Brodifacoum contamination of synthetic cannabinoid causing unexplained coagulopathy in multiple trauma: A case report

An 18-year-old female presented to the emergency department after a motor vehicle collision. Initial imaging revealed a liver laceration. Subsequent labs showed significantly elevated prothrombin time, international normalized ratio, and activated partial thromboplastin time. Thromboelastography demonstrated a flatline tracing. The patient denied use of anticoagulation but admitted to synthetic cannabinoid use. It was believed the patient had taken synthetic cannabinoid contaminated by brodifacoum. She was therefore given prothrombin complex concentrate and vitamin K with blood products. The patient underwent sequential embolization, laparotomy, thoracotomy, and repair of the vena cava with a shunt. Thirty minutes postoperatively, her coagulation tests and thromboelastography were much improved. Two and a half hours postoperatively, it was determined she had sustained non-survivable injuries. The patient experienced brain death due to prolonged hypotension as a result of hemorrhagic shock with bleeding exacerbated by brodifacoum. To our knowledge, this is the first case reported of a trauma-induced coagulopathy exacerbated by brodifacoum-contaminated synthetic cannabinoid. Her coagulopathy was clearly not due to trauma alone and contributed greatly to the difficulty in controlling hemorrhage. The synthetic cannabinoid-associated coagulopathy rendered her otherwise potentially survivable injuries fatal. Given the frequency of multiple trauma and the recent increase in the prevalence of synthetic cannabinoid, it can be expected that the incidence of trauma complicated by synthetic cannabinoid-associated coagulopathy will increase in the near future. For patients that present with prolonged prothrombin time and/or activated partial thromboplastin time, it is important to inquire about recent synthetic cannabinoid use.

Neurological outcomes in traffic accidents: A propensity score matching analysis of medical and non-medical origin cases of out-of-hospital cardiac arrest

AIM

This study aimed to comprehensively compare the characteristics of out-of-hospital cardiac arrest (OHCA) with medical and non-medical origins attributed to traffic accidents and explore the potential association between the cases with a medical origin and neurologically favorable outcomes.

METHODS

In this retrospective nationwide population-based study, baseline data were collected between January 2018 and December 2020. We analyzed 5091 OHCA associated with traffic accidents on the road scene. Only those encounters involving treatment or transport by prehospital emergency medical technicians were included. The characteristics of OHCA incidents and their outcomes were analyzed by categorizing patients into "medical origin" and "non-medical origin" groups.

RESULTS

Medical-origin cases exhibited several distinct characteristics, including higher frequencies of occurrence during the daytime (79.3% [706/890] vs. 68.9% [2895/4201], p < 0.001), a higher prevalence among male (77.8% [692/890] vs. 68.3% [2871/4201], p < 0.001) and younger patients (median [25-75%]: 63 years [42-77] vs. 66 years [50-76], p = 0.003), a higher proportion of shockable initial rhythms(10.5% [93/890] vs. 1.1% [45/4201], p < 0.001), an increased number of cases requiring advanced airway management (33.8% [301/890] vs. 28.5% [1199/4201], p = 0.002) and adrenaline administration by emergency medical teams (26.9% [239/890] vs. 21.7% [910/4201], p < 0.001), and shorter transport times (55.3% [492/890] vs. 60.9% [2558/4201], p = 0.002) compared to non-medical-origin cases. However, medical-origin cases also had lower witness rates (42.8% [381/890] vs. 27.2% [1142/4201], p < 0.001) and were less likely to be transported to higher-level hospitals (55.3% [492/890] vs. 60.9% [2558/4201], p = 0.002). Propensity score matching analysis identified factors associated with favorable neurological outcomes in medical-origin traffic accidents. The adjusted odds ratios were as follows: 8.46 (3.47-20.61) for cases with shockable initial rhythms, 2.36 (1.01-5.52) for cases involving traffic accidents due to medical origin, and 0.09 (0.01-0.67) for cases where advanced airway management was provided.

CONCLUSION

In this retrospective study, the occurrence of OHCAs of medical origin involving traffic accidents were associated with favorable neurological outcomes. These cases more frequently demonstrated favorable factors for survival compared to those classified as of non-medical origin. The findings have important implications for public health and EMS professionals, they will guide future research aimed at optimizing prehospital care strategies and improving survival rates for similar cases.

Effectiveness of lumbar motion style acupuncture treatment on inpatients with acute low back pain: A pragmatic, randomized controlled trial

BACKGROUND AND PURPOSE

This parallel, single-center, pragmatic, randomized controlled study aimed to investigate the effectiveness and safety of motion style acupuncture treatment (MSAT; a combination of acupuncture and Doin therapy) to reduce pain and improve the functional disability of patients with acute low back pain (aLBP) due to road traffic accidents.

MATERIALS AND METHODS

Ninety-six patients with aLBP admitted to the Haeundae Jaseng Hospital of Korean Medicine in South Korea due to traffic accidents were treated with integrative Korean medicine (IKM) with additional 3-day MSAT sessions during hospitalization (MSAT group, 48 patients) or without (control group, 48 patients), and followed up for 90 days.

RESULTS

The mean numeric rating scale (NRS) scores of low back pain (LBP) of the MSAT and control groups were both 6.7 (95% confidence interval [CI]: 6.3, 7.1) at baseline. After completing the third round of all applicable treatment sessions (the primary endpoint in this study), the mean NRS scores of the MSAT and control groups were 3.76 (95% CI: 3.54, 3.99) and 5.32 (95% CI: 5.09, 5.55), respectively. The difference in the mean NRS score between the two groups was 1.56 (95% CI: 1.25, 1.87).

CONCLUSION

IKM treatment combined with MSAT can reduce pain and improve the range of motion of patients with aLBP.

TRIAL REGISTRATION

This trial is registered at ClinicalTrial.gov (NCT04956458).

Two Cases of Posttraumatic Stress Disorder Caused by a Motor Vehicle Accident Treated with Virtual Reality Exposure Therapy

Exposure-response prevention is an effective approach to treat anxiety disorders. Virtual reality exposure therapy (VRET) is a promising treatment for patients with posttraumatic stress disorder (PTSD). New research has helped refine and update VRET. In this study, we introduce a form of VRET developed for patients suffering from PTSD after a traffic accident, and present two cases treated using this protocol. After 6 weeks of VRET treatment, the two participants not only improved their PTSD symptoms, but also improved their depressed mood, anxiety, and insomnia symptoms. Future studies of VRET for car accident-related PTSD should utilize a controlled design with randomization in order to account for numerous possible confounds.

Time series traffic collision analysis of London hotspots: Patterns, predictions and prevention strategies

Despite recent measures on accident prevention, road collisions, mainly on London's "A" roads, persist as accident sources, endangering vulnerable users in particular. Analysing evidence from London's A-Roads unveils issues concerns and trends. This study utilises extensive data to target factors magnifying accidents: speed, traffic, vulnerable interactions. Stats 19 and transport data including volumes, types, speeds, and congestion parameters are all analysed alongside the collision data. The descriptive statistics have been employed to understand nature of data in the first instance. This has supported the process to cleanse the data outliers or periods where were subjected to incidents and interventions. Predictive model development is conducted to analyse and forecast accident frequency using ARIMA and SARIMAX models forecasted accident rates and interventions. ARIMA yielded higher accuracy. Method of analysis resulted in a statistically reliable formulation of the main factors, enabling use of this method for similar cities across the world. Formulated analysis revealed key contributors as population density, weather, and time of the day. The analysis of data supported identification of strategies emerging as infrastructure improvements, traffic control measures and severity and vulnerable users affected in particular. The analysis reveals distinct exhibits of causation, leading to focused recommendations on infrastructure enhancements, traffic control measures, and the impact on severity and vulnerable users, deviating from prior research findings. Insights aid safer London roads, have global predictive and mitigation value.

Pediatric motor vehicle crashes injuries: A systematic review for forensic evaluation

Children involved in car crashes can experience either direct trauma or inertial injuries resulting from interactions with external objects, such as other vehicles, or with the restraint system. Furthermore, improper use of restraint systems can lead to additional severe injuries. Recent reports from international institutions underscored the persistent prevalence of inadequate restraint systems utilization and this widespread issue increases children's vulnerability and risk of injuries.The aim of this study is to provide a systematic review of the literature on injuries sustained in children involved in road accidents describing and analyzing elements useful for forensic assessment.The literature search was performed using PubMed, Scopus and Web of Science from January 1970 to March 2023. Eligible studies have investigated issues of interest to forensic medicine about traffic accidents involving pediatric passengers. A total of 69 studies satisfied the inclusion criteria and were categorized and analyzed according to the anatomical regions of the body affected (head, neck, thoraco-abdominal, and limb injuries), and the assessment of lesions in reconstruction of the accident was examined and discussed.The review highlights that in motor vehicle accidents involving children, the forensic evaluation of both the cause of death and accident dynamics needs to consider several factors, such as the child's age, the type of restraint system employed, and the specific passenger seat occupied. Considering the complexity of the factors that can be involved in this road accident, it is crucial that there is a comprehensive exchange of information between the judge and the medical expert.

Effect of helmet use on maxillofacial injuries due to bicycle and scooter accidents: a systematic literature review and meta-analysis

Maxillofacial injury is a common injury resulting from bicycle (including e-bike) and scooter accidents. With 80,000 admissions to emergency departments in 2019, bicycle accidents account for more than half of all traffic-related emergency department visits in the Netherlands. The United States reports approximately 130,000 injuries and 1000 fatalities related to cycling annually. This systematic review and meta-analysis was performed to examine the protective effect of helmets against maxillofacial injuries resulting from bicycle and scooter (including e-bike and e-scooter) accidents. After a systematic literature search, 14 studies were found to be eligible for this systematic review. Of these, 11 were included in the meta-analysis. None of the included studies focused on vehicles with motors (e-bikes and e-scooters); all focused only on non-motorized vehicles. All included studies were non-randomized, which could have led to bias in the pooled results. Data from the included studies were tested for heterogeneity using the binary random-effects model (DerSimonian-Laird method), and the odds ratio for the occurrence of maxillofacial injury in cyclists wearing a helmet versus those not wearing a helmet was calculated by random-effects meta-analysis. Patients who had worn a helmet suffered significantly fewer maxillofacial injuries than patients who had not, in bicycle accidents (odds ratio 0.682). In conclusion, wearing a helmet has a significant protective effect against maxillofacial injury, indicating the need for strict helmet legislation.

Pregnancy is associated with more severe injuries from motor vehicle crashes

OBJECTIVE

Whether pregnancy is associated with severe injuries from motor vehicle crashes (MVCs) remains unclear. This study aimed to investigate the potential relationship between pregnancy and severity of injuries from MVCs.

METHODS

We identified a total of 23,559 pregnant women victims who encountered MVCs during pregnancy as well as 94,236 age- and calendar year-at MVC matched non-pregnant women victims that are also involved in MVCs. Injury severity was assessed using the Maximum Abbreviated Injury Scale (MAIS) based on the diagnosis of medical claims after MVCs. Multinomial logistic regression models were used to estimate the odds ratio and corresponding 95 % CI of injury severity levels associated with pregnancy.

RESULTS

Pregnant women had a significantly higher risk of both severe (adjusted odds ratio, aOR = 1.79, 95 % CI = 1.54-2.08) and mild injuries (aOR = 8.63, 95 % CI = 8.21-9.07) following MVCs as compared to non-pregnant women victims. Particularly, pregnant women who were riding scooters had an increased risk of severe injury (aOR = 4.25, 95 % CI = 3.58-5.04). In addition, pregnant women who experienced MVC but without any injury were more likely to visit a clinic than non-pregnant MVC victims.

CONCLUSION

Pregnant women victims, particularly those who were riding scooters involved in MVCs suffered from a higher risk of severe injury as compared to their non-pregnant counterparts. Our findings suggest that women should consider avoiding riding a scooter and must use restrictive devices during pregnancy, which would help reduce the severity of injuries sustained following an MVC.

Fracture of the Second Rib: An Indirect Sign of Serious Trauma Like Fracture of the First Rib?

Background

The first 3 ribs are anatomically well-protected, shielded by the large thoracic muscles, the shoulder girdle, and the arm. A significant force is required to fracture these ribs; thus, such fractures suggest a high-energy trauma and are associated with injuries to vital organs of the thorax, such as the aorta, the heart, the lungs and the great vessels.

Methods

A retrospective analysis was conducted over a 10-year period at a single hospital. The study assessed patients with fractures of the second rib, including their concurrent injuries and the overall severity of their trauma.

Results

Among the 76 patients included in the study, the average age was 47.35 years, 81.5% were men, and 19.5% were women. Thirteen patients (17.1%) survived their injuries. The most common causes of injury were road traffic accidents (63%) and pedestrian injuries (22%). The patients who did not survive sustained injuries to an average of 5 additional organs, while survivors had injuries to an average of 2.07 additional organs. Left rib fractures were the most frequently observed (46%). The most serious concurrent injuries reported were to the aorta (5.26%), heart (10.52%), lung (52.36%), head (57.89%), liver (30.2%), spleen (26.31%), and kidney (17.1%).

Conclusion

As indicators of serious injury to vital endothoracic organs, isolated fractures of the second rib should be considered equal to first rib fractures in clinical importance.

Traffic safety and public health in China - Past knowledge, current status, and future directions

Transportation-related harms have developed into a social disease, threatening public safety and health in China. We aimed to increase the global understanding of traffic safety and public health in China from past knowledge, current status, and future directions by collecting, collating, and analyzing the Chinese traffic incidents reported in the published literature. A systematic search of China National Knowledge Infrastructure, Weipu, and published articles referenced in PubMed, Web of Science and ProQuest between January 1, 1988 and April 30, 2023 was performed. China encountered the first recorded traffic accident as early as three thousand years ago in the Shang Dynasty. An increase in vehicle capacity and velocity increased the traffic risks during the transition from rickshaws and livestock to motor vehicles in varying traffic environments. Humans are not only the decisive factor of a large number of vehicles, traffic routes, and environmental variables, but also the victims at the end and starting point of traffic accidents. Injuries (mechanical force, burns) and diseases (traffic-related air pollution, noise) caused by traffic activities not only threaten public health, but also cause risks to safe driving. Analysis of traffic activities and biomarkers promotes the treatment of traffic injuries in ethology and medicine. China prepared for the construction of healthy transportation in the "decade of road safety" toward an estimation of worldwide road traffic injuries in 2030. Improvement of traffic safety concerning public health under the "Outline of the National Comprehensive Three-dimensional Transportation Network Planning" in China will propel the realization of worldwide traffic environmental advancement.

Medications and traffic accidents involving older drivers: do Spanish primary healthcare physicians know enough?

BACKGROUND

Our aim was to evaluate Spanish family doctors' knowledge about medications that increase the risk of traffic accidents involving older drivers, and to obtain data about the involvement of family doctors in accident prevention activities and the associations between these factors and their demographic and workplace characteristics.

METHODS

A cross-sectional study of 1888 family doctors throughout Spain was carried out from 2016 to 2018. Participants completed a previously validated self-administered questionnaire that explored whether family doctors distinguished between medications associated with a high or low risk of involvement in a traffic accident, investigated the appropriateness of advice given to older patients, and physicians' involvement in preventive activities. Multiple regression models were used to estimate the adjusted association of these variables with each other and with characteristics of family doctors in the sample.

RESULTS

On a scale of 1 (never or hardly ever) to 4 (always), the indexes constructed to evaluate how often family doctors believed they should oversee the use of high-risk and low-risk medications yielded values of 3.38 for the former and 2.61 for the latter (p < 0.001). Only 24% responded correctly to all three items that inquired about the appropriateness of the advice they gave to older patients. On a scale of 1 to 4, the frequency at which family doctors gave older patients advice about preventive measures was 2.85, and only 43% reported allocating time during appointments to provide this advice. These latter two variables were directly associated with appropriate values for the index used to evaluate physicians' oversight of medications associated with a high risk. The perception of risk associated with medications and involvement in preventive activities were both greater among female participants.

CONCLUSIONS

Family doctors correctly identified medications according to their risk of playing a role in traffic accidents, although the recommendations they gave to their patients were not always appropriate. These findings, along with physicians' infrequent involvement in preventive activities, suggest a need to improve family doctors' competencies and increase the resources available to them so that they can provide their older patients with advice on ways to prevent involvement in traffic accidents.

A hybrid of regularization method and generalized path analysis: modeling single-vehicle run-off-road crashes in a cross-sectional study

BACKGROUND

Determining risk factors of single-vehicle run-off-road (SV-ROR) crashes, as a significant number of all the single-vehicle crashes and all the fatalities, may provide infrastructure for quicker and more effective safety measures to explore the influencing and moderating variables in SV-ROR. Therefore, this paper emphasizes utilizing a hybrid of regularization method and generalized path analysis for studying SV-ROR crashes to identify variables influencing their happening and severity.

METHODS

This cross-sectional study investigated 724 highway SV-ROR crashes from 2015 to 2016. To drive the key variables influencing SV-ROR crashes Ridge, Least Absolute Shrinkage and Selection Operator (Lasso), and Elastic net regularization methods were implemented. The goodness of fit of utilized methods in a testing sample was assessed using the deviance and deviance ratio. A hybrid of Lasso regression (LR) and generalized path analysis (gPath) was used to detect the cause and mediators of SV-ROR crashes.

RESULTS

Findings indicated that the final modified model fitted the data accurately with [Formula: see text]= 16.09, P < .001, [Formula: see text]/ degrees of freedom = 5.36 > 5, CFI = .94 > .9, TLI = .71 < .9, RMSEA = 1.00 > .08 (90% CI = (.06 to .15)). Also, the presence of passenger (odds ratio (OR) = 2.31, 95% CI = (1.73 to 3.06)), collision type (OR = 1.21, 95% CI = (1.07 to 1.37)), driver misconduct (OR = 1.54, 95% CI = (1.32 to 1.79)) and vehicle age (OR = 2.08, 95% CI = (1.77 to 2.46)) were significant cause of fatality outcome. The proposed causal model identified collision type and driver misconduct as mediators.

CONCLUSIONS

The proposed HLR-gPath model can be considered a useful theoretical structure to describe how the presence of passenger, collision type, driver misconduct, and vehicle age can both predict and mediate fatality among SV-ROR crashes. While notable progress has been made in implementing road safety measures, it is essential to emphasize that operative preventative measures still remain the most effective approach for reducing the burden of crashes, considering the critical components identified in this study.

A death due to faulty airbag system-case report

Injuries due to automobile safety devices have been reported and we report a rare fatality due to a defective airbag system. A compact hybrid car driven by a 37-year-old male at moderate speed had crashed through an unprotected manhole. The car had moved around 200 m before it came to a halt. The passers-by had noticed that the driver was unconscious, partly leaning forward with an inflated airbag. He was pronounced dead on admission. The car had sustained minor indentation on front bumper. Autopsy revealed a circular perforated laceration on the neck associated with completely transected right carotid artery and partially transected jugular vein. There was a 2 × 2-cm cylindrical metal object lodged at C4-C5 vertebrae level, and the remaining part of this was retrieved during scene investigation and identified as a part of a metal canister in the inflator component of the airbag system. There was a perforation in the airbag which was similar in size to the retrieved foreign body. The cause of death was ascertained as hemorrhagic shock due to bleeding from ruptured neck vessels caused by primary shrapnel projected from the faulty airbag system. Following the incident, the manufacturers replaced faulty airbag systems in similar models. If abnormally fatal injuries are observed, a scene visit along with automotive expert opinion would provide valuable insight into the incident. Such information would alert the general public on regular screening of safety measures and prompt manufacturers to recall faulty products.

Fall and collision related injuries among pedestrians, sickness absence and associations with accident type and occupation

OBJECTIVES

This study explores pedestrian fall accidents and collisions with other road users in the Swedish road transport system, and sickness absence (SA) in relation to accident type, injury, and occupation. Further, it studies the associations between accident type, occupation, and duration of SA.

METHODS

Data from several national registers were used that included 15,359 working age pedestrians (20-64 years) receiving healthcare after a fall or collision throughout 2014-2016. Individual characteristics, accident type, injury, and occupation were presented and related to SA. Logistic regression was used to estimate odds ratios (OR), with 95% confidence intervals, for associations between accident type, occupation, and SA duration.

RESULTS

About 11,000 pedestrians (72%) were involved in fall accidents in the road traffic environment and well over 4,000 in collisions with another road user; 22% of all injured pedestrians had a new SA. The population had a higher proportion of women and individuals in older age groups (≥45). Of the falls, 31% were due to snow or ice, and these were associated with a higher OR for both short SA (<90 days) 1.76 (95% CI 1.56-1.98) and long SA (≥90 days) 1.81 (95% CI 1.51-2.18), compared to the group slipping, tripping, and stumbling. The working sectors health & social care, and construction had the highest ORs for SA. A higher OR was found for health & social care, short SA 1.58 (95% CI 1.38-1.81), long SA 1.79 (95% CI 1.45-2.20) and for construction, short SA 1.56 (95% CI 1.24-1.96), long SA 1.75 (95% CI 1.26-2.44), compared to the sector finance, communication, & cultural service.

CONCLUSIONS

The OR for having short and long SA was higher in falls due to snow or ice and differed between occupational sectors.

PRACTICAL IMPLICATIONS

This information contributes to the knowledge base for planning a safe road transport system for pedestrians.

Effectiveness of Wearable Protection Equipment for Seated Pedestrians

This study used finite element models to investigate the efficacy of seated pedestrian protection equipment in vehicle impacts. The selected safety equipment, a lap belt, an airbag vest, and a bicycle helmet, were chosen to mitigate the underlying biomechanical causes of seated pedestrian injuries reported in the literature. The impact conditions were based on the three most dangerous impact scenarios from a previous seated pedestrian impact study. Serious injury (AIS 3+) risks were compared with and without protective equipment. A 50th percentile male occupant model and two generic vehicle models, the family car (FCR) and sports utility vehicle (SUV), were used to simulate vehicle collisions. Three impact conditions were run with every combination of protective equipment (n = 24). The helmet reduced head and brain injury risks from the vehicle-head and ground-head contacts. The airbag reduced the head injury risk in the FCR vehicle-head contact but increased the brain injury risks in the SUV impacts from increased whiplash. The lap belt increased head injury risks for both the FCR and the SUV impacts because it created a stronger FCR vehicle-head contact and SUV ground-head contact. When the belt and airbag were used together the head injury risks dramatically decreased because the pedestrian body impacted the ground arm or leg first and slowly rolled onto the ground which resulted in softer ground-head contacts and in two instances, no ground-head contact. Only the helmet proved effective in all impact conditions. Future testing must be completed before recommending the belt or airbag for seated pedestrians.

In-hospital complications after trauma due to road traffic accidents

PURPOSE

The study aimed to verify the association between in-hospital complications and characterization and clinical variables including hospital care and trauma severity.

METHODS

This analysis with the prospective cohort data was conducted at a municipal hospital in São Paulo, Brazil, and included participants aged 14 years or older, with traumatic injuries from traffic accidents. Data was collected from January 2015 to July 2016 and included demographics variables, type of traumatic event, clinical parameters, length of stay in the Emergency department and in the Intensive Care Unit, length of hospital stay, survival probability, trauma severity and mortality.

RESULTS

Of the 327 patients, 25.1% had in-hospital complications and their occurrence was statistically associated with higher mean age, run-overs and higher trauma severity. The length of stay in the emergency room, hospital stay, ICU stay, percentage of deaths, and hospital readmission were higher in patients with complications. The number of complications was correlated with trauma severity, ICU stay, and mortality.

CONCLUSION

Complications were associated with older age, run-overs, greater trauma severity, length of stay and readmission after hospital discharge.

[Active and passive safety systems (not only) for senior citizens : Systems to increase road safety]

BACKGROUND

Due to a constantly increasing life expectancy and the need to stay mobile at a high age, the proportion of over 65-year-olds in traffic accidents is increasing from year to year.

METHOD

In order to identify potentials for increasing the safety of seniors in road traffic, accident data were analyzed with respect to the categories of road users and accident types of this age group. Based on the accident data analysis, active and passive safety systems are described that could increase the road safety particular for senior citizens.

RESULTS

It was found that older road users are frequently involved in accidents as car occupants, cyclists and pedestrians. In addition, car drivers and cyclists aged 65 years and older are frequently involved in driving, turning and crossing accidents. Lane departure warning and emergency braking assistants have a high potential for accident avoidance as they can defuse critical situations at the last moment. Restraint systems (airbags, seat belts) adapted to physical characteristics could minimize the severity of injuries to older car occupants.

The absence of data on driving under the influence of alcohol in road traffic studies: a scoping review of non-randomized studies with vote counting based on the direction of effects of alcohol policies

BACKGROUND

Data on driving under the influence of alcohol (DUIA) are not always available, accurate, or reliable, making it difficult to study the effects of alcohol policies on road traffic outcomes. The objectives of our study were twofold: 1) to describe how road traffic outcomes of alcohol policies are assessed when DUIA data are missing, and 2) to explore the effects of alcohol policies when DUIA data are missing.

METHODS

We conducted a scoping review of non-randomized studies that assessed the road traffic outcomes of alcohol policies when DUIA data are missing. Until November 2021, we searched studies published between 2000 and 2021, in English or French, via MEDLINE, APA PsycInfo, CINAHL, and SocINDEX. We assessed the risk of bias in the included studies with the Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group. The selection process, data extraction, and the risk of bias assessment were conducted independently and in duplicate. We used vote counting based on the direction of the effects of alcohol policies as a synthesis method. The protocol for this review was published in PROSPERO under record number CRD42021266744.

RESULTS

Twenty-four eligible studies were included. Regarding objective 1, most studies used uncontrolled interrupted time series designs to assess road traffic fatalities resulting from night-time crashes. The reasons for missing DUIA data were generally not reported. Regarding objective 2, we found evidence for an association between alcohol policies and decreased road traffic fatalities. Subgroup analyses found no evidence for an association between methodological modifiers and positive effect directions for road traffic fatalities.

CONCLUSION

Caution is needed when interpreting road traffic outcomes associated with alcohol policies when DUIA data are missing. Greater efforts should be made to improve the reporting of outcomes assessments. Future studies must address several methodological issues (e.g., more granular data, well-defined intervention and implementation, and controlled designs). Our results should be compared to those from others reviews where DUIA data were available to confirm or recalibrate the associations found in studies where DUIA data were missing.

Computational Seated Pedestrian Impact Design of Experiments with Ultralight Wheelchair

Pedestrians who use wheelchairs (seated pedestrians) report higher mortality rates than standing pedestrians in vehicle-to-pedestrian collisions but the cause of this mortality is poorly understood. This study investigated the cause of seated pedestrian serious injuries (AIS 3+) and the effect of various pre-collision variables using finite element (FE) simulations. An ultralight manual wheelchair model was developed and tested to meet ISO standards. The GHBMC 50th percentile male simplified occupant model and EuroNCAP family car (FCR) and sports utility vehicle (SUV) were used to simulate vehicle collisions. A full factorial design of experiments (n = 54) was run to explore the effect of pedestrian position relative to the vehicle bumper, pedestrian arm posture, and pedestrian orientation angle relative to the vehicle. The largest average injury risks were at the head (FCR: 0.48 SUV: 0.79) and brain (FCR: 0.42 SUV: 0.50). The abdomen (FCR: 0.20 SUV: 0.21), neck (FCR: 0.08 SUV: 0.14), and pelvis (FCR: 0.02 SUV: 0.02) reported smaller risks. 50/54 impacts reported no thorax injury risk, but 3 SUV impacts reported risks ≥ 0.99. Arm (gait) posture and pedestrian orientation angle had larger effects on most injury risks. The most dangerous arm posture examined was when the hand was off the wheelchair handrail after wheel propulsion and the two more dangerous orientations were when the pedestrian faced 90° and 110° away from the vehicle. Pedestrian position relative to the vehicle bumper played little role in injury outcomes. The findings of this study may inform future seated pedestrian safety testing procedures to narrow down the most concerning impact scenarios and design impact tests around them.

A task-level emergency experience reuse method for freeway accidents onsite disposal with policy distilled reinforcement learning

A large number of freeway accident disposals are well-recorded by accident reports and surveillance videos, but it is not easy to get the emergency experience reused from past recorded accidents. To reuse emergency experience for better emergency decision-making, this paper proposed a knowledge-based experience transfer method to transfer task-level freeway accident disposal experience via multi-agent reinforcement learning algorithm with policy distillation. First, the Markov decision process is used to simulate the emergency decision-making process of multi-type freeway accident scene at the task level. Then, an adaptive knowledge transfer method named policy distilled multi-agent deep deterministic policy gradient (PD-MADDPG) algorithm is proposed to reuse experience from past freeway accident records to current accidents for fast decision-making and optimal onsite disposal. The performance of the proposed algorithm is evaluated on instantiated cases of freeway accidents that occurred on the freeway in Shaanxi Province, China. Aside from achieving better emergency decisions performance than various typical decision-making methods, the result shows decision maker with transferred knowledge owns 65.22%, 11.37%, 9.23%, 7.76% and 1.71% higher average reward than those without in the five studied cases, respectively. Indicating that the emergency experience transferred from past accidents contributes to fast emergency decision-making and optimal accident onsite disposal.

Persistent effects of mobile phone conversation while driving after disconnect: Physiological evidence and driving performance

Cognitive workload has been known as a key factor in traffic accidents, which can be highly increased by talking on the phone while driving. A wide range of studies around the world investigated the effects of mobile phone conversations on driving performance and traffic accidents. But less noticed is the durability of cognitive effects of mobile phone conversations. This study aimed to determine the effects of different types of mobile phone conversations on physiological response and driving performance during and after the conversation. Heart rate, heart rate variability (physiological response), Standard deviation of lane position (SDLP), and the relative distance between two cars (driving performance) of 34 samples (male and female) in the driving simulator were recorded. In this study, three types of conversations (neutral, cognitive, and arousal) were used. Neutral conversation did not pursue specific purpose questions. Cognitive conversations were simple mathematical problem-solving questions and arousal conversations aimed at arousing participant emotions. Each conversation was used as a secondary task in a condition. The study had three conditions; in each condition the participant drove for 15 min. Each condition consisted of 5 min of driving (Background), 5 min of driving and conversation (dual tasks) and 5 min of driving after conversation to trace the effects of the conversation. Vehicle speed was 110 km/h in each of the three conditions using car-following scenario. The results showed that neutral conversations had no significant effects on physiological response. Though, arousal conversations had significant effects on physiological responsiveness and driving performance during conversations, where it was even more significant after disconnection. Therefore, the content of the conversation determines the amount of cognitive load imposed on the driver. Considering the persistence of cognitive effects caused by conversation, the risk of traffic accidents is still high even after disconnection.

A Hybrid of Random Forests and Generalized Path Analysis: A Causal Modeling of Crashes in 52,524 Suburban Areas

BACKGROUND

Determining suburban area crashes' risk factors may allow for early and operative safety measures to find the main risk factors and moderating effects of crashes. Therefore, this paper has focused on a causal modeling framework.

STUDY DESIGN

A cross-sectional study.

METHODS

In this study, 52524 suburban crashes were investigated from 2015 to 2016. The hybrid-random-forest-generalized-path-analysis technique (HRF-gPath) was used to extract the main variables and identify mediators and moderators.

RESULTS

This study analyzed 42 explanatory variables using a RF model, and it was found that collision type, distinct, driver misconduct, speed, license, prior cause, plaque description, vehicle maneuver, vehicle type, lighting, passenger presence, seatbelt use, and land use were significant factors. Further analysis using g-Path demonstrated the mediating and predicting roles of collision type, vehicle type, seatbelt use, and driver misconduct. The modified model fitted the data well, with statistical significance ( χ230 =81.29, P<0.001) and high values for comparative-fit-index and Tucker-Lewis-index exceeding 0.9, as well as a low root-mean-square-error-of-approximation of 0.031 (90% confidence interval: 0.030-0.032).

CONCLUSION

The results of our study identified several significant variables, including collision type, vehicle type, seatbelt use, and driver misconduct, which played mediating and predicting roles. These findings provide valuable insights into the complex factors that contribute to collisions via a theoretical framework and can inform efforts to reduce their occurrence in the future.

Age-specific characteristics of road traffic injuries among children and adolescents in South Korea

OBJECTIVE

Road traffic injuries (RTIs) are the leading cause of mortality among children and adolescents. This study aimed to identify and compare the age-specific epidemiology, clinical characteristics and factors related to severe RTIs among children and adolescents who had RTIs.

METHODS

This multicenter cross-sectional study was conducted using data collected between January 2011 and December 2018 in the Emergency Department-based Injury In-depth Surveillance registry in South Korea. A total of 66,632 participants younger than 19 years who presented with RTIs to emergency departments (EDs) were classified under three age groups: preschoolers (age 0-6 years, n = 18,694), elementary school student (age 7-12 years, n = 21,251), and middle and high school student (age 13-18 years, n = 26,687). Data on demographic and injury-related factors were analyzed, and multivariate logistic regression was used to determine the factors related to severe RTIs, which were defined as the Excess Mortality Ratio-based Injury Severity Score ≥16.

RESULTS

RTIs among children and adolescents were more common in boys (71.0%), during weekdays (39.7%), in the summer (31.1%), and between 12 noon and 6 pm (47.9%). The most common type of road users were passengers (preschoolers, 46.4%) and cyclists (age 7-12 years and age 13-18 years, 50.1% and 36.2%, respectively). The proportion of head injury was highest in the preschoolers group (57.3%). The length of ED stay, Excess Mortality Ratio-adjusted Injury Severity Score, and the proportion of intensive care unit admission increased with age. Nighttime (0-6 am), vulnerable road users (motorcyclists, bicyclists, and pedestrians), and use of emergency medical services were significantly associated with severe injury.

CONCLUSIONS

The three age groups of patients younger than 19 years with RTIs differed in the types of road user, proportions of injured body regions, and clinical outcomes. In an effort to reduce RTIs to children and adolescents, age-specific focused intervention should be considered. Additionally, the injury severity was found to be associated with nighttime occurrence, vulnerable road users, ED visit through emergency medical services, and nonuse of safety devices across all age group.

PTSD malingering detection in damage claim cases: Diagnostic accuracy in cases of personal injury as a result of motor vehicle accidents

This study aimed to assess the accuracy of post-traumatic stress disorder (PTSD) diagnoses made by mental health experts in people reporting post-traumatic stress symptoms related to traffic accidents. Data were collected from sixty participants: 30 with possible traumatic experiences and 30 who had never experienced this or other types of traumatic events. Six professional diagnosticians examined the participants with Structured Clinical Interview for the Study of Axis I Disorders (SCID-I for DSM-IV-TR) in conditions similar to those typical of judicial cases related to traffic accident damage claims. There was no significant difference in the number of PTSD diagnoses between malingerers and non-malingerers. Some PTSD symptoms were more frequently recognized in malingerers. This study demonstrates that even professional diagnosticians with clinical and jurisprudence experience have significant difficulty identifying PTSD malingering. This difficulty can be linked to the limitations of diagnoses based on introspective reports.

[Injury severity and injury patterns in older participants in road traffic]

Older people are or remain increasingly mobile for longer and participate in road traffic as car drivers or passengers, cyclists, and pedestrians. Regardless of their role in causing accidents, they are more likely to be seriously injured due to their higher vulnerability. If they are involved in an accident they suffer increasingly more from severe injuries, which consequently leads to longer hospitalization times. These aspects are even more applicable for persons aged 75 years or more than for persons aged 65-74 years. From a German in-depth accident study (GIDAS) analysis of the individual injuries of different types of road users, the most frequently severely injured body regions as well as the leading injuries can be derived. Primarily head and thorax injuries are of importance and secondarily also injuries to the lower extremities (especially for cyclists and pedestrians). The majority of the presented results confirm findings from comparable studies; however, this study was conducted for the first time on the basis of the abbreviated injury scale (AIS) 2015 and some individual injuries (especially commotio cerebri, which dominates in almost all age and road user groups) were upgraded from AIS1 to AIS2 in the latest AIS revision. As a result, the current results partly show significant increases in injury severity, especially for the head, compared to earlier studies based on the AIS 2008.

Exploring the perspectives of key stakeholders in returning to work after minor to serious road traffic injuries: a qualitative study

PURPOSE

This qualitative study conducted in Queensland, Australia aimed to explore various stakeholders' perspectives on (1) the barriers and facilitators of Return to Work (RTW) for injured persons following minor to serious Road Traffic Injuries (RTI) in a fault-based scheme, and to investigate the changes needed to better support RTW following RTI.

METHODS

The study was performed using the Interpretive Description methodological approach. Data were collected during interviews (n = 17), one focus group (n = 4), and an open-ended survey (n = 10) with five categories of stakeholders: treating health providers, workplace representatives, legal representatives, rehabilitation advisors, and insurers. Participants were eligible to participate if they had at least one year of employment history in their respective profession in Queensland, Australia, and were experienced in assisting the RTW of people with RTI. Thematic analysis was used to analyse the data.

RESULTS

Seven themes were extracted reflecting the barriers and facilitators of RTW along with stakeholders' recommendations to address these barriers. These themes were: (1) knowledge is power; (2) stakeholder expertise; (3) early and appropriate treatment matters; (4) insurers could do better; (5) necessity of employers' support; (6) fix the disjointed system; (7) importance of individual factors pre- and post- injury. The main barriers identified were stakeholders' insufficient communication and knowledge on RTW process following RTI.

CONCLUSIONS

Individual and system barriers identified in this study suggest that RTW after RTI occurs in a complex system requiring the commitment of all stakeholders. This is particularly important for managing knowledge-related barriers by provision of high quality and easily accessible information about the RTW process, disability schemes, and the nature of RTI.

Statistical Analysis of Toxicological Data of Victims of Traffic Accidents in Galicia (Spain)

Driving under the influence of alcohol or drugs is a very common behavior in our environment and a serious problem for public health. On the one hand, in 2016, 400,000 people died in the world in traffic accidents in which ethanol was involved. On the other hand, traffic accidents in which the use of drugs of abuse other than ethyl alcohol accounted for more than 160,000 deaths worldwide in 2017. The objective of this work is to carry out a review of the 710 cases of people who died in traffic accidents received at the forensic toxicology service of the Institute of Forensic Sciences of the University of Santiago de Compostela (Galicia-Spain) over a period of 10 years (2009-2019). We performed an observational study of period prevalence, in which the following data were collected: age, sex, year, and analytical results in plasma, in the case of being positive. The data collected was subjected to statistical treatment. Of the 710 cases analyzed, 123 correspond to pedestrians and 587 to occupants of vehicles or motorcycles. A total of 77.6% of the deceased were men. At least one psychotropic substance was found in the blood of almost 40% of the victims. The most frequently found substance was ethyl alcohol, which appeared in 231 cases, more frequently in males. The second place is occupied by benzodiazepines, which appeared in 43 cases, followed by cocaine, which was detected in 25 cases. Polydrug use was found in only 44 cases, with the association of ethanol and cocaine being the most commonly found, followed by that of ethanol and benzodiazepines. Only in 5 of the cases analyzed there were 3 or more substances present. With the data obtained in this study, it is shown that in traffic accidents, the finding of different toxic or medicinal substances is frequent. Ethyl alcohol continues to be very present in road accidents (most detected substance), with the great impact that this implies. Secondly, the presence of benzodiazepines stands out, and cocaine is the third most detected toxic in this study. These results allow to obtain a profile of the substances most frequently involved in traffic accidents. Despite the surveillance, control, and information campaigns that the Spanish Government regularly carries out, the results are far from satisfactory.

Differences in perception of safety in driving environment according to shared PMD user experience through multi-criteria analysis

A shared personal mobility device (PMD) is a transportation model that rents personal transportation devices, such as bicycles and kickboards, through a sharing platform. The use of shared PMD has increased, but related complaints and traffic accidents are doubling with it every year. This study applied an analytic network process (ANP) methodology for the multi-criteria analysis. A survey including normal citizens was conducted to evaluate the importance of safety regarding shared PMD experience. The evaluation factors differ according to the experience of using the shared PMD device, although 'driving continuity' and 'separation of sidewalks and roadways' were the most important. PMD users gave greater priority to 'removal of the road gap', 'traffic safety signs', 'dedicated parking area' and 'management of obstacles' compared to non-users. On the other hand, for non-PMD users, 'bicycle lane width', 'strengthening enforcement', and 'user safety education' were more important. The results showed that importance differed depending on the participant's experience of using a shared PMD or the lack of it. In the case of users, factors that have a direct effect on driving were prioritised, and in the case of non-users, auxiliary operations and management, such as crackdowns and education, were prioritised.

Ambient temperature and risk of motor vehicle crashes: A countrywide analysis in Spain

BACKGROUND

Some studies have documented that cold or hot ambient temperatures increase the risk of motor vehicle crashes. However, the number of existing studies is still limited, especially for the effects of cold.

OBJECTIVES

To estimate the relationship between ambient temperatures and risk of motor vehicle crashes in Spain, and to estimate the same association when restricting to those crashes with driver performance-associated factors (namely distraction, fatigue, sleepiness or disease).

METHODS

We used data for the period 1993-2013. We conducted a time series analysis controlling for seasonality and trends and using the distributed lag nonlinear model framework to estimate nonlinear and delayed effects of up to 7 days. Analyses were conducted at the province level and combined using multivariate meta-analysis.

RESULTS

The study included 1,908,460 motor vehicle crashes, 37% of them with associated driver performance factors. The overall analysis showed that the risk of crashes increased almost linearly with temperature. The estimates of the cumulative effect of lags 0-7 when comparing the 99th percentile and the first percentile of temperature produced a relative risk (RR) of 1.15 (95% confidence interval (CI): 1.11, 1.20). The estimates were slightly higher when analyses were restricted to crashes with driver performance-associated factors (RR: 1.23, 95% CI: 1.17, 1.30). In some provinces that reached temperatures below 0 °C, an increased risk with cold temperatures was also observed. An added effect of both cold spell and heat wave periods was found only in the analysis of crashes with driver performance-associated factors (cold spells, RR: 1.029, 95% CI: 1.005, 1.053; heat waves, RR: 1.020, 95% CI: 1.002, 1.039).

CONCLUSIONS

The increase of temperature increased the risk of motor vehicle crashes in Spain. Measures aimed at reducing the influence of heat on the risk of motor vehicle crashes can have important benefits for public health.

Mapping the knowledge of traffic collision Reconstruction: A scientometric analysis in CiteSpace, VOSviewer, and SciMAT

Traffic collisions are incidents with high fatality rate which generate billions of US dollars of loss worldwide each year. Post-collision scene reconstruction, which involves knowledge of multiple disciplines, is an important approach to restore the traffic collision and infer the cause of it. This paper uses software CiteSpace, VOSviewer, and SciMAT to conduct a visualization study of knowledge mapping on the literature of traffic collision scene reconstruction from 2001 to 2021 based on the Web of Science database. Knowledge mapping is a cutting-edge research method in scientometric, which has been widely applied in medicine and informatics. Compared with traditional literature review, knowledge mapping with visual techniques identifies hot keywords and key literature in the field more scientifically, and displays them in schematic diagrams intuitively which allows to further predict potential hotspots. A total of 803 original papers are retrieved to analyze and discuss the evolution of the field in the past 20 years, from macro to micro, in term of background information, popular themes, and knowledge structure. Results indicate the number of publications in this field is limited, and collaborations among authors and among institutions are insufficient. In the meantime, mappings imply the top three hot themes being scene reconstruction, computer technology, and injuries. The introduction of AI related technologies, such as neural networks and genetic algorithms, into collision reconstruction would be a potential research direction.

The effect of the COVID-19 pandemic on forensic cases admitted to an emergency department

The COVID-19 disease has given rise to various negative effects on human life in terms of health and economic and social well-being. We believe that these negative effects may have led to increased forensic incidents such as violence and suicide. Therefore, in this study, we sought to examine the effects of COVID-19 in forensic cases admitted to an emergency department. Methods: This is a retrospective observational study, performed at the emergency department of Fatih Sultan Mehmet Education and Research Hospital. Forensic cases admitted between March and June 2020 (pandemic period) and forensic cases admitted between March and June 2019 (pre-pandemic period) were compared in the study. Results: A total of 4296 patients were included in the study, of which 3011 were admitted during the pre-pandemic period and 1285 during the time of the COVID-19 pandemic. While the percentages of suicide attempts (3.6%), motorcycle traffic accidents (7.4%), and violent incidents (29.4%) were higher during the pandemic period, the percentages of in-vehicle traffic accidents (5.4%) and pedestrian traffic accidents (2.2%) were lower (respectively, p = 0.035, p = 0.005, p < 0.001, p = 0.015, p = 0.008). At the time of the pandemic, the percentages of incidents of violence against women (44.2%) and traffic accidents with a motorcycle involving men (9.3%) were higher than during the time before the pandemic (p < 0.001 and p < 0.001, respectively). Conclusions: The effects of the pandemic on our lifestyle are indisputable. This study reveals that the pandemic also affected patients who were admitted to the emergency department for forensic reasons. In addition, the increase in the percentages of suicide and violent events indicates that pandemics probably increase feelings of fear, loss, and hopelessness, and special precautions should be taken to maintain order in the society.

Spatial influence of engineering construction on traffic accidents, a case study of Jinan

Due to urban construction, engineering transport vehicles are gradually increased on roads, which might speed up traffic accident risks. To investigate the influence of urban construction on traffic accidents, this paper adopted 1977 traffic accidents of engineering transport vehicles and 220 engineering construction projects for correlation analysis. First, considering three degrees (Major, Ordinary and Minor) of accidents, the spatial autocorrelation test of engineering transport vehicle accidents is carried out by using spatial econometric. Then to further evaluate and analyze the spatial regression model, the optimal model is selected to analyze the spatial influence of the floor area of different types of engineering construction projects on the accidents of engineering transport vehicles. The results show that the accident of engineering transport vehicles itself is spatially dependent, that is, the higher the severity of the accident, the more concentrated it is in space, and there is a significant spatial positive correlation with engineering construction projects. And the floor areas of synthetic land, residential land, commercial land and land for roads and transportation facilities have significant spatial effects on engineering transport vehicle accidents, and the indirect effects are also concerned. The increase of floor area of roads and transportation facilities is more likely to induce accidents of engineering transport vehicles. For every 10,000 square meters of the floor area of roads and transportation facilities, there are 12.66 accidents of engineering transport vehicles in the region and its neighboring areas.

Type 2 diabetes mellitus increases the severity of non-fatal injuries, but not the risk of fatal injuries, among driver victims of motor vehicle crashes in Taiwan

OBJECTIVES

Limited information is available on whether diabetes increases the severity of injuries from motor vehicle crashes (MVCs). This study aimed to investigate the association of type 2 diabetes with injury severity among driver victims of MVCs.

METHODS

This cohort study involved 75,737 adult driver victims with type 2 diabetes from Taiwan's Police-Reported Traffic Accident Registry in 2015-2017, along with 150,911 sex-, age-, and calendar year-matched controls. The severity level of non- fatal injuries was derived from the International Classification of Diseases Programs for Injury Categorization based on the diagnostic codes of National Health Insurance claims within 3 days after an MVC. Information on fatal injuries within 3 days after an MVC was obtained from the Taiwan Death Registry. Logistic regression models were used to estimate the odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) of injury severity in association with type 2 diabetes.

RESULTS

After adjusting for potential confounders, driver victims with type 2 diabetes experienced significantly higher risks of mild and severe non-fatal injuries than their counterparts without diabetes, with covariate-adjusted ORs of 1.08 (95% CI, 1.05 to 1.11) and 1.28 (95% CI, 1.20 to 1.37), respectively. By contrast, the adjusted OR for fatal injuries was not significantly elevated, at 1.02 (95% CI, 0.89 to 1.18). Similar results were found when car and scooter driver victims were analyzed separately.

CONCLUSIONS

Type 2 diabetes was found to moderately increase the severity of non-fatal injuries from MVCs among car and scooter driver victims.

Analysis of road traffic injuries and casualties in China: a ten-year nationwide longitudinal study

Background

Road traffic injuries (RTIs) are a serious global problem, and a huge challenge for both economic development and public health.

Methods

This longitudinal study was based on the national data from Chinese authorities. Descriptive analysis was utilized to analyze the prevalence and trend of RTIs among different types, groups and regions. In addition, ridge regression or/and curve regression were also used to explore the relationship between those possible influencing factors and RTIs.

Results

From 2010 to 2019, the death toll from motor vehicle accidents (MVAs) decreased firstly and then increased, while the death toll from non-MVAs continued to rise since 2012, and the death toll from pedestrian and occupant accidents fluctuated only a little. The mortality rate of MVA was relatively stable from 2010 to 2012, and declined from 2013. The mortality rate of motor vehicle accidents was higher in rural than urban, the same to male compared with female. The results of ridge regression showed that gross domestic product (GDP)-per-capita, total population, number of health personnel and car ownership were positively correlated with the death toll of non-MVAs (P < 0.05). Additionally, the results of curve regression suggested that the quadratic or cubic relationship between each factor and the number of MVAs was well fitted, while only partially fitted in fatalities.

Conclusions

In recent years, RTIs in China show different trends, and the problem of non-motor vehicle traffic injuries has been neglected which should be paid more attention. Moreover, according to the new trends and traffic conditions in RTIs revealed in this study, it is necessary to formulate targeted intervention measures establish a multi-faceted comprehensive safety system to reduce the disease burden of RTIs as well as the total injuries.

A knowledge elicitation approach to traffic accident analysis in open data: comparing periods before and after the Covid-19 outbreak

Extracting knowledge from open data of traffic accidents has been attracting increasing attention to policymakers responsible for road safety. This article presents a knowledge elicitation approach to exploring the determinants of traffic accidents from open government data of an urban area in Taiwan. The collected open dataset contains 34 decisional attributes and one predictive attribute (i.e., type of injury, including head, breast, leg), and 47,974 cases. Prediction models using a classification-oriented mechanism and generated rules that considered datasets from before (B-dataset; 30,116 cases) and after (A-dataset; 17,868 cases) beginning to combat the Covid-19 pandemic in an urban area of Taiwan were compared. The findings showed that prediction accuracy was acceptable but not high, at 70.73% for B-dataset and 74.77% for A-dataset. Determinants in the human and vehicle categories revealed higher classification ranks than those in the temporal and environment categories. Traffic accidents involving motorcycles were 5.13% higher in A-dataset, whereas those involving cars were 4.11% lower. Injury on leg or foot was 3.46% higher in A-dataset, whereas other types of injury were up to 1.00% lower. The average support for rules in the A-dataset rule base and the simplicity of the A-dataset decision tree were higher than those of B-dataset. The research demonstrates the value of open government data in prediction model development and knowledge elicitation to support policymaking in the traffic safety domain.

Identification of contributing factors and hotspots of pedestrian-vehicle collisions in urban areas: An alternative hybrid method for small cities

OBJECTIVE

Traffic safety numbers in developing countries show a serious global problem that requires studies and actions to promote safety for the most vulnerable users, such as pedestrians, as a way of contributing to sustainable urban mobility. Therefore, this research proposes a hybrid method to identify contributing factors and critical points according to the profile of crashes involving pedestrians being run over by motor vehicles in small cities.

METHODS

The proposed method uses multivariate data analysis, specifically Exploratory Factor Analysis (EFA) and Cluster Analysis (CA), combined with geospatial tools. The study scenario corresponds to pedestrian-vehicle collisions that occurred in the urban area of Cachoeira do Sul, a small city in Rio Grande do Sul, Brazil, recorded in police reports between 2015 and 2018. Additionally, Geographic Information Tools (GIS) were used to collect characteristics of the road environment.

RESULTS

According to EFA, a set of attributes configured as contributing factors are discussed according to the components of the traffic system: user, road, vehicle, and environment. Subsequently, a CA was applied with the road-environmental factors, and three pedestrian-vehicle collision profiles were extracted, with clustering according to road segments with homogeneous characteristics. Moreover, a Kernel Density Estimate (KDE) was used to obtain heat maps of the pedestrian collisions profiles. The results allowed interventions to be proposed according to the contributing factors of each profile.

CONCLUSIONS

The multivariate statistical analysis supported the discussion of the factors contributing to the occurrence of pedestrian-vehicle collisions in small cities in developing countries. The spatial visualization of the results showed urban corridors with a high risk for pedestrians and the identification of hotspots in the city. In addition, the study demonstrated that the hybrid method tested is an alternative for the government of cities with few resources to promote safety mobility.

Real-World Crash Circumstances Among Newly Licensed Adolescent Drivers With and Without Attention-Deficit/Hyperactivity Disorder

PURPOSE

Adolescents with attention-deficit/hyperactivity disorder (ADHD) have 30%-40% higher crash rates. However, we still do not understand which factors underlie heightened crash risk and if crash circumstances differ for drivers with ADHD. We compared prevalences of crash responsibility, driver actions, and crash types among adolescent and young adult drivers with and without ADHD who crashed within 48 months of licensure.

METHODS

In this exploratory retrospective cohort study, we identified patients of Children's Hospital of Philadelphia's (CHOP) New Jersey (NJ) primary care locations who were born between 1987 and 2000, NJ residents, had their last CHOP visit ≥ age 12 years, and acquired a driver's license. We linked CHOP electronic health records to NJ's licensing and crash databases. ADHD diagnosis was based on International Classification of Diseases, Ninth Revision, Clinical Modification/International Classification of Diseases, Tenth Revision, Clinical Modification codes. Prevalence ratios were estimated using generalized estimating equation log-binomial regression.

RESULTS

We identified 934 drivers with ADHD in 1,308 crashes and 5,158 drivers without ADHD in 6,676 crashes. Within 48 months postlicensure, drivers with ADHD were more likely to be at fault for their crash (prevalence ratio: 1.09 [1.05-1.14]) and noted as inattentive (1.15 [1.07-1.23]). With the exception that drivers with ADHD were less likely to crash while making a left/U-turn, we did not find substantial differences in crash types by diagnosis. Analyses also suggest females with ADHD may have a higher risk of colliding with a nonmotor vehicle and crashing due to unsafe speed than females without ADHD.

DISCUSSION

The results suggest crash circumstances do not widely differ for drivers with and without ADHD but highlight several factors that may be particularly challenging for young drivers with ADHD.

Traumatic brain injury in the new millennium: new population and new management

INTRODUCTION

Traumatic brain injury (TBI) is one of the leading causes of death and disability globally. We present a study describing epidemiological changes in severe TBI and the impact these changes have had on management and analysing alternatives that may improve outcomes in this new population.

MATERIALS AND METHODS

We performed a retrospective, descriptive, cross-sectional analysis of patients presenting severe TBI at our hospital in the period of 1992-1996 and 2009-2013. We analysed demographic data, including age, sex, mortality, aetiology, anticoagulation, treatment, and functional outcome.

RESULTS

We reviewed data from 220 patients. In the second cohort, there were 40% fewer patients, mean age was 12 years older, patients were more frequently receiving anticoagulation therapy, and the percentage of interventions was halved. Aetiology varied, with traffic accidents being the main cause in the first group, and accidental falls and being hit by cars in the second group. There were no intergroup differences for mortality or functional outcomes.

CONCLUSION

The age of patients admitted due to severe TBI has increased. As a result of this, the main cause of severe TBI in our population is accidental falls in elderly, anticoagulated patients. Despite the low-energy nature of trauma, patients in the second cohort presented a poorer baseline status, and were less frequently eligible for surgery, with no improvement in mortality or functional outcomes.

Analysis of risk factors affecting traffic accident injury in United Arab Emirates (UAE)

The mortality and severe injuries due to traffic accidents in United Arab Emirates (UAE) are hastening the necessity for a study that can identify the consequential risk factors. This study was conducted by utilizing a 5740 traffic accidents police reports that occurred in Abu Dhabi, UAE between 2008 and 2013. A multinomial logit regression model was applied to determine the significant factors among the 14 potential risk factors that were used in this study. The dependent variable was the level of injury that consisted of four categories: slight injury, medium injury, severe injury, and fatal injury. The results showed that pedestrian, the unutilized seatbelt, roads that had four or more than four lanes, male casualty, 100 km/h speed limit or higher, and casualty older than 60 years were found to be the factors that can increase the probability of being involved in a fatal traffic accident. In contrast, rear-end collisions and intersections had a lower probability of causing fatal injury. Then, the eight significant predictors were included in a neural network to compare the performance of both methods and to identify the normalized importance values for the significant independent variables. The neural network had proven to be more accurate in general than the traditional regression models such as the multinomial logit model.

Traumatic brain injury in the new millennium: A new population and new management

INTRODUCTION

Traumatic brain injury (TBI) is one of the leading causes of death and disability globally. We present a study describing epidemiological changes in severe TBI and the impact these changes have had on management and analysing alternatives that may improve outcomes in this new population.

MATERIALS AND METHODS

We performed a retrospective, descriptive, cross-sectional analysis of patients presenting severe TBI at our hospital in the period of 1992-1996 and 2009-2013. We analysed demographic data, including age, sex, mortality, aetiology, anticoagulation, treatment, and functional outcome.

RESULTS

We reviewed data from 220 patients. In the second cohort, there were 40% fewer patients, mean age was 12years older, patients were more frequently receiving anticoagulation therapy, and the percentage of interventions was halved. Aetiology varied, with traffic accidents being the main cause in the first group, and accidental falls and being hit by cars in the second group. There were no intergroup differences for mortality or functional outcomes.

CONCLUSION

The age of patients admitted due to severe TBI has increased. As a result of this, the main cause of severe TBI in our population is accidental falls in elderly, anticoagulated patients. Despite the low-energy nature of trauma, patients in the second cohort presented a poorer baseline status, and were less frequently eligible for surgery, with no improvement in mortality or functional outcomes.

Association of benzodiazepines, Z-drugs, pregabalin, and melatonin with traffic accidents: A nationwide cohort and case-crossover study in Danish adults

BACKGROUND

Benzodiazepines, Z-drugs, pregabalin, and melatonin (BZPMs) have been associated with a higher risk of traffic accidents, but the evidence is inconsistent, and lacking for newer drugs.

AIM

To examine the association of BZPMs with risk of traffic accidents.

METHODS

All Danish adults (n = 3,823,588) were followed for redeemed prescriptions of BZPM and for incident traffic accidents registered in Danish registers from 2002 through 2018. Associations were examined in cohort and case-crossover designs using Cox proportional hazard and conditional logistic regression with adjustment for co-variables.

RESULTS

A total of 19.3% (n = 738,019) of all participants initiated treatment with BZPMs. During the mean follow-up of 10.3 years, 595,173(15.5%) of participants were involved in a traffic accident. In the cohort analysis, all BZPMs besides pregabalin were associated with a higher risk of traffic accidents in adults below 70 years, with chlordiazepoxide showing the strongest association (hazard ratio (HR)_{age 18-49} = 1.76, 95% confidence interval (CI): 1.67-1.86 and HR_{age 50-69} = 1.84, 95% CI: 1.70-2.00). In the older age groups, the specific BZPM medications were associated with lower or no risk of traffic accidents. However, in case-time-crossover analysis with inherited control for confounders, no BZPM medication was positively associated with traffic accidents, except for chlordiazepoxide, which had a higher odds ratio in middle-aged group (1.62, 95% CI: 1.15-2.29).

CONCLUSIONS

This study does not fully support that BZPM use is a risk factor for traffic accidents. However, a positive association was found for chlordiazepoxide, which is approved for treatment of acute alcohol withdrawal.

Road traffic injuries and substance use in Latin America: A systematic review

OBJECTIVE

The aim of the study is to identify and report the epidemiological patterns of substance use on fatal and non-fatal road traffic injuries (RTIs) in Latin America.

METHODS

A systematic review identified all published studies from January 2010 through October 2020. Twenty-eight studies were included from PubMed and SciELO databases. The Newcastle-Ottawa scale was used to assess the methodological quality of the studies.

RESULTS

The prevalence of alcohol consumption in fatal RTIs in studies where 100% of the target population were tested varies from 15.3% up to 55% in Brazil; with respect to non-fatal RTIs, it varies from 9.1% in car drivers in Brazil to 24.1% in emergency patients in Argentina. The most studied drug other than alcohol was cannabis, present in 6.5% up to 20.8% of non-fatal RTIs cases, but lower rates of testing for drugs was reported. Few studies reported epidemiological association measures.

CONCLUSIONS

This article shows that scientific production on substance use and RTIs in the region is limited and reports the prevalence of substance use, with few estimates of the relative risk of drug use and RTIs.

Barriers and Facilitators Associated with Return to Work Following Minor to Serious Road Traffic Musculoskeletal Injuries: A Systematic Review

Purpose To identify factors impeding or facilitating Return to Work (RTW) after minor to serious musculoskeletal Road Traffic Injuries (RTI). Methods Six electronic databases were searched for studies published 1997-2020. Quantitative and qualitative studies were included if they investigated barriers or facilitators associated with RTW in people with minor to serious musculoskeletal RTI aged over 16 years. Methodological quality was assessed using McMaster Critical Review Form for Quantitative studies and McMaster Critical Review Form for Qualitative Studies. Results are presented narratively as meta-analysis was not possible. Results Eleven studies (10 quantitative and 1 qualitative) were included. There was strong evidence that individuals with higher overall scores on the (short-form or long-form) Örebro Musculoskeletal Pain Questionnaire (ÖMPQ) at baseline were less likely to RTW, and individuals with higher RTW expectancies at baseline were more likely to RTW after musculoskeletal RTI. There was weak evidence for higher disability levels and psychiatric history impeding RTW after musculoskeletal RTI. Conclusions Post-injury scores on the ÖMPQ and RTW expectancies are the most influential factors for RTW after minor to serious musculoskeletal RTI. There is a need to identify consistent measures of RTW to facilitate comparisons between studies.

The hidden aspect of carotid lesions in traffic accidents: A little-known phenomenon

Vascular injuries that occur during traffic accidents are a commonly neglected aspect that can add more detail to the framework of a case. In this study, we analysed a case series of 150 traffic accidents, 39 of which were marked by microscopically identifiable vascular lesions. The purpose was to identify the presence of carotid injuries in individuals who died due to traffic accidents and had nonpenetrating trauma of the neck. We focused on the discrepancies regarding the macroscopical aspect and the histology and demonstrated how histological analysis of the carotids in cases of trauma can reveal injuries that are attributable to the trauma itself. We conducted a histological analysis of the lesions to describe their distribution and type and investigate potential correlations. The study offers insight on how to examine road accidents that involve traumatic injury of the carotid arteries. Indeed the main task of the forensic pathologist in the case of death is to establish the existence of a causal relationship between the micro- or macroscopic alterations observed in the autopsy and the traumatic event that led to the death of the subject. Thus, further morphological elements were provided to the forensic practitioners that may reveal injuries attributable to the trauma itself and should be evaluated in cases of trauma in traffic accidents.

Epidemiological Review of Spinal Cord Injury due to Road Traffic Accidents in Latin America

Spinal cord injury (SCI) is a disease that affects the normal function of the spinal cord. Road traffic accidents (RTAs) represent the main cause of SCI worldwide. SCI may generate physical disability and economic dependency, which is especially significant in low- and middle-income countries such as most of the Latin American countries. The main objective of this study was to present an epidemiological review of SCI secondary to RTAs. Stronger evidence on this condition in Latin America is important for future-specific data collection and prevention strategies. A literature review was carried out using specific search strategies in databases of indexed journals from the period 2000 to 2019. Data on SCI secondary to RTAs in the Latin American region were collected and analyzed. After initial screening and removal of duplicates, 16 articles met the inclusion criteria and were chosen for analysis. Data from 7 Latin American countries were retrievable. On average, RTAs were responsible for 40.81% of SCI. Data from different studies are heterogeneous. Car accidents and moto accidents were equally responsible for SCIs (50.61% vs. 49.06%). The thoracic segments were the most commonly affected (57.87%). Males in their 30s were the most affected category (76.6%). SCI due to RTAs may represent a severe but preventable condition that affects mostly men in their productive age, generating important social and economic issues. Data about this condition in Latin America are scarce, and could limit prevention and treatment strategies. Prospective data collection about this condition is recommended.

Prenatal cannabis use disorder and future risk of road traffic injuries in Canadian children

The extent to which child traffic injuries may be attributed to parents who use cannabis before driving is unknown. We investigated whether prenatal cannabis use disorders may predict future road traffic injuries in children. We conducted a cohort study of 792,082 children in Quebec, Canada with 6,280,663 years of follow-up between 2006 and 2019. The main exposure measure was maternal cannabis use disorder before or during pregnancy. The main outcome measure was future hospitalizations for transport-related injuries in children after birth. Using Cox proportional hazards regression models adjusted for potential confounders, we estimated hazard ratios and 95% confidence intervals (CI) for the association of prenatal cannabis use disorders with transport-related injuries in children. Maternal cannabis use disorders before birth were associated with 5.64 times the risk of hospitalization for future motor vehicle crash injuries in children (95% CI 2.61-12.21). The risk increased with the child's age. Prenatal cocaine, opioid, and other drug use disorders were not associated with pediatric transport-related injuries. Maternal cannabis use disorders before birth may be an early predictor of childhood injuries from motor vehicle crashes.

Effects of stricter drunk-driving laws on alcohol-related road traffic death, injury, and crash rates in South Korea: A synthetic counterfactual approach using Bayesian structural time-series models

In December 2018, new drunk-driving laws were enacted in Korea to impose stricter penalties and standards for driving under the influence of alcohol. This study aimed to estimate the effects of stricter drunk-driving laws on alcohol-related road traffic death, injury, and crash rates in Korea. Using police-reported traffic accident data and registered vehicle data from 2013 to 2020, monthly road traffic outcome rates were calculated: the response series involved alcohol-related rates and the non-equivalent control series involved total and non-alcohol-related rates. Based on a controlled interrupted time-series design using Bayesian structural time-series models, effects of the laws on alcohol-related road traffic outcome rates were evaluated. After implementation of these laws, the alcohol-related road traffic crash rate decreased by 14.3% (95% credible interval [CrI] -26.8% to -1.9%), alcohol-related road traffic injury rate by 17.6% (95% CrI -31.6% to -3.8%), and alcohol-related minor road traffic injury rate by 20.2% (95% CrI -32.4% to -7.7%). Alcohol-related road traffic death and severe injury rates also decreased more than the declining trends in the pre-period, but reduced non-significantly by 15.0% (95% CrI -47.2% to 17.3%) and 9.9% (95% CrI -33.9% to 14.5%), respectively. The mixed effectiveness of Korea's new drunk-driving laws on alcohol-related road traffic outcomes suggests that additional strategies are necessary to consistently and effectively reduce alcohol-related road traffic outcomes. More research is needed on ways to enhance the effectiveness of drunk-driving laws.

The effects of road safety education on the occurrence of motorcycle violations and accidents for novice riders: An analysis of population-based data

The prevalence of motorcycle riding among novice riders in most Southeast Asia countries presents an alarming rate of traffic violations and fatal accidents. Since 2013, Taiwan's government has gradually required a road safety class (RSC) for the rider's licensing process. The RSC consisted of watching videotapes of motorcycle-involved crashes followed by lectures on safety measures. Our study tried to see whether a compulsory RSC could lower the likelihood and frequency of road accidents and traffic violations among novice riders. To avoid self-selection bias, we selected 480,114 novice riders aged 18-20 years, licensed one year before starting the trial period and one year after full implementation of RSC. Using the 2012-2018 data from the Taiwan Ministry of Transportation and Communication (MOTC), we applied the logistic model to evaluate RSC effects on the risk of violations and accidents. Then, we used the negative binomial regression to model their frequency in response to RSC exposure. Following the novice drivers 1-3 years after licensing, our results showed that the RSC has a short-term effect in lowering their traffic violations' likelihood by 12%∼17% and their frequency by 11%; however, the RSC effects only last two years in reducing the counts of motorcycle-involved offenses and accidents. The RSC reduction effect was lower for the tendency of accidents than the violations, probably because committing traffic violations was self-determined; in contrast, the collision occurrence was more or less related to the riders' own or other road users' carelessness. The RSC could be more effective if a certification test for road safety education were required or if a penalty is imposed on distracted learners during the training.

The effect of the presence or absence of skull fractures on intracranial lesion development in road traffic accidents

OBJECTIVE

The aim of this study was to investigate the effect of the presence or absence of skull fractures on the development of intracranial lesions in cases of head trauma associated with traffic accidents.

MATERIALS AND METHODS

A retrospective review was made of the medico-legal reports of 774 cases with injuries sustained in a traffic accident and which applied for expert examination as forensic cases at the Department of Forensic Medicine of our University between 1 January 2014 and 31 December 2019. A total of 162 cases (20.1%) were identified which were radiologically diagnosed with at least one skull fracture or intracranial lesion. These cases were evaluated in terms of age, gender, type of accident, and localization of skull fractures and/or intracranial lesions, and they were compared statistically to determine whether the presence or absence of skull fractures affected the development of intracranial lesions.

RESULTS

The 162 cases evaluated comprised 120 males and 42 females with a mean age of 25.1 ± 16.4 years. Intracranial lesions were accompanied by skull fractures in 77 cases, skull fracture alone was determined in 18 cases, and intracranial lesion alone in 67 cases. Skull fractures were mostly (64.5%) seen in the 1-20 years age group, and the intracranial lesions (90%) were mostly seen in the ≥41 years age group. Linear and diastatic fracture rates were highest in the temporal and frontal regions. The intracranial lesion/case ratio was 1.5/1 in cases without skull fracture, and 1.2/1 in cases with skull fracture.

CONCLUSION

The results of this study showed that the rate of linear or diastatic fractures was higher in females, which was associated with skull thickness. Skull fractures were found to occur most between the ages of 1 and 20 years, and the presence of skull fractures was determined to reduce the incidence of intracranial lesions by decreasing intracranial pressure.