Asociación del tipo de vehículo con el riesgo de provocar una colisión entre vehículos

ObjectiveTo quantify the magnitude of the association between the type of vehicle and the probability of being responsible for a collision between two or more vehicles.MethodFrom the registry of road crashes with victims maintained by the Spanish Traffic General Directorate (2014 and 2015), a matched case-control study was designed. Cases were offending drivers involved in the 27,630 collisions between two or more vehicles in which only one of the drivers had committed a driving mistake or offence. Each case was matched with the non-offending drivers of the vehicles involved in the same crash: in all, 31,219 controls were included. Apart from the commission of offences and the type of vehicle involved, we got information about other characteristics of the driver (age, sex, etc.) and about the vehicle (age). Odds ratios (OR) were calculated in order to quantify the association between each type of vehicle and the odds of being responsible for the collision, crude and adjusted (by conditioned logistic regression) by the rest of collected variables.ResultsIn comparison with private cars, bicycles had a lower risk of causing a collision (adjusted OR: .30), and also mopeds (aOR: .52) and buses (aOR: .63). Vans (aOR: 1.19) and four-wheel vehicles (aOR: 1.33) increased the risk.ConclusionTwo-wheeled vehicles and buses had a lower risk of causing collisions than private cars. This association is independent of some of the characteristics of the driver, as well as the age of the vehicle.     

Establishment of the model of motorcyclist ejection injury

Objective： To establish the device and model of motorcyclist ejection injury. Methods： Based on our laboratory devices, a motorcyclist ejection injury simulation system was developed. A total of ! 8 pigs were approved by the local animal experi- mentation and ethics committee to serve as the motorcyclist substitutes. In this ejection motion, the animal rode freely at the motor driver seat and was straightly accelerated by means of our custom motorcyclist ejection injury simulation system. When it was speeded up to the preset velocity （v=30, 40 or 50 km/h） at the preset position, the animal was ejected forward. Pathological and dynamic analyses were conducted, accompanied with the high-speed photograph, acceleration/velocity signal test, gross observation and light microscope examination as well as the abbreviated injury score-injury severity score （AIS-ISS） scale. Results： The high-speed photograph indicated that during the ejection procedure the motorcycle was first arrested and decelerated suddenly, and then the motorcycle driver was ejected forward, accompanied with the rotation motion in the air. Finally, the head, shoulder and thorax of the ejected animal impacted directly on the hard ground. Varying degrees of injury focusing on the liver, heart, lung and spleen were found. There existed a significant positive correlation between ISS and the ejection velocity of the motorcycle drivers （ISS=16.7±2.9 for 30 km/h, 25.0±0.0 for 40 km/h and 37.3±1.0 for 50 km/h）. The detailed injury characteristics were as follows： for the mildly injured animals, there were interlobar gaps or leaf gaps and lobar surface blood coagulation blocks in the liver, and mild lung hemorrhage; for the severely injured animals, there were liver comminuted laceration, moderate lung hemorrhage and heart injury. Animals suffering from the most severe injuries died half an hour later. Conclusion： The new injury model stated in this paper has a high stability and good repeatability, and is likely to be helpful to deeply investigate the injury mechanisms and protection countermeasures of motorcyclist ejection injury.     

Epidemiology and Regional Distribution of Pediatric Unintentional Emergency Injury in Korea from 2010 to 2011

Injury is a leading cause of death and disability in children and adolescents worldwide. The purpose of the current study was to investigate the epidemiologic characteristics of the pediatric unintentional injuries presenting to the Korean emergency department (ED). We included unintentional injuries in patients aged < 20 yr. Data collected from January 2010 to December 2011 was extracted from the National Emergency Department Information System (NEDIS) of Korea. The NEDIS data included information on patient''s age and gender, geographic location of the ED visits, mechanism of injuries; and clinical outcomes. Most (94.1%) injuries were unintentional while 5.9% were intentional. The rate of ED visit for pediatric unintentional injury was 6,097 per 100,000 and critical injury was 59.8 per 100,000 (< 20 yr habitants). The mortality rate was 5.4 per 100,000. The mortality rate of pediatric unintentional injuries was 0.1% including the prehospital death and ED death. Unintentional pediatric injuries occurred most commonly in those age 0-4 boys and girls and were predominantly caused by collisions. Male motorcyclists aged 15-19 yr formed a critical injury high-risk group. The rates of critical injury and mortality were highest in Jeju, Gangwon, Gwangju, and Jeonbuk than those in other regions. High-risk groups by age, gender, mechanism and region should be targeted to prevent pediatric injuries in Korea.     

Improving prehospital trauma care in Rwanda through continuous quality improvement: an interrupted time series analysis

IntroductionInjury is a major cause of premature death and disability in East Africa, and high-quality pre-hospital care is essential for optimal trauma outcomes. The Rwandan pre-hospital emergency care service (SAMU) uses an electronic database to evaluate and optimize pre-hospital care through a continuous quality improvement programme (CQIP), beginning March 2014.Materials and methodsThe SAMU database was used to assess pre-hospital quality metrics including supplementary oxygen for hypoxia (O2), intravenous fluids for hypotension (IVF), cervical collar placement for head injuries (c-collar), and either splinting (splint) or administration of pain medications (pain) for long bone fractures. Targets of >90% were set for each metric and daily team meetings and monthly feedback sessions were implemented to address opportunities for improvement. These five pre-hospital quality metrics were assessed monthly before and after implementation of the CQIP. Met and unmet needs for O2, IVF, and c-collar were combined into a summative monthly SAMU Trauma Quality Scores (STQ score). An interrupted time series linear regression model compared the STQ score during 14 months before the CQIP implementation to the first 14 months after.ResultsDuring the 29-month study period 3,822 patients met study criteria. 1,028 patients needed one or more of the five studied interventions during the study period. All five endpoints had a significant increase between the pre-CQI and post-CQI periods (p < 0.05 for all), and all five achieved a post-CQI average of at least 90% completion. The monthly composite STQ scores ranged from 76.5 to 97.9 pre-CQI, but tightened to 86.1-98.7 during the post-CQI period. Interrupted time series analysis of the STQ score showed that CQI programme led to both an immediate improvement of +6.1% (p = 0.017) and sustained monthly improvements in care delivery—improving at a rate of 0.7% per month (p = 0.028).ConclusionThe SAMU experience demonstrates the utility of a responsive, data-driven quality improvement programme to yield significant immediate and sustained improvements in pre-hospital care for trauma in Rwanda. This programme may be used as an example for additional efforts engaging frontline staff with real-time data feedback in order to rapidly translate data collection efforts into improved care for the injured in a resource-limited setting.     

Clinical characteristics of 1653 injured motorcyclists and factors that predictmortality from motorcycle crashes in Malaysia

PurposeAmongst the ASEAN countries, Malaysia has the highest road fatality risk (>15 fatalities per 100 000 population) with 50% of these fatalities involving motorcyclist. This contributes greatly to ward admissions and poses a significant burden to the general surgery services. From mild rib fractures to severe intra-abdominal exsanguinations, the spectrum of cases managed by surgeons resulting from motorcycle accidents is extensive. The objective of this study is to report the clinical characteristics and identify predictors of death in motorcycle traumatic injuries from a Malaysian trauma surgery centre.MethodsThis is a prospective cross-sectional study of all injured motorcyclists and pillion riders that were admitted to Hospital Sultanah Aminah and treated by the trauma surgery team from May 2011 to February 2015. Only injured motorcyclists and pillion riders were included in this study. Patient demography and predictors leading to mortality were identified. Significant predictors on univariate analysis were further analysed with multivariate analysis.ResultsWe included 1653 patients with a mean age of (35 ± 16.17) years that were treated for traumatic injuries due to motorcycle accidents. The mortality rate was 8.6% (142) with equal amount of motorcycle riders (788) and pillion riders (865) that were injured. Amongst the injured were male predominant (1 537) and majority of ethnic groups were the Malays (897) and Chinese (350). Severity of injury was reflected with a mean Revised Trauma Score (RTS) of 7.31 ± 1.29, New Injury Severity Score (NISS) of 19.84 ± 13.84 and Trauma and Injury Severity Score (TRISS) of 0.91 ± 0.15. Univariate and multivariate analysis revealed that age≥35, lower GCS, head injuries, chest injuries, liver injuries, and small bowel injuries were significant predictors of motorcycle trauma related deaths with p < 0.05. Higher trauma severity represented by NISS, RTS and TRISS scores was also significant for death with p < 0.05.ConclusionAge, lower GCS, presence of head, chest, liver, small bowel injuries and higher severity on NISS, RTS and TRISS scores are predictive of death in patients involved with motorcycle accidents. This information is important for prognostic mortality risk prevention and counselling.     

Analysis of 86 fatal motorcycle frontal crashes in Chongqing, China

Objective: To analyze the injuries of motorcyclists involved in fatal motorcycle frontal crashes.Methods: A survey group involving multi-discipline experts was built to randomly collect data on fatal m...     

摩托车道路交通伤害流行特点及干预措施综述

摩托车作为一种高速且低稳定性的交通运输工具，在道路交通事故中无法为驾驶者及乘客提供足够的保护，造成其事故发生率、死亡率及伤残率高。鉴于国内有关摩托车道路交通伤害的研究较少，本文系统概括了当前国内外摩托车道路交通伤害的流行现状、影响因素和预防措施，并分析了近些年来我国摩托车保有量和道路交通伤害的变化趋势，为我国摩托道路交通伤害预防提供参考。     

Helmet use by drivers and passengers of motorcycles in Pamplona (Spain), 1992

In 1992 a new Traffic Rules Code was enacted in Spain. This Code included a helmet law that came into force on 1 September 1992. Since then, helmet use is compulsory for motorcycles in urban areas. Previously, helmet use had been obligatory only for motorcycle in highways. To evaluate driver and passenger compliance with the helmet law, an observational prevalence survey of helmet use in Pamplona (a city of 183,539 inhabitants in the north of Spain) was performed. The utilization of helmet by motorcycle drivers and their passengers was recorded three months before and three after the helmet law took effect. Helmet use increased from 19.7% in the first period to 94,8% in the second period. After the law took effect helmet use was higher among drivers 97.5% than among passengers 77.5%. Passengers used helmet more frequently when the driver was also using helmet. The prevalence ratio of helmet use, in those passengers whose driver used helmet versus those who didn't, was 9.91 (95% CI=1.52, 64.83). Health education and law enforcement efforts should be targeted to drivers to prevent them from giving a ride to passengers without helmet.     

Motorcycle accidents in China

Objective： To analyze the characteristics and causes of motorcycle accidents in China from 2000 to 2005.
Methods： We collected data on possession of motor- cycles and automobiles, number of traffic crashes, casualty and economic loss from 2000-2005 Statistic Annual Report of Traffic Management Bureau, Ministry of Public Security of China. The data was processed statistically by SPSS 11.0 software package.
Results： During 6 years, the number of motorcycle accidents were up to 122 300 in 2003, which was the highest, and then gradually decreased. However, the casualty had the tendency of consistent increase, for example, the motorcycle accidents resulted in 26 200 deaths and 157 500 injuries in 2005. The mortality per 10 000 motorcycles and the ratio of deaths to injuries were lower than those of automobiles, but the mortality per 100 motorcycle accidents was significantly higher than that of automobiles （P〈0.01）.
Conclusions： China has attached great importance to the management of traffic safety, which is beneficial to con- trol and reduce traffic accidents in recent years. However, the casualty keeps increasing annually. Therefore, it is urgent to strengthen the management of motorcycles, promote the education of motorcyclists, take effective traffic measures and improve the first-aid system of traffic injuries.