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Franceschetti L, Galante N, Ciprandi B, Benini B, Mazzarelli D, Cattaneo C. Identification issues in bodies maimed by train fatalities: The role of the forensic pathologist. Forensic Sci Med Pathol 2023; 19:517-524. [PMID: 36662408 DOI: 10.1007/s12024-022-00571-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 01/21/2023]
Abstract
Traffic accident injuries are relevant causes of mortality in industrialized countries. Among traffic accidents, the most destructive effect on the victim's body is produced by trains, which in a very short time provoke a complete distortion of the normal anatomical profiles and extensive amputations of the body. Deaths by severe body mutilation and/or decapitation require complex forensic investigation, as the victims' identification and the recognition of their body are not often feasible. In this study, a retrospective analysis of a series of cases of railway accidents is presented, with the aim of showing potential identification strategies, including a systematic physical re-assembling of the body. Among the railway fatalities assessed at the University Institute of Legal Medicine of Milan from 2016 until 2020, 61 cases were analyzed, focusing on the collection of postmortem data to improve accuracy for the identification of the victims. The results showed that the identification could be based on elements traditionally called "secondary identifiers" which, however, are becoming more and more important for positive identification, especially when dealing with migrants, vagrants, and homeless people. However, several issues need to be considered such as the limitations of the public prosecutors to perform expensive analyses (i.e., genetic testing), and the lack of antemortem data to be compared with postmortem findings, both odontological and fingerprint. In cases where it is not possible to proceed with identification or formal recognition of victims of railroad accidents with severe mutilations, a systematic physical re-assembling of the body is critical to reaching positive identification.
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Affiliation(s)
- Lorenzo Franceschetti
- LABANOF, Laboratorio di Antropologia e Odontologia Forense, Dipartimento di Scienze Biomediche per la Salute, Istituto di Medicina Legale, Università degli Studi di Milano, via Luigi Mangiagalli 37, Milan, 20133, Italy.
| | - Nicola Galante
- LABANOF, Laboratorio di Antropologia e Odontologia Forense, Dipartimento di Scienze Biomediche per la Salute, Istituto di Medicina Legale, Università degli Studi di Milano, via Luigi Mangiagalli 37, Milan, 20133, Italy
| | - Barbara Ciprandi
- LABANOF, Laboratorio di Antropologia e Odontologia Forense, Dipartimento di Scienze Biomediche per la Salute, Istituto di Medicina Legale, Università degli Studi di Milano, via Luigi Mangiagalli 37, Milan, 20133, Italy
| | - Benedetta Benini
- LABANOF, Laboratorio di Antropologia e Odontologia Forense, Dipartimento di Scienze Biomediche per la Salute, Istituto di Medicina Legale, Università degli Studi di Milano, via Luigi Mangiagalli 37, Milan, 20133, Italy
| | - Debora Mazzarelli
- LABANOF, Laboratorio di Antropologia e Odontologia Forense, Dipartimento di Scienze Biomediche per la Salute, Istituto di Medicina Legale, Università degli Studi di Milano, via Luigi Mangiagalli 37, Milan, 20133, Italy
| | - Cristina Cattaneo
- LABANOF, Laboratorio di Antropologia e Odontologia Forense, Dipartimento di Scienze Biomediche per la Salute, Istituto di Medicina Legale, Università degli Studi di Milano, via Luigi Mangiagalli 37, Milan, 20133, Italy
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Thiery C, Jost D, Scannavino M, Lemoine F, Travers S. Epidemiology and prehospital medical management of railroad victims in Paris and its suburbs: a retrospective study. Eur J Emerg Med 2023; 30:379-380. [PMID: 37650743 DOI: 10.1097/mej.0000000000001071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
- Christophe Thiery
- Intensive Care Unit, Emile Durkheim Hospital, Epinal
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | - Daniel Jost
- Paris Fire Brigade Medical Emergency Department, Paris, France
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Kontoghiorghe CN, Graham SM, Rodriguez J, Matzopoulos R, Maqungo S. Train related injuries: A descriptive analysis highlighting orthopaedic injuries and management. SICOT J 2021; 7:43. [PMID: 34402792 PMCID: PMC8370016 DOI: 10.1051/sicotj/2021038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/04/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Orthopaedic injuries constitute a major aspect of morbidity and mortality following train accidents. The pattern of orthopaedic/musculoskeletal injuries sustained following these accidents has not been fully characterised. The main aim of this study is to describe the range of orthopaedic injuries reported in a major trauma centre and evaluate their management, as well as reporting mortality and amputation rates. Further aims are to identify the social and demographic background of the patients to suggest treatment and prevention strategies. Methods: This study is a retrospective observation of all clinical files of patients presented to Level 1 Trauma Centre in Cape Town, South Africa, as “train casualty” from January 2013 to July 2019, which were reviewed and evaluated. A total of 174 patients were included, of which 92 were orthopaedic referrals. The average age was 29 years, and 87% were male. Results: Tibial fractures were most common (N = 19), 38% of patients sustained open fractures, and 68% of patients (in total) underwent surgery. Wound debridement was the most common operation, followed by open reduction internal fixation (ORIF). Twelve patients (13%) underwent amputation to 14 body parts. Eight patients (4.6%) (in total) died in the trauma unit. Discussion: This study provides insight into train accident victims and their orthopaedic injuries and management patterns. The victims are largely young males. The majority of orthopaedic injuries require surgical intervention, and those who make it to the hospital have a good chance of survival and limb salvage. It appears that in addition to early hospital access and specialised updated treatments, morbidity and mortality in train accidents could be reduced by improving safety measures and social awareness to reduce railway violence and accidents.
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Affiliation(s)
- Christina Niovi Kontoghiorghe
- Division of Orthopaedic Surgery, Groote Schuur Hospital, 7935 Cape Town, South Africa - University College London Hospitals NHS Foundation Trust, NW1 2BU London, UK
| | - Simon Matthew Graham
- Division of Orthopaedic Surgery, Groote Schuur Hospital, 7935 Cape Town, South Africa - Institute of Population Health Sciences, University of Liverpool, L69 3BX Liverpool, UK - Department of Orthopaedic and Trauma Surgery, Liverpool University Teaching Hospital Trust, L9 7AL Liverpool, UK
| | - Joel Rodriguez
- Division of Orthopaedic Surgery, Groote Schuur Hospital, 7935 Cape Town, South Africa - University of Texas Southwestern Medical Center, Dallas, 75390 TX, USA
| | - Richard Matzopoulos
- Burden of Disease Research Unit, South African Medical Research Council, 7505 Cape Town, South Africa - School of Public Health and Family Medicine, University of Cape Town, 7925 Cape Town, South Africa
| | - Sithombo Maqungo
- Division of Orthopaedic Surgery, Groote Schuur Hospital, 7935 Cape Town, South Africa - Division of Global Surgery, University of Cape Town, 7925 Cape Town, South Africa
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Bagaria DK, Banerjee N, Gupta A, Kumar S, Mishra B, Choudhary N, Kumar A, Priyadarshini P, Sagar S, R M Pandey. Train-Associated Injuries Pose a Significant Burden on Trauma Care Systems of Emerging Economies. World J Surg 2021; 44:2993-2999. [PMID: 32383056 PMCID: PMC7224012 DOI: 10.1007/s00268-020-05563-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Indian railway system is the fourth largest in the world and causes about 15 deaths every day, due to intentional or unintentional reasons. This study presents a 5-year retrospective analysis of patients injured due to train-associated events, managed at a level-1 trauma center in India. MATERIALS AND METHODS Hospital-based trauma registry data of train-associated injuries presenting between 2012 and 2016 were analyzed. Data from 726 patients were analyzed for demographics, injury events, injury regions, their management and outcomes. ISS and NISS were used to quantify the injury severity. RESULTS Mean age was 33 years, with male-to-female ratio 86 to 14%. The majority of patients (62%) were between 20-40 years. The median ISS was 9 (IQR 4-16), median hospital stays 11 days (IQR6-23), with in-hospital mortality of 17.4%. Presence of head injury; ISS > 9 and CPR in ED were independent risk factors of mortality. Trespassers on the rail track had significantly more severe injuries compared to passengers (Median ISS 13 vs. 9, p = 0.012; Median NISS 22 vs.17, p = 0.015); however, mortality and hospital length of stay were not significantly different. Location of injury event (on platform or tracks) showed no difference between the severity of injuries, mortality and hospital length of stay. CONCLUSIONS Current study reports comprehensive injury patterns and outcomes of train-associated injuries from a low- and middle-income country (LMIC). Apart from the mortality, there is a high incidence of permanent disabilities from extremity amputations. No significant difference was noted in the severity and outcomes among patients injured on or off train platforms, emphasizing the need for comprehensive safety measures including enforcement and promoting safe behavior not only on locations like train tracks but equally at platforms.
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Affiliation(s)
- Dinesh Kumar Bagaria
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Niladri Banerjee
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Gupta
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
| | - Subodh Kumar
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Biplab Mishra
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Narendra Choudhary
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Abhinav Kumar
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Pratyusha Priyadarshini
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Sagar
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Dept. of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Byerly S, Inaba K, Biswas S, Cheng V, Cho J, Wang E, Strumwasser A, Matsushima K, Demetriades D. Hit by a Train: Injury Burden and Clinical Outcomes. J Emerg Med 2019; 57:6-12. [PMID: 31078347 DOI: 10.1016/j.jemermed.2019.03.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 03/17/2019] [Accepted: 03/30/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Few data exist regarding the train vs. pedestrian (TVP) injury burden and outcomes. OBJECTIVE This study aimed to examine the epidemiology and outcomes associated with TVP injuries. METHODS This is a retrospective National Trauma Databank study (January 2007 to July 2012) including trauma patients sustaining TVP injury. Demographics, injury data, interventions, and outcomes were abstracted. Patients injured by a train were compared to patients who sustained an automobile vs. pedestrian (AVP) injury. RESULTS Of the 152,631 patients struck by ground transportation during the study time frame, 1863 (1.2%) were TVP. Median TVP age was 38 years (interquartile range [IQR] 24-50 years), 81.6% were male, median Injury Severity Score (ISS) was 13 (IQR 6-24). TVP patients were more severely injured (ISS 13 vs. 9; p < 0.001) and required more proximal amputations (13.4% vs. 0.2%; p < 0.001) and cavitary operations (18.2% vs. 2.8%; p < 0.001). TVP patients had higher rates of intensive care unit admission, mechanical ventilation and transfusion, longer length of stay, and higher in-hospital mortality. On multivariable logistical regression, TVP was an independent predictor for higher injury burden, ISS ≥25 (adjusted odds ratio [AOR] 1.650), immediate operative need (AOR 7.535), and complications (AOR 1.317). CONCLUSIONS TVP is associated with a significant injury burden. These patients have a significantly higher need for immediate operation and more complicated hospital course.
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Affiliation(s)
- Saskya Byerly
- Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Kenji Inaba
- Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Subarna Biswas
- Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Vince Cheng
- Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Jayun Cho
- Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Eugene Wang
- Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Aaron Strumwasser
- Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Kazuhide Matsushima
- Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Demetrios Demetriades
- Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
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Ghomi H, Bagheri M, Fu L, Miranda-Moreno LF. Analyzing injury severity factors at highway railway grade crossing accidents involving vulnerable road users: A comparative study. TRAFFIC INJURY PREVENTION 2016; 17:833-841. [PMID: 26980425 DOI: 10.1080/15389588.2016.1151011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 02/02/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The main objective of this study is to identify the main factors associated with injury severity of vulnerable road users (VRUs) involved in accidents at highway railroad grade crossings (HRGCs) using data mining techniques. METHODS This article applies an ordered probit model, association rules, and classification and regression tree (CART) algorithms to the U.S. Federal Railroad Administration's (FRA) HRGC accident database for the period 2007-2013 to identify VRU injury severity factors at HRGCs. RESULTS The results show that train speed is a key factor influencing injury severity. Further analysis illustrated that the presence of illumination does not reduce the severity of accidents for high-speed trains. In addition, there is a greater propensity toward fatal accidents for elderly road users compared to younger individuals. Interestingly, at night, injury accidents involving female road users are more severe compared to those involving males. CONCLUSIONS The ordered probit model was the primary technique, and CART and association rules act as the supporter and identifier of interactions between variables. All 3 algorithms' results consistently show that the most influential accident factors are train speed, VRU age, and gender. The findings of this research could be applied for identifying high-risk hotspots and developing cost-effective countermeasures targeting VRUs at HRGCs.
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Affiliation(s)
- Haniyeh Ghomi
- a School of Railway Engineering , Iran University of Science and Technology , Tehran , Iran
| | - Morteza Bagheri
- a School of Railway Engineering , Iran University of Science and Technology , Tehran , Iran
| | - Liping Fu
- b Department of Civil and Environmental Engineering , University of Waterloo , Waterloo , Ontario , Canada
| | - Luis F Miranda-Moreno
- c Department of Civil and Applied Mechanics , McGill University , Montreal , Quebec , Canada
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A train-related fatality—old dilemmas: accident, suicide, or homicide? Premortem or postmortem decapitation? Forensic Sci Med Pathol 2014; 10:278-83. [DOI: 10.1007/s12024-013-9509-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2013] [Indexed: 11/26/2022]
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Nagesh K, Babu YR, Palimar V, Manjunath S, Rastogi P. Excavation of the chest due to railway mishap. AUST J FORENSIC SCI 2012. [DOI: 10.1080/00450618.2011.620005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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10
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Lumenta DB, Vierhapper MF, Kamolz LP, Keck M, Frey M. Train surfing and other high voltage trauma: differences in injury-related mechanisms and operative outcomes after fasciotomy, amputation and soft-tissue coverage. Burns 2011; 37:1427-34. [PMID: 21852047 DOI: 10.1016/j.burns.2011.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Revised: 07/21/2011] [Accepted: 07/22/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND In the context of scarce reports on train surfers among high voltage electric injuries, we conducted a retrospective review between January 1994 and December 2008. METHODS After matching for inclusion criteria we reviewed patient records of 37 true high voltage injuries (12 train surfers [TS] and 25 other high voltage injuries [HV]). RESULTS TS were significantly younger (TS 15.8 years vs. HV 33.3 years, p<0.0001), and had a greater %TBSA (TS 49.7%TBSA vs. HV 21.5%TBSA, p=0.0003) without affecting the median length-of-stay (TS 52 days vs. HV 49 days) or number of operations (TS 4 vs. HV 3). TS had different injury patterns, with a higher percentage of affected extremities (TS 72.9% vs. HV 52.0%, p=0.0468) and associated injuries (TS 58% vs. HV 20%, n.s.) than HV. Both groups demonstrated comparable fasciotomy (TS 71.4% vs. HV 55.8%) and amputation rates (TS 17.1% vs. HV 15.4%). While TS required less flaps (TS 3/12 vs. HV 18/25; p=0.0153), soft-tissue reconstruction revealed an overall low incidence of complication rates (one partial pedicled flap loss and two total free flap losses). CONCLUSIONS Train surfers have proven to be a distinct group of patients among high-voltage injuries notably as a result of a younger age, a shorter electric contact duration and higher velocity-induced trauma. With a possibly declining trend of train surfing-related accidents in an aging society, it will be interesting to see if emerging economies will face comparable phenomena, for which prevention strategies remain key.
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Affiliation(s)
- David Benjamin Lumenta
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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Krämer P, Aul A, Vock B, Frank C. [Emergency response management near the tracks of the public railway network: special aspects of missions connected with the German national railway system]. Anaesthesist 2010; 59:1021-8. [PMID: 20852836 DOI: 10.1007/s00101-010-1784-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Emergency response management and rescue operations concerning the railway network in Germany need special attention and implementation in several ways. The emergency response concerning the German national railway network managed by Deutsche Bahn AG is subject to various rules and regulations which have to be followed precisely. Only by following these rules and procedures is the safety of all emergency staff at the scene ensured. The German national railway network (Deutsche Bahn AG) provides its own emergency response control center, which specializes in managing its response to emergencies and dispatches an emergency response manager to the scene. This person serves as the primary Deutsche Bahn AG representative at the scene and is the only person who is allowed to earth the railway electrical power lines. This article will discuss different emergency situations concerning railway accidents and the emergency medical response to them based on a near collision with a high speed train during a rescue mission close to the railway track. Injury to personnel could only be avoided by chance and luck. The dangers and risks for rescue staff are specified. Furthermore, the article details practical guidelines for rescue operations around the German national railway track system.
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Affiliation(s)
- P Krämer
- Luftrettungszentrum Christoph 5, Ludwigshafen, Deutschland
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Abstract
The aim of the present study was to review international literature on the incidence of suicide on railway networks, describe risk factors associated with it, and examine existing prevention practices. Searches on Medline and PsycINFO for the period 1966-2007 were performed. Thirty original studies published in English on epidemiology of rail suicide were included in the review along with peer-reviewed articles on risk factors and prevention of rail suicide. Internationally, suicide by collision with a train accounted for 1-12% of all suicides, with up to 94% of all attempts resulting in death. Suicide by train seriously affects not only survivors, but also train drivers and bystanders. Correlations between density of rail network, number of passengers and number of suicides by train have been found. Conflicting data exist on gender ratio of this type of suicide, but studies are homogenous in identifying young adults (20-40 year of age) as those most exposed to train suicide. Documented psychiatric diagnoses were found in up to 83% of cases. Mid-seasonal peaks were also identified, with events occurring mostly during late morning and early afternoon. Limited evidence exists for effective suicide prevention practices. Successful examples are represented by pits and sliding door systems (Singapore Mass Rapid Transit System) and responsible media reporting (Viennese Subway). Suicide by train involves emotional and financial costs to individuals and society as a whole. A combination of different strategies might significantly reduce its effect.
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Affiliation(s)
- Karolina Krysinska
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Mount Gravatt Campus, Qld 4111, Australia
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Massive internal injury in the absence of significant external injury after collisions of passenger vehicles with much larger vehicles. J Forensic Leg Med 2008; 15:219-22. [DOI: 10.1016/j.jflm.2007.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2007] [Accepted: 10/08/2007] [Indexed: 11/15/2022]
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Matzopoulos R, Peden M, Bradshaw D, Jordaan E. Alcohol as a risk factor for unintentional rail injury fatalities during daylight hours. Int J Inj Contr Saf Promot 2006; 13:81-8. [PMID: 16707343 DOI: 10.1080/17457300500249582] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Railway fatalities account for approximately 10% of transport fatalities in Cape Town. The objective of this study was to examine alcohol intoxication as a risk factor during daylight hours by conducting a case - control study to compare rail passenger and pedestrian fatalities (cases) with motor vehicle passenger and pedestrian fatalities (controls). Rail passenger and rail pedestrian fatalities were defined as cases with motor vehicle passenger and pedestrian fatalities as the respective controls. Data were collected from post-mortem reports at two mortuaries from 1994 to 1996. Blood alcohol concentration was the dependent variable. The independent variables were age, gender, date of death, day of week, time of injury and external cause of death. The late afternoon and early evening period from 1600 hours to 1900 hours had the highest frequency of fatalities for all case and control groups. Of the 56 predominately male (89%) railway passenger cases with an average age of 34.5 (SD 12.5) years, Friday (27%) was the most frequent day of death. Railway pedestrian cases (89% male, average age 36.8 years (SD 13.3)) were more likely to be killed on a Monday (11% of cases). Among the controls, motor vehicle passengers (63% male, average age 39.9 (SD 15.5)) were more likely to die on a Sunday (25%) and pedestrians (82% male, average age 41 (SD 14.7)) on a Saturday (21%). The study showed that alcohol consumption is an important risk factor for rail fatalities during daylight hours, with rail passenger fatalities being 4.71 (1.72 - 12.88) and rail pedestrian fatalities 1.62 (0.98 - 2.69) times more likely to be intoxicated than the respective controls. The results provide more evidence for public health campaigners to tackle endemic alcohol abuse and to develop diverse interventions that do not exclusively target motor vehicle drivers.
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Affiliation(s)
- Richard Matzopoulos
- Crime, Violence and Injury Lead Programme, Medical Research Council of South Africa, P.O. Box 19070, Tygerberg, 7505, South Africa.
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Rådbo H, Svedung I, Andersson R. Suicides and other fatalities from train-person collisions on Swedish railroads: a descriptive epidemiologic analysis as a basis for systems-oriented prevention. JOURNAL OF SAFETY RESEARCH 2005; 36:423-8. [PMID: 16303140 DOI: 10.1016/j.jsr.2005.08.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2005] [Accepted: 08/30/2005] [Indexed: 05/05/2023]
Abstract
PROBLEM Suicide is a dominating, although hidden, safety problem on Swedish railroads. The aim of this paper is to describe the epidemiology of fatal train-person collisions as a basis for systems-oriented prevention. METHOD Data on collision circumstances were collected from narrative reports at the Swedish National Rail Administration. RESULTS The events were evenly distributed by months and weekdays, however, most suicides occur during the day while unintentional events usually occur at night. Most train-person collisions happened in densely populated areas, and 75% of the suicide victims were waiting on the track before the collision. Significance test between types of injury event (suicide, accident, or unknown intent) showed small or no differences. CONCLUSION Traditional approaches to accident prevention by systems modification seem largely applicable to combat railroad suicide as well. IMPACT ON INDUSTRY Our findings show promising preventive potentials.
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Affiliation(s)
- Helena Rådbo
- Department of Social Sciences, Division of Public Health Sciences, Karlstad University, SE-651 88 Karlstad, Sweden.
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Cherpitel CJ, Borges GLG, Wilcox HC. Acute alcohol use and suicidal behavior: a review of the literature. Alcohol Clin Exp Res 2004; 28:18S-28S. [PMID: 15166633 DOI: 10.1097/01.alc.0000127411.61634.14] [Citation(s) in RCA: 190] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Both acute and chronic use of alcohol are associated with suicidal behavior. However, the differing relationship of each component of alcohol use and possible causal mechanisms remain unclear. METHODS This article reviews and summarizes associations between acute alcohol consumption (with and without intoxication) and suicidal behavior (both completed suicide and suicide attempts) among adults 19 years and older, as presented in literature published between 1991 and 2001. Possible mechanisms and methodologic challenges for evaluating the association are also discussed. An application of a research design (the case-crossover study) that has the potential for addressing the effects of acute alcohol use over and above usual or chronic use is presented. RESULTS The majority of articles reviewed were restricted to descriptive studies that documented the prevalence of suicide completers or attempters who tested positive for alcohol use. A wide range of alcohol-positive cases were found for both completed suicide (10-69%) and suicide attempts (10-73%). Common methodologic limitations included the lack of control groups (for evaluating risk conferred by alcohol use), selection and ascertainment bias, and small sample sizes. The results of the case-crossover pilot study indicated substantially higher risk of suicide during or shortly after use of alcohol compared with alcohol-free periods. CONCLUSIONS Although there is a substantial literature of published studies on acute alcohol use and suicidal behavior, the majority of studies focus on completed suicide and report prevalence estimates. Findings from such studies are subject to several possible sources of bias and have not advanced our knowledge of mechanisms in the association between acute alcohol use and suicidal behavior. The case-crossover design may help to overcome some limitations of these studies and facilitate evaluation of associations and possible causal mechanisms by which acute alcohol use is linked to suicidal behavior.
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