CHILDREN IN TRAFFIC ACCIDENTS

The part that children play in traffic accidents has been studied by numerous workers from differing points of view. Slätis,1 in a study of 5,291 persons injured in traffic accidents and receiving medical treatment in Sweden, found that 16.3% were less than 15 years of age. An examination by Mackay2 of a series of 250 accidents investigated at the scene in Birmingham, England, found that children less than 16 years of age formed 6.2% of the 464 persons involved. In Brisbane, Australia, Jamieson and Tait3 found that children less than 15 years old formed 10.9% of a group of 1,000 admissions or deaths from traffic accidents. Gädeke4 in Germany, found children less than 15 years old were injured more often in rural accidents, that traffic accidents formed 35 to 40% of all fatal accidents in children, and that injuries to the head and lower limb were most common. In Sweden, Ekström, et al.5 found that the majority of children involved in accidents they studied were pedestrians or pedal cyclists, and 40% were between 5 and 9 years old. Moore and Lilienfeld6 reported on 31,001 occupants of known age in 14,520 automobiles involved in injury-producing accidents on rural highways in the United States. They found that children less than 12 years of age formed 9%, adolescents age 12 to 18 years formed 16%, and adults of more than 18 years formed 75%. They found that children received fewer and less severe injuries than adolescents or adults, in each seating position. Front seat passengers in each age group were injured more often and more severely than rear seat passengers.

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Evolution of hospitalizations due to TBI according to the etiology of trauma in SUS Brazil 2010 – 2019

10.5327/1516-3180.652 ◽

2021 ◽

Author(s):

Luciana Maria Capurro de Queiroz Oberg ◽

Regina Marcia Cardoso de Sousa

Keyword(s):

United States ◽

Young People ◽

Traffic Accidents ◽

Public Health Problem ◽

The Elderly ◽

The United States ◽

Main Mechanism ◽

Age Group ◽

Very Elderly ◽

Mechanism Of Trauma

Introduction: Traumatic brain injury (TBI) is the main determinant of morbidity, mortality and disability for trauma victims, being considered a serious public health problem because it mainly affects individuals of productive age. The etiology of trauma differs according to the age group affected: falls in age extremes and external causes – especially traffic accidents – in young people and adults, constituting the main mechanism of trauma as a whole. Recent studies show that the epidemiology of TBI in the United States is changing: falls have been ahead of traffic accidents as the main mechanism of trauma, especially in the age group above 85 years of age, accompanied by the general reduction in TBI due to traffic accidents. Objective: To describe the evolution of the incidence of hospitalizations due to TBI and trauma mechanisms in the SUS between 2010 and 2019. Methods: Descriptive, cross-sectional study that analyzed hospital morbidity due to TBI in Brazil and the mechanism of trauma, from 2010 to 2019. General hospitalization data were obtained from SIH/ SUS. The ICD10 codes used were those referring to TBI: “Fracture of the skull and bones of the face” and “Intracranial trauma”. Descriptive statistics were used for data analysis. Data were collected in February 2021. Results: There was an increase in the incidence of TBI in all age groups in the period studied. Traffic accidents, despite all prevention actions, remain an important etiology in young people, adults and the elderly. There is a significant increase in the incidence of TBI and falls in the elderly and very elderly population. Conclusion: When compared to the evolution of the TBI profile in the United States, there was also an increase in incidence and etiology “falls” in the elderly and very elderly in Brazil. However, traffic accidents still represent an expressive mechanism of trauma related to TBI.

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Children in Car Crashes: Analysis of Data for Injury and Use of Restraints

PEDIATRICS ◽

10.1542/peds.93.6.960 ◽

1994 ◽

Vol 93 (6) ◽

pp. 960-965 ◽

Cited By ~ 1

Author(s):

Carden Johnston ◽

Frederick P. Rivara ◽

Robert Soderberg

Keyword(s):

Risk Factor ◽

Motor Vehicle ◽

The United States ◽

School Age ◽

Front Seat ◽

Injury Rates ◽

Car Seats ◽

Car Seat ◽

Car Crashes ◽

Seating Position

Objective. To determine the effect of car restraints on motor vehicle injury rates for children aged 0 to 14 years. Methods. A probability sample of all police-reported car crashes in the United States in 1990 and 1991 was analyzed for injury rates of passengers aged less than 15 years in relation to restraint usage, age, and seating position. Results. Optimal restraint usage (defined as car seats for children 0 to 4 years old and lap shoulder belts for children 5 to 14 years old) was 40%. The use of the car seat was 76% for infants (0 to 12 months old) and 41% for toddlers (1 to 4 year olds). The non use of a restraint was highest for 10 to 14 year olds (43%). The rate of involvement in car crashes for all children was 21.4 (per 1000/yr). The highest rate was the 14 year olds with 29.6 followed by 2 year olds with 26.5. Injury rates were 4.76 (per 1000/yr) for all children. The lowest rate was 2.91 for infants but increased to 4.78 for 3 year olds. The single strongest risk factor for injury was the non use of a restraint. (Adjusted odds ratio 2.7; 95% CI 2.4 to 3.0.) The risk factor for injury for the front seat was 1.5 (95% CI 1.4 to 1.7). Use of the car seat reduced injuries by 60% for 0 to 4 year olds, whereas the lap shoulder harness was only 38% effective for 5 to 14 year olds (P ≤ .001) Injury rates of unrestrained 0 to 4 and 5 to 14 year olds were similar. Conclusions. Greater involvement in car crashes and less use of car restraints explains the 64% higher rate of injury for 3 year olds than for infants. It is time to target the toddlers. Restraints designed for adults are not as effective for the school age child as car seats are for the preschool child. A better restraint for the school age child should be designed and evaluated. Meanwhile, increased usage of current restraints must be encouraged, as they substantially reduce injuries.

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The mechanism of injuring of front-seat passengers in head-on motor vehicle collisions: Forensic issues

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1306409n ◽

2013 ◽

Vol 141 (5-6) ◽

pp. 409-414 ◽

Cited By ~ 1

Author(s):

Slobodan Nikolic ◽

Veljko Strajina ◽

Vladimir Zivkovic

Keyword(s):

Traffic Accidents ◽

Motor Vehicle ◽

Road Traffic ◽

Underlying Mechanism ◽

Body Region ◽

Front Seat ◽

Body Regions ◽

Expert Analysis ◽

The Moment ◽

Seating Position

Forensic pathologists sometimes need to determine seating positions of automobile occupants after road traffic accidents as accurately as possible. That could be of essential significance particularly in regard to the question of guilt both in the criminal and civil law. So far, medical surveys have implied the specific injury which would undoubtedly point at the allocation of the seating positions of fatally injured car occupant. Some of the injuries could occur by both direct and indirect force action. Same type of injury of the specific body region in both drivers and front seat passengers could occur by different mechanism and in different phases of the accident. Sometimes neither the order of injury occurrence remains unclear, nor whether some of the injuries are post?mortal. What makes it even harder is the fact that same body regions, i.e. head and thorax, are most affected in both drivers and front seat passengers, and that these injuries are often fatal. Even if the victim survives the accident for some time and later dies in hospital, the possibility of accident reconstruction and determination of car occupants seating position at the moment of accident declines with the time length of survival period. Examining the victims? clothes, searching for biological traces, technical expert inspection of the vehicle, traffic expert analysis of the site, enables adequate reconstruction of the traffic accident. All this implies that in such cases the knowledge of underlying mechanism of car occupants? injury is insufficient, and that a close cooperation between forensic pathologists and the team of other forensic technical experts is necessary.

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Autopsy findings in drivers and passengers from fatal motor vehicle collisions: limited differences in injury patterns and toxicological test results

Forensic Science Medicine and Pathology ◽

10.1007/s12024-021-00359-z ◽

2021 ◽

Author(s):

Jan Mario Breen ◽

Pål Aksel Næss ◽

Christine Gaarder ◽

Arne Stray-Pedersen

Keyword(s):

Motor Vehicle ◽

Contact Point ◽

Seat Belt ◽

Rear Seat ◽

Motor Vehicle Collisions ◽

Front Seat ◽

Severe Injuries ◽

Vehicle Collisions ◽

Autopsy Findings ◽

Drug Concentrations

AbstractWe performed a retrospective study of the injuries and characteristics of occupant fatalities in motor vehicle collisions in southeast Norway. The goal was to provide updated knowledge of injuries sustained in modern vehicles and detect possible differences in injury pattern between drivers and passengers. Forensic autopsy reports, police, and collision investigation reports from 2000 to 2014 were studied, data extracted and analyzed.A total of 284 drivers, 80 front-seat passengers, and 37 rear-seat passengers were included, of which 67.3% died in front collisions, 13.7% in near-side impacts, 13.5% in rollovers and 5.5% in other/combined collisions. Overall, 80.5% died within one hour after the crash. The presence of fatal injuries to the head, neck, thorax and abdomen were observed in 63.6%, 10.7%, 61.6% and 27.4% respectively. All occupants with severe injuries to the head or neck had signs of direct impact with contact point injuries to the skin or skull. Injuries to the heart and spleen were less common in front-seat passengers compared to drivers. Seat belt abrasions were more common and lower extremity fractures less common in both front-seat and rear-seat passengers compared to drivers. Blood alcohol and/or drug concentrations suggestive of impairment were present in 30% of all occupants, with alcohol more often detected among front-seat passengers compared to drivers.Few driver-specific and passenger-specific patterns of injury could be identified. When attempting to assess an occupant’s seating position within a vehicle, autopsy findings should be interpreted with caution and only in conjunction with documentation from the crash scene.

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Skull and Face Injuries and Associated Factors in Pedestrian Victims of Traffic Accidents: A Single Trauma Center Analysis

Current Dentistry ◽

10.2174/2542579x02999200608131337 ◽

2020 ◽

Vol 2 (1) ◽

pp. 53-59

Author(s):

Josimara A. de Araújo Varela ◽

Tatiana F.T. Palitot ◽

Smyrna L.X. de Souza ◽

Alidianne F.C. Cavalcanti ◽

Alessandro L. Cavalcanti

Keyword(s):

Medical Records ◽

Associated Factors ◽

Traffic Accidents ◽

Age Group ◽

Chi Square ◽

Cross Sectional ◽

Significance Level ◽

The Face ◽

Chi Square Test ◽

The City

Objective: This study aimed to analyze the presence of lesions in the skull and face and the associated factors in pedestrian victims of traffic accidents. Methods: A cross-sectional, descriptive-analytical study carried out through the analysis of medical records of pedestrian victims of traffic accidents in an emergency service in the city of Campina Grande, Brazil, during the year of 2016. Information was collected regarding gender, age group, day of the week, time of the accident, type of vehicle involved, presence of trauma to the skull and face, and outcomes. The Chi-square and Fisher's Exact tests were used, with a significance level of 5%. Results: A total of 1,884 medical records were evaluated, out of which 7.1% (n = 133) involved pedestrians. Men were the most frequent victims (68.4%), and victims of age 60 years old or over (30.5%) predominated. Almost one-third of the cases were recorded during the weekends (30.5%), and the most prevalent time was at night (52.7%). Regarding the type of vehicle involved, motorcycles predominated (47.4%). Head trauma was present in 37.6% of victims, while facial injuries corresponded to 8.2%. In 12% of cases, the victims died. The variables of gender, age group, occurrence on weekends, and trauma to the face showed a statistically significant association with the occurrence of traffic accidents (Chi-square test; p<0.05). Conclusion: Among pedestrian victims of traffic accidents, there is a predominance of men aged 65 years or over. Accidents are frequent at night, and motorcycles are the main vehicles involved. The presence of trauma to the skull and face regions is high.

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Racial Disparities in Cognitive Function: The Roles of Cumulative Stress Exposures Across the Life Course

Innovation in Aging ◽

10.1093/geroni/igaa057.1627 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 504-504

Author(s):

Ruijia Chen ◽

Jennifer Weuve ◽

Laura Kubzansky ◽

David Williams

Keyword(s):

Executive Function ◽

Cognitive Function ◽

Episodic Memory ◽

Life Course ◽

Racial Disparities ◽

The United States ◽

Coping Resources ◽

Age Group ◽

Cumulative Stress ◽

The Life Course

Abstract Introduction: Racial disparities in cognitive function have been well-documented in the literature, but factors driving the disparities remain under explored. This study aims to quantify the extent to which cumulative stress exposures across the life course explain Black–White disparities in executive function and episodic memory. Method: Data were drawn from the 2004–2006 wave of the Midlife Development in the United States (MIDUS) and the MIDUS refresher study (N=5,967, 5,277 White, 690 Black). Cumulative stress exposures were assessed by using 10 domains of stressors (e.g., financial stress, childhood adversity). Cognitive function was assessed using the Brief Test of Adult Cognition by Telephone. Marginal structural models were conducted to quantify the proportion of the effect of race/ethnicity status on cognitive function that can be explained by cumulative stress exposures. Result: Blacks reported higher levels of cumulative stress exposures and lower average levels of executive function and episodic memory than Whites. Cumulative stress exposures explained 8.43% of the disparities in executive function and 13.21 % of the disparities in episodic memory. Cumulative stress exposures had stronger effects on racial disparities in cognitive function in the older age group (age≥ 55 years old) than in the younger age group (age < 55 years old). Conclusion: Cumulative stress exposures explain modest proportions of racial disparities in levels of cognitive function. Interventions that focus on reducing stress exposures or improving coping resources among Blacks may help lessen racial disparities in cognitive function at the population level.

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Epidemiology of Acute Extensor Mechanism Injuries in Collegiate-Level Athletes in the United States

Sports Health A Multidisciplinary Approach ◽

10.1177/19417381211012969 ◽

2021 ◽

pp. 194173812110129

Author(s):

Kevin K. Chen ◽

Jimmy J. Chan ◽

William Ranson ◽

Nicholas Debellis ◽

Hsin-Hui Huang ◽

...

Keyword(s):

Large Scale ◽

Injury Rate ◽

Collegiate Athletes ◽

The United States ◽

Extensor Mechanism ◽

Surveillance Program ◽

Level Of Evidence ◽

Severe Injuries ◽

Male Athletes ◽

Collegiate Level

Background: Extensor mechanism injuries involving the quadriceps tendon, patella, or patellar tendon can be a devastating setback for athletes. Despite the potential severity and relative frequency with which these injuries occur, large-scale epidemiological data on collegiate-level athletes are lacking. Study Design: Descriptive epidemiology study. Level of Evidence: Level 4. Methods: Knee extensor mechanism injuries across 16 sports among National Collegiate Athletic Association (NCAA) men and women during the 2004-2005 to 2013-2014 academic years were analyzed using the NCAA Injury Surveillance Program (NCAA-ISP). Extensor mechanism injuries per 100,000 athlete-exposures (AEs), operative rate, annual injury and reinjury rates, in-season status (pre-/regular/postseason), and time lost were compiled and calculated. Results: A total of 11,778,265 AEs were identified and included in the study. Overall, 1,748 extensor mechanism injuries were identified, with an injury rate (IR) of 14.84 (per 100,000 AEs). N = 114 (6.5%) injuries were classified as severe injuries with a relatively higher median time loss (44 days) and operative risk (18.42%). Male athletes had higher risk of season-ending injuries in both all (3.20% vs 0.89%, P < 0.01) and severe (41.54% vs 16.33%, P < 0.01) extensor mechanism injuries. Similarly, contact injuries were more frequently season-ending injuries (4.44% vs 1.69%, P = 0.01). Women’s soccer (IR = 2.59), women’s field hockey (IR = 2.15), and women’s cross country (IR = 2.14) were the sports with the highest rate of severe extensor mechanism injuries. Conclusion: Extensor mechanism injuries in collegiate athletes represent a significant set of injuries both in terms of volume and potentially to their athletic careers. Male athletes and contact injuries appear to have a greater risk of severe injuries. Injuries defined as severe had a higher risk of operative intervention and greater amount of missed playing time. Clinical Relevance: Knowledge of the epidemiology of extensor mechanism injuries may help clinicians guide their athlete patients in sports-related injury prevention and management.

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Analysis of Severe Injuries in Crashes Involving Large Trucks Using K-Prototypes Clustering-Based GBDT Model

Safety ◽

10.3390/safety7020032 ◽

2021 ◽

Vol 7 (2) ◽

pp. 32

Author(s):

Syed As-Sadeq Tahfim ◽

Chen Yan

Keyword(s):

Injury Severity ◽

Unobserved Heterogeneity ◽

The United States ◽

Clustering Methods ◽

Severe Injuries ◽

Traffic Crash ◽

Crash Data ◽

Boosted Decision Trees ◽

The Individual ◽

Crash Characteristics

The unobserved heterogeneity in traffic crash data hides certain relationships between the contributory factors and injury severity. The literature has been limited in exploring different types of clustering methods for the analysis of the injury severity in crashes involving large trucks. Additionally, the variability of data type in traffic crash data has rarely been addressed. This study explored the application of the k-prototypes clustering method to countermeasure the unobserved heterogeneity in large truck-involved crashes that had occurred in the United States between the period of 2016 to 2019. The study segmented the entire dataset (EDS) into three homogeneous clusters. Four gradient boosted decision trees (GBDT) models were developed on the EDS and individual clusters to predict the injury severity in crashes involving large trucks. The list of input features included crash characteristics, truck characteristics, roadway attributes, time and location of the crash, and environmental factors. Each cluster-based GBDT model was compared with the EDS-based model. Two of the three cluster-based models showed significant improvement in their predicting performances. Additionally, feature analysis using the SHAP (Shapley additive explanations) method identified few new important features in each cluster and showed that some features have a different degree of effects on severe injuries in the individual clusters. The current study concluded that the k-prototypes clustering-based GBDT model is a promising approach to reveal hidden insights, which can be used to improve safety measures, roadway conditions and policies for the prevention of severe injuries in crashes involving large trucks.

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Abstract 257: Urban Teaching and Non-Teaching Hospitals Outcomes: Myocardial Infarction

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.257 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Priscilla O Okunji ◽

Johnnie Daniel

Keyword(s):

Myocardial Infarction ◽

Mortality Rate ◽

Income Group ◽

The United States ◽

Teaching Hospitals ◽

Age Difference ◽

Age Group ◽

Urban Teaching ◽

Significant Difference ◽

The Impact

Background: Patients with myocardial infarction reportedly have different outcomes on discharge according to hospital characteristics. In the present study, we evaluated the differences between urban teaching hospitals (UTH) and non-teaching hospitals (NTH), discharged in 2012. We also investigated on the outcomes. Methods: Sample of 117,808 subjects diagnosed with myocardial infarction were extracted from a nationwide inpatient stay dataset using the International Classification Data, ICD 9 code 41000 in the United States, according to hospital location, size, and teaching status. Results: The analysis of the data showed that more whites were admitted to both teaching and non teaching hospitals with more males (~24%) admitted than their female counterparts. However, blacks were admitted more (~15%) in urban teaching hospitals than medium urban non teaching hospitals. Age difference was noted as well, while age group (60-79 years) were admitted more in UTH, inversely urban non-teaching hospitals admitted more older (80 years or older) age group. A significant difference (~28%) was observed in both hospital categories with UTH admitting more patients of $1.00 - $38,999.00 income group than other income categories. In addition, it was observed that patients with MI stayed more (~5%) for 14 or more days, and charged more especially for income group of $80,000 or above in UTH than NTH. No significant difference was found in the mortality rate for both hospital categories. Conclusion: The overall outcomes showed that the mortality rate between urban teaching and non-teaching hospitals were non significant, though the inpatients MI stayed longer and were charged more in UTH than NTH. The authors call for the study to be replicated with a higher level of statistical measures to ascertain the impact of the variables on the outcomes for a more validated result.

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A PEDIATRIC HOME CARE PROGRAM IN LONDON—TEN YEARS EXPERIENCE

PEDIATRICS ◽

10.1542/peds.36.3.314 ◽

1965 ◽

Vol 36 (3) ◽

pp. 314-321

Author(s):

A. B. Bergman ◽

H. Shrand ◽

T. E. Oppé

Keyword(s):

Home Care ◽

Home Environment ◽

Hospital Costs ◽

Care Program ◽

Chronically Ill ◽

The United States ◽

Age Group ◽

Small Children ◽

Descriptive Account ◽

Sick Children

RECENT YEARS have seen a resurgence of interest in organized Home Care programs as a variety of factors have spurred the search for alternatives to hospital care. Chief among them has been the economic burden of spiraling hospital costs. Many programs have been devised to enable chronically ill persons in the older age group—the "home-bound" geriatric patient—to be supervised in their own homes. There are, however, special reasons for attempting to control the admission of children to hospitals. Illness is a time when a child becomes more dependent than usual and seems to need the security of parents and the comfort of familiar home environment. Even though enlightened hospitals now encourage visiting, many parents cannot take advantage of this for such reasons as distance and having to care for the other children at home. There is debate as to the amount of emotional harm caused by hospitalization of small children; most workers would say it does no good, and, in some cases, can lead to serious sequelae. The Home Care Program for sick children at St. Mary's Hospital in London was started in April, 1954. One of us (A.B.B.) had the opportunity of participating in this program in 1961 while serving as an Exchange Registrar from Children's Hospital (Boston). It is felt that even though conditions in the United States and Great Britain may be different, there are enough similarities to make a descriptive account of the program of interest to American physicians. The Development of Home Care Schemes Historically, doctors looked after the sick in their own homes when private fees could be afforded.

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