Single-vehicle crashes and alcohol: a retrospective study of passenger car fatalities in northern Sweden

Unintentional drowning fatalities in Sweden between 2002 and 2021

BACKGROUND

Despite declining over the past three decades, unintentional drownings still account for an estimated 236 000 annual deaths worldwide. Susceptibility persists amongst demographic groups and is influenced by sex, age, and socio-economic status, emphasizing the need for targeted interventions. Due to rapidly evolving population dynamics, particularly within Europe, there is a further responsibility to understand the impact of ethnicity on the risks of drowning to guide prevention.

METHODS

We conducted a national population-based retrospective study using data from the Swedish National Board of Forensic Medicine and Statistics Sweden for the years 2002 to 2021. The analysis includes variables such as age, sex, presence of alcohol and narcotics as well as activity undertaken at the time of drowning and type of water body. Furthermore, we considered ethnicity to identify subpopulations at greater risks.

RESULTS

Results revealed a plateau in unintentional drowning rates in Sweden since 2012, despite an overall decrease from 2002 to 2021. Findings confirm the trend that males are overrepresented within drowning statistics across all age groups, and that individuals aged > 50 constitute over half of all unintentional drownings. Men aged between 40-69 years boating, and individuals of non-Swedish origin, particularly those < 20 years of age, face a notably greater risk of drowning, underscoring the need for subpopulation-targeted prevention strategies.

CONCLUSION

The ten-year plateau in unintentional drowning signals the need for an official national prevention strategy with annual evaluations. Suggestions also include improved parental supervision of children, further avoidance of alcohol while swimming and boating, as well as targeted swimming lessons and water competency training for individuals of non-Swedish origin.

Estimation of crash type frequencies on individual collector roadway segments

Individual collision types have different underlying causes and thus the relationships between roadway/traffic characteristics and crash frequency are likely to differ across unique collision types. One way these different influences have been studied is by developing separate statistical models for each collision type. While this is the most straightforward approach, developing collision-specific models can be very tedious and can produce unreliable estimates for collision types that are less frequently observed. Moreover, ignoring correlations between different collision types may result in biased and inefficient parameter estimation. To overcome these limitations, researchers have adopted a multivariate approach that explicitly accounts for the correlation among individual collision types. As an alternative to multivariate approach, two-stage approaches have been proposed in which one model is estimated to predict total crash frequency and its prediction is combined with another model, used to predict the proportions of different collision types. More efficient one-stage joint models, in which both the frequency and proportion models are estimated simultaneously and predictions are provided more directly, have also been proposed for macro-level analysis. This study investigates the performance of this joint model paradigm in analyzing unique collision type frequencies on individual road segments. For this, a joint negative binomial-multinomial fractional split (NB-MFS) model is used. Moreover, this study also proposes the use of a multinomial logit (MNL) model to estimate the proportion of different collision types. As total crash frequency NB model and MNL model utilize different datasets, a two-stage estimation process is required, which leads to the two-stage NB-MNL model proposed here. The performance of proposed model is compared with that of collision-specific NB models, multivariate negative binomial (MVNB) model, and NB-MFS model in predicting crash frequency by collision type on two-way two-lane urban-suburban collector roadway segments in Pennsylvania. The goodness of fit statistics show that the NB-MNL model performs better than collision-specific NB models, MVNB model and joint NB-MFS model and is thus a promising approach in predicting crash frequency by collision type.

A copula-based approach for jointly modeling crash severity and number of vehicles involved in express bus crashes on expressways considering temporal stability of data

The consequences of crashes, including injury, loss of lives, and damage to properties, are further worsened when buses plying expressways are involved in the crash. Previous studies have separately analyzed crash severity in terms of monetary cost, injuries and loss of lives, and the size of crashes in terms of the number of vehicles involved. However, as both outcome variables are correlated, it is imperative to perform a combined analysis using an appropriate econometric model to achieve a better model fit. This study contributes to the literature by jointly exploring the factors influencing the severity and size of express bus-involved crashes that occur on expressways and characterizes the dependence between both outcome variables by employing a more plausible copula regression framework. Likelihood ratio tests were also conducted to investigate the temporal stability of the factors that affect both crash severity and size. Based on the goodness-of-fit statistics, the Frank copula model proved superior to the independent ordered probit model. The estimate of the underlying dependence between the outcome variables provided a better comprehension of the correlation between them. Temporal instability was detected for the individual parameters in the models and is attributed to the changing driving behavior due to the heightened road safety campaigns. The results suggest that traffic exposure measures are significantly associated with a higher propensity of observing increased bus crash severity and size. Insights into the factors influencing the size and severity of express bus crashes are discussed, and appropriate engineering, enforcement, and education-related countermeasures are proposed.

Risk of Injury and Mortality among Driver Victims Involved in Single-Vehicle Crashes in Taiwan: Comparisons between Vehicle Types

Vehicle-type specific injury severity has rarely been investigated mainly because of a lack of such information in hospital-based studies that normally exclude those who are severely injured and die on the scene. No study has been conducted either on driver characteristics in single vehicle crashes in Taiwan according to vehicle type. This was the first population-based study aiming to describe demographic characteristics in association with vehicle-specific rates of injury and fatality among driver victims involved in single-vehicle crashes in Taiwan. We presented sex and age-specific number and proportion of driver victims according to vehicle type. We calculated sex and age-specific rates of injury and fatality. Injury and fatality rates were also graphically presented. Bicycle and motorcycle rider victims generally had higher injury rates but lower fatality rates. However, older (45+) bicycle rider victims had greater fatality risk. By contrast, truck and car driver victims were generally associated with lower injury rates but with higher fatality rates. Elderly (65+ years) truck driver victims suffered from higher rates of injury and fatality. Male victims were found to have a higher fatality rate than female victims regardless of vehicle type. The vehicle-type-specific analyses of injury and fatality are considered useful in identifying single-vehicle crash victims at greater risks of injury and fatality.

Role of Passengers in Single-Vehicle Drunk-Driving Crashes: An Injury-Severity Analysis

Background: Drunk-driving is a major crash risk factor, and crashes resulting from this risky behavior tend to be serious and have significant economic and societal impacts. The presence of passengers and their demographics and activities can influence risky driving behaviors such as drunk-driving. However, passengers could either be an “enabling” factor to take more risks or could be an “inhibiting” factor by ensuring safe driving by a drunk-driver. Objective: This study examines whether the presence of passengers affects the contributing factors of single-vehicle (SV) drunk-driving crashes, by presenting a severity analysis of single- and multi-occupant SV drunk-driving crashes, to identify risk factors that contribute to crash severity outcomes, for the effective implementation of relevant countermeasures. Method: A total of 7407 observations for 2012–2016 from the crash database of the State of Alabama was used for this study. The variables were divided into six classes: temporal, locational, driver, vehicle, roadway, and crash characteristics and injury severities into three: severe, minor, and no injury. Two latent class multinomial logit models—one each for single- and multi-occupant crashes—were developed, to analyze the effects of significant factors on injury severity outcomes using marginal effects. Results: The estimated results show that collision with a ditch, run-off road, intersection, winter season, wet roadway, and interstate decreased the probability of severe injuries in both single- and multi-occupant crashes, whereas rural area, road with downward grade, dark and unlit roadway, unemployed driver, and driver with invalid license increased the likelihood of severe injuries for both single- and multi-occupant crashes. Female drivers were more likely to be severely injured in single-occupant crashes, but less likely in multi-occupant crashes. A significant association was found between severe injuries and weekends, residential areas, and crash location close (<25 mi ≈40.23 km) to the residence of the at-fault driver in multi-occupant crashes. Sport utility vehicles were found to be safer when driving with passengers. Conclusions: The model findings show that, although many correlates are consistent between the single- and multi-occupant SV crashes that are associated with locational, roadway, vehicle, temporal, and driver characteristics, their effect can vary across the single- and multi-occupant driving population. The findings from this study can help in targeting interventions, developing countermeasures, and educating passengers to reduce drunk-driving crashes and consequent injuries. Such integrated efforts combined with engineering and emergency response may contribute in developing a true safe systems approach.

Freeway single and multi-vehicle crash safety analysis: Influencing factors and hotspots

Single-vehicle (SV) and multi-vehicle (MV) crashes have been recognized as differing in spatial distribution and influencing factors, but little consideration has been given to these differences as related to hotspot identification. For the purpose of better hotspot identification, this study aims to analyze influencing factors of SV and MV crashes and to explore the consistency between SV and MV hotspots. Crash data, roadway geometric design features, and traffic characteristics were collected along the two directions of a 45-km freeway section in Shanghai, China. Univariate negative binomial conditional autoregressive (NB-CAR) and bivariate negative binomial spatial conditional autoregressive (BNB-CAR) models were developed to analyze the influencing factors and specifically address (1) site correlation between SV and MV crashes within the same freeway segment, and (2) spatial correlation among different freeway segments within the same direction. The modeling results showed substantial differences in the significant factors that influence SV and MV crashes, including both roadway geometric features and traffic operational factors. A non-negligible site correlation was found between SV and MV crashes. Taking into account the site correlation, the BNB-CAR model outperformed the NB-CAR model in terms of parameter estimation and model fitting. For hotspot identification, potential for safety improvement based on the empirical Bayes method was adopted to handle the crash fluctuation problem. Substantial inconsistency was found between SV and MV hotspots despite the site correlation: in the top ten hotspots, no hotspot was shared by the two crash types. This result highlights the importance of differentiating SV and MV crashes when identifying hotspots, providing insight into freeway safety analysis.

Intermittent hypoxia training: Powerful, non-invasive cerebroprotection against ethanol withdrawal excitotoxicity

Ethanol intoxication and withdrawal exact a devastating toll on the central nervous system. Abrupt ethanol withdrawal provokes massive release of the excitatory neurotransmitter glutamate, which over-activates its postsynaptic receptors, causing intense Ca2+ loading, p38 mitogen activated protein kinase activation and oxidative stress, culminating in ATP depletion, mitochondrial injury, amyloid β deposition and neuronal death. Collectively, these mechanisms produce neurocognitive and sensorimotor dysfunction that discourages continued abstinence. Although the brain is heavily dependent on blood-borne O2 to sustain its aerobic ATP production, brief, cyclic episodes of moderate hypoxia and reoxygenation, when judiciously applied over the course of days or weeks, evoke adaptations that protect the brain from ethanol withdrawal-induced glutamate excitotoxicity, mitochondrial damage, oxidative stress and amyloid β accumulation. This review summarizes evidence from ongoing preclinical research that demonstrates intermittent hypoxia training to be a potentially powerful yet non-invasive intervention capable of affording robust, sustained neuroprotection during ethanol withdrawal.

Truck crash severity in New York city: An investigation of the spatial and the time of day effects

This paper investigates the differences between single-vehicle and multi-vehicle truck crashes in New York City. The random parameter models take into account the time of day effect, the heterogeneous truck weight effect and other influencing factors such as crash characteristics, driver and vehicle characteristics, built environment factors and traffic volume attributes. Based on the results from the co-location quotient analysis, a spatial generalized ordered probit model is further developed to investigate the potential spatial dependency among single-vehicle truck crashes. The sample is drawn from the state maintained incident data, the publicly available Smart Location Data, and the BEST Practices Model (BPM) data from 2008 to 2012. The result shows that there exists a substantial difference between factors influencing single-vehicle and multi-vehicle truck crash severity. It also suggests that heterogeneity does exist in the truck weight, and it behaves differently in single-vehicle and multi-vehicle truck crashes. Furthermore, individual truck crashes are proved to be spatially dependent events for both single and multi-vehicle crashes. Last but not least, significant time of day effects were found for PM and night time slots, crashes that occurred in the afternoons and at nights were less severe in single-vehicle crashes, but more severe in multi-vehicle crashes.

Bootstrap resampling approach to disaggregate analysis of road crashes in Hong Kong

Road safety affects health and development worldwide; thus, it is essential to examine the factors that influence crashes and injuries. As the relationships between crashes, crash severity, and possible risk factors can vary depending on the type of collision, we attempt to develop separate prediction models for different crash types (i.e., single- versus multi-vehicle crashes and slight injury versus killed and serious injury crashes). Taking advantage of the availability of crash and traffic data disaggregated by time and space, it is possible to identify the factors that may contribute to crash risks in Hong Kong, including traffic flow, road design, and weather conditions. To remove the effects of excess zeros on prediction performance in a highly disaggregated crash prediction model, a bootstrap resampling method is applied. The results indicate that more accurate and reliable parameter estimates, with reduced standard errors, can be obtained with the use of a bootstrap resampling method. Results revealed that factors including rainfall, geometric design, traffic control, and temporal variations all determined the crash risk and crash severity. This helps to shed light on the development of remedial engineering and traffic management and control measures.

Injury patterns and features of cycling fatalities in South Australia

There has been an increase in cycling in Australia. This means that more cyclists are at risk of injuries, which account for a proportion of transport-related fatalities. In this study, all cyclist fatalities from 2002 to 2013 in South Australia where post-mortem examinations were performed were investigated. There were 42 deaths representing 3% of the total road fatalities over the same time. Of this total number of cases, 13 deaths (31%) involved collapse (mostly natural causes from an underlying medical condition) and 29 (69%) resulted from trauma. There were no cases of hyperthermia. Of the decedents 95% were male, and the mean age at death was 47 years. Fatal incidents were more likely to occur during April and November, and on a Monday. However, statistical analysis was not possible due to the small number of cases. Fatalities (traumatic and collapse) predominantly occurred whilst the cyclist was riding (86%). The majority of riding fatalities were as a result of collision with vehicles (81%). Drugs (including alcohol) were detected in two (15%) of the 13 cases of the collapses, and in seven (26%) of the 27 trauma cases tested. In trauma cases, death was most often due to multiple injuries. The most frequent area for injury was the head (found in 90% of traumatic deaths). Despite the increasing numbers of cyclists on South Australian roads over the last decade, death rates have trended downwards suggesting that road safety campaigns and the provision of more dedicated bicycle lanes have had a positive outcome.

Effect of driver, roadway, collision, and vehicle characteristics on crash severity: a conditional logistic regression approach

The aim of the study is to examine the factors that appear to have a higher potential for serious injury or death of drivers in traffic accidents in Turkey, such as collision type, roadway surface, vehicle speed, alcohol/drug use, and restraint use. Driver crash severity is the dependent variable of this study with two categories, fatal and non-fatal. Due to the binary nature of the dependent variable, a conditional logistic regression analysis was found suitable. Of the 16 independent variables obtained from Turkish police accident reports, 11 variables were found most significantly associated with driver crash severity. They are age, education level, restraint use, roadway condition, roadway type, time of day, collision location, collision type, number and direction of vehicles, vehicle speed, and alcohol/drug use. This study found that belted drivers aged 18-25 years involving two vehicles travelling in the same direction, in an urban area, during the daytime, and on an avenue or a street have better chances of survival in traffic accidents.

Comparing single vehicle and multivehicle fatal road crashes: a joint analysis of road conditions, time variables and driver characteristics

The difference between single vehicle crashes and multivehicle crashes was investigated in a collection of fatal crashes from six European countries. Variables with respect to road conditions, time variables, and participant characteristics were studied separately at first and then jointly in a logistic multiple regression model allowing to weigh different accounts of single vehicle as opposed to multivehicle crash occurrence. The most important variables to differentiate between single and multivehicle crashes were traffic flow, the presence of a junction and the presence of a physical division between carriageways. Heavy good vehicles and motorcycles were less likely to be involved in single vehicle crashes than cars. Moreover crashes of impaired drivers with more passengers were more likely to be single vehicle crashes than those of other drivers. Young drivers, rural roads, nights and weekends were all shown to have a higher proportion of single vehicle crashes but in the multivariate analysis these effects were demonstrated to be mediated by the road conditions named above.

Investigating the effect of modeling single-vehicle and multi-vehicle crashes separately on confidence intervals of Poisson-gamma models

Crash prediction models still constitute one of the primary tools for estimating traffic safety. These statistical models play a vital role in various types of safety studies. With a few exceptions, they have often been employed to estimate the number of crashes per unit of time for an entire highway segment or intersection, without distinguishing the influence different sub-groups have on crash risk. The two most important sub-groups that have been identified in the literature are single- and multi-vehicle crashes. Recently, some researchers have noted that developing two distinct models for these two categories of crashes provides better predicting performance than developing models combining both crash categories together. Thus, there is a need to determine whether a significant difference exists for the computation of confidence intervals when a single model is applied rather than two distinct models for single- and multi-vehicle crashes. Building confidence intervals have many important applications in highway safety. This paper investigates the effect of modeling single- and multi-vehicle (head-on and rear-end only) crashes separately versus modeling them together on the prediction of confidence intervals of Poisson-gamma models. Confidence intervals were calculated for total (all severities) crash models and fatal and severe injury crash models. The data used for the comparison analysis were collected on Texas multilane undivided highways for the years 1997-2001. This study shows that modeling single- and multi-vehicle crashes separately predicts larger confidence intervals than modeling them together as a single model. This difference is much larger for fatal and injury crash models than for models for all severity levels. Furthermore, it is found that the single- and multi-vehicle crashes are not independent. Thus, a joint (bivariate) model which accounts for correlation between single- and multi-vehicle crashes is developed and it predicts wider confidence intervals than a univariate model for all severities. Finally, the simulation results show that separate models predict values that are closer to the true confidence intervals, and thus this research supports previous studies that recommended modeling single- and multi-vehicle crashes separately for analyzing highway segments.

Alcohol and drugs in fatally and non-fatally injured motor vehicle drivers in northern Sweden

Alcohol and drugs are important risk factors for traffic injuries, a major health problem worldwide. This prospective study investigated the epidemiology and the presence of alcohol and drugs in fatally and hospitalized non-fatally injured drivers of motor vehicles in northern Sweden. During a 2-year study period, blood from fatally and hospitalized non-fatally injured drivers was tested for alcohol and drugs. The study subjects were recruited from well-defined geographical areas with known demographics. Autopsy reports, medical journals, police reports, and toxicological analyses were evaluated. Of the fatally injured, 38% tested positive for alcohol and of the non-fatally 21% tested positive; 7% and 13%, respectively, tested positive for pharmaceuticals with a warning for impaired driving; 9% and 4%, respectively, tested positive for illicit drugs. The most frequently detected pharmaceuticals were benzodiazepines, opiates, and antidepressants. Tetrahydrocannabinol was the most frequently detected illicit substance. No fatally injured women had illegal blood alcohol concentration. The relative proportion of positively tested drivers has increased and was higher than in a similar study 14 years earlier. This finding indicates that alcohol and drugs merit more attention in future traffic safety work.

Passenger car collision fatalities--with special emphasis on collisions with heavy vehicles

Between 1995 and 2004, 293 passenger car occupants died in collisions with other vehicles in northern Sweden (annual incidence: 3.3 per 100,000 inhabitants, 6.9 per 100,000 cars, or 4.8 per 10(9)km driven); half of these deaths involved heavy vehicles. The annual number of passenger car occupant deaths per 100,000 cars in car-truck/bus collisions has remained unchanged since the 1980s, but in car-car collisions it has decreased to one third of its former level. As crash objects, trucks and buses killed five times as many car occupants per truck/bus kilometer driven as did cars. The collisions were characterized by crashes in the oncoming vehicle's lane, under icy, snowy, or wet conditions; crashes into heavy vehicles generally occurred in daylight, on workdays, in winter, and on 90 and 70 km/h two-lane roads. Head and chest injuries accounted for most of the fatal injuries. Multiple fatal injuries and critical and deadly head injuries characterized the deaths in collisions with heavy vehicles. An indication of suicide was present in 4% of the deaths; for those who crashed into trucks, this percentage was doubled. Among the driver victims, 4% had blood alcohol levels above the legal limit of 0.2g/L. Frontal collision risks might be reduced by a mid-barrier, by building less injurious fronts on trucks and buses, by efficient skid prevention, and by use of flexible speed limits varying with road and light conditions.

Fatal drink-driving accidents of young adult and middle-aged males--a risky driving style or risky lifestyle?

OBJECTIVE

A range of situational and lifestyle-related factors in drink-driving fatal accidents were studied involving young adult and middle-aged male drivers in Finland.

METHODS

Fatal drink-driving accidents were compared to fatal accidents in which the driver had been sober. The study included all 18-to 59-year-old male drivers' fatal car and van accidents investigated by the Road Accident Investigation Teams in Finland between 2000 and 2002 (n = 366 accidents). The variables describing the situation included the time of the accident, the road condition, the speed, possession of a valid licence, seat-belt usage, and the presence of passengers.

RESULTS

The study found that among young adult males most of the studied situational factors bore no relation to the state of the driver (sober or drink driver). Only the time of day, seat-belt, usage, and possession of a valid licence were related to the state of the driver. Among middle-aged male drivers, drink-driving and sober driving accidents differed more clearly. Further, when the social situation in the car was examined, it was found that accidents of sober and drink drivers differed from each other within the group of middle-aged drivers but not within the group of young adult drivers. Heavy alcohol usage was found to characterize the lifestyle of the studied middle-aged drink drivers.

CONCLUSIONS

It was concluded that for young adult males drink-driving was a part of a more general risky driving style. Among middle-aged males drink-driving was more related to a risky lifestyle with drinking problems. Possible countermeasures are discussed with regard to drink-driving among young adult and middle-aged males.

Impact of lowering the legal blood alcohol concentration limit to 0.03 on male, female and teenage drivers involved alcohol-related crashes in Japan

In June of 2002, a revision to part of the Road Traffic Act drastically increased the penalties for drinking and driving offences in Japan. Most notably, the legal blood alcohol concentration (BAC) limit for driving was lowered from 0.05 mg/ml to 0.03 mg/ml. The rationale for the new lower BAC limit was predicated on the assumption that drinking drivers will comply with the new, lower limit by reducing the amount of alcohol they consume prior to driving, thereby lowering their risk of crash involvement. This, in turn, would lead to fewer alcohol-related crashes. A key limitation of previous lower BAC evaluation research in determining the effectiveness of lower legal BAC limit policies is the assumption of population homogeneity in responding to the laws. The present analysis is unique in this perspective and focuses on the evaluation of the impact of BAC limit reduction on different segments of the population. The chief objective of this research is to quantify the extent to which lowering the legal limit of BAC has reduced male, female and teenager involvement in motor vehicle crashes in Japan since 2002. Most notably, the introduction of reduced BAC limit legislation resulted in a statistically significant decrease in the number of alcohol-impaired drivers on the road in Japan, indicating responsiveness to the legal change among adults and teenagers. In addition, this preliminary assessment appears to indicate that the implementation of 0.03 BAC laws and other associated activities are associated with statistically significant reductions in alcohol-involved motor vehicle crashes. In comparison, the rates of total crashes showed no statistically significant decline nor increase in the period following the introduction of the BAC law, indicating that the lower BAC limit only had an effect on alcohol-related crashes in Japan. The evidence suggests that the lower BAC legal limit and perceived risk of detection are the two most important factors resulting in a sustained change in drinking and driving behaviour in Japan. It is recommended that future research and resources in other countries be focused on these factors as determinants to reduced alcohol-related crashes.

Effectiveness of bans and laws in reducing traffic deaths: legalized Sunday packaged alcohol sales and alcohol-related traffic crashes and crash fatalities in New Mexico

We determined the relative risk of alcohol-related motor vehicle accidents and fatalities after New Mexico lifted its ban on Sunday packaged alcohol sales. We extracted all alcohol-related crashes from New Mexico police reports for 3652 days between July 1, 1990, and June 30, 2000, and found a 29% increase in alcohol-related crashes and a 42% increase in alcohol-related crash fatalities on Sundays after the ban on Sunday packaged alcohol sales was lifted. There was an estimated excess of 543.1 alcohol-related crashes and 41.6 alcohol-related crash fatalities on Sundays after the ban was lifted. Repealing the ban on Sunday packaged alcohol sales introduced a public health and safety hazard in New Mexico.

Driver's alcohol and passenger's death in motor vehicle crashes

OBJECTIVE

Previous studies on alcohol involvement associated with fatal injury in traffic crashes have focused on the drivers, but the passenger's view is not well known. This study (1) analyzes the relationship between passenger's death and alcohol inebriation of the driver and (2) estimates the role of alcohol as the cause of a crash by examining who was at fault, sober, or inebriated.

METHOD

The study includes all motor vehicle passengers (n = 420) who died in crashes in Sweden 1993 through 1996 and were medicolegally autopsied. Autopsy reports from the Departments of Forensic Medicine, including toxicological analyses, and police reports were studied. Presence of alcohol among drivers was based on blood and breath tests.

RESULTS

One-fifth of the fatally injured passengers and one-fifth of the tested drivers were under the influence of alcohol. The youngest drivers had the highest prevalence of drunken driving. Drivers at fault were alcohol positive in 21% of these crashes and drivers were not at fault in 2% of these crashes. In 53% of the crashes where both the passenger and driver were alcohol positive, the passenger had a lower alcohol concentration than the driver. Children (<16 years) comprised 15% of the killed passengers. Notably, the children were riding with a driver who was under influence of alcohol in 13% of these crashes. Alcohol involvement was not tested in half of the surviving drivers.

CONCLUSIONS

The data show that 20% of both passengers and drivers were under the influence of alcohol. Increased testing of surviving drivers regarding alcohol and other drugs is recommended.

An epidemiological study on alcohol/drugs related fatal traffic crash cases of deceased drivers in Hong Kong between 1996 and 2000

This study is designed to evaluate the correlation between fatal vehicle crashes (FVC) and consumption of alcohol and/or drugs among drivers. Between 1996 and 2000 in Hong Kong, a total of 197 FVC cases of deceased drivers were investigated. The blood and/or urine samples of the victims were examined for the presence of alcohol and drugs. The 197 cases were then classified into two groups: single-vehicle crashes (SVC) and multiple-vehicle crashes (MVC). Out of the 106 cases for the latter group, alcohol and/or drugs were detected in 22 cases (21%) while the remaining 84 cases (79%) were regarded as no significant finding. As for the 91 cases in SVC group, 51 cases (56%) were positive for alcohol and/or drugs. The findings indicate that a driver consuming alcohol and/or drugs has a higher risk of being involved in a FVC. The most frequently detected drugs for SVC group (11 cases) were: 46% central nervous system (CNS) stimulants (including designer drugs like MDMA); 36% cannabis; 18% benzodiazepines and 9% ketamine. The detected drug for the only case in the MVC group was a CNS stimulant. The number of cases with ketamine, methamphetamine and MDMA detected has increased in recent years as these party drugs have gained popularity in Hong Kong.

Fatal traffic injuries among pedestrians, bicyclists and motor vehicle occupants

The objective of this study was to investigate characteristic injuries of pedestrians and bicyclists (unprotected) compared to motor vehicle occupants' (protected) in fatal traffic accidents. Cases of 664 fatal traffic accidents (371 pedestrians, 45 bicyclists, and 248 motor vehicle occupants) were collected from 1999 to 2001 using the database of the Forensic Institute in Budapest. Autopsy reports were analyzed. Location of injuries, blood alcohol levels, seasonal distribution and natural diseases influencing accident outcome were evaluated. For statistical analysis, odds ratio (OR) with 95% confidence interval (CI) was used by a conditional logistic regression. There were substantial differences in distribution of injuries suffered by pedestrians, bicyclists and motor vehicle occupants. Among pedestrians and bicyclists there was a higher rate of head injuries, such as skull fractures, epidural haemorrhage, subdural haemorrhage, brain contusion, and injuries of the lower extremities. Thoracic damages, such as traumatic aortic rupture, hemothorax, and abdominal damages, like liver rupture were dominant in motor vehicle occupants. Considering existing natural diseases, coronary artery disease was the only one with higher occurrence among motor vehicle occupants 24 (9.7%) compared with pedestrians and bicyclist 36 (8.6%). These results underline the importance of preventive strategies in transportation, pointing out that different methods are necessary to reduce fatal injuries of various traffic participants.

The influence of passengers on the risk of the driver causing a car collision in Spain. Analysis of collisions from 1990 to 1999

OBJECTIVE

To determine how the number of passengers, their age and their sex influence the risk of different types of Spanish drivers causing a collision between two or more cars.

METHODS

We selected, from the Spanish database of traffic crashes resulting in personal injuries or death, those collisions between two or more cars that occurred between 1990 and 1999 in which only one of the involved drivers committed a driving infraction. These drivers were considered the cases; non-infractor drivers were considered their matched controls. We collected information on the number, age and sex of the passengers in each vehicle, along with some potential confounding variables of the drivers and the vehicles involved. Crude and adjusted odds ratios were calculated for the main categories of driver and passenger.

RESULTS

A protective effect for the presence of passengers was detected (adjusted odds ratio: 0.69; 95% CI: 0.67-0.70). The protective effect was higher for drivers aged more than 45 years and lower for the youngest drivers (<24 years old). The strongest association was observed for female passengers who accompanied male drivers. The protective effect was lower for passengers older than 64 years.

CONCLUSIONS

Our results suggest that drivers are less likely to cause a car collision between two or more cars that results in personal injuries or death when they are accompanied by passengers, regardless of driver or passenger characteristics.

Beta-carbolines in chronic alcoholics following trauma

In our society every second polytraumatized patient is a chronic alcoholic. A patient's alcohol-related history is often unavailable and laboratory markers are not sensitive or specific enough to detect alcohol-dependent patients who are at risk of developing alcohol withdrawal syndrome (AWS) during their post-traumatic intensive care unit (ICU) stay. Previously, it has been found that plasma levels of norharman are elevated in chronic alcoholics. We investigated whether beta-carbolines, i.e. harman and norharman levels, could identify chronic alcoholics following trauma and whether possible changes during ICU stay could serve as a predictor of deterioration of clinical status. Sixty polytraumatized patients were transferred to the ICU following admission to the emergency room and subsequent surgery. Chronic alcoholics were included only if they met the DSM-III-R and ICD-10 criteria for alcohol dependence or chronic alcohol abuse/harmful use and their daily ethanol intake was > or =60 g. Harman and norharman levels were assayed on admission and on days 2, 4, 7 and 14 in the ICU. Harman and norharman levels were determined by high pressure liquid chromatography. Elevated norharman levels were found in chronic alcoholics (n = 35) on admission to the hospital and remained significantly elevated during their ICU stay. The area under the curves (AUC) showed that norharman was comparable to carbohydrate-deficient transferrin (CDT) and superior to conventional laboratory markers in detecting chronic alcoholics. Seventeen chronic alcoholics developed AWS; 16 of these patients experienced hallucinations or delirium. Norharman levels were significantly increased on days 2 and 4 in the ICU in patients who developed AWS compared with those who did not. An increase in norharman levels preceded hallucinations or delirium with a median period of approximately 3 days. The findings that elevated norharman levels are found in chronic alcoholics, that the AUC was in the range of CDT on admission and that norharman levels remained elevated during the ICU stay, support the view that norharman is a specific marker for alcoholism in traumatized patients. Since norharman levels increased prior to the onset of hallucinations and delirium it seems reasonable to investigate further the potential role of norharman as a possible substance which triggers AWS.

Association of main driver-dependent risk factors with the risk of causing a vehicle collision in Spain, 1990-1999

PURPOSE

To assess the strength of association of main driver-dependent risk factors with the risk of causing a collision between vehicles in Spain, from 1990 to 1999.

METHODS

The data for this paired-by-collision, case-control study were obtained from the Spanish Dirección General de Tráfico traffic crash database. The study included all 220284 collisions involving two or more vehicles with four or more wheels, in which only one of the drivers involved committed an infraction. Infractor drivers comprised the case group; noninfractor drivers involved in the same collision were their corresponding paired controls.

RESULTS

All driver-dependent factors were associated with the risk of causing a collision. The highest adjusted odds ratio estimates were obtained for sleepiness (64.35; CI, 45.12-91.79), inappropriate speed (28.33; CI, 26.37-30.44), and driving under the influence of alcohol with a positive breath test (22.32; CI, 19.64-25.37). An increase in the number of years in possession of a driving license showed a protective effect, albeit the strength of the effect decreased as age increased.

CONCLUSIONS

Our results emphasize the urgent need to implement strategies aimed mainly at controlling speeding, sleepiness, and alcohol consumption before driving-the main driver-dependent risk factors for causing a vehicle collision.

Age and sex differences in the risk of causing vehicle collisions in Spain, 1990 to 1999

This retrospective, paired case-control study was designed to estimate crude and adjusted effects of age and sex on the risk of causing collisions between vehicles with four or more wheels in Spain during the period from 1990 to 1999. We selected all 220284 collisions registered from 1990 to 1999 in the Spanish Dirección General de Tráfico (DGT) traffic crash database in which only one driver committed any infraction. Information was collected about age, sex and several confounding factors for both the responsible and paired-by-collision nonresponsible drivers. Crude and adjusted odds ratios (aORs) were calculated for each age and sex category. For men, the lowest risk was seen for drivers aged 25-49 years. Below the age of 35 years the crude odds ratio (cOR) was highest in the 18-24-year-old group (1.61; CI: 1.57-1.65). The risk increased significantly and exponentially after the age of 50 years, to a maximum odds ratio of 3.71 (3.43-4.00) for drivers aged >74 years. In women, the lowest risk values were found for the 25-44-year-old age group. In older women the risk increased significantly with age to a maximum odds ratio of 3.02 (2.31-3.97) in the oldest age group. aOR estimates tended to be lower than crude estimates for drivers younger than 40 years of age, but the opposite was seen for drivers 40 years old and older. Regarding sex differences, among younger drivers crude and aORs for men were higher than for women. Our results suggest that the risk of causing a collision between vehicles with four or more wheels is directly dependent on the driver's age.

Novice drivers' accidents and violations--a failure on higher or lower hierarchical levels of driving behaviour

The study compared accident and offence rates of 28 500 novice drivers in Finland. The purpose was to study differences in accident and offence rates between male and female novice drivers of different age. The drivers reported in a mailed questionnaire, how many accidents they had been involved in and how much they had driven during their whole driving career. All the drivers had a driving experience of 6-18 months. Information about offences for a 2-year period was obtained from an official register of drivers' licences. The drivers were classified into three age brackets: 18-20, 21-30 and 31-50 years. The effect of driving experience was controlled by dividing the drivers into different mileage brackets. The data was analysed and the results were discussed in the framework of the hierarchical model of driving behaviour. Young novice drivers and especially young male drivers showed more problems connected to the higher hierarchical levels of driving behaviour than middle-aged novice drivers. The number of accidents and offences was highest among the young males and their accidents took place more often at night than female or older drivers' accidents. Female drivers showed more problems connected to the lower hierarchical levels of driving behaviour, e.g. problems in vehicle handling skills. Ways of measuring accident risk of different driver groups were also discussed, as well as the usefulness and reliability of self-reports in accident studies.

Assessment of donor fatty livers for liver transplantation

AIM

The effect of fatty liver on graft survival, especially with reference to macrovesicular and microvesicular steatosis, is still uncertain. This preliminarily study was designed to create a noninvasive method for the quantification of the hepatic fat content in vivo and to establish provisional criteria for the assessment of fatty donor livers before liver transplantation among transplant surgeons, radiologists, and pathologists.

METHODS AND MATERIALS

Different degrees of rat fatty liver model were established by feeding rats a diet deficient in choline and methionine for different periods of time. Computed tomography (CT) with test tubes containing variable percentages of fat equivalent substance were used to assess the severity of fatty change of the rat liver. This was then correlated with the histological classification, level of hepatic enzymes, and graft survival.

RESULTS

Linear correlation between the fat volume fraction added to the test tubes and CT density were found. The process of producing a fatty liver via diet alteration peaked at week 3. At this time hepatic enzymes, radiological fat content, and posttransplantation survival were worse (P=0.013), compared with other time points. Radiological assessment of fatty liver correlated well with survival and serum glutamic oxaloacetic transaminase and glutamic pyruvate transaminase levels.

CONCLUSION

Severe microvesicular steatosis does not influence recipient survival, however, macrovesicular steatosis affects graft survival. Caliber CT is a practical and simple method that allows an accurate noninvasive quantitative assessment of hepatic fatty infiltration. It has potential to be a useful parameter for the assessment of donor livers for clinical liver transplantation.

Pedestrian fatalities and alcohol

Since the share of alcohol-positive victims has been reported not to show the same reduction in pedestrian fatalities as in other 'road users', this study analysed pedestrian fatalities with special emphasis on the presence of alcohol. Autopsied pedestrian fatalities (286 victims) in northern Sweden from 1977 to 1995 were investigated, using autopsy and police reports. Blood alcohol was detected in 19% of the fatalities, with a median concentration of 1.6 g/l. The proportion of test-positive victims did not change significantly during the period of study. Males more often tested positive for alcohol than females (24 vs. 11%). Further, the test-positive victims had a lower mean age (49 vs. 59 years) and the proportion of test-positive victims was higher during weekends and nights. Pedestrian fatalities testing positive for alcohol differ from those testing negative in several respects. The public should be enlightened of the fact that drinking is a risk not only among users of motor vehicles, but also among pedestrians. Separation of pedestrians from motor vehicles by, e.g. fences, is of greatest importance.

Substance abuse and withdrawal in the intensive care unit. Contemporary issues

Because 36% of intentional injury victims are drug dependent, the association between drug abuse and violence, especially in urban settings, is high. Withdrawal syndromes in ICU patients confuse their clinical management, may be extremely difficult to diagnose, are often lethal, need to be suspected, and should be prophylaxed against; therefore, all ICU patients should be considered to be at high risk for drug or alcohol dependence, should be tested for evidence of such drugs, and should be interviewed (together with their family members) for the presence of drug dependence traits. Appropriate patients should be referred for formal evaluation and treatment. Withdrawal syndromes must be promptly recognized, differentiated from traumatic or metabolic deterioration, and immediately treated. As patients are unique, so is their drug dependence. Individualized withdrawal therapy, not a "one method fits all" approach, works best. The mainstay of most withdrawal therapy is supportive care and benzodiazepine therapy. Also, considering the high rate of multiple intoxicants present in trauma patients, withdrawal can occur from multiple agents in a single patient, further compounding these difficulties. Withdrawal from unusual substances, such as GHB, or from therapeutic interventions (e.g., prolonged opioid or benzodiazepine administration) also must be considered.

Incidence of xenobiotics among drivers killed in single-vehicle crashes

The authors have performed a study of single-vehicle crashes (SVCs) in order to verify a correlation between the loss of vehicle control and the presence of drugs in the body. Overall, 129 cases were recorded and occurred in the catchment area of the Institute of Legal Medicine in Milan between 1986 to 1996. Among the 129 cases under study, respectively 121 men and eight women, 101 were car-drivers and 28 motor-cyclists. The median age was equal to 29 years, while the average age to 32.0 years (range 15-65 years). Fifty eight cases (45.0%) were "positive" for the presence of ethanol > or = 0.8 g/l or other drugs. The sample of "positive cases" was studied according to sex, age, day, hour and type of vehicle. Considering the cases with presence of ethanol, although under the legal limit (20 cases), the total amount of cases (78) becomes even more consistent. The amount of ethanol was found to be respectively 0.34 g/l in daily drivers and 0.87 g/l in nightly drivers (p < 0.01). Our considerations confirm the importance of toxicological analyses in the forensic investigation of traffic deaths being the sample under study recorded following criteria which minimised other possible factors effecting road accidents.

Differences in fatal loss-of-control accidents between young male and female drivers

The study describes some factors behind fatal loss-of-control accidents of young male and female drivers. These loss-of-control accidents were compared to accidents in which the driver did not lose control of the car. The data comprised all fatal car accidents of young (18-21 years old) drivers in Finland during the years 1978-1991. Only culpable drivers were included in the analysis (the number of accidents studied was 338 for males and 75 for females). All these accidents were investigated by the Road Accident Investigation Teams in Finland and the original team reports were used. The results showed that equal proportions of all male and female drivers' accidents were loss-of-control accidents. However, when male drivers lost control of their car, it usually led to a single-vehicle accident, but for female drivers the loss of control usually resulted in a collision with another car. Male drivers drove too fast and under the influence of alcohol more often in loss-of-control accidents than in other types of accidents. Typically the male drivers' loss of control accidents took place during evenings and nights. The female drivers' loss-of-control accidents usually took place in slippery road conditions. This study concludes that risky driving habits play a bigger role in male drivers' loss-of-control accidents than in male drivers' no loss-of-control accidents or in any kind of female drivers' accidents. Lack of vehicle handling skills may be crucial in female drivers' loss-of-control accidents. Advantages of studying loss-of-control accidents instead of single-vehicle accidents are discussed.

Drugs of abuse and alcohol in weekend drivers involved in car crashes in Belgium

STUDY OBJECTIVE

To determine levels of alcohol and drugs of abuse in weekend drivers injured in car crashes.

METHODS

This study was the first systematic drug and alcohol testing of blood and urine samples of drivers injured in weekend car crashes in Belgium. Five collaborating hospital in Flanders participated. All injured weekend drivers admitted to the emergency units from July 1, 1994, to June 30, 1995, were included in the study sample. Sampling times were from Friday at 8 PM to Monday at 8 AM.

RESULTS

Of the 211 injured drivers, 47.9% had positive test results for screenings for drugs or alcohol; 35.5% only for alcohol, 6.6% only for drugs, and 5.7% had positive results for both alcohol and drugs. Of the 87 weekend drivers with positive alcohol test results, 8% had a blood alcohol concentration (BAC) level below 80 mg/dL, 25.3% had a concentration between 150 and 190 mg/dL, and 39% had a BAC of 200 mg/dL or greater. There seems to be a consistent association between the consequences of the weekend crashes and the use of alcohol, drugs, or both. More than 50% of those who had negative results for drugs and alcohol could leave the hospital within 24 hours after their car crash. For the majority of those with positive findings for alcohol only or for drugs and alcohol (respectively, 72% and 78%), hospitalization in a general hospital unit or ICU was necessary.

CONCLUSION

The results suggest that testing drivers for use of alcohol alone is insufficient.

Drug and alcohol use among injured motor vehicle drivers in Sweden: prevalence, driver, crash, and injury characteristics

Injured motor vehicle drivers who were hospitalized (Umeå: n = 130) and fatally injured drivers who were autopsied (Umeå, Northern Sweden: n = 111; Gothenburg, Western Sweden: n = 136) from May 1991 through December 1993 were tested for alcohol and for both licit and illicit drugs. Nineteen percent of the Umeå-hospitalized drivers (UHDs), 26% of the Umeå fatally injured drivers (UFDs), and 21% of the Gothenburg fatally injured drivers (GFDs) tested positive for drugs and/or alcohol. Ten percent of the UHDs, 8% of the UFDs, and 6% of the GFDs tested positive for drugs. Almost 5% of the UHDs, had illicit drugs, and 6% had licit drugs. Only 3% of the GFDs and none of the UFDs had illicit drugs. Benzodiazepines, followed by opiates, tetrahydrocannabinol, and amphetamine were the most common drugs detected. Twelve percent of the UHDs, 24% of the UFDs, and 17% of the GFDs tested positive for alcohol. Two percent of the UHDs, 6% of the UFDs, and 2% of the GFDs had a combination of drugs and alcohol.

A review of successful transport and home injury interventions to guide developing countries

Injury is recognized as an increasing public health problem in developing countries. Extensive research on injury control has been conducted in the U.S. and other industrialized countries in the past several decades, but research is still in its infancy in developing countries. In this paper, successful interventions for transport and home injuries are reviewed in the context of the developing country setting. The aim is to evaluate injury interventions developed in the industrialized countries and identify those likely to be usable in developing countries. The evaluation criteria used include the efficacy of the interventions, as well as their affordability, feasibility and sustainability. The review demonstrates that while several interventions are available in the field of injury prevention for developing countries to import, caution should be taken in doing this. The use of automobile safety seat belts, bicyclist and motorcyclist helmets, speed limits, laws banning the sale of alcohol at lorry parks, pedestrian crossing signs, adequate roadway lighting, separation of pedestrians from vehicles, conspicuity-enhancement measures, simple safety equipment, and poison prevention packaging should be seriously considered by developing countries to reduce the morbidity and mortality from transport and home injuries. Since injury prevention may often require a blend of several interventions due to the multifactorial nature of the causes of injury, interventions that appear to be most effective are those with multidimensional strategies including education, legislation and environmental modification. This review should serve as a useful guide to injury control efforts in developing countries which must grapple with limited resources and low levels of education.

Use of fatty donor liver is associated with diminished early patient and graft survival

It is well known that implantation of donor livers with severe fatty infiltration (>60%) is frequently associated with early hepatic dysfunction and an increased incidence of primary nonfunction after liver transplantation. The outcome of donor livers with less fatty infiltration has not been well defined. We, therefore, studied the outcome of 59 liver transplantations in which donor livers with up to 30% fat were used. Patient outcome was compared to a time-matched control group of 57 patients. The two groups were similar in terms of age, gender, preservation time, primary diagnosis, and UNOS status. We compared both groups with regard to 4-month and 2-year patient and graft survival. We also assessed the incidence of ischemic type biliary strictures and hepatic artery thrombosis, and evaluated the causes of graft loss in both groups. We found that use of donor livers with up to 30% fatty infiltration was associated with a significant decrease in 4-month graft survival (76% vs. 89%, P<0.05) and in 2-year patient survival (77% vs. 91%, P<0.05). Primary nonfunction and primary dysfunction formed the main cause of graft loss and mortality. Multivariate analysis showed that fatty infiltration is an independent predictive factor for outcome after transplantation. We conclude that liver allografts with up to 30% fat lead to diminished outcome after liver transplantation. However, this diminished outcome should be viewed with respect to the increasing mortality on the national waiting list.

Intercurrent complications in chronic alcoholic men admitted to the intensive care unit following trauma

OBJECTIVE

A chronic alcoholic group following trauma was investigated to determine whether their ICU stay was longer than that of a non-alcoholic group and whether their intercurrent complication rate was increased.

DESIGN

Prospective study.

SETTING

An intensive care unit.

PATIENTS

A total of 102 polytraumatized patients were transferred to the ICU after admission to the emergency room and after surgical treatment. Of these patients 69 were chronic alcoholics and 33 were allocated to the non-alcoholic group. The chronic-alcoholic group. met the DSM-III-R and ICD-10 criteria for alcohol dependence or chronic alcohol abuse/harmful use. The daily ethanol intake in these patients was > or = 60 g. Diagnostic indicators included an alcoholism-related questionnaire (CAGE), conventional laboratory markers and carbohydrate-deficient transferrin.

MEASUREMENT AND RESULTS

Major intercurrent complications such as alcohol withdrawal syndrome (AWS), pneumonia, cardiac complications and bleeding disorders were documented and defined according to internationally accepted criteria. Patients did not differ significantly between groups regarding age, TRISS and APACHE score on admission. The rate of major intercurrent complications was 196% in the chronic alcoholic vs 70% in the non-alcoholic group (p = 0.0001). Because of the increased intercurrent complication rate, the ICU stay was significantly prolonged in the chronic-alcoholic group by a median period of 9 days.

CONCLUSIONS

Chronic alcoholics are reported to have an increased risk of morbidity and mortality. However, to our knowledge, nothing is known about the morbidity and mortality of chronic alcoholics in intensive care units following trauma. Since chronic alcoholics in the ICU develop more major complications with a significantly prolonged ICU stay following trauma than non-alcoholics, it seems reasonable to intensify research to identify chronic alcoholics and to prevent alcohol-related complications.

Therapy of alcohol withdrawal syndrome in intensive care unit patients following trauma: results of a prospective, randomized trial

OBJECTIVES

To assess the effect of three different alcohol withdrawal therapy regimens in traumatized chronic alcoholic patients with respect to the duration of mechanical ventilation and the frequency of pneumonia and cardiac disorders during their intensive care unit (ICU) stay.

DESIGN

A prospective, randomized, blinded, controlled clinical trial.

SETTING

A university hospital ICU.

PATIENTS

Multiple-injured alcohol-dependent patients (n=180) transferred to the ICU after admission to the emergency room and operative management. A total of 180 patients were included in the study; however, 21 patients were excluded from the study after assignment.

INTERVENTIONS

Patients who developed actual alcohol withdrawal syndrome were randomized to one of the following treatment regimens: flunitrazepam/clonidine (n=54); chlormethiazole/haloperidol (n=50); or flunitrazepam/haloperidol (n=55). The need for administration of medication was determined, using a validated measure of the severity of alcohol withdrawal (Revised Clinical Institute Withdrawal Assessment for Alcohol Scale).

MEASUREMENTS AND MAIN RESULTS

The duration of mechanical ventilation and major intercurrent complications, such as pneumonia, sepsis, cardiac disorders, bleeding disorders, and death, were documented. Patients did not differ significantly between groups regarding age, Revised Trauma and Injury Severity Score and Acute Physiology and Chronic Health Evaluation II score on admission. In all except four patients in the flunitrazepam/clonidine group, who continued to hallucinate, the Revised Clinical Institute Withdrawal Assessment for Alcohol Scale decreased to <20 after initiation of therapy. ICU stay did not significantly differ between groups (p=.1669). However, mechanical ventilation was significantly prolonged in the chlormethiazole/haloperidol group (p=.0315) due to an increased frequency of pneumonia (p=.0414). Cardiac complications were significantly (p=.0047) increased in the flunitrazepam/clonidine group.

CONCLUSIONS

There was some advantage in the flunitrazepam/clonidine regimen with respect to pneumonia and the necessity for mechanical ventilation. However, four (7%) patients had to be excluded from the study due to ongoing hallucinations during therapy. Also, cardiac complications were increased in this group. Thus, flunitrazepam/haloperidol should be preferred in patients with cardiac or pulmonary risk. Further studies are required to determine which therapy should be considered.

Relevance of carbohydrate-deficient transferrin as a predictor of alcoholism in intensive care patients following trauma

Every second traumatized patient is a chronic alcoholic. Chronic alcoholics are at risk due to an increased morbidity and mortality. Reliable and precise diagnostic methods for detecting alcoholism are mandatory to prevent posttraumatic complications by adequate prophylaxis. The patient's history, however, is often not reliable, and conventional laboratory markers are not sensitive or specific enough. The aim of this study was to investigate whether carbohydrate-deficient transferrin (CDT) is a sensitive and specific marker to detect alcoholism in traumatized patients. One hundred and five male traumatized patients or their relatives gave their written informed consent to participate in this institutionally approved study. All patients were transferred to the intensive care unit after admission to the emergency room, followed by surgical treatment. Diagnostics included an alcoholism-related questionnaire, conventional laboratory markers (mean corpuscular volume, gamma-glutamyltransferase, aspartate aminotransferase, and alanine aminotransferase), and CDT sampling (microanion-exchange chromatography, turbidimetry, and radioimmunoassay, respectively). Only patients in whom a reliable history could be obtained were included. Alcoholism was diagnosed if the patients met the Diagnostic and Statistical Manual of Mental Disorders criteria for chronic alcohol abuse or dependence. The administration of fluids before CDT sampling was carefully documented. Patients did not differ significantly regarding age, Trauma and Injury Severity Score, and Acute Physiology and Chronic Health Evaluation score. The sensitivity of the CDT research kit was 70% and of the commercially available kit CDTect was 65%. Early sampling in the emergency room and before administration of large volumes of fluid increased the sensitivity to 83% for the CDT research kit and 74% for CDTect, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

The relationship of the retail availability of alcohol and alcohol sales to alcohol-related traffic crashes

The research literature on the relationship of alcohol consumption to motor vehicle crash risk clearly implicates the importance of minimizing the use of alcohol in conjunction with the operation of motor vehicles. However, there has been relatively little documentation of the direct impact of changes in beverage-specific alcohol sales on the most common surrogate for alcohol-involved traffic crashes, single-vehicle nighttime fatalities. Similarly, there have been few studies of the relationship between the physical availability of alcohol and fatal crash rates which have concurrently controlled for differences in alcohol sales. Indeed, the possibility that reduced availability might lead to increases rather than decreases in fatal crashes (due to increased driving after drinking) has not been adequately tested. This paper presents a series of analyses of time-series cross-sectional data from 38 states over 12 years to evaluate the impact of changes in alcohol sales and the physical availability of alcohol upon single-vehicle nighttime fatal crashes. The results of the study showed, first, that independent of a number of economic and demographic covariates, rates of single-vehicle nighttime fatal crashes were most strongly related to sales of beer and less so to sales of spirits and wine. Second, net of beverage-specific alcohol sales, the physical availability of alcohol was not related to measurable changes in fatal crash rates. Thus, reductions in availability intended to reduce alcohol sales and problems would not appear to increase traffic-related crashes through increased driving exposure.

Single road traffic deaths--accident or suicide?

Many authors have suggested that some deaths resulting from road traffic accidents are in fact suicide. The purpose of this study was to examine the circumstances of single road traffic deaths in County Mayo, Ireland, over the 15-year period from 1978 to 1992 inclusive. Using the information available from the coroners' files, evidence was sought to support the hypothesis that some accidental deaths may have been disguised suicides. The authors could find no conclusive evidence to suggest that this hypothesis was true. However, there was suspicion of suicide in six (4.5%) of the 134 fatalities examined. Interesting data regarding gender differences, seasonality, time of accident, and the consumption of alcohol were found.