An analysis of traffic injuries in Taiwan in relation to alcohol use and economic loss

Prognostic analysis of patients with blunt chest trauma admitted to an intensive care unit

BACKGROUND/PURPOSE

Predictors of mortality in blunt chest trauma patients have mostly been studied by univariate analysis. This study used multivariate analysis to identify the independent predictors in these patients admitted to a surgical intensive care unit (SICU).

METHODS

One hundred and twenty-seven blunt thoracic trauma patients consecutively admitted to a SICU were enrolled and evaluated by quantified injury severity scores including Acute Physiology and Chronic Health Evaluation II (APACHE II), Glasgow Coma Scale (GCS), Therapeutic Intervention Scoring System (TISS) and Injury Severity Score (ISS). Incidence of thoracic and extrathoracic injuries, transfusion and resuscitation volumes, PaO2/FIO2 ratio and the presence of shock were also evaluated.

RESULTS

In the univariate analysis, clinical characteristics of survivors (n = 113) and non-survivors (n = 14) at admission were similar regarding age, gender, incidence of intrathoracic injuries and extrathoracic injuries and ISS. The following variables were higher for non-survivors: APACHE II score, 19 +/- 6 vs.12 +/- 6 (p = 0.002); TISS points, 39 +/- 13 vs. 29 +/- 15 (p = 0.019); the presence of shock, 93% vs. 42% (p < 0.001). Non-survivors also had lower GCS, 8 +/- 5 vs.14 +/- 3 (p < 0.001), and PaO2/FIO2 ratio, 211 +/- 124 vs. 340 +/- 145 (p = 0.002). Of the shock patients, they had significantly higher volumes of blood transfusions and fluid resuscitations (p < 0.001) and a higher incidence of abdominal injuries (p = 0.031) and mortality rate (p < 0.001) than non-shock patients. Multivariate logistic regression analysis identified three independent risk factors of mortality: GCS (adjusted odds ratio [OR], 0.76; 95% confidence interval [CI], 0.64-0.89; p = 0.001), PaO2/FIO2 ratio (adjusted OR, 0.75; 95% CI, 0.58-0.98; p = 0.036) and shock (adjusted OR, 3.8; 95% CI, 1.24-11.69; p = 0.020).

CONCLUSION

Blunt chest trauma was usually associated with injuries of other organ systems, especially of the abdomen and head. Besides a decreased PaO2/FIO2, a lower GCS and a presence of shock were also independent prognostic predictors of mortality for these patients admitted to the ICU.

Alcohol-related Injuries at an emergency department in Eastern Taiwan

BACKGROUND/PURPOSE

Injuries are major causes of mortality and morbidity in Taiwan. Alcohol involvement often plays a role in injuries. The purpose of this study was to determine the prevalence of alcohol-related injuries at an emergency department in Eastern Taiwan and their associated factors.

METHODS

All injured patients who made emergency visits between October 2002 and September 2003 were enrolled. For each patient, the attending nurse completed an injury-coding sheet, which included the results of an assessment of whether the patient had an alcohol odor or alcohol consumption related behavior. Nurses recorded suspicion of alcohol consumption based on possible categories of "no alcohol odor", "alcohol odor", "intoxicated", "suspected" or "unknown". Blood alcohol testing was also performed based on the decision of the attending physician. Injuries were defined as alcohol-related based on the report of "alcohol odor" or "intoxicated" by the nurse or a positive blood alcohol test. Logistic regression was used to assess the significance of the association of possible related factors with alcohol-related injury.

RESULTS

A total of 8822 eligible visits were studied and 14% were classified as alcohol-related. The proportion of alcohol-related injuries was 14.9% for vehicle-related injuries, and 51.3% for assaults. Male, young to middle aged, aboriginal ethnicity and visits after midnight were factors associated with increased likelihood of alcohol-related injuries. Multiple logistic regression analysis revealed that the three factors most significantly associated with alcohol-related injuries were visits after midnight (odds ratio, OR, 7.5; 95% confidence interval, CI, 6.4-8.9], assaults (OR, 3.4; 95% CI, 2.3-4.8), and head injuries (OR, 2.7; 95% CI, 2.3-3.2).

CONCLUSION

Injuries were alcohol related in one out of seven patients this study from an emergency department in eastern Taiwan. Ongoing epidemiologic monitoring of the prevalence and nature of alcohol abuse among patients visiting the ED are urgently needed.

Feasibility of identification of alcohol intoxication by nurses in emergency departments

Vehicle-related injuries are the major cause of death and injuries in Hualien County, and driving under the influence of alcohol plays a major role in such crashes. From December 1997 to May 1998, we determined the blood alcohol concentrations (BAC) of injured individuals from vehicle crashes at two emergency departments in Hualien. Nurses were asked to record whether the patient presented with an alcohol odor. The accuracy of detection by nurses was assessed from the BAC and groups with increased prevalence were identified for screening. Of 945 patients assessed, 505 (53.4%) tested positive by BAC and 320 (33.9%) were identified with an alcohol odor. With a BAC threshold of more than 50 mg/dL, detection sensitivity was 75.4%, specificity was 90.4%, and accuracy was 85.0% (95% confidence interval: 82.7, 87.3). Patients with an alcohol odor were significantly more likely to be men, aborigines, or head-injured patients. The accuracy of detection showed no significant difference by gender, head injury, or driver status. We suggest that detection of alcohol odor by nurses may be a feasible assessment of the role of alcohol in road traffic accidents. This may provide essential data for injury prevention strategies and programs.

Factors associated with severity of motorcycle injuries among young adult riders

STUDY OBJECTIVE

A cohort of 4,729 junior college students in Taiwan was studied to determine risk factors for increased severity of motorcycle injuries.

METHODS

Crash characteristics were collected by using self-administered questionnaires soon after a student was involved in a motorcycle crash. The proportional odds model with generalized estimating equations, with correlated ordinal responses for collisions categorized into not injured, mildly injured, and severely injured categories, was used to determine the odds of injury severity.

RESULTS

A total of 1,889 motorcycle crashes involving 1,284 persons occurred over a 20-month period from November 1994 to June 1996. There were 1,339 noninjuries, 474 mild injuries, and 76 severe injuries. The adjusted odds ratio (OR) of rural to urban roads having a greater level of injury severity was 1.64. Compared with noncollisions, collisions with a moving car (adjusted OR=1.76), a parked car (adjusted OR 1.90), or another stationary object (adjusted OR=2.31) increased the odds for a greater level of injury severity. Riders using Sanyang (adjusted OR=1.63) and Yamaha (adjusted OR=1.39) motorcycles had greater odds of being involved in a crash with a greater level of injury compared with those riding Kymco motorcycles. Darkness (adjusted OR=1.65) and greater speeds (adjusted OR=1.63 to 4.69) also increased the odds of greater injury severity.

CONCLUSION

At the time of motorcycle crashes, factors such as being on rural roads, collisions with a heavier object, some motorcycle makes, darkness, and greater speeds increased the severity of motorcycle injuries among these young adult riders.

A longitudinal study of risk factors for motorcycle crashes among junior college students in Taiwan

A cohort of 4729 junior college students in an urban and a rural area in Taiwan was followed up for a period of 20 months. Students' characteristics, including riding exposures, as well as human, vehicular, and environmental factors were collected using one initial and three follow-up questionnaires. The Anderson-Gill (AG) multiplicative intensity model was used to determine the risk of a motorcycle crash over time while also allowing for the modeling of multiple events. The average response rate for the four assessments was 92%. The adjusted relative hazard (RH) for students living in the rural as opposed to the urban area for crashes was 1.67 at the beginning of the study but decreased to 0.66 by the end. Past motorcycle crash history, number of riding days, average riding distance, risk-taking level, alcohol consumption, and traffic violations were all significantly associated with an increased risk of being involved in a crash. Conversely, increasing age, riding experience, and automobile licensure were related to a decreased risk of crashing. Furthermore, helmet use was not independently related to the risk of crashing. In conclusion, a high-risk group predisposed to involvement in a motorcycle crash, including both non-injury and injury-related crashes, can be identified using selected risk factors for crash prevention among young riders.

Crash severity, injury patterns, and helmet use in adolescent motorcycle riders

BACKGROUND

This study examined crash severity and injury patterns between helmeted and unhelmeted adolescent motorcycle riders.

METHODS

Among an initial population of 4,721 junior college students, 1,284 students were involved in 1,889 motorcycle crashes during a 20-month follow-up period. Crash severity was measured by both the type of collision object and the repair cost of motorcycle damage.

RESULTS

The incidence rates of crash, injury, hospitalization, and deaths per 1,000 person-years in the cohort were 358, 104, 14, and 1.3, respectively. Compared with helmeted riders, unhelmeted riders had more noncollisions and fewer collisions with a moving car but there was no significant difference in repair cost of motorcycle damage between these groups. More injuries to the external skin, face, and head and more severe injuries occurred in unhelmeted than in helmeted riders. Among crashes resulting in hospitalization/death, more injuries to the face and head occurred in unhelmeted riders than in helmeted riders.

CONCLUSION

Crashes involving unhelmeted riders were not more severe but more frequently involved face and head injuries than crashes involving helmeted riders.

Alcohol consumption in victims of violence: a trend study for the period 1970-1998

This 29-yr. retrospective study is about alcohol consumption by victims of violence intentionally injured (N = 13,048) and general patients unintentionally injured (N = 296,544) who were treated for their injuries at the Trauma Center of the University Hospital Groningen (The Netherlands) during the period 1970-1998. The incidence rate for general patients with alcohol consumption was statistically significantly greater than the incidence rate of victims of violence with alcohol consumption. A long-term significant linear trend was observed for both types of patients during the 29-yr. period. However, the increase in incidence rate among the general patients with alcohol consumption was four times greater than the increase in incidence rate for the victims of violence with alcohol consumption. Males predominated in both types of patients (with and without alcohol consumption). The statistically significant highest incidence rates (and male predominance) were found in the age group 20-24 years for both categories of patients.

Age-period-cohort analysis of motor vehicle mortality in Taiwan, 1974-1992

The aim of this study was to examine the effects of age, calendar period of death and birth cohort in motor vehicle mortality in Taiwan over the period 1974-1992. A log-linear model modified from the method of Osmond and Gardner (Stat. Med. 1: 245-259; 1982) was used. Age turned out to be a significant predictor of motor vehicle mortality. The most risky group (over 70 years) had 27.1 and 16.3 times the mortality of the least risky group (5-9 years, 10-14 years) for males and females respectively. The period effect showed a continuously increasing mortality trend since 1974 in females. The pattern in males is similar except that it has slightly leveled off in recent years. The birth cohorts at the highest risk of motor vehicle death were those born between 1979 and 1983 for both sexes. However, males born between 1929 and 1933 also had a high mortality. This analysis provided a better understanding of the trend of mortality from motor vehicle crashes.