Risk of permanent medical impairment (RPMI) in car crashes correlated to age and gender

Effectiveness of neck-specific exercises with and without internet-based support on dizziness/unsteadiness in chronic whiplash-associated disorders: Secondary analyses of a randomised controlled trial

AIM

To investigate the effectiveness in individuals with chronic whiplash-associated disorders (WADs) of neck-specific exercise (NSE) supervised by a physiotherapist twice a week for 12 weeks versus neck-specific exercise with internet support and four physiotherapy visits (NSEIT) regarding dizziness, unsteadiness and balance, and to investigate the differences between WAD grades.

METHOD

This is a secondary analysis of a prospective randomised multicentre study (RCT) with concealed allocation (ClinicalTrials.gov Protocol ID: NCT03022812). The outcomes were dizziness measured on the Dizziness Handicap Inventory (DHI); dizziness at rest and during activity and unsteadiness using visual analogue scales; and standing on one leg with eyes closed (SOLEC). Participants (n = 140) were randomised to NSE or NSEIT. Measurements were obtained at baseline, and at three- and 15-month follow-ups by assessor-blinded investigators.

RESULTS

There were no significant differences between NSEIT and NSE in any of the outcomes (p>0.38). Both NSEIT and NSE improved over time (p<0.02; effect size (ES) = 0.74-1.01) in DHI score and dizziness during activity. There was a significant group-by-time interaction effect in dizziness (at rest: p = 0.035; ES: 0.66; and during activity: p = 0.016; ES: 1.24) between WAD grades. Individuals with WAD grade 3 had dizziness/unsteadiness to a greater extent and improved in all outcomes over time (p<0.04) compared to those with WAD grade 2, except for SOLEC.

CONCLUSIONS

There were no significant group differences between NSEIT and NSE. Both groups decreased in terms of self-reported dizziness (DHI, dizziness during activity), with medium to large effect size. Those with WAD grade 3 have dizziness/unsteadiness to a greater extent than those with WAD grade 2. Despite improvements, many participants still reported dizziness at 15-month follow-up, and additional balance training and/or vestibular exercise may be investigated for potential additional effect.

Characteristics of equestrian accidents and injuries leading to permanent medical impairment

BACKGROUND

Equestrian sports, also referred to as equestrianism, is practiced all over the world and a popular leisure activity in Sweden. Equestrianism is the country's second-largest youth sport, and previous studies indicate that accidents are common in equestrianism. However, few previous studies have examined acute equestrian injuries leading to permanent medical impairment (PMI).

METHODS

By using nationwide insurance data comprising all injured equestrians registered in the Swedish Equestrian Federation, the aim was to analyse characteristics of equestrian accidents and particularly injuries leading to PMI, both in general and by age, gender, incident type, injury type and injured body region. Injury incidence and injuries leading to PMI were examined. All equestrians injured during 2017-2021 were included (n = 6,876), however, only injuries occurring in 2017 and 2018 were used to analyse the risk and the injury distribution of injuries leading to PMI. Injury incidence was calculated separately for males and females, as well as for different age groups, by dividing the number of insurance claims by the number of members multiplied by 1,000. Risk Ratio (RR) was calculated between gender. Pearson's chi-squared test was used to analyse differences in distribution for categorical variables.

RESULTS

The majority of injuries affected females, correlating to approximately three times higher risk, compared to males. The age group 21-40 years were associated with the highest injury risk (14.26/1,000 registered riders). In total 12% of all injuries led to PMI. Injuries to the upper and lower extremities, along with fractures, had a higher risk of resulting in a PMI. The risk of injury leading to PMI was higher among riders over 20 years of age.

CONCLUSIONS

The fact that females face nearly three times the injury risk of males, and riders aged 21-40 had the highest injury risk while younger riders (Luke KL, McAdie T, Smith BP, Warren-Smith AK. New insights into ridden horse behaviour, horse welfare and horse-related safety. Appl Anim Behav Sci. 2022;246:105539.); (Havlik HS. Equestrian sport-related injuries: a review of current literature. Curr Sports Med Rep. 2010;9(5):299-302.); (Samuels K, Bettis A, Davenport DL, Bernard AC. Occupational vs. non-occupational equestrians: Differences in demographics and injury patterns. Injury. 2022;53(1):171-5.); (Gharooni A-A, Anwar F, Ramdeep R, Mee H. Severe equestrian injuries: A seven-year review of admissions to a UK major trauma centre. Trauma. 2023;25(1):41-7.); (Hasler RM, Gyssler L, Benneker L, Martinolli L, Schotzau A, Zimmermann H, et al. Protective and risk factors in amateur equestrians and description of injury patterns: A retrospective data analysis and a case - control survey. J Trauma Manag Outcomes. 2011;5:4.); (Meredith L, Brolin K, Ekman R, Thomson R. Analyses of injuries to equestrians in a Swedish district over a 16-year period. Translational Sports Med. 2019;2:270-8.) had a lower risk, indicates that preventive efforts should target both older and female riders. Injuries predominantly resulting in PMI involve upper and lower extremities, however, to prevent the most serious injuries significantly affecting a rider's daily life, measures preventing head and spinal cord neck injuries, must be implemented. Head injures remain the most frequent, serious and most significant group of injuries to prevent and mitigate, within equestrian sports.

Effect of neck-specific exercises with and without internet support on cervical range of motion and neck muscle endurance in chronic whiplash-associated disorders: analysis of functional outcomes of a randomized controlled trial

OBJECTIVE

To compare the effects of a neck-specific exercise programme with internet support and 4 physiotherapist sessions (NSEIT) and the same neck-specific exercises supervised by a physiotherapist (NSE) on neck muscle endurance and cervical range of motion.

DESIGN

Randomized controlled trial.

PATIENTS

A total of 140 participants with chronic whiplash-associated disorders grade II or grade III were randomly assigned to the NSEIT or NSE groups.

METHODS

Outcomes were changes in active cervical range of motion, cranio-cervical flexion test, neck muscle endurance, and neck pain, at 3- and 15-month follow-ups.

RESULTS

There were no significant differences between the NSEIT and NSE groups. There was a significant group-by-time inter-action effect in active cervical range of motion flexion/extension where the NSEIT group improved to 3-month follow-up, but the NSE group did not. Both groups were significantly improved over time in all other outcomes (p < 0.001) at 3- and 15-month follow-ups, with effect size between 0.64 and 1.35 in active cervical range of motion, cranio-cervical flexion test, dorsal neck muscle endurance, and neck pain, and effect size between 0.22 and 0.42 in ventral neck muscle endurance.

CONCLUSION

Both NSE and NSEIT led to improved neck function. Depending on the patients' needs, either NSE or NSEIT could be used as treatment for patients with chronic whiplash-associated disorders.

Trauma Outcomes in Pediatric Nonfatal Road Traffic Accidents

BACKGROUND

By 2025, road traffic injuries are projected to rank third in the global burden of disease, posing a significant challenge that affects health, social well-being, and economic aspects. According to data from the Romanian Police National Statistics Center, there have been an average of 342 traffic accidents per year involving pediatric patients over the past 10 years.

MATERIALS AND METHODS

A retrospective research study was conducted, encompassing 358 cases of road traffic accidents identified for the study, with data collected over a span of eight years, and with the aim of analyzing the types of injury and treatment methods in relation to age and sex, while also focusing on the duration of hospitalization and the occurrence of complications.

RESULTS

An oscillating trend is observed from 2015 to 2020, with its lowest value recorded in 2017 at around 6.8% and its peak in 2019 at 20.1%. Notably, post-pandemic (COVID-19), the cases underwent a substantial decline of approximately 60%. At least 78.7% of those who did not undergo orthopedic reduction required surgery, whereas among those who underwent orthopedic reduction, only 23.4% needed surgery. Regarding the frequency of complications 17.3% of the total cases experienced complications.

CONCLUSIONS

According to our findings, age has a significant effect on the type of accident (p < 0.05). Complications occurred in 17.3% of patients, most commonly surgical (24 cases, 38.7%), orthopedic (17 cases, 27.4%), and neurological (15 cases, 24.2%).

A 13-Year Long-Term Follow-Up of a Case Report With Continued Improvement in Severe Chronic Neck and Head Pain Alleviated With Chiropractic BioPhysics® Spinal Rehabilitation Protocols

Alleviation of headaches (HAs), neck pain (NP), and disability is a desirable clinical outcome for the billions globally who suffer from these conditions. Chiropractic BioPhysics® (CBP®) methods may provide an option for head and neck-injured patients. A 62-year-old female historically injured multiple times including two motor vehicle collisions (MVC), and a strike to the face with a hockey puck; all resulting in chronic pain and suffering. The subject sought and received successful treatment in 2016 using this conservative protocol at a facility in the USA. The resolution of symptoms following 36 treatments was previously reported. Following 13 years without treatment beyond home exercises, the subject was re-evaluated and found to be stable in the long term for pain, structural and functional assessment. Thirty-six treatments over 12 weeks in 2016 led to an improvement in numerical pain rating scale (NPRS) for NP (5/10 to 1/10), and HA (9+/10 to 0/10), resolution of NP disability (6/100 to 0/100) as well as normalization of ROM without pain and resumption of all activities of daily living including high-level athletics without pain and disability. A 13-year follow-up found continued stability objectively and subjectively. We provide a case of successful conservative treatment using specific traction, exercises, and spine manipulation procedures. CBP® provides an option to treat pain and this case adds to growing evidence.

Circumstances and outcome of active transportation injuries: protocol of a British Columbian inception cohort study

INTRODUCTION

Active transport (AT) is promoted by urban planners and health officials for its environmental, economic and societal benefits and its uptake is increasing. Unfortunately, AT users can be injured or killed due to falls or collisions. Active transport injury (ATI) prevention efforts are hindered by limited research on the circumstances, associated infrastructure, injury pattern, severity and outcome of ATI events. This study seeks to address these knowledge gaps by identifying built environment features associated with injury and risk factors for a poor outcome following ATI.

METHODS AND ANALYSIS

This prospective observational study will recruit an inception cohort of 2000 ATI survivors, including pedestrians, cyclists and micromobility users aged 16 years and older who arrive at a participating emergency department within 48 hours of sustaining an ATI. Baseline interviews capture demographic and socioeconomic information, pre-injury health and functional status, as well as circumstances of the injury event and recovery expectations. Follow-up interviews at 2, 4, 6 and 12 months postinjury (key stages of recovery) use standardised health-related quality of life tools to determine physical and mental health outcomes, functional recovery and healthcare resource use and lost productivity costs.

ETHICS AND DISSEMINATION

The Active Transportation Injury Circumstances and Outcome Study is approved by our institutional research ethics board and the research ethics boards of all participating sites. This study aims to provide healthcare providers with knowledge of risk factors for poor outcome following ATI with the goal of improving patient management. Additionally, this study will provide insight into the circumstances of ATI events including built environment features and how those circumstances relate to recovery outcomes. This information can be used to inform city engineers and planners, policymakers and public health officials to plan roadway design and injury prevention policy.

Risk of permanent medical impairment after road traffic crashes: A systematic review

PURPOSE

To systematically review the risk of permanent disability related to road traffic injuries (RTIs) and to determine the implications for future research regarding permanent impairment following road traffic crashes.

METHODS

We conducted this systematic review according to the preferred reporting items for systematic reviews and meta-analysis statement. An extended search of the literature was carried out in 4 major electronic databases for scientific research papers published from January 1980 to February 2020. Two teams include 2 reviewers each, screened independently the titles/abstracts, and after that, reviewed the full text of the included studies. The quality of the studies was assessed using the strengthening the reporting of observational studies in epidemiology (STROBE) checklist. A third reviewer was assessed any discrepancy and all data of included studies were extracted. Finally, the data were systematically analyzed, and the related data were interpreted.

RESULTS

Five out of 16 studies were evaluated as high-quality according to the STROBE checklist. Fifteen studies ranked the initial injuries according to the abbreviated injury scale 2005. Five studies reported the total risk of permanent medical impairment following RTIs which varied from 2% to 23% for car occupants and 2.8% to 46% for cyclists. Seven studies reported the risk of permanent medical impairment of the different body regions. Eleven studies stated the most common body region to develop permanent impairment, of which 6 studies demonstrated that injuries of the cervical spine and neck were at the highest risk of becoming permanent injured.

CONCLUSION

The finding of this review revealed the necessity of providing a globally validated method to evaluate permanent medical impairment following RTIs across the world. This would facilitate decision-making about traffic injuries and efficient management to reduce the financial and psychological burdens for individuals and communities.

Demographic and clinical profile of an inception cohort of road trauma survivors

BACKGROUND

Road trauma is a major public health concern, often resulting in reduced health-related quality of life and prolonged absenteeism from work even after so-called 'minor' injuries that do not result in hospitalization. This manuscript compares pre-injury health, sociodemographic characteristics and injury details between age, sex, and road user categories in a cohort of 1,480 road trauma survivors.

METHODS

This was a prospective observational inception cohort study of road trauma survivors recruited between July 2018 and March 2020 from three trauma centres in British Columbia, Canada. Participants were aged ≥ 16 years and arrived in a participating emergency department within 24 h of involvement in a motor vehicle collision. Data were collected from structured interviews and review of medical records.

RESULTS

The cohort of 1,480 road trauma survivors included 280 pedestrians, 174 cyclists, 118 motorcyclists, 683 motor vehicle drivers, and 225 passengers. Median age was 40 (IQR = [27, 57]) years; 680 (46%) were female. Males and younger patients were significantly more likely to report better pre-injury physical health. Motorcyclists and cyclists tended to report better physical health and less severe somatic symptoms, whereas pedestrians and motor vehicle drivers reported better mental health. Injury severity and hospital admission rates were higher in pedestrians and motorcyclists and lower in motorists. Upper and lower extremity injuries were most common in pedestrians, cyclists and motorcyclists, whereas neck injuries were most common in motor vehicle drivers and passengers.

CONCLUSIONS

In a large cohort of road trauma survivors, overall injury severity was low. Motorcyclists and pedestrians, but not cyclists, had more severe injuries than motorists. Extremity injuries were more common in vulnerable road users. Future research will investigate one-year recovery outcomes and identify risk factors for poor recovery.

Efficacy of Neck-Specific Exercise With Internet Support Versus Neck-Specific Exercise at a Physiotherapy Clinic in Chronic Whiplash-Associated Disorders: Multicenter Randomized Controlled Noninferiority Trial

BACKGROUND

Neck-specific exercises (NSE) supervised by a physiotherapist twice a week for 12 weeks have shown good results in chronic whiplash-associated disorders (WADs), but the effect of exercise delivered via the internet is unknown.

OBJECTIVE

This study examined whether NSE with internet support (NSEIT) and 4 physiotherapy sessions for 12 weeks were noninferior to the same exercises supervised by a physiotherapist twice a week for 12 weeks (NSE).

METHODS

In this multicenter randomized controlled noninferiority trial with masked assessors, we recruited adults aged 18-63 years with chronic WAD grade II (ie, neck pain and clinical musculoskeletal signs) or III (ie, grade II plus neurological signs). Outcomes were measured at baseline and at 3- and 15-month follow-ups. The primary outcome was change in neck-related disability, measured with the Neck Disability Index (NDI; 0%-100%), with higher percentages indicating greater disability. Secondary outcomes were neck and arm pain intensity (Visual Analog Scale [VAS]), physical function (Whiplash Disability Questionnaire [WDQ] and Patient-Specific Functional Scale [PSFS]), health-related quality of life (EQ-5D-3L and EQ VAS), and self-rated recovery (Global Rating Scale [GRS]). The analyses were conducted on an intention-to-treat basis and with the per-protocol approach as sensitivity analyses.

RESULTS

Between April 6, 2017, and September 15, 2020, 140 participants were randomly assigned to the NSEIT group (n=70) or the NSE group (n=70); 63 (90%) and 64 (91%), respectively, were followed up at 3 months, and 56 (80%) and 58 (83%), respectively, at 15 months. NSEIT demonstrated noninferiority to NSE in the primary outcome NDI, as the 1-sided 95% CI of the mean difference in change did not cross the specified noninferiority margin (7 percentage units). There were no significant between-group differences in change in NDI at the 3- or 15-month follow-up, with a mean difference of 1.4 (95% CI -2.5 to 5.3) and 0.9 (95% CI -3.6 to 5.3), respectively. In both groups, the NDI significantly decreased over time (NSEIT: mean change -10.1, 95% CI -13.7 to -6.5, effect size=1.33; NSE: mean change -9.3, 95% CI -12.8 to -5.7, effect size=1.19 at 15 months; P<.001). NSEIT was noninferior to NSE for most of the secondary outcomes except for neck pain intensity and EQ VAS, but post hoc analyses showed no differences between the groups. Similar results were seen in the per-protocol population. No serious adverse events were reported.

CONCLUSIONS

NSEIT was noninferior to NSE in chronic WAD and required less physiotherapist time. NSEIT could be used as a treatment for patients with chronic WAD grades II and III.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03022812; https://clinicaltrials.gov/ct2/show/NCT03022812.

Physiotherapists' experiences of internet-based neck-specific exercises for patients with chronic whiplash-associated disorders

Objective

Neck-specific exercises for individuals with chronic whiplash-associated disorders (WAD) have shown promising results, but there is also a need for more efficient and flexible ways of rehabilitation, such as use of digital health tools. Understanding physiotherapists' experiences of an internet-based tool may help to improve digital tools within physiotherapy. The purpose of this study was to describe how physiotherapists' experience an internet-based neck-specific exercise program for patients with chronic WAD.

Methods

This study has a qualitative design. Focus group discussions were held with physiotherapists who have been treating patients with chronic WAD, using an internet-based neck-specific exercises program in a randomized controlled multi-center trial in south and central Sweden. Three focus groups were held with three participants in each group. Phenomenography was applied as a research approach for data analysis.

Results

One main category was identified as "internet-based program as a complement to regular rehabilitation," with five descriptive sub-categories: (a) support in patient work; (b) usefulness based on a patient's prerequisites and preferences; (c) physiotherapist and patient interaction; (d) increasing efficiency in rehabilitation; and (e) enabling patient participation, autonomy and self-management.

Conclusions

From a physiotherapy perspective, an internet-based program could work as a method of complementary support to the standard rehabilitation treatment for patients with chronic WAD, as long as it is interactive and adjustable to the individual. The internet-based program could lead to increased autonomy and self-efficacy, and save resources and time for physiotherapists and patients. Further, more research is needed to strengthen these digital tools within the healthcare system.

Age-based differences in the disability of spine injuries in pediatric and adult motor vehicle crash occupants

OBJECTIVE

The objective was to develop a disability-based metric for quantifying disability rates as a result of motor vehicle crash (MVC) spine injuries and compare functional outcomes between pediatric and adult subgroups.

METHODS

Disability rate was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank-Research Data System for the top 95% most frequent Abbreviated Injury Scale (AIS) 3 spine injuries (14 unique injuries). Pediatric (7-18 years), young adult (19-45 years), middle-aged adult (46-65 years), and older adult (66+ years) MVC occupants with FIM scores available and at least one of the 14 spine injuries were included. FIM scores of 1 or 2 at time of discharge were used to define disability and correspond to full functional or modified dependence in self-feeding, locomotion, and/or verbal expression. Disability rate was evaluated on a per injury basis for each AIS 3 spine injury and calculated as the proportion of cases associated with disability (i.e. FIM of 1 or 2) out of the total cases of that particular injury. Disability rates were calculated with and without the exclusion of cases with severe co-injuries (AIS 4+) to minimize bias from additional non-spinal injuries that could have contributed to disability. Associations between adjusted disability rates and existing mortality rates were investigated.

RESULTS

Locomotion impairment alone was the most frequent disability type for the top 14 AIS 3 spine injuries (7 cervical, 4 thoracic, and 3 lumbar) across all age groups and spine regions. Adjusted and unadjusted disability rates ranged from 0-69%. Adjusted disability rates increased with age: 14.8 ± 10% (mean ± SD) in pediatrics to 16.2 ± 6.6% (young adults), 29.2 ± 10.9% (middle-aged adults), and 45.0 ± 12.2% (older adults). Among all adult populations, adjusted mortality and disability rates were positively correlated (R²>0.24), with disability rates consistently greater than corresponding mortality rates.

CONCLUSIONS

Older adults had significantly greater disability rates associated with MVC spine injuries across all spinal regions. MVC disability rates for pediatrics were considerably lower. Overall, rates of mortality were significantly lower than rates of disability. The adjusted disability rates developed can supplement existing injury metrics by accounting for age- and location-specific functional implications of MVC spine injuries.

Trauma outcomes in nonfatal road traffic accidents: a Portuguese medico-legal approach

The objective of this study was to compare the outcomes of nonfatal road traffic accidents by the victims’ age group and sex. We used the Portuguese medico-legal rules for personal injury assessment, in the scope of the Civil Law in that country, which includes a three-dimensional methodology. This was a retrospective study including 667 victims of road traffic accidents aged 3–94 years old. Their final medico-legal reports all used the Portuguese methodology for personal injury assessment. Outcomes were analysed by the victims’ age group (children, working-age adults, and older people) and sex. Road traffic accidents were generally serious (ISS mean 9.5), with higher severity in children and older people. The most frequent body sequelae were musculoskeletal (64.8%), which were associated with functional and situational outcomes. Temporary damage resulted in an average length of impairment of daily life of 199.6 days, 171.7 days to return to work, and an average degree of quantum doloris (noneconomic damage related to physical and psychological harm) of 3.7/7. The average permanent damage was 7.3/100 points for Permanent Functional Deficit, 0.43/3 for Permanent Professional Repercussion, 2/7 for Permanent Aesthetic Damage, 3.9/7 for Permanent Repercussion on Sexual Activity and 3.2/7 for Permanent Repercussion on Sport and Leisure Activities. Overall, 19% of people became permanently dependent (10.6% needed third-party assistance). The medico-legal methodology used, considering victims’ real-life situation, allows a comprehensive assessment. There were several significant differences among the three age groups but none between sexes. These differences and the impact of the more severe cases justify further detailed medico-legal studies in these specific situations on children, older people, and severely injured victims.

Key points:

This was a retrospective study of accident mechanisms and injury outcomes in Portugal, and considered the outcomes in the victims’ real-life situation.

Lesions from road traffic accidents were generally serious, with higher severity among children and older people.

The most frequent sequels were musculoskeletal, and associated with functional and situational outcomes.

Both temporary and permanent outcomes had repercussions for the victims.

There were significant differences between children, working-age adults and older people, but none between sexes.

Dynamic Responses of Female Volunteers in Rear Impact Sled Tests at Two Head Restraint Distances

The objective of this study was to assess the biomechanical and kinematic responses of female volunteers with two different head restraint (HR) configurations when exposed to a low-speed rear loading environment. A series of rear impact sled tests comprising eight belted, near 50th percentile female volunteers, seated on a simplified laboratory seat, was performed with a mean sled acceleration of 2.1 g and a velocity change of 6.8 km/h. Each volunteer underwent two tests; the first test configuration, HR10, was performed at the initial HR distance ∼10 cm and the second test configuration, HR15, was performed at ∼15 cm. Time histories, peak values and their timing were derived from accelerometer data and video analysis, and response corridors were also generated. The results were separated into three different categories, HR10_C (N = 8), HR15_C (N = 6), and HR15_NC (N = 2), based on: (1) the targeted initial HR distance [10 cm or 15 cm] and (2) whether the volunteers’ head had made contact with the HR [Contact (C) or No Contact (NC)] during the test event. The results in the three categories deviated significantly. The greatest differences were found for the average peak head angular displacements, ranging from 10° to 64°. Furthermore, the average neck injury criteria (NIC) value was 22% lower in HR10_C (3.9 m²/s²), and 49% greater in HR15_NC (7.4 m²/s²) in comparison to HR15_C (5.0 m²/s²). This study supplies new data suitable for validation of mechanical or mathematical models of a 50th percentile female. A model of a 50th percentile female remains to be developed and is urgently required to complement the average male models to enhance equality in safety assessments. Hence, it is important that future protection systems are developed and evaluated with female properties taken into consideration too. It is likely that the HR15 test configuration is close to the limit for avoiding HR contact for this specific seat setup. Using both datasets (HR15_C and HR15_NC), each with its corresponding HR contact condition, will be possible in future dummy or model evaluation.

Predictors of poor health and functional recovery following road trauma: protocol of a British Columbian inception cohort study

Introduction

Road trauma (RT) is a major public health problem affecting physical and mental health, and may result in prolonged absenteeism from work or study. It is important for healthcare providers to know which RT survivors are at risk of a poor outcome, and policy-makers should know the associated costs. Unfortunately, outcome after RT is poorly understood, especially for RT survivors who are treated and released from an emergency department (ED) without the need for hospital admission. Currently, there is almost no research on risk factors for a poor outcome among RT survivors. This study will use current Canadian data to address these knowledge gaps.

Methods and analysis

We will follow an inception cohort of 1500 RT survivors (16 years and older) who visited a participating ED within 24 hours of the accident. Baseline interviews determine pre-existing health and functional status, and other potential risk factors for a poor outcome. Follow-up interviews at 2, 4, 6, and 12 months (key stages of recovery) use standardised health-related quality of life tools to determine physical and mental health outcome, functional recovery, and healthcare resource use and lost productivity costs.

Ethics and dissemination

The Road Trauma Outcome Study is approved by our institutional Research Ethics Board. This study aims to provide healthcare providers with knowledge on how quickly RT survivors recover from their injuries and who may be more likely to have a poor outcome. We anticipate that this information will be used to improve management of all road users following RT. Healthcare resource use and lost productivity costs will be collected to provide a better cost estimate of the effects of RT. This information can be used by policy-makers to make informed decisions on RT prevention programmes.

Emergency Response to Vehicle Collisions: Feedback from Emergency Medical Service Providers

(1) Background: The purpose of this study is to identify emergency medical technicians’ perceptions of the most pressing issues that they experience when responding to motor vehicle collisions and record their opinions about what information is needed to improve the efficiency and effectiveness of the care they provide. (2) Methods: Emergency medical technicians participated in one-on-one structured interviews about their experiences responding to motor vehicle collisions. Their feedback on dispatching procedures and protocols, travel to and from the scene, and the response process was collected. (3) Results: Participants reported experiencing difficulties related to lack of or inaccuracies in information, interactions with traffic, incompatibility in communication technology, scene safety, resource management, and obtaining timely notifications of motor vehicle collisions. Regarding the type of information most needed to improve emergency medical response, respondents indicated a desire for additional data related to the vehicle and its occupants. (4) Conclusions: The early and widespread availability of this information is expected to aid emergency responders in coordinating necessary resources faster and more optimally, help service optimization in situations with multiple motor vehicle collisions in close temporal proximity, and improve on-scene safety for first responders and other necessary personnel.

Health status and quality of life among road users with permanent medical impairment several years after the crash

OBJECTIVE

Improvements in road infrastructure and vehicle safety have been achieved in many countries during the last decades. As the number of fatalities have dropped, the consequences of non-fatal injuries have been brought into focus. Therefore, the objective was to investigate self-reported health status and health-related quality of life several years after the crash for road-users that sustained injuries resulting in permanent medical impairment (PMI).

METHODS

A self-administered questionnaire using instruments to measure if health, health-related quality of life and physical activity had been affected by the crash, were used. The injured road-users were identified from insurance policy holders of the Folksam Insurance Group. The response rate was 29%, a total of 2078 responses were received from the 7174 road-users with PMI that received the questionnaire.

RESULTS

In total 85% were still suffering from the injuries several years after the crash (8-18 year after the crash). Furthermore, road-users with injuries to the spine were having highest pain intensity. Older road-users had poorer self-reported health status than younger road-users. Although, younger road-users had the greatest change in physical activity when comparing before and after the crash. Before the crash in total 63% were physically active while only 34% after the crash. The higher the PMI the higher it affected health several years after the crash.

CONCLUSIONS

The Swedish definition of serious injury, an injury leading to PMI, was found to correlate with self-reported health loss; 85% of the injured road-users reported that they still had remaining symptoms several years after the accident. The injured body region leading to PMI after an accident can vary from the body regions reported to cause long-term health loss. It was found that the higher the degree of PMI the higher the health loss. Sustaining a PMI regardless severity and injured body region has the same effects on general health for men and women. Sustaining a PMI will both lower the health-related quality of life and physical activity after the crash compared to before.

Sickness absence, disability pension and permanent medical impairment among 64 000 injured car occupants of working ages: A two-year prospective cohort study

OBJECTIVE

There is a lack of knowledge regarding sickness absence (SA) and disability pension (DP) as consequences of road traffic injuries, and on the association between DP and permanent medical impairment (PMI). Therefore, the aim of this study was to investigate SA, DP, and PMI among injured passenger car occupants two years after a crash, and how they are associated, accounting for sociodemographics, crash-related factors, and previous SA/DP.

METHODS

This prospective cohort study included 64 007 injured car occupants aged 17-62 years at the time of a crash occurring in 2001-2013, involving a car insured at Folksam Insurance Group in Sweden. Information on sociodemographics, crash-related factors, SA (in SA spells >14 days) and DP status at inclusion and at two-year follow-up, and PMI assessed by the insurance company was used. PMI grades were categorized as 1-4, 5-9, 10-19, or >19%. Logistic regression was performed to calculate odds ratios (OR) with 95% confidence intervals (CI) for DP at follow-up and for PMI, respectively.

RESULTS

At the time of the crash 13% were already on SA or DP. At follow-up two years after the crash, 6% among those not already on SA/DP at the time of the crash were on SA and 2% on DP. Furthermore, 8% of the total cohort had a determined PMI. Among those not already on DP at the crash, 3% with no PMI had DP at follow-up. This proportion was higher the higher PMI grade. Among individuals without already ongoing DP at the crash date, 10% of those with a PMI 1-4 ha d DP, compared to 76% among PMI ≥ 20. Already ongoing SA at the time of the crash (OR = 39.16, 95% CI 34.89-43.95) and PMI grade (PMI ≥ 5 OR = 27.44, 95% CI 23.88-31.52, reference group PMI 0) were found to be associated with DP at two years after crash. The factor most strongly associated with PMI was the model year of the car. The older the car, the higher the risk of PMI (Model year ≤ 1990 OR = 3.36, 95% CI 2.67-4.23, reference group model year 2006-2010). An association with the same direction was also found between the model year of the car and DP at follow-up.

CONCLUSIONS

The association between PMI grade and DP status at follow-up among occupants not on DP at the crash date indicates that both could be used to measure long-term consequences of road traffic injury. In this cohort, already ongoing SA at the crash date was associated with DP at the two-year follow-up, emphasizing the importance of accounting for this factor in future research.

How safe is tuning a radio?: using the radio tuning task as a benchmark for distracted driving

Drivers engage in non-driving tasks while driving, such as interactions entertainment systems. Studies have identified glance patterns related to such interactions, and manual radio tuning has been used as a reference task to set an upper bound on the acceptable demand of interactions. Consequently, some view the risk associated with radio tuning as defining the upper limit of glance measures associated with visual-manual in-vehicle activities. However, we have little knowledge about the actual degree of crash risk that radio tuning poses and, by extension, the risk of tasks that have similar glance patterns as the radio tuning task. In the current study, we use counterfactual simulation to take the glance patterns for manual radio tuning tasks from an on-road experiment and apply these patterns to lead-vehicle events observed in naturalistic driving studies. We then quantify how often the glance patterns from radio tuning are associated with rear-end crashes, compared to driving only situations. We used the pre-crash kinematics from 34 crash events from the SHRP2 naturalistic driving study to investigate the effect of radio tuning in crash-imminent situations, and we also investigated the effect of radio tuning on 2,475 routine braking events from the Safety Pilot project. The counterfactual simulation showed that off-road glances transform some near-crashes that could have been avoided into crashes, and glance patterns observed in on-road radio tuning experiment produced 2.85-5.00 times more crashes than baseline driving.

Incidence and body location of reported acute sport injuries in seven sports using a national insurance database

Sports with high numbers of athletes and acute injuries are an important target for preventive actions at a national level. Both for the health of the athlete and to reduce costs associated with injury. The aim of this study was to identify injuries where injury prevention should focus, in order to have major impact on decreasing acute injury rates at a national level. All athletes in the seven investigated sport federations (automobile sports, basketball, floorball, football (soccer), handball, ice hockey, and motor sports) were insured by the same insurance company. Using this insurance database, the incidence and proportion of acute injuries, and injuries leading to permanent medical impairment (PMI), at each body location, was calculated. Comparisons were made between sports, sex, and age. In total, there were 84 754 registered injuries during the study period (year 2006-2013). Athletes in team sports, except in male ice hockey, had the highest risk to sustain an injury and PMI in the lower limb. Females had higher risk of injury and PMI in the lower limb compared to males, in all sports except in ice hockey. This study recommends that injury prevention at national level should particularly focus on lower limb injuries. In ice hockey and motor sports, head/neck and upper limb injuries also need attention.

A review of the revised Functional Capacity Index as a predictor of 12 month outcomes following injury

The measurement of functional outcomes following severe trauma has been widely recognised as a priority for countries with developed trauma systems. In this respect, the Functional Capacity Index (FCI), a multi-attribute index which has been incorporated into the most recent Abbreviated Injury Scale (AIS) dictionary, is potentially attractive as it offers 12-month functional outcome predictions for patients captured by existing AIS-coded datasets. This review paper outlines the development, construction and validation of the predictive form of the FCI (termed the pFCI), the modifications made which produced the currently available 'revised' pFCI, and the extent to which the revised pFCI has been validated and used. The original pFCI performed poorly in validation studies. The revised pFCI does not address many of the identified limitations of the original version, and despite the ready availability of a truncated version in the AIS dictionary, it has only been used in a handful of studies since its introduction several years ago. Additionally, there is little evidence for its validity. It is suggested that the pFCI should be better validated, whether in the narrow population group of young, healthy individuals for which it was developed, or in the wider population of severely injured patients. Methods for accounting for the presence of multiple injures (of which two have currently been used) should also be evaluated. Many factors other than anatomical injury are known to affect functional outcomes following trauma. However, it is intuitive that any model which attempts to predict the ongoing morbidity burden in a trauma population should consider the effects of the injuries sustained. Although the revised pFCI potentially offers a low-cost assessment of likely functional limitations resulting from anatomical injury, it must be more rigorously evaluated before more comprehensive predictive tools can be developed from it.

Prehospital transportation decisions for patients sustaining major trauma in road traffic crashes in Sweden

OBJECTIVE

The objective of this study was to evaluate the proportion and characteristics of patients sustaining major trauma in road traffic crashes (RTCs) who could benefit from direct transportation to a trauma center (TC).

METHODS

Currently, there is no national classification of TC in Sweden. In this study, 7 university hospitals (UHs) in Sweden were selected to represent a TC level I or level II. These UHs have similar capabilities as the definition for level I and level II TC in the United States. Major trauma was defined as Injury Severity Score (ISS) > 15. A total of 117,730 patients who were transported by road or air ambulance were selected from the Swedish TRaffic Accident Data Acquisition (STRADA) database between 2007 to 2014. An analysis of the patient characteristics sustaining major trauma in comparison with patients sustaining minor trauma (ISS < 15) was conducted. Major trauma patients transported to a TC versus non-TC were further analysed with respect to injured body region and road user type.

RESULTS

Approximately 3% (n = 3, 411) of patients sustained major trauma. Thirty-eight percent of major trauma patients were transported to a TC, and 62% were transported to a non-TC. This results in large proportions of patients with Abbreviated Injury Scale (AIS) 3+ injuries being transported to a non-TC.  The number of AIS 3+ head injuries for major trauma patients transported to a TC versus non-TC were similar, whereas a larger number of AIS 3+ thorax injuries were present in the non-TC group. The non-TC major trauma patients had a higher probability of traveling in a car, truck, or bus and to be involved in a crash in a rural location.

CONCLUSIONS

Our results show that the majority of RTC major trauma patients are transported to a non-TC. This may cause unnecessary morbidity and mortality. These findings can guide the development of improved prehospital treatment guidelines, protocols and decision support systems.

Transient pressure changes in the vertebral canal during whiplash motion--A hydrodynamic modeling approach

In vehicle collisions, the occupant's torso is accelerated in a given direction while the unsupported head tends to lag behind. This mechanism results in whiplash motion to the neck. In whiplash experiments conducted for animals, pressure transients have been recorded in the spinal canal. It was hypothesized that the transients caused dorsal root ganglion dysfunction. Neck motion introduces volume changes inside the vertebral canal. The changes require an adaptation which is likely achieved by redistribution of blood volume in the internal vertebral venous plexus (IVVP). Pressure transients then arise from the rapid redistribution. The present study aimed to explore the hypothesis theoretically and analytically. Further, the objectives were to quantify the effect of the neck motion on the pressure generation and to identify the physical factors involved. We developed a hydrodynamic system of tubes that represent the IVVP and its lateral intervertebral vein connections. An analytical model was developed for an anatomical geometrical relation that the venous blood volume changes with respect to the vertebral angular displacement. This model was adopted in the hydrodynamic tube system so that the system can predict the pressure transients on the basis of the neck vertebral motion data from a whiplash experiment. The predicted pressure transients were in good agreement with the earlier experimental data. A parametric study was conducted and showed that the system can be used to assess the influences of anatomical geometrical properties and vehicle collision severity on the pressure generation.

Differences in long-term medical consequences depending on impact direction involving passenger cars

OBJECTIVE

There is limited knowledge of the long-term medical consequences for occupants injured in car crashes in various impact directions. Thus, the objective was to evaluate whether injuries leading to permanent medical impairment differ depending on impact direction.

METHODS

In total, 36,743 injured occupants in car crashes that occurred between 1995 and 2011 were included. All initial injuries (n = 61,440) were classified according to the Abbreviated Injury Scale (AIS) 2005. Injured car occupants were followed for at least 3 years to assess permanent medical impairment. The data were divided into different groups according to impact direction and levels of permanent impairment. The risk of permanent medical impairment was established for different body regions and injury severity levels, according to AIS.

RESULTS

It was found that almost 12% of all car occupants sustained a permanent medical impairment. Given an injury, car occupants involved in rollover crashes had the highest overall risk to sustain a permanent medical impairment. Half of the head injuries leading to long-term consequences occurred in frontal impacts. Far-side occupants had almost the same risk as near-side occupants. Occupants who sustained a permanent medical impairment from cervical spine injuries had similar risk in all impact directions (13%) except from rollover (17%). However, these injuries occurred more often in rear crashes. Most of the injuries leading to long-term consequences were classified as minor injuries by AIS for all impact directions.

CONCLUSIONS

Studying crash data from a perspective of medical impairment is important to identify injuries that might not be prioritized only considering the AIS but might lead to lower quality of life for the occupant and also costs for society. These results can be used for road transport system strategies and for making priority decisions in vehicle design.