An analysis of 6215 hospitalized unintentional injuries among children aged 0-14 in northwest China

The aim of this study was to analyze the sorts and the external causes of hospitalized unintentional injuries among children aged 0-14 so as to learn the status of children's unintentional injuries in northwest China and then to give some references for the prevention. As many as 6215 abstracts of the discharged medical records of hospitalized children for unintentional injuries from 31 hospitals in northwest China from January 1, 2002 to December 31, 2003 were analyzed, especially for the different external causes and sorts of injuries according to ages, genders and locations. We identified 2081 (33.5%) fractures, 1279 (20.6%) scald/burns, 1125 (18.1%) internal organ injuries and 611 (9.8%) open injuries among the 6215 hospitalized children for unintentional injuries. Boy's cases were 2.2 times as many as those of girl's. The age characteristics of each injury was as follows: scald/burns occurred mostly in children under 3 (53.8%), especially in children under 1 year (58.5%); fractures occurred mostly in children above 4 (38.2%), especially in children aged 7-14 years (41.0%). The proportion of traffic accidents and falls were the highest among children aged 7-14, with 28.5% for traffic accidents and 34.4% for falls, respectively. The total cost of hospitalization was US $1 033 876.0, with a mean cost of US $166.3 per case. The total length of stay in hospital was 106 915.2 days, with a mean of 17.2 days per case. A large proportion of fall, traffic accident, and fire/explosion induced fractures, scald/burns, internal organ and encephalic injuries characterize the childhood unintentional injuries in northwest China. From the analyses of external causes, prevention strategies for different external causes should be correspondingly specific.     

Estimating the human recovery costs of seriously injured road crash casualties

Road crashes result in substantial trauma and costs to societies around the world. Robust costing methods are an important tool to estimate costs associated with road trauma, and are key inputs into policy development and cost–benefit analysis for road safety programmes and infrastructure projects. With an expanding focus on seriously injured road crash casualties, in addition to the long standing focus on fatalities, methods for costing seriously injured casualties are becoming increasingly important. Some road safety agencies are defining a seriously injured casualty as an individual that was admitted to hospital following a road crash, and as a result, hospital separation data provide substantial potential for estimating the costs associated with seriously injured road crash casualties. The aim of this study is to establish techniques for estimating the human recovery costs of (non-fatal) seriously injured road crash casualties directly from hospital separation data. An individuals’ road crash-related hospitalisation record and their personal injury insurance claim were linked for road crashes that occurred in New South Wales, Australia. These records provided the means for estimating all of the costs to the casualty directly related to their recovery from their injuries. A total of 10,897 seriously injured road crash casualties were identified and four methods for estimating their recovery costs were examined, using either unit record or aggregated hospital separation data. The methods are shown to provide robust techniques for estimating the human recovery costs of seriously injured road crash casualties, that may prove useful for identifying, implementing and evaluating safety programmes intended to reduce the incidence of road crash-related serious injuries.     

Complementing police road-crash records with trauma registry data--an initial evaluation

This paper examines the consistency of hospital and police reporting of outcomes of road traffic crashes using a database of linked police crash reports and trauma registry records. Criteria for inclusion into the trauma registry include trauma-related causes with subsequent stay of more than 24 h or death due to injuries. During the 1997 calendar year there were 497 cases of road-related injuries within the combined trauma registry of Sir Charles Gairdner and Fremantle Hospitals, of which only 82% had matching police records. Linkage rates were associated with gender, injury severity and the number of vehicles involved. Within the road user category, pedestrians were least likely to link. Of the linked records, police classification of injury severity was correct in 78% of cases. Male casualties were more likely to be correctly classified than females, after adjustment for related variables including injury severity. Correct classification of injury by police was also closely related to severity of injury. Identification and targeting of these groups of casualties is vital in refining the road-crash reporting system. Increased crash reporting and availability of data from these two sources will provide road authorities with more reliable measures of injury outcome.     

Validity of using linked hospital and police traffic crash records to analyse motorcycle injury crash characteristics

Linking hospital discharge and police traffic crash records has been used to provide information on causes and outcomes for hospitalised traffic crash cases. Motorcyclists are particularly vulnerable to injury in a traffic crash, but no published linkage studies have reported in detail on this road user group. The present study examined motorcycle traffic crash injury cases in New Zealand in 2000–2004 by probabilistically linking national hospital discharge records with police traffic crash reports. Injury cases had to have spent at least one night in hospital before being discharged and were defined as serious or moderate based on their International Classification of Disease Injury Severity Scores (ICISS). Despite a robust linkage process, only 46% of cases could be linked to a police record; 60% of the serious injuries and 41% of the moderate. The low linkage was most likely due to under-reporting of crashes to or by the police. While moderate injury cases were expected to be under-reported, the level of under-reporting of cases with serious threat-to-life injuries is concerning. To assess whether the linked dataset could provide valid information on the crash circumstances and injury outcomes of hospitalised motorcycle crash cases, the characteristics of the linked and unlinked hospital discharge cases were compared using chi-square tests and multivariate logistic regression. Serious injury cases were less likely to be linked if only one vehicle was involved, or the injured riders and passengers were younger than 20 years or spent less than one week in hospital. For moderate injury cases, there were also differences in linkage by injured body region and crash month. While these discrepancies need to taken into consideration when interpreting results, the linked hospital-police dataset has the potential to provide insights into motorcycle crash circumstances and outcomes not otherwise obtainable.     

Using multiple datasets to understand trends in serious road traffic casualties

Accurate information on the incidence of serious road traffic casualties is needed to plan and evaluate prevention strategies. Traditionally police reported collisions are the only data used. This study investigate the extent to which understanding of trends in serious road traffic injuries is aided by the use of multiple datasets. Health and police datasets covering all or part of Great Britain from 1996-2003 were analysed. There was a significantly decreasing trend in police reported serious casualties but not in the other datasets. Multiple data sources provide a more complete picture of road traffic casualty trends than any single dataset. Increasing availability of electronic health data with developments in anonymised data linkage should provide a better platform for monitoring trends in serious road traffic casualties.     

Measuring transport injuries in a developing country: an application of the capture-recapture method

The purposes of this study are to provide an estimation of the incidence of transport injuries in a defined local community in Nicaragua by using the capture-recapture method, and to compare results using this method when data at different levels of severity are utilized.Two sources of injury data were used to monitor injuries: hospital data (inpatient and outpatient) and traffic police records. Characteristics available for matching included name, age, sex, and date of occurrence. The methodology of capture-recapture was used to estimate the ascertainment degree of both sources of data and the estimate mortality and incidence rates. Estimates were calculated both when all hospital data were taken into account (inpatient and outpatient combined) and when only inpatient records were matched against police records.First, including police records and all hospital data, the mortality and morbidity estimates were 35.5/100000 and 43.7/1000 per year, respectively. Second, when outpatients were excluded from the analysis, the corresponding estimates were 28.6/100000 and 7.5/1000, respectively. In non-fatal cases, the ascertainment-corrected coverage through police records was 2.6% and through hospital surveillance 19.0% when both inpatients and outpatients were included. In fatal cases, the corresponding rates were 56.1 and 22.8%, respectively. The combined data set pointed out pedestrians and cyclists as the main risk groups. Most fatalities were due to head injuries.Our results show that neither police records nor hospital records nor the aggregate database provided acceptable coverage of transport-related injuries. Combining police and hospital data by means of capture-recapture analysis produces more valid estimates, but caution must be given to the issue of severity heterogeneity between the two sources.     

Analyzing pedestrian crash injury severity at signalized and non-signalized locations

This study identifies and compares the significant factors affecting pedestrian crash injury severity at signalized and unsignalized intersections. The factors explored include geometric predictors (e.g., presence and type of crosswalk and presence of pedestrian refuge area), traffic predictors (e.g., annual average daily traffic (AADT), speed limit, and percentage of trucks), road user variables (e.g., pedestrian age and pedestrian maneuver before crash), environmental predictors (e.g., weather and lighting conditions), and vehicle-related predictors (e.g., vehicle type). The analysis was conducted using the mixed logit model, which allows the parameter estimates to randomly vary across the observations. The study used three years of pedestrian crash data from Florida. Police reports were reviewed in detail to have a better understanding of how each pedestrian crash occurred. Additionally, information that is unavailable in the crash records, such as at-fault road user and pedestrian maneuver, was collected. At signalized intersections, higher AADT, speed limit, and percentage of trucks; very old pedestrians; at-fault pedestrians; rainy weather; and dark lighting condition were associated with higher pedestrian severity risk. For example, a one-percent higher truck percentage increases the probability of severe injuries by 1.37%. A one-mile-per-hour higher speed limit increases the probability of severe injuries by 1.22%. At unsignalized intersections, pedestrian walking along roadway, middle and very old pedestrians, at-fault pedestrians, vans, dark lighting condition, and higher speed limit were associated with higher pedestrian severity risk. On the other hand, standard crosswalks were associated with 1.36% reduction in pedestrian severe injuries. Several countermeasures to reduce pedestrian injury severity are recommended.     

Moped injuries among adolescents: a significant forgotten problem?

OBJECTIVES: The study's objective is to investigate the size of the problem of moped injuries among children and young adults. DESIGN: A comprehensive prospective injury registration has been carried out at the Central Hospital and Emergency Clinic in Rogaland county in Norway. Out of this system we selected cases of traffic injuries occurring from 1990 to 1996 among a defined population aged 0-24 years and analyzed incidence of traffic injury by the type of transport of the victim. RESULTS: Moped injuries represented 9% (85 per 100,000 person-years) of all (hospitalized and non-hospitalized) traffic related injuries among people under 25 years and 44% of all cases among persons aged 16 and 17 years. Moped injuries represented 13% of hospitalized cases altogether and 50% of hospitalized traffic injuries among persons aged 16 and 17 years. The overall male:female moped injury incidence rate ratio was 2.7 (95% CI 2.0-3.7). Police records captured only 40% of the moped injuries overall. 43% of moped injuries were lone accidents and 40% occurred in a moped-car collision. CONCLUSION: Moped injuries represent a major source of serious traffic injury among older children. This risk seems to be partially overlooked. Significantly higher attention seems to be warranted to reduce the risk of moped injury in populations where the moped is a popular means of transport among older children.     

The construction of a road injury database

In order to effectively examine possible causes and determinants of road trauma, reliable informa- tion on the participants, circumstances, and resultant injuries and deaths must be available. Characteristics of participants (persons and vehicles) and the circumstances of road accidents are routinely collected by police and road authorities, whereas details of the injuries and medical care provided to casualties are collected by hospital and ambulance services. A road injury database, linking data collected by the Health, Police, and Main Roads Departments of the Government of Western Australia with records of the St. John Ambulance Association and the Death Register, has been established. This paper describes the procedures used to link the various sources of data and discusses the design, construction, and quality of the resultant relational database.     

Driver injury severity outcome analysis in rural interstate highway crashes: a two-level Bayesian logistic regression interpretation

There is a high potential of severe injury outcomes in traffic crashes on rural interstate highways due to the significant amount of high speed traffic on these corridors. Hierarchical Bayesian models are capable of incorporating between-crash variance and within-crash correlations into traffic crash data analysis and are increasingly utilized in traffic crash severity analysis. This paper applies a hierarchical Bayesian logistic model to examine the significant factors at crash and vehicle/driver levels and their heterogeneous impacts on driver injury severity in rural interstate highway crashes. Analysis results indicate that the majority of the total variance is induced by the between-crash variance, showing the appropriateness of the utilized hierarchical modeling approach. Three crash-level variables and six vehicle/driver-level variables are found significant in predicting driver injury severities: road curve, maximum vehicle damage in a crash, number of vehicles in a crash, wet road surface, vehicle type, driver age, driver gender, driver seatbelt use and driver alcohol or drug involvement. Among these variables, road curve, functional and disabled vehicle damage in crash, single-vehicle crashes, female drivers, senior drivers, motorcycles and driver alcohol or drug involvement tend to increase the odds of drivers being incapably injured or killed in rural interstate crashes, while wet road surface, male drivers and driver seatbelt use are more likely to decrease the probability of severe driver injuries. The developed methodology and estimation results provide insightful understanding of the internal mechanism of rural interstate crashes and beneficial references for developing effective countermeasures for rural interstate crash prevention.     

Discrepancies in vehicular crash injury reporting: Northeastern Ohio Trauma Study. IV

People injured in motor vehicle traffic crashes were identified from a population-representative incidence sample of hospital emergency department visits. Matched police reports of crashes were sought in official state records of motor vehicle traffic crashes. Of the emergency department cases, 55% had matched police reports. The frequency of matched reports was highest for drivers (74%), people transported to the hospital by emergency vehicle (69%), and those requiring hospital admission (74%). The frequency was lowest for people younger than 16 years (28%), people injured as occupants of vehicles other than passenger cars (24%), medicaid recipients (33%), and nonresidents of the study region (40%). Motor vehicle traffic injuries are undercounted in police-reported statistics. For many groups, police reporting is less than 50% of the cases identified through emergency departments. The likelihood that a case of motor vehicle traffic injury will have a matched police report depends on demographic, social and crash factors as well as on injury severity.     

Distribution and circumstances of injuries in squatter settlements of Karachi, Pakistan

OBJECTIVES: This research was conducted to study incidence, distribution, type, causes, severity and circumstances of injuries among people living in squatter settlements in Karachi, Pakistan. METHODS: Trained interviewers sought a 2 weeks recall for minor injuries for which no health care was sought, 2 months recall for major injuries for which a health provider was consulted and 1 year recall for hospitalization, disability and death from every third household in five squatter settlements in Karachi between May and August 1995. For understanding the injury circumstances 250 in-depth interviews of the injured or the close relatives were also conducted. RESULTS: Among 1182 households, having 9891 residents, 84 minor, 42 major injury episodes, 7 hospitalizations, 0.6 permanent disabilities and 0.3 deaths per 1000 person years were reported. Including all injury episodes, the common types of injury were cutting or piercing (n = 532), falls (n = 382) and burns (n = 235) estimating to 54, 38 and 23 injury episodes per 1000 person years. Injury mainly resulted from a piece of glass (n = 367), falling from height (n = 98) and knife (n = 97) estimating to 37, 10 and 10 injury episodes per 1000 person years, respectively. Fall (n = 32, 3.2/1000 person years) was the major reason for hospitalizations and all permanent disabilities resulted from closed injuries. Medically trained providers were mostly contacted (n = 339, 34/1000 person years), but traditional healers were preferred in bone injury. CONCLUSION: Injuries are a major cause of morbidity and mortality in Pakistan and the national health and development agenda should include assessment and prevention of injuries.     

Injuries from single-vehicle crashes and snow depth

Swedish official statistics on road traffic accidents shows a remarkable variability among different winter seasons in single-vehicle crashes resulting in personal injuries--one of the major causes of personal injury in road traffic. This study presents results from analyses investigating the role played by snow as an injury-reducing factor. The regression model specified implies, when applied to Swedish data, that an increase in snow depth by 1 cm--for snow depths less than 40 centimetres--reduces the number of crashes with occupant injury by 3%. This finding has implications for assessing trends in traffic safety through the use of routine statistics on motor vehicle occupant injuries and also shows that roadside design is a decisive factor in the generation of injury to the individual in single-vehicle crashes.     

Estimation of the severity of safety critical events

Today, various measures are used to estimate the severity of a traffic conflict. However, these measures are all limited to estimating the crash risk and do not include any estimates of the possible consequences of a potential crash. In accident analysis the estimated severity of the event is related to the outcome of the crash, such as injury levels. This article proposes a new method for estimating the severity of safety critical events based on both an estimate of crash risk and an estimate of possible consequence that, in addition to a measure of safety margins, takes vehicle mass as well as the relative speed of the involved road users into consideration. The article compares the estimated severity of 61 conflicts and 9 accidents of the proposed method with the traffic conflict technique.The results from the severity estimates of our proposed method show a significant difference in the severity levels of events involving vehicles with similar mass compared to critical events involving vehicles with dissimilar mass and events involving pedestrians. The proposed method gives the possibility to compare different conflicts, with regard to severity, with each other regardless of what type of conflict it is, e.g. intersection or rural road, or what kind of road users that are involved.In addition, an event classification, i.e. serious or very serious event, based on the severity estimate of the proposed method, shows promising results indicating that the severities are estimated in a homogenous way. The article concludes that our proposed method of estimating the severity of critical event seems to be able to reflect the dangerousness in a more realistic way than the traffic conflict technique and should facilitate the development of traffic safety analysis methods.     

Injury mortality and morbidity in New Zealand

An overview of the injury problem in New Zealand is presented. National mortality and morbidity data demonstrate that relative to other diseases injuries represent a significant community health problem. Injuries are the fourth leading cause of death and account for 32% of Potential Years of Life Lost between the ages of 1 and 70. Injuries are the second leading cause of hospital admission and account for nearly 12% of all admissions. Injury rates vary dramatically by age, sex, socioeconomic status, and race. In general, males, particularly those 20-24 years old, have higher death and hospitalisation rates than females. A notably exception is elderly females, who have a hospitalisation rate nearly twice as high as elderly males. Maori and those from low socioeconomic levels have the highest injury rates. The leading causes of injury death are motor vehicle crashes (37%) and self-inflicted injury (21%). This contrasts to some extent with the two leading causes of hospitalisation, namely falls (25%) and motor vehicle crashes (19%). The road, home, and places of recreation and sport are the most common places of occurrence of serious injury. Head injuries, in particular concussions, and fractures of the lower limbs, particularly the femur, account for 35% of all injury morbidity. Treatment and rehabilitation costs for injuries that resulted in hospitalisations, visits to accident and emergency centres, and a claim on the Accident Compensation Corporation cost an average of $133 (1983) per head of population.     

The tolerance of the human body to automobile collision impact – a systematic review of injury biomechanics research, 1990–2009

Road traffic injuries account for 1.3 million deaths per year world-wide. Mitigating both fatalities and injuries requires a detailed understanding of the tolerance of the human body to external load. To identify research priorities, it is necessary to periodically compare trends in injury tolerance research to the characteristics of injuries occurring in the field. This study sought to perform a systematic review on the last twenty years of experimental injury tolerance research, and to evaluate those results relative to available epidemiologic data. Four hundred and eight experimental injury tolerance studies from 1990–2009 were identified from a reference index of over 68,000 papers. Examined variables included the body regions, ages, and genders studied; and the experimental models used. Most (20%) of the publications studied injury to the spine. There has also been a substantial volume of biomechanical research focused on upper and lower extremity injury, thoracic injury, and injury to the elderly – although these injury types still occur with regularity in the field. In contrast, information on pediatric injury and physiological injury (especially in the central nervous system) remains lacking. Given their frequency of injury in the field, future efforts should also include improving our understanding of tolerances and protection of vulnerable road users (e.g., motorcyclists, pedestrians).     

The western australian road injury database (1987-1996): ten years of linked police, hospital and death records of road crashes and injuries

Accurate information about injuries and their causes is essential to road safety research, policy development and evaluation. Such information is most powerful when it is available for all road crashes within a jurisdiction. The Western Australian Road Injury Database achieves this through the on-going linkage of crash details from reports to police with the details of injuries to casualties contained in hospital and death records. Over the 10-year period 1987-1996, 386,132 road crashes involving 142,308 casualties were reported to the police in Western Australia. There were also 47,757 hospital discharge records and 2,906 death records related to road crashes during this period. Of the 142,308 police casualties, 17 848 had a matching hospital discharge record and 2,454 had a matching death registration. Linkage within the hospital records revealed that the 47,757 discharge records involved 43,179 individuals, of whom 39,073 were admitted to hospital once, 3,653 were admitted twice, 374 were admitted three times and 78 were admitted more than three times. Of the 43,179 hospitalised casualties, 817 had a matching death record. Linked police, hospital and death records of road crash casualties provide accurate outcome information for casualties in crashes reported to the police. In addition, estimates of under reporting of crashes for different road user groups can be made by comparing hospital records with and without a matching police record. This article demonstrates the power of a linked system to answer complex research questions related to outcome and under-reporting.     

Bayes classifiers for imbalanced traffic accidents datasets

Traffic accidents data sets are usually imbalanced, where the number of instances classified under the killed or severe injuries class (minority) is much lower than those classified under the slight injuries class (majority). This, however, supposes a challenging problem for classification algorithms and may cause obtaining a model that well cover the slight injuries instances whereas the killed or severe injuries instances are misclassified frequently. Based on traffic accidents data collected on urban and suburban roads in Jordan for three years (2009–2011); three different data balancing techniques were used: under-sampling which removes some instances of the majority class, oversampling which creates new instances of the minority class and a mix technique that combines both. In addition, different Bayes classifiers were compared for the different imbalanced and balanced data sets: Averaged One-Dependence Estimators, Weightily Average One-Dependence Estimators, and Bayesian networks in order to identify factors that affect the severity of an accident. The results indicated that using the balanced data sets, especially those created using oversampling techniques, with Bayesian networks improved classifying a traffic accident according to its severity and reduced the misclassification of killed and severe injuries instances. On the other hand, the following variables were found to contribute to the occurrence of a killed causality or a severe injury in a traffic accident: number of vehicles involved, accident pattern, number of directions, accident type, lighting, surface condition, and speed limit. This work, to the knowledge of the authors, is the first that aims at analyzing historical data records for traffic accidents occurring in Jordan and the first to apply balancing techniques to analyze injury severity of traffic accidents.     

Injuries to the elderly in the traffic environment

Two hundred ninety-seven persons, all aged 60 or over (180 women, 117 men), injured in the traffic environment, and treated at the Regional Hospital in Ume?, over a one-year period, were analysed. Injuries were grouped into three main categories: falls (52%), vehicle-associated events (44%), and "other" injury events (4%). In women, falls were a more common cause of injury than vehicle events, whilst in men there was a tendency for a converse relationship. Two-thirds of the falls involved slipping on ice and snow. Ice- and snow- related injuries (all categories) accounted for 37% of the total cost of all injuries in the elderly in the traffic environment. The main groups in the vehicle-associated injury category were cyclists (48%), car occupants (34%), other occupants (14%), and pedestrians (4%). Vehicle-associated injuries became more common with advancing age, resulted in the most severe and critical [Maximum Abbreviated Injury Scale (MAIS) greater than or equal to 4] injuries and the most fatalities, and cost (total and mean) more than falls. In conclusion, from the injury cost point of view, it is most important to prevent vehicle-associated injuries. However, when total frequencies are considered, falls deserve to be given just as much priority in injury prevention programs as vehicle-associated injuries, to make the traffic environment safer for this growing population.     

The external costs of traffic injury: Definition, estimation, and possibilities for internalization

The external costs of traffic injury in Norway are estimated. External costs are all costs that are imposed on others and not borne by the person whose activity generates the costs. Three types of external cost are identified: system externalities, physical injury externalities, and traffic volume externalities. System externalities are costs that road users impose on the rest of society. Physical injury externalities are costs that one group of road users imposes upon another in crashes in which both groups are involved. Traffic volume externalities are the costs imposed on other road users when an additional road user joins traffic. System externalities are estimated to be about 30% of the total cost of traffic injury. Physical injury externalities are estimated to be about 10% of the total cost of traffic injury. No precise estimate can be given for traffic volume externalities. Possibilities for internalizing the external costs are discussed. In Norway, current taxes on ownership and use of motor vehicles cover the external costs of traffic injury, although the taxes were not designed with this purpose in mind.