Motorcycle crashes and upper extremity trauma

Objectives: Upper extremity injuries following motorcycle crashes (MCC) incur increased healthcare costs and rehabilitation needs. We aim to characterize the epidemiology of MCC upper extremity injuries and identify factors that influence the severity of and cost of care for upper extremity injuries. Methods: We performed a retrospective cohort analysis of 571 patients with upper extremity injuries after MCC at a level 1 trauma center from 2002 to 2013. We collected data pertaining to demographics, helmet use, toxicology, bony injury, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), hospital length of stay (LOS), and cost. Continuous variables were compared using t-test or Wilcoxon rank test, depending on data distribution, and dichotomous variables were compared using Pearson’s chi-squared or Fisher’s exact tests. Regression models were used to evaluate the effect of intoxication or helmets on injury location, severity, cost of care, and LOS. Results: The incidence of MCC upper extremity injury was 47.5%, with hand and forearm fractures the most common injuries (25.5% and 24.7% of total injuries). Intoxicated patients were more likely to have a high cost of care (p = 0.012), extended LOS (p = 0.038), plastic surgery involvement in their care (p = 0.038), but fewer upper extremity bony injuries (p = 0.019). Non-helmeted patients sustained less upper extremity bony injuries (p < 0.001) and upper extremity soft tissue injuries (p = 0.001), yet more severe injuries (ISS ≥ 30, p = 0.006 and GCS < 9, p < 0.01) than helmeted patients. Conclusion: Upper extremity injuries are common in motorcyclists. Despite vital protection for the brain and maxillofacial injury, helmeted MCC patients have an increased incidence of upper extremity injuries compared to non-helmeted patients, but overall have less severe injuries. Intoxicated patients have fewer upper extremity bony injuries, but the higher cost of care, and extended LOS. Therefore, even with the increased risk of injury helmets may expose to the upper extremity, helmets reduced overall morbidity and mortality. In addition to mandatory helmet laws, we advocate for further development of safety equipment focusing specifically on the prevention of upper extremity injuries.

Defining crash configurations for Powered Two-Wheelers: Comparing ISO 13232 to recent in-depth crash data from Germany, India and China

The motorcyclist safety standard ISO 13232, based on crash data from Europe and the USA from the 1970s, still sets the direction for the development and evaluation of protective measures today. However, it is unclear how relevant the crash configurations in the standard are to present-day motorcycle crashes in Europe, the USA and other parts of the world. We analyzed recent in-depth crash data from Germany, India and China, examining powered two-wheeler (PTW) crash configurations in which at least one police-reported serious injury was present. After assessing the relevance of the ISO's PTW crash configurations to those we found in each country, we suggested new configurations to guide the development of safety systems that would be more effective at reducing PTW-related fatalities and serious injuries. In all three databases, passenger cars were among the top two most frequent collision partners and a car front impacting the side of the PTW was the most common configuration. Notably, although collisions with trucks constituted the most common scenario in India and ground impact (primary collision) was a common scenario in both Germany and India, the ISO did not include either configuration. Further, in three of the seven ISO crash configurations, one of the collision partners is stationary, although stationary collision partners were rare in our data. Our results show that the ISO crash configurations do not represent the most frequent PTW road crashes in Germany, India or China. However, the Chinese database was confined to crashes with a collision partner with four or more wheels. Further, weighting factors for these data were not available, so we could not extrapolate the frequency of the Chinese crash configurations across the entire population. A revised version of the ISO could serve as a basis for a full-scale PTW crash test program. However, the observed differences between countries imply that a single global standard may not be feasible. To optimize the evaluation of a PTW safety system, we recommend the inclusion of configurations which are frequent in the region or country of interest-in addition to common configurations occurring frequently all around the world.

Investigation of accidents involving powered two wheelers and bicycles - A European in-depth study

INTRODUCTION

The number of road fatalities have been falling throughout the European Union (EU) over the past 20 years and most Member States have achieved an overall reduction. Research has mainly focused on protecting car occupants, with car occupant fatalities reducing significantly. However, recently there has been a plateauing in fatalities amongst 'Vulnerable Road Users' (VRUs), and in 2016 accidents involving VRUs accounted for nearly half of all EU road deaths.

METHOD

The SaferWheels study collected in-depth data on 500 accidents involving Powered Two-Wheelers (PTWs) and bicycles across six European countries. A standard in-depth accident investigation methodology was used by each team. The Driver Reliability and Error Analysis Method (DREAM) was used to systematically classify accident causation factors.

RESULTS

The most common causal factors related to errors in observation by the PTW/bicycle rider or the driver of the other vehicle, typically called 'looked but failed to see' accidents. Common scenarios involved the other vehicle turning or crossing in front of the PTW/bicycle. A quarter of serious or fatal injuries to PTW riders occurred in accidents where the rider lost control with no other vehicle involvement.

CONCLUSIONS

Highly detailed data have been collected for 500 accidents involving PTWs or bicycles in the EU. These data can be further analyzed by researchers on a case-study basis to gain detailed insights on such accidents. Preliminary analysis suggests that 'looked but failed to see' remains a common cause, and in many cases the actions of the other vehicle were the critical factor, though PTW rider speed or inexperience played a role in some cases. Practical Applications: The collected data can be analyzed to better understand the characteristics and causes of accidents involving PTWs and bicycles in the EU. The results can be used to develop policies aimed at reducing road deaths and injuries to VRUs.

Patterns of traumatic injuries and outcomes to motorcyclists in a developing country: A cross-sectional study

OBJECTIVE

Motorcyclists are frequently involved in road traffic accidents and may suffer polytraumatic injuries, contributing a substantial burden on healthcare systems particularly in lower-middle-income countries. This study aimed to describe patterns of injury, in-hospital course, and outcomes of road accident trauma in motorcyclists, including polytrauma, at a Trauma Facility in Pakistan.

METHODS

A retrospective review was conducted by using relevant trauma codes to extract data from records for all victims presenting with motorcycle trauma between January 2018 and June 2019, to a tertiary care hospital in Pakistan. Data collected included victim characteristics, mechanism of accident, patterns of traumatic injury, management, in-hospital complications, and outcomes. Polytrauma was defined as traumatic injuries in two or more anatomic regions with abbreviated injury scale (AIS) ≥ 3. Multivariable logistic regression, adjusted for age, gender, and mechanism of accident, was performed to identify in-hospital complications and outcomes associated with polytrauma.

RESULTS

A total of 514 victims, 90.9% male and 39.5% aged between 18-30 years, were included in this study. The victim was the motorcycle driver in 94.6% of cases. The most common mechanism of accident was motorcycle vs. other motor vehicle (56.2%). Patients were mostly admitted under the services of Orthopedic Surgery (50.8%) and Neurosurgery (30%), with common sites of injury being the lower extremity (42.6%), head (38.1%), and upper extremity (26.8%). Polytrauma occurred in 19.5% of victims. Patients were managed surgically in 77.3% of cases, with the most common procedure being open reduction of fractures (48.1%). Blood transfusion was required in 4.1% of patients. The commonest in-hospital complication was acute kidney injury (23.7%). The median length of stay was 3 days, and 4.1% of patients expired in the hospital. Polytrauma was significantly associated with the need for blood transfusion (2.642 [1.053-6.630]), AKI (2.212 [1.339-3.652]) and hospital length of stay (1.059 [1.025-1.094]), but not with mortality.

CONCLUSION

Although orthopedic injuries occur most frequently in motorcycle trauma, polytrauma necessitating multi-disciplinary management and complicating hospital stay is also common. Understanding patterns of injuries and management in motorcycle trauma will enable trauma teams in a developing country like Pakistan to devise evidence-based management protocols, especially for cases of polytrauma.

Investigating the feasibility of motorcycle autonomous emergency braking (MAEB): Design criteria for new experiments to field test automatic braking

Autonomous Emergency Braking (AEB) was proved to be an effective and reliable technology in reducing serious consequences of road vehicles crashes. However, the feasibility in terms of end-users' acceptability for the AEB for motorcycles (MAEB) still has to be evaluated. So far, only Automatic Braking (AB) activations in straight-line motion and decelerations up to 2 m/s² were tested with common riders. This paper presents a procedure which provides comprehensive support for the design of new experiments to further investigate the feasibility of MAEB among end-users. Additionally, this method can be used as a reference for designing tests for other advanced rider assistance systems.•A comprehensive literature review was carried out to investigate previous findings related to MAEB. After that, a series of pilot tests using an automatic braking device on an instrumented motorcycle were performed.•The specifications for new AB experiments were defined (in terms of test conditions, participants requirements, safety measures, test vehicles and instrumentation).•A test protocol was defined to test the system in different riding conditions and with different AB working parameters. A proposal for the data analysis was presented.

Relation between riding pleasure and vehicle dynamics - Results from a motorcycle field test

Powered two-wheelers are a common means of transport all over the world. In several countries, primary motorcycles with high displacement involve another purpose, namely motorcycling is a leisure activity. Motorcycles are used as tools of transport pleasure as opposed to being purely used for individual commuting purposes. The aim of the current study involves investigating the relation between experienced riding pleasure and riding behavior in a field test. Specifically, N = 12 motorcyclists between 21 and 66 years of age were observed while riding for approximately 8 h on public roads. The measurement setup included a logger for vehicle dynamics and vehicle handling data, GNSS data, video data, and subjective measures recorded as audio comments at predefined points of interest along the round course. A comprehensive dataset with more than 6000 km of motorcycling was gathered. The results indicate that parameters of lateral vehicle behavior, such as the maximum lean angle, reflected riding pleasure. Interestingly, this is applicable for curvy sections as well as straight roads. High ratings of riding pleasure correlated with riding in snaky lines as a type of self-stimulation on straight sections. Longitudinal vehicle dynamics, such as the range of accelerations, tend to increase with the riding pleasure in curves. Hence, the effects are smaller than those for lateral vehicle behavior and not visible on straight sections. Generally, curvy sections on rural roads produce higher pleasure than straight roads. On a global level, riding pleasure increases during the first few hours of riding and subsequently decreases with respect to the time on task. The results are discussed in the context of studies on driving pleasure from the automotive sector and more fundamental psychological theories that explain pleasure as a physiological stimulation or flow. Several individuals ride motorcycles to experience pleasure. A better understanding of rider behavior in these situations can aid in deriving proper assistance and to provide individual support to a rider, thereby increasing riding pleasure as well as safety.

Motorcycle-related head and neck injuries: increased risk among ethnic minorities

Background

Ethnic disparities have been associated with injury and mortality. The impact of ethnicity on head and neck injury (HNI), traumatic brain injury (TBI), in-hospital mortality and resource utilization following a motorcycle crash (MCC) is undetermined. This study explored the influence of ethnicity in these aspects and the effect of helmet use on HNI and TBI following a MCC.

Methods

The National Trauma Registry provided hospitalization data on motorcycle riders and passengers between 2008 and 2017. Ethnicity was classified as Jews or Arabs, the two major ethnic groups in Israel. Univariate followed by multivariable logistic models were applied to examine ethnic disparities. Mediation effect was tested by structural equation modeling.

Results

Among 6073 MCC casualties, Arabs had increased odds of HNI (OR = 1.37,95% CI = 1.12–1.65) and TBI (OR = 1.51,95%CI = 1.12–1.99), and a six-fold decreased odds of helmet use (OR = 0.16,95%CI = 0.12–0.22). The HNI and TBI associations with ethnicity were mediated by helmet use. Arabs had significantly higher odds for admission to intensive care unit (OR = 1.36,95%CI = 1.00–1.83), and lower odds for ambulance evacuation (OR = 0.73,95%CI = 0.61–0.89) and discharge to rehabilitation (OR = 0.55,95%CI = 0.39–0.7). In-hospital mortality was not associated with ethnicity.

Conclusions

Helmet non-use is an important etiologic factor associated with motorcycle-related HNI and TBI among Arabs. While in Israel, ethnic equality exists in in-hospital health care, disparities in ambulance and rehabilitation utilization was found. Intervention programs should target the Arab population and focus on helmet compliance.

Why are powered two wheeler riders still fatally injured in road junction crashes? - A causation analysis

INTRODUCTION

Powered Two Wheeler (PTW) crashes continue to be a road safety concern with a plateauing of the number of associated fatalities.

METHOD

Forty one UK fatal or serious injury crashes involving a PTW and another vehicle at a junction were examined. Crash causation was analysed using the Driver Reliability and Error Analysis Method (DREAMv3.2). Crashes were split into two groups: Group A, where the other vehicle was travelling in the opposite direction to the PTW and commenced a right turn across the PTW's path; and Group B where the other vehicle turned right out of a side road (or entrance) across the PTW's path.

RESULTS

Overall, the factor that led directly to the crash (phenotype) was most commonly 'too high speed' or 'too late action' for the motorcyclist and 'too early action' for the other driver. Missed or late observations were contributory factors for both PTW riders and other vehicle drivers. Some differences between groups were observed with the PTW riders in Group B more likely to have 'insufficient skills' and the other vehicle drivers in Group A more likely to have 'attention allocation' as a causation factor. For both groups the crashes occurred because the other vehicle failed to give way to the PTW with causation chains that suggest 'looked but failed to see' is still an issue in this type of crash. The excessive speed of the PTW contributed to some crashes.

CONCLUSIONS

This analysis suggests that drivers failing to give way to PTW riders at junctions is still a problem. This may relate to the 'looked but did not see' phenomenon. Causation differences were observed between the examined groups. Practical considerations: The DREAM methodology is an effective tool in analysing crash data from police collision investigation reports. Different countermeasures may be necessary to prevent different types of junction crashes.

Association between Adult Attention-Deficit/Hyperactivity Disorder and Driving Behaviors among Iranian Motorcyclists

Objective

To investigate the association between attention-deficit/hyperactivity disorder (ADHD) score and driving behaviors among motorcycle drivers in Iran.

Methods

This multi-center cross-sectional study was conducted on 1747 motorcyclists in three cities of Iran. We used a random sampling method in this study and gathered data using two standard questionnaires. Data were presented using descriptive statistics, also t-test, and ANOVA used for analysis.

Results

The mean age of participants was 27.41±8.80 years. ADHD scores of the participants ranged from 0 to 87, with a mean score 31±15.86. All risky driving behaviors (RDBs) were significantly associated with a higher mean of ADHD score. For example, driving with illegal speed (p<0.001), not wearing a crash helmet (p=0.016), driving while exhausting (p<0.001), talking with other passengers (p<0.001), being fined by the police in the past year (p=0.028), and maneuvering while driving (p<0.001) were related to a higher mean of ADHD score.

Conclusion

All RDBs were significantly associated with the ADHD score among motorcyclists in Iran. In this regard, health care providers should inform people with ADHD about the negative consequences associated with driving and ADHD. Public health policymakers should consider management of ADHD through a comprehensive approach to improve driving performance and competencies among motorcyclists in order to decrease RDBs and traffic accidents.

Prevalence and factors associated with effective helmet use among motorcyclists in Mysuru City of Southern India

BACKGROUND

Helmet use reduces the risk and severity of head injury and death due to road traffic crash among motorcyclists. The protective efficacy of different types of helmets varies. Wearing firmly fastened full-face helmet termed as effective helmet use provides greatest protection. This study estimates the prevalence and factors associated with effective helmet use among motorcyclists in Mysuru, a tier II city in Southern India.

METHODS

Cross-sectional road side observational study of 3499 motorcyclists (2134 motorcycle riders and 1365 pillion riders) at four traffic intersections was done followed by interview of random sample of 129 of the above riders. Effective helmet use proportion and effective helmet use per 100 person-minute of observation was calculated. Multivariate logistic regression analysis was done to identify factors associated with effective helmet use.

RESULTS

Prevalence of effective helmet use was 28 per 100 riders and 19.5 per 100 person-minute of observation in traffic intersections. Prevalence rates of effective helmet use was higher among riders (34.5% vs pillion riders 18.1%), female riders (51.3% vs male riders 26.8%), and male pillion riders (30.5% vs female pillion riders 13.7%). Riders commuting for work and school and those ever stopped by the police in the past 3 months had significantly higher odds of effective helmet use.

CONCLUSION

Despite helmet use being compulsory by law for motorcyclists, the effective helmet use was low in Mysore. Strict enforcement and frequent checks by the police are necessary to increase the effective helmet use.

The epidemiology of paediatric off-road motorcycle trauma attended by emergency medical services in Victoria, Australia

BACKGROUND

Paediatric participation in competitive and recreational off-road motorcycle sports is increasing in popularity worldwide, however injuries frequently occur and the sport is associated with significant morbidity.

OBJECTIVE

This study describes the profile of paediatric off-road motorcycle trauma attended by emergency medical services (EMS) in Victoria, Australia.

METHODS

A retrospective review included paediatric (<16 years) competitive and recreational off-road motorcycle patients attended by EMS between 2010 and 2017 in the State of Victoria, Australia. Patient characteristics and injuries sustained were described using descriptive statistics. Predictors of EMS transport were identified using multivariable logistic regression analyses.

RESULTS

There were 1,479 paediatric motocross patients attended by EMS between 2010 and 2017. This represents 1.6% of the total state-wide EMS paediatric trauma (<16 years) workload, and equates to an average incidence of 22.2 per 100,000 population. The median age of patients was 13 years (IQR: 10-14) and 89.5% were male. The most common final diagnoses recorded by paramedics were 'fractures' (25.5%, n = 377) and 'unspecified pain' (19.5%, n = 289). Administration of analgesia (76.3%) was the most common EMS management, followed by spinal immobilisation (54.7%) and splinting (33.4%). The vast majority (91.5%) of patients were transported to hospital by EMS. Following admission, 38 (2.6%) patients were confirmed to have sustained major trauma, 78.9% of which had been transported direct from scene to a major trauma centre for definitive care. Median ISS for confirmed major trauma patients was 14 (IQR: 14-22). Four (0.4%) patients received pre-hospital CPR. All four sustained injuries from recreational off-road, motorcycle activities and all four cases died, two at the scene and two in-hospital.

CONCLUSION

Off-road motorcycle activities are an important cause of death and injury in Victorian children, as highlighted and demonstrated by the four deaths and high EMS transport rates borne out in this study. Riders and parents need to be aware of these risks, and organised events must have adequate on-site medical care resources.

Age and engine displacement are associated with unsafe motorcycle rider actions

BACKGROUND

Our goal was to examine the relationship between age and engine displacement in cubic centimeters (CCs) and crash responsibility.

METHODS

Male motorcyclists, aged 16-94, involved in a fatal crash in the United States (1987-2015) who tested negative for both drugs and alcohol were included. Employing a case control design, cases had committed one or more Unsafe Motorcyclist Actions (UMAs), the proxy measure of responsibility; controls had no UMAs recorded. Odds ratios were computed via multinomial regression examining the effect of motorcyclists' age and motorcycle displacement (up to 1500 CCs, in 250 CC increments) on crash responsibility by any UMA and top three individual UMAs committed.

RESULTS

A total of 19,166 motorcyclists met our inclusion criteria. Increased displacement was observed in older motorcyclists and in more recent crashes. Fifty-six percent of motorcyclists committed one or more UMAs (n = 10,743). The top three individual UMAs were: Speeding (35%, n = 6,728), Weaving (24%, n = 3,269), and Erratic Operation (6%, n = 1,162). Odds ratios for committing any UMA were the greatest for riders on 750 CC motorcycles, followed closely by 500 and 1000 CC motorcycles. By 1250 CCs the effect of displacement on rider crash responsibility (any UMA) was no longer statistically significant. Typically, younger ages (e.g., 20-30) on motorcycles with 500-1000 CCs were associated with the highest odds of either speeding, weaving, or erratic riding compared to similar aged riders on 250 CC motorcycles. Exceptions were observed, for example riders at 70 years of age on 1500 CCs having higher odds of speeding than younger riders on equivalent CC motorcycles.

CONCLUSION

Education and legislative measures should be considered. Educationally, the development of training interventions focusing on control, stability, and breaking differences with more powerful motorcycles (750 to 1250 CCs) is needed. Legislatively, licensing tiers could be employed based on displacement and educational requirements. Education and legislative measures could help to curb the trend seen between high-powered motorcycles and crash responsibility.

Epidemiologic study of traffic crash mortality among motorcycle users in Iran (2011-2017)

PURPOSE

Motorcycle accident is a major cause of road traffic injuries and the motorcyclists are considered as vulnerable road users. The present study aimed to determine the epidemiological characteristics of fatal motorcycle crashes in Iran.

METHODS

In this cross-sectional study, a total of 28,356 motorcycle traffic fatalities registered in the Legal Medicine Organization of Iran were analyzed during the period between March 2011 and March 2017. The examined variables included demographic characteristics, helmet use, crash mechanisms, crash location, position state, type of counterpart vehicle, cause of death and place of death. In the study, road traffic mortalities involving drivers and/or passenger of motorcycles were included. Cases or events registered without these conditions were excluded from the study. To analyse the data, SPSS statistics 25 and GraphPad Prism 8 softwares were used.

RESULTS

Of the 122,682 fatal traffic injury cases, 28,356 (23.1%) were motorcycle users, of whom 95.3% were male and 4.7% were female. Most of the motorcycle fatalities belonged to the age group of 18-24 years (29.1%). Head trauma was the major cause of death (59.0%). Also, the overall proportion of safety helmet use among motorcycle crash victims was estimated at 37.4%. Most of the road traffic crash cases (46.8%) happened out of city and half of people (49.9%) died in hospital. About 77.4% of the victims were motorcycle riders and 21.1% were pillion passengers. The highest rate of mortality belonged to the self-employed (38.4%) and then workers (21.8%) and students (10.2%). In addition, most fatalities occurred in people with low education (77.5%) and the least occurred in university graduates (5.5%). Among 31 provinces of Iran, Fars had the highest (9.3%) occurrence rate and Kohgiluyeh and Buyer-Ahmad had the lowest (0.5%). Most of the crash mechanisms were due to motorcycle-vehicle crashes (80.2%), followed by rollover (9.8%).

CONCLUSION

Comprehensive public education and special rules are needed to reduce the rate of deaths in motorcycle crashes.

The effects of e-ridehailing on motorcycle ownership in an emerging-country megacity

The impact of app-based e-hailing or ridesourcing services on various transport metrics is an area of active research, and research so far have focused on the car-based (or four-wheeled vehicle based) services only. In many cities in the developing and emerging countries, motorcycle-based passenger e-hailing services have become very popular in the last few years, but the implications of these have not been studied before. This study investigates the effects of motorcycle-hailing apps in Dhaka - a megacity in Bangladesh - on the size of its motorcycle fleet. We employ segmented multiple regression on timeseries data to show that there was a statistically significant increase in motorcycle ownership in Dhaka as a result of the motorcycle-hailing services. The findings were also supported by a visual intervention analysis. By the end of 2018, there were 7.45% more motorcycles in Dhaka than there would have been if these app-based e-hailing services were not available. We conclude with potential implications of these increases in motorcycle numbers and future research directions.

Crash risk factors for novice motorcycle riders

BACKGROUND

Motorcycle riders have the highest injury and fatality rates among all road users. This research sought in-depth understanding of crash risk factors to help in developing targeted measures to reduce motorcycle crash injuries and fatalities.

METHODS

We used interview data from a study of 2,399 novice motorcycle riders in Victoria, Australia from 2010 to 2012 linked with their police-recorded crash and offence data. The outcome measure was self and/or police reported crash. The association between potential risk factors and crashes was explored in multivariable logistic regression models.

RESULTS

In the multivariable analysis, riders who reported being involved in three or more near crashes had 1.74 times (95% CI 1.11-2.74) higher odds of crashing compared to riders who reported no near-crash events, and riders who participated in a pre-learner course had 1.41 times higher odds of crashing (95% CI 1.07-1.87) compared with riders who did not attend a pre-learner course. Riders who had been involved in a crash before the study had 1.58 times (95% CI 1.14-2.19) higher odds of crashing during the study period compared with riders who were not involved in a crash. Each additional month of having held a license and learner permit decreased the odds of crashing by 2%, and each additional 1,000 km of riding before the study increased the odds of crashing by 2%.

CONCLUSION

Measures of pre-learner training and riding experience were the strongest predictors of crashing in this cohort of novice motorcycle riders. At the time of the study there was no compulsory rider training to obtain a learner permit in Victoria and no on-road courses were available. It may be plausible that riders who voluntarily participated in an unregulated pre-learner course became or remained at high risk of crash after obtaining a rider license. We suggest systematically reviewing the safety benefits of voluntary versus mandatory pre-learner and learner courses and the potential need to include on-road components.

Motorcycle-related trauma:effects of age and site of injuries on mortality. A single-center, retrospective study

Background

Motorcyclists are often victims of road traffic incidents. Though elderly patients seem to have worse survival outcomes and sustain more severe injuries than younger patients, concordance in the literature for this does not exist. The aim of the study is to evaluate the impact of age and injury severity on the mortality of patients undergoing motorcycle trauma.

Methods

Data of 1725 patients consecutively admitted to our Trauma Center were selected from 2002 to 2016 and retrospectively analyzed. The sample was divided into three age groups: ≤ 17 years, 18–54 years, and ≥ 55 years. Mortality rates were analyzed for the overall population and patients with Injury Severity Score (ISS) ≥ 25. Differences in survival among age groups were evaluated with log-rank test, and multivariate logistic regression models were created to identify independent predictors of mortality.

Results

A lower survival rate was detected in patients older than 55 years (83.6% vs 94.7%, p = 0.049) and in those sustaining critical injuries (ISS ≥ 25, 61% vs 83%, p = 0.021). Age (p = 0.027, OR 1.03), ISS (p < 0.001, OR 1.09), and Revised Trauma Score (RTS) (p < 0.001, OR 0.47) resulted as independent predictors of death. Multivariate analysis identified head (p < 0.001, OR 2.04), chest (p < 0.001, OR 1.54), abdominal (p < 0.001, OR 1.37), and pelvic (p = 0.014, OR 1.26) injuries as independent risk factors related to mortality as well. Compared to the theoretical probability of survival, patients of all age groups showed a survival advantage when managed at a level I trauma center.

Conclusions

We detected anatomical injury distributions and mortality rates among three age groups. Patients aging more than 55 years had an increased risk of death, with a prevalence of severe chest injuries, while younger patients sustained more severe head trauma. Age represented an independent predictor of death. Management of these patients at a level I trauma center may lead to improved outcomes.

Differences in severity of injuries between motorcyclist and bicyclist fatalities in single vehicle collisions

To understand the injury severity of bicyclists and motorcyclists in single vehicle collisions, we performed a retrospective analysis of forensic autopsy cases of 25 motorcyclists and 14 bicyclists performed from 1999 to 2018. Collision details, injury characteristics, and involvement of alcohol were examined. The injury severity between bicyclists and motorcyclists was compared. The average age of victims was 62.3 years. All motorcyclists and no bicyclists wore a helmet. Motorcyclists had more severe injuries than bicyclists (mean Injury Severity Score of 42 and 27, respectively). The motorcyclists had more severe chest injuries but fewer severe facial injuries than bicyclists, owing to the difference in collision velocity or rate of helmet use (p < 0.05). Alcohol was present in the blood of 52.0% of bicyclists but no motorcyclists. The mean blood alcohol concentration of these bicyclists was 1.59 mg/mL. The bicyclists under the influence of alcohol had more severe injuries to neck and upper extremities than non-drunken bicyclists (p < 0.05). Our results may be useful for determining the cause of death and reconstructing the mechanisms of fatal injuries in bicyclists and motorcyclists.

Active safety systems for powered two-wheelers: A systematic review

Objective: Active safety systems, of which antilock braking is a prominent example, are going to play an important role to improve powered two-wheeler (PTW) safety. This paper presents a systematic review of the scientific literature on active safety for PTWs. The aim was to list all systems under development, identify knowledge gaps and recognize promising research areas that require further efforts.Methods: A broad search using "safety" as the main keyword was performed on Scopus, Web of Science and Google Scholar, followed by manual screening to identify eligible papers that underwent a full-text review. Finally, the selected papers were grouped by general technology type and analyzed via structured form to identify the following: specific active safety system, study type, outcome type, population/sample where applicable, and overall findings.Results: Of the 8,000 papers identified with the initial search, 85 were selected for full-text review and 62 were finally included in the study, of which 34 were journal papers. The general technology types identified included antilock braking system, autonomous emergency braking, collision avoidance, intersection support, intelligent transportation systems, curve warning, human machine interface systems, stability control, traction control, and vision assistance. Approximately one third of the studies considered the design and early stage testing of safety systems (n. 22); almost one fourth (n.15) included evaluations of system effectiveness.Conclusions: Our systematic review shows that a multiplicity of active safety systems for PTWs were examined in the scientific literature, but the levels of development are diverse. A few systems are currently available in the series production, whereas other systems are still at the level of early-stage prototypes. Safety benefit assessments were conducted for single systems, however, organized comparisons between systems that may inform the prioritization of future research are lacking. Another area of future analysis is on the combined effects of different safety systems, that may be capitalized for better performance and to maximize the safety impact of new technologies.

High-speed helmeted head impacts in motorcycling: A computational study

The motorcyclist is exposed to the risk of falling and impacting ground head-first at a wide range of travelling speeds - from a speed limit of less than 50 km/h on the urban road to the race circuit where speed can reach well above 200 km/h. However, motorcycle helmets today are tested at a single and much lower impact speed, i.e. 30 km/h. There is a knowledge gap in understanding the dynamics and head impact responses at high travelling speeds due to the limitation of existing laboratory rigs. This study used a finite element head model coupled with a motorcycle helmet model to simulate head-first falls at travelling speed (or tangential velocity at impact) from 0 to 216 km/h. The effect of different falling heights (1.6 m and 0.25 m) and coefficient of frictions (0.20 and 0.45) between the helmet outer shell and ground were also examined. The simulation results were analysed together with the analytical model to better comprehend rolling and/or sliding phenomena that are often observed in helmet oblique impacts. Three types of helmet-to-ground interactions are found when the helmet impacts ground from low to high tangential velocities: (1) helmet rolling without slipping; (2) a combination of sliding and rolling; and (3) continuous sliding. The tangential impulse transmitted to the head-helmet system, peak angular head kinematics and brain strain increase almost linearly with the tangential velocity when the helmet rolls but plateaus when the helmet slides. The critical tangential velocity at which the motion transit from the rolling regime to the sliding regime depends on both the falling height and friction coefficient. Typically, for a fall height of 1.63 m and a friction coefficient of 0.45, the rolling/sliding transition occurs at a tangential velocity of 10.8 m/s (38.9 km/h). Low sliding resistance in helmet design, i.e. by the means of a lower friction coefficient between the helmet outer shell and ground, has shown a higher reduction of brain tissue strain in the sliding regime than in the rolling regime. This study uncovers the underlying dynamics of rolling and sliding phenomena in high-speed oblique impacts, which largely affect head impact biomechanics. Besides, the study highlights the importance of testing helmets at speeds covering both the rolling and sliding regime since potential designs for improved head protection at high-speed impacts can be more distinguishable in the sliding regime than in the rolling regime.

Different demographic and drinking profiles of motorcyclists and car drivers with the first-time offense of driving/riding under the influence of alcohol

BACKGROUND

Driving/riding under the influence (DUI) of alcohol is a major public concern worldwide. Only a few studies have distinguished DUI-related variables between motorcyclists and car drivers. This study examined the differences in demographic characteristics and drinking behaviors among first-time DUI offenders operating different transportation vehicles, and risk factors for frequent DUI (fDUI) among them.

METHODS

We conducted an anonymous survey for 561 first-time DUI offenders who attended a mandatory educational program. Participants self-administered questionnaires concerning alcohol drinking behaviors and DUI. We defined fDUI as at least two DUI behaviors per month based on self-reported information. Demographic and drinking characteristics were compared between DUI offenders, car drivers and motorcyclists. Logistic regression analysis was used to examine risk factors for fDUI.

RESULTS

Two-thirds of first-time DUI offenders were motorcyclists. Compared with car drivers, motorcyclists were younger and less educated, with a higher percentage of them being women and unmarried. Car drivers reported a higher rate of fDUI than motorcyclists (16.5% vs. 9.7%). Regression analysis revealed that binge drinkers had a higher fDUI risk in both groups. Regarding the drinking place prior to DUI behavior, workplace was significantly associated with fDUI in car drivers.

CONCLUSIONS

Distinct strategies may be required for motorcyclists and car drivers for DUI recidivism prevention, and drinking place interventions should also be considered.

Detecting motorcycle helmet use with deep learning

The continuous motorization of traffic has led to a sustained increase in the global number of road related fatalities and injuries. To counter this, governments are focusing on enforcing safe and law-abiding behavior in traffic. However, especially in developing countries where the motorcycle is the main form of transportation, there is a lack of comprehensive data on the safety-critical behavioral metric of motorcycle helmet use. This lack of data prohibits targeted enforcement and education campaigns which are crucial for injury prevention. Hence, we have developed an algorithm for the automated registration of motorcycle helmet usage from video data, using a deep learning approach. Based on 91,000 annotated frames of video data, collected at multiple observation sites in 7 cities across the country of Myanmar, we trained our algorithm to detect active motorcycles, the number and position of riders on the motorcycle, as well as their helmet use. An analysis of the algorithm's accuracy on an annotated test data set, and a comparison to available human-registered helmet use data reveals a high accuracy of our approach. Our algorithm registers motorcycle helmet use rates with an accuracy of -4.4% and +2.1% in comparison to a human observer, with minimal training for individual observation sites. Without observation site specific training, the accuracy of helmet use detection decreases slightly, depending on a number of factors. Our approach can be implemented in existing roadside traffic surveillance infrastructure and can facilitate targeted data-driven injury prevention campaigns with real-time speed. Implications of the proposed method, as well as measures that can further improve detection accuracy are discussed.

Obesity and age as factors in leg amputations in fatal motorcycle crashes

The autopsy files at Forensic Science South Australia were searched over an 11-year period from January 2008 to December 2018 for all cases of motorcycle fatalities in which there had been lower-limb amputations. Six cases were identified, consisting of five male riders and one female pillion passenger. The age range was 48–67 years (average 59 years), which was significantly older than the control group (40.6 years; p < 0.01). All the decedents were overweight, with a body mass index (BMI) of 28.7–43.5 kg/m2 (average 34.9 kg/m2), which again was significantly greater than the control group (28.8 kg/m2; p < 0.05). Five of the incidents involved a collision between a motorcycle and a motor vehicle; the remaining case involved a collision with a tree. Five of the amputations were on the right side in the motorcycle-vehicle impacts, and they varied in severity from loss of a foot to a hind-quarter amputation. There was a single left lower-leg amputation which occurred during the collision with a tree, which was beside the road on the motorcyclist’s left. This study has shown that motorcyclists at greatest risk of lower-limb/pelvis amputations are older than the average rider with higher BMIs. This may be significant information given the increase in both BMI and age in many populations.

The epidemiology and prehospital care of motorcycle crashes in a sub-Saharan African urban center

OBJECTIVE

Road traffic crashes (RTCs) are common among motorcyclists in Kigali, Rwanda. The Service d'Aide Medicale Urgente (SAMU), a prehospital ambulance service, responds to many of these crashes. We aimed to describe motorcycle-related RTCs managed by SAMU.

METHODS

SAMU clinical data including demographic information, injury characteristics, and management details were analyzed descriptively for all motorcycle crashes occurring between December 2012 and July 2016.

RESULTS

Every patient included in this study was injured. These patients all called the ambulance for their injuries after a motorcycle crash. There were 2,912 motorcycle-related RTCs over the study period, representing 26% of all patients managed by SAMU. The incidence of motorcycle crashes in Kigali was 258 crashes per 100,000 people over the 3.5-year study period. The average age was 30 years and 80% were males. The most common injuries were to the lower extremities (n = 958, 33%), head (n = 878, 30%), or upper extremities (n = 453, 16%). Injuries often resulted in fractures of extremities (n = 740, 25%) and external hemorrhage anywhere in the body (unspecified region; n = 660, 23%), yet few were severe based on the Kampala Trauma Score (n = 23, 2%) and Glasgow Coma Scale (n = 42, 1.5%). The most common interventions were provision of diclofenac (n = 1,526, 52.5%), peripheral intravenous (IV) access (n = 1,217, 42%), and administration of IV fluids (n = 1,048, 36%).

CONCLUSION

Motorcycle-related RTCs represent a large burden of disease for patients treated by SAMU in Kigali, Rwanda. Young men are most at risk of injury, which imposes a financial strain on society. Though injuries occurred frequently, critical trauma cases from motorcycle crashes were uncommon. This may be a result of several initiatives in Rwanda to improve road safety.

Results of a Campaign for Motorcycle Helmets Advocacy in a City in Southwest of Iran; A Population-Based Intervention Study

Objective:

We conducted a triple phase project for motorcycle helmets advocacy in Darab, a city in southwest Iran. The aim of this study was to evaluate the effect of the project on decreasing the hazards of motorcycle accidents.

Methods:

Using a questionnaire, data for ICU admission rates, hospital costs for patients who required ICU admission, rate of helmet usage, mortality and the duration of ICU care for patients admitted to Darab hospital due to motorcycle accidents in Winter 2015 (before conducting the project) and Winter 2016 (after conducting the project) were gathered and compared. This feature was also separately done for patients younger than 17 years.

Results:

The rate of wearing helmets increased significantly in winter 2016 (from 3.4 % to 33%). Also ICU admission rate due to head trauma was significantly decreased after the project was done (from 14.5 % to 4%). However, hospital costs for patients required ICU admission were increased in winter 2016. This increase, though not significant, seems to be due to an increase in health service expenses in the year 2016 as compared with the year 2015. The mortality rate was not significantly changed between the two mentioned years results. For patients younger than 17 years, no ICU admissions were needed in winter 2016.

Conclusion:

Even a short period of intervention can have positive effects on increasing the safety of motorcycle drivers.

Traumatic brain injury among two-wheeled motor vehicle riders in Utsunomiya, Japan: a comparison between mopeds and motorcycles

PURPOSE

Two-wheeled motor vehicles are dichotomized into mopeds and motorcycles (MCs) based on their engine capacity. While efforts have been made, mostly by European researchers, to evaluate the possible difference in the frequency/severity of riders' traumatic brain injury (TBI) between the two categories, the results have been inconsistent.

METHODS

To evaluate whether such differences exist in Japan, a single-center, retrospective observational study was conducted on two-wheeled motor vehicle riders wearing a helmet during high-energy road traffic accident (RTA). Between January 2011 and December 2017, 127 moped and 128 MC helmeted riders involved in RTAs had been treated in our institution.

RESULTS

Moped riders were significantly older than MC riders (50.7 ± 25.0 years vs. 35.1 ± 18.6 years, p = 0.04). The frequency of TBI was significantly higher in moped riders than in MC riders (21.3% vs. 10.9%; p = 0.03). However, the frequency of other bodily injuries did not differ significantly. Among the riders with TBI, neither injury severity nor outcomes differed significantly. Multivariate regression analysis showed that the presence of altered mental status was predictive of TBI (OR 23.398; 95% CI 9.187-59.586; p < 0.001). Moped riders trended to have a higher likelihood of sustaining TBI (OR 2.122; 95% CI 0.870-5.178; p = 0.098).

CONCLUSIONS

Mopeds are frequently utilized by elderly in Japan, which may have been causally associated with the higher frequency of TBI in moped riders, while other causes, including the difference in helmet type, may also be involved. This study is limited by its small sample size and retrospective design, and multi-center prospective studies are warranted.