Daily fluctuations in Honolulu motor vehicle accidents

Changes in daily motor vehicle accidents during 1990 are examined for the City and County of Honolulu. Adjusting for changed reporting criteria, daily accidents fluctuate according to an interaction between traffic volume, weekday travel patterns, holidays and weather. Fridays, particularly, and Saturdays have more daily accidents. Minor holidays generate more daily accidents, but major holidays generate fewer daily accidents, primarily because of lower traffic volume. Rainfall increases the risk of accidents substantially. The interaction between afternoons and rainfall is particularly dangerous. Unemployment also appears to reduce daily accidents.     

Bicyclist injury severities in bicycle-motor vehicle accidents

This research explores the factors contributing to the injury severity of bicyclists in bicycle-motor vehicle accidents using a multinomial logit model. The model predicts the probability of four injury severity outcomes: fatal, incapacitating, non-incapacitating, and possible or no injury. The analysis is based on police-reported accident data between 1997 and 2002 from North Carolina, USA. The results show several factors which more than double the probability of a bicyclist suffering a fatal injury in an accident, all other things being kept constant. Notably, inclement weather, darkness with no streetlights, a.m. peak (06:00 a.m. to 09:59 a.m.), head-on collision, speeding-involved, vehicle speeds above 48.3 km/h (30 mph), truck involved, intoxicated driver, bicyclist age 55 or over, and intoxicated bicyclist. The largest effect is caused when estimated vehicle speed prior to impact is greater than 80.5 km/h (50 mph), where the probability of fatal injury increases more than 16-fold. Speed also shows a threshold effect at 32.2 km/h (20 mph), which supports the commonly used 30km/h speed limit in residential neighborhoods. The results also imply that bicyclist fault is more closely correlated with greater bicyclist injury severity than driver fault.     

The epidemiology of fatal motor vehicle accidents in Kuwait

The main objectives of this study are to present data on fatal motor vehicle accidents in Kuwait with a view to find out the principal epidemiological features, establish a baseline for future evaluation, use international death rates to compare Kuwait with other countries and offer specific recommendations as to how the risks involved can be reduced. The epidemiology of all fatal accidents which had occurred in Kuwait between 1 January 1977 and 31 December 1978 are analysed. This two-year series, which includes 726 accidents and represents 1.7% of all types of accidents, resulted in 803 deaths (7.3% of the national deaths toll) and 1175 injuries. The death rates per hundred million vehicle kilometers of travel, per 100,000 registered motor vehicles and per 100,000 resident population in 1978 were about 8.5, 84.8 and 31.7 respectively. These figures reveal significantly higher rates than in some industrialized countries, thus ranking motor vehicle accidents among the four leading causes of death and probably as the commonest single cause of death in Kuwait. The study shows that children under the age of 15 yr contributed 26.2% of all motor vehicle fatalities. 40.9% of pedestrian deaths (55.2% of the series), 25% of pedal-cyclist deaths, 6.3% of motorcyclist deaths and 1.2% of driver deaths. It also confirms the importance of the motor vehicle-pedestrian type of accident (58.3%) and the over-representation of buses, trucks and motorcycles with respect to involvement in fatal accidents as compared to their relative ratios of registered vehicles. The principal recommendations call for the formation of a National Council for Road Safety, the establishment of intensive roadside care, traffic education of road users and at risk groups, improvement of the environment and the firm enforcement of the law to curb the toll of this killer disease in a traditional country undergoing rapid modernization like Kuwait.     

Effects on accidents of periodic motor vehicle inspection in Norway

An extensive programme of periodic motor vehicle inspection was introduced in Norway after 1995, when the treaty between Norway and the European Union (EU) granting Norway (not a member of the EU) access to the EU inner market took effect (The EEA treaty). This paper evaluates the effects on accidents of periodic inspections of cars. Trucks and buses were not included in the study. Negative binomial regression models were fitted to data on accidents and inspections created by merging data files provided by a major insurance company and by the Public Roads Administration. Technical defects prior to inspection were associated with an increased accident rate. Inspections were found to strongly reduce the number of technical defects in cars. Despite this, no effect of inspections on accident rate were found. This finding is inconsistent with the fact that technical defects appear to increase the accident rate; one would expect the repair of such defects to reduce the accident rate. Potential explanations of the findings in terms of behavioural adaptation among car owners are discussed. It is suggested that car owners adapt driving behaviour to the technical condition of the car and that the effect attributed to technical defects before inspection may in part be the result of a tendency for owners who are less concerned about safety to neglect the technical condition of their cars. These car owners might have had a higher accident rate than other car owners irrespective of the technical condition of the car.     

Trends in spinal cord injury

This study reports on trends in spinal cord injury based on the Australian Spinal Cord Injury Register (ASCIR), which provided full coverage in those aged 15 years and over. The underlying annual rate of change from 1986 to 1997 was calculated for age-specific, crude and age-standardised incidence rates. An appropriate model for this type of data was the Poisson regression model, with a Poisson error distribution, a log link function and the natural log of population treated as an 'offset'. It was found that there was no change in the age-standardised rate of spinal cord injury. However, an assessment of specific rates by age, sex, cause and neurological group revealed some contrasting trends, notably declining rates in young males, transport-related injury and complete tetraplegia, and increasing rates in elderly males, fall-related injury and incomplete tetraplegia and complete paraplegia. These changes are considered to reflect the impact of a raft of public health measures directed at transport-related injury but a paucity of prevention programs directed at fall-related spinal cord injury. More research is required to determine the causes of the increasing rate of elderly male fall-related spinal cord injury. There is also more that can be done to prevent transport-related spinal cord injury. Sport utility vehicles pose an increased concern. In order to reinvigorate the debate about the need for a vehicle rollover resistance rating in Australia, the spinal cord injury risk of different models of SUV should be measured. This has already been implemented in the United States, providing the public with information to assist purchasing based on safety considerations.     

Thermal trauma resulting from motor vehicle operation or maintenance

Burn injury may result from the operation or maintenance of motor vehicles. We reviewed the experience of one burn center with injuries related to motor vehicle use over the 6 year period 1987–1992. One hundred and fifty patients with motor vehicle related burns were identified comprising 11.3% of all admissions for this period. The mean extent of burn injury was 22.8% total body surface area with a mean full thickness (third degree) burn size of 11.7%. The average hospital length of stay was 42.41 days. The most common mechanisms of injury were collisions resulting in fire (n = 48), carburetor priming (n = 37) and scalding from radiator fluid contact (n = 27). Burns resulting from vehicle operation or maintenance are costly and potentially preventable.     

Mixed logit analysis of bicyclist injury severity resulting from motor vehicle crashes at intersection and non-intersection locations

Standard multinomial logit (MNL) and mixed logit (MXL) models are developed to estimate the degree of influence that bicyclist, driver, motor vehicle, geometric, environmental, and crash type characteristics have on bicyclist injury severity, classified as property damage only, possible, nonincapacitating or severe (i.e., incapacitating or fatal) injury. This study is based on 10,029 bicycleinvolved crashes that occurred in the State of Ohio from 2002 to 2008. Results of likelihood ratio tests reveal that some of the factors affecting bicyclist injury severity at intersection and non-intersection locations are substantively different and using a common model to jointly estimate impacts on severity at both types of locations may result in biased or inconsistent estimates. Consequently, separate models are developed to independently assess the impacts of various factors on the degree of bicyclist injury severity resulting from crashes at intersection and non-intersection locations.Several covariates are found to have similar impacts on injury severity at both intersection and non-intersection locations. Conversely, six variables were found to significantly influence injury severity at intersection locations but not non-intersection locations while four variables influenced bicyclist injury severity only at non-intersection locations. In crashes occurring at intersection locations, the likelihood of severe bicyclist injury increases by 14.8 percent if the bicyclist is not wearing a helmet, 82.2 percent if the motorist is under the influence of alcohol, 141.3 percent if the crash-involved motor vehicle is a van, 40.6 percent if the motor vehicle strikes the side of the bicycle, and 182.6 percent if the crash occurs on a horizontal curve with a grade. Results from non-intersection locations show the likelihood of severe injuries increases by 374.5 percent if the bicyclist is under the influence of drugs, 150.1 percent if the motorist is under the influence of alcohol, 53.5 percent if the motor vehicle strikes the side of the bicycle and 99.9 percent if the crash-involved motor vehicle is a heavy-duty truck.     

Characteristics of three- and four-wheeled all-terrain vehicle accidents in Quebec

During a seven-month survey from May to November 1985, 624 victims injured from three- or four-wheeled all-terrain vehicles (ATVs) were observed in the emergency rooms of 10 regional hospitals in Quebec. A total of 1,100 injuries were identified, including 3 fatal and 104 serious to critical injuries (AIS greater than or equal to 3). These injuries were to the lower limb (29%), the upper limb (28%), the head, neck, and face (26%), and the thorax, abdomen, and pelvis (18%). Close to one-half (45%) of the victims were 19 years old and less; 54% reported wearing helmets. Ten percent of the victims were hospitalized for an average period of 8 days. In 70% of the cases, the vehicle overturned: half of these vehicles turned on the side, 27% toward the back, and 19% flipped forward. Two-thirds of persons injured were involved in accidents in which no external objects were hit by the vehicle; these accidents typically involved vehicle overturns, both on hills and on level ground. Ninety-five percent of the vehicles were in good mechanical condition. The use of these vehicles presents a danger whether used by a child or an adult, by an experienced or an inexperienced rider. The average user may not be aware that three- and four-wheel ATVs demand considerable skill and caution. We suggest the use of accident reconstruction studies for possible engineering solutions.     

Psychoactive substance use and the risk of motor vehicle accidents.

The driving performance is easily impaired as a consequence of the use of alcohol and/or licit and illicit drugs. However, the role of drugs other than alcohol in motor vehicle accidents has not been well established. The objective of this study was to estimate the association between psychoactive drug use and motor vehicle accidents requiring hospitalisation. A prospective observational case-control study was conducted in the Tilburg region of The Netherlands from May 2000 to August 2001. Cases were car or van drivers involved in road crashes needing hospitalisation. Demographic and trauma related data was collected from hospital and ambulance records. Urine and/or blood samples were collected on admission. Controls were drivers recruited at random while driving on public roads. Sampling was conducted by researchers, in close collaboration with the Tilburg police, covering different days of the week and times of the day. Respondents were interviewed and asked for a urine sample. If no urine sample could be collected, a blood sample was requested. All blood and urine samples were tested for alcohol and a number of licit and illicit drugs. The main outcome measures were odds ratios (OR) for injury crash associated with single or multiple use of several drugs by drivers. The risk for road trauma was increased for single use of benzodiazepines (adjusted OR 5.1 (95% Cl: 1.8-14.0)) and alcohol (blood alcohol concentrations of 0.50-0.79 g/l, adjusted OR 5.5 (95% Cl: 1.3-23.2) and >or=0.8 g/l, adjusted OR 15.5 (95% Cl: 7.1-33.9)). High relative risks were estimated for drivers using combinations of drugs (adjusted OR 6.1 (95% Cl: 2.6-14.1)) and those using a combination of drugs and alcohol (OR 112.2 (95% Cl: 14.1-892)). Increased risks, although not statistically significantly, were assessed for drivers using amphetamines, cocaine, or opiates. No increased risk for road trauma was found for drivers exposed to cannabis. The study concludes that drug use, especially alcohol, benzodiazepines and multiple drug use and drug-alcohol combinations, among vehicle drivers increases the risk for a road trauma accident requiring hospitalisation.     

Psychoactive substance use and the risk of motor vehicle accidents.

The driving performance is easily impaired as a consequence of the use of alcohol and/or licit and illicit drugs. However, the role of drugs other than alcohol in motor vehicle accidents has not been well established. The objective of this study was to estimate the association between psychoactive drug use and motor vehicle accidents requiring hospitalisation. A prospective observational case-control study was conducted in the Tilburg region of The Netherlands from May 2000 to August 2001. Cases were car or van drivers involved in road crashes needing hospitalisation. Demographic and trauma related data was collected from hospital and ambulance records. Urine and/or blood samples were collected on admission. Controls were drivers recruited at random while driving on public roads. Sampling was conducted by researchers, in close collaboration with the Tilburg police, covering different days of the week and times of the day. Respondents were interviewed and asked for a urine sample. If no urine sample could be collected, a blood sample was requested. All blood and urine samples were tested for alcohol and a number of licit and illicit drugs. The main outcome measures were odds ratios (OR) for injury crash associated with single or multiple use of several drugs by drivers. The risk for road trauma was increased for single use of benzodiazepines (adjusted OR 5.1 (95% Cl: 1.8-14.0)) and alcohol (blood alcohol concentrations of 0.50-0.79 g/l, adjusted OR 5.5 (95% Cl: 1.3-23.2) and >or=0.8 g/l, adjusted OR 15.5 (95% Cl: 7.1-33.9)). High relative risks were estimated for drivers using combinations of drugs (adjusted OR 6.1 (95% Cl: 2.6-14.1)) and those using a combination of drugs and alcohol (OR 112.2 (95% Cl: 14.1-892)). Increased risks, although not statistically significantly, were assessed for drivers using amphetamines, cocaine, or opiates. No increased risk for road trauma was found for drivers exposed to cannabis. The study concludes that drug use, especially alcohol, benzodiazepines and multiple drug use and drug-alcohol combinations, among vehicle drivers increases the risk for a road trauma accident requiring hospitalisation.     

Driver age and traffic citations resulting from motor vehicle collisions

This paper is an initial effort to examine whether driver age is related to the likelihood of receiving a traffic citation as a consequence of a crash. All crashes involving two motor vehicles in Wisconsin, 1991 were examined; additional information on any injuries resulting from a crash were obtained from hospital discharge records. Controlling for a variety of driver, vehicle and crash-related factors, these data suggest that the likelihood of receiving a citation is an increasing function of driver age.     

Risky driving habits and motor vehicle driver injury

Risky driving is an important cause of motor vehicle injury, but there is a lack of good epidemiological data in this field, particularly data comparing risky driving in younger drivers to those of other age groups. We examined the relationship between risky driving habits, prior traffic convictions and motor vehicle injury using cross-sectional data amongst 21,893 individuals in New Zealand, including 8029 who were aged 16-24 years. Those who reported frequently racing a motor vehicle for excitement or driving at 20 km/h or more over the speed limit, and those who had received traffic convictions over the past 12 months, were between two and four times more likely to have been injured while driving over the same time period. Driving unlicensed was a risk factor for older but not younger drivers, and driving at 20 km/h or more above the speed limits was a stronger risk factor for younger (<25 years) than older drivers. These results confirm the need for interventions targeting risky driving and suggest that different strategies may be required for different high-risk groups.     

Mechanical failures as a contributing cause to motor vehicle accidents South Africa

Over the past decades motor vehicles became the primary mode of transportation in developing countries. At the same time an improvement in automotive engineering and manufacturing as well as the phenomena of urbanisation have resulted in more vehicles spending more time on the road at higher speeds. Invariably this leads to driving scenarios where safety critical manoeuvres have to be performed that rely on the mechanical condition of the vehicles. In developing countries, where economic realities force the population to make use of older and less reliable vehicles, the risk of accidents caused by some sort of mechanical failure increases. The casualty rate (events causing death and/or serious injuries) for road traffic accidents in South Africa is amongst the highest in the world. This trend has persisted with little variation over the years, despite the efforts of local road safety organisations and research institutes to decrease them. The main goal of this study was to establish the contribution of mechanical failures to motor vehicle accidents, and furthermore, to compare it with international trends. Data obtained from accident response units (ARU) indicate that tyres and brakes were the main contributors to mechanical failures resulting in accidents in the Pretoria region (Gauteng Province). However, the reported percentage of approximately 3% is comparable to similar statistics from developed countries. Detailed information on the condition of road-going vehicles was then collected in this area. The roadside survey (potential mechanical defect tests (PMDT)) indicated that 40% of the vehicles surveyed on the suburban road and 29% of the vehicles surveyed on the highway had mechanical defects that contravened current road and traffic regulations in South Africa and may, therefore, be at risk of causing an accident due to a mechanical failure. In the Minibus (taxi) survey, large irregularities in tyre inflation pressure were identified as a cause of concern. The main conclusion from this work is that tyres and brakes are the two most dominant components that contribute to the mechanical defects causing accidents, with overloading an additional factor to consider. It is important to acknowledge that these three factors can easily be monitored during simple roadside inspections.     

An ADL measure for spinal cord injury

Occupational therapists do not have a comprehensive, objective method for measuring how persons with tetraplegia perform activities of daily living (ADL) in their homes and communities, because SCI ADL performance is usually determined in rehabilitation. The ADL Habits Survey (ADLHS) is designed specifically to address this knowledge gap by surveying performance on relevant and meaningful activities in homes and communities. After a comprehensive task analysis and pilot development, 30 activities were selected that emphasize a broad range of hand and wrist, reaching, and grasping movements in compound activities. A sample of 49 persons with cervical spinal cord injuries responded to items. The sample was predominantly male, median age was 41 years, and ASIA motor classification levels ranged from C2 through C8/T1 with majority concentration in C4, C5, or C6 (68%). Each participant report was rated by an occupational therapist using a seven category rating scale, and the item by participant response matrix (30 X 49) was analyzed with a Rasch model for rating scales. Results showed excellent participant separation (>4) and very high reliability (>.95), and both item and participant fit values were adequate (STANDARDIZED INFIT less than absolute value of 3). With only two exceptions, all participants fit the Rasch rating scale model, and only one item "Light housekeeping" presented significant fit issues. Principal Components Analysis an analysis of item residuals did not reveal serious threats to unidimensionality. A between group fit comparison of participants with more versus less movement found invariant item calibrations, and ANOVA of participant measures found statistically significant differences across ASIA motor classification levels. These ADLHS results offer occupational therapists a new method for measuring ADL that is potentially more sensitive to functional changes in tetraplegia than most instruments in common use. Accommodation of step disorder with a three category rating scale did not diminish measurement properties.     

Analysis of injury severity and vehicle occupancy in truck- and non-truck-involved accidents.

The impact that large trucks have on accident severity has long been a concern in the accident analysis literature. One important measure of accident severity is the most severely injured occupant in the vehicle. Such data are routinely collected in state accident data files in the U.S. Among the many risk factors that determine the most severe level of injury sustained by vehicle occupants, the number of occupants in the vehicle is an important factor. These effects can be significant because vehicles with higher occupancies have an increased likelihood of having someone seriously injured. This paper studies the occupancy/injury severity relationship using Washington State accident data. The effects of large trucks, which are shown to have a significant impact on the most severely injured vehicle occupant, are accounted for by separately estimating nested logit models for truck-involved accidents and for non-truck-involved accidents. The estimation results uncover important relationships between various risk factors and occupant injury. In addition, by comparing the accident characteristics between truck-involved accidents and non-truck-involved accidents, the risk factors unique to large trucks are identified along with the relative importance of such factors. The findings of this study demonstrate that nested logit modeling, which is able to take into account vehicle occupancy effects and identify a broad range of factors that influence occupant injury, is a promising methodological approach.     

Incidence and patterns of spinal cord injury in Australia

The objective of this paper is to report on the epidemiology of spinal cord injury (SCI) based on the Australian SCI register and to discuss the implications for prevention. All adult cases of SCI are reported to the registry. The case reports for 1998/1999 were aggregated and described. The age adjusted rate of persisting SCI was 14.5 per million of population. Rates were highest in young adults and in males. The vast majority of cases (93%) were due to unintentional injury. Forty-three percent were due to motor vehicle crashes, principally from motor vehicle rollover. Cases of SCI from falls, aquatic activities, and working for income are also described. Incomplete cervical cord injuries were most common (38%), particularly as a result of motor vehicle crashes and low falls. The study indicates that the surveillance of SCI needs to be improved internationally so that comparative studies can be undertaken. It is recommended that the Centers for Disease Control case definition be adopted. Australia is one of the few countries that have a register based on that case definition, and the only one that has a register covering a full national adult population. The results presented on the basis of this data source provide some hitherto unavailable information on the incidence rates and patterns of SCI. National population based surveillance is fundamental to an understanding of the epidemiology, and hence the prevention, of this severe and costly health and welfare problem.     

The influence of vehicle damage on injury severity of drivers in head-on motor vehicle crashes

Data from crashes investigated through the Crash Injury Research and Engineering Network (CIREN) Program were used to assess differences in injury patterns, severity, and sources for drivers, protected by safety belts and deploying steering wheel air bags, in head-on frontal impacts. We studied whether exterior vehicle damage with a different distribution (wide vs. narrow) across the front vehicle plane influenced injury characteristics. Drivers from both impact types were similar on the basis of demographic characteristics (except age), restraint use, and vehicle characteristics. There were significant differences in the type of object contacted and intrusion into the passenger compartment at the driver's seat location. The mean delta V (based on the kilometers per hour change in velocity during the impact) was similar for drivers in both (wide vs. narrow) impact types. There were no significant differences in injury patterns and sources except that drivers in wide impacts were almost 4 times more likely (odds ratio (OR)=3.81, 95% confidence limits (CL) 1.26, 11.5) to have an abbreviated injury scale (AIS) 3 serious or greater severity head injury. Adjusted odds ratios showed that drivers in wide impacts were less likely (OR=0.54, 95% CI 0.37, 0.79) to have severe injury (based on injury severity score (ISS)>25) when controlling for intrusion, vehicle body type, vehicle curb weight, age, proper safety belt use, and delta V. Drivers with intrusion into their position or who were driving a passenger vehicle were almost twice more likely to have severe injury, regardless of whether the frontal plane damage distribution was wide or narrow. Our study supports that the type of damage distribution across the frontal plane may be an important crash characteristic to consider when studying drivers injured in head-on motor vehicle crashes.     

The prevalence of drugs in motor vehicle accidents and traffic violations in Shanghai and neighboring cities

The objective of this study was to determine the prevalence of psychoactive drug use among motor vehicle drivers in Shanghai and its neighboring cities. We selected 10,002 drivers involved in a traffic accident or violation between 2007 and 2008 in Shanghai, Suzhou and Wuxi. We checked for the presence of psychoactive drugs from blood samples using liquid chromatography tandem mass spectrometry (LC–MS–MS). Of the 10,002 drivers, 10.5% tested positive for drugs (excluding alcohol). Cold medicines were the most frequently detected drugs including chlorpheniramine (4.78%), pseudoephedrine (2.15%) and paracetamol (1.32%). The use of multiple cold medicines was common. Illegal drugs such as methamphetamine (0.15%), ketamine (0.03%) and MDMA (0.01%) were also detected. The prevalence of psychoactive drugs among drivers involved in traffic accidents or violations in Shanghai and its neighboring cities was lower compared to previous reports in Europe. Furthermore, cannabis—which has been reported to be the most widely used psychoactive drug after alcohol—was not commonly encountered among Shanghai drivers.