Injuries in the vulnerable road user fatalities; a study from Sri Lanka

Distinguishing injury patterns in fatal falls from heights versus pedestrian impacts: an autopsy study for differential diagnosis in ambiguous cases

This study investigated the injury patterns associated with fatal falls from heights compared to individuals struck by cars, aiming to enhance the differential diagnosis in ambiguous cases, where it is unclear whether the body fell from nearby building or was left on the street following a road traffic incident. A retrospective review of comprehensive forensic reports from the Institute of Legal Medicine of the University of Rome "Tor Vergata" between 2012 and 2023 was conducted. The analysis included 232 cases, gathering data on internal organ injuries, skeletal fractures, external skin injuries, as well as pleural, peritoneal, and pericardial effusions. Bilateral lung injuries were significantly more common in falls from height (33.3%) compared to pedestrians (13.6%, p < 0.001). Liver injuries also occurred more frequently in fall victims (49.6%) than in pedestrians (28.2%, p < 0.001). Skull fractures were more frequent in falls from height (68.2%) versus individuals struck by cars (55.3%, p = 0.044), while unilateral leg fractures were more common in pedestrians (28.2%) compared to fall victims (16.3%, p = 0.029). External injuries, notably to the head and legs, were more frequent in pedestrians. The "Total Injured Skin Area" analysis revealed a significant discriminative power with an optimal cut-off of 84.2 cm², suggesting that injuries exceeding this threshold may be indicative of a pedestrian road fatality.

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.

Bicycle injuries: A systematic review for forensic evaluation

Bicycles are employed as means of transportation across various age groups, from young students to the elderly, for work, education, health, and leisure trips. Despite not achieving high speeds, bicyclists remain vulnerable to severe and even fatal injuries when they are involved in traffic accidents. Although the rising awareness of ecological issues and traffic law enforcement mean that cyclists are increasingly susceptible to road traffic crashes and injuries. Injuries resulting from a traffic accident involving cyclists can show distinct and specific characteristics depending on the manner of occurrence. The aim of this study is to provide a systematic review of the literature on injuries sustained in cyclists involved in road accidents describing and analysing elements useful for forensic assessment. The literature search was performed using PubMed, Scopus, and Web of Science from January 1970 to March 2023. Eligible studies have investigated issues of interest to forensic medicine about traffic accidents involving bicycles. A total of 128 studies satisfied the inclusion criteria and were categorized and analyzed according to the anatomical regions of the body affected (head, neck, thoraco-abdominal, and limb injuries), and the assessment of lesions in reconstruction of the bicycle accident was examined and discussed. This review highlights that injuries resulting from a traffic accident involving cyclists can show distinct and specific characteristics depending on the manner of occurrence and the energy levels involved in the crash. The assessment of injuries offers valuable insights that integrated with circumstantial and engineering data perform the reconstruction of accident dynamics.

Distracted Driving Behavior Among Adults in the Perambalur District: A Cross-Sectional Study

Background Distracted driving is a major public health concern. Distraction results in reduced speed control, lateral lane position, reduced situational awareness, and impaired response times to roadway hazards. Visual, cognitive, and manual distractions impair drivers in different ways. With the above background, this study was conducted with the objective of estimating the proportion of distracted driving behavior and its predictors among the adult population in the Perambalur district, Tamil Nadu, India, by using the Total Distracted Driving Scale. Materials and methods A cross-sectional study was conducted among 403 adults aged 18 years and above by convenience sampling technique in the Perambalur district for six months. A pretested, semi-structured proforma was used to collect data on socio-demographic characteristics such as age, sex, education, and occupation. To quantify distracted driving behavior, the Total Distracted Driving Scale was used. This scale contains seven questions about talking on the phone, five questions about texting, and five questions about using specific devices while driving. Data were entered into Microsoft Excel and analyzed using the Statistical Package for the Social Sciences (SPSS) Version 21. Descriptive statistics were used to describe the distracted driving behavior with respect to each variable, and to find out the significance, a corresponding statistical test was employed. A p-value of less than 0.05 was considered statistically significant. Results The mean age of the study participants was 24.86 ± 10.63 years. More than half of the study subjects (52.4 percent) were females, and around 87.3 percent of them were Hindu by religion. Among the study participants, around 66.74 percent mentioned that they had used a cell phone while driving. Around 38 percent of the study participants admitted that they had been in or were near-crash circumstances during the past year. Around 87 percent of the study participants who had a crash or near-crash in the past year admitted that they had been distracted while driving. On primary analysis, religion of individuals and increased driving frequency had a statistically significant association with a history of distracted driving. Study participants who were using three- and four-wheelers and those who used cellphones while driving had a statistically significant association with a history of distracted driving. According to the regression, cell phone users are 3.915 times more distracted than those who do not use cellphones (p = 0.001). Subjects with a history of crashes or near-crashes were 56.96 times more distracted than those without a history (p < 0.001). Conclusion In the present study, three-fourths of the study population used a cell phone while driving. More than three-fourths of the study participants admitted that they had been in a crash or near-crash circumstances during the past year. Distracted driving was responsible for four-fifths of all crashes or near-collisions. Use of a cell phone while driving and a history of near-crashes have a higher risk of distraction than those who do not.

Cost-Effectiveness of Lay First Responders Addressing Road Traffic Injury in Sub-Saharan Africa

BACKGROUND

To investigate the cost-effectiveness of training lay first responders (LFRs) to address road traffic injury (RTI) in sub-Saharan Africa (SSA) as the first step toward formal emergency medical services (EMS) development.

MATERIALS/METHODS

Cost data from five LFR programs launched between 2008 and 2019 in SSA was collected for LFR cost estimation, including three prospective collections from our group. We systematically reviewed literature and projected aggregate disability-adjusted life years (DALYs) from RTI in SSA that are addressable by LFRs to inform cost-effectiveness ratios ($USD cost per DALY averted). Cost-effectiveness ratios were then compared against African per capita gross domestic product (GDP) to determine the cost-effectiveness of LFRs addressing RTIs in SSA, following WHO-CHOICE guidelines, which state cost-effectiveness ratios less than GDP per capita are considered "very cost-effective."

RESULTS

Average annual cost per LFR trained across five programs was calculated to be 16.32USD (training=4.04USD, supplies=12.28USD). Following WHO and Disease Control Priorities recommendations for adequate emergency catchment, initial training of 750 LFRs per 100,000 people would cost 12,239.47USD with projected total annual DALYs averted equal to 227.7 per 100,000. Cost per DALY averted would therefore be 53.75USD with appropriate LFR availability, less than sub-Saharan African GDP per capita (1,585.40USD) and the lowest sub-Saharan African GDP per capita (Burundi, 261.20USD).

CONCLUSION

Following WHO-CHOICE guidelines, training LFRs can be a highly cost-effective means to address RTI morbidity and mortality across sub-Saharan Africa. With EMS unavailable for 91.3% of the African population, training LFRs can be an affordable first step toward formal EMS development.

Epidemiology and patterns of road traffic fatalities in India pre- and post-motor vehicle (Amendment) act 2019: An autopsy-based study

Background

Road traffic accidents (RTAs) are a preventable cause of death. The government of India enacted the motor vehicle amendment (MVA) act on September 01, 2019, to curtail the alarming trend of RTAs and their associated fatality. The study objective was to compare the epidemiology and pattern of fatal RTAs before and after the MVA Act 2019 of India.

Methods

An autopsy-based cross-sectional study was conducted at the Department of Forensic Medicine and Toxicology (FMT) of a tertiary-care hospital from March 2019 to February 2020. The sample comprised 75 fatal RTA victims who underwent postmortem at FMT. Patients were studied in two groups: One pre-MVA group (n = 47) and one Post-MVA group (n = 28). The data were obtained from medical records and inquest reports with autopsy correlation. Data pertaining to sociodemographic profile, mechanism, injury profile including injury-severity-score (ISS) and survival-time was recorded.

Results

There was a 40.4% decline in mortality among RTA victims (P = 0.057) in the post-MVA group. The case fatality rate also declined during post-MVA implementation months compared to pre-MVA months (1.61 vs. 1.96). A significant correlation was noted between the ISS and survival-time of victims (P < 0.001, r = -0.522). The mean age of patients was 39.87 ± 17.44 years. Heavy motor vehicles along with motorized two-wheeler were the most common offending-vehicle. The median ISS of all victims was 41 (33-57). Head injury was the most common cause of death (60%).

Conclusion

Study results signal-toward early triumph of the new MVA act, probably due to enhanced adherence to safety gears and constructive behavioral change.

Evaluating the combined effect of alcohol-involved and un-helmeted riding on motorcyclist fatalities in Taiwan

BACKGROUND

Alcohol-involved riders tend to engage in other risk-taking behaviours such as un-helmeted riding which could further increases injury severity. The combined effect of alcohol-involved and un-helmeted riding on fatal injuries is rarely investigated. This study investigated the interaction effect between blood alcohol concentration and helmet use on fatal injuries.

METHODS

This study used the National Taiwan Traffic Crash Dataset for the period from 2011 to 2015. Data on road crashes involving a motorcycle and an automobile were extracted and analysed. Multiple logistic regression models were used to calculate the adjusted odds ratio (AOR). We calculated an interaction effect for blood alcohol concentration and helmet use based on STROBE guidelines.

RESULTS

There were a total of 669,292 motorcyclist casualties; among these casualties, 3459 (0.5 %) motorcyclists sustained fatal injuries. Alcohol-involved riders were 9.47 times (AOR = 9.47; 95 % CI = 8.75-10.25) more likely than sober ones to sustain fatal injuries. Alcohol-involved and un-helmeted riders were approximately 18 times (AOR = 18.1; CI: 15.9-20.4) more likely to sustain fatal injuries than sober and helmeted riders. Riders involved in head-on crashes and approach-turn motorcycle crashes had an increased probability of sustaining fatal injuries by 240 % (AOR = 3.4; 95 % CI = 2.91-4.09) and 132 % (AOR = 2.3; 95 % CI = 2.016-2.67), respectively.

CONCLUSIONS

This study found that alcohol-involved riding acts synergistically with un-helmeted riding to increase motorcyclist injury severity.

Hospital-Based Case Series Analysis of Road Traffic Trauma Patients in Sri Lanka

Road traffic accidents claim many lives each year worldwide and cause significant disability among survivors. Resulting socioeconomic burden is severe in low- and middle-income countries. Global emphasis currently focuses on trauma education and prevention in addition to improving post-injury care. Sri Lankan government recently made compulsory legislation to improve the safety standards of imported motor vehicles. Such regulations would not directly protect vulnerable road users (VRUs) who form the main bulk of Sri Lankan and South Asian automobile trauma casualties. With the objective of reviewing the management outcome of automobile trauma in order to correlate the potential impact of new legislation on injury prevention, data of all admitted road traffic injury victims were audited for 2 months. Out of 473 eligible cases (332 (70.2%)—males; mean age 37.2 years), there were 14 (3%) fatalities. Of 459 (97%) survivors, 77 (16%) suffered major injuries. Twelve out of 14 (85.7%) fatalities, 64 of 77 (83.1%) survivors with major injuries and 263 of 382 (68.8%) cases of lesser injuries were VRUs (p value = 0.02: chi-square). VRUs had a significantly higher mean Injury Severity Score (ISS) of 10.96 ± 8.43 SD than non-VRUs who had a mean ISS of 8.14 ± 6.04 SD (p = 0.003: t test). Among all survivors, 33/39 (84.6%) with permanent disability, 95/110 (86.4%) with temporary disability and 199/310 (64.2%) with no residual disability were VRUs (p value < 0.0001: chi-square). Of 222 drivers/riders, 45 (20.3%) had consumed alcohol prior to the incident and 20 (9%) were driving without a valid licence. Thirty-four out of 162 (21%) motor bike travellers were not wearing a protecting helmet. Results denote that VRUs suffer significant majority of the fatalities and major injuries after road traffic trauma and to have higher residual temporary/permanent disability among survivors. Recent compulsory motor vehicle safety measures are unlikely to directly protect majority of automobile trauma victims in Sri Lanka. To obtain a higher impact on road traffic injury prevention, main emphasis has to be given to improve the safety standards of VRUs in developing countries.

Geoclinical analyses for areas at high risk for motorcycle-related road traffic injury in a district in Malaysia

Objective:

The goal of this prospective cross-sectional study was particularly to collect data on the epidemiology, the pattern of injury among motorcyclists and to relate with spatial data in a local district.

Methods:

It involved data collection from prehospital care and inhospital care record. In addition, it utilized geospatial ARCGIS® version 10.1 software in the identification of hotspot location of road traffic injury. Written informed consent was obtained from patient(s) or relatives for their anonymized information to be published in any article.

Results:

A total of 439 cases were recruited over 10 months. The mean age (standard deviation) of the motorvehicle crash victims was 26.04 (15.26) years. Male comprised 302 (73.3%) of the cases. A total of 176 (42.7%) of the victims were between the ages of 20–40 years. A total of 176 (42.7%) of the motorcyclists admitted were wearing the safety helmets either from the history taking or from the witness. A total of 117 (28.4%) and 28 (6.8%) of the victims were admitted to the general wards and critical care units, respectively for further management. The mean (standard deviation) length of hospital stays was 7.19 (6.94) days. Based on hotspot mapping using ARCGIS 10.1, most of the motorvehicle crash cases occurred mainly within the specific borough. This finding concurred with the locations of the state roads involved that traversed mainly within the same borough. Further geospatial and temporal analysis showed that most of the motorvehicle crash that occurred during the weekend were located within the suburban areas.

Conclusion:

Motorcyclists, being male and young age are the vulnerable group of road users commonly injured on our road. The initial geospatial analysis of injury-related motorvehicle crash cases has shown common hotspot trending along certain roads and borough within the district. This new knowledge can be used in the future for preventive and road safety programs in high-risk areas.

An Investigation of Dynamic Responses and Head Injuries of Standing Subway Passengers during Collisions

With the development of the subway and the pressing demand of environmentally friendly transportation, more and more people travel by subway. In recent decades, the issues about passenger passive safety on the train have received extensive attention. In this research, the head injury of a standing passenger in the subway is investigated. Three MADYMO models of the different standing passenger postures, defined as baseline scenarios, are numerically set up. HIC₁₅ values of passengers with different postures are gained by systematic parametric studies. The injury numerical simulation results of various scenarios with different friction coefficients, collision acceleration, standing angle, horizontal handrail height, and ring handrail height are analyzed. Results show that the horizontal handrail provides better protection in the three different standing passenger postures. Different friction coefficients and the standing angle have great impact on the head injuries of passengers in three different scenarios. The handrail height also has some effects on head injury of passengers with different standing postures, so it is necessary to be considered when designing the interior layout of the subway. This study may provide guidance for the safety design of the subway and some advices for standing subway passengers.

School Area Road Safety Assessment and Improvements (SARSAI) programme reduces road traffic injuries among children in Tanzania

PURPOSE

To determine the impact of a paediatric road traffic injury (RTI) prevention programme in urban Sub-Saharan Africa.

SETTING

Dares Salaam, Republic of Tanzania.

METHODS

Household surveys were conducted in catchment areas around 18 primary schools in Dar es Salaam, Republic of Tanzania; the catchment areas were divided into control and intervention groups. Collected data included basic demographic information on all school-aged household members and whether or not they had been involved in an RTI in the previous 12 months, and, if so, what the characteristics of that RTI were. Based on these findings, a separate road safety engineering site analysis and consultation with the communities and other stakeholders, an injury-prevention programme was developed and implemented, consisting of infrastructure enhancements and a site-specific educational programme. The programme was initially implemented at the intervention schools. After 1 year, data were collected in the same manner. The control group received the same intervention after follow-up data were collected.

RESULTS

Data were collected on 12 957 school-aged children in the baseline period and 13 555 school-aged children in the post-intervention period, in both the control and intervention communities. There was a statistically significant reduction in RTIs in the intervention group and a non-significant increase in RTI in the control group. The greatest reduction was in motorcycle-pedestrian RTI, private vehicle-pedestrian RTI and morning RTI.

CONCLUSION

The programme demonstrated a significant reduction in paediatric RTI after its implementation, in very specific ways. This study demonstrates that for a reasonable investment, scientifically driven injury-prevention programmes are feasible in resource-limited settings with high paediatric RTI rates.

Injury factors associated with discharge status from emergency room at two major trauma hospitals in The Gambia, Africa

INTRODUCTION

Injuries are the leading cause of disability across all ages and gender. In this study, we identified predictors of discharge status and disability at discharge among patients who seek emergency room treatment.

MATERIALS AND METHODS

The study was conducted in two major trauma hospitals in urban Gambia. 1905 patients participated in the study. 74.9% were males, and 25.1% were females. The study includes injured patients from all mechanisms. However, patients' records without age, gender, injury mechanism, and deposition from the emergency room were considered incomplete and excluded. We examined distributions of injury by age, gender, mechanism, place of occurrence, intent, primary body part injured, and primary nature of injury. We identified demographic and injury characteristics associated with hospital admission (compared to emergency department discharge) and discharge disability (any level of disability compared with none).

RESULTS

The leading mechanisms of injury were road traffic (26.1%), struck by objects (22.1%), cut/pierce (19.2%), falls (19.2%), and burns (5.4%). Injuries most commonly occurred in the home (36.7%) and on the road (33.2%). For those aged 19-44, the proportion of injuries due to assault was higher for females (35.9%) than males (29.7%). Males had increased odds for admission (aOR=1.48 95% CI=1.15-1.91) and for disability (aOR=1.45; 95% CI=1.06-1.99). Increased odds for admission were found for brain injuries, fractures, large system injuries, and musculoskeletal injuries when compared with soft tissue injuries. The highest odds for any level of discharge disability were found for brain injuries, fractures, injuries from falls, burns, and road traffic.

CONCLUSIONS

Epidemiology of injuries in The Gambia is similar to other low-income countries. However, the magnitude of cases and issues uncovered highlights the need for a formal registry.

The epidemiology and hotspots of road traffic injuries in Moshi, Tanzania: An observational study

Road traffic injuries (RTIs) continue to increase with the proliferation of motor vehicles, especially in low-income countries where safe road infrastructure is lacking. Knowing where and why RTIs occur would allow for increased safety and prevention planning. In this study, police records of 300 motor vehicle collisions which occurred between February 2013 and January 2014 in Moshi, Tanzania were reviewed. Analysis of variables including victim age, gender, type of collision, conditions, and use of safety equipment were analyzed. Geographic information system (GIS) analysis was performed to identify areas with the most collisions. Most injuries occurred at four intersections on two main corridor. Car crashes represented 48% of reports while motorcycle collisions were 35% of reports. Victims were predominantly male. The majority (64%) of RTI victims in cars used seatbelts while only 43% of motorcyclists wore helmets; none of those who used the helmet or seatbelt suffered a grievous injury. These data demonstrate that RTIs in Moshi occur in predictable high traffic locations. RTIs injure victims of all backgrounds and safety equipment is not universally utilized. More investment is needed in improved data collection methods, and a greater emphasis on intersection safety is needed to reduce these preventable injuries.

Road traffic injuries among children and adolescents in Singapore - Who is at greatest risk?

INTRODUCTION

Pediatric road traffic injuries remain a significant cause of death and disability in many countries in Asia, despite the implementation of road traffic safety laws. We aim to describe the injuries, the use of restraints among road users, and risk factors associated with severe injuries for children in Singapore.

METHODS

We performed a retrospective chart review of road traffic injuries presenting to the only two pediatric tertiary care hospitals in Singapore, from January 2012 to April 2016. We included children <16years old presenting to the emergency departments within 24h after injury (pedestrian, bicycle, motorcycle, motor vehicle). We calculated the frequencies for specific injury mechanisms, injury severity scores (ISS), and in-hospital outcomes of severe injuries (death, urgent resuscitation and emergent surgery). We performed a multivariate logistic regression to determine risk factors associated with severe injury.

RESULTS

There were 2468 patients during the study period. The mean age was 7.9 years (SD 4.7); 60.1% of road injuries involved motor vehicle occupants (1483/2468). Most bicyclist/motorcyclists were not wearing helmets (70.0%, 245/350) and 51.1% of motor vehicle passengers (758/1483) were not restrained. Compared to motor vehicle passengers, pedestrians (adjusted OR 2.38, 95% CI 1.41-3.99), bicyclists (adjusted OR 2.12, 95% CI 1.04-4.32) and motorcyclists (adjusted OR 6.09, 95% CI 2.04-18.24) were more likely to sustain severe injuries.

CONCLUSION

Child pedestrians, bicyclists and motorcyclists are especially vulnerable for severe injures. Further injury prevention efforts must focus on the enforcement of legislation to protect these high-risk groups.

Cyclists fatalities: Forensic remarks regarding 335 cases

A retrospective study was carried out on post-mortem examination data regarding 335 cyclists involved in fatal accidents along the period 1983-2012. The following variables were considered: temporal data (year, month, day of the week and hour of the day), circumstances of the accident, vehicles involved, victims' features (sex, age), pathological and toxicological findings, cause of death. Most victims were male (77.62%), with a mean age of 58 years. In most cases vehicles other than only bicycles were involved, more frequently cars, followed by heavy motor vehicles. Head was the most frequently body region involved in lethal injuries (65.37%); low extremities were the body district most frequently involved in non-lethal injuries (63.9%). This study confirmed the importance of using helmet; head protection should be a priority for bikers.

Simulative investigation on head injuries of electric self-balancing scooter riders subject to ground impact

The safety performance of an electric self-balancing scooter (ESS) has recently become a main concern in preventing its further wide application as a major candidate for green transportation. Scooter riders may suffer severe brain injuries in possible vehicle crash accidents not only from contact with a windshield or bonnet but also from secondary contact with the ground. In this paper, virtual vehicle-ESS crash scenarios combined with finite element (FE) car models and multi-body scooter/human models are set up. Post-impact kinematic gestures of scooter riders under various contact conditions, such as different vehicle impact speeds, ESS moving speeds, impact angles or positions, and different human sizes, are classified and analyzed. Furthermore, head-ground impact processes are reconstructed using validated FE head models, and important parameters of contusion and laceration (e.g., coup or contrecoup pressures and Von Mises stress and the maximum shear stress) are extracted and analyzed to assess the severity of regional contusion from head-ground contact. Results show that the brain injury risk increases with vehicle speeds and ESS moving speeds and may provide fundamental knowledge to popularize the use of a helmet and the vehicle-fitted safety systems, and lay a strong foundation for the reconstruction of ESS-involved accidents. There is scope to improve safety for the use of ESS in public roads according to the analysis and conclusions.

Are electric self-balancing scooters safe in vehicle crash accidents?

With the pressing demand of environmentally friendly personal transportation vehicles, mobility scooters become more and more popular for the short-distance transportation. Similar to pedestrians and bicyclists, scooter riders are vulnerable road users and are expected to receive severe injuries during traffic accidents. In this research, a MADYMO model of vehicle-scooter crash scenarios is numerically set up. The model of the vehicle with the scenario is validated in pedestrian-vehicle accident investigation with previous literatures in terms of throwing distance and HIC15 value. HIC15 values gained at systematic parametric studies. Injury information from various vehicle crashing speeds (i.e. from 10m/s to 24m/s), angles (i.e. from 0 to 360°), scooter's speeds (i.e. from 0m/s to 4m/s), contact positions (i.e. left, middle and right bumper positions) are extracted, analyzed and then compared with those from widely studied pedestrian-vehicle and bicycle-vehicle accidents. Results show that the ESS provides better impact protection for the riders. Riding ESS would not increase the risk higher than walking at the same impact conditions in terms of head injury. The responsible reasons should be the smaller friction coefficient between the wheel-road than the heel-road interactions, different body gestures leading to different contact positions, forces and timing. Results may shed lights upon the future research of mobility scooter safety analysis and also the safety design guidance for the scooters.

Assessing bicycle-related trauma using the biomarker S100B reveals a correlation with total injury severity

PURPOSE

Worldwide, the use of bicycles, for both recreation and commuting, is increasing. S100B, a suggested protein biomarker for cerebral injury, has been shown to correlate to extracranial injury as well. Using serum levels of S100B, we aimed to investigate how S100B could be used when assessing injuries in patients suffering from bicycle trauma injury. As a secondary aim, we investigated how hospital length of stay and injury severity score (ISS) were correlated to S100B levels.

METHODS

We performed a retrospective, database study including all patients admitted for bicycle trauma to a level 1 trauma center over a four-year period with admission samples of S100B (n = 127). Computerized tomography (CT) scans were reviewed and remaining data were collected from case records. Univariate- and multivariate regression analyses, linear regressions and comparative statistics (Mann-Whitney) were used where appropriate.

RESULTS

Both intra- and extracranial injuries were correlated with S100B levels. Stockholm CT score presented the best correlation of an intracranial parameter with S100B levels (p < 0.0001), while the presences of extremity injury, thoracic injury, and non-cervical spinal injury were also significantly correlated (all p < 0.0001, respectively). A multivariate linear regression revealed that Stockholm CT score, non-cervical spinal injury, and abdominal injury all independently correlated with levels of S100B. Patients with a ISS > 15 had higher S100 levels than patients with ISS < 16 (p < 0.0001). Patients with extracranial, as well as intracranial- and extracranial injuries, had significantly higher levels of S100B than patients without injuries (p < 0.05 and p < 0.01, respectively). The admission serum levels of S100B (log, µg/L) were correlated with ISS (log) (r = 0.53) and length of stay (log, days) (r = 0.45).

CONCLUSIONS

S100B levels were independently correlated with intracranial pathology, but also with the extent of extracranial injury. Length of stay and ISS were both correlated with the admission levels of S100B in bicycle trauma, suggesting S100B to be a good marker of aggregated injury severity. Further studies are warranted to confirm our findings.