when setting vehicle safety design priorities. In frontal crashes this burden in life years is similar to the burden attributable to fatality.

Incidence trends of traumatic spinal cord injury and traumatic brain injury in Spain, 2000-2009

AIMS

The aim of the present study was to estimate the incidence of hospital discharges for traumatic spinal cord injury (TSCI) and traumatic brain injury (TBI) in Spain by injury circumstances (traffic crashes and others), injury severity, gender and age group and to describe its trends over the period 2000-2009.

METHODS

It is a study of trends that includes hospital discharges with a primary diagnosis of TSCI or TBI. Crude and age-standardised rates were calculated per million inhabitants. Changes in rates between 2000 and 2009 were assessed through calculation of the relative risk adjusted for age, using Poisson regression.

RESULTS

Between 2000 and 2009 in Spain, 10,274 patients were admitted for traumatic TSCI, and 206,503 for TBI. The annual incidence rate for TSCI was 23.5 per million, that for TBI was 472.6 per million. The overall incidence rate for TSCI fell significantly between 2000 and 2009 by 24.2% (traffic-related 40.9%, other 12.9%), as did that for TBI (23.8% overall, 60.2% traffic-related, with no change for other circumstances). Among people aged 65 years and over, no change was observed for TSCI, incidence of TBI fell significantly when due to traffic crashes, but there was a dramatic increase of 87% in men and 89.3% in women when due to other circumstances.

CONCLUSIONS

Over the last decade the incidence of these types of injury has fallen significantly when the injury resulted from traffic crashes, and to a lesser extent when from other circumstances. However TBI incidence among people aged 65 and over injured in non-traffic-related circumstances has risen dramatically.

Validation of self-reported motor-vehicle crash and related work leave in a multi-purpose prospective cohort

Validation studies about self-reported motor vehicle crashes and related work leave are scarce. The Seguimiento Universidad de Navarra (SUN) is a multi-purpose cohort study undertaken in Spain. Motor vehicle crash risk factors are assessed within it. The objective of this study was to validate the incidents of self-reported motor vehicle crashes (MVC) and related work leave through mailing and clinical notes' review. The method included questions in the cohort's questionnaire regarding motor vehicle crash incident and work leave. We made both a re-test and a criterion validity study for self-reported answers. The results show a moderate κ Cohen's correlation coefficient for both events. Re-test reliability κ for MVC was 0.55, for MVC-related work leave it was 0.53. Criterion validity κ was 0.25 for MVC and 0.25 for MVC-related work leave. These results show a moderate agreement for re-test both for MVC and work MVC-related leave. For criterion validity, the results show a fair agreement. The magnitude of the agreement is similar to other similar studies and allows the use of these data in epidemiological studies.

Driving position field study, differences with the whiplash protocol and biomechanics experimental responses

Rear-impact collisions at low speed are a leading cause of economic costs among motor vehicle accidents. Recently, EuroNCAP has incorporated in its protocol the whiplash test, to reproduce a low-speed rear impact. This paper presents a field driving study to assess the potential differences between the EuroNCAP dummy tests and actual drivers in the field, focusing on occupant position and biomechanics experimental results. A total of 182 drivers were randomly selected in two geographical areas in Spain. The driving position of each driver was recorded with a focus on the most relevant measurements for rear impact. Statistical analysis was performed to obtain means, standard deviations and density functions to compare observational seating position with that of the EuroNCAP testing protocol. The observational data showed a similar seatback angle to that used in the EuroNCAP protocol (24° in front of 25° for the protocol), a greater distance between the head vertex and the top of the head restraint (53mm compared to 39.5mm), and less distance between the occipital bone of the head and the headrest (67.9 compared to 89.3mm). Based on these data, 4 dummy tests were conducted using the dummy BioRID IIg. The baseline test was designed to reproduce the dummy position according to EuroNCAP 3.0 whiplash protocol. Three different additional tests were defined to reproduce the actual observed driving position as well as to assess a "worst case" scenario in terms of reduced seatback angle. These variations in initial driver position, comparing the EuroNCAP protocol to the observational study results, were not observed to cause significant differences in the biomechanical values measured in the BioRID IIg, The T1 acceleration was reduced less than 8%, the NIC was increased about 8%, and the NKm presented a reduction of 20%. Reducing the seat angle was observed to be more harmful in terms of NIC.

Risk of injury according to participation in specific physical activities: a 6-year follow-up of 14 356 participants of the SUN cohort

BACKGROUND

Physical activity is generally accepted as a healthy habit. Nevertheless, its associated risk to cause injuries has not been sufficiently evaluated. Measuring this risk more precisely would contribute to giving more accurate health advice to the general population.

METHODS

Data are from participants (60% women, mean age 38 years) in a cohort of university graduates in Spain (1999-2008). Among other exposures and outcomes, they self report on frequency of participation in several physical activities over 1 year, and on incidence of sports-related injuries after 2, 4 or 6 years follow-up. Participation in 17 physical activities was categorized as a dichotomous variable (yes/no) and also according to average time per week spent in each one. Proportional hazards regression was used to estimate the adjusted relative risks [hazard ratios (HRs)] of incident injury associated with each specific physical activity or with total weekly energy expenditure in leisure-time activity [metabolic equivalents (METs)-h/week]. Statistical analyses were stratified by sex.

RESULTS

We identified 1658 incident sports-related injuries among 14 356 participants after a median follow-up of 4.6 years. When we adjusted for overall energy expenditure (METs-h/week) in other activities, age and body mass index (BMI), a higher risk of injury was associated with participation in soccer, other team sports, skiing, tennis, running and athletics (HRs ranging from 1.50 to 1.86) among men. With the exception of soccer (rarely practiced by women in Spain), similar results were found for women (HRs ranging from 1.61 to 2.04). Walking, gymnastics, swimming, mountain hiking and gardening were associated with a low injury risk.

CONCLUSIONS

Despite the healthy effects of physical activity, we consider that the higher risk for injuries related to soccer, team sports, skiing, tennis, running or athletics should be taken into consideration when advice for more physical activity is given to the general population. Daily routine physical activities such as walking or gardening should be encouraged.

Smoking status, changes in smoking status and health-related quality of life: findings from the SUN ("Seguimiento Universidad de Navarra") cohort

We aimed to evaluate the association between smoking, changes in smoking, and quality of life in a cohort of Spanish university graduates. Smoking habits were self-reported at baseline and four years later. Quality of life was assessed using the Short Form-36 (SF-36) at year 4. Statistical differences in SF-36 scores between groups were determined using ANCOVA with age and sex as covariates. Out of 5,234 eligible participants over 2000-2006, there were 2,639 non-smoker participants, 1,419 ex-smokers, and 1,048 smokers. Within the previous four years, 435 participants became recent quitters and 205 starters. Comparing smoking and health status in year 4, non-smokers showed better scores than the other categories of ever smoking in all dimensions except in the vitality scale value, which was similar in non-smokers and in those smoking less than 15 cigarettes/day. Comparing changes in smoking and health in year 4, continuing smokers had statistically significant worse scores than non-smokers in general health, social functioning, role-emotional and mental health, whereas recent quitters showed statistically significant improvements in role-emotional and mental health over those who had continued smoking or those who became smokers. Our findings support a dose-response relationship between cigarette consumption and a worse quality of life in general and mental health in particular. They also support that changes in smoking have an impact on health.

Comparison of mortality due to severe multiple trauma in two comprehensive models of emergency care: Atlantic Pyrenees (France) and Navarra (Spain)

BACKGROUND

Injury due to external causes is an important health problem in our society today. Emergency care systems based on the concept of "comprehensive care" can prevent deaths and disabilities as well as limit the severity and pain caused by trauma.

OBJECTIVE

To investigate the frequency and characteristics of different mechanisms of injury and to estimate mortality, comparing two comprehensive emergency systems: Atlantic Pyrenees (AP) in France and Navarra (NA) in Spain.

MATERIAL AND METHODS

A prospective cohort study of severe multiple-injury patients attended to by the comprehensive emergency care systems of AP and NA from April 1, 2001 to March 31, 2002. Data were collected from personal patient data, the emergency coordination center "112," pre-hospital and hospital health care levels, and discharge data. Bivariate statistical analysis and multivariate logistic regression models were employed for statistical management.

RESULTS

There were 614 severe multiple trauma patients recorded, 278 in AP and 336 in NA. Significant differences were observed in arrival time, pre-hospitalization care, pre-hospital Revised Trauma Score (RTS), Injury Severity Score (ISS) at the intensive care unit, and procedures used (intubation, administration of fluids, immobilization, and diagnostic methods). Logistic regression showed significant differences in patient death, age (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.03), penetrating or accidental injuries, (OR 3.85, 95% CI 1.1-13.1), RTS (OR 0.58, 95% CI 0.5-0.7), and ISS score (OR 1.05, 95% CI 1.0-1.1).

CONCLUSION

Despite a more aggressive approach and employment of greater resources, the French comprehensive trauma system does not show greater survival rates among injured patients compared to Navarra, even when controlling for confounding factors like age, injury mechanism, RTS, ISS, and others.

A comparison of information on motor vehicle crashes as reported by written or telephone interviews

OBJECTIVE

To compare information about traffic crash injuries and kilometers driven reported in a written questionnaire with information reported in a telephone interview.

DESIGN

Telephone and paper surveys.

SETTING

The Seguimiento Universidad de Navarra (SUN, University of Navarra Follow-up) study, in Spain. The SUN study is an open enrollment cohort study with 17 000 enrolled graduates followed through biennial mailed questionnaires.

SUBJECTS

A sample of 542 individuals from the SUN study participants.

MAIN OUTCOME MEASURE

Agreement on information about traffic crash injuries and mileage driven in a mailed questionnaire and a telephone survey.

RESULTS

Participation was 90.4%. Considering the phone survey as the gold standard, data on traffic crash injuries in the mailed questionnaire had 83% sensitivity (95% CI 77% to 89%), 77% specificity (95% CI 71% to 82%), 74% positive predictive value (95% CI 67% to 80%), and 89% negative predictive value (95% CI 83% to 93%). Agreement beyond chance, measured by the kappa statistic, was 0.63 (95% CI 0.56 to 0.70). Correlation between questionnaire and telephone surveys and kilometers driven on average during a year assessed by the intraclass correlation coefficient was 0.64 (95% CI 0.57 to 0.70), p<0.001.

CONCLUSIONS

Information on sustained traffic crash injuries and traveled mileage over the previous two years as reported through mailed questionnaires in a highly educated population could be used in the study of associations between traffic crash injuries and a variety of risk factors.

Predictors of follow-up and assessment of selection bias from dropouts using inverse probability weighting in a cohort of university graduates

Dropouts in cohort studies can introduce selection bias. In this paper, we aimed (i) to assess predictors of retention in a cohort study (the SUN Project) where participants are followed-up through biennial mailed questionnaires, and (ii) to evaluate whether differential follow-up introduced selection bias in rate ratio (RR) estimates. The SUN Study recruited 9907 participants from December 1999 to January 2002. Among them, 8647 (87%) participants answered the 2-year follow-up questionnaire. The presence of missing information in key variables at baseline, being younger, smoker, a marital status different of married, being obese/overweight and a history of motor vehicle injury were associated with being lost to follow-up, while a self-reported history of cardiovascular disease predicted a higher retention proportion. To assess whether differential follow-up affected RR estimates, we studied the association between body mass index and the risk of hypertension, using inverse probability weighting (IPW) to adjust for confounding and selection bias. Obese individuals had a higher crude rate of hypertension compared with normoweight participants (RR=6.4, 95% confidence interval (CI): 3.9-10.5). Adjustment for confounding using IPW attenuated the risk of hypertension associated to obesity (RR=2.4, 95% CI: 1.1-5.3). Additional adjustment for selection bias did not modify the estimations. In conclusion, we show that the follow-up through mailed questionnaires of a geographically disperse cohort in Spain is possible. Furthermore, we show that despite existing differences between retained or lost to follow-up participants this may not necessarily have an important impact on the RR estimates of hypertension associated to obesity.

Lesiones por tráfico, de ocio y domésticas y laborales. Descripción de la situación en España

The aim is to describe impact on health of unintentional injuries (E800-E949, CIE-9) (V01-X59, Y40-Y86, Y88, Y89 CIE10) in terms of mortality and morbidity and to make certain recommendations regarding information systems. Transport, including occupational transport, is the activity that causes highest mortality, 5,920 in 2002. However, the overall number of deaths for the rest of circumstances where injuries occurred (falls, burns, drowning and others) rises to 5,032, the above being injuries that take place where we live and work, that is domestic, leisure and workplace settings. For the severity of road traffic injuries data are provided from the analysis of the Minimum Basic Data Set after Hospital Discharge in Spain. Differences are shown between severe injuries reported by the Traffic General Directorate (26,566) and hospital discharges for the same year (40,174). For leisure and domestic injuries, Primary Health Care sentinel networks are those producing the most information about the situation, particularly in the field of childhood injuries. The consultation incidence for this cause fluctuates between 931 and 1118 in the under 14s and between 1306 and 1971 in the under 5 s. For injuries occurring in the workplace the best information is provided by specific registry systems. Their incidence was 75.5 for the year 2000 and 70.5 in year 2002 for every 1000 workers paying national insurance.

Factors associated with severity and hospital admission of motor-vehicle injury cases in a southern European urban area

OBJECTIVES

To describe the characteristics of motor-vehicle (MV) injury cases admitted to Emergency departments (ED), and to assess factors related to injury severity and hospital admission.

SETTING

Subjects were MV injury patients, aged 16 or more, admitted to four EDs in the city of Barcelona (Spain), from July 1995 to June 1996.

METHODS

Cross-sectional design. The data analyzed were obtained from the information routinely transmitted from the EDs to the Municipal Institute of Health, based on the processing of ED logs. Severity was assessed with the Abbreviated Injury Scale and the Injury Severity Score. Univariate and bivariate descriptive statistical analyses were performed, as well as multiple logistic regressions.

RESULTS

For the 3791 MV-injury cases included in the study period, a larger contribution of cases was noted for males (63.1%), for cases younger than 30 years (55.3%) and for motorcycle or moped occupants (47.1%). After adjusting for age, sex and the presence of multiple injuries, pedestrians, followed by moped and motorcycle occupants were at a higher risk of a more severe injury (OR: 1.77, 1.61 and 1.50 respectively). Correspondingly, these user groups also showed a higher likelihood of a hospital admission (OR: 2.03, 1.92 and 2.00 respectively), when attended to in an ED. Injury cases attended to in the ED during night hours (OR: 2.06) were also at a higher risk of a hospital admission.

CONCLUSIONS

In Barcelona, pedestrians and two-wheel MV occupants, besides accounting for two-thirds of MV injury cases, are the user groups with a greater risk of a more severe injury. as well as a higher chance of a hospital admission, independently of demographic and health care factors.

Motor-vehicle injury patterns in emergency-department patients in a south-European urban setting

The objectives are to identify the main injury patterns in the various types of user (of cars, motorcycles/mopeds, bicycles and pedestrians) injured in traffic crashes and treated in hospital emergency services, along with their main demographic characteristics. One-year cumulative survey all of patients attended to emergency departments in Barcelona, Spain, over a 12-month period (1998) for injuries due to motor vehicle crashes. Bivariate descriptive analyses were conducted to identify the different profiles of motor-vehicle injury patients by age, sex, user type, injured body region and type of injuries. ISS scoring was used to determine injury severity. Of the nearly 17,000 injured traffic victims during 1998, 62% were men. Young people between 15 and 39 (71.6%) were most affected. 42% were users of two-wheeled motor vehicles, followed by car occupants (32%) and pedestrians (24%). Neck sprain (33%) was the most common injury among car occupants, multiple contusion and contusion of lower limbs among two-wheeled motor vehicles (23.5% and 14% respectively) and pedestrians (17.3% and 14.4% respectively) and upper limb fractures (20%) among cyclists. Motorcycle and moped users, mainly young males, have the highest probability of suffering injuries, with lower limbs being the most affected anatomical region. Elderly pedestrians sustaining injuries to the lower limbs and the head contribute substantially to the overall injury situation.

[Quality of emergency diagnosis of lesions of external causes requiring hospitalization]

OBJECTIVE

To establish the quality of emergency department diagnoses for those patients whose injuries required hospital admission.

METHODS

Emergency and hospital discharge diagnostics were retrieved for 339 injured patients. Severity scores (ISS) were calculated using an automatic conversion procedure (ICDMAP). Emergency diagnoses for each patient (grouped into categories) were compared with the hospital discharge ones. Quality was analyzed based on accuracy (Percy groups) and reliability (percentage of concordance) measurements. Severity scores were evaluated using reliability measures (percentage of concordance and intraclass correlation coefficient-ICC-).

RESULTS

Mean diagnoses per patient were 1.1 at the emergency department and 1.4 at hospital discharge. In the latter, there were diagnoses in each category except for those more unspecific, where there was a reduction. Overall, emergency information showed under notification. Severity scores were higher with hospital discharge data. There was a 63% percentage of concordance. When grouped into categories, severity scores had an ICC of 0.61 (moderate-good).

CONCLUSION

Emergency departments are a potential good source of information about injury severity even for those patients who require hospital admission. Emergency department injury surveillance can be very useful in assessing the magnitude and distribution of injury severity at the population level. Nevertheless for individual severity assessment, use of hospital discharge information is recommended.