Motorcycle protective clothing: protection from injury or just the weather?

Motorcycle injuries: a systematic review for forensic evaluation

The intricate interplay of exposure and speed leave motorcyclists vulnerable, leading to high mortality rates. During the collision, the driver and the passenger are usually projected away from the motorcycle, with variable trajectories or final positions. Injuries resulting from the crash can exhibit distinct and specific characteristics depending on the circumstances of the occurrence.The aim of this study is to provide a systematic review of the literature on injuries sustained by motorcyclists involved in road accidents describing and analyzing elements that are useful for forensic assessment.The literature search was performed using PubMed, Scopus and Web of Science from January 1970 to June 2023. Eligible studies have investigated issues of interest to forensic medicine about during traffic accidents involving motorcycle. A total of 142 studies met the inclusion criteria and were classified and analyzed based on the anatomical regions of the body affected (head, neck, thoraco-abdominal, pelvis, and limb injuries). Moreover, also the strategies for preventing lesions and assessing injuries in the reconstruction of motorcycle accidents were examined and discussed.This review highlights that, beyond injuries commonly associated with motorcycle accidents, such as head injuries, there are also unique lesions linked to the specific dynamics of accidents. These include factors like the seating position of the passenger or impact with the helmet or motorbike components. The forensic assessment of injury distribution could serve as support in reconstructing the sequence of events leading to the crash and defining the cause of death in trauma fatalities.

Road traffic safety for older adults: an emerging public health challenge in Thailand

BACKGROUND

Road safety for older adults should receive more attention in low-income and middle-income countries with rapidly ageing populations.

METHODS

Using injury surveillance data from Khon Kaen Regional Hospital in northeastern Thailand, we calculated the proportion of older adults in the total number of patients who were fatally and non-fatally injured in road traffic crashes in each year from 2001 to 2020 and the proportion of road user type in the fatal and non-fatal patients by age groups for the entire study period to examine the extent to which older adults were involved in the crashes and with what mode of transportation.

RESULTS

During the 20-year period, there were 5046 fatal and 180 353 non-fatal patients of whom 509 (10%) and 6087 (3%) were aged 65 years or older, respectively. From 2001 to 2020, this proportion increased from 3% to 20% among the fatal patients and from 1% to 6% among the non-fatal patients. Of the fatal and non-fatal patients aged 65 years or older, 50% and 54% were involved in road traffic crashes while driving motorcycles and 28% and 22% while riding bicycles or walking, respectively. Compared with patients aged 65-74 years, those aged 75 years or older tended to be bicyclists or pedestrians in the crashes, though as high as 40% of them were motorcycle drivers.

CONCLUSION

Older adults are increasingly injured in road traffic crashes as vulnerable road users in Thailand. Therefore, road safety efforts should consider their presence on the road.

Effectiveness of road safety interventions: An evidence and gap map

Background

Road Traffic injuries (RTI) are among the top ten leading causes of death in the world resulting in 1.35 million deaths every year, about 93% of which occur in low- and middle-income countries (LMICs). Despite several global resolutions to reduce traffic injuries, they have continued to grow in many countries. Many high-income countries have successfully reduced RTI by using a public health approach and implementing evidence-based interventions. As many LMICs develop their highway infrastructure, adopting a similar scientific approach towards road safety is crucial. The evidence also needs to be evaluated to assess external validity because measures that have worked in high-income countries may not translate equally well to other contexts. An evidence gap map for RTI is the first step towards understanding what evidence is available, from where, and the key gaps in knowledge.

Objectives

The objective of this evidence gap map (EGM) is to identify existing evidence from all effectiveness studies and systematic reviews related to road safety interventions. In addition, the EGM identifies gaps in evidence where new primary studies and systematic reviews could add value. This will help direct future research and discussions based on systematic evidence towards the approaches and interventions which are most effective in the road safety sector. This could enable the generation of evidence for informing policy at global, regional or national levels.

Search Methods

The EGM includes systematic reviews and impact evaluations assessing the effect of interventions for RTI reported in academic databases, organization websites, and grey literature sources. The studies were searched up to December 2019.

Selection Criteria

The interventions were divided into five broad categories: (a) human factors (e.g., enforcement or road user education), (b) road design, infrastructure and traffic control, (c) legal and institutional framework, (d) post-crash pre-hospital care, and (e) vehicle factors (except car design for occupant protection) and protective devices. Included studies reported two primary outcomes: fatal crashes and non-fatal injury crashes; and four intermediate outcomes: change in use of seat belts, change in use of helmets, change in speed, and change in alcohol/drug use. Studies were excluded if they did not report injury or fatality as one of the outcomes.

Data Collection and Analysis

The EGM is presented in the form of a matrix with two primary dimensions: interventions (rows) and outcomes (columns). Additional dimensions are country income groups, region, quality level for systematic reviews, type of study design used (e.g., case-control), type of road user studied (e.g., pedestrian, cyclists), age groups, and road type. The EGM is available online where the matrix of interventions and outcomes can be filtered by one or more dimensions. The webpage includes a bibliography of the selected studies and titles and abstracts available for preview. Quality appraisal for systematic reviews was conducted using a critical appraisal tool for systematic reviews, AMSTAR 2.

Main Results

The EGM identified 1859 studies of which 322 were systematic reviews, 7 were protocol studies and 1530 were impact evaluations. Some studies included more than one intervention, outcome, study method, or study region. The studies were distributed among intervention categories as: human factors (n = 771), road design, infrastructure and traffic control (n = 661), legal and institutional framework (n = 424), post-crash pre-hospital care (n = 118) and vehicle factors and protective devices (n = 111). Fatal crashes as outcomes were reported in 1414 records and non-fatal injury crashes in 1252 records. Among the four intermediate outcomes, speed was most commonly reported (n = 298) followed by alcohol (n = 206), use of seatbelts (n = 167), and use of helmets (n = 66). Ninety-six percent of the studies were reported from high-income countries (HIC), 4.5% from upper-middle-income countries, and only 1.4% from lower-middle and low-income countries. There were 25 systematic reviews of high quality, 4 of moderate quality, and 293 of low quality.

Authors' Conclusions

The EGM shows that the distribution of available road safety evidence is skewed across the world. A vast majority of the literature is from HICs. In contrast, only a small fraction of the literature reports on the many LMICs that are fast expanding their road infrastructure, experiencing rapid changes in traffic patterns, and witnessing growth in road injuries. This bias in literature explains why many interventions that are of high importance in the context of LMICs remain poorly studied. Besides, many interventions that have been tested only in HICs may not work equally effectively in LMICs. Another important finding was that a large majority of systematic reviews are of low quality. The scarcity of evidence on many important interventions and lack of good quality evidence-synthesis have significant implications for future road safety research and practice in LMICs. The EGM presented here will help identify priority areas for researchers, while directing practitioners and policy makers towards proven interventions.

Epidemiology and estimated economic impact of musculoskeletal injuries in polytrauma patients in a level one trauma centre in Singapore

Introduction

Musculoskeletal injuries are the most common reason for surgical intervention in polytrauma patients.

Methods

This is a retrospective cohort study of 560 polytrauma patients (injury severity score [ISS] >17) who suffered musculoskeletal injuries (ISS >2) from 2011 to 2015 in National University Hospital, Singapore.

Results

560 patients (444 [79.3%] male and 116 [20.7%] female) were identified. The mean age was 44 (range 3-90) years, with 45.4% aged 21-40 years. 39.3% of the patients were foreign migrant workers. Motorcyclists were involved in 63% of road traffic accidents. The mean length of hospital stay was 18.8 (range 0-273) days and the mean duration of intensive care unit (ICU) stay was 5.7 (range 0-253) days. Patient mortality rate was 19.8%. A Glasgow Coma Scale (GCS) score <12 and need for blood transfusion were predictive of patient mortality (p < 0.05); lower limb injuries, road traffic accidents, GCS score <8 and need for transfusion were predictive of extended hospital stay (p < 0.05); and reduced GCS score, need for blood transfusion and upper limb musculoskeletal injuries were predictive of extended ICU stay. Inpatient costs were significantly higher for foreign workers and greatly exceeded the minimum insurance coverage currently required.

Conclusion

Musculoskeletal injuries in polytrauma remain a significant cause of morbidity and mortality, and occur predominantly in economically productive male patients injured in road traffic accidents and falls from height. Increasing insurance coverage for foreign workers in high-risk jobs should be evaluated.

Traumatic spinal injury patterns of on vs. off-road motorcycle crashes

OBJECTIVE

Two wheel motorized vehicles used in both street transportation and recreation are a common cause of severe injury in the United States (US). To date, there has been limited data describing the spinal injury patterns among these motorcycle injury patients in the US. The goal of this study is to characterize and compare differences in specific injury patterns of patients sustaining traumatic spinal injuries after motocross (off-road) and street bike (on-road) collisions in the southwestern US at a Level I Trauma Center.

METHODS

Trauma registry data was queried for patients sustaining a spinal injury after motorcycle collision from 2010 to 2019 at a single Level I Trauma Center. Computed tomography (CT) scan and magnetic imaging resonance imaging (MRI) reports from initial trauma evaluation were reviewed and data was manually obtained regarding injury morphology and location.

RESULTS

A total of 1798 injuries were identified in 549 patients who sustained a motorcycle collision, specifically 67 off-road and 482 on-road motorcycle patients. Off-road motorcycle patients were found to be significantly younger (34.75 vs. 42.66, p = 0.00015). A total of 46.2% of the off-road injuries were determined to be from compression mechanisms, compared to 32.9% in the on-road cohort (p = 0.0027). The on-road cohort was more likely to have an injury classified as insignificant, such as transverse and spinous process fractures (60.1% vs. 42.5%, p = 00.25). There was no significant difference in regards to junctional, mobile, and semirigid spine segments between the two cohorts.

CONCLUSIONS

Different fracture patterns were seen between the off-road and on-road motorcycle cohorts. Off road motorcyclists experienced significantly more compression and translational injuries, while on road motorcyclists experienced more frequent insignificant injury patterns. Data on the different fracture patterns may help professionals develop safety equipment for motorcyclists.

Changes in incidence and severity of commercial motorcycle accidents due to the use of delivery service platforms in Korea: a retrospective cohort study

Purpose

Recently, a sharp increase in the use of delivery services has led to an increase in motorcycle accidents. This study aimed to identify the characteristics of the commercial motorcycle injured patients and factors related to the severity during the past 10 years.

Methods

Patients (15-64 years old) who visited the emergency department with commercial motorcycle accidents injury registered in the Korean Emergency Department-based Injury In-depth Surveillance (2011-2020) database, were included. All included cases were categorized into two groups according to the period: group 1 (2011-2015) and group 2 (2016-2020). General characteristics and the factors associated with severity were investigated.

Results

Among 8,123 emergency department visits, patients in group 1 were 3,071, and patients in group 2 were 5,052. The odds for severity were affected by patients age (odds ratio [OR], 1.008; 95% confidence interval [CI], 1.004-1.013), and overnight/morning (00:00-12:00; OR, 1.243; 95% CI, 1.091-1.415). The odds for severity were higher in head and neck injury (OR, 8.357; 95% CI, 7.410-9.424) and torso injury (OR, 4.122; 95% CI, 3.610-4.708). The odds for the severity of accidents based on excess mortality ratio-adjusted Injury Severity Score (EMR-ISS) after 2015 were significant (OR, 1.491; 95% CI, 1.318-1.687). Hospitalization in the intensive care unit and death were associated with accidents after 2015 (OR, 2.593; 95% CI, 2.120-3.170).

Conclusions

Commercial motorcycle accidents have increased significantly over the past decade. There were statistical differences in severity based on EMR-ISS and the hospitalization in intensive care unit and death.

Friction burns in cyclists: An under-recognised problem

INTRODUCTION

Cycling-related friction burns, also known as abrasions or "road rash", can occur when cyclists are involved in a fall or a collision. However, less is known about this type of injury as they are often overshadowed by concurrent traumatic and/or orthopaedic injuries. The aims of this project were to describe the nature and severity of friction burns in cyclists admitted to hospitals with specialist burn services in Australia and New Zealand.

METHODS

A review of cycling-related friction burns recorded by the Burns Registry of Australia and New Zealand was undertaken. Summary statistics described demographic, injury event and severity, and in-hospital management data for this cohort of patients.

RESULTS

Between July 2009 and June 2021, 143 cycling-related friction burn admissions were identified (accounting for 0.4% of all burns admissions during the study period). Seventy-six percent of patients with a cycling-related friction burn were male, and the median (interquartile range) of patients was 14 (5-41) years. The greatest proportion of cycling-related friction burns were attributed to non-collision events, namely falls (44% of all cases) and body parts being caught or coming into contact with the bicycle (27% of all cases). Although 89% of patients had a burn affecting less than five percent of their body, 71% of patients underwent a burn wound management procedure in theatre such as debridement and/or skin grafting.

CONCLUSIONS

In summary, friction burns in cyclists admitted to participating services were rare. Despite this, there remains opportunities to better understand these events to inform the development of interventions to reduce burn injury in cyclists.

Over 30-year retrospective analyses of moped-motorcycle fatal road accidents in the northern area of the Italian region of Emilia Romagna and review of the literature: Aiming for further preventive measures in the future

Road traffic injuries are a major cause of morbidity and mortality worldwide, with pedestrians and riders of two-wheeled motor vehicles being the most vulnerable. The present study aims to determine the epidemiological characteristics of fatal motorcycle crashes in a portion of the Italian region of Emilia Romagna, and to compare them with the data available in literature. Data were retrieved from autopsy reports on 350 subjects who died following road accidents involving moped or motorcycle in the cities of Parma, Piacenza, and Reggio Emilia. Two types of data were extrapolated: circumstantial and traumatological. The population was divided into subgroups according to gender, crash time, alcohol positivity, presence or absence of the helmet, and the period elapsed between the accident and death. Most of the considered road accidents occurred during the day and on weekends. 25.5 % of the victims tested positive for alcohol. As far as traumas are concerned, the limbs resulted to be the most affected body segment, followed by the head (87.4 %), the thorax (85.7 %), the abdomen (65.7 %), and lastly the neck (50.3 %). According to similar studies, the sample victim of a moped/ motorcycle accident is a young male subject. The results obtained allow us to demonstrate that the mandatory use of the helmet has reduced skull and brain injury over the years. At present, no law regulates the use of protections for other body parts. Regulatory interventions in this sense would be desirable given the ever more rapid technical evolutions in the field of motorcycles.

Mitigating fuel tank syndrome pelvic injuries - is there potential for rider worn protectors?

OBJECTIVE

The aim of this study was to investigate the feasibility of rider-worn pelvis protection for mitigating injury risk when contacting the motorcycle fuel tank in a crash.

METHODS

A newly developed test apparatus was designed and constructed to simulate the interaction between a rider's pelvis and the motorcycle fuel tank in a frontal crash. Impacts were performed at a velocity of 18 km/h into four motorcycle fuel tanks. Further testing used a rigid fuel tank surrogate and the pelvis surrogate in an unprotected condition and with a series of impact protector prototypes. A subset of prototype samples was also tested at varying tank angles (30°, 37.5°, 45°) and impact speeds (8.5 km/h, 13 km/h, 18 km/h). Analysis of variance was used to determine whether the protector prototypes reduced pelvis response compared to unprotected.

RESULTS

Resultant peak pelvis acceleration was reduced by three pelvis impact protector prototypes compared to an unprotected condition. The reduction in peak acceleration occurred without a significant change in the peak pelvis rotational velocity. The pattern of protector performance was consistent at varying fuel tank angles but only reduced the pelvis response at the highest impact speed tested of 18 km/h.

CONCLUSIONS

The results indicate that there may be potential for using pelvis impact protection to mitigate injury risk by absorbing and/or distributing impact energy that would otherwise be transmitted to the rider's pelvis. However, due to the current paucity in understanding of pelvis biomechanics to anteroposterior loading, it is unknown whether the pelvis acceleration reductions achieved would prevent injury.

Risky motorcycle riding behaviour among young riders in Manipal, India

BACKGROUND

Motorcycles are one of the most commonly used transportation modes in low and middle-income countries. In India, motorized two-wheelers comprise 70% of the total vehicle population, and motorcycle users are considered the most vulnerable road users. It is essential to understand the risky riding behaviour and associated factors among the motorcyclists to develop evidence-based traffic safety programs targeting motorcycle riders. The purpose of the current study was two-fold. First, it aimed to determine the appropriate structure of a modified version of the MRBQ among young riders in Manipal, India. Second, it assessed to what extent MRBQ factors were associated with self-reported crash involvement and violations.

METHODS

The motorcycle rider behaviour questionnaire (MRBQ) is a 43-item scale that assesses five aspects of risky motorcycle rider behaviour, i.e., violations, control errors, traffic errors, stunts, and protective equipment. The MRBQ, along with measures of socio-demographic variables and the number of motorcycle crashes, was filled out by 300 young motorcycle riders who were in the age group of 18-25 years and had been riding for at least the past three years (93% males, 92.3% students).

RESULTS

Five factors emerged out of the MRBQ after an exploratory factor analysis: traffic errors, control errors, stunts, protective equipment, and violations. Cronbach's alpha for these factors ranged from .66 to .82. Reports of performing stunts and committing violations were positively associated with self-reported near-crash experiences over the past three months. Riders reporting stunts, violations and using a motorcycle of 125-200 cc reported having received more fines in the last three months. These findings were confirmed in both univariate and multivariate binary logistic regression models.

CONCLUSION

The study assessed the factor structure of a modified version MRBQ and the extracted factors associations with self-reported crash involvement. The factor structure revealed in the current study is consistent with MRBQ factor structures found in other countries. However, the support for a relationship between MRBQ factors and self-reported crashes was less significant. The findings suggest that if replicated by future studies, local policymakers are advised to focus on the five MRBQ factors while planning future interventions to achieve a reduction in the number of road crashes among motorcyclists.

[Differences in injury patterns in motorcycle accidents involving children and adolescents]

Hintergrund

Verkehrsunfälle und ihre Verletzungsfolgen stellen eine häufige traumatische Ursache für das Versterben und für das Auftreten von irreversiblen Schäden bei Kindern und Jugendlichen dar. Bei Motorradunfällen unterscheiden sich dabei Verletzungsmuster abhängig vom Patientenalter.

Ziel der Arbeit

Ziel dieser Studie ist es, die typischen Verletzungsmuster nach Motorradunfällen im Kindes- und Jugendalter vergleichend zu beschreiben, da diese einen ausschlaggebenden Einfluss auf die Prävention sowie die adäquate Behandlung der jeweiligen Patientengruppen bieten können.

Material und Methoden

In die Studie wurden innerhalb der Jahre 2002–2018 22.923 Patienten aus dem TraumaRegister der Deutschen Gesellschaft für Unfallchirurgie (DGU®) eingeschlossen. Die Auswertung erfolgte in 4 Altersgruppen: Gruppe 1 (4 bis 15 Jahre), Gruppe 2 (16 bis 17 Jahre), Gruppe 3 (18 bis 20 Jahre) sowie Gruppe 4 (21 bis 50 Jahre) als Kontrolle.

Ergebnisse

In Gruppe 2 stellten Extremitätenverletzungen das häufigste Verletzungsmuster dar und traten überwiegend im Bereich der unteren Extremität auf. Zudem ergab die Analyse, dass Gruppe 1 häufiger ein schweres Schädel-Hirn-Trauma erleidet, trotz initial schlechtem Zustand aber ein besseres Outcome aufweist. Thorakale, abdominelle sowie Wirbelsäulen- und Beckenverletzungen kommen bei den jüngeren Altersgruppen seltener vor. Insbesondere stellen Rippenfrakturen eine Rarität bei Kindern dar. In der Diagnostik werden Kinder im Vergleich zu Erwachsenen seltener einer Ganzkörper-CT-Diagnostik zugeführt.

Diskussion

Die Studie deckt altersabhängige Unterschiede in den Verletzungsmustern von Patienten auf, die als Beifahrer oder Fahrer eines Motorrades in einen Unfall involviert waren. Zudem konnten ebenso Unterschiede in der prä- und innerklinischen Versorgung herausgearbeitet werden.

High Riding Prostate: Epidemiology of Genitourinary Injury in Motorcyclists from a UK Register of over 12,000 Victims

BACKGROUND

The mechanism of motorcycle accidents (high speeds, pelvis behind fuel tank) may predispose to genitourinary injury (GUI) but the epidemiology is poorly understood. Previous studies have assessed GUI patterns in cyclists, and road traffic accident victims in general, but no study has analyzed GUI patterns in a large cohort of motorcyclists.

OBJECTIVES

We aimed to better understand patterns of urological injuries among motorcyclists admitted to hospital. We aimed to determine any relationship between pelvic fracture and GUI patterns or severity.

METHODS

The Trauma Audit Research Network was reviewed to identify motorcyclists admitted between January 2012 and December 2016 (n = 12,374). Cases were divided into riders (n = 11,926) and pillion passengers (n = 448), and the data analyzed to identify urological injuries and their associations. The associations between pelvic fracture and other injury types were tested for significance by one- and two-way χ 2.

RESULTS

GUI was identified in 6%. Renal trauma was the most common GUI among riders (4%) and pillions (2%). There was no statistically significant relationship between grade of renal trauma and presence of pelvic fracture. Urethral injury occurred in 0.2% of riders and passengers, and bladder injury in 0.4% of riders and 0.7% of pillions. Urethral and bladder injuries were positively associated with pelvic fracture, which was present in 81 and 92%, respectively. Testicular trauma occurred in 0.4% of riders and 0.7% of pillions. Body armor was recorded in 3% of casualties with urological trauma, and 3% overall.

CONCLUSIONS

A significant proportion of motorcyclists brought to accident and emergency department have GUI, most commonly renal trauma. Pelvic fracture is more common in pillion passengers than riders, and associated with urethral and bladder injuries, but it does not predict severity of renal trauma. External genital injuries are rare, but we recommend examination in the tertiary survey, as consequences of missed injury are severe. Further research is needed to explore protective effects of motorcyclist clothing.

Development and Validation of the Overall Foot Pain Questionnaire in Motorcycle Riders

Objectives: Our primary aim was to develop a transcultural adaptation of a cycling questionnaire using the Borg CR-10 scale as a tool to describe the discomfort among motorcyclists during the riding process in two trial sessions. Design: A transcultural adaptation and descriptive cross-sectional study. Settings: Jarama motorcycling circuit (Madrid, Spain). Participants: The participants were riders recorded across in a final motorcycling race. Interventions: The study design is based in two tools, the adapted Motorcyclist Questionnaire (MQ-21) with 21 items and Borg CR10 Scale^® was used to determine discomfort level during motorcycling performance. The translation procedure, reliability, and reproducibility were performed. Results: All items showed an almost perfect intraclass correlation coefficient (ICC) (ICC = 0.909–1.00), except for item 9 (ICC = 0.881). Almost perfect internal consistency was shown for the total score (Cronbach α = 0.899). No systematic differences existed among test and retest in all items (p > 0.05) according to Bland–Altman plots. Respondents experienced slight discomfort on their body parts during the test-retest 1 h riding process. Foot discomfort was scored as 1.20, being the eighth of the 12 studied body parts. Conclusions: Internal consistency and test-retest reliability of the MQ-21 questionnaire were excellent and this questionnaire may be recommended to be used in motorcycling sports and clinical settings to evaluate the discomfort.

Mapping fractures from traffic accidents in Sweden: How do cyclists compare to other road users?

Introduction: Cyclists account for a large share of injured road users in traffic. The crash data analysis for cyclist safety and protection should be based on a representative dataset of real-world crashes. This manuscript aimed to explore the patterns of cyclists' fractures and factors associated with fractures of higher severity.Methods: This paper exemplifies a methodology that combines injuries from a crash database, including both hospital and police reports and fracture registry database from orthopedic centers nationally in Sweden.Results: Car occupants were most frequently involved in crashes resulting in fractures (37%), followed by motorcyclists (27.6%) and bicyclists (15.4%). Common fracture locations differed by the type of road user, where cyclists were more frequently fractured in the lower arm, compared to other road users, such as car drivers, motorcyclists and pedestrians who suffered mostly of fractures in the lower leg. Within cyclists, injuries also differed by gender, suggesting that combination of different countermeasures may be needed in order to provide sufficient protection for all cyclist. In the analyzed data, male cyclists with an average age of 49 were the most frequently fractured cyclists. Fractures of cyclists to the acetabulum (100%), pelvis (84.2%), vertebra (75%) and tibia (70.3%) were most frequently high energy fractures. Single bicycle incidents (OR = 0.165) and collisions with another bicycle (OR = 0.148) were significantly less likely to result in a high energy fracture than a collision with a car.Conclusions: The results of this study may guide the design of appropriate protective devices for the cyclists based on the different injury mechanisms and provide implications for prioritizing new countermeasures, campaigns, or regulations.

Examining correlations between motorcyclist's conspicuity, apparel related factors and injury severity score: Evidence from new motorcycle crash causation study

Motorcyclists are vulnerable road users at a particularly high risk of serious injury or death when involved in a crash. In order to evaluate key risk factors in motorcycle crashes, this study quantifies how different "policy-sensitive" factors correlate with injury severity, while controlling for rider and crash specific factors as well as other observed/unobserved factors. The study analyzes data from 321 motorcycle injury crashes from a comprehensive US DOT FHWA's Motorcycle Crash Causation Study (MCCS). These were all non-fatal injury crashes that are representative of the vast majority (82%) of motorcycle crashes. An anatomical injury severity scoring system, termed as Injury Severity Score (ISS), is analyzed providing an overall score by accounting for the possibility of multiple injuries to different body parts of a rider. An ISS ranges from 1 to 75, averaging at 10.32 for this sample (above 9 is considered serious injury), with a spike at 1 (very minor injury). Preliminary cross-tabulation analysis mapped ISS to the Abbreviated Injury Scale (AIS) injury classification and examined the strength of associations between the two. While the study finds a strong correlation between AIS and ISS classification (Kendall's tau of 0.911), significant contrasts are observed in that, when compared to ISS, AIS tends to underestimate the severity of an injury sustained by a rider. For modeling, fixed and random parameter Tobit modeling frameworks were used in a corner-solution setting to account for the left-tail spike in the distribution of ISS and to account for unobserved heterogeneity. The developed random parameters Tobit framework additionally accounts for the interactive effects of key risk factors, allowing for possible correlations among random parameters. A correlated random parameter Tobit model significantly out-performed the uncorrelated random parameter Tobit and fixed parameter Tobit models. While controlling for various other factors, we found that motorcycle-specific shoes and retroreflective upper body clothing correlate with lower ISS on-average by 5.94 and 1.88 units respectively. Riders with only partial helmet coverage on-average sustained more severe injuries, whereas, riders with acceptable helmet fit had lower ISS Methodologically, not only do the individual effects of several key risk factors vary significantly across observations in the form of random parameters, but the interactions between unobserved factors characterizing random parameters significantly influence the injury severity score as well. The implications of the findings are discussed.

Effect of Accelerated Ageing on the Mechanical and Structural Properties of the Material System Used in Protectors

Currently, there is a wide range of materials for motorcyclists available on the market that have a significant ability to absorb impact energy. Understanding the aging processes of materials is crucial for guaranteeing the long-term durability and safety of a new product. For this reason, the effect of accelerated aging on the mechanical and structural properties of the multifunctional materials used in commercial protectors was analyzed. The accelerated aging considered in this study simulated 3 years of use under real conditions. Then, DMTA and FT-IR research, as well as impact tests, were carried out on the commercially available protectors for motorcyclists, before and after the accelerated aging processes. Structural analysis using FT-IR showed no significant changes in the structure of the polymers used for producing the protectors. The DMA test results are consistent with those obtained from the impact study. Both methods showed that the samples maintain their protective properties, after accelerated aging. All of the examined protectors show that an increase in force is transferred through the sample, after the accelerated aging processes, but they still provide protection, according to the ISO standard.

Does a full-face helmet effectively protect against facial injuries?

Background

The effectiveness of helmet use in preventing or reducing the severity of head injuries has been largely demonstrated. However, the effectiveness of different types of helmets in reducing facial or non-facial head injuries has received much less attention.

Methods

A postal survey on motorized two-wheeler crashes was conducted in 2016. 7148 riders of motorized two-wheelers (MTW) injured in a crash between 2010 and 2014 and identified in the Rhône Trauma Registry were invited to complete a questionnaire in order to collect detailed information about their accidents. The analysis was based on a population of 405 helmeted riders who declared having received an impact on the head. Facial and non-facial head injury risks were estimated according to helmet type (full face or other) by logistic regression, controlled for type of object hit by the head (and gender for risk of non-facial head injury), and weighted to take nonresponse into account.

Results

Three-quarter of helmeted MTW drivers were wearing a full-face helmet at the time of the accident. Victims wearing a full-face helmet were about three times less likely to have sustained injury to the face, compared to victims wearing another type of helmet (adjusted OR = 0.31; 95% CI: 0.11-0.83). On the other hand, the presence of non-facial head injury did not vary significantly according to whether a full-face or other helmet was worn (adjusted OR = 0.84; 95% CI: 0.33-2.13).

Conclusions

Our study suggests that full-face helmets provide better facial protection for MTW users compared to other types of helmets, whereas there is no evidence of any difference in protection afforded the skull or the brain.

Effectiveness of protective clothing for motorized 2-wheeler riders

OBJECTIVE

This study assesses the effectiveness of protective clothing (motorcycle jacket, trousers, gloves, knee-high or ankle boots, back protection) for motorized 2-wheeler (MTW) riders.

METHODS

This retrospective observational study used injury data from the Rhône Registry of Road Accident Victims, plus a postal survey conducted in 2016. Seven thousand one hundred forty-eight MTW riders involved in accidents between 2010 and 2014 were identified from the Registry and were invited to complete a questionnaire. Nine hundred seventy-nine individuals returned the questionnaire with relevant information; 951 with complete injury descriptions and clothing information were included in the study. The impact of protective clothing on injury risk was estimated using Poisson regression, with weighting for nonrespondents.

RESULTS

Sixty-seven percent of MTW riders sustained upper limb injuries and 47% sustained lower limb injuries. Gloves were the most frequent gear worn (76%), followed by jackets (59%) and knee-high or ankle boots (37%). Only 23% had back protection and 0.3% had an airbag. Wearing protective clothing was associated with a lower risk of soft tissue injury to upper and lower limbs: For upper limbs, the risk was lower when one of 2 items (a motorcycle jacket or gloves) was worn (relative risk [RR] = 0.36; 95% confidence interval [CI], 0.18-0.75) and was lowest when both were worn (RR = 0.28; 95% CI, 0.12-0.69); for lower limbs, risk was reduced by wearing both motorcycle trousers and boots (RR = 0.60; 95% CI, 0.40-0.91) but was not significantly reduced when only one of these items was worn (RR = 0.90; 95% CI, 0.67-1.21). This protective effect was mainly due to a reduction in abrasions/lacerations rather than contusions. However, protective clothing did not reduce the risk of fracture, dislocation, or sprain, except for knee-high or ankle boots, which were associated with lower risk of ankle or foot fracture (RR = 0.43; 95% CI, 0.24-0.75). No effect of back protectors was shown.

CONCLUSIONS

This study confirms the potential for motorcycle clothing to protect users from injury, in particular abrasions and lacerations. However, it did not show any significant protective effect against more serious injuries, such as fracture, dislocation, or sprain, except for knee-high or ankle boots, which reduced foot and ankle fracture risk. Our results argue for more widespread use of protective clothing by MTW users.

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

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

Near-miss crashes and other predictors of motorcycle crashes: Findings from a population-based survey

OBJECTIVE

Crash and injury surveillance studies have identified a range of rider-related factors, including age, sex, licensure, training and experience, as being associated with motorcycle crash risk. The aim of this study was to establish whether these previously identified factors were associated with crash involvement in an Australian-based population.

METHODS

Data obtained from motorcyclists recruited from road authority licensing offices in a population-based survey design were analyzed. In addition to descriptive analysis, survey logistic regression was used to examine predictors of self-reported motorcycle crashes. A statewide population prevalence study of motorcyclists in New South Wales, Australia, was conducted using a multistage stratified random sampling plan. Participants (n = 503) represented 47% of eligible riders invited to participate. The distribution of responses was weighted to represent the population based on motorcycle registrations as a proxy for active motorcyclists, adjusted for age, sex, and variations in sample size and population density between survey sites.

RESULTS

This analysis investigated factors associated with having crashed in the past 12 months. The key predictors of increased crash risk included frequent near-crash experiences (6-10) in the past year (adjusted odds ratio [OR_adj] = 5.3; 95% confidence interval [CI], 1.3-21.8), having 4 or more riding demerit points (OR_adj = 4.1; 95% CI, 1.1-14.7), and motorcycle type and riding purpose. Sports (OR_adj = 2.8; 95% CI, 1.1-7.3) and commuter motorcycles (OR_adj = 4.0; 95% CI, 1.1-15.3) were associated with higher odds of crashes compared to cruiser/touring motorcycles. Those whose purpose for riding frequently involved commuting, high-speed roads, or motorcycle sports had higher odds of being involved in a crash compared to riders who rarely took part in such activities. Rider age, license type, and time holding a motorcycle license were not predictive of crash involvement when other factors were taken into account.

CONCLUSIONS

These findings provide important population-level information and insights about risk exposure for motorcyclists. Taking a more tailored approach to data collection meant that factors associated with crash involvement were identified that are not commonly observed in studies relying on administrative data. In particular, the study highlights the importance of near-crash experiences as warnings to riders and the need to use such experiences as learning opportunities to improve their riding style and safety.

Lives saved by laws and regulations that resulted from the Bloomberg road safety program

OBJECTIVE

To estimate lives saved during 2008-2023 by traffic safety laws passed in six developing countries while participating in the Bloomberg Road Safety Program (BRSP).

METHODS

BRSP-funded local staff identified relevant laws and described enforcement to the study team. We analyzed road crash death estimates for 2004-2013 from the Global Burden of Disease and projected estimates absent intervention forward to 2023. We amalgamated developing country and US literature to estimate crash death reductions by country resulting from laws governing drink driving, motorcycle helmets, safety belt use, and traffic fines.

RESULTS

BRSP helped win approval of traffic safety laws in Brazil, China, Kenya, Mexico, Turkey, and Vietnam. In 2008-2013, those laws saved an estimated 19,000 lives. Many laws only took effect in 2014. The laws will save an estimated 90,000 lives in 2014-2023. Of the 109,000 lives saved, drink driving laws will account for 84%, increased motorcyclist protection for 13%, increased fines and penalty points for 2%, and safety belt usage mandates for 1%. Drink driving reductions in China will account for 56% of the savings and reduced drink driving and motorcycling deaths in Vietnam for 35%. The savings in China will result from a narrow intervention with just 4% estimated effectiveness against drink driving deaths. As a percentage of deaths anticipated without BRSP effort, the largest reductions will be 11% in Vietnam and 5% in Kenya.

CONCLUSIONS

Viewed as a public health measure, improving traffic safety provided large health gains in developing nations.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

PRACTICAL IMPLICATIONS

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

Dependences of Rheological and Compression Mechanical Properties on Cellular Structures for Impact-Protective Materials

In this study, three typical impact-protective materials, D3O, PORON XRD, and DEFLEXION were chosen to explore the dependences of rheological and compression mechanical properties on the internal cellular structures with polymer matrix characteristics, which were examined using Fourier transform infrared spectroscopy, thermogravimetric analyses, and scanning electron microscopy with energy dispersive spectroscopy. The rheological property of these three foaming materials were examined using a rheometer, and the mechanical property in a compression mode was further examined using an Instron universal tensile testing machine. The dependences of rheological parameters, such as dynamic moduli, normalized moduli, and loss tangent, on angular frequency, and the dependences of mechanical properties in compression, such as the degree of strain-hardening, hysteresis, and elastic recovery, on the strain rate for D3O, PORON XRD, and DEFLEXION can be well-correlated with their internal cellular structural parameters, revealing, for example, that D3O and PORON XRD exhibit simultaneously high strength and great energy loss in a high-frequency impact, making them suitable for use as soft, close-fitting materials; however, DEFLEXION dissipates much energy whether it suffers a large strain rate or not, making it suitable for use as a high-risk impact-protective material. The rheometry and compression tests used in this study can provide the basic references for selecting and characterizing certain impact-protective materials for applications.

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.

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.

Children and motorcycles: a systematic review of risk factors and interventions

Objective

To (i) identify person, vehicle and environmental risk factors for injury among children using motorcycles, and (ii) identify and appraise studies of interventions designed to reduce the occurrence or severity of injury among children using these vehicles.

Method

A systematic approach was used to collate data from published and grey literature globally on risk factors for motorcycles injury, and studies reporting evaluation of interventions to counter this injury. Academic data sets and public search engines (including Google and Yahoo!) were used. Websites of major conferences, organisations and networks were also searched. Finally, researchers and units working in this area were also contacted by email or phone seeking relevant research. All study types were eligible, excluding clinical case studies. The Haddon Matrix was used as a framework for synthesising the data.

Results

The review revealed that robust investigations of risk factors for injury among children using motorcycles are relatively scarce, and there are few interventional studies reporting effectiveness of countermeasures to this problem. Epidemiological literature is generally limited to discussion of human factors, and less attention has been given to vehicle and environmental factors. Furthermore, much of the literature is commentaries and descriptive studies. There has been little rigorous study of risk factors unique to children riding motorcycles.

Conclusions

This first attempt at extensively reviewing literature related to risk factors and interventions for children and motorcycles using the Haddon Matrix as a framework clearly highlights need for more rigorous study as information is lacking in all cells of this matrix.

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.

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.

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.

Motorcycle fuel tanks and pelvic fractures: A motorcycle fuel tank syndrome

OBJECTIVE

Pelvic injuries are a serious and commonly occurring injury to motorcycle riders involved in crashes, yet there has been limited research investigating the mechanisms involved in these injuries. This study aimed to investigate the mechanisms involved in pelvic injuries to crashed motorcyclists.

METHOD

This study involved in-depth crash investigation and 2 convenience-based data sets were used. These data sets investigated motorcycle crashes in the Sydney, Newcastle, and Adelaide regions. Participants included motorcycle riders who had crashed either on a public road or private property within the study areas. The mechanism of injury and the type of injuries were investigated.

RESULTS

The most frequent cause of pelvic injuries in crashed motorcyclists was due to contact with the motorcycle fuel tank during the crash (85%). For riders who had come into contact with the fuel tank, the injury types were able to be grouped into 3 categories based on the complexity of the injury. The complexity of the injury appeared to increase with impact speed but this was a nonsignificant trend. The pelvic injuries that did not occur from contact with the fuel tank in this sample differed in asymmetry of loading and did not commonly involve injury to the bladder. They were commonly one-sided injuries but this differed based on the point of loading; however, a larger sample of these injuries needs to be investigated.

CONCLUSION

Overall improvements in road safety have not been replicated in the amelioration of pelvic injuries in motorcyclists and improvements in the design of crashworthy motorcycle fuel tanks appear to be required.

Does the improved stability offered by motorcycle antilock brakes (ABS) make sliding crashes less common? In-depth analysis of fatal crashes involving motorcycles fitted with ABS

OBJECTIVE

This research investigated the following issue. Though several tests indicate that motorcycle ABS may increase motorcycle stability, thus reducing the risk of a sliding crash involving braking (i.e., the rider is separated from the motorcycle and slides along the road surface prior to collision), there is limited research showing to what extent sliding crashes are reduced by ABS in real-life conditions.

METHODS

The Swedish Transport Administration (STA) and the Norwegian Public Roads Administration (NPRA) carry out in-depth studies for all road fatalities. A total of 38 in-depth studies with ABS motorcycles were included: 22 in Sweden and 16 in Norway (2005-2014). These were compared with 98 cases in Sweden and 32 in Norway involving motorcycles of the same types but without ABS. The data sets were analyzed separately and also merged together. The difference between the proportions of sliding crashes regardless braking was analyzed; selective recruitment was handled with a sensitivity analysis. Induced exposure was used to calculate the reduction of all crashes and those involving braking.

RESULTS

Four ABS cases (11%) involved falling off the motorcycle prior to collision, and 35% of the non-ABS crashes were sliding (P =.004). The sensitivity analysis showed that the results were stable, with a relative difference of sliding crashes ranging between 65 and 78%. None of the 4 sliding crashes with ABS occurred during braking; that is, all ABS riders who braked prior to collision crashed in an upright position. In the 4 sliding cases with ABS, the riders lost control of their motorcycles: 2 while accelerating on asphalt with very poor friction, 1 while negotiating a curve with an excessive lean angle, and 1 by abruptly releasing the throttle in the middle of a curve. Although based on a limited number of cases, the distributions of sliding and upright collisions among crashes without braking were similar, thus suggesting that the crash posture would not be affected by ABS if no braking occurred. The calculations with induced exposure showed that upright crashes with braking were also reduced by ABS; all fatal crashes, regardless of braking, were reduced by 52%.

CONCLUSIONS

Though this research was based on a limited material, it confirmed that sliding fatal crashes are significantly decreased by ABS. Considering that ABS will soon be mandatory in the European Union on all new motorcycles with engine displacement over 125cc, these findings should be taken into account in the future design and testing of motorcycle-friendly road barriers and integrated protection systems.

Elite Motorcycle Racing: Crash Types and Injury Patterns in the MotoGP Class

BACKGROUND

Crashes are a small but regular feature of elite motorcycle racing. These crashes provide a novel opportunity to benchmark and analyze motorcycle crash mechanics, crash types, and associated injuries at high speeds in a cohort of riders who are well protected and in a controlled environment.

PURPOSE

The purpose was to benchmark the prevalence of injuries, categorize crash subtypes, and determine associated injury patterns.

METHODS

This was an institutional review board-approved, prospective observational cohort study of MotoGP riders for 1 racing season in 3 venues. Accident type was determined by race-marshal report and visual analysis of race footage for each crash. Accident types were defined as lowside (falling toward the inside of the turn), highside (falling over and toward the outside of the turn), and topside (going over the handlebars of the motorcycle). Specific injuries and hospital admission data were collected using a standardized data collection form. Basic descriptive statistics were performed on all categorical variables. We used the exact binomial test examine the association between accident type and retirement from race, transport to medical building, transport to hospital, and injuries sustained.

RESULTS

Crash prevalence was 9.7 per hundred rider hours. There were 78 crashes: 58 lowsides, 13 highsides, 2 topsides, and 5 indeterminate. In the lowside group (n = 58), 19 (95% confidence interval [CI], 0.21-0.46) riders retired, 0 required emergent transportation to the track facility or to the hospital, and 1 (95% CI, <0.1-0.9) significant injury was noted. In the highside group (n = 13), 10 (95% CI, 0.46-0.95) retired, 9 (95% CI, 0.39-0.91) were transported to the track medical facility, and 3 (95% CI, 0.05-0.54) were admitted to the hospital. In the highside group, there were 7 (95% CI, 0.25-0.81) significant injuries. In the topside group, both riders were retired with 1 hospital admission. Lowside crashes had a lower rate of retirement from race, emergent transport, and significant injuries compared with highside crashes.

CONCLUSIONS

Lowside crashes are lower risk than highside crashes. Most highside crashes are caused by oversteering to prevent an impending lowside crash. Strategies to reduce oversteering to prevent a lowside crash may reduce highside crashes, enhance the safety for riders in MotoGP racing, and be applicable to recreational motorcycle riding.

The Preventive Effect of Head Injury by Helmet Type in Motorcycle Crashes: A Rural Korean Single-Center Observational Study

Introduction. The goal of this study was to determine the preventive effect on head injury by helmet type: full face helmet (FFH), open face helmet (OFH), and half-coverage helmet (HCH). Methods. This is a retrospective observational study of motorcycle crash victims between June 2012 and May 2015 in a rural town in Korea. We performed multiple linear regression to predict the effect of each type of helmet compared to unhelmeted status in preventing head injury using dependent variables based on the Abbreviated Injury Scale (AIS) and applied logistic regression modeling to compare the incidence of head injury. Results. Of the 738 patients, the number of FFH patients was 33.5%, followed by unhelmeted (27.8%), OFH (17.6%), and HCH (13.0%) patients. The FFH and OFH group had a lower head maximum AIS than unhelmeted group (coefficient: -0.368, 95% CI: -0.559 to -0.177 and coefficient: -0.235, 95% CI: -0.459 to -0.010, resp.) and only FFHs experienced a reduction effect of severe and minor head injury (OR: 0.206, 95% CI: 0.080 to 0.533 and OR: 0.589, 95% CI: 0.377 to 0.920, resp.). Conclusions. FFHs and OFHs reduce the risk of head injury, and FFHs have a more preventive effect on head injury in motorcycle crashes.

Thermal and cardiovascular strain imposed by motorcycle protective clothing under Australian summer conditions

Motorcycle protective clothing can be uncomfortably hot during summer, and this experiment was designed to evaluate the physiological significance of that burden. Twelve males participated in four, 90-min trials (cycling 30 W) across three environments (25, 30, 35 °C [all 40% relative humidity]). Clothing was modified between full and minimal injury protection. Both ensembles were tested at 25 °C, with only the more protective ensemble investigated at 30 and 35 °C. At 35 °C, auditory canal temperature rose at 0.02 °C min(-1) (SD 0.005), deviating from all other trials (p < 0.05). The thresholds for moderate (>38.5 °C) and profound hyperthermia (>40.0 °C) were predicted to occur within 105 min (SD 20.6) and 180 min (SD 33.0), respectively. Profound hyperthermia might eventuate in ~10 h at 30 °C, but should not occur at 25 °C. These outcomes demonstrate a need to enhance the heat dissipation capabilities of motorcycle clothing designed for summer use in hot climates, but without compromising impact protection. Practitioner's Summary: Motorcycle protective clothing can be uncomfortably hot during summer. This experiment was designed to evaluate the physiological significance of this burden across climatic states. In the heat, moderate (>38.5 °C) and profound hyperthermia (>40.0 °C) were predicted to occur within 105 and 180 min, respectively.

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.

Single-vehicle and Multi-vehicle Accidents Involving Motorcycles in a Small City in China: Characteristics and Injury Patterns

Introduction

There is a gap that involves examining differences between patients in single-vehicle (SV) versus multi-vehicle (MV) accidents involving motorcycles in Shantou, China, regarding the injury patterns and mortality the patients sustained. This study aims to address this gap and provide a basis and reference for motorcycle injury prevention.

Method

Medical record data was collected between October 2002 and June 2012 on all motorcycle injury patients admitted to a hospital in the city of Shantou of the east Guangdong province in China. Comparative analysis was conducted between patients in SV accidents and patients in MV accidents regarding demographic and clinic characteristics, mortality, and injury patterns.

Results

Approximately 48% (n = 1977) of patients were involved in SV accidents and 52% (n = 2119) were involved in MV accidents. The average age was 34 years. Collision of a motorcycle with a heavy vehicle/bus (4%) was associated with a 34 times greater risk of death (RR: 34.32; 95% CI: 17.43-67.57). Compared to patients involved in MV accidents, those involved in SV accidents were more likely to sustain a skull fracture (RR: 1.47; 95% CI: 1.22-1.77), an open head wound (RR: 1.46; 95% CI: 1.23-1.74), an intracranial injury (RR: 1.39; 95% CI: 1.26-1.53), a superficial head injury (RR: 1.37; 95% CI: 1.01-1.86), an injury to an organ (RR: 2.01; 95% CI: 1.24-3.26), and a crushing injury (RR: 1.98; 95% CI: 1.06-3.70) to the thorax or abdomen. However, they were less likely to sustain a spinal fracture (RR: 0.58; 95% CI: 0.39-0.85), a pelvic fracture (RR: 0.22; 95% CI: 0.11-0.46), an upper extremity fracture (RR: 0.75; 95% CI: 0.59-0.96), or injuries to their lower extremities, except for a dislocation, sprain, or injury to a joint or ligament (RR: 0.82; 95% CI: 0.49-1.36).

Conclusion

The relative risk of death is higher for patients involved in multi-vehicle accidents than patients in single-vehicle accidents, especially when a collision involves mass vehicle(s). Injury to the head dominated motorcycle injuries. Single-vehicle accidents have a higher correlation with head injury or internal injuries to the thorax or abdomen. Multi-vehicle accidents are more correlated with extremity injuries, especially to the lower extremities or external trauma to the thorax or abdomen.

Safe system approach to reducing serious injury risk in motorcyclist collisions with fixed hazards

Collisions with fixed objects in the roadway environment account for a substantial proportion of motorcyclist fatalities. Many studies have identified individual roadway environment and/or motorcyclist characteristics that are associated with the severity of the injury outcome, including the presence of roadside barriers, helmet use, alcohol use and speeding. However, no studies have reported the cumulative benefit of such characteristics on motorcycling safety. The safe system approach recognises that the system must work as a whole to reduce the net injury risk to road users to an acceptable level, including the four system cornerstone areas of roadways, speeds, vehicles and people. The aim of the present paper is to consider these cornerstone areas concomitantly, and quantitatively assess the serious injury risk of motorcyclists in fixed object collisions using this holistic approach. A total of 1006 Australian and 15,727 (weighted) United States motorcyclist-fixed object collisions were collected retrospectively, and the serious injury risks associated with roadside barriers, helmet use, alcohol use and speeding were assessed both individually and concomitantly. The results indicate that if safety efforts are made in each of the safe system cornerstone areas, the combined effect is to substantially reduce the serious injury risk of fixed hazards to motorcyclists. The holistic approach is shown to reduce the serious injury risk considerably more than each of the safety efforts considered individually. These results promote the use of a safe system approach to motorcycling safety.

Cyclists' clothing and reduced risk of injury in crashes

INTRODUCTION

A majority of cyclists' hospital presentations involve relatively minor soft tissue injuries. This study investigated the role of clothing in reducing the risk of cyclists' injuries in crashes.

METHODS

Adult cyclists were recruited and interviewed through hospital emergency departments in the Australian Capital Territory. This paper focuses on 202 who had crashed in transport related areas. Eligible participants were interviewed and their self-reported injuries corroborated with medical records. The association between clothing worn and injury was examined using logistic regression while controlling for potential confounders of injury.

RESULTS

A high proportion of participants were wearing helmets (89%) and full cover footwear (93%). Fewer wore long sleeved tops (43%), long pants (33%), full cover gloves (14%) or conspicuity aids (34%). The primary cause of injury for the majority of participants (76%) was impact with the ground. Increased likelihood of arm injuries (Adj. OR=2.06, 95%CI: 1.02-4.18, p=0.05) and leg injuries (Adj. OR=3.37, 95%CI: 1.42-7.96, p=0.01) were associated with wearing short rather than long sleeves and pants. Open footwear was associated with increased risk of foot or ankle injuries (Adj. OR=6.21, 95%CI: 1.58-23.56, p=0.01) compared to enclosed shoes. Bare hands were associated with increased likelihood of cuts, lacerations or abrasion injuries (Adj. OR=4.62, 95%CI: 1.23-17.43, p=0.02) compared to wearing full cover gloves. There were no significant differences by fabric types such as Lycra/synthetic, natural fiber or leather.

CONCLUSIONS

Clothing that fully covers a cyclist's body substantially reduced the risk of injuries in a crash. Coverage of skin was more important than fabric type. Further work is necessary to determine if targeted campaigns can improve cyclists' clothing choices and whether impact protection can further reduce injury risk.

Validation of the principles of injury risk zones for motorcycle protective clothing

INTRODUCTION

The distributions of motorcycle crash impacts and injuries were compared to the four impact risk zones and protective performance specified in the European Standard for motorcycle clothing (EN 13595).

METHODS

Crashed motorcyclists' (n=117) injuries and clothing damage were categorized by body area into the four risk zones. Three levels of protection were defined: protective clothing with impact protection, protective clothing only and non-protective clothing.

RESULTS

The distribution of impact/injury sites corresponded to the predictions of EN 13595, with the proportion of all injuries decreasing from 43.9% in Zone 1, to 18.0%, 16.7%, and 11.5% in Zones 2 to 4, respectively. Protective clothing modified the distribution of injuries with substantially more injuries (OR=2.69, 95% CL: 20.1-3.59) at unprotected impact sites.

PRACTICAL APPLICATION

These findings support an appropriate framework for determining performance specifications for the manufacture of motorcycle clothing that will effectively reduce the risk of injury in crashes.

Distribution and type of crash damage to motorcyclists' clothing: validation of the zone approach in the European Standard for motorcycle protective clothing, EN13595

OBJECTIVE

Though the use of protective clothing reduces the risk of injury for motorcycle riders, not all protective clothing performs the same in crashes. A European Standard for motorcycle protective clothing (EN13595) was released in 2002 that specifies 4 zones in motorcycle clothing with different levels of protective qualities and 4 different test methods for assessing damage resistance. This project examined damage location and type in clothing worn by riders following a crash to establish the distribution of impact points and validate the zones described in EN13595.

METHOD

Data from 117 crashed motorcycle riders collected during crash investigation were examined. These data included medical data and clothing inspections and contained 576 cases of clothing damage. To ensure that the impact point distribution included all possible contact locations, an additional 433 distinct injury locations were examined where injury had occurred but clothing was either undamaged or not present at that location. Descriptive techniques were used in the analysis.

RESULTS

The majority of damage occurred in areas covering the extremities or pelvic girdle (93%), with most occurring on the wrists and hands (18%) and ankles and feet (18%). Clothing regions covering the shoulder (10%), forearm (10%), elbow (9%), thigh (7%), lower leg (6%), and pelvic-hip region (5%) were also frequently damaged. Other body regions contributed only 8 percent of damage seen. Analysis of distinct injury locations demonstrated a similar distribution of impact. The most common types of clothing damage were abrasion, accounting for 69 percent, and torn material, which accounted for 26 percent of all damage. Further, the majority of material abrasion and tearing occurred in regions corresponding to zone 1, followed by zones 2, 3, and then 4. There were very few instances (3%) of burst and cut damage.

CONCLUSIONS

The results are in agreement with the general concept of the zones used in the EU Standard. However, these results indicate that minor adjustments may be warranted. In particular, the number of impacts to the forearm and lower leg suggest that these regions might be better protected by considering the whole regions as zone 1or 2 rather than the multiple regions as currently indicated in the EU Standard. However, the subjective nature of determining the zone in which damage (and/or injury) occurred limits these findings and any others that attempt to validate the zone principles using real-world data. Further validation requires consideration of the severity of impact at different zones.

The rising burden of serious thoracic trauma sustained by motorcyclists in road traffic crashes

In many countries increased on-road motorcycling participation has contributed to increased motorcyclist morbidity and mortality over recent decades. Improved helmet technologies and increased helmet wearing rates have contributed to reductions in serious head injuries, to the point where in many regions thoracic injury is now the most frequently occurring serious injury. However, few advances have been made in reducing the severity of motorcyclist thoracic injury. The aim of the present study is to provide needed information regarding serious motorcyclist thoracic trauma, to assist motorcycling groups, road safety advocates and road authorities develop and prioritise counter-measures and ultimately reduce the rising trauma burden. For this purpose, a data collection of linked police-reported and hospital data was established, and considerable attention was given to establishing a weighting procedure to estimate hospital cases not reported to police and fatal cases not admitted to hospital. The resulting data collection of an estimated 19,979 hospitalised motorcyclists is used to provide detailed information on the nature, incidence and risk factors for thoracic trauma. Over the last decade the incidence of motorcyclist serious thoracic injury has more than doubled in the population considered, and by 2011 while motorcycles comprised 3.2% of the registered vehicle fleet, one quarter of road traffic-related serious thoracic trauma cases treated in hospitals were motorcyclists. Motor-vehicle collisions, fixed object collisions and non-collision crashes were fairly evenly represented amongst these cases, while older motorcyclists were over-represented. Several prevention strategies are identified and discussed.

Bicycle crashes in different riding environments in the Australian capital territory

INTRODUCTION

Cyclists are increasingly overrepresented in traffic crash casualties in Australia. There is evidence that better cycling infrastructure increases participation, but whether it reduces the numbers of injured cyclists is less clear. This study examined injury outcomes of crashes in different cycling environments.

METHODS

Adult cyclists injured on- and off-road were recruited from emergency departments from November 2009 to May 2010 in the Australian Capital Territory. Eligible participants (n = 313/372, 84.1%) were interviewed and their injury self-reports were corroborated with medical records where available. Participants who had crashed in transport-related areas (n = 202, 64.5%) are the focus of this article.

RESULTS

Participants had crashed in traffic (39.1%), in cycle lanes (7.9%), on shared paths (36.1%), and on footpaths (16.8%). Based on average weekly traffic counts, the crash involvement rate per 1000 cyclists was 11.8 on shared paths compared to 5.8 on cycle lanes. Over half of the participants (52.0%) were injured in single-vehicle bicycle crashes. The remainder involved other road users, including motor vehicles (20.8%), other bicycles (18.8%), pedestrians (6.4%), and animals (2.0%). Pedestrians were involved in 16.4 percent of crashes on shared paths. Minor injuries (Abbreviated Injury Scale [AIS] 1) were sustained by 58.4 percent of cyclists, moderately severe injuries (AIS 2) were sustained by 36.1 percent of cyclists, and 5.4 percent of cyclists were seriously injured (AIS 3+). The average treatment required was 1.8 days with 7.5 days off work and cost to the cyclist of $869 excluding medical treatment. Cyclists who crashed on shared paths or in traffic had higher injury severity scores (ISS; 4.4, 4.0) compared to those in cycle lanes or on footpaths (3.3, 3.4) and required more treatment days (2.8, 1.7 versus 0.0, 0.2).

CONCLUSIONS

Fewer cyclists were injured in on-road cycle lanes than in other cycling environments, and a high proportion of injuries were incurred on shared paths. This study highlights an urgent need to determine appropriate criteria and management strategies for paths classified as suitable for shared or segregated usage. Supplemental materials are available for this article. Go to the publisher's online edition of Traffic Injury Prevention to view the supplemental files.

Roles of motorcycle type and protective clothing in motorcycle crash injuries

Background. The aims of this study were to identify subgroups of motorcyclists with a higher accident risk and evaluate the efficiency of protective clothing for preventing injuries. Methods. A 1-year prospective study of motorcycle crashes was conducted beginning in June 2012. Participants were patients involved in motorcycle crashes and admitted to our emergency department. Results. A total of 226 patients were included in the study. In total, 174 patients were involved in crashes with light motorcycles. Patients involved in a motorcycle accident without a helmet had a higher incidence of head and maxillofacial trauma. Motorcycle jackets were not protective for systemic injuries (P > 0.05) or upper extremity fractures (P > 0.05). Motorcycle pants (P > 0.05) and motorcycle shoes (P > 0.05) were not protective against leg and foot fractures. However, motorcycle protective clothes were protective against soft-tissue injuries (P = 0.001). Conclusion. Riders of heavy motorcycles rode more safely than riders of light motorcycles. Light motorcycle riders were the most vulnerable and comprised the largest percentage of motorcyclists. Helmets may be effective for preventing head and facial injuries. Other protective clothes were not effective against fractures or systemic injuries.

A mixed logit analysis of two-vehicle crash severities involving a motorcycle

Using motorcycle crash data for Iowa from 2001 to 2008, this paper estimates a mixed logit model to investigate the factors that affect crash severity outcomes in a collision between a motorcycle and another vehicle. These include crash-specific factors (such as manner of collision, motorcycle rider and non-motorcycle driver and vehicle actions), roadway and environmental conditions, location and time, motorcycle rider and non-motorcycle driver and vehicle attributes. The methodological approach allows the parameters to vary across observations as opposed to a single parameter representing all observations. Our results showed non-uniform effects of rear-end collisions on minor injury crashes, as well as of the roadway speed limit greater or equal to 55mph, the type of area (urban), the riding season (summer) and motorcyclist's gender on low severity crashes. We also found significant effects of the roadway surface condition, clear vision (not obscured by moving vehicles, trees, buildings, or other), light conditions, speed limit, and helmet use on severe injury outcomes.

Determinants of personal protective equipment (PPE) use in UK motorcyclists: exploratory research applying an extended theory of planned behaviour

Despite evident protective value of motorcycle personal protective equipment (PPE), no research has assessed considerations behind its uptake in UK riders. A cross-sectional online questionnaire design was employed, with riders (n=268) recruited from online motorcycle forums. Principal component analysis found four PPE behavioural outcomes. Theoretical factors of intentions, attitudes, injunctive and descriptive subjective norms, risk perceptions, anticipated regret, benefits and habit were also identified for further analysis. High motorcycle jacket, trousers and boots wear, middling high-visibility wear and low non-Personal Protective Equipment wear were found. Greater intentions, anticipated regret and perceived benefits were significantly associated with increased motorcycle jacket, trousers and boots wear, with habit presence and scooter use significantly associated with increased high-visibility wear. Lower intentions, anticipated regret and risk perceptions, being female, not holding a car licence and urban riding were significantly associated with increased non-PPE wear. A need for freedom of choice and mixed attitudes towards PPE use were evident in additional comments. PPE determinants in this sample provide a preliminary basis for future uptake interventions. Larger scale and qualitative research is needed to further investigate relevant constructs.

Effectiveness of motorcycle protective clothing: riders' health outcomes in the six months following a crash

BACKGROUND

Little is known about the contribution of protective clothing worn in motorcycle crashes to subsequent health-related outcomes, impairment and quality of life.

METHODS

A prospective cohort of 212 adult motorcyclists were recruited following presentations to hospitals or crash repair services in a defined geographic area in Australia between June 2008 and July 2009. Data was obtained from participant interviews and medical records at baseline, then by mailed survey two and six months post-crash (n=146, 69%). The exposure factor was usage of protective clothing classified as full protection (motorcycle jacket and pants), partial protection (motorcycle jacket) and unprotected (neither). Outcomes of interest included general health status (Short Form SF-36), disability (Health Assessment Questionnaire) treatment and recovery progress, quality of life and return to work in the six months post-crash. Odds ratios (OR) were estimated for categorical outcomes using multiple logistic regression to assess differences in outcomes associated with levels of protection adjusted for potential confounders including age, sex, occupation, speed and type of impact. Non-parametric procedures were used for data that was not normally distributed.

RESULTS

Compared to unprotected riders, both fully and partially protected riders had fewer days in hospital and reported less pain immediately post-crash; at two months both protection groups were less likely to have disabilities or reductions in physical function. By six months there were no significant differences in disability or physical function between groups, but both protection groups were more likely to be fully recovered and returned to pre-crash work than unprotected riders. Fully protected riders achieved better outcomes than either partially or unprotected riders on most measures. There were few significant differences between the full and partial protection groups although the latter showed greater impairment in physical health two months post-crash.

CONCLUSIONS

We found strong associations between use of protective clothing and mitigation of the consequences of injury in terms of post-crash health and well-being. Given this evidence it seems likely that the use of protective clothing will confer significant benefits to riders in the event of a crash.