Road traffic injuries in the elderly

The temporal trend of road traffic mortality in China from 2004 to 2020

Background

Road traffic accidents are one of the critical disasters that cause massive negative influences to the social economy and people's property, health and life safety. The purpose of this study is to analyze the temporal trend of road traffic mortality in China from 2004 to 2020, and further analyze the key factors that the influencing changes in China's road traffic mortality and provides information for the development of targeted interventions to reduce the number of preventable deaths.

Methods

The data were retrieved from the Chinese Death Cause Monitoring Data Set from 2004 to 2020. The road traffic mortality rates were standardized by the Sixth National Population Census (6th NPC) data. Joinpoint regression method was manipulated to analyze temporal trends of standardized road traffic mortality. The study used annual percentage change (APC) and average annual percentage change (AAPC) calculated by the Joinpoint regression model to describe trends in road traffic mortality rates.

Results

The overall age-adjusted road traffic mortality in China showed a declining trend from 2004 to 2020 (AAPC2004-2020 = - 4.2%), from 20.9 to 12.92 per 100,000. Rural road traffic mortality rates were generally higher than the one in urban areas, and males were generally higher than females. There was an overall downward trend of the standardized road traffic mortality in the East and Central regions between 2004 and 2020. It was worth noting that the road traffic mortality rates in the Western region showed an upward trend from 2006 to 2011 (APC2006-2011 = 3.3%) and continued to decline after 2011 (APC2011-2020 = - 6.7%). The road traffic mortality rates of aged 65 years and older was highest, which required focused attention.

Conclusions

From 2004 to 2020, the road traffic mortality rates in China generally declined. At the same time, there was a slow reduction or even an upward trend in road traffic mortality rates among the elderly and in western regions. Rural males are a priority group for road traffic injury prevention.

Trauma (Excluding Falls) in the Older Adult

Trauma in the older adult will increasingly become important to emergency physicians hoping to optimize their patient care. The geriatric patient population possesses higher rates of comorbidities that increase their risk for trauma and make their care more challenging. By considering the nuances that accompany the critical stabilization and injury-specific management of geriatric trauma patients, emergency physicians can decrease the prevalence of adverse outcomes.

Global burden and trends of transport injuries from 1990 to 2019: an observational trend study

BACKGROUND

Transport injuries (TIs) are a major cause of global disability-adjusted life-years (DALYs) and mortality. In this study, we aimed to assess the global burden and trends of TIs from 1990 to 2019.

METHODS

We assessed the annual age-standardised incidence rate (ASIR) and age-standardised DALYs rate of TIs by sex, age, Social Development Index (SDI) and geographical region from 1990 to 2019 from the Global Burden of Disease Study 2019. The changing trends were described by estimated annual percentage changes (EAPCs).

RESULTS

Globally, in 2019, the ASIR and age-standardised DALYs rates of TIs were 134 6.06/100 000 (95% UI 11 42.6/100 000-157 5.57/100 000) and 97 7.91/100 000 (86 8.91/100 000-107 6.81/100 000), respectively. From 1990 to 2019, the global ASIR of TIs presented significant upwards trends with the EAPC (0.25%, 95% CI 0.19% to 0.31%), and it was significantly increased in the age groups of 15-49 (0.37%, 95% CI 0.29% to 0.45%), 50-69 (0.40%, 95% CI 0.36% to 0.44%) and 70+ (0.22%, 95% CI 0.17% to 0.28%). Prominent increases in ASIR were detected in middle-SDI areas (0.72%, 95% CI 0.57% to 0.87%), low-middle SDI areas (0.66%, 95% CI 0.59% to 0.72%) and low-SDI areas (0.21%, 95% CI 0.17% to 0.26%). The global age-standardised DALYs rate presented downwards trends with the EAPC (-1.27%, 95% CI -1.35% to -1.2%), and it was significantly decreased in all age groups and SDI areas.

CONCLUSION

Globally, TIs still cause a serious burden, and the incidence has significantly increased, especially in people above the age of 14 and in middle-SDI and low-SDI areas, thus necessitating more attention and health interventions.

A systematic review and meta-synthesis of the complex and interconnected factors that influence planning for driving retirement

INTRODUCTION

With an aging population there are more older drivers than ever before. To reduce unnecessary road accidents and assist older drivers to successfully transition to non-driving, a better understanding of the factors that influence planning for driving retirement is required. This review explores documented factors that may influence older adults in planning for driving retirement, thus providing new understandings that can inform future preventative road safety measures, interventions, and policies.

METHOD

A systematic search was performed using four databases to locate qualitative studies on the factors that influenced older drivers to plan for driving retirement. To identify factors influencing planning for driving retirement, a thematic synthesis approach was utilized. Identified themes were categorized in relation to elements of the Social Ecological Model theoretical framework.

RESULTS

The systematic search resulted in 12 included studies from 4 countries. Four major themes and 11 subthemes were identified regarding planning driver retirement. Each subtheme denotes a factor that may facilitate and/or impede older drivers planning for driving retirement.

CONCLUSION

These results indicate that it is vitally important to encourage older drivers to plan for driving retirement as early as possible. Stakeholders involved in the safety of older drivers (including family, clinicians, road authorities, and policy makers) should work together on interventions and policies that empower older drivers to successfully plan for driving retirement in order to improve road safety and quality of life.

PRACTICAL APPLICATIONS

Introducing conversations about driving retirement via medical appointments, family, media, and peer-support groups could facilitate planning for driving retirement. Community-based ride-sharing systems and subsidized private transport options are needed to ensure continued mobility of older adults, especially in rural and regional areas that lack alternate transport services. When devising urban and rural planning, transport, license renewal, and medical testing rules, policy makers should consider older drivers' safety, mobility, and quality of life after driving retirement.

Crash characteristics for classic/historic vehicles and comparisons to newer vehicles

INTRODUCTION

Older vehicles, commonly referred to as "classic," "vintage," or "historic" vehicles (CVH), share the roadways with newer vehicles. Older vehicles lacking safety systems likely come with an increased risk of fatality, however there is no study examining the typical conditions for crashes involving CVH.

METHOD

This study utilized information from crashes occurring in 2012 to 2019 to estimate fatal crash rates for vehicles grouped by model year deciles. Data from crashes documented in the National Highway Traffic Safety Administration's (NHTSA) FARS and GES/CRSS data sets were utilized to examine roadway, temporal, and crash types for passenger vehicles produced in 1970 or earlier (CVH).

RESULTS

These data show CVH crashes are rare (<1% of crashes), but carry a relative risk of fatality from 6.70 (95th CI: 5.44-8.26) for impacts with other vehicles, which was the most common crash, to 9.53 (7.28-12.47) for rollovers. Most crashes occurred in dry weather, typically during summer, in rural areas, most frequently on two lane roads, and in areas with speed limits between 30 and 55 mph. Factors associated with fatality for occupants in CVH included alcohol use, lack of seat belt use, and older age.

CONCLUSIONS AND PRACTICAL APPLICATIONS

Crashes involving a CVH are a rare event but have catastrophic consequences when they do occur. Regulations that limit driving to daylight hours may lower the risk of crash involvement, and safety messaging to promote belt use and sober driving may also help. Additionally, as new "smart" vehicles are developed, engineers should keep in mind that older vehicles remain on the roadway. New driving technologies will need to safely interact with these older, less safe vehicles.

An investigation of elderly occupant injury risks based on anthropometric changes compared to young counterparts

OBJECTIVE

The objective of the study was to investigate the difference between elderly and young occupant injury risks using human body finite element modeling in frontal impacts.

METHODS

Two elderly male occupant models (representative age 70-80 years) were developed using the Global Human Body Consortium (GHBMC) 50th percentile as the baseline model. In the first elderly model (EM-1), material property changes were incorporated, and in the second elderly model (EM-2), material and anthropometric changes were incorporated. Material properties were based on literature. The baseline model was morphed to elderly anthropometry for EM-2. The three models were simulated in a frontal crash vehicle environment at 56 km/h. Responses from the two elderly and baseline models were compared with cadaver experimental data in thoracic, abdominal, and frontal impacts. Correlation and analysis scores were used for correlation with experimental data. The probabilities of head, neck, and thoracic injuries were assessed.

RESULTS

The elderly models showed a good correlation with experimental responses. The elderly EM-1 had higher risk of head and brain injuries compared to the elderly EM-2 and baseline GHBMC models. The elderly EM-2 demonstrated higher risk of neck, chest, and abdominal injuries than the elderly EM-1 and baseline models.

CONCLUSIONS

The study investigated injury risks of two elderly occupants and compared to a young occupant in frontal crashes. The change in the material properties alone (EM-1) suggested that elderly occupants may be vulnerable to a greater risk of head and thoracic injuries, whereas change in both anthropometric and material properties (EM-2) suggested that elderly occupants may be vulnerable to a greater risk of thoracic and neck injuries. The second elderly model results were in better agreement with field injury data from the literature; thus, both anthropometric and material properties should be considered when assessing the injury risks of elderly occupants. The elderly models developed in this study can be used to simulate different impact conditions and determine injury risks for this group of our population.

Major trauma associated with mobility scooters: An analysis of the trauma audit research network

AIMS

To establish the incidence and nature of injuries seen in patients following mobility scooter incidents.

METHODS

The Trauma Audit and Research Network (TARN) database was used to collect data concerning injuries associated with mobility scooters. The data was taken from incidents that occurred between February 2014 and November 2020. The data analysed included: patient demographics, injury mechanism and patterns and associated mortality rates.

RESULTS

1,504 patients were identified of which 61.4% were male. The median age was 76.2 years (IQR 63.5-84.9). The median injury severity score (ISS) was 9 (IQR 9-17), with major trauma (ISS ≥16) being observed in 29.4% of patients. Injuries to the limb were most common, although injuries to the head were most severe. Vehicle collisions accounted for 65.4% of injuries and were most closely associated with the most severe incidents. The median length of stay in hospital was 12 days, excluding the patients who died. Overall, mortality following injury was 10.6%, but the mortality rate was 15.4% in those aged 75 years and over, and 24.2% in those sustaining severe trauma.

CONCLUSION

As the population ages, injury characteristics of those with both major and non-major trauma changes. Mobility scooter use is prevalent amongst older people, and we provided a detailed analysis of injuries sustained with their use across a national database. The length of stay and the inherent resource use, because of admission following mobility scooter trauma, is considerable. These injuries particularly affect the 'most elderly' and carry a considerable mortality burden.

Road traffic accident-related thoracic trauma: Epidemiology, injury pattern, outcome, and impact on mortality—A multicenter observational study

Background

Thoracic trauma is a major cause of death in trauma patients and road traffic accident (RTA)-related thoracic injuries have different characteristics than those with non-RTA related thoracic traumas, but this have been poorly described. The main objective was to investigate the epidemiology, injury pattern and outcome of patients suffering a significant RTA-related thoracic injury. Secondary objective was to investigate the influence of serious thoracic injuries on mortality, compared to other serious injuries.

Methods

We performed a multicenter observational study including patients of the Rhône RTA registry between 1997 and 2016 sustaining a moderate to lethal (Abbreviated Injury Scale, AIS≥2) injury in any body region. A subgroup (AISThorax≥2 group) included those with one or more AIS≥2 thoracic injury. Descriptive statistics were performed for the main outcome and a multivariate logistic regression was computed for our secondary outcome.

Results

A total of 176,346 patients were included in the registry and 6,382 (3.6%) sustained a thoracic injury. Among those, median age [IQR] was 41 [25–58] years, and 68.9% were male. The highest incidence of thoracic injuries in female patients was in the 70–79 years age group, while this was observed in the 20–29 years age group among males. Most patients were car occupants (52.3%). Chest wall injuries were the most frequent thoracic injuries (62.1%), 52.4% of which were multiple rib fractures. Trauma brain injuries (TBI) were the most frequent concomitant injuries (29.1%). The frequency of MAISThorax = 2 injuries increased with age while that of MAISThorax = 3 injuries decreased. A total of 16.2% patients died. Serious (AIS≥3) thoracic injuries (OR = 12.4, 95%CI [8.6;18.0]) were strongly associated with mortality but less than were TBI (OR = 27.9, 95%CI [21.3;36.7]).

Conclusion

Moderate to lethal RTA-related thoracic injuries were rare. Multiple ribs fractures, pulmonary contusions, and sternal fractures were the most frequent anatomical injuries. The incidence, injury pattern and mechanisms greatly vary across age groups.

Effects of Shopping Rehabilitation on Older People's Daily Activities

In an aged society, the deterioration of physical and cognitive functions is prevalent. To motivate the rehabilitation of older persons, an initiative known as “shopping rehabilitation” incorporates shopping as an element of a nudge. The purpose of this study was to clarify motor function changes and cognitive functions of participants during shopping rehabilitation, through a semi-experimental study. We measured changes in the Kihon Checklist score before and after rehabilitation interventions. A paired t-test was used to analyze changes in the overall score of the basic checklist before and after the rehabilitation intervention. In December 2020, 59 participants answered the Kihon Checklist after their shopping rehabilitation intervention. During the 6-month intervention period, the number of participants with a checklist score of 8 or higher was significantly reduced after the intervention (p = 0.050). In the sub-analysis, the score improved significantly for the group with families (p = 0.050). Improvement was observed in the group living alone, but the difference was not significant (p = 0.428). The shopping rehabilitation intervention improved the Kihon Checklist score. Continuous observations and research are necessary to measure the long-term effects of shopping rehabilitation and the mechanisms that foster their maintenance and effects.

Challenges in the PREHOSPITAL emergency management of geriatric trauma patients - a scoping review

BACKGROUND

Despite a widely acknowledged increase in older people presenting with traumatic injury in western populations there remains a lack of research into the optimal prehospital management of this vulnerable patient group. Research into this cohort faces many uniqu1e challenges, such as inconsistent definitions, variable physiology, non-linear presentation and multi-morbidity. This scoping review sought to summarise the main challenges in providing prehospital care to older trauma patients to improve the care for this vulnerable group.

METHODS AND FINDINGS

A scoping review was performed searching Google Scholar, PubMed and Medline from 2000 until 2020 for literature in English addressing the management of older trauma patients in both the prehospital arena and Emergency Department. A thematic analysis and narrative synthesis was conducted on the included 131 studies. Age-threshold was confirmed by a descriptive analysis from all included studies. The majority of the studies assessed triage and found that recognition and undertriage presented a significant challenge, with adverse effects on mortality. We identified six key challenges in the prehospital field that were summarised in this review.

CONCLUSIONS

Trauma in older people is common and challenges prehospital care providers in numerous ways that are difficult to address. Undertriage and the potential for age bias remain prevalent. In this Scoping Review, we identified and discussed six major challenges that are unique to the prehospital environment. More high-quality evidence is needed to investigate this issue further.

Analyzing the safety impact of longer and heavier vehicles circulating in the European market

INTRODUCTION

The European Union (EU) has developed different strategies to internalize the costs of excessive motor traffic in the road freight transport sector. One of these is a relaxation of restrictions on the size and load capacity of trucks that circulate between member States and a proposal has been made for Longer and Heavier Vehicles (LHVs) to be allowed to circulate across borders. LHVs are the so-called "megatrucks" (i.e., trucks with a length of 25 meters and a weight of 60 tonnes). Megatrucks have allowed to circulate for decades in some European countries such as Norway, Finland, and Sweden, world leaders in traffic accident prevention, although the impact that cross-border traffic would have on road safety is still unknown.

METHODS

This article provides an econometric analysis of the potential impact on road safety of allowing the circulation of "megatrucks" throughout the EU.

RESULTS

The findings show that countries that currently allow megatrucks to circulate present lower traffic accident and fatality levels, on average.

CONCLUSIONS

The circulation of this type of vehicle is only advisable in countries where there is a certain degree of maturity and demonstrated achievements in the field of road safety. Practical applications: European countries that have allowed megatruck circulation obtaining better road safety outcomes in terms of accidents, although the accident lethality rate seems to be higher. Consequently, introducing megatruck circulation requires a prior proper preparation and examination.

The Effect of Aging Physiology on Critical Care

Older patients experience a decline in their physiologic reserves as well as chronic low-grade inflammation named "inflammaging." Both of these contribute significantly to aging-related factors that alter the acute, subacute, and chronic response of these patients to critical illness, such as sepsis. Unfortunately, this altered response to stressors can lead to chronic critical illness followed by dismal outcomes and death. The primary goal of this review is to briefly highlight age-specific changes in physiologic systems majorly affected in critical illness, especially because it pertains to sepsis and trauma, which can lead to chronic critical illness and describe implications in clinical management.

I've got to be independent': views of older people on recovery following road traffic injury in New South Wales, Australia

BACKGROUND

Mild to moderate road traffic injury (RTI) in people of working age is associated with limited recovery. Less is known about RTI recovery in older age. This study explored the perspectives and factors associated with recovery and health-related quality of life following mild to moderate RTI in older age in New South Wales, Australia.

METHODS

A qualitative study using content analysis was undertaken. Participants aged 65 or more years were purposively selected from a larger inception cohort study of health outcomes following mild to moderate RTI conducted in New South Wales, Australia. Semi-structured interviews were undertaken at approximately 12 or 24 months post-injury. Content analysis was used to code and analyse the data, with methodological rigour obtained by double-coding and discussing findings to reach consensus. Results were reported using the consolidated criteria for reporting qualitative research (COREQ).

RESULTS

Nineteen participants were invited to participate in the study of which 12 completed interviews. Data saturation was reached at the twelfth interview. Recovery experiences were diverse. Five main themes were identified: recovery is regaining independence; injury and disability in older age; the burden of non-obvious disability; the importance of support; and positive personal approaches. Key facilitators of recovery were: regaining independence; support from family and friends; and positive personal approaches. Key barriers were: threats to independence; passive coping behaviours; non-obvious disabilities (chronic pain, psychological impacts); and reluctance to raise ongoing issues with General Practitioners. Threats to independence, especially not driving and self-care, appeared to have a more profound effect on recovery than physical functioning.

CONCLUSION

Older people view injury as a threat to independent functioning. This is somewhat different to what younger people report. Regaining independence is key to older people's recovery and health-related quality of life following RTI, and should be a key consideration for health professionals, services and supports working with this unique cohort. Greater efforts to help older people regain their independence following RTI are needed and can be facilitated by health professionals and appropriate service provision.

TRIAL REGISTRATION

Australia New Zealand clinical trial registry identification number ACTRN12613000889752 .

Tactical and strategic driving behaviour in older drivers: The importance of readiness to change

The aim of this study was to explore the way in which reports of strategic and tactical driving self-regulation are influenced by readiness to change driving behaviour in older men and women, either reporting or not reporting modification of driving behaviour for health-related reasons, and/or increased driving difficulty. Current Australian drivers aged over 60 years (N = 258) responded to a self-report questionnaire. Hierarchical regression analyses indicated increased use of tactical behaviours were associated with greater driving difficulty, more readiness to change and male gender (R² = 23.2%) . These effects were moderated by a significant association between readiness to change, driving modifications for health reasons and age (R²_chg = 2.9%). Greater readiness to change was associated with increased use of tactical behaviours for older drivers who did not modify driving for health reasons, independent of ageIndependent of age. This association was also found for younger old drivers with health difficulties, but not for older old drivers with health difficulties. Hierarchical regression indicated that greater readiness to change, increased driving difficulty, female gender and modification of driving for health reasons were associated with reports of increased strategic self-regulation (R² = 50.8%). These effects were moderated by readiness to change and age, and readiness to change and gender (R²_chg = 2.1%). The association between readiness to change and strategic self-regulation was stronger for women than men, and the strength of this association became substantially stronger with increasing age. It was concluded that readiness to change driving behaviour may promote different forms of driving self-regulation for different individuals, and that older drivers may use the different forms of driving self-regulation independently of one another.

Comparison between elderly and young drivers' performances on a driving simulator and self-assessment of their driving attitudes and mastery

Elderly people are often considered dangerous drivers due to a decline in visual exploration and cognitive functions. The purpose of this study was to look into 18 young (between 21 and 35  years old) and 12 elderly (between 65 and 78 years old) drivers' behaviour. We compared their self-assessment of driving as well as their visual and cognitive competencies. Then we assessed their driving competencies and self-regulation practices by using different scenarios on a driving simulator. These scenarios were designed to test drivers in situations that were intended to solicit the cognitive competencies identified as problematic for elderly drivers (attention, executive functions: anticipation, planning, mental flexibility). Results showed that, although elderly drivers did not always perform as well as young drivers, they could put in place compensatory strategies which may reduce their risk of being injured and future research should explore ways of enhancing those strategies. In particular, more should be done in order to strengthen elderly's understanding regarding their driving difficulties and help them set up coping methods with respect to these difficulties.

The burden of road traffic injuries in the northeast of Iran: the result of a population-based registry

BACKGROUND

Road traffic injuries (RTIs) are an important public health problem around the world, with the majority of RTIs occurring in low- and middle-income countries. This study aimed to determine disability-adjusted life years (DALY) of RTIs in the northeast of Iran.

METHODS

In this cross-sectional study, we used the death registration system to calculate years of life lost (YLL) due to RTIs. To determine the years lost due to disability (YLD), hospital records of all people injured in road accidents were used. To estimate DALY, we used YLD and YLL to calculate DALY according to the Global Burden of Disease (GBD) 2003 guideline and the age/sex composition of the population was taken from the Statistical Centre of Iran (SCI) in 2016. All collected data entered into Excel software and performed calculations.

RESULTS

Our findings showed that a total of 3403 RTIs and 132 deaths were recorded in 2016. The DALY was 38 per 1,000 of which 26.9 per 1,000 were related to YLL and 11.1 per 1,000 were related to YLD. The highest YLL rate in both sexes was in the 15-29 and 30-44 age groups with 49.8 per 1,000 and 46.0 per 1,000, respectively. This reflects a sex ratio of DALY in males (57.7 per 1,000) to females (8.6 per 1,000) was 6.7.

CONCLUSIONS

It seems to be necessary, appropriate effective intervention programs and periodic evaluations are required regarding prevention and reducing traffic accidents mostly in middle-aged men.

A geographically weighted regression to estimate the comprehensive cost of traffic crashes at a zonal level

Global road safety records demonstrate spatial variation of comprehensive cost of traffic crashes across countries. To the best of our knowledge, no study has explored the variation of this matter at a local geographical level. This study proposes a method to estimate the comprehensive crash cost at the zonal level by using person-injury cost. The current metric of road safety attributes safety to the location of the crash, which makes it challenging to assign the crash cost to home-location of the individuals who were involved in traffic crashes. To overcome this limitation, we defined Home-Based Approach crash frequency as the expected number of crashes by severity that road users who live in a certain geographic area have during a specified period. Using crash data from Tennessee, we assign those involved in traffic crashes to the census tract corresponding to their home address. The average Comprehensive Crash Cost at the Zonal Level (CCCAZ) for the period of the study was $18.2 million (2018 dollars). Poisson and Geographically Weighted Poisson Regression (GWPR) models were used to analyzing the data. The GWPR model was more suitable compared to the global model to address spatial heterogeneity. Findings indicate population of people over 60-years-old, the proportion of residents that use non-motorized transportation, household income, population density, household size, and metropolitan indicator have a negative association with CCCAZ. Alternatively, VMT, vehicle per capita, percent educated over 25-year-old, population under 16-year-old, and proportion of non-white races and individuals who use a motorcycle as their commute mode have a positive association with CCCAZ. Findings are discussed in line with road safety literature.

Congestion, Road Safety, and the Effectiveness of Public Policies in Urban Areas

Congestion and road accidents are both considered essential challenges for sustainable mobility in large cities, but their relationship is only partially explored by the literature. In this paper, we empirically examine different public policies aimed at reducing urban traffic congestion but which may also have indirect effects on road accidents and casualties. We use data from 25 large urban areas in Spain for the period 2008–2017 and apply econometric methods to investigate how a variety of public policies do affect both negative externalities. Although the relationship between congestion and road safety is complex, we find that the promotion of certain modes of public transportation and the regulation of parking spaces may contribute to making cities more sustainable, both in terms of the time spent traveling and the probability of being affected by an accident. Considering whether policies addressing congestion improve or damage road safety as an indirect result is a useful approach for local policy-makers and planners in their attempt to get sustainable transportation outcomes.

Frailty in Patients With Trauma Who Are Critically Ill: A Prospective Observational Study to Determine Feasibility, Concordance, and Construct and Predictive Validity of 2 Frailty Measures

BACKGROUND

As the older population increases, more older people are exposed to trauma. Frailty can be used to highlight patients at risk of a poorer outcome.

OBJECTIVE

The objectives of this study were to compare 2 frailty measures with regard to concordance, floor and ceiling effects, and construct and predictive validity and to determine which is more valid and clinically applicable in a critically ill trauma population.

DESIGN

This was a prospective observational study.

METHODS

Patients were included if admitted to an intensive care unit (ICU) under a trauma medical unit and ≥ 50 years old. Frailty was determined using 2 frailty measures, the Frailty Phenotype (FP) and Clinical Frailty Scale (CFS).

RESULTS

One hundred people were enrolled; their mean age was 69.2 years (SD = 10.4) and 81% had major trauma (as determined with the Injury Severity Score). Frailty was identified with the FP in 22 participants and with the CFS in 13 participants. The 2 frailty measures had an excellent correlation (Spearman rank correlation coefficient = 0.77; 95% confidence interval = 0.66-0.85). Both the FP and the CFS had large floor effects but no ceiling effects. The FP and CFS showed construct validity, with frailty being significantly associated with increasing age, requiring an aid to mobilize, and more falls and hospital admissions. Frailty on the FP was predictive of ICU and hospital mortality, whereas frailty on the CFS was predictive of hospital mortality.

LIMITATIONS

The limitations of this study include the use of a single site, small sample size, and collection of frailty measures retrospectively.

CONCLUSIONS

Measuring frailty in a trauma ICU population was feasible, with excellent correlation between the 2 frailty measures. Both showed aspects of construct and predictive validity; however, the FP identified frailty in more participants and was associated with more comorbidities and higher mortality at ICU discharge. Therefore, the FP might be more clinically relevant in this population.

Violent deaths among elderly in Attica, Greece: A 5-year survey (2011-2015)

According to World Health Organization (WHO) estimations, approximately 6 million people lose their lives yearly due to some kind of injury, while one-third of these incidents are due to violent acts. Violent deaths include accidents (road traffic accidents, drownings, falls, heat effects etc), suicides as well as homicides. Elderly people seem to be at greater risk due to their special characteristics as a vulnerable social group. The aim of this study was to investigate violent deaths (accidents, suicides and homicides) among elderly people in Attica, Greece, during the period 2011-2015 by examining manner of death with respect to demographic data (gender and age) and toxicological examination results. A total of 546 violent deaths among people over 65 years old were included in this study. Autopsy findings along with toxicological examination results were collected from the archives of the Department of Forensic Medicine and Toxicology of the National and Kapodistrian University of Athens. The findings of the study showed that most of the victims were male (63.74%). The overwhelming majority of violent deaths (425 cases) were accidents, 92 cases suicides, and the remaining 29 cases homicides. Drowning was the leading cause of all accidental deaths, followed by road traffic accidents. Hangings prevailed among violent suicide methods and asphyxiation presented as a predominant homicide method.

Lesiones graves y moderadas por accidentes de tránsito en mayores de 60 años. Medellín, Colombia

Introducción. Cada día, 3 400 personas mueren en el mundo por un accidente de tránsito (AT); miles sufren lesiones o adquieren una discapacidad cada año por la misma causa. En Colombia, en 2016 se registró una tasa de 92.8 heridos y 14.9 muertes por cada 100 000 habitantes.Objetivo. Describir las características de los AT y el entorno de su atención en mayores de 60 años con lesiones moderadas o graves en Medellín, Colombia, durante el periodo 2015-2016.Materiales y métodos. Estudio descriptivo de las características de personas mayores de 60 años con lesiones moderadas y graves después de un AT.Resultados. Se evaluaron 247 personas, 93.1% con lesiones moderadas; el 94.1% de las lesiones graves ocurrieron cuando se atropelló un peatón. En 60.7% de los AT una moto estuvo involucrada. El puntaje global del WHODAS-II fue de 40.6 y los dominios de funcionamiento más afectados fueron actividades domésticas, actividades fuera de la casa y movilidad; en cuanto a la calidad de vida, se afectó la función física, el desempeño físico y el cambio en salud.Conclusión. Los mayores de 60 años con lesiones por AT fueron, en su mayoría, peatones atropellados por motocicletas. El AT afectó la calidad de vida y el funcionamiento de los pacientes.

Comparison of Secular Trends in Road Injury Mortality in China and the United States: An Age-Period-Cohort Analysis

This study aimed to identify and compare the mortality trends for road injuries in China and the United States, and evaluate the contributions of age, period, and cohort effects to the trends from 1990 to 2014. Using the 2016 Global Burden of Disease Study database, the mortality trends were analyzed by joinpoint regression and age-period-cohort modeling. Overall, the mortality for road injuries was higher in China than in the United States. The mortality in China increased from 1992 to 2002 (annual percent change [APC] was 1.9%), and then decreased from 2002 to 2015 (APC_2002–2009 was 1.5%; APC_2009–2015 was 3.5%). For the United States, the mortality decreased from 1990 to 2010 (APC_1990–1997 was 1.8%; APC_1997–2005 was 0.7%; APC_2005–2010 was 4.2%). Age-period-cohort modeling revealed significant period and cohort effects. Compared with the period 2002–2004, the period risk ratios (RRs) in 2010–2014 period declined by 14.62% for China and 18.86% for the United States. Compared with the 1955–1959 birth cohort, the cohort RRs for China and the United States in the 2010–2014 cohort reduced by 47.60% and 75.94%, respectively. Period and cohort effects could not be ignored for reducing road injury mortalities.

Epidemiology of Road Traffic Injuries among Elderly People; A Systematic Review and Meta-Analysis

Objective:

To systematically review the epidemiological patterns and interventions for prevention of road traffic injuries (RTIs) among elderly.

Methods:

Searching keywords including: accident, trauma, road injury, road traffic injuries, aging, old, elder, strategy, intervention, road traffic crash prevention and traffic accident in databases including, Google scholar, SID, IranMedex, PubMed and Scopus. English and non-Persian articles, articles presented in congresses, articles that considered elderly people to have age under than 60 years were excluded. The reporting quality of articles was assessed by two experts using Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) check list.

Results:

RTIs compromised 23.6% of total injuries among elderly. The most frequent injuries were about car accidents (51.4%). Pedestrian injuries composed 48.1% of the RTIs. Head and neck (32.1%) were most injured body parts. There was a significant difference between elderly and non-elderly people in terms of RTIs associated mortality (Odd=2.57 [1.2-5.4 CI 95%]). Overall 25 main domains of intervention and 73 subordinate domains were extracted in five categories (human, road and environment, tools and cars, medical, legal and political issues).

Conclusion:

According to the notable prevalence and fatality of RTIs, lack of sufficient studies and valid evidence of the present study can provide an appropriate evidence for better interventions for RTIs prevention among elderly.

A decade of road traffic fatalities among the elderly in north-West Iran

Background

Iran has a uniquely catastrophic status for road traffic injury incidence and fatality. The elderly account for a substantial number of the hospitalizations and fatalities due to traffic injuries. The aim of this study was to investigate the crash mechanisms and medical outcomes of traffic fatalities among the elderly in East Azerbaijan province of Iran during the period 2006–2016.

Methods

A total of 9435 fatalities registered in East Azerbaijan forensic medicine database, Iran, during 2006–2016, were investigated. Of these, 1357 were elderly persons (age > 65). Both victim- and crash-related variables were compared for the elderly and other age groups. Bivariate and multivariate analysis methods were applied using Stata statistical software package version 13.

Results

Of the 9435 fatalities, 1357 victims (14.4%) were elderly persons. The mean age of the elderly traffic fatalities was 75.3(SD = 6.2) years. About 78% of the elderly versus 80% of those in other age groups were males. A decreasing trend of fatal traffic accidents was observed over the study period both for the elderly and other age groups. The elderly were nearly seven times more likely to die as a pedestrian compared to other age groups. By exclusively analyzing pedestrians, it was found that motorcycles were responsible for pedestrian deaths in 9.1% of the fatalities while this figure was 5.5% for pedestrians in other age groups killed in a traffic accident (P < 0.05). About 56% (N = 761) of the elderly died in hospital which was higher than the proportion for other age groups (39%). Ambulance was the main vehicle for transferring the injured victims in four-fifths of the cases both for the elderly and other age groups. Although, in the present study, head injuries were the most common type of injury regardless of the age group, the elderly had a lower percentage of head injuries and a higher percentage of injuries to the torso, pelvis and limbs compared to younger victims.

Conclusions

Pedestrian inner-city crashes in East Azerbaijan province of Iran are a major cause of road injury fatalities among the elderly and should be considered as a priority in road safety interventions.

A Retrospective Epidemiological Study of the Traffic-Related Injuries Cases Admitted to a Local Hospital

Road traffic injuries (RTI) are important public health problem globally. Accurate data about RTIs and its subsequent health consequences are essential to monitor the effectiveness of current RTI prevention measures and to readdress policies.

Objective

We presented the surveillance of RTI in Kwai Tsing by integrating data from traffic accident data system (TRADS) and injury surveillance system (ISS) from Princess Margaret Hospital.

Method

Retrospective observational study to examine traffic-related injuries by integrating data from TRADS and ISS databases. A multivariate analysis was performed to identify risk factors associated with hospital admissions in RTI.

Result

A total of 725 patients were included. About 19% of the visits led to hospitalisation and six deaths (0.83%) were reported. Pedestrian elders were significantly more at risk to traffic injury mortality and hospitalisation.

Conclusion

This study demonstrates the feasibility of an integrated surveillance system for RTI based on existing local databases. Special preventive measures should be tailored for pedestrian and elderly to improve their safety by improving the quality of their walking environment.

Contributory Factors to critically wrong road-crossing judgements among older people: an integrated research study

Introduction

Older people are having higher risk of vehicle-pedestrian collisions. This study examines the relative importance of different environmental, physical and cognitive factors in contributing to critically wrong road-crossing judgements.

Methods

An integrated research design is adopted. Older pedestrians were recruited through Elderly Community Centres in Hong Kong. Data about their physical and cognitive ability were collected through setting up outreach laboratories within the participants' neighbourhood communities. In addition to obtaining two walking speeds, three clinical tests (the visual acuity test, Timed Up and Go test and Mini Mental State Examination [MMSE] test) were conducted. A questionnaire survey collected personal information and activity data. Eighteen different road-crossing scenarios showing the same dual-lane one-way local road with different traffic conditions (a vehicle approaching at different distances, at different speeds, and on different lanes) were captured in videos and presented to the participants. Their decision time and judgement for each scenario were recorded in a computer. Apart from descriptive statistics, a binary logistic generalised estimating equation model was estimated. The dependent variable is whether a road-crossing judgement was critically wrong or not.

Results and Conclusions

A total of 7,182 road-crossing judgements of 399 older people were collected. The most statistically significant factors contributing to critically wrong road-crossing judgements are the road environment variables of the speed and distance of the oncoming vehicle. On physical variables, walking speed is the most important factor. Lastly, the cognitive variable of MMSE score is significant. For the mild and moderate impairment groups, the chances of making a critically wrong judgement are 1.83 and 2.01 times that of the normal group respectively.

Predictors of Outcomes of Pedestrian Casualties in Motor Vehicle Injuries Managed in Emergency Department

Introduction

Pedestrian injury is a major health care concern. This study aims to identify predictors of mortality and severe injury in pedestrian casualties in motor vehicle injury managed in emergency department in the local setting.

Methods

This is a retrospective cohort study of a linked hospital and police trauma registry (2004 to 2008). All pedestrian casualties treated in the emergency department (ED) of two regional hospitals in Hong Kong were included. Logistic regression was performed for potential predictor variables (age >65 years; injury patterns including head or face, thorax/abdomen/pelvis, neck/spine, extremities; existence of multiple injuries; heavy vehicles involved; body impact with the vehicles; injury at night and wet road surface) against mortality and severe injury, defined as Injury Severity Scale (ISS) >15.

Results

A total of 1542 pedestrian casualties were analysed. Age >65 was found to be an independent predictor of mortality in pedestrian casualties, with odds ratio (OR) of 5.15 (95% CI=2.21-12.00; p<0.001). Other independent predictors of mortality included injury to head/face (OR=4.52, 95% CI=1.75-11.7, p=0.002), injury to thorax/abdomen/pelvis (OR=13.36, 95% CI=5.64-31.6; p<0.001), multiple injuries (OR=4.0, 95% CI=1.06-15.1; p=0.041) and wet road surface (OR=3.27, 95% CI=1.31-8.17; p=0.011). These factors were also independent predictors for severe injury. Involvement of heavy vehicles and body impact with vehicles were not independent predictors of mortality. However, these were significant predictors of severe injury (OR=1.86 and 2.85 respectively).

Conclusion

Old age, injury to head/face or thorax/abdomen/pelvis, multiple injuries and wet road surface in accident scene are independent predictors for mortality in pedestrian casualties. In addition, involvement of heavy vehicles and body impact with vehicles are predictors of severe injury.

The Tragically Hip: Trauma in Elderly Patients

Old age is a risk factor for poor outcome in trauma patients, as a result of undertriage and the presence of occult life-threatening injuries. The mechanisms of injury for geriatric trauma differ from those in younger patients, with a much higher incidence of low-impact trauma, especially falls from a low height. Frailty is a risk factor for severe injury after minor trauma, and caring for these patients require a multidisciplinary team with both trauma and geriatric expertise. With early recognition and aggressive management, severe injuries can still be associated with good outcomes, even in very elderly patients.

Injury Characteristics and Outcomes in Elderly Trauma Patients in Sub-Saharan Africa

BACKGROUND

Traumatic injury in the elderly is an emerging global problem with an associated increase in morbidity and mortality. This study sought to describe the epidemiology of elderly injury and outcomes in sub-Saharan Africa.

METHODS

We conducted a retrospective analysis of adult patients (≥ 18 years) with traumatic injuries presenting to the Kamuzu Central Hospital (KCH) in Lilongwe, Malawi, over 5 years (2009-2013). Elderly patients were defined as adults aged ≥65 years and compared to adults aged 18-44 and 45-64 years. We used propensity score matching and logistic regression to compare the odds of mortality between age groups using the youngest age group as the reference.

RESULTS

42,816 Adult patients with traumatic injuries presented to KCH during the study period. 1253 patients (2.9 %) were aged ≥65 years with a male preponderance (77.4 %). Injuries occurred more often at home as age increased (25.3, 29.5, 41.1 %, p < 0.001) and falls were more common (14.1, 23.8, 36.3 %, p < 0.001) for elderly patients. Elderly age was associated with a higher proportion of hospital admissions (10.6, 21.3, 35.2 %, p < 0.001). Upon propensity score matching and logistic regression analysis, the odds ratio of mortality for patients aged ≥65 was 3.15 (95 % CI 1.45, 6.82, p = 0.0037) compared to the youngest age group (18-44 years).

CONCLUSIONS

Elderly trauma in a resource-poor area in sub-Saharan Africa is associated with a significant increase in hospital admissions and mortality. Significant improvements in trauma systems, pre-hospital care, and hospital capacity for older, critically ill patients are imperative.

Demographic and regional characteristics of road traffic injury deaths in Jiangsu Province, China

Background

The study investigates the magnitude and distribution of fatal road traffic injuries (RTIs) in the Chinese province of Jiangsu by road user.

Method

The 13 694 RTI deaths and years of potential life lost (YPLL) that occurred in 2012 were analysed; vulnerable and non-vulnerable road users were considered separately. Age-adjusted mortality and YPLL were compiled and the association between demographic characteristics and RTI mortality rate was analysed using negative binomial regression.

Results

The age-adjusted RTI mortality and YPLL in Jiangsu in 2012 were 18.14 (95% CI: 17.84-18.45) and 494.3 (95% CI: 492.7-496.0) per 100 000 population. Half of the deaths were among pedestrians and for vulnerable road users as a whole, male fatalities were over three times that of female (adjusted incidence rate ratio = 3.26, 95% CI: 1.89-3.77). Fatalities in the oldest age group (80+ years) were over 14 times that of the youngest one (0-9 years) (adjusted incidence rate ratio = 14.13, 95% CI: 9.49-21.01). Fatality rates in the central and northern regions surpassed that of the south.

Conclusion

As in the rest of the country, RTIs are a considerable public health problem in Jiangsu where fatality and YPLL rates fall heavily on pedestrians, men, and older persons and are more pronounced in the less developed regions.

Longitudinal Research on Aging Drivers (LongROAD): study design and methods

BACKGROUND

As an important indicator of mobility, driving confers a host of social and health benefits to older adults. Despite the importance of safe mobility as the population ages, longitudinal data are lacking about the natural history and determinants of driving safety in older adults.

METHODS

The Longitudinal Research on Aging Drivers (LongROAD) project is a multisite prospective cohort study designed to generate empirical data for understanding the role of medical, behavioral, environmental and technological factors in driving safety during the process of aging.

RESULTS

A total of 2990 active drivers aged 65-79 years at baseline have been recruited through primary care clinics or health care systems in five study sites located in California, Colorado, Maryland, Michigan, and New York. Consented participants were assessed at baseline with standardized research protocols and instruments, including vehicle inspection, functional performance tests, and "brown-bag review" of medications. The primary vehicle of each participant was instrumented with a small data collection device that records detailed driving data whenever the vehicle is operating and detects when a participant is driving. Annual follow-up is being conducted for up to three years with a telephone questionnaire at 12 and 36 months and in-person assessment at 24 months. Medical records are reviewed annually to collect information on clinical diagnoses and healthcare utilization. Driving records, including crashes and violations, are collected annually from state motor vehicle departments. Pilot testing was conducted on 56 volunteers during March-May 2015. Recruitment and enrollment were completed between July 2015 and March 2017.

CONCLUSIONS

Results of the LongROAD project will generate much-needed evidence for formulating public policy and developing intervention programs to maintain safe mobility while ensuring well-being for older adults.

The effect of age and demographics on rib shape

Elderly populations have a higher risk of rib fractures and other associated thoracic injuries than younger adults, and the changes in body morphology that occur with age are a potential cause of this increased risk. Rib centroidal path geometry for 20 627 ribs was extracted from computed tomography (CT) scans of 1042 live adult subjects, then fitted to a six-parameter mathematical model that accurately characterizes rib size and shape, and a three-parameter model of rib orientation within the body. Multivariable regression characterized the independent effect of age, height, weight, and sex on the rib shape and orientation across the adult population, and statistically significant effects were seen from all demographic factors (P < 0.0001). This study reports a novel aging effect whereby both the rib end-to-end separation and rib aspect ratio are seen to increase with age, producing elongated and flatter overall rib shapes in elderly populations, with age alone explaining up to 20% of population variability in the aspect ratio of mid-level ribs. Age was not strongly associated with overall rib arc length, indicating that age effects were related to shape change rather than overall bone length. The rib shape effect was found to be more strongly and directly associated with age than previously documented age-related changes in rib angulation. Other demographic results showed height and sex being most strongly associated with rib size, and weight most strongly associated with rib pump-handle angle. Results from the study provide a statistical model for building rib shapes typical of any given demographic by age, height, weight, and sex, and can be used to help build population-specific computational models of the thoracic rib cage. Furthermore, results also quantify normal population ranges for rib shape parameters which can be used to improve the assessment and treatment of rib skeletal deformity and disease.

Age-related changes in thoracic skeletal geometry of elderly females

OBJECTIVE

Both females and the elderly have been identified as vulnerable populations with increased injury and mortality risk in multiple crash scenarios. Particularly in frontal impacts, older females show higher risk to the chest and thorax than their younger or male counterparts. Thoracic geometry plays a role in this increase, and this study aims to quantify key parts of that geometry in a way that can directly inform human body models that incorporate the concept of person age.

METHODS

Computed tomography scans from 2 female subject groups aged 20-35 and 65-99 were selected from the International Center for Automotive Medicine scan database representing young and old female populations. A model of thoracic skeletal anatomy was built for each subject from independent parametric models of the spine, ribs, and sternum, along with further parametric models of those components' spatial relationships. Parameter values between the 2 groups are directly compared, and average parameter values within each group are used to generate statistically average skeletal geometry for young and old females. In addition to the anatomic measures explicitly used in the parameterization scheme, key measures of rib cage depth and spine curvature are taken from both the underlying subject pool and from the resultant representative geometries.

RESULTS

Statistically significant differences were seen between the young and old groups' spine and rib anatomic components, with no significant differences in local sternal geometry found. Vertebral segments in older females had higher angles relative to their inferior neighbors, providing a quantification of the kyphotic curvature known to be associated with age. Ribs in older females had greater end-to-end span, greater aspect ratio, and reduced out-of-plane deviation, producing an elongated and overall flatter curvature that leads to distal rib ends extending further anteriorly in older individuals. Combined differences in spine curvature and rib geometry led to an 18-mm difference in anterior placement of the sternum between young and old subjects.

CONCLUSIONS

This study provides new geometric data regarding the variability in anthropometry of adult females with age and has utility in advancing the veracity of current human body models. A simplified scaffold representation of underlying 3-dimensional bones within the thorax is presented, and the reported young and old female parameter sets can be used to characterize the anatomic differences expected with age and to both validate and drive morphing algorithms for aged human body models. The modular approach taken allows model parameters to hold inherent and intuitive meaning, offering advantages over more generalized methods such as principal component analysis. Geometry can be assessed on a component level or a whole thorax level, and the parametric representation of thorax shape allows direct comparisons between the current study and other individuals or human body models.

Road Crashes in Older Persons and the Use of Comorbidity Polypharmacy Score in an Asian Population

Introduction: Age-related physiological changes predispose older road users to higher mortality from traffic crashes. We aimed to describe the injury epidemiology of these patients, and explore the association between the comorbidity polypharmacy score (CPS) and outcomes. Materials and Methods: This retrospective study utilised data from the Trauma Registry in the National University Hospital, Singapore, between January 2011 and December 2014. Patients involved in traffic crashes aged 45 years and above with injury severity scores (ISS) of 9 and higher were included. Results: There were 432 patients; median age was 58 (interquartile range, 51 to 65.5) years with predominance of male patients (82.2%) and Chinese ethnicity (66%). Overall mortality was 9.95%, with lower odds associated with higher Glasgow Coma Scale (odds ratio [OR] 0.73; 95% confidence interval [CI], 0.65 to 0.81, P <0.001), higher diastolic blood pressure (OR 0.98; 95% CI, 0.97 to 1.00, P = 0.031), and lower ISS of 9 to 15 (OR 0.10; 95% CI, 0.02 to 0.43, P = 0.002). The need for blood products was associated with higher mortality (OR 7.62; 95% CI, 2.67 to 21.7, P <0.001). CPS did not predict mortality. Independent predictors of discharge venue included length of stay, tier of injury and CPS group. Moderate CPS was statistically significant for nursing home placement (OR 10.7; 95% CI, 2.33 to 49.6, P = 0.002) but not for rehabilitation facility. Conclusion: CPS score is useful in predicting discharge to a nursing home facility for older patients with traffic crashes. Further larger studies involving other trauma types in the Asian population are needed to evaluate its utility. Key words: Elderly, Motor vehicle crashes, Trauma severity indices

The influence of age-related health difficulties and attitudes toward driving on driving self-regulation in the baby boomer and older adult generations

Our study aimed to determine how age- and disease-related difficulties were associated with attitudes and beliefs about driving self-regulation in men and women in the baby boomer and older generations. Three hundred and ninety-nine men (n=204) and women (n=195) aged between 48 and 91 years participated in a cross-sectional study of Australian drivers. Demographic characteristics and measures of driving confidence, driving difficulty and driving self-regulation; perceptions of visual, physical and cognitive capacity; and attitudes and beliefs about driving were obtained. Driving self-regulation in men and women was explained by different mechanisms. For men, self-report of visual and cognitive difficulties and poor driving confidence predicted driving self-regulation. For women, negative attitudes toward driving mediated the associations found between health-related difficulties and driving self-regulation. Barriers to driving self-regulation were not associated with the driving self-regulatory practices of men or women. Regardless of generation, women reported poorer driving confidence, greater driving difficulty and more driving self-regulation than men. We concluded that age- and disease-related difficulties are related to increasing driving self-regulation in mature men and women. These results indicate that different pathways are needed in models of driving self-regulation for men and women regardless of generational cohort.

Pedestrians' adherence to road traffic regulations on the N1 Highway in Accra, Ghana

Introduction

Pedestrian behavior and adherence to road traffic regulation is vital in the prevention and control of road traffic accidents (RTA) especially on highways in Ghana. We assessed pedestrians’ adherence to road crossing regulations on the George Walker Bush (N1) Highway in Accra.

Methods

We conducted a cross sectional study of pedestrians crossing the N1 highway from both sides of the road between 7:00 am and 11:00am. We observed all pedestrians using a checklist and interviewed 413 using a structured questionnaire. We collected data on basic demographics, and pedestrians’ knowledge on road crossing (exposures). Data was, cleaned and analyzed using Epi-info version 3.5.4. Pearson Chi-square was used to assess differences in proportions for categorical variables. Binary logistic regression was used to test for association between pedestrian choice of route and exposures.

Results

We observed (n = 1856) pedestrians crossing the road during the study period; 1155 (62.2%) males, 461 (24.8%) did not use the approved route(s). Majority 317(76.8%) were adults between the ages of 20-49, mostly males 265 (56.4%). Most people (92.7%) had at least basic education. AOR for sex (male) was 1.7(1.1-2.6), and regular use of Highway (always) was 0.4(0.2-0.8) at 95% CI.

Conclusion

One out of every 4pedestrians using the N1 Highway used an unapproved route. Majority of pedestrians who regularly cross the Highway at unapproved routes were males. We recommend vigorous public education and addition of more footbridges.

The Burden of Road Traffic Injuries in Yazd Province - Iran

OBJECTIVES

To estimate the Disabled-adjusted Life Years (DALYs) of Road Traffic Accidents in patients referred to hospitals in Yazd Province, central Iran.

METHODS

This cross-sectional study was conducted in Yazd province during 2010. To calculate the Years of Life Lost (YLL) due to premature death and to calculate the incidence of non-fatal injuries and Years Lost due to Disability (YLD), the data were collected from Yazd death registration system and hospital records. The causes of death and nature of non-fatal injuries were classified using International Classification of Diseases (ICD-10). We estimated Disability Adjusted Life Years (DALYs) on the guidelines of the Global Burden of Disease Study (discount rate: 0.03, age weight: 0.04, constant age weight correction factor: 0.165). Age and sex composition was taken from the National Statistical Center for the year 2010.

RESULTS

During 2009, 483 deaths were caused by traffic accidents in Yazd Province, 382 (79.09%) of which were males, and 101 (20.91%) were females. The mortality rates for males and females were 70.98 and 20.15 in 100,000, respectively. The years of life lost due to premature deaths were 15.84/1000 in men and 4.75/1,000 in women. Total YLLs caused by traffic accidents were 10,908 years. The injuries caused by traffic accidents were calculated as 15.21 and 3.73/1,000 in males and females, respectively. The total YLDs was calculated 1.51/1,000. The total burden of Road Traffic Injuries in Yazd province was 12478 years (DALYs), 87.41% of which was due to premature death, and 12.59% was related to disability. Also, 78.32% was lost in males. The age specific peak of burden was in 15-29 year.

CONCLUSION

This study showed that traffic accidents in Yazd impose a high burden. It seems that it is one of the health sector priorities. It is recommended to revise laws on use of motorcycles, especially on helmet use for motorcyclists, enforce strict laws in residential areas, and review social determinant affecting the incidence of such accidents.

The Geriatric Driver: Factors That Influence When to Stop Driving

The increase in the growth of the elderly population in the past 2 decades has been paralleled by an increase in the number of active elderly drivers. Consequentially, this growth has been accompanied by a rise in fatal road-related accidents. Due to age-related fragility, elderly drivers are more susceptible to injuries and death following a road-related accident. The increased risk of accidents has become a growing public health issue and has led to certain guidelines and restrictions for elderly drivers. Moreover, the cognitive and physiological decline that exacerbates with age has encouraged preventative measures aimed at optimizing their ability to operate motor vehicles. Some of these include yearly vision, cognitive, motor, and mental assessment tests. Results obtained from these tests may help suggest when an elderly driver becomes unsuitable to drive.

Trends in Road Traffic Deaths in Yazd, Iran, 2004 - 2010

Background

Road traffic deaths are a considerable public health problem and a major source of lost financial and human resources. Most mortality occurs in low- and middle-income countries.

Objectives

This study aimed to measure road traffic fatality rates and years of lost life, and also to depict a view of trends in road traffic deaths from 2004 to 2010 in Yazd city, a province in central Iran.

Materials and Methods

This retrospective case study analyzed road traffic deaths that were classified under the V01 - V99 codes of the ICD-10 in Yazd province from March 2004 to March 2010, using data that were collected from the death registration system of the Yazd province health center. Cases were classified according to age, sex, time of year, and residence (urban vs. rural). Years of lost life and road fatality rate per 100,000 people were calculated. Data were analyzed using chi-square test and ANOVA with SPSS 16.

Results

During the seven-year period of this study, 3,028 people in Yazd province died due to road traffic accidents (9.1% of total deaths in the province). Most deaths occurred among people aged 20-24 (15%), men (82.7%), and urban residents (82.6%). Total years of lost life (YLL) were 73,875 (60,337 and 13,489 in men and women, respectively). The road traffic fatality rate per 100,000 was 47.6 in 2004 and 37.6 in 2010. In the study period, the rate of traffic fatalities decreased for men (from 77.9 to 68.5) but this is not the case for women (from 14.8 to 19.2). Road traffic deaths peaked every summer.

Conclusions

Despite the overall reduction trend, the road traffic fatality rate in Yazd province is still alarmingly high compared to national and global data. In addition, the female population shows increasing death rates. These findings can serve as a basis for health care professionals and policymakers to conduct preventive measures, especially during summer, and plan specifically for reducing fatalities in the female population.

A Study on Mortality Profile among Fifty Plus- (50+-) Population (FPP) of India: A 5-Year Retrospective Study at New Delhi District

Objectives. To find out the mortality profile vis-a-vis different epidemiological factors at the time of autopsy among the 50+-Population. Material and Method. A five-year retrospective evaluation of medicolegal records between 2006 and 2010 was done at Lady Hardinge Medical College, New Delhi. Results. A total of 493 (17.78%) cases belonged to 50+-Population age group out of total 2773 autopsies performed. The proportion of unidentified/unknown persons among this age group was 36.51%. The unnatural and natural causes constituted 44.62% and 55.38% cases, respectively. The unspecified pneumonitis (50.18%) was reported as the commonest cause followed by coronary artery disease and respiratory tuberculosis among natural ones and the transport accident (57.27%) followed by accidental and intentional self-poisoning and exposure to noxious substances and falls among the unnatural ones. Conclusion. The findings reveal that this age group most commonly dies of natural causes rather than the unnatural ones even in autopsy cases. They have definite cure with timely interventions. The study also points out the need to devise the road and home safety measures to reduce mortality among the study population.

Comorbidity-Polypharmacy Score as Predictor of Outcomes in Older Trauma Patients: A Retrospective Validation Study

INTRODUCTION

Traditional injury severity assessment is insufficient in estimating the morbidity and mortality risk for older (≥45 years) trauma patients. Commonly used tools involve complex calculations or tables, do not consider all comorbidities, and often rely on data that are not available early in the trauma patient's hospitalization. The comorbidity-polypharmacy score (CPS), a sum of all pre-injury medications and comorbidities, was found in previous studies to independently predict morbidity and mortality in this older patient population. However, these studies are limited by relatively small sample sizes. Consequently, we sought to validate previous research findings in a large, administrative dataset.

METHODS

A retrospective study of patients ages≥45 years was performed using an administrative trauma database from St. Luke's University Hospital's Level I Trauma Center. The study period was from 1 January 2008 to 31 December 2013. Abstracted data included patient demographics, injury mechanism and severity [injury characteristics and severity score (ISS)], Glasgow coma scale (GCS), hospital and intensive care unit lengths of stay (HLOS and ILOS, respectively), morbidity, post-discharge destination, and in-hospital mortality. Univariate analyses were conducted with mortality, all-cause morbidity, and discharge destination as primary end-points. Variables reaching statistical significance (p≤0.20) were included in a multivariate logistic regression model. Data are presented as adjusted odds ratios (AORs), with p<0.05 denoting statistical significance.

RESULTS

A total of 5863 patient records were analyzed. Average patient age was 68.5±15.3 years (52% male, 89% blunt mechanism, mean GCS 14.3). Mean HLOS and ILOS increased significantly with increasing CPS (p<0.01). Independent predictors of mortality included age (AOR 1.05, p<0.01), CPS (per-unit AOR 1.08, p<0.02), GCS (AOR 1.43 per-unit decrease, p<0.01), and ISS (per-unit 1.08, p<0.01). Independent predictors of all-cause morbidity included age (AOR 1.02, p<0.01), GCS (AOR per-unit decrease 1.08, p<0.01), ISS (per-unit AOR 1.09, p<0.01), and CPS (per-unit AOR 1.04, p<0.01). CPS did not independently predict need for discharge to a facility.

CONCLUSIONS

This study confirms that CPS is an independent predictor of all-cause morbidity and mortality in older trauma patients. However, CPS was not independently associated with need for discharge to a facility. Prospective multicenter studies are needed to evaluate the use of CPS as a predictive and interventional tool, with special focus on correlations between specific pre-existing conditions, pharmacologic interactions, and morbidity/mortality patterns.

Persistent Pain Among Older Adults Discharged Home From the Emergency Department After Motor Vehicle Crash: A Prospective Cohort Study

STUDY OBJECTIVE

Motor vehicle crashes are the second most common form of trauma among older adults. We seek to describe the incidence, risk factors, and consequences of persistent pain among older adults evaluated in the emergency department (ED) after a motor vehicle crash.

METHODS

We conducted a prospective longitudinal study of patients aged 65 years or older who presented to one of 8 EDs after motor vehicle crash between June 2011 and June 2014 and were discharged home after evaluation. ED evaluation was done through in-person interview; follow-up data were obtained through mail-in survey or telephone call. Pain severity (0 to 10 scale) overall and for 15 parts of the body were assessed at each follow-up point. Principal component analysis was used to assess the dimensionality of the locations of pain data. Participants reporting pain severity greater than or equal to 4 attributed to the motor vehicle crash at 6 months were defined as having persistent pain.

RESULTS

Of the 161 participants, 72% reported moderate to severe pain at the ED evaluation. At 6 months, 26% of participants reported moderate to severe motor vehicle crash-related pain. ED characteristics associated with persistent pain included acute pain severity; pain located in the head, neck, and jaw or lower back and legs; poor self-rated health; less formal education; pre-motor vehicle crash depressive symptoms; and patient's expected time to physical recovery more than 30 days. Compared with individuals without persistent pain, those with persistent pain were substantially more likely at 6-month follow-up to have also experienced a decline in their capacity for physical function (73% versus 36%; difference=37%; 95% confidence interval [CI] 19% to 52%), a new difficulty with activities of daily living (42% versus 17%; difference=26%; 95% CI 10% to 43%), a 1-point or more reduction in overall self-rated health on a 5-point scale (54% versus 30%; difference=24%; 95% CI 6% to 41%), and a change in their living situation to obtain additional help (23% versus 8%; difference=15%; 95% CI 2% to 31%).

CONCLUSION

Among older adults discharged home from the ED post-evaluation after a motor vehicle crash, persistent pain is common and frequently associated with functional decline and disability.

Can cars and trucks coexist peacefully on highways? Analyzing the effectiveness of road safety policies in Europe

We examine the impact on the traffic accident rate of the interaction between trucks and cars on Europe's roads using a panel data set that covers the period 1999-2010. We find that rising motorization rates for trucks lead to higher traffic fatalities, while rising motorization rates for cars do not. Empirically, the model we build predicts the positive impact of stricter speed limit legislation for trucks in the reduction of road fatalities. These findings lend support to European strategies and aimed at promoting alternative modes of freight transport, including rail and maritime transport.

Analyzing fault and severity in pedestrian-motor vehicle accidents in China

The number of pedestrian-motor vehicle accidents and pedestrian deaths in China surged in recent years. However, a large scale empirical research on pedestrian traffic crashes in China is lacking. In this study, we identify significant risk factors associated with fault and severity in pedestrian-motor vehicle accidents. Risk factors in several different dimensions, including pedestrian, driver, vehicle, road and environmental factors, are considered. We analyze 6967 pedestrian traffic accident reports for the period 2006-2010 in Guangdong Province, China. These data, obtained from the Guangdong Provincial Security Department, are extracted from the Traffic Management Sector-Specific Incident Case Data Report. Pedestrian traffic crashes have a unique inevitability and particular high risk, due to pedestrians' fragility, slow movement and lack of lighting equipment. The empirical analysis of the present study has the following policy implications. First, traffic crashes in which pedestrians are at fault are more likely to cause serious injuries or death, suggesting that relevant agencies should pay attention to measures that prevent pedestrians from violating traffic rules. Second, both the attention to elderly pedestrians, male and experienced drivers, the penalty to drunk driving, speeding, driving without a driver's license and other violation behaviors should be strengthened. Third, vehicle safety inspections and safety training sessions for truck drivers should be reinforced. Fourth, improving the road conditions and road lighting at night are important measures in reducing the probability of accident casualties. Fifth, specific road safety campaigns in rural areas, and education programs especially for young children and teens should be developed and promoted. Moreover, we reveal a country-specific factor, hukou, which has significant effect on the severity in pedestrian accidents due to the discrepancy in the level of social insurance/security, suggesting that equal social security level among urban and rural people should be set up. In addition, establishing a comprehensive liability distribution system for non-urban areas and roadways will be conducive to both pedestrians' and drivers' voluntary compliance with traffic rules.

Improvements in hip fracture incidence counterbalanced by the rise of other fracture types: data from Spain 2000-2010

BACKGROUND

In recent years, the incidence of injury in older people has increased. The aim of this study is to address the hypothesis that this increase is due to an increase in the incidence of some injuries that, while less common than hip fractures, are sufficient jointly to counteract the decrease or stabilisation in hip fracture rates observed in most countries.

METHODS

We performed a descriptive study of trends using data from the National Hospital Discharge Register. We included individuals 65 years and older who were discharged from a Spanish hospital during the period 2000-2010 with at least one injury diagnosis in the primary diagnosis field on the discharge form. The dependent variables were the following injury groups, classified using the Barell Matrix: hip fracture, shoulder and upper arm fractures, forearm and elbow fractures, thoracic fractures, lower leg and ankle fractures, and TBI type 1 internal injury. Incidence rates were calculated per 100,000 inhabitants (data from National Statistics Institute) and stratified by sex and age group. Trends, in terms of Annual Percent Change (APC), were assessed using Poisson Regression with discharge year as the independent variable.

RESULTS

Hip fracture continues to be the most important injury type in older people. Thoracic fractures and TBI internal injuries are more common in men, while fractures in the upper extremities are more common in women. All injuries increased in frequency with age, except lower leg and ankle fractures, which decreased. While a secular decreasing trend in hip fracture was noted, the incidences of fractures of the shoulder and upper arm, forearm and elbow, and lower leg and ankle, as well as of TBI type 1 internal injuries have increased steadily.

CONCLUSIONS

Although hip fracture continue to be the most common type of injury in older people, this study has allowed identifying other types of injury that are becoming increasingly common. These trends are driving paradigm changes in the burden of injuries requiring treatment within the hospital system, and must be taken into account in the design of preventative programs and actions.

Risk factors for fatal and nonfatal road crashes in iran

Background:

Road traffic injuries are among the leading causes of death in the world and Iran.

Objectives:

The aim of this study was to assess the role of age, sex, education, and time of accident on human casualties and mortalities of road crashes in Iran.

Materials and Methods:

This study was based on data gathered by Iranian Police Department from the records of road crashes from April 4, 2008 through April 4, 2009. Road crashes are categorized into three types: with no human casualties, with injuries, and with human mortalities.

Results:

The largest rate of human causalities was observed in people aged between 25 to 34 years (P < 0.001). Illiterate people had 81% smaller odds of causality in road crashes (P < 0.001) in comparison with those with a kind of academic education. Overall, 73.4% of crashes had happened during the last ten days of a month were with human casualties (P < 0.001) and human casualties rate was slightly higher in crashes happened between 1 AM to 5 AM Fatality rate was slightly higher in the females (OR = 2.6, P = 0.068). The smallest odds of fatality were found in the people aged between 18 to 24 years and the highest odds were seen in people ≥ 55 years of age (P < 0.001). In people with a university education, 61.9% of crashes were with fatality (P = 0.026). In addition, 82.8% of crashes during winter, 60.2% of crashes during autumn, and 35.8% of crashes during summer were with mortalities. Overall, 78.3% of crashes with human casualties that had happened during 1 AM to 5 AM led to mortalities. There was also a significant association between injury and its intensity with fastening seatbelts.

Conclusions:

Older age, university degrees, female sex, wintertime, and the time of accident seem to be the most important risk factors in road crashes that lead to fatalities in Iran. Drivers in Iran should be informed and trained regarding these risk factors, which have direct effect on casualties and mortalities in road crashes.

Can health public expenditure reduce the tragic consequences of road traffic accidents? The EU-27 experience

This study uses data for the EU-27 countries in the period 1999-2009 to estimate determinants of road traffic fatality rates. Controlling for country attributes and road safety policy variables, we examine the influence of variables related with the national health systems; the number of hospital beds per square kilometer, and the percentage of health expenditures over gross domestic product. We find evidence that the density of hospital beds contributes to the fall in traffic-related fatalities. Furthermore, the quality of general medical facilities and technology associated with increases in health expenditure may be also a relevant factor in reducing road traffic fatalities.

Evaluation of the revised trauma and injury severity scores in elderly trauma patients

BACKGROUND

Severity-of-illness scoring systems have primarily been developed for, and validated in, younger trauma patients.

AIMS

We sought to determine the accuracy of the injury severity score (ISS) and the revised trauma score (RTS) in predicting mortality and hospital length of stay (LOS) in trauma patients over the age of 65 treated in our emergency department (ED).

MATERIALS AND METHODS

Using the Illinois Trauma Registry, we identified all patients 65 years and older treated in our level I trauma facility from January 2004 to November 2007. The primary outcome was death; the secondary outcome was overall hospital length of stay (LOS). We measured associations between scores and outcomes with binary logistic and linear regression.

RESULTS

A total of 347 patients, 65 years of age and older were treated in our hospital during the study period. Median age was 76 years (IQR 69-82), with median ISS 13 (IQR 8-17), and median RTS 7.8 (IQR 7.1-7.8). Overall mortality was 24%. A higher value for ISS showed a positive correlation with likelihood of death, which although statistically significant, was numerically small (OR=1.10, 95% CI 1.06 to 1.13, P<0.001). An elevated RTS had an inverse correlation to likelihood of death that was also statistically significant (OR=0.48, 95% CI 0.39 to 0.58, P<0.001). Total hospital LOS increased with increasing ISS, with statistical significance decreasing at the highest levels of ISS, but an increase in RTS not confirming the predicted decrease in total hospital LOS consistently across all ranges of RTS.

CONCLUSIONS

The ISS and the RTS were better predictors of mortality than hypothesized, but had limited correlation with hospital LOS in elderly trauma patients. Although there may be some utility in these scores when applied to the elderly population, caution is warranted if attempting to predict the prognosis of patients.