Who's calling? Social networks and mobile phone use among motorcyclists

Mobile phone use while riding a motorcycle poses a key safety risk, particularly among younger people who have been found to be more susceptible to distracted driving. While previous research has examined the influence of social networks on mobile phone use while driving a car, no research has explored this association in the context of motorcycle use. Using a survey of university students in Vietnam, this research explores the association between social networks and mobile phone use among motorcyclists and the links this has to reported crashes/falls. Results show that the majority of students are most likely to use a mobile phone to communicate with a friend while riding, either through talking (56.5%) or text messaging (62.0%). However, respondents who frequently talk to a girlfriend/boyfriend or spouse while riding were more likely to experience a crash/fall than those who frequently talk with others while riding (e.g. parent, brother/sister). In addition, those who frequently text message a friend while riding were more likely to experience a crash/fall than those who frequently text message others while riding. The results highlight a clear association between social networks and mobile phone use while riding a motorcycle. Developing a culture of societal norms, where mobile phone use while riding a motorcycle is considered socially unacceptable, will help to reduce the prevalence and ultimate crash risk associated with mobile phone use while riding.

Novelty helmet use and motorcycle rider fatality

OBJECTIVES

To compare the risk of fatal injury across helmet types among collision-involved motorcyclists.

METHODS

We used data from a cohort of motorcyclists involved in police-reported traffic collisions. Eighty-four law enforcement agencies in California collected detailed information on helmet and rider characteristics during collision investigations in June 2012 through July 2013. Multiply-adjusted risk ratios were estimated with log-binomial regression.

RESULTS

The adjusted fatal injury risk ratio for novelty helmets was 1.95 (95% CI 1.11-3.40, p 0.019), comparing novelty helmets with full-face helmets. The risk ratios for modular, open-face, and half-helmets, compared with full-face helmets, were not significant.

CONCLUSIONS

A more complete understanding of the inadequacy of novelty helmets can be used in educational and law enforcement countermeasures to improve helmet use among motorcycling populations in California and other US states. Law enforcement approaches to mitigating novelty helmet use would seem attractive given that novelty helmets can be visually identified by law enforcement officers with sufficient training.

Energy attenuation performance of impact protection worn by motorcyclists in real-world crashes

OBJECTIVE

Laboratory studies have demonstrated that impact protectors (IP) used in motorcycle clothing can reduce fracture severities. While crash studies have reported IP are associated with reduced likelihood of soft tissue injury, there is little evidence of their effectiveness in reducing fracture likelihood. This discrepancy might be related to IP quality. There are mandatory requirements for IP supplied with protective clothing in Europe, but not elsewhere. This study examines the energy attenuation performance of IP used by Australian riders.

METHODS

IP were harvested from clothing worn by crashed riders admitted to hospital. The IP were examined and energy attenuation properties were determined using EN 1621-1 test procedures. Impact injury was identified from medical records and defined as fractures, dislocations, and avulsions that occurred following impact to the rider's shoulders, elbows, hips, and/or knees. Fisher's exact test was used to examine the relationship between meeting the EN 1621-1 energy attenuation requirements and impact injury. The association between the average and maximum transmitted force, and impact injury was examined using generalized estimating equations. Motorcycle riders were recruited as part of an in-depth crash study through three hospitals in New South Wales, Australia, between 2012 and 2014. Riders were interviewed, and engineers conducted site, vehicle, and clothing inspections. Clothing was collected, or identical garments were purchased.

RESULTS

Clothing was inspected for 62 riders. Of these, 19 wore clothing incorporating 76 IP. Twenty-six of these were impacted in the crash event. Almost all impacted IP (96%) were CE marked, and most (83%) met Level 1 energy attenuation requirements of EN 1621-1 when tested. Of the 26 impacted IP, four were associated with impact injuries, including midshaft and distal clavicle fractures and a scapula and olecranon fracture. No associations between meeting EN 1621-1 requirements and impact injury were found (p = 0.5). There was no association between average force transmitted and impact injury (95% CI: 0.91-1.24); however, as maximum force transmitted increased, the odds of impact injury increased (95% CI: 1.01-1.2). These results indicate a high probability of impact injury at 50 kN, the limit of maximum transmitted force specified in EN 1621-1.

CONCLUSION

The allowable transmitted force of EN 1621-1 may be too high to effectively reduce the probability of impact injury. This is not surprising, given human tolerance levels that are reported in literature. Reducing the force limit below the reported fracture tolerance limits might be difficult with current technology. However, there is scope to reduce the EN 1621-1 maximum limit of 50 kN transmitted force. A reduction in the maximum force limit would improve rider protection and appears feasible, as 77% of tested IP recorded a maximum force <35 kN. This level of transmitted force is estimated to be associated with <20% probability of impact injury. While the performance of IP available to Australian riders is not regulated, most IP was CE marked. The results indicate a significant association between maximum transmitted force, tested according to EN 1621-1 procedures, and impact injury. Further investigation of the EN 1621-1 requirements may be warranted. This work will interest those targeting protective equipment for motorcyclists as a mechanism for reducing injury to these vulnerable road users.

Motocross-associated head and spine injuries in adult patients evaluated in an emergency department

BACKGROUND

Motor vehicle-related injuries (including off-road) are the leading cause of traumatic brain injury (TBI) and acute traumatic spinal cord injury in the United States.

OBJECTIVES

To describe motocross-related head and spine injuries of adult patients presenting to an academic emergency department (ED).

METHODS

We performed an observational cohort study of adult ED patients evaluated for motocross-related injuries from 2010 through 2015. Electronic health records were reviewed and data extracted using a standardized review process.

RESULTS

A total of 145 motocross-related ED visits (143 unique patients) were included. Overall, 95.2% of patients were men with a median age of 25years. Sixty-seven visits (46.2%) were associated with head or spine injuries. Forty-three visits (29.7%) were associated with head injuries, and 46 (31.7%) were associated with spine injuries. Among the 43 head injuries, 36 (83.7%) were concussions. Seven visits (16.3%) were associated with at least 1 head abnormality identified by computed tomography, including skull fracture (n=2), subdural hematoma (n=1), subarachnoid hemorrhage (n=4), intraparenchymal hemorrhage (n=3), and diffuse axonal injury (n=3). Among the 46 spine injuries, 32 (69.6%) were acute spinal fractures. Seven patients (4.9%) had clinically significant and persistent neurologic injuries. One patient (0.7%) died, and 3 patients had severe TBIs.

CONCLUSION

Adult patients evaluated in the ED after motocross trauma had high rates of head and spine injuries with considerable morbidity and mortality. Almost half had head or spine injuries (or both), with permanent impairment for nearly 5% and death for 0.7%.

Motorcycle-related hospitalizations of the elderly

Background

To investigate the injury pattern, mechanisms, severity, and mortality of the elderly hospitalized for treatment of trauma following motorcycle accidents.

Methods

Motorcycle-related hospitalization of 994 elderly and 5078 adult patients from the 16,548 hospitalized patients registered in the Trauma Registry System between January 1, 2009 and December 31, 2013.

Results

The motorcycle-related elderly trauma patients had higher injury severity, less favorable outcomes, higher proportion of patients admitted to the intensive care unit (ICU), prolonged hospital and ICU stays and higher mortality than those adult motorcycle riders. It also revealed that a significant percentage of elderly motorcycle riders do not wear a helmet. Compared to patients who had worn a helmet, patients who had not worn a helmet had a lower first Glasgow Coma Scale (GCS) score, and a greater percentage presented with unconscious status (GCS score ≤8), had sustained subdural hematoma, subarachnoid hemorrhage, cerebral contusion, severe injury (injury severity score 16–24 and ≥25), had longer hospital stay and higher mortality, and had required admission to the ICU.

Conclusions

Elderly motorcycle riders tend to present with a higher injury severity, worse outcome, and a bodily injury pattern differing from that of adult motorcycle riders, indicating the need to emphasize use of protective equipment, especially helmets, to reduce their rate and severity of injury.

Differences between the sexes in motorcycle-related injuries and fatalities at a Taiwanese level I trauma center

Background

Female patients present with unique physiological and behavioral characteristics compared to male patients. The aim of this study was to investigate and compare the injury patterns, injury characteristics, and mortality of male and female patients hospitalized for treatment of motorcycle accident-related trauma in a level I trauma center.

Methods

Retrospective analysis of motorcycle-related injuries from the Trauma Registry System was performed to identify and compare 4028 male and 2919 female patients hospitalized for treatment between January 1, 2009 and December 31, 2013.

Results

The female patients were younger, less often drunken, more often wore helmets, were transported by emergency medical services, and arrived at the emergency department between 7 a.m. and 5 p.m. compared to male patients. Analysis of Abbreviated Injury Scale scores revealed that female patients sustained significantly higher rates of injuries to the extremities, but lower rates of injuries to the head/neck, face, and thorax than male patients did. Female patients had a significant lower Injury Severity Score (ISS) and adjusted odds ratio of in-hospital mortality (AOR 0.83, 95% CI: 0.83–0.86) after adjustment by ISS. However, the logistic regression analysis of propensity score-matched patients with adjusted confounders including helmet-wearing status and alcohol intoxication revealed that the gender did not significantly influence mortality (OR 0.82, 95% CI 0.47–1.43; p = 0.475), implying the an associated risky behaviors may attribute to the difference of odds of mortality between the male and female patients. In addition, a significantly fewer female patients were admitted to the intensive care unit (ICU), and female patients had a significantly shorter hospital and ICU length of stay.

Conclusion

Female motorcycle riders have different injury characteristics, lower ISS and in-hospital mortality, and present with a bodily injury pattern that differs from that of male motorcycle riders.

Level of evidence

Epidemiologic study, level III.

The relationship between Motorcycle Rider Behaviour Questionnaire scores and crashes for riders in Australia

Motorcycle riders are over-represented in road fatalities in Australia. While riders represent 18% of the road users killed each year, motorcycle registrations constitute only 4.5% of the registered vehicle fleet. The Motorcycle Rider Behaviour Questionnaire (MRBQ) was developed with a view toward understanding behaviours likely to be associated with crash risk. These include behaviours that are either intentional (such as violations of road and speed regulations and stunts) or unintentional (such as errors relating to traffic or control of the motorcycle), as well as protective behaviours related to use of safety equipment. The dual aims of the current study were, first, to determine the appropriate structure of a modified version of the MRBQ for use in a representative sample of riders in Australia and, second, to understand which MRBQ factors are associated with crash involvement. A stratified sampling procedure was undertaken to ensure the socio-economic status of local government area, age and gender of the sample was representative of the broader population of riders in New South Wales, Australia. The sample consisted of 470 riders (males=89%). Exploratory factor analysis revealed a 29-item, five factor structure was suitable on the Australian data encompassing traffic errors, speed violations, protective gear, control errors and stunts. Overall, riders reported relatively safe behaviours, with frequent use of protective gear and infrequent aberrant behaviours. However, even though infrequent, violations of speed and errors related to control of the motorcycle increased the odds of near-crash involvement, whilst stunt behaviours were associated with increased odds of crash involvement. Interventions and countermeasures need to target these specific behaviours.

Examination of factors associated with use rates after transition from a universal to partial motorcycle helmet use law

OBJECTIVES

Motorcycle riders account for a disproportionately high number of traffic injuries and fatalities compared to occupants of other vehicle types. Though research has demonstrated the benefits of helmet use in preventing serious and fatal injuries in the event of a crash, helmet use has remained relatively stable in the United States, where the most recent national estimates show a 64% use rate. Use rates have been markedly lower among those states that do not have a universal helmet law for all riders. In 2012, the state of Michigan repealed its longstanding mandatory helmet use law. In order to gain insights as to the effects of this legislative change, a study was conducted to examine short-term changes in helmet use and identify factors associated with use rates.

METHODS

A statewide direct observation survey was conducted 1 year after the transition from a universal helmet law to a partial helmet law. A random parameters logistic regression model was estimated to identify motorcyclist, roadway, and environmental characteristics associated with helmet use. This modeling framework accounts for both intravehicle correlation (between riders and passengers on the same motorcycle) as well as unobserved heterogeneity across riders due to important unobserved factors.

RESULTS

Helmet use was shown to vary across demographic segments of the motorcyclist population. Use rates were higher among Caucasian riders, as well as among those age 60 and above. No significant difference was observed between male and female riders. Use was also found to vary geographically, temporally, and with respect to various environmental characteristics. Geographically, helmet use rates tended to be correlated with historical restraint use trends, which may be reflective of riding environment and general differences in the riding population. To this end, rates were also highly variable based upon the type of motorcycle and whether the motorcyclist was wearing high-visibility gear.

CONCLUSIONS

The study results demonstrate the short-term reduction in helmet use following transition from a universal to partial motorcycle helmet law. The reduction in use is somewhat less pronounced than has been experienced in other states, which may be reflective of general differences among Michigan motorcyclists because the state has also generally exhibited higher use rates of seat belts and other forms of occupant protection. The study results also highlight potential target areas for subsequent education and public awareness initiatives aimed at increasing helmet use.

Impact of Helmet Use on Injury and Financial Burden of Motorcycle and Moped Crashes in Hawai'i: Analysis of a Linked Statewide Database

Helmet use reduces injury severity, disability, hospital length of stay, and hospital charges in motorcycle riders. The public absorbs billions of dollars annually in hospital charges for unhelmeted, uninsured motorcycle riders. We sought to quantify, on a statewide level, the healthcare burden of unhelmeted motorcycle and moped riders. We examined 1,965 emergency medical service (EMS) reports from motorcycle and moped crashes in Hawai'i between 2007-2009. EMS records were linked to hospital medical records to assess associations between vehicle type, helmet use, medical charges, diagnoses, and final disposition. Unhelmeted riders of either type of vehicle suffered more head injuries, especially skull fractures (adjusted odds ratio (OR) of 4.48, P < .001, compared to helmeted riders). Motorcyclists without helmets were nearly three times more likely to die (adjusted OR 2.85, P = .001). Average medical charges were almost 50% higher for unhelmeted motorcycle and moped riders, with a significant (P = .006) difference between helmeted ($27,176) and unhelmeted ($40,217) motorcycle riders. Unhelmeted riders were twice as likely to self-pay (19.3%, versus 9.8% of helmeted riders), and more likely to have Medicaid or a similar income-qualifying insurance plan (13.5% versus 5.0%, respectively). Protective associations with helmet use are stronger among motorcyclists than moped riders, suggesting the protective effect is augmented in higher speed crashes. The public financial burden is higher from unhelmeted riders who sustain more severe injuries and are less likely to be insured.

Mortality from motorcycle crashes: the baby-boomer cohort effect

BACKGROUND

Motorcyclists are known to be at substantially higher risk per mile traveled of dying from crashes than car occupants. In 2014, motorcycling made up less than 1 % of person-miles traveled but 13 % of the total mortality from motor-vehicle crashes in the United States. We assessed the cohort effect of the baby-boomers (i.e., those born between 1946 and 1964) in motorcycle crash mortality from 1975 to 2014 in the United States.

METHODS

Using mortality data for motorcycle occupants from the Fatality Analysis Reporting System, we performed an age-period-cohort analysis using the multiphase method and the intrinsic estimator method.

RESULTS

Baby-boomers experienced the highest mortality rates from motorcycle crashes at age 20-24 years and continued to experience excess mortality after age 40 years. After removing the effects of age and period, the estimated mortality risk from motorcycle crashes for baby-boomers was 48 % higher than that of the referent cohort (those born between 1930 and 1934, rate ratio 1.48; 95 % CI: 1.01, 2.18). Results from the multiphase method and the intrinsic estimator method were consistent.

CONCLUSIONS

The baby-boomers have experienced significantly higher mortality from motorcycle crashes than other birth cohorts. To reduce motorcycle crash mortality, intervention programs specifically tailored for the baby-boomer generation are warranted.

Exposure factors of Victoria's active motorcycle fleet related to serious injury crash risk

OBJECTIVE

The purpose of this study was to describe the nature and extent of current powered 2-wheeler (PTW) risk exposures in order to support future efforts to improve safety for this mode of transport.

METHODS

A cross-sectional analysis of the control arm of a population-based case-control study was conducted. The control sample was selected from 204 sites on public roads within 150 km of the city of Melbourne that were locations of recent serious injury motorcycle crashes. Traffic observations and measurements at each site were sampled for a mean of 2 h on the same type of day (weekday, Saturday, or Sunday) and within 1 h of the crash time. Photographs of passing riders during this observation period recorded data relating to characteristics of PTWs, age of riders, travel speed of PTWs and all vehicles, time gaps between vehicles, visibility, and protective clothing use.

RESULTS

Motorcycles and scooters represented 0.6% of all traffic (compared with 4% of all vehicle registrations). Riders were significantly more likely to have larger time gaps in front and behind when compared to other vehicles. The average travel speed of motorcycles was not significantly different than the traffic, but a significantly greater proportion were exceeding the speed limit when compared to other vehicles (6 vs. 3%, respectively). The age of registered owners of passing motorcycles was 42 years. Over half of riders were wearing dark clothing with no fluorescent or reflective surfaces. One third of motorcyclists had maximum coverage of motorcycle-specific protective clothing.

CONCLUSIONS

A very low prevalence of motorcyclists combined with relatively higher rates of larger time gaps to other vehicles around motorcycles may help explain their overrepresentation in injury crashes where another vehicle fails to give way. An increased risk of injury in the event of a crash exists for a small but greater proportion of motorcyclists (compared to other vehicle types) who were exceeding the speed limit. An apparent shift toward older age of the active rider population may be reducing injury crash risk relative to exposure time. There is significant scope to improve the physical conspicuity of motorcyclists and the frequency of motorcycle specific protective clothing use. These results can be used to inform policy development and monitor progress of current and future road safety initiatives.

Motorcycle helmet fixation status is more crucial than helmet type in providing protection to the head

INTRODUCTION

In Malaysia, motorcyclists continue to outnumber other road users in injuries and deaths. The objective of this study was to determine the association between helmet fixation and helmet type with head injury and severity of head injury among Malaysian motorcyclists.

METHODS

The study design was a prospective cross-sectional study. The participants involved injured motorcyclists who were admitted in five selected hospitals in Klang Valley, Malaysia. Participants who sustained head injury were selected as the cases while those with injury below the neck (IBN) were selected as the controls. Questionnaire comprising motorcyclist, vehicle, helmet and crash factors was examined. Diagnoses of injuries were obtained from the participants' medical records.

RESULTS

The total subjects with head injuries were 404 while those with IBN were 235. Majority of the cases (76.2%) and controls (80.4%) wore the half-head and open-face helmets, followed by the tropical helmets (5.4% and 6.0% of the cases and controls, respectively). Full-face helmets were used by 1.2% of the cases and 4.7% of the controls. 5.7% of the cases and 6.0% of the controls did not wear a helmet. 32.7% of the cases and 77.4% of the controls had their helmets fixed. Motorcyclists with ejected helmets were five times as likely to sustain head injury [adjusted odds ratio, AOR 5.73 (95% CI 3.38-9.73)] and four times as likely to sustain severe head injury [AOR of 4.83 (95% CI 2.76-8.45)]. The half head and open face helmets had AOR of 0.24 (95% CI 0.10-0.56) for severe head injury when compared to motorcyclists who did not wear a helmet.

CONCLUSION

Helmet fixation is more effective than helmet type in providing protection to the motorcyclists.

A systematic review on the effectiveness of back protectors for motorcyclists

Background

Motorcyclists are a vulnerable road-user population who are overrepresented in traffic injuries. Utilisation of back protectors may be an effective preventive measure for spine injuries in motorcyclists. Since use of back protectors is increasing it is important that clinical evidence supports their use. The study aimed to investigate the current evidence on the ability of back protectors to reduce the rate of back injuries and patient mortality in motorcycle crashes.

Methods

A systematic literature search was conducted using various electronic databases. Systematic reviews, randomised controlled trials, controlled clinical trials, cohort studies, case series and case reports were included Opinion pieces and laboratory or biomechanical studies were excluded. Back protectors and spine protectors were included as the intervention; neck braces and speed humps were excluded. The target outcomes were any injuries to the back or death. Only English language studies were included.

Results

The search strategy yielded 185 studies. After excluding 183 papers by title and abstract and full-text evaluation, only two small cross-sectional studies were included. Foam inserts in motorcycle jackets and non-standard clothing may possibly be associated with higher risk of injuries, while hard shell and standard back protectors may possibly be associated with a reduced rate of back and spinal injury.

Conclusion

This systematic review highlighted lack of appropriate evidence on efficacy of back protectors. Based on limited information, we are uncertain about the effects of back protectors on spinal injuries. Further research is required to substantiate the effects of back protectors on mortality and other injuries to the back.

Electronic supplementary material

The online version of this article (doi:10.1186/s13049-016-0307-3) contains supplementary material, which is available to authorized users.

The effect of motion and signalling on drivers' ability to predict intentions of other road users

Failure in making the correct judgment about the intention of an approaching vehicle at a junction could lead to a collision. This paper investigated the impact of dynamic information on drivers' judgments about the intentions of approaching cars and motorcycles, and whether a valid or invalid signal was provided was also manipulated. Participants were presented with videoclips of vehicles approaching a junction which terminated immediately before the vehicle made any manoeuvre, or images of the final frame of each video. They were asked to judge whether or not the vehicle would turn. Drivers were better in judging the manoeuvre of approaching vehicles in dynamic than static stimuli, for both vehicle types. Drivers were better in judging the manoeuvre of cars than motorcycles for videos, but not for photographs. Drivers were also better in judging the manoeuvre of approaching vehicles when a valid signal was provided than an invalid signal, demonstrating the importance of providing a valid signal while driving. However, drivers were still somewhat successful in their judgments in most of the conditions with an invalid signal, suggesting that drivers were able to focus on other cues to intention. Finally, given that dynamic stimuli more closely reflect the demands of real-life driving there may be a need for drivers to adopt a more cautious approach while inferring a motorcyclist's intentions.

Observation of motorcycle helmet use rates in Michigan after partial repeal of the universal motorcycle helmet law

Motorcycle crashes result in a significant health burden, including many fatal injuries and serious non-fatal head injuries. Helmets are highly effective in preventing such trauma, and jurisdictions that require helmet use of all motorcyclists have higher rates of helmet use and lower rates of head injuries among motorcyclists. The current study examines helmet use and characteristics of helmeted operators and their riding conditions in Michigan, following a weakening of the state's universal motorcycle helmet use law in April 2012. Data on police-reported crashes occurring during 2012-14 and from a stratified roadside observational survey undertaken in Southeast Michigan during May-September 2014 were used to estimate statewide helmet use rates. Observed helmet use was more common among operators of sports motorcycles, on freeways, and in the morning, and least common among operators of cruisers, on minor arterials, and in the afternoon. The rate of helmet use across the state was estimated at 75%, adjusted for roadway type, motorcycle class, and time of day. Similarly, the helmet use rate found from examination of crash records was 73%. In the observation survey, 47% of operators wore jackets, 94% wore long pants, 54% wore boots, and 80% wore gloves. Protective clothing of jackets and gloves was most often worn by sport motorcycle operators and long pants and boots most often by riders of touring motorcycles. Findings highlight the much lower rate of helmet use in Michigan compared with states that have a universal helmet use law, although the rate is higher than observed in many states with partial helmet laws. Targeted interventions aimed at specific groups of motorcyclists and situations where helmet use rates are particularly low should be considered to increase helmet use.

The prevalence of crash risk factors in a population-based study of motorcycle riders

INTRODUCTION

Motorcyclists represent an increasing proportion of road traffic casualties but, while factors associated with crashes are readily identifiable, little is known about the prevalence of those risk factors in the motorcycling population.

METHOD

A stratified random-sampling frame was used to survey the population of registered motorcycles owners in New South Wales (NSW) when they attended motor registry offices. The postal codes in the State database of registered motorcycle were used to stratify the population into quartiles based on socioeconomic characteristics and to determine sample weights.

RESULTS

Participants (n=506) represented 47% of eligible riders approached. On average participants were aged 43, rode 7h/week and had 17 years of riding experience. Estimates based on multiple ownership rates suggest motorcycle registration numbers exceed the active riding population by approximately 15%. Less than half rode under 101km/week, 25% rode over 300km/week and just 42% rode every day. More rode frequently for leisure (70%) than for commuting (53%) and over half rarely rode in dark (52%) or wet (67%) conditions. Most wore protective clothing - helmets (100%), jackets (82%), pants (56%), boots (57%) and gloves (73%). Those with traffic infringements (32%) were mostly for driving (25%), not riding (10%) offences. In the past year, 13% had one or more motorcycle crashes including minor spills and 76% one or more near-crash experiences. The youngest riders (15-19) reported the highest rates of exposure in kilometres, hours, frequency of riding and commuting. They also reported lower crash involvement (3%) but more near-crashes (80%).

CONCLUSIONS

This study provides an account of the prevalence of key risk factors across age groups in a population of active motorcycle riders in NSW. Novice riders were represented in all age groups although most novices were under 40 years. These data can be used to guide the development of targeted countermeasures aimed at improving motorcycling safety for riders of different age groups.

Improving motorcycle conspicuity through innovative headlight configurations

Most motorcycle crashes involve another vehicle that violated the motorcycle's right-of-way at an intersection. Two kinds of perceptual failures of other road users are often the cause of such accidents: motorcycle-detection failures and motion-perception errors. The aim of this study is to investigate the effect of different headlight configurations on motorcycle detectability when the motorcycle is in visual competition with cars. Three innovative headlight configurations were tested: (1) standard yellow (central yellow headlight), (2) vertical white (one white light on the motorcyclist's helmet and two white lights on the fork in addition to the central white headlight), and (3) vertical yellow (same configuration as (2) with yellow lights instead of white). These three headlight configurations were evaluated in comparison to the standard configuration (central white headlight) in three environments containing visual distractors formed by car lights: (1) daytime running lights (DRLs), (2) low beams, or (3) DRLs and low beams. Video clips of computer-generated traffic situations were displayed briefly (250ms) to 57 drivers. The results revealed a beneficial effect of standard yellow configuration and the vertical yellow configuration on motorcycle detectability. However, this effect was modulated by the car-DRL environment. Findings and practical recommendations are discussed with regard to possible applications for motorcycles.

Riding into the golden years: injury patterns and outcomes of advanced-age motorcycle trauma

BACKGROUND

Our objectives were to characterize injury, complications, and outcomes for older riders after motorcycle accidents due to the rising trend in advanced-age motorcyclists.

METHODS

From 2008 to 2013, injured motorcyclists were compared by age group: younger (0 to 54 years) vs older (≥55 years) in a retrospective review of the trauma databank at North Memorial Medical Center, a Level-1 trauma center.

RESULTS

Of 432 patients, the older group (n = 100) had more fractures (60% vs 42%), injuries per patient (2 vs 1), intensive care unit admissions (48% vs 32%), ventilator days (8 vs 5), in-hospital complications (16% vs 8%), and hospital days (5.5 vs 3) than the younger group (n = 332), P < .01. The older group was also more likely to be discharged to a destination other than home, 35% vs 18%, P < .01.

CONCLUSIONS

Older riders are at risk for more severe injury, longer and more complex hospitalizations, and higher care demands after discharge. Both age-specific treatment and care systems will need to evolve to accommodate the needs of the aging trauma population.

Motorcycle helmet use and the risk of head, neck, and fatal injury: Revisiting the Hurt Study

Most studies find strong evidence that motorcycle helmets protect against injury, but a small number of controversial studies have reported a positive association between helmet use and neck injury. The most commonly cited paper is that of Goldstein (1986). Goldstein obtained and reanalyzed data from the Hurt Study, a prospective, on-scene investigation of 900 motorcycle collisions in the city of Los Angeles. The Goldstein results have been adopted by the anti-helmet community to justify resistance to compulsory motorcycle helmet use on the grounds that helmets may cause neck injuries due to their mass. In the current study, we replicated Goldstein's models to understand how he obtained his unexpected results, and we then applied modern statistical methods to estimate the association of motorcycle helmet use with head injury, fatal injury, and neck injury among collision-involved motorcyclists. We found Goldstein's analysis to be critically flawed due to improper data imputation, modeling of extremely sparse data, and misinterpretation of model coefficients. Our new analysis showed that motorcycle helmets were associated with markedly lower risk of head injury (RR 0.40, 95% CI 0.31-0.52) and fatal injury (RR 0.44, 95% CI 0.26-0.74) and with moderately lower but statistically significant risk of neck injury (RR 0.63, 95% CI 0.40-0.99), after controlling for multiple potential confounders.

Alcohol and drug involvement in motorcycle driver injuries in the city of Sao Paulo, Brazil: Analysis of crash culpability and other associated factors

BACKGROUND

Earlier studies have already identified that a greater proportion of injured drivers are under the effects of illicit drugs than alcohol in Brazil, but the crash risk attributable to each substance is still unknown.

METHODS

Injured motorcycle drivers who were involved in traffic accidents in the West Zone of the city of Sao Paulo were recruited for a cross-sectional study based on crash culpability analysis. Alcohol and drug positivity among drivers was evaluated according to their responsibility for the crash. Culpability ratios were generated based on the proportion of drivers who were deemed culpable in relation to those considered not culpable according to the use of drugs and alcohol.

RESULTS

Of the 273 drivers recruited, 10.6% tested positive for alcohol. Among those who were also tested for drugs (n=232), 20.3% had consumed either alcohol and/or other drugs, 15.5% of whom were positive only for drugs other than alcohol, specifically cannabis and cocaine. Drivers who tested positive for alcohol were significantly less likely to possess a valid driver's license and to report driving professionally, whereas those who had consumed only drugs were more likely to drive professionally. The culpability ratio estimated for alcohol-positive drivers was three times higher than that for alcohol-free drivers, showing a superior ratio than drivers who had consumed only drugs other than alcohol, who presented a 1.7 times higher culpability ratio than drug-free drivers.

CONCLUSION

Substance use was overrepresented among culpable motorcycle drivers, with alcohol showing a greater contribution to crash culpability than other drugs.

Motorcycle helmet type and the risk of head injury and neck injury during motorcycle collisions in California

The use of novelty motorcycle helmets is often prompted by beliefs that wearing a standard helmet can contribute to neck injury during traffic collisions. The goal of this analysis was to examine the association between helmet type and neck injury risk and the association between helmet type and head injury. Data were collected during the investigation of motorcycle collisions of any injury severity by the California Highway Patrol (CHP) and 83 local law enforcement agencies in California between June 2012 and July 2013. We estimated head injury and neck injury risk ratios from data on 7051 collision-involved motorcyclists using log-binomial regression. Helmet type was strongly associated with head injury occurrence but was not associated with the occurrence of neck injury. Rider age, rider alcohol use, and motorcycle speed were strong, positive predictors of both head and neck injury. Interventions to improve motorcycle helmet choice and to counteract misplaced concerns surrounding neck injury risk are likely to lead to reductions in head injury, brain injury, and death.

Does an on-road motorcycle coaching program reduce crashes in novice riders? A randomised control trial

OBJECTIVES

Motorcycle riding is increasing globally and confers a high risk of crash-related injury and death. There is community demand for investment in rider training programs but no high-quality evidence about its effectiveness in preventing crashes. This randomised trial of an on-road rider coaching program aimed to determine its effectiveness in reducing crashes in novice motorcycle riders.

METHODS

Between May 2010 and October 2012, 2399 newly-licensed provisional riders were recruited in Victoria, Australia and completed a telephone interview before randomisation to intervention or control groups. Riders in the intervention group were offered an on-road motorcycle rider coaching program which involved pre-program activities, 4h riding and facilitated discussion in small groups with a riding coach. Outcome measures were collected for all participants via telephone interviews at 3 and 12 months after program delivery (or equivalent for controls), and via linkage to police-recorded crash and offence data. The primary outcome was a composite measure of police-recorded and self-reported crashes; secondary outcomes included traffic offences, near crashes, riding exposure, and riding behaviours and motivations.

RESULTS

Follow-up was 89% at 3 months and 88% at 12 months; 60% of the intervention group completed the program. Intention-to-treat analyses conducted in 2014 indicated no effect on crash risk at 3 months (adjusted OR 0.90, 95% CI: 0.65-1.27) or 12 months (adjusted OR 1.00, 95% CI: 0.78-1.29). Riders in the intervention group reported increased riding exposure, speeding behaviours and rider confidence.

CONCLUSIONS

There was no evidence that this on-road motorcycle rider coaching program reduced the risk of crash, and we found an increase in crash-related risk factors.

Repeal of the Michigan helmet law: the evolving clinical impact

BACKGROUND

Michigan repealed a 35-year mandatory helmet law in April 2012. We examined the impact of this legislation on a level 1 trauma center.

METHODS

A retrospective cohort study comparing the 7-month period before and the 3 motorcycle seasons after the helmet law repeal.

RESULTS

A total of 345 patients were included in the study. Nonhelmeted riders increased from 7% to 28% after the repeal. Nonhelmeted crash scene fatalities were higher after the repeal (14% vs 68%). The nonhelmeted cohort had significantly higher in-patient mortality (10% vs 3%), injury severity score (19 vs 14.5) and abbreviated injury scale head (2.2 vs 1.3). Non-helmeted riders also had increased alcohol use, intensive care unit length of stay and need for mechanical ventilation. The median hospital cost for the non-helmeted cohort was higher (P < .05).

CONCLUSIONS

The impact of the Michigan helmet law repeal continues to evolve. Three years after this legislative change, we are now observing increased injury severity score, higher in-patient mortality, and worse neurologic injury.

Burden of motorcycle-related injury in Malaysia

BACKGROUND

Road traffic injury (RTI) contributes to major morbidity and mortality in both developed and developing countries. Most of the injuries are caused by road-related injuries that specifically relate to motorcycle crash. We attempted to conduct a short survey to determine the magnitude of burden related to motorcycle-related RTIs in Malaysia. We hypothesize that motorcycle-related RTI in Malaysia contributes significantly to the health burden in the country.

METHODS

The cross-sectional survey involves data searching related to RTI in Malaysia from the relevant agencies such as the Ministry of Health Malaysia, Royal Police Force, and Malaysia Institute of Road Safety Research (MIROS) through their official websites and PubMed search. The three agencies are well established and recognized by the Malaysian government in dealing with data collection for the injury nationwide. The primary aim is to determine the prevalence of motorcycle-related RTI, and secondary outcomes are the overall mortality and the contributing factors.

RESULTS

Of the cause of trauma, 80 % is due to RTI, and the most vulnerable road users such as pedestrians and motorcyclists are affected the most. Of all RTI, 70 % is contributed by the motorcycle crash, and there are a significant number of deaths for both rider and pillion rider of the motorcycle than for other types of vehicles. Human error is the main reason to be blamed, specifically the attitude of the riders on the road.

CONCLUSIONS

Trauma is one of the common reasons for death and hospitalization in Malaysia. Motorcycle-related RTI in Malaysia contributes significantly to the health burden in Malaysia. The Malaysian government and non-government agencies have worked together seriously in implementing a preventive measure to reduce the incidence and aftermath of motorcycle-related RTI. However, data is still lacking, and every effort is made to increase the amount of research in the field. Strengths of the article are as follows:Latest alarming data on motorcycle-related injuries in the developing country.The data is collected from multi-agencies recognized by ministries in the country.Very limited publication specifically on motorcycle-related injuries is available. Limitations of the article are as follows:The data is only from one country.The statistical data is gathered from a variety of sources, i.e., relevant agencies and authorities and website of the involved ministries.

Types and causalities in dead patients due to traumatic injuries

Background:

Trauma constitutes a major public health problem in our country and contributes significantly to unacceptably high morbidity and mortality.

Objectives:

This study aimed to evaluate the epidemiology of trauma in dead patients referred to Shahid Rajaee Trauma Hospital, Shiraz, Iran.

Patients and Methods:

In a cross-sectional study, all patients with trauma admitted to our center were enrolled between March 2011 and February 2012. Age, gender, months of referring, causalities, and injured body parts of the victims were extracted from the data registry and analyzed.

Results:

A total of 9113 patients, including 7163 (78.6%) males and 1950 (21.4%) females were evaluated. Among them, 479 patients (5.3%) had died. There was a significant difference between the age of alive and dead patients (35.70 ± 0.18 and 45.44 ± 1.01 years, respectively (P < 0.001)). In addition, dead men had significantly higher percentage than alive men (83.7% and 78.3%, respectively, P = 0.005). The highest percentages of men and women who referred to our center and died were in September. Crashing by car had the most frequency of dead (247 cases) in referred patients and motorcycle accident, stabbing, and falling related injuries with 67, 36 and 26 dead cases were in the next ranks. Thorax injury had the most frequency between dead patients (53.2% of all dead) and the intracranial injury and trauma to extremities altogether were in the next ranks, which constituted more than 18.8% of all dead.

Conclusions:

Our data demonstrated that car and motorcycle accidents are the most important cause of trauma and thorax trauma had the most frequency among dead patients. Epidemiological evaluations and preventive measures such as this study should be conducted to provide valuable data.