Seating position and patterns of severely injured body parts among child passengers in motor vehicle crashes: Japan as a distinct case

ABSTRACT

This study describes injury patterns and outcomes related to the seating position of child passengers involved in motor vehicle crashes in Japan. Using data obtained from a national trauma registry database, we compared the occurrence of injuries by body parts, length of hospital stay and in-hospital deaths between front-seating and rear-seating among children. We analysed 166 children aged 0–5 years and 205 children aged 6–12 years. No significant differences were observed between front- and rear-seating for injured body parts, length of hospital stay or in-hospital deaths in the 0–5-year-old victims. Among those aged 6–12 years, rear-seating was associated with a higher incidence of head and chest injuries but the length of stay or in-hospital deaths did not differ. These findings contrast those of previous studies, which found that rear-seating reduces injury risk, possibly attributed to low age-appropriate restraint use among school-aged children in Japan.     

Seatbelt and child restraint use among vehicle occupants in Ho Chi Minh City: an observational study in Vietnam

Abstract

This paper presents the trend of seatbelt use, disaggregated by vehicle occupants, in Ho Chi Minh City between 2016 and 2018. We conducted statistical analyses to identify the determinants of seatbelt use, including the effect of a new fine imposed against seatbelt law violation in the rear seats that became effective in January 2018. Seatbelt use was observed in at least half of all vehicle occupants, and drivers were more likely to use seatbelts than passengers. Only 4.4% of children younger than 5-years and 2.5% of 5 to12-year-olds used a child restraint system. Seatbelt use increased among all occupants after the imposed fine, especially among rear-seat passengers. Imposing new or increasing fixed penalties, with enforcement and public education, may increase seatbelt use to prevent road traffic injuries.     

Are child passenger fatalities and child passenger severe injuries equally affected by child restraint legislation? The case of Chile

The objective of this study is to determine the contribution of Chile's 2005 child restraint legislation to the reduction of child passenger fatalities and severe injuries. We analysed motor vehicle injury and fatality data from Chile's National Road Safety Commission of the Ministry of Transport from 2000 to 2012 to determine the effect of Chile's 2005 mandatory child restraint legislation. Using interrupted time-series Poisson regression models, we assessed the effect of the law on two dependent variables: (1) number of child fatalities in car and (2) number of children severely injured. The independent variable was the 2005 enactment of Chile's mandatory child restraint legislation. Coefficients from the interrupted time-series Poisson regression models indicate that Chile's enactment of child restraint legislation in 2005 is significantly associated with a total of 35% reduction in child passenger severely injured but only three years after its enactment, and significant associations between this policy and child fatalities were less evident.     

Child injuries in land vehicles that do not require restraints

Abstract

The goal of this study was to determine the injury profiles of Canadian children who presented to the Emergency Department from 1990 to 2016 due to an injury caused while traveling in a form of land transportation that did not require child restraint. A case series was conducted using data from the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP). Children who were injured while travelling on land transportation for which child restraint is not required, who presented to a Canadian Emergency Department that participates in eCHIRPP between April 1, 1990 to August 29, 2016, were included. Overall, 1856 children sustained 2139 injuries (mean age: 9.8?years (SD 4.5), 45.5% male). The majority of children were injured on a school bus (49.3%). The most commonly injured body part was the head or neck (52.6%). The most common type of injury was a superficial or open wound (33.1%), followed by traumatic brain injury (19.3%). Overall, 39.4% of injuries required no treatment in hospital. Overall, approximately 70 children presented to eCHIRPP EDs per year on a land transportation vehicle that does not require restraints. Biomechanical studies are needed to improve safety on land transportation vehicles that do not require seatbelts.     

Severity of alcohol-related motor vehicle crashes in British Columbia: case - control study

The objective of the present study was to compare the injury severity and vehicle damage severity rates of alcohol-related crashes with rates of non-alcohol-related crashes in British Columbia (BC). Injury severity rates and vehicle damage severity rates were taken from 2002 Insurance Corporation of British Columbia traffic collision data. The data were computed in order to compare the differences in injury severity and vehicle damage severity rates of alcohol-related vs. non-alcohol-related motor vehicle crashes. Case - control methods were used in this study to analyse the risk of alcohol-related crashes compared to non-alcohol-related crashes in BC. Odds ratios (OR) and 95% CI were calculated to estimate relative risks. In the case - control analysis, the risk of fatal collision was increased for those drinking and driving compared with those driving sober (OR 4.70; 95% CI 3.15 - 7.01). Risk of injury collision was increased for those drinking and driving compared with those driving sober (OR 1.32; 95% CI 1.19 - 1.37). Importantly, the risk of vehicle damage severity was increased for those drinking and driving compared with those driving sober (write-off vehicle OR 4.24; 95% CI 3.70 - 4.86, severely damaged vehicles OR 1.98; 95% CI 1.77 - 2.21). The study reinforces existing literature to suggest that current evidence is sufficient to show an increased risk of injury and fatality to drivers and occupants in alcohol-related crashes. This paper not only emphasizes this well-known relationship, but also such consequences as increased vehicle damage severity. The connection between drinking and severity of motor vehicle crashes is popularly believed and has now received substantial scientific support. There is strong justification for injury prevention experts and policy-makers to step up motor vehicle crash injury prevention advocacy by implementing evidence-based policies to reduce rates of alcohol-impaired driving in the province of BC. Most unintentional injuries in BC are related to motor vehicle crashes. Significant improvements can be made in these statistics by: increasing the use of occupant protection (safety belt and child restraint seats); reducing alcohol-related injuries through multiple strategies including corrections in the physical environment, extensive enforcement of drinking and driving laws and health promotion/education.     

The influence of licence status on Kansas child fatalities due to motor vehicle crashes

The influence of driver licensure on child motor vehicle crash (MVC) deaths in Kansas was investigated. Fatalities from 1994-2000 due to MVCs were extracted from the Kansas State Child Death Review Board and the Fatality Analysis Reporting Systems databases. It was found that 14% (52 of 363) of child fatalities from MVCs in Kansas occurred in vehicles where the driver was not licensed. Driver licence status was associated with use of safety restraints, the victim's age and race, weekend driving and rural county location. All child deaths involving unlicensed drivers were preventable. New legislation on vehicle sanctions may be required to assist law enforcement. Safety restraint laws should be enforced and promoted to the public. Transportation options are necessary for unlicensed drivers, particularly if they have young children and live in a rural community. Thus, a multi-system approach involving law enforcement, accident prevention strategies and transportation options will save the lives of children.     

Compulsory child restraint seat law and motor vehicle child occupant deaths and injuries in Japan 1994-2005

The purpose of child restraint seats (CRS) is to reduce the number of individuals killed or injured in motor vehicle (MV) crashes. Japanese Road Traffic Law 17-3-4 (April 2000) specifies a requirement that CRS be used for all children aged 0-5 years. The objective of this evaluation was to determine the legislative impact on fatalities in Japan for the period 1994-2005. Data were obtained from the Institute for Traffic Accident Research and Data Analysis. A time-series Poisson regression model was used to analyse the change (6 years pre/post) in incidence rate ratios of fatality and injury in MV crashes among children ages 0-5 years. Despite increases in CRS use, fatalities failed to decrease significantly after enactment of the law (incidence rate ratio: 0.80; 95% CI: 0.49-1.31). In 2005, 67% of children aged 0-5 years, who were killed as MV occupants were not seated in CRS. Between 2000 and 2005, the lack of CRS led to 43% of front seat passenger deaths, 54% of rear seat deaths, 143 children died in total and 500 + children were seriously injured. It was found that the compulsory CRS law enacted in April 2000 did not result in a statistically significant reduction in child MV occupant fatalities and injuries in Japan.     

NEWS & EVENTS

Abstract

Seat belt use does not only save lives but prevents the severity of injuries in road traffic crashes (RTCs). Vehicle type and usage have been found to influence the use of seat belt in cities like Kumasi, the host of Kwame Nkrumah University of Science and Technology (KNUST) campus. This paper presents a study on an un-obstructive survey of seat belt use by vehicle occupants entering and leaving KNUST campus through the four entrances from 7 to 9 am and 3 to 5?pm on five weekdays. A total of 5489 vehicles with 9542 occupants comprising 5489 drivers, front-right and first back seat and second back seat passengers were observed. The majority of the private and SUV drivers used seat belts. Meanwhile, almost all the commercial drivers did not use seat belts. There is a statistically significant relationship between vehicle type and use and the use of seat belt in KNUST.     

Non-seatbelt use and associated factors among passengers

Seatbelt use is the most effective way to save lives and reduce severe injuries. However, the percentage of non-seatbelt use is still high among drivers and passengers. Although the factors related to non-seatbelt use among drivers have been widely studied, the factors associated with non-seatbelt use among passengers have not been well documented. In addition, recent surveys showed that the driver's attitude has a significant impact on the passenger's seatbelt use. However, the lower response rate and less accurate of self-reported seatbelt use in survey studies, especially among participants who had a high level perception of penalty for non-seatbelt use. Therefore, we examined the association between passenger's seatbelt use and driver's seatbelt use with a statewide injury surveillance system. 36,012 passengers who were involved in motor vehicle crashes (MVC) in 2004–2013 were included in this study. Our results showed that if a driver wore a seatbelt, 92.6% of his/her passengers also wore seatbelts while if a driver did not wear a seatbelt, only 19.1% of his/her passengers wore seatbelts. Compared to the passenger whose driver wore a seatbelt, the passenger had a significantly higher probability of non-seatbelt use (odds ratio = 46.7; 95% confidence intervals, 42.7–51.1) if his/her driver did not wear a seatbelt. The driver has the greatest influence on the passenger's seatbelt use. The findings will provide important information for future public health practices to increase seatbelt use at the highest possible rate for passengers, such as educational interventions for drivers and seatbelt reminders use.     

Analysis of fatal injuries in Serbian underground coal mines – 50 years review

Abstract

The study presented here analyzes mining accidents and fatal injuries in Serbian underground coal mines over a period of 50?years, in order to assess the effectiveness of legislation changes in the overall safety of work environment. Two distinct periods, prior to 2000 and after 2000 were compared. The data from the period after 2000 were further analyzed to provide better understanding of the results. In order to assess the overall state of safety in Serbian mines, the data on fatal injuries were also compared to the international data. It was found that the legislative changes are more easily accepted by the common workers than by the mine management. Consequently, the key recommendation for the safety of coal mine companies in Serbia is the investment in the new technology. Additionally, mine management should be in the focus of the mining inspection with a stronger penal policy regarding mine safety neglect.     

Determinants of severe injury and mortality from road traffic accidents among motorcycle and car users in Southern Thailand

Abstract

This study aimed to identify factors associated with severe injury and mortality from road traffic accidents (RTA) among motorcycle and car users in southern Thailand. The data were obtained from the Office of Disease Prevention and Control, Thailand, for years 2008–2013. Chi-squared tests were used to assess associations between determinants and outcomes and these associations were then estimated after adjusting for possible confounding with other factors using logistic regression. Severe injury and mortality contributed 11.6% and 5% to RTA of motorcycle users, and 14.3% and 7.5% for car users. Among motorcycle users, male gender, older age, and not wearing a helmet increased severe injury and mortality rates, whereas drivers had more severe injuries than passengers. Older car users had higher severe injury and mortality rates, whereas not fastening seat belts had higher mortality. Safety device use should be made mandatory for both drivers and passengers. Male motorcycle users and the elderly should be focused on.     

The employer costs of motor vehicle crashes

The latest published estimate of the cost of US motor vehicle crashes to employers is for 1989. This study estimates annual employer costs in 1998-2000. Incidence was estimated with occupational injury data and motor vehicle crash data for 1998-2000. Employer costs were estimated from Federal estimates of crash costs by source of payment using data on the percentage of varied payment streams (e.g. health insurance, sick leave) paid by employers. Motor vehicle crash injuries on and off the job cost employers almost $60 billion annually, including $16.3 billion in fringe benefit costs; $25.2 billion in property damage, workplace disruption and other non-fringe costs; and $18.4 billion in wage-risk premiums. Traffic safety programmes can reduce the fringe benefit bill without reducing the benefits offered to employees. Eliminating alcohol-impaired and unrestrained driving would save employers $15.2 billion annually.     

Assessment of the road safety performance of four roundabouts in Kumasi,Ghana

Upgrade of the Ejisu-Kumasi section of the N6 saw the construction of roundabouts at selected intersections. Their use appears challenging particularly for vehicles with elevated Centre-of-Gravity. The objective of this study was to establish the relative risk of traffic accident deaths or hospitalized injuries at the roundabouts. Five-year crash data covering a 100 m stretch upstream and downstream of the roundabouts were analysed. A total of 119 crashes occurred with 18% casualty hospitalization and 12%fatalities. Compared with the Ejisu roundabout, fatal or hospitalized injuries were significantly higher at the Boadi (OR = 25.6, p = 0.0021) and Kwame Nkrumah University of Science and Technology Police Station Junctions (OR = 48.2, p < 0.001). Occupants of buses, heavy goods vehicles and riders of two wheelers were at elevated risk of deaths or serious injuries. Crash severity at the round abouts was aggravated by night-time, steep gradients and adverse cambers. It is recommended that, signalization and grade separation should be used in the current arrangement where appropriate.     

An economic analysis of child restraints

Child safety in automobiles became an important safety issue during the 1970s. It was recognized that children needed their own specific restraint systems and that unrestrained children were particularly susceptible to serious injuries, in particular head injury. As a result performance standards for child restraints were issued by the federal government while states passed child restraint use laws. This study examined the cost per life year saved for child restraints which were in use in 1987. These costs are likely to be overestimated since the analysis did not consider the benefits from injury reduction, the quality of the life year saved and the effect of the child's death on remaining family members. The discount rate had a major impact on the cost per life year saved due to the long life expectancy of young children. It was concluded that child restraints were cost effective though problems of misuse and nonuse remained.

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Zusammenfassung Eine ökonomische Analyse von Kinder-Sicherheitssitzen im Auto. Anfang der 70er Jahre wurde die Sicherheit von Kindern in Automobilen zu einem wichtigen Thema, nachdem beobachtet worden war, da\ ungesicherte Kinder erheblichen Gefahren von Verletzungen ausgesetzt sind, insbesondere von Kopfverletzungen. Die Notwendigkeit spezieller Kindersicherungen wurde deutlich; Sicherheitsstandards für Kindersitze wurden behördlich erlassen und die Benutzung von solchen Sitzen bindend vorgeschrieben.Die vorliegende Untersuchung ermittelte für das Jahr 1987 die Kosten von Kinder-Sicherheitssitzen pro gerettetem Lebensjahr, wobei in der Berechnung sowohl die Zahl der geretteten Leben wie auch die Lebenserwartung eines Kindes im Jahre 1987 berücksichtigt wurden. Die Berechnung erfa\te nicht die positiven Effekte durch Verringerung der Verletzungsgefahr, die Lebensqualität der geretteten Lebensjahre und die negativen Effekte auf die Familie eines getöteten Kindes; insofern dürften die ermittelten Kosten tendenziell überschätzt sein. Hauptergebnis der Analyse ist, da\ Kinder-Sicherheitssitze auch bei rein ökonomischer Betrachtung kosteneffektiv sind, wenn es auch Probleme dadurch gibt, da\ die Sitze gelegentlich fehlerhaft oder überhaupt nicht benutzt werden.

     

Short Reports

As the US population ages, more older adults will face transportation and mobility challenges. This study examines the characteristics and contributing circumstances of nonfatal older adult pedestrian injuries. Data were obtained from the National Electronic Injury Surveillance System-All Injury Programme (NEISS-AIP) for the years 2001 through 2006. Cases included persons aged 65 years and older who were nonfatally injured on a public roadway. The results indicated that on average, an estimated 52,482 older adults were treated in emergency departments each year for nonfatal pedestrian injuries. Falling and being hit by a motor vehicle were the leading mechanisms of injury, resulting in 77.5% and 15.0% of older adult pedestrian injuries, respectively. More than 9000 older pedestrian fall-related injuries each year involved a kerb. It is concluded that the growth in the older adult population could add to the overall burden of these nonfatal pedestrian injuries. Making transportation and mobility improvements, including environmental modifications, is important for preventing these injuries.     

Road traffic injury among child motorcyclists in Vientiane Capital,Laos: a cross-sectional study using a hospital-based injury surveillance database

This study investigated the distribution of motorcyclists, including drivers and passengers, who were involved in road traffic crashes and admitted to hospital in Vientiane Capital, Laos. The focus was on child motorcycle drivers and passengers under 15 years. A hospital-based injury surveillance database in Vientiane Capital was used. The surveillance was performed in two hospitals. From 1 September to 31 December 2009, 3968 patients were admitted to the participating hospitals with road traffic injuries. Patients under 15 years accounted for 10.8% (427/3968). The majority of patients under 15 years were motorcycle drivers or passengers (71.7%, 306/427). Child motorcyclists including drivers and passengers were less likely to wear a helmet than adults (adjusted odds ratio [OR], 0.3, 95% confidence interval [CI], 0.2–0.5, for children 10–14 years; adjusted OR: 0.1, 95% CI, 0.05–0.4, for children under 10 years). It is suggested that stricter regulation enforcement for child motorcycle drivers and passengers may be needed. In addition, barriers against wearing helmets for motorcycle drivers and passengers in Laos should also be examined in further studies.     

Road traffic crash injuries and fatalities in the city of Kerman,Iran

The objective of this study was to investigate road traffic crash injuries and fatalities. Cases of 3902 road traffic injuries (1709 drivers, 891 passengers, 376 pedestrians and 926 motorcyclists) and 1564 road traffic fatalities (RTFs; 1222 males and 342 females) were collected from 2005 to 2008 using the database of the police forces and Department of Forensic Medicine in Kerman, respectively. Results showed that 66% of the injuries were related to car occupants (drivers and passengers) and men/women ratio was 5:1. The highest men/women ratio was (12.2:1) for drivers, while the lowest ratio (1.8:1) was for pedestrians. Most of the injuries had taken place at 16:01–20:00 h followed by 08:01–12:00 h. Highest numbers of injuries were found in male with the age groups of 18–24 years. The highest fatality rate of 79 per 100,000 population occurred in 2007–2008. Fatality ratio indicated higher male ratio, four times higher than females. The victims were 39% male between 30 and 55 years of age. Head injuries were present in 69% of the cases. In our series of forensic autopsy cases, head injuries were more frequent in motor vehicle occupants, pedestrians and motorcyclists. On average, two people died per day in RTFs in Kerman.