Non-seatbelt use and associated factors among passengers

Survival rates in atlanto-occipital dissociation: a look at the past 20 years

BACKGROUND CONTEXT

Atlanto-occipital dissociation (AOD) has historically been considered a fatal injury. Recent small case series, however, have suggested that AOD injuries have become increasingly survivable. There has not been an adequately powered study that confirms this.

PURPOSE

The aim of this study is to assess whether the survival rate for patients with AOD increased over time.

STUDY DESIGN/SETTING

Retrospective case series.

PATIENT SAMPLE

Patients with traumatic AOD identified from our Level 1 Trauma Center database.

OUTCOME MEASURES

Mortality following traumatic AOD.

METHODS

Patients with traumatic AOD from 1996 to 2019 were retrospectively identified from our Level 1 Trauma Center database using International Classification of Diseases 9 and 10 codes. Patients were stratified into two cohorts- those diagnosed before August 1, 2015 and after.

RESULTS

A total of 52 patients met our inclusion criteria and were analyzed. Mean age was 34.41 (11.71), with 34 (65.4) females, and 26 (50) Hispanics. Mean BMI was 28.13 (7.30), mean injury severity score was 40.79 (21.72), and mean Glasgow coma scale was 5.91 (4.72). Overall, 33 patients died (63.5%). The mortality rate before 2015 was 81.80%, this number dropped down to 50% for those who were treated post 2015 (p=.01).

CONCLUSIONS

This study demonstrates that patients treated recently for AOD at a level 1 trauma center were more likely to survive than patients treated in the past at the same center. Possible reasons for the improved survival rate seen in this study include: increased awareness of AOD, improved diagnostic protocols with more uniform computed tomography based imaging, and advances in the care of these patients.

Observed relationships between driver and passenger restraint use in the front and rear seats

OBJECTIVE

Seat belt usage has increased substantially since the 1960s, yet driver use continues to affect passenger usage. Recent observational restraint use findings for Maryland will examine the relationship between driver and passenger usage, including adults and children in the rear seat.

METHODS

Analyses were based on observational front and rear seat studies administered in parallel from 2016 to 2019. A statistically rigorous front seat project yielded weighted results among drivers and outboard passengers. A study of adults and children in the rear seat was based on a convenience sample of vehicles. Restraint usage results were presented as frequencies and proportions among occupants with known belt use, along with the 95% confidence interval for overall rates.

RESULTS

Overall restraint usage rates averaged 90.9% in the front seat study and 81.1% in the rear seat sample. In vehicles with two front seat occupants and a belted driver, the proportion of belted passengers averaged 93.0% over four years. However, among unbelted drivers, only 41.6% of passengers were belted on average. In the rear seat study, an average of 82.7% were belted in vehicles driven by a restrained driver, differing for children (92.0%) versus adults (70.4%). Analysis of vehicles with an unbelted driver revealed an average of 45.0% of belted rear seat occupants, with a considerable difference for children (65.0%) compared with adults (21.0%).

CONCLUSIONS

Observational seat belt studies in Maryland in recent years have shown that, despite overall rates above 80%, passenger use in both the front and rear seats is associated with driver restraint use.

Rear-seat seatbelt use in urban Southeast Asia: results from Bandung and Bangkok

Road traffic injuries (RTIs) remain a leading cause of morbidity and mortality in Southeast Asia. We aim to estimate the prevalence and predictors of rear seatbelt use, a key behavioural risk factor for RTI, in Bandung and Bangkok, two cities in Southeast Asia. Roadside observational studies were conducted to provide a representative picture of the prevalence in each city. From eight rounds of observations (July 2015 to April 2019), 39,479 and 7,207 rear-seat passengers were observed in Bandung and Bangkok. Across all rounds, 4.2% of rear-seat passengers used seatbelts in Bandung, compared to 8.4% in Bangkok. In both cities, males and adults, as compared to females and adolescents (aged 12-17 years), had higher odds of rear seatbelt use, as did passengers with a restrained driver. Findings highlight the need for rear seatbelt laws in Bandung and improved enforcement of existing rear seatbelt laws in Bangkok.

Seatbelts Save Lives, and Spines, in Motor Vehicle Accidents: A Review of the National Trauma Data Bank in the Pediatric Population

STUDY DESIGN

Database study.

OBJECTIVE

The purpose of this study was to use a large, nationwide database to determine prevalence of pediatric spine fractures in the United States, associated injuries, mechanisms of injury (MOI), use of safety devices, and mortality rates.

SUMMARY OF BACKGROUND DATA

Spinal fractures account for 1% to 2% of pediatric injuries. However, they are associated with significant comorbidities and complications. Motor vehicle accidents (MVAs) are most responsible for increased incidence observed.

METHODS

Retrospective review of National Trauma Data Bank between 2009 and 2014 (analysis in 2019) for all vertebral fractures in patients under 18 years of age. Subanalysis included those in MVAs where protective device use data were available. Patient demographics, MOI, geographical and anatomical region of injury, concomitant musculoskeletal/organ injury, protective device usage, hospital length of stay, surgical procedures, and mortality were all analyzed.

RESULTS

A total of 34,563 patients with 45,430 fractured vertebrae included. Median age was 15 years. Most fractures (63.1%) occurred in patients aged 15 to 17 years, most frequent MOI was MVA (66.8%), and most common geographic location was the South (38%). Males sustained more spine fractures than females, overall (58.4% vs. 41.6%; P < 0.001) and in MVAs (54.4% vs. 45.6%; P < 0.001). Those in MVAs wearing seatbelts had lower odds of cranial (29.6% vs. 70.4%; odds ratio [OR] = 0.85, 95% confidence interval [CI]: 0.82-0.89; P < 0.001) and thoracic (30.1% vs. 69.9%; OR = 0.88, 95% CI: 0.84-0.91; P < 0.001) organ injury, multivertebral (30% vs. 70%; OR = 0.78, 95% CI: 0.73-0.83; P < 0.001) and concomitant nonvertebral fractures (30.9% vs. 69.1%; OR = 0.89, 95% CI:0.73-0.83; P < 0.001), and 21% lower odds of mortality (29.3% vs. 70.7%; OR = 0.79, 95% CI: 0.66-0.94; P = 0.009). Over 70% of drivers were not restrained during MVA, with majority of seatbelt violations incurred by males, ages 15 to 17, in the South.

CONCLUSION

Over 60% of pediatric spinal fractures occur in children aged 15 to 17 years, coinciding with the beginning of legal driving. MVA is the most common cause and has significant association with morbidity/mortality. Nearly two- thirds pediatric spinal fractures sustained in MVAs occurred without seatbelts. Absence of seatbelts associated with >20% greater odds of mortality. Ensuring new drivers wear protective devices can greatly reduce morbidity/ mortality associated with MVA.Level of Evidence: 3.

Correlates of front-seat passengers' non-use of seatbelts at night

When properly worn, seatbelts can save lives. They are designed to prevent occupants from hitting objects inside their vehicle and from being ejected out of their vehicle in the event of a crash. Despite their proven effectiveness in reducing the severity of injuries, seatbelt non-use among passengers still remains a problem, especially at night. Although the factors associated with not using a seatbelt have been widely studied, research studies documenting this behavior at night are limited in the literature. The primary objective of this paper is to explore the factors related to front-seat passengers' seatbelt non-use at night using a 2015-2016 longitudinal observation survey conducted in five counties in East Tennessee. The Generalized Estimating Equation, a rigorous modeling technique, is employed for the data analysis. The findings show that front-seat passengers who are most likely to not wear seatbelts at night are males, traveling in passenger cars and pickup trucks, traveling during the first half of the year (January to June), traveling late at night (after 10 p.m) and on local streets. The findings also indicate that drivers may have the greatest influence on their accompanying passengers' seatbelt use. That is, when drivers fail to wear seatbelts at night, their accompanying front-seat passengers are more likely to fail as well. The model results show that there are many consistent correlations between the non-use of seatbelts and personal, vehicle and environmental characteristics. Accounting for these factors may be important when developing intervention strategies that promote nighttime seatbelt use.

Nighttime seat belt use among front seat passengers: Does the driver's belt use matter?

INTRODUCTION AND METHOD

We explored the relationship between nighttime seat belt use of right-front passengers and their drivers using observational data from 33,310 vehicles in east Tennessee during March 2015 - May 2017.

RESULTS

Overall, nighttime passenger seat belt use varied by 50 percentage points from 92% when drivers were belted to 42% when drivers were not belted, suggesting that part-time seat belt users can be heavily influenced by the seat belt status of their traveling companions. When stratified by vehicle type and sex, passenger seat belt use by driver seat belt status varied as much as 74 percentage points from 96% to 22%. Passenger seat belt use was typically lower when riding with unbelted same-sex drivers than when riding with unbelted drivers of the opposite sex. Conclusions and Practical Applications: This finding suggests that the role of peer influence in decision-making about seat belt use may differ depending on the sex of a vehicle driver and his or her passengers. Further research is warranted to explore this finding as well as other social and cultural influences that have not been fully examined in seat belt research.

Factors Associated With Unrestrained Young Passengers in Motor Vehicle Crashes

: media-1vid110.1542/5984244682001PEDS-VA_2018-2507Video Abstract BACKGROUND AND OBJECTIVE: Unrestrained child passengers are at significant risk of crash-related injury. Previous researchers using nationally representative crash data from 1992 to 1993 found an association between driver and passenger safety-belt use. Our objective in this study is to investigate factors associated with young, unrestrained passengers in fatal and nonfatal motor vehicle crashes using updated national crash data.

METHODS

We analyzed 2011-2015 Fatality Analysis Reporting System and National Automotive Sampling System data and included vehicles with a young passenger (≤19 years old) in a crash. Driver and passenger characteristics were compared by using bivariate analyses separately for fatal and nonfatal crashes. Logistic regression analyses were performed on a combined data set to predict passenger restraint use.

RESULTS

In unadjusted bivariate models, unrestrained drivers had a higher probability of having an unrestrained passenger across all passenger age groups for both fatal and nonfatal crashes. In multivariate logistic regression models that included both fatal and nonfatal crashes and were adjusted for several driver and passenger characteristics, unrestrained drivers had a higher risk of having an unrestrained young passenger across all age groups.

CONCLUSIONS

In both fatal and nonfatal crashes, a driver being unrestrained is a strong predictor of the child passenger also being unrestrained. Policy and regulation to better ensure that drivers are properly restrained (eg, expanding primary seat-belt laws to all states) may serve as effective means for increasing rates of proper child-occupant-restraint use.