Motor vehicle crash injury patterns and the Virginia seat belt law

Injuries to front seat occupants in tow-away crashes in the Charlottesville, Va, area were compared for 1 year before and 1 year after Virginia's seat belt use law took effect. Vehicle and occupant data were combined to examine crash and injury patterns. Reported seat belt use in crashes increased after the law, and there were substantial decreases in injuries. Front seat occupants were less likely to receive medical treatment following a crash in the postlaw period. The reduction in the number of injuries was greater for passengers in the right front seat than for drivers and for frontal crashes than for other types of crashes. The injury reduction effects occurred primarily through reductions in the number of head and face injuries, particularly those that occur from contact with windshields and instrument panels.     

Injuries associated with three-wheeled, all-terrain vehicles, Alaska, 1983 and 1984

From January 1983 through December 1984, twenty deaths and at least 534 injuries in Alaska were associated with three-wheeled, all-terrain vehicles. Age at death ranged from 12 to 53 years; 15 deaths (75%) were in the 15- to 34-year age group. Of the 20 fatalities, 12 (60%) might have been prevented had the riders been wearing a helmet. Alcohol use was detected or highly suspected as the major contributing cause of the fatal crash for 12 of 15 drivers and three of five female passengers. Potential risk factors for injuries associated with all-terrain vehicles include alcohol use, failure to use helmets, rider inexperience and inattention, and excessive speed.     

Effect of seat belts on injuries to front and rear seat passengers

Data on 2520 occupants of cars involved in accidents were analysed in relation to injury and the severity of the crash to investigate the effect of rear seat passengers on injury to restrained and unrestrained front seat occupants and vice versa. Unrestrained front seat occupants showed a higher incidence of serious injury when there were rear seat passengers. The presence of a rear seat passenger did not affect significantly the overall incidence of injury among restrained front seat occupants within the range of crash severity considered. Unrestrained rear seat passengers behind unrestrained front seat occupants showed a higher incidence of moderate injury and a lower incidence of no injury than those behind restrained front seat occupants. It is concluded that legislation on seat belts has not greatly increased the risk of person to person injury.     

Severity of injuries in road crashes. A comparison of injured occupants of forward control vehicles and conventional passenger cars

Light vans are being used increasingly as substitutes for conventional passenger cars in Australia. These "forward control" vans are not required to meet the same safety standards as passenger cars. A study group of 258 injured occupants of light vans was identified from the records of the Motor Accidents Board of Victoria. A comparison group of 3468 injured occupants of conventional cars was also identified. Both groups had been injured in accidents occurring in Victoria between 1980 and 1983. The injuries received by the van occupants were compared with those received by the car occupants. Van occupants injured in frontal crashes were more likely to have sustained leg injury, and were more likely to have sustained serious injury than were car occupants who were injured in frontal crashes. Forward control vans were found to lack protection for occupants in frontal crashes.     

Bicycle accidents in childhood

The results of a 10 year study of bicycle fatalities and an eight year study of serious non-fatalities are reported for urban Brisbane (population 1,000,000). There were 845 serious non-fatal bicycle accidents and 46 fatalities during the study. Boys were involved in 86% of accidents. Boys have an accident rate of 134.21 per 100,000 population at risk and a fatality rate of 5.06 per 100,000 at risk. Serious bicycle accidents have increased by 50% in this decade; but considering fatal cases alone, no secular trend was evident over the 10 year period of the study. This suggests that an increase in the overall rate of bicycle accidents has been in part compensated by less serious injuries. In 70% of fatalities children had head injuries, and 87% of fatalities followed a collision between a cyclist and a motor vehicle or a train. Bicycle accidents on the roads most commonly occur to boys aged between 12 and 14 years on a straight road at "mid-block" between 3 and 5 pm in clear weather conditions and in daylight. It is concluded that injuries and fatalities after bicycle accidents can be reduced by protecting children's heads, separating child cyclists from other road traffic, or educating and training both cyclists and other road users in safe behaviour. The compulsory use of helmets and the restriction of access to the roads by child cyclists to reduce injuries are, however, still controversial in many areas.     

The effects of mandatory seat belt wearing on the mortality and pattern of injury of car occupants involved in motor vehicle crashes in Victoria.

Compulsory seat belt wearing, first introduced in the world in Victoria in 1970, has effectively reduced the number of deaths and injuries for car occupants involved in motor vehicle crashes, whilst those for the unprotected pedestrian and pedal and motor cyclist have continued to increase. This legislation does not apply to children under the age of eight years, only 5.5% of whom travel restrained in motor cars, and their death and injury patterns remain unchanged. Seat belts offer the most remarkable protection for car occupants involved in frontal-impact collisions. However, a high percentage of car occupants who are the recipients of a side impact in a collision receive serious multiple injuries, particularly chest and pelvic injuries, and seat belts offer little protection except that head injuries are less common when a seat belt is being worn. Compulsory lateral strengthening of motor vehicles must be introduced in Australia. Ten per cent of car occupants admitted to hospital after frontal-impact collisions show injuries directly attributable to the wearing of seat belts. These include fracture of the clavicle, bruising and fracture of the sternum, cardiac tamponade, abdominal contusions and bowel lacerations. Seat belts, to be fully effective, must be fitted correctly. There is definite room for improvement in seat belt design.     

Elderly licensure laws and motor vehicle fatalities

Context  Little is known about how state-level driver licensure laws, such as in-person renewal, vision tests, road tests, and the frequency of license renewal relate to the older driver traffic fatality rate. Objective  To determine whether state driver's license renewal policies are associated with the fatality rate among elderly drivers. Design, Setting, and Population  Retrospective, longitudinal study conducted January 1990 through December 2000 of all fatal crashes in the contiguous United States identified in the Fatality Analysis Reporting System, which involved either an older (ages 65-74 years, 75-84 years, and 85 years) or middle-aged (ages 25-64 years) driver. Two regression approaches were used to study the effect of state laws mandating in-person renewal, vision tests, road tests, and frequency of license renewal on driver fatalities, controlling for state-level factors including the number of licensed elderly drivers, primary and secondary seatbelt laws, maximum speed limit laws, blood alcohol level of 0.08, and administrative license revocation drinking and driving laws, per capita income, and unemployment rate. The first regression approach examined only elderly driver fatalities and the second approach examined daytime elderly driver fatalities and used daytime fatalities among middle-aged drivers as a general control for unobserved variation across states and over time. Main Outcome Measures  Older driver fatalities and older and middle-aged daytime driver fatalities. Results  Among individuals aged 85 years or older, there were a total of 4605 driver fatalities and 4179 daytime driver fatalities during the study period. For this age cohort, after controlling for middle-aged daytime driver deaths, states with in-person license renewal were associated with a lower driver fatality rate (incident rate ratio [RR], 0.83; 95% confidence interval [CI], 0.72-0.96). This was the only policy related to older drivers that was significantly associated with a lower fatality risk across both regression models. Thus, state-mandated vision tests, road tests, more frequent license renewal, and in-person renewal (for individuals aged 65-74 years and 75-84 years) were not found to be independently associated with the fatality rate among older drivers in the 2 models. Conclusions  In-person license renewal was related to a significantly lower fatality rate among the oldest old drivers. More stringent state licensure policies such as vision tests, road tests, and more frequent license renewal cycles were not independently associated with additional benefits.      

Prevalence of recent cocaine use among motor vehicle fatalities in New York City

We determined the prevalence of recent cocaine and alcohol use among motor vehicle fatalities occurring in New York, NY, from 1984 through 1987. Recent cocaine use was detected at autopsy in 18.2% of the sample and no significant difference between drivers (20.0%) and passengers (13.9%) was found. Both alcohol and cocaine metabolites were found in 10.0% of cases tested. The prevalence of cocaine metabolites or alcohol detected in driver fatalities aged 16 through 45 years did not change significantly when the period prior to the widespread availability of "crack" cocaine (1984 through 1985) was compared with the period immediately following the introduction of crack cocaine (1986 through 1987). Additional studies are needed both to elucidate the association between cocaine use and these fatalities and to determine the value of screening persons seriously injured in traffic accidents in areas where such drug use is endemic.     

Contribution of alcohol to deaths in road traffic accidents in Tayside 1982-6

In Britain the precise number and relative proportions of deaths among drivers, passengers, and pedestrians in road traffic accidents related to alcohol are not known. These data were obtained in Tayside by cross matching police accident records with blood alcohol concentrations at necropsy. Of 71 alcohol-related deaths 30 were the drivers (or motorcyclists) themselves, nine were their passengers, 23 were pedestrians with raised blood alcohol concentrations, and nine were innocent victims. The high blood alcohol concentrations of the intoxicated drivers, passengers, and pedestrians, which may point to alcoholism, suggest that publicity campaigns will be of little value in reducing the number of deaths in road traffic accidents related to alcohol. The time at which these accidents occurred was related to licensing hours and this should be taken into account when considering changes in licensing laws.     

Natural deaths while driving: would screening for risk be ethically justified?

OBJECTIVES: To determine the epidemiology and the underlying pathological conditions of natural deaths among motor vehicle drivers. Sudden death while driving may cause damage to properties, other vehicles or road users. Although the Medical Commission on Accident Prevention recommended restrictions to drivers at risk of sudden death due to their medical conditions, these restrictions are useless if they do not result in greater safety to the public. DESIGN: A retrospective study of natural deaths of motor vehicle drivers. SETTING: Natural deaths of motor vehicle drivers reported to the coroner for Birmingham and Solihull. SUBJECTS: 86 consecutive natural deaths of motor vehicle drivers in a five-year period between 1984 and 1988. RESULTS: Of the 86 fatalities reviewed, 80 (93%) sudden deaths were caused by ischaemic heart disease. Fifty vehicles were involved in collision with 32 properties, 20 other vehicles and six pedestrians. Fifty-one out of 80 cardiac deaths had past cardiac history and three had reported chest pain prior to the sudden death. CONCLUSION: An applied normative ethical assessment based on the basic moral principles of autonomy, justice, beneficence and non-maleficence are discussed. We conclude that medical screening of drivers has little benefit for the drivers or other persons.     

Drinking and recreational boating fatalities: a population-based case-control study.

CONTEXT: Alcohol is increasingly recognized as a factor in many boating fatalities, but the association between alcohol consumption and mortality among boaters has not been well quantified. OBJECTIVES: To determine the association of alcohol use with passengers' and operators' estimated relative risk (RR) of dying while boating. DESIGN, SETTING, AND PARTICIPANTS: Case-control study of recreational boating deaths among persons aged 18 years or older from 1990-1998 in Maryland and North Carolina (n = 221), compared with control interviews obtained from a multistage probability sample of boaters in each state from 1997-1999 (n = 3943). MAIN OUTCOME MEASURE: Estimated RR of fatality associated with different levels of blood alcohol concentration (BAC) among boaters. RESULTS: Compared with the referent of a BAC of 0, the estimated RR of death increased even with a BAC of 10 mg/dL (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.2-1.4). The OR was 52.4 (95% CI, 25.9-106.1) at a BAC of 250 mg/dL. The estimated RR associated with alcohol use was similar for passengers and operators and did not vary by boat type or whether the boat was moving or stationary. CONCLUSIONS: Drinking increases the RR of dying while boating, which becomes apparent at low levels of BAC and increases as BAC increases. Prevention efforts targeted only at those operating a boat are ignoring many boaters at high risk. Countermeasures that reduce drinking by all boat occupants are therefore more likely to effectively reduce boating fatalities.     

A study on the use of car occupant restraint in Selangor

A survey was conducted in December 1995 to study car occupant restraint usage in Selangor. A total of 1082 car occupants were observed in 536 cars. The results of the study shows that only 57.3% of the car occupants observed were protected by any form of restraints. Most of the cars (99.8%) examined had front seat belts but only 44.2% had rear seat belts. Only 0.6% of the cars were found to have child restraints in the cars. 80.2% of drivers used restraints and only 65.4% of front seat passengers used any forms of restraints. In the case of the rear seat passengers, only 0.42% used an available restraint. More people in the urban areas (84.42%) than in the rural areas (66.51%) used seat belts. Usage of seat belts by car drivers influenced the use of seat belts by front seat passengers. Type of seat belts fitted was associated with usage rate. It is sad to note that 21.9% of the drivers used seat belts incorrectly.     

2004-2015年中国高速公路与普通公路交通伤对比研究

目的 明确我国高速公路道路与普通公路交通事故在事故严重性、时间分布、道路环境、驾龄分布方面的差异.方法 采集2004-2015年高速公路和普通公路交通伤相关数据(除西藏和重庆外),包括事故起数、死亡人数、受伤人数、直接财产损失、24 h分布、驾龄分布和道路环境条件等.分析高速公路道路交通事故与普通公路的差异.定量资料采用描述性分析;高速公路与普通公路比较采用独立样本t检验;危险因素的危险程度大小采用相对危险度表示,差异性分析采用x2检验.结果 高速公路事故与普通公路相比,里程死亡率为4.51倍(P＜0.01),事故死亡率为2.21倍(P＜0.01),每起事故直接财产损失约为10倍(P＜0.01),交通伤伤死率为1.64倍(P＜0.01).高速公路交通事故发生死亡的危险性是普通公路交通事故的1.97倍(RR=1.97,95％ CI:1.96～1.99).24 h内的事故分布特点:高速公路呈双高峰特点(4:00-6:00和15:00-17:00),而普通公路8:00-24:00没有明显的高发时间段,两者时间分布差异具有统计学意义(P＜0.01).高速公路致死性事故多发生在晴朗天气和干燥路面,RR值分别为1.17(95％ CI:1.15 ～1.19)和1.23(95％ CI:1.21 ～ 1.26),与普通公路比较差异具有统计学意义(P=0.028).驾驶员驾龄＞10年导致高速公路致死性事故明显高于普通公路(P=0.043).结论 我国高速公路交通伤严重程度明显高于普通公路交通伤.高速公路交通事故更倾向于发生在凌晨、高龄驾驶员、环境条件较好的情况下.     

Driver casualties in Victoria (1978-1980). Predominant influences of driver inexperience and alcohol

The driving experience and blood alcohol profiles of motor vehicle driver casualties in Victoria for the period 1978-1980 were examined. Drivers with less than five years' experience were markedly over-represented among the casualties. There was a progressive and marked decline in the number of driver casualties between each of the first five years of driving experience. First-year probationary drivers had three times the casualty involvement of drivers with five years' experience. Probationary licensed drivers, who hold approximately 13% of licenses, accounted for 28% of driver casualties. Blood alcohol levels in excess of the legal limit of 11 mmol/L (0.05 g/100 mL) were more frequent in probationary drivers than in fully licensed drivers (30.4%, compared with 24.4% in fully licensed drivers). These findings, in conjunction with the known impairment of driving skills caused even by blood alcohol levels lower than the legal limit, lead us to recommend that legislation should be enacted making it an offence for probationary license holders to drive a motor vehicle after the ingestion of alcohol. In addition, educational programmes about high-risk accident situations and the alcohol problem on the road should be instituted as an integral part of training before a driving license is issued.     

Accident characteristics of injured motorcyclists in Malaysia

This study examines the accident characteristics of injured motorcyclists in Malaysia. The aim of this study is to identify the characteristics of motorcyclists who are at higher fatality risk and subsequently be the targeted group for the fatality-reduction countermeasures. A total of 412 motorcycle crash victims with serious or fatal injuries were analysed. The results showed that the injured motorcyclists were predominant young, novice riders of less than 3 years licensure and male. A fatal outcome was more likely to be associated with a larger engine capacity motorcycle, collision with a heavy vehicle, head on collision, and collision at a non-junction road. In contrast, a non-fatal outcome was more likely to be associated with a small engine capacity motorcycle, collision with another motorcycle or passenger car, junction accidents, and side or rear collisions.     

Carrying passengers as a risk factor for crashes fatal to 16- and 17-year-old drivers

Context  Injuries from motor vehicle crashes are the leading cause of death among teenagers. Carrying passengers has been identified as a possible risk factor for these crashes. Objective  To determine whether the presence of passengers is associated with an increased risk of crashes fatal to 16- and 17-year-old drivers and whether the risk varies by time of day and age and sex of drivers and passengers. Design and Setting  Incidence study of data from the Fatality Analysis Reporting System and General Estimates System (1992-1997), as well as the Nationwide Personal Transportation Survey (1995). Subjects  Drivers aged 16 and 17 years who drove passenger cars, vans, or pickup trucks. Main Outcome Measure  Driver deaths per 10 million trips by number of passengers, driver age and sex, and time of day; and driver deaths per 1000 crashes by passenger age and sex. Results  Compared with drivers of the same age without passengers, the relative risk of death per 10 million trips was 1.39 (95% confidence interval [CI], 1.24-1.55) for 16-year-old drivers with 1 passenger, 1.86 (95% CI, 1.56-2.20) for those with 2 passengers, and 2.82 (95% CI, 2.27-3.50) for those with 3 or more passengers. The relative risk of death was 1.48 (95% CI, 1.35-1.62) for 17-year-old drivers with 1 passenger, 2.58 (95% CI, 2.24-2.95) for those with 2 passengers, and 3.07 (95% CI, 2.50-3.77) for those with 3 or more passengers. The risk of death increased significantly for drivers transporting passengers irrespective of the time of day or sex of the driver, although male drivers were at greater risk. Driver deaths per 1000 crashes increased for 16- and 17-year-olds transporting male passengers or passengers younger than 30 years. Conclusion  Our data indicate that the risk of fatal injury for a 16- or 17-year-old driver increases with the number of passengers. This result supports inclusion of restrictions on carrying passengers in graduated licensing systems for young drivers.      

Trends in hospitalisation rates for road traffic injuries in child motor vehicle passengers in New South Wales, July 1998--June 2005

OBJECTIVE: To analyse changes in the incidence of injuries requiring hospitalisation for child passengers in motor vehicle crashes. DESIGN, SETTING AND PARTICIPANTS: Population-based study of children (aged 0 -15 years) residing in New South Wales and admitted to hospital for injuries resulting from a traffic crash in the period 1 July 1998 - 30 June 2005, identified from the NSW Inpatient Statistics Collection. MAIN OUTCOME MEASURES: Age-standardised rates of hospitalisation for injuries, and trends by inpatient demographics, severity of injuries, and injury sites and types. RESULTS: 2297 children were hospitalised for injuries sustained in a motor vehicle crash over the study period. The overall hospitalisation rate for injuries was relatively constant, with a non-significant decline of - 0.4% (95% CI, - 3.1% to 2.3%). The rate of hospitalisation for serious injuries also declined non-significantly (- 5.5% [95% CI, -11.8% to 1.1%]). Only hospitalisation rates for traumatic brain injuries declined significantly (-11.1% [95% CI, -19.0% to - 2.8%]) over the study period. CONCLUSION: The rate of hospitalisation for injuries to NSW-resident child motor vehicle passengers due to traffic crashes has not significantly decreased. High hospitalisation rates and the subsequent burden to the community and public health system make further injury prevention efforts for child motor vehicle passengers a priority.     

Impaired driving from medical conditions: a 70-year-old man trying to decide if he should continue driving

Some medical disorders can impair performance, increasing the risk of driving safety errors that can lead to vehicle crashes. The causal pathway often involves a concatenation of factors or events, some of which can be prevented or controlled. Effective interventions can operate before, during, or after a crash occurs at the levels of driver capacity, vehicle and road design, and public policy. A variety of systemic, neurological, psychiatric, and developmental disorders put drivers at potential increased risk of a car crash in the short or long term. Medical diagnosis and age alone are usually insufficient criteria for determining fitness to drive. Strategies are needed for determining what types and levels of reduced function provide a threshold for disqualification in drivers with medical disorders. Evidence of decreased mileage, self-restriction to driving in certain situations, collisions, moving violations, aggressive driving, sleepiness, alcohol abuse, metabolic disorders, and multiple medications may trigger considerations of driver safety. A general framework for evaluating driver fitness relies on a functional evaluation of multiple domains (cognitive, motor, perceptual, and psychiatric) that are important for safe driving and can be applied across many disorders, including conditions that have rarely been studied with respect to driving, and in patients with multiple conditions and medications. Neurocognitive tests, driving simulation, and road tests provide complementary sources of evidence to evaluate driver safety. No single test is sufficient to determine who should drive and who should not.     

武汉部分城区1993年和2003年交通损伤分析

目的:探讨伤者性别、受伤者类别、车辆类型、受伤地点与交通损伤的关系。方法:对武汉市部分城区(市区)1993年和2003年1219份交通事故活体损伤案例进行统计分析。结果:受伤者性别比例、事故发生地点的分布上两年份无显著统计学差异;汽车乘客与摩托车手受伤比例增长了一倍,汽车司机、行人受伤比例基本不变,骑自行车者受伤比例由原来的约30%下降到15%;在导致交通损伤的所有车辆中摩托车、乘用车所占比例相对增多,货车所占比例相对下降,客车所占比例基本不变。结论:机动车辆数量的增多导致市民受伤和伤残案例大幅度上升,中国城市道路交通事故损伤发生率正进入高速增长期。     

Graduated driver licensing in Michigan: early impact on motor vehicle crashes among 16-year-old drivers

CONTEXT: Graduated driver licensing (GDL) programs are being adopted in many states to address the high rate of motor vehicle fatalities among teens by requiring teenaged drivers to gain experience and maturity under conditions of relatively low crash risk before gaining full driving privileges. OBJECTIVE: To evaluate the early impact of Michigan's GDL program on traffic crashes among 16-year-old drivers. DESIGN, SETTING, AND SUBJECTS: Analysis of Michigan motor vehicle crash data from 1996 (before GDL program implementation) vs 1998 and 1999 (after GDL program implementation) for 16-year-olds, adjusting for trends among persons 25 years or older. INTERVENTION: Michigan's GDL program, instituted April 1, 1997, for teens younger than 18 years entering the driver license system, includes 3 licensure levels, each with driving restrictions and requirements to progress to the next level. Requirements include extended, supervised practice in the learning level, 2-phase driver education, and night driving restrictions in the intermediate level. MAIN OUTCOME MEASURES: Rates in 1996 vs 1998 and 1999 for all police-reported crashes; for fatal injury, nonfatal injury, and fatal/nonfatal injury combined crashes; for day, evening, and night crashes; for single-vehicle and multivehicle crashes; and for alcohol-related crashes. RESULTS: Overall, the rate of 16-year-old drivers (per 1000 population) involved in crashes declined from 154 in 1996 to 111 in 1999 (relative risk [RR], 0.72; 95% confidence interval [CI], 0.71-0.73). After adjusting for populationwide trends, the overall crash risk for 16-year-olds was significantly reduced in 1999 from 1996 by 25% (adjusted RR, 0.75; 95% CI, 0.74-0.77). There were also significant reductions for nonfatal injury and combined fatal and nonfatal crashes; for day, evening, and night crashes; and for single-vehicle and multivehicle crashes. Fatal crashes declined from 1996 to 1999, but not significantly (RR, 0.74; 95% CI, 0.49-1.14), and alcohol-related crashes continued at a low rate (RR, 1.01; 95% CI, 0.80-1.29). CONCLUSIONS: Analysis of the first 2 full calendar years following Michigan's GDL program implementation indicates substantial crash reductions among 16-year-olds. Future research is necessary to determine if these reductions are maintained and if other jurisdictions achieve similar results.