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.

Mobile phone related crashes among motorcycle taxi drivers

In many countries, motorcycle taxis remain an important mode of travel due to their fast, flexible, and inexpensive service. The recent advent of ride-hailing services has led to dramatic growth in the fleet of motorcycle taxis and additional types of motorcycle taxi drivers. Furthermore, mobile phone use while riding a motorcycle is an emerging safety issue, particularly among ride-hailing motorcycle taxi drivers. This paper investigates mobile phone use while riding, crashes and mobile phone related crashes among ride-hailing, traditional, and hybrid motorcycle taxi drivers, using data from a survey in Hanoi, Vietnam. Results show that ride-hailing motorcycle taxi drivers had the highest prevalence of mobile phone use while riding a motorcycle taxi (95.3%), followed by hybrid (88.6%) and traditional taxi drivers (64%). Approximately 32.6%, 19.3%, and 9.7% of motorcycle taxi drivers reported being involved in a crash, injury crash, and mobile phone related crash respectively. Mobile phone related crashes represent 20.5% of all reported crashes. Logistic and negative binomial regression were used to explore factors influencing mobile phone use while riding and crash frequencies. Regression results indicate that ride-hailing taxi drivers were more likely to be involved in a mobile phone related crash. Delivery trips were found to be associated with increases in crashes whereas passenger trips were found to be associated with decreases in crashes. Policy implications are also discussed.

A clustering approach to developing car-to-two-wheeler test scenarios for the assessment of Automated Emergency Braking in China using in-depth Chinese crash data

Two-wheeled vehicles (motorized and non-motorized, referred to as TWs) are an important part of the transport system in China. They also represent an important challenge for road safety, with many TW user fatalities and injuries every year. Recently, active safety systems for cars, such as Automated Emergency Braking (AEB), promise to reduce road traffic fatalities and injuries. For these systems to work effectively, it is necessary to understand and define the complex traffic scenarios to be addressed. The aim of this study is to contribute to the development of test procedures for AEB specifically, drawing on the China In-Depth Accident Study (CIDAS) data from July 2011 to February 2016 to describe typical scenarios for crashes between cars and TWs by means of cluster analysis. In total, 672 car-to-TW crashes were extracted. The data was clustered according to five main crash characteristics: time of crash, view obstruction, pre-crash driving behavior of the car driver and the TW driver, and relative moving direction. The analysis resulted in six car-to-TW crash scenarios typical of China. In three scenarios the car and the TW travel perpendicularly to each other before the crash, in two they travel in the same direction, and in one they travel in opposite directions. Further, each scenario can be described with three characteristics (the road speed limit, the TW's first contact point on the car, and the car's first contact point on the TW) that can be included in an AEB test suite. Some scenarios were similar to those in the Euro New Car Assessment Program (Euro NCAP). For example, in one, a TW moving straight ahead was hit by a car moving perpendicularly, and in the other the car hit a TW traveling in the same direction. Both occurred in daytime, without a visual obstruction. However, in contrast to the Euro NCAP, typical scenarios in China included night-time scenarios, scenarios where the car or the TW was turning, and those in which the TW was hidden from the car by an obstruction. The results contribute to a proposed novel AEB test suite with realistic scenarios specific to China.

When policy meets the pedal: A reduction in motorcyclist fatalities following the implementation of a road traffic law in Lagos, Nigeria

Objective: The Lagos State Road Traffic Law of 2012 sought to curb reckless okada use and the objective of this study is to determine its impact on motorcyclist fatalities in Nigeria's most densely populated state. This is the first study to date that analyzes the potential impact of the Law on motorcyclist fatalities across Lagos State.Methods: We retrospectively reviewed monthly motorcyclist fatalities in Lagos between January 2012 and December 2015. We analyzed the data using Geographic Information Systems (GIS) software, and used Quantum GIS ver. 2.16.2 to create maps illustrating the spatial-epidemiological distribution of motorcyclist fatalities across Lagos' health facilities. The data was collated into three eight-month periods for analysis (pre-intervention, immediate post-intervention, and sustained post-intervention). Period 1 was January to August 2012, Period 2 was September 2012 to April 2013, and Period 3 was May to December 2013. The data were compared in SPSS using the Welch's ANOVA and Tanhame (post-hoc) tests with a 5% significance level.Results: Motorcyclist fatalities in Lagos fell by an average of 76% over the study period. Over 55% of the fatalities were recorded in five health facilities, located in an area of high road network density. The number of newly registered motorcycles also declined by an average of 69%. The Welch's ANOVA yielded a statistically significant difference between the Periods' means (p < 0.0001). The Tamhane post-hoc test showed significant differences in the mean decrease in fatalities between Period 1 and Period 2 (p = 0.002), and Period 1 and Period 3 (p < 0.0001).Conclusions: This study shows a significant decline in motorcyclist fatalities following the implementation of the Lagos State Road Traffic Law of 2012. A more comprehensive approach to data collection along with an updated law could contribute towards a sustainable reduction of motorcyclist mortality.

Young driver fatal motorcycle accident analysis by jointly maximizing accuracy and information

While young drivers (YDs) constitute ∼10% of the driver population, their fatality rate in motorcycle accidents is up to three times higher. Thus, we are interested in predicting fatal motorcycle accidents (FMAs), and in identifying their key factors and possible causes. Accurate prediction of YD FMAs from data by risk minimization using the 0/1 loss function (i.e., the ordinary classification accuracy) cannot be guaranteed because these accidents are only ∼1% of all YD motorcycle accidents, and classifiers tend to focus on the majority class of minor accidents at the expense of the minority class of fatal ones. Also, classifiers are usually uninformative (providing no information about the distribution of misclassifications), insensitive to error severity (making no distinction between misclassification of fatal accidents as severe or minor), and limited in identifying key factors. We propose to use an information measure (IM) that jointly maximizes accuracy and information and is sensitive to the error distribution and severity. Using a database of ∼3600 motorcycle accidents, a Bayesian network classifier optimized by IM predicted FMAs better than classifiers maximizing accuracy or other predictive or information measures, and identified fatal accident key factors and causal relations.

Trends and patterns in fatal US motorcycle crashes, 2000-2016

Objective: To investigate trends of motorcyclist fatalities and identify at-risk populations by motorcyclist demographics and crash characteristics. Methods: We used the Fatality Analysis Reporting System (FARS) database (2000-2016) to track fatality rate trends, which were quantified by using Poisson mixed-effects regression models comparing 2000-2001 and 2007-2008, as well as 2009-2010 and 2015-2016. Results: The overall fatality rate per 100,000 population increased from 2000 to 2016, defined by two trend lines-before and after the economic recession in 2008-2009. The overall fatality rate ratio between 2000-2001 and 2007-2008 was 1.60 [95% Confidence Interval (CI): 1.51-1.70], and between 2009-2010 and 2015-2016 was 1.09 (95% CI: 1.02-1.18). Fatality rates increased among all age groups, particularly for motorcyclists aged 60 and older. Those aged 18-29 had the highest fatality rates overall. Age-and-sex standardized state fatality rates were consistently highest in Wyoming, South Dakota, and South Carolina and lowest in Massachusetts, New York and New Jersey. Conclusion: Motorcycle fatality rates increased overall and across all age groups between 2000 and 2016. Fatalities for the oldest riders showed the steadiest increasing trends. Results highlight the continued public health burden of motorcyclist fatalities and, by extension, the importance of improving motorcycle safety.

Turn signal use among car drivers and motorcyclists at intersections: a case study of Da Nang, Vietnam

Turn signal neglect is a major cause of traffic crashes, particularly rear-end collisions. However, little research has investigated the use of turn signals among motorists, particularly in developing countries with high levels of motorcycle use. This research aimed to investigate the prevalence and factors associated with turn signal use at intersections among car drivers and motorcyclists in Da Nang, Vietnam. Cross-sectional roadside observations were undertaken at 24 sites across Da Nang City during weekday and weekend periods. A total of 17,142 vehicles were observed, including 2392 cars and 14,750 motorcycles. Turn signal use among car drivers (68.27%) was found to be significantly higher than motorcyclists (40.13%). Binary logistic regression modelling showed that turn signal neglect at intersections was associated with making a right turn, not carrying passengers, travelling outside of the city centre, travelling on weekdays, and the absence of separate car lanes, pedestrian crossings and traffic lights. Despite national legislation regulating turn signal use in Vietnam, the use of turn signals is relatively low compared with developed countries. The findings highlight the need for both greater and more targeted enforcement of existing legislation combined with extensive road safety education.

Could wearing motorcycle protective clothing compromise rider safety in hot weather?

Motorcycle protective clothing (PPE) effectively reduces the risk of injury in crashes, however in hot conditions many motorcyclists ride unprotected. Recent work found available motorcycle PPE to be thermally inefficient in hot weather with potential to cause significant thermal strain under average Australian summer conditions. The current study investigated the potential for the cognitive and psychophysical concomitants of thermal strain to compromise reaction times, mood and fatigue with potential consequences for motorcyclists' safety.

METHOD

Volunteers wearing motorcycle PPE participated in a 90 min trial (cycling 30 W) in 35 °C, 40%RH with overhead radiant heaters and a fan to simulate wind speed. Heart rate, core and skin temperature were recorded continuously. Reaction time and subjective ratings of thermal sensation and comfort, workload and mood were recorded at baseline, during rest breaks at 25 min intervals and on completion of the trail. Repeated measures analysis assessed each participant's performance against their own baseline.

RESULTS

Core temperatures increased by 2 °C (p < .0001), skin temperatures (3 °C, (p < .0001) and heart rates (66bpm, p < .0001). Reaction times fluctuated 36 ms 8% (p < .0001) over the trial. Subjective workload increased 68% (p = 0.001) and mood deteriorated 33 points (p < .0001) including feeling less alert (p = <.0001), contented (p = 0.001) and calm (p = 0.0004). Multivariate repeated measures analysis found significant associations between core temperature and workload (p = 0.01), mood (p = 0.001) and reaction time (<.0001). Skin temperature and workload (p = 0.02), mood (p = 0.01) and reaction time (<.0001). Subjective ratings of temperature sensation and wetness discomfort were associated respectively with increased workload (p = 0.0001, p = 0.004), mood change (p < .0001, p = 0.04) and reaction time (p < .0001, p < .0001).

CONCLUSIONS

The physiological impact of wearing thermally inefficient motorcycle PPE in hot conditions could impair motorcyclists cognitive and psychophysical functioning and, potentially, their riding performance and safety. These outcomes indicate an urgent need for manufacturers to develop motorcycle PPE that is effective and suitable for use, in hot conditions.

A multinomial logit analysis of factors associated with severity of motorcycle crashes in Ghana

Objective: The objective of this study was to explore the factors affecting motorcycle crash severity in Ghana. Methods: A retrospective analysis of motorcycle crash data between 2011 and 2015 was conducted using a motorcycle crash data set extracted from the National Road Traffic Crash Database at the Building and Road Research Institute (BRRI) in Ghana. Injury severity was classified into 4 categories: Fatal, hospitalized, injured, and damage only. A multinomial logit modeling framework was used to identify the possible determinants of motorcycle crash severity. Results: During the study period, a total of 8,516 motorcycle crashes were recorded, of which 22.9% were classified as fatal, 42.1% were classified as hospitalized injuries, 29.4% were classified as slight injuries, and 5.6% were classified as damage-only crashes. The estimation results indicate that the following factors increase the probability of fatal injuries: At a junction; weekend; signage; poor road shoulder; village settlement; tarred and good road surface; and collision between motorcycle and heavy goods vehicle (HGV). Motorcycle crashes occurring during the daytime and on the weekend increases the probability of hospitalized injury. The results also suggest that motorcycle crashes occurring during the daytime, in curves or inclined portions of roads, or in unclear weather conditions decrease the probability of fatal injury. Conclusions: This study provides further empirical evidence to support motorcycle crash modeling research, which is lacking in developing countries. The ability to understand the various factors that influence motorcycle crash severity is a step forward in providing an appropriate basis upon which informed motorcycle crash policies can be developed. Particular attention should be given to the provision of road signage at junctions and speed humps and controlling traffic during the weekend. In addition, road maintenance should be carried out periodically to address motorcycle safety in Ghana.

Unhelmeted Motorcycle Riders Have Increased Injury Burden: A Need to Revisit Universal Helmet Laws

BACKGROUND

The aim of this study was to compare hospital outcomes for patients in a motorcycle collision with and without helmet use. The study was conducted as a retrospective analysis of the National Trauma Data Bank's 2013 data set, which included reported data from 100 hospitals across the United States.

METHODS

Inclusion criterion for this study is a motorcycle crash involving a driver or passenger. The total number of patients in motorcycle crashes as reported by the National Trauma Data Bank in 2013 was 10,345. Helmet use, hospital stay, ICU and ventilation days, mortality, Glasgow Coma Score, Injury Severity Score, patient payer mix, and complication data were obtained.

RESULTS

Patients were divided into two groups: those wearing a helmet (n = 6250) and those without (n = 4095). Patients not wearing a helmet had an increased risk of admission to the ICU (OR = 1.36, P < 0.001, CI 1.25-1.48), requiring ventilation support (OR = 1.55, P < 0.001, CI 1.39-1.72), presenting with a Glasgow Coma Score of eight or below (OR = 2.15, P < 0.001), and in-patient mortality (OR = 2.00, P < 0.001, CI 1.58-2.54). Unhelmeted patients were more likely to have government insurance or be uninsured than those patients wearing a helmet (P < 0.001).

CONCLUSIONS

It is not well understood why many states are repealing or have repealed universal helmet laws. Lack of helmet use increases the severity of injury in traumatized patients leading to a substantial financial impact on health care costs. Our analysis suggests the need to revisit the issue regarding laws that require protective headwear while riding motorcycles because of the individual and societal impact.

LEVEL OF EVIDENCE

III.

Motorcycle active safety systems: Assessment of the function and applicability using a population-based crash data set

Objective: Motorcycles and mopeds, often referred to as powered 2-wheelers (PTWs), play an important role in personal mobility worldwide. Despite their advantages, including low cost, space occupancy, and fuel efficiency, the risk of sustaining serious or fatal injuries is higher than that for occupants of passenger cars. The development of safety systems specific for PTWs represents a potential way to reduce casualties among riders. With the proliferation of new active and passive safety technologies, the question as to which might offer the most value is important. In this context, a prioritization process was applied to a set of PTW active safety systems to evaluate their applicability to crash scenarios alone and in combination. The systems included in the study were antilock braking (ABS), autonomous emergency braking (AEB), collision warning, curve warning, and curve assist. Methods: With the functional performance of the 5 safety systems established, the relevance of each system to specific crash configurations and vehicle movements defined by a standardized accident classification system used in Victoria, Australia, was rated by 2 independent reviewers, with a third reviewer acting as a moderator where disagreements occurred. Ratings ranged from 1 (definitely not applicable) to 4 (definitely applicable). Using population-based crash data, the number and percentage of crashes that each safety system could potentially influence, or be relevant for, was defined. Applying accepted injury costs permitted the derivation of the societal economic cost of PTW crashes and the potential reductions associated with each safety system given a theoretical crash avoidance effectiveness of 100%. Results: In the 12-year period 2000-2011, 23,955 PTW riders and 1292 pillion passengers were reported to have been involved in a road crash, with over 500 killed and more than 10,000 seriously injured; only 3.5% of riders/pillion passengers were uninjured. The total economic cost associated with these injured riders and pillion passengers was estimated to be AU$11.1 billion (US$7.70 billion; €6.67 billion). The 5 safety systems, as single solutions or in combination, were relevant to 57% of all crashes and to 74% of riders killed. Antilock braking was found to be relevant to the highest number of crashes, with incremental increases in coverage when combined with other safety systems. Conclusions: The findings demonstrate that ABS, alone and in combination with other safety systems, has the potential to mitigate or possibly prevent a high percentage of PTW crashes in the considered setting. Other safety systems can influence different crash scenarios and are also recommended. Given the high cost of motorcycle crashes and the increasing number of PTW safety technologies, the proposed approach can be used to inform the process of selection of the most suitable interventions to improve PTW safety.

Factors associated with motorcycle traffic crash fatalities among active duty U.S. Army personnel

OBJECTIVE

Research on factors associated with motorcycle fatalities among active duty U.S. Army personnel is limited. This analysis describes motorcycle crash-related injuries from 1995 through 2014 and assesses the effect of alcohol use and helmet use on the risk of fatal injury among active duty U.S. Army motorcycle operators involved in a traffic crash, controlling for other factors shown to be potentially associated with fatality in this population.

METHODS

Demographics, crash information, and injury data were obtained from safety reports maintained in the Army Safety Management Information System. Traffic crashes were defined as crashes occurring on a paved public or private roadway or parking area, including those on a U.S. Army installation. Analysis was limited to motorcycle operators. Odds ratios (ORs) and 95% confidence intervals (95% CIs) from a multivariable analysis estimated the effect of alcohol use and helmet use on the risk of a fatal injury given a crash occurred, controlling for operator and crash characteristics.

RESULTS

Of the 2,852 motorcycle traffic crashes, most involved men (97%), operators aged 20-29 years of age (60%), and operators who wore helmets (95%) and did not use alcohol (92%). Two thirds of reported crashes resulted in injuries requiring a lost workday; 17% resulted in fatality. Controlling for operator and crash characteristics, motorcycle traffic crashes involving operators who had used alcohol had a 3.1 times higher odds of fatality than those who did not use alcohol (OR =3.14; 95% CI, 2.17-4.53). Operators who did not wear a helmet had 1.9 times higher odds of fatality than those who did wear a helmet (OR =1.89; 95% CI, 1.24-2.89).

CONCLUSIONS

Among U.S. Army motorcycle operators, alcohol use and not wearing a helmet increased the odds of fatality, given that a crash occurred, and additional modifiable risk factors were identified. Results will help inform U.S. Army motorcycle policies and training.

Patterns of motorcycle helmet use - A naturalistic observation study in Myanmar

Developing countries are subject to increased motorization, particularly in the number of motorcycles. As helmet use is critical to the safety of motorcycle riders, the goal of this study was to identify observable patterns of helmet use, which allow a more accurate assessment of helmet use in developing countries. In a video based observation study, 124,784 motorcycle riders were observed at seven observation sites throughout Myanmar. Recorded videos were coded for helmet use, number of riders on the motorcycle, rider position, gender, and time of day. Generally, motorcycle helmet use in Myanmar was found to be low with only 51.5% percent of riders wearing a helmet. Helmet use was highest for drivers (68.1%) and decreased for every additional passenger. It was lowest for children standing on the floorboard of the motorcycle (11.3%). During the day, helmet use followed a unimodal distribution, with the highest use observed during the late morning and lowest use observed in the early morning and late afternoon. Helmet use varied significantly between observation sites, ranging from 74.8% in Mandalay to 26.9% in Pakokku. In Mandalay, female riders had a higher helmet use than male riders, and helmet use decreased drastically on a national holiday in the city. Helmet use of motorcycle riders in Myanmar follows distinct patterns. Knowledge of these patterns can be used to design more precise helmet use evaluations and guide traffic law policy and police enforcement measures. Video based observation proved to be an efficient tool to collect helmet use data.

Motorcyclist injury risk as a function of real-life crash speed and other contributing factors

The Vision Zero approach advocates for a road transport system designed with human injury tolerance and human fallibility as its basis. While biomechanical limits and the relationship between speed and injury outcome has been extensively investigated for car occupants and pedestrians, research analyzing this relationship for motorcyclists remains limited. The aim of this study was to address this issue by developing multivariate injury risk models for motorcyclists that estimate the relationship between speed and injury severity. For that purpose, motorcycle injury crashes from the German In-Depth Accident Study (GIDAS) database for the period 1999-2017 (n = 1037) were extracted. Different models were tested using logistic regression and backwards elimination of non-significant variables. The best fitting model in the current study included relative speed, type of crash opponent, impact location on the motorcycle and impact mechanism of the rider during the crash. A strong and significant relationship between relative speed and injury severity in motorcycle crashes was demonstrated. At 70 km/h, the risk for at least serious injuries in collisions with wide objects, crash barriers and narrow objects was 20%, 51%, and 64%, respectively. Further, it was found that head-on collisions between motorcycles and passenger cars, with both vehicles traveling at 60 km/h (a relative speed at 120 km/h), present 55% risk of at least serious injury to the motorcycle rider. More research is needed to fully understand the boundary conditions needed to design a safe road transport system for motorcyclists. However, this study provides important insights into the relationship between speed and injury severity for riders in various crash situations. The results may be useful in the discussion of appropriate speed limits and in determining the benefits of countermeasures which aim to reduce crash speed.

Pediatric and adolescent injury in motocross

Motocross is a competitive outdoor extreme sport in which motorcyclists race across vast courses of jumps, berms and long straightaways of unpredictable terrain. While the sport has gained notoriety in adult popular culture through contests like the X Games, motocross is also increasingly popular among youth in the Unites States and beyond. In the setting of contemporary discussions on traumatic brain injury, this poses an obvious challenge to those advising children and parents on the risks of motocross to the developing brain and spine. The available literature demonstrates that even when practiced with appropriate protective equipment, motocross poses an increased risk for acquiring major trauma to the brain, spine and limbs for which the long-term consequences have been poorly studied. Riders and parents should be counseled about the risks of these injuries prior to participation and in accordance with state laws. Furthermore, formal return-to-play guidelines following concussions should be developed.

Can Planned Traffic Patterns Improve Survival Among the Injured During Mass Casualty Motorcycle Rallies?

BACKGROUND

Mass casualty events are infrequent and create an abrupt surge of patients requiring emergency medical services within a brief period. We hypothesize that implementation of a controlled "traffic loop" pattern during a planned high-volume motorcycle rally could improve overall mortality and impact patient outcomes.

MATERIALS AND METHODS

We performed a retrospective analysis of all motorcycle-related injuries during the city's annual motorcycle rally over a 4-y period. Comparative analysis was completed between those injured during "nontraffic loop" hours versus the city's scheduled 23-mile, 3-d "traffic loop" pattern. The two groups were compared for age, gender, injuries, Injury Severity Score, Glasgow Coma Scale, length of stay, ventilator-free days, and mortality. The primary outcome was mortality.

RESULTS

A total of 139 patients were included (120 nonloop and 19 loop). Mean (standard deviation) age was 36.1 (11.2) y and 72.1% were male. Both groups were equivalent in age, gender, Injury Severity Score, and Glasgow Coma Scale. Traffic loop patients required longer intensive care unit length of stay, (median = 9.0, range: 1-49 d), ventilator days (median = 29.5), (range: 1-49 d) and experienced abdominal trauma (P = 0.002). Emergency medical services transport times during loop hours had shorter response times than the nonloop injury group (7.79 ± 5.2 min and 13.22 ± 14.01 min (P = 0.049). No deaths occurred during the city's scheduled traffic loop (0 versus 22, P = 0.0447).

CONCLUSIONS

Controlled traffic patterns during high-volume city gatherings can improve overall mortality and morbidity. Regional trauma system preparedness with field triage guidelines and coordinated trauma care is warranted to effectively care for the injured.

The danger zone: Injuries and conditions associated with immediately fatal motorcycle crashes in the state of Michigan

BACKGROUND

Immediately fatal motorcycle crashes have not been well characterized. This study catalogues injuries sustained in fatal motorcycle crashes and assesses the impact of crash conditions on injury patterns.

METHODS

Autopsy records from the office of the medical examiner of Kent County, MI and publicly available traffic reports were queried for information pertaining to motorcyclists declared dead on-scene between January 1, 2007, and December 31, 2016.

RESULTS

A total of 71 autopsies of on-scene motorcycle crash fatalities were identified. The two most prevalent injuries were traumatic brain injury (TBI) (85%) and rib fractures (79%). The majority of fatalities occurred in daylight hours (54.3%) and in a 55 mph speed limit zone (63.8%).

CONCLUSIONS

This study provides a catalogue of the injuries sustained in immediately fatal motorcycle crashes and the associated conditions. Advocacy efforts that highlight the risks associated with motorcycle riding and that promote safe riding practices are warranted.

Correlations between mobile phone use and other risky behaviours while riding a motorcycle

Motorcyclist safety is a major concern in many developing countries. Understanding motorcycle riders' risky behaviours, particularly among the younger population, is essential to developing effective interventions. This paper explores the correlations between mobile phone use while riding and other risky riding behaviours as well as the relationships between perceived risks and risky riding behaviours, using an online survey of university students in Vietnam. Results show that calling while riding a motorcycle had the highest prevalence (74%) while reckless overtaking had the lowest prevalence (33.2%). Survey participants who indicated that they had the behaviours of reckless overtaking or riding on sidewalks were around twice as likely to call, text, or search for information while riding. In addition, those who admitted that they rode a motorcycle while under the influence of alcohol were nearly twice as likely to call or text while riding. The results also show that perceived crash risks reduced the likelihood of risky riding behaviours, including calling, texting, searching for information, speeding, running red lights, riding on the wrong side of a road, and riding on sidewalks. A more coordinated approach to enforcement is needed to help reduce the prevalence of multiple risk taking behaviours among motorcyclists.

Risk factors for motorcycle loss-of-control crashes

OBJECTIVE

The present article identifies and assesses the effect of critical factors on the risk of motorcycle loss-of-control (LOC) crashes.

METHOD

Data come from a French project on road crashes, which include all fatal road crashes and a random sample of 1/20th of nonfatal crashes in France in 2011, based on police reports. A case-control study was carried out on a sample of 903 crashes for 444 LOC motorcycle riders (case) and 470 non-LOC and nonresponsible motorcycle riders (control). The sample was weighted due to the randomization of nonfatal crashes. Missing values were imputed using multiple imputation.

RESULTS

Road alignment and surface conditions, human factors, and motorcycle type played important roles in motorcycle LOC crashes. Riding in a curve was associated with a 3-fold greater risk of losing control of motorcycle than riding in a straight line. Poor road adhesion significantly increased the risk of losing control; the risk increased more than 20-fold when deteriorated road adhesion was encountered unexpectedly, due to loose gravel, ice, oil, bumps, road marking, metal plates, etc. For motorcyclists, riding with a positive blood alcohol concentration (over or equal to the legal limit of 0.5 g/L) was very dangerous, often resulting in losing control. The risk of LOC crash varied for different types of motorcycle: Riders of roadsters and sports bikes were more likely to have an LOC crash greater than that of riders of basic or touring motorcycles. In addition, LOC risk increased with speed; a model using the square of the traveling speed showed better fit than one using speed itself.

CONCLUSION

The LOC crash factors related to riders, vehicles, and road infrastructure identified here were expected but were rarely identified and taken simultaneously into account in previous studies. They could be targeted by countermeasures to improve motorcyclist safety.

Factors contributing to motorcycle fatal crashes on National Highways in India

This study analyses fatal crash patterns, and identifies the risk factors contributing to motorcycle versus non-motorcycle fatal crashes using binomial logistic regression on two-, four- and six-lane National Highways (NHs) in India utilizing police fatal crash data. The distribution of victims' mode by striking vehicles shows that percentage share of striking vehicles (truck) against the victims' vehicles (motorcycle) is 44%, 52% and 37% on two-lane NH-8, four-lane NH-24 and six-lane NH-1, respectively. Nine explanatory variables pertaining to fatal crash, victim, roadway and environment are considered for the model (using combined data of cited three NHs). The results of the logistic regression model (motorcycle versus non-motorcycle fatal crashes) show that for variable 'collision type', likelihood of occurrence of 'rear-end', 'sideswipe' and 'head-on' fatal crashes are 42-times, 35-times and 25-times more than 'hit pedestrian' respectively. Similarly, for variable 'number of vehicle', likelihood is thrice as 'single-vehicle' than 'two or more vehicles'; and, for variable 'number of lane', probability is more on 'two-lane' NH-8 than 'four-lane' NH-24. Based on the study results, it is recommended to upgrade two-lane (undivided carriageway) to four-lane (divided carriageway) NHs to reduce 'head-on' collision.

Ambulance traffic accidents in Taiwan

BACKGROUND/PURPOSE

Ambulance traffic accidents (ATAs) are the leading cause of occupation-related fatalities among emergency medical service (EMS) personnel. We aim to use the Taiwan national surveillance system to analyze the characteristics of ATAs and to assist EMS directors in developing policies governing ambulance operations.

METHODS

A retrospective, cross-sectional and largely descriptive study was conducted using Taiwan national traffic accidents surveillance data from January 1, 2011 to October 31, 2016.

RESULTS

Among the 1,627,217 traffic accidents during the study period, 715 ATAs caused 8 deaths within 24 h and 1844 injured patients. On average, there was one ATA for every 8598 ambulance runs. Compared to overall traffic accidents, ATAs were 1.7 times more likely to result in death and 1.9 times more likely to have injured patients. Among the 715 ATAs, 8 (1.1%) ATAs were fatal and 707 (98.9%) were nonfatal. All 8 fatalities were associated with motorcycles. The urban areas were significantly higher than the rural areas in the annual number of ATAs (14.2 ± 7.3 [7.0-26.7] versus 3.1 ± 1.9 [0.5-8.4], p = 0.013), the number of ATA-associated fatalities per year (0.2 ± 0.2 [0.0-0.7] versus 0.1 ± 0.1 [0.0-0.2], p = 0.022), and the annual number of injured patients (who needed urgent hospital visits) in ATAs (19.4 ± 7.3 [10.5-30.9] versus 5.2 ± 3.8 [0.9-15.3], p < 0.001).

CONCLUSION

The ATA-associated fatality rate in Taiwan was high, and all fatalities were associated with motorcycles. ATAs in a highly motorcycle-populated area may require further investigation. An ambulance traffic accident reporting system should be built to provide EMS policy guidance for ATA reduction and outcome improvements.

Motorcyclists' self-reported riding mileage versus actual riding mileage in the following year

INTRODUCTION

Accurate motorcyclist mileage estimates are important because self-evaluation of riding experience is related to riding behavior, the relationship of self-reported to actual or future mileage is necessary in targeting training and considering survey responses, and motorcycle crash statistics require accurate travel data.

METHOD

This study collected real-world data from motorcyclists over the course of two months to two years per rider. This paper explores motorcyclists' self-reported annual riding mileage (obtained via pre-study surveys) and the actual amount of riding during the study (based upon odometer readings and GPS data).

RESULTS

Of the 91 riders who had been riding for at least a year before the study, significantly more (73%) rode less the following year than reported for the previous year. The recorded annualized mileage averaged 89% of the reported mileage from the previous year. Analyses based on estimated average annual mileage were similar to those using the previous year estimation, and the pattern held regardless of age group, motorcycle type, or gender. The exception was novice or returning riders, who tended to either significantly underestimate or increase actual mileage as they began (or continued) to ride.

CONCLUSIONS

Motorcyclists' estimation of riding experience expressed as mileage may not be indicative of current or future mileage.

PRACTICAL APPLICATIONS

Reliance on self-reported mileage during training to categorize groups, for interpretation of studies, or to develop motorcycle travel data and safety statistics may be unrealistic. Certainly any use of self-reported mileage should incorporate the concept that mileage overestimation seems likely. Because questions about previous year and average annual mileage may elicit similar responses, motorcyclist surveys should be constructed to prompt the most thoughtful responses in terms of mileage estimations. In general, reported mileage should not be relied upon as an accurate predictor of future actual mileage.

Upper extremity open fractures in hospitalized road traffic accident patients: adult versus pediatric cases

Background

Fractures in pediatrics show epidemiological characteristics which are different from fractures in adults. The objective of this study was to examine the injury profiles of open upper extremity fractures (UEFs) in all modes of injury related to road traffic accidents (RTAs) in adult and pediatric hospitalized patients.

Methods

Data on 103,465 RTA patients between 1997 and 2013 whose records were entered in a centralized country trauma database were reviewed. Data on open UEFs related to mode of injury (car, motorcycle, bicycle, and pedestrian) was compared between adult (18+ years) and pediatric (0–17 years) RTA patients.

Results

Of 103,465 RTA cases, 17,263 (16.7%) had UEFs. Of 73,087 adults, 13,237 (18.1%) included UEFs and of 30,378 pediatric cases, 4026 (13.2%) included UEFs (p < 0.0001). Of 17,263 cases with UEFs, we reviewed 22,132 fractures with 2, 743 (12.4%) open fractures. Adults had a greater risk for open fractures (2221, 13%) than the pediatric cases (522, 10.3%) (p < 0.0001). Overall, of a total of 22,132 UEFs, most of the fractures were in the radius (22.8%), humerus (20.3%), clavicle (17.5%), and ulna (15.4%). The adult pedestrian group had a significantly higher risk for open UEFs than the pediatric group (11 vs 8%, p = 0.0012).

Conclusions

This study demonstrates the difference between adult and pediatric open fractures in hospitalized RTAs. We showed that adults had a greater risk for open UEFs compared to children, and the adult pedestrian group particularly had a significantly higher risk for open UEFs than the pediatric group.

A study of the correlation between ultrafine particle emissions in motorcycle smoke and mice erythrocyte damages

Sharply increasing of motor vehicles every year contributes to amounts of ultrafine particles (UFPs) in the air. Besides, the existence of UFPs in the blood may cause erythrocyte damages that subject to shape deformation. This study was aimed to investigate the influence of UFPs in the motorcycle smoke exposed to mice in different concentrations to the erythrocyte damages. The experiments were conducted by injecting the motorcycle smoke with the varied amounts in an experimental chamber (dimension of 30×20×20cm³) where the mice were put in advance for exposuring twice a day (100s). Total numbers of UFPs in the smoke were calculated by measuring the total concentrations multiplied by the smoke debit. They were measured using a TSI 8525 P-Trak UPC. The effects of the smoke exposures in the mice's erythrocytes related to the UFPs in the smoke were observed by a binocular CX-31 Computer Microscope after the 2nd, 4th, 6th, 8th, and 10th exposure days. The erythrocyte damages were calculated from the total abnormal erythrocytes divided by the total erythrocytes. Our results showed that more UFPs exposed to mice resulted in more the erythrocytes damages. Longer exposures caused more damages of the mice erythrocytes. This study found significant correlations between the numbers of UFPs exposed to mice and the erythrocyte damages. Our finding gives important evidence that motorcycle emissions especially UFPs affect on health.

Validation of the abrasion resistance test protocols and performance criteria of EN13595: The probability of soft tissue injury to motorcycle riders by abrasion resistance of their clothing

INTRODUCTION

Motorcyclists represent an increasing proportion of road users globally and are increasingly represented in crash statistics. Soft tissue injuries are the most common type of injuries to crashed motorcyclists. These injuries can be prevented through the use of protective clothing designed for motorcycle use. However, the quality of such clothing is not controlled in many countries around the world. A European Standard was developed to assess the performance of clothing but as this is not mandatory, clothing certified to this Standard is difficult to obtain. Given the importance of this Standard, and that it has been validated only once, further validation work is required.

METHODS

In-depth crash investigation data were used to investigate the relationship between the abrasion resistance performance of clothing and real-world injury outcome. Clothing was collected from riders who crashed on public roads in Sydney and Newcastle, Australia. This clothing was tested according to the EU Standard and the time to hole was recorded. Hospital medical records were reviewed and the association between a rider suffering a soft tissue injury and the time-to-hole for the garment was examined.

RESULTS

The probability of soft tissue injury for Level 1 Standard garments was between 40-60%, but more than 60% of garments tested failed to meet the minimum requirement.

CONCLUSIONS

The findings of this study provide qualified support for the Standard, with a marginal association between time-to-hole and injury being found.

PRACTICAL IMPLICATIONS

This work supports the need for improved safety performance and an increased number of high performing garments being available to motorcyclists.