Risk factors in motorcyclist fatalities in Taiwan

Clinical outcomes of rib fracture stabilization and conservative treatment in a high-volume Asian trauma center: a propensity score-matched retrospective study

BACKGROUND

Rib fractures are common chest wall injuries with conservative treatment and surgical stabilization of rib fractures (SSRF) as treatment options. We retrospectively compared the efficacy and long-term prognosis of conservative treatment and SSRF as treatment options for rib fractures.

METHODS

This retrospective study was conducted at a single trauma center in Taiwan. The study population comprised patients with rib fractures who underwent conservative treatment or SSRF at the National Taiwan University Hospital between 2017 and 2022. We analyzed the outcomes between the operative and non-operative groups, including the length of intensive care unit and hospital stays, pain scales at admission and follow-up, and post-operative complication rates.

RESULTS

Of the 217 patients with rib fractures in this study, 103 received SSRF, and 114 received conservative treatment. Patients in the operative group had worse consciousness statuses and higher injury severity scores than those in the non-operative group. In addition, patients in the operative group had more preoperative chest complications than those in the non-operative group. Regarding outcomes and long-term prognoses, patients in the operative group had longer intensive care unit and hospital stays than those in the non-operative group; however, patients in the operative group had better recovery quality than those in the non-operative group.

CONCLUSIONS

Our study showed that, in patients who meet the surgical indications, SSRF is an effective and safe way to relieve acute pain after thoracic injury and achieve better recovery and quality of life after surgical intervention.

Seasonal variations and temporal instability of motorcyclist injury severity in Cambodia: Analyses based on a random parameter logit model with heterogeneity in means and variances

Motorcycles are a prevalent mode of transportation in countries like Cambodia that experience distinct rainy and dry seasons. However, the safety concerns associated with motorcycling in this region have not been thoroughly investigated. This study addresses this research gap by examining the severity of motorcyclist injuries in Cambodia, considering the potential variations across seasons and the fluctuations in contributing factors over time. Utilizing a random parameter logit model with heterogeneity in means and variances, the research analyzes motorcycle crash data from 2015 to 2017 to identify heterogeneities in the determinants of injury severity. The study confirms seasonal variations and temporal instabilities in influential factors, highlighting the need for distinct modeling for dry and rainy seasons due to varying contributing factors. Key findings include the consistent increase in fatal injury risk associated with head-on collisions and elderly rider involvement across both seasons. During the rainy season, motorcycle-to-motorcycle crashes significantly heighten the likelihood of severe injuries, with weekend crashes more likely to result in fatalities. Furthermore, more than half of speeding incidents during the rainy season consistently led to fatal injuries across all three years. In contrast, during the dry season, riders faced a greater risk of severe injuries compared to pillion riders, with crashes on national roads more likely to lead to fatal outcomes. Temporal stability tests further reveal that the influence of external variables on motorcyclist injury severity varies across years, stressing the need for tailored, season-specific approaches to effectively mitigate and prevent crashes.

The prevalence of helmet use in motorcyclists around the world: a systematic review and meta-analysis of 5,006,476 participants

Road traffic injuries present a significant public health burden, especially in developing countries. This systematic review and meta-analysis synthesized global evidence on motorcycle helmet use prevalence by including 299 records across 249 articles involving 5,006,476 participants from 1982 to 2022. The findings revealed a declining trend in helmet use prevalence over the past four decades, with an overall prevalence of 48.71%. The meta-regression analysis did not find any statistically significant change in the overall prevalence. Subgroup analysis showed higher helmet use prevalence in observation/survey records (54.29%) compared to crashed patient records (44.84%). Riders/Motorcyclists demonstrated a higher likelihood of wearing helmets than passengers in both observation/survey records (62.61 vs. 28.23%) and crashed patient records (47.76 vs. 26.61%). Countries with mandatory helmet use laws had higher helmet usage prevalence compared to those without (52.26 vs. 37.21%). The African continent had the lowest helmet use rates, while Latin America and the Caribbean regions had higher rates. This study provides a comprehensive overview of global helmet use prevalence, emphasizing disparities between high and low-income countries, variations in law enforcement, and trends over four decades. Targeted interventions are necessary to improve helmet-wearing habits, especially among passengers and regions with low usage rates. Effective legislation and awareness campaigns are crucial for promoting helmet use and reducing road traffic injuries burden.

The impact of COVID-19 restrictions on motorcycle crashes in Taiwan

Taiwan is one of the countries with the highest motorcycle per capita globally, and motorcycle crashes are predominant among traffic crashes. This study examines the impact of coronavirus disease 2019 restrictions on motorcycle crashes. We analyzed the trend of motorcycle crashes in Taipei City from 2019 to 2020 using the dataset provided by the Department of Transportation, Taipei City Government, Taiwan. We found 47,108 and 51,441 motorcycle crashes in 2019 and 2020, involving 61,141 and 67,093 motorcycles, respectively. Mopeds had the highest risk in 2020, followed by heavy motorcycles [≥550 cubic capacity (cc)] and scooters compared to 2019. Food delivery motorcycle crashes increased for scooters (0.93% in 2019 to 3.45% in 2020, P < .0001) and heavy motorcycles (250 < cc < 550) (0.90% in 2019 to 3.38% in 2020, P < .0001). While fatalities remained under 1%, 30% to 51% of motorcyclists sustained injuries. Food delivery with scooters or heavy motorcycles (250 < cc < 550) was significantly associated with motorcyclist injuries and deaths. Compared with 2019, the adjusted odds ratios of motorcyclist injuries and deaths in 2020 were 1.43 (95% confidence interval = 1.05-1.94) for heavy motorcycles (≥550 cc) and 1.07 (95% confidence interval = 1.04-1.09) for scooters. This study shows that coronavirus disease 2019 restrictions was associated with elevated risks of crashes, injuries, and deaths among motorcyclists, reflecting the general preference for private transport over public transport. The popularity of food delivery services also contributed to increased motorcycle crashes.

Examining factors influencing the severity of motorized two-wheeler crashes in Delhi

Failure to meet road safety targets has necessitated urgent actions from stakeholders worldwide, especially in developing countries like India. Road safety of motorized two-wheelers (MTWs), one of India's most preferred travel modes for urban commutes, is in danger and witnessing threatening figures of fatalities and injuries. Most of the studies in the domain of MTW safety were conducted in developed countries, with very limited research in countries having a significant proportion of MTWs. The present work investigates police-reported crash data to identify the contributory factors of motorized two-wheeler crash severity. Data from MTW crash-prone areas were selected from Delhi, which is leading in road traffic fatalities among the million-plus urban cities in India. A binary logistic regression model was developed using the data for 2016-2018 period. The model results show that the odds of fatal motorized two-wheeler crashes increase when the following circumstances apply: crash occurs on underpasses; involves bus, truck, heavy motor vehicle (lorry, crane) as the striking vehicle; when hit-and-run type of crash occurs and when older age-group (> = 55) riders are involved. Finally, based on the findings, countermeasures were suggested to facilitate policymakers and traffic enforcement agencies, in improving the road safety situation of MTW users.

Fatal crashes and rare events logistic regression: an exploratory empirical study

Objective

Fatal road accidents are statistically rare, posing challenges for accurate estimation through the classic logit model (LM). This study seeks to validate the efficacy of a rare events logistic model (RELM) in enhancing the precision of fatal crash estimations.

Methods

Both LM and RELM were employed to examine the relationship between pertinent risk factors and the incidence of fatal crashes. Crash-injury datasets sourced from Hillsborough County, Florida served as the empirical basis for evaluating the performance metrics of both LM and RELM.

Results

The analysis revealed that RELM yielded more accurate predictions of fatal crashes compared to LM. Receiver operating characteristic (ROC) curves were constructed, and the area under the curve (AUC) for each model was computed to offer a comparative performance assessment. The empirical evidence notably favored RELM over LM as substantiated by superior AUC values.

Conclusion

The study offers empirical validation that RELM is demonstrably more proficient in predicting fatal crashes than the LM, thereby recommending its application for nuanced traffic safety analytics.

Drivers' liability-based comparative severity analysis of motorized two-wheeler crashes

OBJECTIVE

This study aims to investigate comparative severity analysis of motorized two-wheeler (MTW) crashes based on drivers' liability using police-reported a crash data base.

METHODS

Using crash data from 2016 to 2020, this study examines and analyses the key factors affecting the severity of MTW injuries in Dehradun. For analysis, the ordinal logistic approach is used because severity levels are attributed with natural ordering. Differentiating from past studies, this research distinguished between collisions in which MTW crashes were considered as first party (crash in which MTW rider is accountable) and second person (crash in which MTW rider is a victim).

RESULTS

Result suggests that age, pillion passenger, type of collision, road network, and impacting vehicle increase the seriousness of a crash in both cases. However, crash day, crash time, and light condition were found to be significant in the case of second-party crashes. Similarly, crash seriousness tends to decrease in first-party crashes, whereas it increases in the context of second-party crashes.

CONCLUSION

The statistical results were correlated with past studies to provide proper justification in order to provide a better understanding of small-displacement MTW fatal accidents in developing countries. Additionally, this research aids in the development of mitigation strategies and future research directions to improve the safety of MTW users.

Predicting and factor analysis of rider injury severity in two-wheeled motorcycle and vehicle crash accidents based on an interpretable machine learning framework

OBJECTIVE

As one of the vulnerable road users in accidents, how to improve the two-wheeled motorcyclist's driving safety and reduce accident injury is a public health issue. Accurate identification of the factors influencing the severity of accidents is an important prerequisite for mitigating injury from crashes.

METHODS

Based on a vehicle and a two-wheeled motorcycle crash accident data from the China in-depth accident study database (CIDAS), this study uses the performance evaluation indicators of accuracy, precision, recall, F1-score, AUC, and the ROC curve. The classification and prediction performances of the six machine learning methods on the dataset are compared, and the LightGBM algorithm with the best performance is selected to model the accident injury severity of the motorcyclists. The SHAP method is used to extend the interpretability of the LightGBM model results. Based on the SHAP method, the importance, main effect, and the interaction effect of factors under each accident injury severity are quantitatively analyzed.

RESULTS

The model prediction accuracy is 92.6%, the F1-Score is 92.8%, and the AUC value is 0.986. The importance of factors varies with the accident injury severity of motorcyclists. The kilometers traveled per year by the driver, the throwing distance of the motorcyclist, and the road speed limit are the three most important factors. The motorcyclist is more likely to suffer fatal injuries when the throwing distance is >1,000 cm.

CONCLUSIONS

The prediction model of driver injury severity based on LightGBM algorithm has a good prediction performance. It can be used to analyze the influence factors of injury severity in two-wheeled motorcyclist accident by combining the model with SHAP method. These results could help the traffic management department to take measures to reduce accident injury of motorcyclists.

Motorcyclist injury severity analysis: a comparison of Artificial Neural Networks and random parameter model with heterogeneity in means and variances

In Thailand, the motorcyclist mortality rate is steadily on the rise and remains a serious concern for highway administrators and burden on both economic and local people. Using motorcycle-crash data in Thailand from 2016 to 2019, this study empirically employed and compared the Artificial Neural Networks (ANN) model and random parameters binary probit model with heterogeneity in means and variances (RPBPHM) to explore the effects of a wide range of associated risk characteristics on the severity outcomes of the motorcyclist. Study results revealed that probabilities of injury or fatal crash increase for crashes that involve male riders, riding with pillion, speeding, improper overtaking, riders under influence of alcohol, fatigue riders, undivided road and so on. The probability of non-injury crash increases for crashes on main or frontage traffic lane, four-lane road, concrete road, during rain, involving collision with other motorcycles, rear-end crashes, sideswipe crashes, single-motorcycle crashes and crashes within urban areas. The RPBPHM models were found to outperform the ANN model (quadratic support vector machine) in all performance metrics. The findings could potentially assist policymaker, safety professionals, practitioners, trainers, government agencies or highway designers in future planning and serve as guidance for mitigation policies directed at safety improvement for motorcyclists.

Unveiling the relevance of traffic enforcement cameras on the severity of vehicle-pedestrian collisions in an urban environment with machine learning models

PURPOSE

One of the leading causes of violent fatalities around the world is road traffic collisions, and pedestrians are among the most vulnerable road users with respect to such incidents. Since walking is highly promoted in urban areas to alleviate motor-vehicle externalities, it is paramount to understand the causes associated with vehicle-pedestrian collisions and their severity to provide safe environments. Although traffic enforcement cameras can address vehicle-vehicle collisions, little is known about their effectiveness with respect to vehicle-pedestrian incidents.

METHODOLOGY

In this study, we trained a set of machine learning models to forecast if a vehicle-pedestrian collision will turn into an injury or fatality, and the most suitable model was used to investigate the contributing features associated with such events with emphasis on the impact of traffic enforcement cameras. In addition to traffic enforcement camera proximity, features associated with the collision, weather, vehicle, victim, and infrastructure are included in the model to reduce unobserved heterogeneity.

RESULTS

Results show that a Linear Discriminant Analysis model surpasses other machine learning models considering the evaluation metrics. Results reveal that the age and gender of the victim, the involvement of larger vehicles in the collision, and the quality of the illumination are the causes associated with pedestrian fatalities. On the other hand, involvement of motorcycles and collisions that occurred in densely populated locations are the causes associated with pedestrian injuries.

CONCLUSIONS

This investigation demonstrates how to articulate machine learning into a vehicle-pedestrian crash analysis to understand the direction and magnitude of covariates in the corresponding severity outcome. Furthermore, it highlights the remarkable effect that traffic enforcement cameras and other features have on vehicle-pedestrian crash severity. These results provide actionable guidance for educational campaigns, enhanced traffic engineering, and infrastructure improvements that could be implemented in the analyzed region to provide safer transportation.

What Factors Would Make Single-Vehicle Motorcycle Crashes Fatal? Empirical Evidence from Pakistan

The existing research on motorcycle safety has shown that single-vehicle motorcycle crashes (SVMC) account for a higher fatality rate than other types of crashes. Also, motorcycle safety has become one of the critical traffic safety issues in many developing countries, such as Pakistan, due to the growing number of motorcycles and lack of sufficient relevant infrastructure. However, the available literature on SVMC and motorcycle safety in developing countries is limited. Therefore, the present study attempted to investigate the factors that contribute to the injury severity of SVMC in a developing country, Pakistan. For this purpose, a random parameter logit model with heterogeneity in means and variances is developed using two years of data extracted from the road traffic injury research project in Karachi city, Pakistan. The study's findings show that the presence of pillion passengers and young motorcyclists indicators result in random parameters with heterogeneity in their means and variances. The study's results also reveal that the summer, morning time, weekends, older motorcyclists, collisions with fixed objects, speeding, and overtaking are positively, while younger motorcyclists and the presence of pillion passengers are negatively associated with fatal crashes. More importantly, in the particular Pakistan's context, female pillion passenger clothes trapped in the wheel, riding under the influence, intersections, U-turns, and collisions due to loss of control are also found to significantly influence the injury severity of SVMC. Based on these research findings, multiple appropriate countermeasures are recommended to enhance motorcycle safety in Pakistan and other developing countries with similar problems.

Multilevel analysis of injury severity of elderly motorcycle riders: The role of regional transport development

OBJECTIVE

Research specifically focusing on the elderly segment of motorcycle riders remains largely scarce, which represents a serious lack in understanding given the fast-growing trend of aging societies around the world. This article examines factors affecting the injury severity of elderly motorcycle riders in Taiwan using a multilevel model consisting of both individual and municipality levels. In particular, this study emphasized the role of municipality-level factors closely related to the municipality characteristics and policy considerations in directing local governments' policies and implementing crash-prevention strategies and measures.

METHODS

A multilevel logistic regression model was specified and estimated by using crash data of elderly motorcycle riders across 20 municipalities in Taiwan between 2012 and 2018. Principal component analysis was employed to identify the municipality-level factors.

RESULTS

Individual-level factors such as being male, old age, no valid license, drunk driving, not wearing a helmet, turning or overtaking others, early morning and evening riding, errors in traffic signaling, and exceeding the speed limit have significant effects on injury severity. The highlighted municipality-level factor, the transport development index, demonstrates its significant effect on mitigating injury severity across municipalities.

CONCLUSIONS

Apart from considering individual factors such as driver-related, vehicle-related and road-side-related variables, this paper shed light on the role of transport development level of a municipality in analyzing the injury severity of elderly motorcycle riders. Policy implications in directing local governments' policies and implementing crash-prevention strategies and measures are discussed and provided.

Alcohol-impaired motorcyclists versus car drivers: A comparison of crash involvement and legal consequence from adjudication data

INTRODUCTION

Driving under the influence (DUI) increases the probability of motor-vehicle collisions, especially for motorcycles with less protections. This study aimed to identify commonalities and differences between criminally DUI offenses (i.e., with a blood alcohol concentration (BAC) of 80 mg/dL or higher) committed by motorcyclists and car drivers.

METHODS

A total of 10,457 motorcycle DUIs and 8,402 car DUIs were compared using a series of logistic regression models, using data extracted from the documents of adjudication decisions by the courts of Jiangsu, China.

RESULTS

The results revealed that offenders from the high-BAC group (i.e., 200 mg/dL or higher) accounted for more than 20% of the total DUI offenses, and were more likely to be involved in a crash and punished with a longer detention. Motorcyclists had a higher likelihood of crash involvement, and were also more likely to be responsible for single-vehicle crashes associated with higher odds of injury sustained, compared to alcohol-impaired car drivers. In the verdict, motorcycle offenders were more likely to receive a less severe penalty.

CONCLUSIONS

Interventions are clearly required to focus on reducing in the high-BAC group of offenders. For alcohol-impaired motorcyclists, their risks of crash and injury against BAC climb more steeply than the risks for car drivers. The factors including frequent occurrences, uncertainty of detection, and short-term sentences may weaken the deterrence effect of the criminalization of motorcycle DUI. Practical Applications: The traffic-related adjudication data support traffic safety analysis. Strategies such as combating motorcycle violations (e.g., unlicensed operators or driving unsafe vehicles), undertaking education and awareness campaigns, are expected for DUI prevention.

A state-of-the-art review of factors that predict mortality among traumatic injury patients following a road traffic crash

BACKGROUND

Traffic related injuries are a major public health problem worldwide with millions of people dying every year. The objective of this state-of-the-art review was to identify the factors reported in the literature as being associated with mortality for trauma patients following road traffic crashes.

METHOD

A systematic search was undertaken of PubMed/MEDLINE, EMBASE, CINAHL, Web of Science, and Cochrane Library databases to identify articles published in the past two decades (2000-2020). Of 8257 records, 4507 remained for title, abstract and full text screening after duplicates were removed. The level of evidence of selected studies was assessed using The National Health and Medical Research Council (NHMRC) guideline.

RESULTS

This review included eighty primary research studies examining mortality risk factors following a road traffic crash. The study identified factors in five categories; (i) demographic factors; (ii) behavioural factors; (iii) crash characteristics; (iv) environmental and timing factors; (v) injury severity and pre-injury/condition. The primary studies are summarised in a matrix. Included studies included level II to level IV levels of evidence based on the NHMRC criteria.

CONCLUSION

This study shows that there are a large number of factors associated with increased risk of mortality following diverse types of traffic crashes. Understanding these wide-ranging factors can strengthen injury and mortality prevention by guiding decision makers about where to focus strategy implementation.

A Comparison of Motorcycle Helmet Wearing Intention and Behavior between Urban and Rural Areas

The motorcycle is one of the important modes of transport for Thai people in all provinces due to its convenience and ability to access all areas and cover short distances, which is especially convenient for rural people. However, according to the accident record, it was found that the motorcycle was the vehicle causing the highest amount of accidents, and helmet wearing could save lives and reduce the level of severe injuries. In this regard, the objective of this study was to study and develop a model of factors that affected helmet use behavior using structural equation modeling (SEM) based on the Health Belief Model (HBM). Further, this study compared urban and rural models, so as to suggest suitable guidelines for the promotion of helmet use in the study areas. The sample comprised 801 motorcycle users divided into 401 urban residents and 400 rural residents. From the parameter invariance testing in the two areas, a chi-square difference test found differences in the factor loading, intercepts, and structural paths between urban and rural societies.

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.

Can helmet decrease mortality of craniocerebral trauma patients in a motorcycle accident?: A propensity score matching

A helmet is critical for preventing head injuries during motorcycle accidents. However, South Korean motorcyclists have a lower prevalence of wearing a helmet, compared to developed countries. Therefore, we aimed to evaluate whether helmet wearing was associated with the clinical outcomes in Korean motorcycle accidents. Data were obtained from the Emergency Department-based Injury In-depth Surveillance database 2011-2015. We considered the patients had experienced a motorcycle accident and were only diagnosed with a craniocerebral trauma (CCT). The primary outcome was mortality and the secondary outcomes were the severity and hospitalization duration. The patients were separated whether they were wearing a helmet and the outcomes were compared using multivariate logistic regression after propensity score matching (PSM). Among 1,254,250 patients in the database, 2,549 patients were included. After PSM, 1,016 patients in each group were matched. The univariate analyses revealed that helmet wearing was associated with lesser severity (P < 0.001) and shorter hospitalization (P < 0.001). The regression analysis revealed that mortality was also lower in a helmet-wearing group (odds ratio: 0.34, 95% confidence interval: 0.21-0.56). In conclusion, wearing a helmet may reduce the mortality from a CCT after a motorcycle accident and associated with lesser severity and shorter hospitalization.

Different demographic and drinking profiles of motorcyclists and car drivers with the first-time offense of driving/riding under the influence of alcohol

BACKGROUND

Driving/riding under the influence (DUI) of alcohol is a major public concern worldwide. Only a few studies have distinguished DUI-related variables between motorcyclists and car drivers. This study examined the differences in demographic characteristics and drinking behaviors among first-time DUI offenders operating different transportation vehicles, and risk factors for frequent DUI (fDUI) among them.

METHODS

We conducted an anonymous survey for 561 first-time DUI offenders who attended a mandatory educational program. Participants self-administered questionnaires concerning alcohol drinking behaviors and DUI. We defined fDUI as at least two DUI behaviors per month based on self-reported information. Demographic and drinking characteristics were compared between DUI offenders, car drivers and motorcyclists. Logistic regression analysis was used to examine risk factors for fDUI.

RESULTS

Two-thirds of first-time DUI offenders were motorcyclists. Compared with car drivers, motorcyclists were younger and less educated, with a higher percentage of them being women and unmarried. Car drivers reported a higher rate of fDUI than motorcyclists (16.5% vs. 9.7%). Regression analysis revealed that binge drinkers had a higher fDUI risk in both groups. Regarding the drinking place prior to DUI behavior, workplace was significantly associated with fDUI in car drivers.

CONCLUSIONS

Distinct strategies may be required for motorcyclists and car drivers for DUI recidivism prevention, and drinking place interventions should also be considered.

The Correlation of Age and Patterns of Maxillofacial Bone Fractures and Severity of Associated Injuries Caused by Motorcycle Accidents

BACKGROUND

Every year, there are significant numbers of motorcycle accident casualties in Taiwan. These accidents are the leading cause of maxillofacial trauma. Age should be an important factor of maxillofacial fracture patterns yet there is limited literature on the topic. Therefore, this study aims to evaluate the correlation of age with maxillofacial fracture in motorcycle accidents.

METHODS

This is a retrospective descriptive analysis conducted over 2-year period at Linkou Chang Gung Memorial Hospital. We focused on the population of maxillofacial injury caused by motorcycle accidents. Data, including demographics, age, fracture patterns of facial bones, and other associated injuries, were collected.

RESULTS

Among 881 admissions, there were 179 patients in the minor group, 644 patients in the adult group, and 58 patients in the geriatric group. With patterns of maxillofacial fracture, midface fracture was the most common type. The minor group had higher incidence of mandibular fracture. The geriatric group sustained more midface fracture. Associated injuries, such as severe head injuries and c-spine injury, were more likely to occur with the old age victims. The overall mortality rate was 3.1%.

CONCLUSIONS

Our study presents the different trends of fracture patterns in different age groups, which is associated with different types of treatment required. We summarized all these data in the hope of providing further assistance to trauma doctor dealing with motorcycle accidents.

Factors affecting motorcyclists' injury severities: An empirical assessment using random parameters logit model with heterogeneity in means and variances

Motorcycles constitute 61% of the total registered vehicles in Pakistan and there has been a 371% growth in motorcycles in the country from year 2005-2015. Motorcycle is an essential and popular mode of transportation in Pakistan, therefore, the present study estimated a random parameters logit model to investigate the factors influencing the motorcycle injury severity using motorcycle crash data of Rawalpindi city collected by the Provincial Emergency Response Service. No injury, minor injury, severe injury and fatal injury are used as four categories of motorcyclist injury severity levels to calibrate the model. Mainly the effects of speed limits, crash-specific factors, rider attributes, roadway characteristics, weather and socio-demographics factors are considered for motorcycle-injury severity analysis. It was revealed that probability of fatal/severe injury increases for crashes: involving middle-aged riders (25-50 years) and riders with no education, occurring on roads with posted speed limit of 70 kms per hour or higher, crashes involving a motorcycle and a heavy vehicle, involving collision of a motorcycle with a fixed object and occurring during dry weather conditions. Also, the probability of minor injury increases for crashes: occurring on divided streets and road segments with a posted speed limit of less than 50 kms per hour, involving Chinese brand motorcycles, involving registered motorcycles, and where at least one motorcycle and auto rickshaw is involved. The research findings suggest that besides measures to control/ reduce the risky motorcyclists behavior there is a need to lower speed limits on roads with a higher motorcycle proportion, separate motorcycles from heavy vehicles and removal of fixed objects from the roadside. Besides data limitations, results are expected to generate more discussion and interest in motorcycle safety in the country and can be used by the enforcement agencies to improve/ enhance the current state of motorcycle safety in the country.

Factors contributing to motorcycle fatal crashes on National Highways in India

This study analyses fatal crash patterns, and identifies the risk factors contributing to motorcycle versus non-motorcycle fatal crashes using binomial logistic regression on two-, four- and six-lane National Highways (NHs) in India utilizing police fatal crash data. The distribution of victims' mode by striking vehicles shows that percentage share of striking vehicles (truck) against the victims' vehicles (motorcycle) is 44%, 52% and 37% on two-lane NH-8, four-lane NH-24 and six-lane NH-1, respectively. Nine explanatory variables pertaining to fatal crash, victim, roadway and environment are considered for the model (using combined data of cited three NHs). The results of the logistic regression model (motorcycle versus non-motorcycle fatal crashes) show that for variable 'collision type', likelihood of occurrence of 'rear-end', 'sideswipe' and 'head-on' fatal crashes are 42-times, 35-times and 25-times more than 'hit pedestrian' respectively. Similarly, for variable 'number of vehicle', likelihood is thrice as 'single-vehicle' than 'two or more vehicles'; and, for variable 'number of lane', probability is more on 'two-lane' NH-8 than 'four-lane' NH-24. Based on the study results, it is recommended to upgrade two-lane (undivided carriageway) to four-lane (divided carriageway) NHs to reduce 'head-on' collision.

Risk factors for crash involvement in older motorcycle riders

A prospective cohort study was conducted to identify risk and protective factors for crash involvement in older motorcyclists. Over a 1-year study period from August 2013 to July 2014, study participants were recruited from local community centers of five cities in Taiwan. People aged ≥60 years who rode a motorcycle at least once per week were eligible and were invited to participate in the study. Among 256 older riders who completed the baseline assessment and at least one of the four follow-up assessments, 79 (33.7%) experienced a motorcycle crash over the study period. Results of the proportional hazards model showed that after controlling for age, gender, and riding distance, older riders who had sustained hearing impairment (hazard ratio (HR)=2.58; 95% confidence interval (CI), 1.30-5.15), rode a motorcycle at speeds of ≥41km/h (HR=2.31; 95% CI, 1.26-4.23), and had experienced a motorcycle crash in the past year (HR=1.81; 95% CI, 1.06-3.09) were more likely to be involved in a crash, compared to their counterparts. Conversely, older riders who were obese (HR=0.43; 95% CI, 0.22-0.82) were less likely to be involved in a crash than those with a normal weight, while longer functional reach distances (HR=0.96; 95% CI, 0.93-0.99) and higher Tinetti balance scores (HR=0.79; 95% CI, 0.69-0.91) were associated with a reduced risk of crash involvement. Among older people riding a motorcycle as their primary source of transportation, several factors associated with the occurrence of motorcycle crashes were identified. Restrictions and modifications of these risk factors may help design effective safety interventions for reducing crash and injury risks of this increasing riding population.

Derivation and validation of different machine-learning models in mortality prediction of trauma in motorcycle riders: a cross-sectional retrospective study in southern Taiwan

OBJECTIVES

This study aimed to build and test the models of machine learning (ML) to predict the mortality of hospitalised motorcycle riders.

SETTING

The study was conducted in a level-1 trauma centre in southern Taiwan.

PARTICIPANTS

Motorcycle riders who were hospitalised between January 2009 and December 2015 were classified into a training set (n=6306) and test set (n=946). Using the demographic information, injury characteristics and laboratory data of patients, logistic regression (LR), support vector machine (SVM) and decision tree (DT) analyses were performed to determine the mortality of individual motorcycle riders, under different conditions, using all samples or reduced samples, as well as all variables or selected features in the algorithm.

PRIMARY AND SECONDARY OUTCOME MEASURES

The predictive performance of the model was evaluated based on accuracy, sensitivity, specificity and geometric mean, and an analysis of the area under the receiver operating characteristic curves of the two different models was carried out.

RESULTS

In the training set, both LR and SVM had a significantly higher area under the receiver operating characteristic curve (AUC) than DT. No significant difference was observed in the AUC of LR and SVM, regardless of whether all samples or reduced samples and whether all variables or selected features were used. In the test set, the performance of the SVM model for all samples with selected features was better than that of all other models, with an accuracy of 98.73%, sensitivity of 86.96%, specificity of 99.02%, geometric mean of 92.79% and AUC of 0.9517, in mortality prediction.

CONCLUSION

ML can provide a feasible level of accuracy in predicting the mortality of motorcycle riders. Integration of the ML model, particularly the SVM algorithm in the trauma system, may help identify high-risk patients and, therefore, guide appropriate interventions by the clinical staff.

Motorcycle-related hospitalizations of the elderly

Background

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

Methods

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

Results

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

Conclusions

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

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

Background

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

Methods

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

Results

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

Conclusion

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

Level of evidence

Epidemiologic study, level III.

Risk Factors for Motorcycle-related Severe Injuries in a Medium-sized City in China

BACKGROUND

Motorcycle vehicles are frequent in China, especially in the small and medium sized cities. Road traffic collisions involving motorcycles often result in severe injuries. We aimed to identify risk factors for severe injuries in inpatients sustaining motorcycle collisions.

METHODS

Patients with road traffic injuries involving motorcycles who presented to the neurosurgery and orthopedic departments of three major comprehensive hospitals in Shantou city were reviewed from October 2012 to June 2013. Data from 349 patients was investigated. Crash and injury characteristics were documented by interviewing patients, their family members, and their doctors. Binary logistic regression was used to determine risk factors for severe injuries.

RESULTS

There were 253 males (72.49%) and 96 females (27.51%), with a male to female ratio of 2.64:1. The mean age was 38.21±17.32 years. One-hundred and fifty patients were in the severe injury group with a mean injury severity score (ISS) of 15.34±9.13. The simple and multiple logistic model showed that males, lack of safeguards, morning and night hours, non-urban areas, collision of a motorcycle with a cycle, ambulance transportation to hospital, admission to a neurosurgery department, lack of traffic control, unobstructed traffic, and poor visibility were all the risk factors.

CONCLUSIONS

This research highlights some problems: less helmet wearing in motorcyclists and cyclists, rural injuries being more serious than urban ones, and head injuries being the main diagnosis in severe injuries. The result of this research is predictable. If the safety equipment is required to be used, such as helmets, and the traffic environment is improved, such as traffic flow, medical resources to injuries and deaths is seasonable, then traffic safety will be improved and accidents will be reduced.

The analysis of influence of individual and environmental factors on 2-wheeled users' injuries

OBJECTIVE

Powered 2-wheeled motor vehicles (PTWs) are one of the most vulnerable categories of road users. Bearing that fact in mind, we have researched the effects of individual and environmental factors on the severity and type of injuries of PTW users. The aim was to recognize the circumstances that cause these accidents and take some preventive actions that would improve the level of road safety for PTWs.

METHODS

In the period from 2001 to 2010, an analysis of 139 road accidents involving PTWs was made by the Faculty of Transport and Traffic Engineering in Belgrade. The effects of both individual (age, gender, etc.) and environmental factors (place of an accident, time of day, etc.) on the cause of accidents and severity and type of injuries of PTWs are reported in this article. Analyses of these effects were conducted using logistic regression, chi-square tests, and Pearson's correlation.

RESULTS

Factors such as categories of road users, pavement conditions, place of accident, age, and time of day have a statistically significant effect on PTW injuries, whereas other factors (gender, road type; that is, straight or curvy) do not. The article also defines the interdependence of the occurrence of particular injuries at certain speeds. The results show that if PTW users died of a head injury, these were usually concurrent with chest injuries, injuries to internal organs, and limb injuries.

CONCLUSIONS

It has been shown that there is a high degree of influence of individual factors on the occurrence of accidents involving 2-wheelers (PTWs/bicycles) but with no statistically significant relation. Establishing the existence of such conditionalities enables identifying and defining factors that have an impact on the occurrence of traffic accidents involving bicyclists or PTWs. Such a link between individual factors and the occurrence of accidents makes it possible for system managers to take appropriate actions aimed at certain categories of 2-wheelers in order to reduce casualties in a particular area. The analysis showed that most of the road factors do not have a statistically significant effect on either category of 2-wheeler. Namely, the logistic regression analysis showed that there is a statistically significant effect of the place of accident on the occurrence of accidents involving bicyclists.

Obese motorcycle riders have a different injury pattern and longer hospital length of stay than the normal-weight patients

Background

The adverse effects of obesity on the physical health have been extensively studied in the general population, but not in motorcycle riders (includes both drivers and pillions). The aim of this study was to compare injury patterns, injury severities, mortality rates, and in-hospital or intensive care unit (ICU) length of stay (LOS) between obese and normal-weight patients who were hospitalized for the treatment of trauma following motorcycle accidents in a level I trauma center.

Methods

Detailed data of 466 obese adult patients with a body mass index (BMI) ≥30 kg/m² and 2701 normal-weight patients (25 > BMI ≥18.5 kg/m²) who had sustained motorcycle accident-related injuries were retrieved from the Trauma Registry System between January 1, 2009 and December 31, 2013. We used the Pearson’s chi-squared test, Fisher’s exact test, and independent Student’s t-test to analyze differences between the two groups.

Results

Compared to normal-weight motorcycle riders, more obese riders were men and drivers as opposed to pillions. In addition, fewer obese motorcycle riders showed alcohol intoxication. Analyses of the patients’ Abbreviated Injury Scale (AIS) scores revealed that obese motorcycle riders presented with a higher rate of injury to the thorax, but a lower rate of injury to the face than normal-weight patients. In addition, obese motorcycle riders had a 2.7-fold greater incidence of humeral, 1.9-fold greater incidence of pelvic, and 1.5-fold greater incidence of rib fractures. In contrast, normal-weight motorcycle riders sustained a significantly higher rate of maxillary and clavicle fractures. Obese motorcycle riders had a significant longer in-hospital LOS than normal-weight motorcycle riders did (10.6 days vs. 9.5 days, respectively; p = 0.044), with an increase in in-hospital LOS of 0.82 days associated with every 10-unit increase in BMI. No statistically significant differences in Injury Severity Score (ISS), New Injury Severity Score (NISS), Trauma-Injury Severity Score (TRISS), mortality, percentage of patients admitted to the ICU, or LOS in the ICU were found between obese and normal-weight patients.

Discussion

No differences of injury severity, mortality, and LOS in the ICU between obese and normal-weight motorcycle riders in this study may be partly attributed to the motorcycle injuries occur at relatively low velocity, considering that the riding of majority of motorcycles are forbidden on highways in Taiwan and that most traffic accidents occur in relatively crowded streets.

Conclusion

Obese motorcycle riders had different injury characteristics and bodily injury patterns than normal-weight motorcycle riders. Moreover, they had a longer in-hospital LOS; this was particularly true for those with pelvic fractures. However, injury severity and mortality were not significantly different between the two groups.

Traumatic injuries among adult obese patients in southern Taiwan: a cross-sectional study based on a trauma registry system

BACKGROUND

The adverse impact of obesity has been extensively studied in the general population; however, the added risk of obesity on trauma-related mortality remains controversial. This study investigated and compared mortality as well injury patterns and length of stay (LOS) in obese and normal-weight patients hospitalized for trauma in the hospital and intensive care unit (ICU) of a Level I trauma center in southern Taiwan.

METHODS

Detailed data of 880 obese adult patients with body mass index (BMI) ≥ 30 kg/m(2) and 5391 normal-weight adult patients (25 > BMI ≥ 18.5 kg/m(2)) who had sustained a trauma injury between January 1, 2009 and December 31, 2013 were retrieved from the Trauma Registry System. Pearson's chi-squared, Fisher's exact, and independent Student's t-tests were used to compare differences between groups. Propensity score matching with logistic regression was used to evaluate the effect of obesity on mortality.

RESULTS

In this study, obese patients were more often men, motorcycle riders and pedestrians, and had a lower proportion of alcohol intoxication compared to normal-weight patients. Analysis of Abbreviated Injury Scale scores revealed that obese trauma patients presented with a higher rate of injury to the thorax, but a lower rate of facial injuries than normal-weight patients. No significant differences were found between obese and normal-weight patients regarding Injury Severity Score (ISS), Trauma-Injury Severity Score (TRISS), mortality, the proportion of patients admitted to the ICU, or LOS in ICU. After propensity score matching, logistic regression of 66 well-matched pairs did not show a significant influence of obesity on mortality (odds ratio: 1.51, 95% confidence interval: 0.54-4.23 p = 0.438). However, significantly longer hospital LOS (10.6 vs. 9.5 days, respectively, p = 0.044) was observed in obese patients than in normal-weight patients, particularly obese patients with pelvic, tibial, or fibular fractures.

CONCLUSION

Compared to normal-weight patients, obese patients presented with different injury characteristics and bodily injury patterns but no difference in mortality.

Modeling the effect of operator and passenger characteristics on the fatality risk of motorcycle crashes

BACKGROUND

In Iran more than 25% of crash fatalities belong to motorcycle operators and passengers in the recent years, from which about 20% are related to passenger fatalities.

METHODS

The aim of this study was to investigate the motorcycle operator and passenger characteristics as well as other contributory factors that may affect the fatality risk of motorcyclists involved in traffic crashes. To this end, motorcycle crash data between 2009 and 2012 was extracted from Iran traffic crash database and a logistic regression analysis was performed to obtain odds ratio estimates for each of the study variables.

RESULTS

The fatality risk of motorcyclists has a direct relationship with the number of pillion passengers carried. Results also indicate that the amount of increase in the likelihood of having a fatality in a motorcycles crash is considerably higher when the operator is accompanied by a male passenger of the same age. Furthermore, results showed that if the crash is occurred in the darkness, on curves, in rural areas and on highways, then the crash would be more likely to be fatal. Moreover, the head-on collisions, older operators, unlicensed operators and not using a safety helmet were found to increase the likelihood of a fatality in a motorcycle crash.

CONCLUSIONS

Preventative measures such as, imposing stricter rules regarding safety helmet usage and confining the number of pillion passengers to one, might be implemented to reduce the fatality risk in motorcycle crashes. In addition, more appropriate infrastructures for penalizing offending motorcyclists could also reduce the frequency of law violations such as not wearing helmet or riding without motorcycle license, which in turn, would result into a reduction in the fatality risk of motorcycle crashes.

Motorcycle-related hospitalization of adolescents in a Level I trauma center in southern Taiwan: a cross-sectional study

BACKGROUND

The aim of this study was to investigate and compare the injury pattern, mechanisms, severity, and mortality of adolescents and adults hospitalized for treatment of trauma following motorcycle accidents in a Level I trauma center.

METHODS

Detailed data regarding patients aged 13-19 years (adolescents) and aged 30-50 years (adults) who had sustained trauma due to a motorcycle accident were retrieved from the Trauma Registry System between January 1, 2009 and December 31, 2012. The Pearson's chi-squared test, Fisher's exact test, or the independent Student's t-test were performed to compare the adolescent and adult motorcyclists and to compare the motorcycle drivers and motorcycle pillion.

RESULTS

Analysis of Abbreviated Injury Scale (AIS) scores revealed that the adolescent patients had sustained higher rates of facial, abdominal, and hepatic injury and of cranial, mandibular, and femoral fracture but lower rates of thorax and extremity injury; hemothorax; and rib, scapular, clavicle, and humeral fracture compared to the adults. No significant differences were found between the adolescents and adults regarding Injury Severity Score (ISS), New Injury Severity Score (NISS), Trauma-Injury Severity Score (TRISS), mortality, length of hospital stay, or intensive care unit (ICU) admission rate. A significantly greater percentage of adolescents compared to adults were found not to have worn a helmet. Motorcycle riders who had not worn a helmet were found to have a significantly lower first Glasgow Coma Scale (GCS) score, and a significantly higher percentage was found to present with unconscious status, head and neck injury, and cranial fracture compared to those who had worn a helmet.

CONCLUSION

Adolescent motorcycle riders comprise a major population of patients hospitalized for treatment of trauma. This population tends to present with a higher injury severity compared to other hospitalized trauma patients and a bodily injury pattern differing from that of adult motorcycle riders, indicating the need to emphasize use of protective equipment, especially helmets, to reduce their rate and severity of injury.

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.

Alcohol-related hospitalizations of adult motorcycle riders

OBJECTIVE

To provide an overview of the demographic characteristics of adult motorcycle riders with alcohol-related hospitalizations.

METHODS

Data obtained from the Trauma Registry System were retrospectively reviewed for trauma admissions at a level I trauma center between January 1, 2009 and December 31, 2013. Out of 16,548 registered patients, detailed information was retrieved regarding 1,430 (8.64%) adult motorcycle riders who underwent a blood alcohol concentration (BAC) test. A BAC level of 50 mg/dL was defined as the cut-off value for alcohol intoxication.

RESULTS

In this study, alcohol consumption was more frequently noted among male motorcycle riders, those aged 30-49 years, those who had arrived at the hospital in the evening or during the night, and those who did not wear a helmet. Alcohol consumption was associated with a lower percentage of sustained severe injury (injury severity score ≥25) and lower frequencies of specific body injuries, including cerebral contusion (0.6; 95% confidence interval [CI] = 0.42-0.80), lung contusion (0.5; 95% CI = 0.24-0.90), lumbar vertebral fracture (0.1; 95% CI = 0.01-0.80), humeral fracture (0.5; 95% CI = 0.27-0.90), and radial fracture (0.6; 95% CI = 0.40-0.89). In addition, alcohol-intoxicated motorcycle riders who wore helmets had significantly lower frequencies of cranial fracture (0.4; 95% CI = 0.29-0.67), epidural hematoma (0.5; 95% CI = 0.29-0.79), subdural hematoma (0.4; 95% CI = 0.28-0.64), subarachnoid hemorrhage (0.5; 95% CI = 0.32-0.72), and cerebral contusion (0.4; 95% CI = 0.25-0.78).

CONCLUSIONS

Motorcycle riders who consumed alcohol presented different characteristics and bodily injury patterns relative to sober patients, suggesting the importance of helmet use to decrease head injuries in alcohol-intoxicated riders.

A data mining approach to investigate the factors influencing the crash severity of motorcycle pillion passengers

INTRODUCTION

Motorcycle passengers comprise a considerable proportion of traffic crash victims. During a 5 year period (2006-2010) in Iran, an average of 3.4 pillion passengers are killed daily due to motorcycle crashes. This study investigated the main factors influencing crash severity of this group of road users.

METHOD

The Classification and Regression Trees (CART) method was employed to analyze the injury severity of pillion passengers in Iran over a 4 y ear period (2009-2012).

RESULTS

The predictive accuracy of the model built with a total of 16 variables was 74%, which showed a considerable improvement compared to previous studies. The results indicate that area type, land use, and injured part of the body (head, neck, etc.) are the most influential factors affecting the fatality of motorcycle passengers. Results also show that helmet usage could reduce the fatality risk among motorcycle passengers by 28%.

PRACTICAL APPLICATIONS

The findings of this study might help develop more targeted countermeasures to reduce the death rate of motorcycle pillion passengers.

Factors associated with recurrence of alcohol-related traffic violations in southern Brazil

OBJECTIVE

To analyze variables associated with recurrence of blood alcohol content (BAC)-related traffic violations among drivers in southern Brazil.

METHOD

This cross-sectional study included 12,204 driving-under-the-influence (DUI) offenders according to data provided by the Rio Grande do Sul state Transportation Department. Sociodemographic characteristics, license duration, license category, and psychological assessment results were analyzed. Drivers convicted of DUI more than once in 2009/2010 were considered recidivists. Variables were evaluated using descriptive statistical analysis and Poisson regression, adjusted by sex, age, and education level.

RESULTS

A total of 538 (4.41%) drivers were considered recidivists. The following variables showed the strongest associations with recidivism: being aged 41-50 years (prevalence ratio [PR] = 3.41), being licensed for ≥ 12 years (PR = 1.86), being licensed for motorcycles, cars and trucks (PR = 1.36), having a license with psychological restrictions (PR = 1.33), and driving a truck or a similar vehicle at the moment of notification (PR = 1.08).

CONCLUSIONS

In the age group with the highest risk for recurrence, drivers showed a higher probability of having a diagnosis of alcohol dependence and other psychiatric comorbidities that hinder the control of alcohol use. Psychological assessments seem to be important in predicting repeat offenses, especially when limited aptitudes are suspected, and should therefore be better investigated.