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Buh FC, Sumbele IUN, Maas AIR, Motah M, Pattisapu JV, Youm E, Meh BK, Kobeissy FH, Wang KW, Hutchinson PJA, Taiwe GS. Traumatic Brain Injury in Cameroon: A Prospective Observational Study in a Level I Trauma Centre. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1558. [PMID: 37763678 PMCID: PMC10535664 DOI: 10.3390/medicina59091558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023]
Abstract
Background and Objective: About 14 million people will likely suffer a traumatic brain injury (TBI) per year by 2050 in sub-Saharan Africa. Studying TBI characteristics and their relation to outcomes can identify initiatives to improve TBI prevention and care. The objective of this study was to define the features and outcomes of TBI patients seen over a 1-year period in a level-I trauma centre in Cameroon. Materials and Methods: Data on demographics, causes, clinical aspects, and discharge status were collected over a period of 12 months. The Glasgow Outcome Scale-Extended (GOSE) and the Quality-of-Life Questionnaire after Brain Injury (QoLIBRI) were used to evaluate outcomes six months after TBI. Comparisons between two categorical variables were done using Pearson's chi-square test. Results: A total of 160 TBI patients participated in the study. The age group 15-45 years was most represented (78%). Males were more affected (90%). A low educational level was seen in 122 (76%) cases. Road traffic incidents (RTI) (85%), assaults (7.5%), and falls (2.5%) were the main causes of TBI, with professional bike riders being frequently involved (27%). Only 15 patients were transported to the hospital by ambulance, and 14 of these were from a referring hospital. CT-imaging was performed in 78% of cases, and intracranial traumatic abnormalities were identified in 64% of cases. Financial constraints (93%) was the main reason for not performing a CT scan. Forty-six (33%) patients were discharged against medical advice (DAMA) due to financial constraints. Mortality was 14% (22/160) and high in patients with severe TBI (46%). DAMA had poor outcomes with QoLIBRI. Only four patients received post-injury physical therapy services. Conclusions: TBI in Cameroon mainly results from RTIs and commonly affects young adult males. Lack of pre-hospital care, financial constraints limiting both CT scanning and medical care, and a lack of acute physiotherapy services likely influenced care and outcomes adversely.
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Affiliation(s)
- Franklin Chu Buh
- Department of Animal Biology and Conservation, Faculty of Science, University of Buea, Buea P.O. Box 63, Cameroon (B.K.M.)
| | - Irene Ule Ngole Sumbele
- Department of Animal Biology and Conservation, Faculty of Science, University of Buea, Buea P.O. Box 63, Cameroon (B.K.M.)
| | - Andrew I. R. Maas
- Department of Neurosurgery, Antwerp University Hospital, University of Antwerp, 2000 Edegem, Belgium;
| | - Mathieu Motah
- Department of Surgery, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala P.O. Box 2701, Cameroon;
| | - Jogi V. Pattisapu
- Department of Pediatric Neurosurgery, University of Central Florida College of Medicine, 6850 Lake Nona Blvd, Orlando, FL 32827, USA;
| | - Eric Youm
- Holo Healthcare, Nairobi 00400, Kenya;
| | - Basil Kum Meh
- Department of Animal Biology and Conservation, Faculty of Science, University of Buea, Buea P.O. Box 63, Cameroon (B.K.M.)
| | - Firas H. Kobeissy
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Riad El-Solh, Beirut P.O. Box 11-0236, Lebanon
| | - Kevin W. Wang
- Center for Neurotrauma, Multiomics & Biomarkers (CNMB), Department of Neurobiology, Neuroscience Institute, Morehouse School of Medicine, 720 Westview Dr SW, Atlanta, GA 30310-1458, USA;
| | | | - Germain Sotoing Taiwe
- Department of Animal Biology and Conservation, Faculty of Science, University of Buea, Buea P.O. Box 63, Cameroon (B.K.M.)
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Thomas M, Tillman P, Riemann BL. Blood alcohol concentration as a measure of risk among pedestrian fatalities in the U.S., 2016-2020. TRAFFIC INJURY PREVENTION 2023; 24:513-520. [PMID: 37459210 DOI: 10.1080/15389588.2023.2229469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/21/2023] [Accepted: 06/21/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVE In the United States, deaths among pedestrians have increased dramatically since 2009 relative to other vulnerable road users, with substance use described as an important risk factor. This study aimed to explore blood alcohol concentrations (BAC g/dL) among pedestrian fatalities in the United States between 2016 and 2020. Exploring the presence of alcohol among pedestrian cases will support targeted interventions designed to reduce risk. METHODS This study utilized pedestrian fatality and alcohol screening data provided by the Fatality Analysis Reporting System (FARS). Logistic models were examined to identify statistical associations (ORs, 95% CI) by age, race, and sex relative to positive BAC exposure (BAC > 0.0 g/dL), mild exposure (BAC > 0.0 < .079 g/dL), moderate to severe alcohol exposure (BAC 0.08-.299 g/dL), and severe exposure (BAC ≥ 0.30 g/dL). RESULTS Between 2016 and 2020, 33,375 pedestrian fatalities were reported to FARS with 75.1% of cases retained for analysis (n = 25,077). Fatalities were more likely to be White (69.3%), male (69.9%), and between 25-64 years of age (67.3%). 74.0% of fatalities were tested for alcohol, with 40.9% screening positive. Females, cases ≥ 75 years of age, and those identified as Asians reported the lowest odds of being positive for alcohol exposure. CONCLUSIONS Results suggest an ongoing threat to pedestrians due to alcohol consumption and that exposure odds vary by demographic characteristics. Unfortunately, analytical approaches to understanding the roles played by drugs and alcohol among vulnerable road users tend to be marginalized in the literature. Analytical, evidence-based investigations are needed to curtail the risk of pedestrian fatalities in the U.S.
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Affiliation(s)
- McKinley Thomas
- Department of Health Sciences and Kinesiology, Georgia Southern University, Waters College of Health Professions, Savannah, Georgia
| | - Paula Tillman
- Department of Health Sciences and Kinesiology, Georgia Southern University, Waters College of Health Professions, Savannah, Georgia
| | - Bryan L Riemann
- Department of Health Sciences and Kinesiology, Georgia Southern University, Waters College of Health Professions, Savannah, Georgia
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Rundle AG, Bader MDM, Branas CC, Lovasi GS, Mooney SJ, Morrison CN, Neckerman KM. Causal Inference with Case-Only Studies in Injury Epidemiology Research. CURR EPIDEMIOL REP 2022; 9:223-232. [PMID: 37152190 PMCID: PMC10161782 DOI: 10.1007/s40471-022-00306-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/03/2022]
Abstract
Purpose of Review We review the application and limitations of two implementations of the "case-only design" in injury epidemiology with example analyses of Fatality Analysis Reporting System data. Recent Findings The term "case-only design" covers a variety of epidemiologic designs; here, two implementations of the design are reviewed: (1) studies to uncover etiological heterogeneity and (2) studies to measure exposure effect modification. These two designs produce results that require different interpretations and rely upon different assumptions. The key assumption of case-only designs for exposure effect modification, the more commonly used of the two designs, does not commonly hold for injuries and so results from studies using this design cannot be interpreted. Case-only designs to identify etiological heterogeneity in injury risk are interpretable but only when the case-series is conceptualized as arising from an underlying cohort. Summary The results of studies using case-only designs are commonly misinterpreted in the injury literature.
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Affiliation(s)
- Andrew G. Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 727, New York, NY 10032, USA
| | | | - Charles C. Branas
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 727, New York, NY 10032, USA
| | - Gina S. Lovasi
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA, USA
| | - Stephen J. Mooney
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Christopher N. Morrison
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 727, New York, NY 10032, USA
| | - Kathryn M. Neckerman
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 727, New York, NY 10032, USA
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van Hoving DJ, van Koningsbruggen C, de Man M, Hendrikse C. Temporal changes in trauma according to alcohol sale restrictions during the South African national COVID-19 lockdown. Afr J Emerg Med 2021; 11:477-482. [PMID: 34490069 PMCID: PMC8410509 DOI: 10.1016/j.afjem.2021.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/26/2021] [Accepted: 08/15/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction The South African government enforced various alcohol sale restrictions during the COVID-19 lockdown in order to reduce hospital admissions related to alcohol-associated injuries. A cross-sectional study was performed to describe the temporal changes in trauma according to alcohol sale restrictions during the South African national COVID-19 lockdown. Methods Data from all trauma-related patients presenting to the emergency centre of Mitchells Plain Hospital from 01/03/2020 till 29/9/2020 and corresponding periods during 2019 were exported from an existing database. The relationship between variables was determined with the χ2-test, Fisher's exact test, independent samples median test or t-test. A sub-analysis compared similar 2020 lockdown levels when a second alcohol ban were instituted while most business were allowed to operate (level 3b – alcohol banned versus level 3 – alcohol restricted). Results Total number of trauma presentations were 539 (14.6%) less in 2020 (n = 3160) than in 2019 (n = 3699); the mean number decreased by 2.5 per day (95% CI −2.9 to −2.1). Lockdown levels with an alcohol ban had on average 4.8 less patients per day than corresponding periods in 2019 (p < 0.001). No significant difference was observed in lockdown levels with alcohol sale restrictions (mean difference per day −0.4, p = 0.195). Trauma presentations increased significantly (mean difference per day 7.0 (95% CI 6.5 to 7.5)) from 2020 lockdown levels with alcohol sales ban (mean per day 11.4) to 2020 lockdown levels with alcohol sale restrictions (mean per day 18.4). Significantly less patients (mean −3.2 (95% CI −3.9 to −2.5)) presented during 2020 lockdown level 3b (alcohol sales banned, mean 13.9) compared to level 3 (alcohol sales restricted, mean 17.1). Conclusion Temporal changes in trauma were observed according to alcohol sale restrictions during South Africa's COVID-19 lockdown periods. Significantly less trauma cases presented during periods with an alcohol ban compared to periods where alcohol sales were only restricted.
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Affiliation(s)
- Daniel J. van Hoving
- Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Corresponding author.
| | - Candice van Koningsbruggen
- Mitchells Plain Hospital and Heideveld Hospital Emergency Centres, Cape Town, South Africa
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Martin de Man
- Mitchells Plain Hospital and Heideveld Hospital Emergency Centres, Cape Town, South Africa
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Clint Hendrikse
- Mitchells Plain Hospital and Heideveld Hospital Emergency Centres, Cape Town, South Africa
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
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Oviedo-Trespalacios O, Çelik AK, Marti-Belda A, Włodarczyk A, Demant D, Nguyen-Phuoc DQ, Rubie E, Oktay E, Argandar GD, Rod JE, Natividade JC, Park J, Bastos JT, Martínez-Buelvas L, Pereira da Silva MDF, Velindro M, Sucha M, Orozco-Fontalvo M, Barboza-Palomino M, Yuan Q, Mendes R, Rusli R, Ramezani S, Useche SA, de Aquino SD, Tsubakita T, Volkodav T, Rinne T, Enea V, Wang Y, King M. Alcohol-impaired Walking in 16 Countries: A Theory-Based Investigation. ACCIDENT; ANALYSIS AND PREVENTION 2021; 159:106212. [PMID: 34098429 DOI: 10.1016/j.aap.2021.106212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 06/12/2023]
Abstract
Alcohol is a global risk factor for road trauma. Although drink driving has received most of the scholarly attention, there is growing evidence of the risks of alcohol-impaired walking. Alcohol-impaired pedestrians are over-represented in fatal crashes compared to non-impaired pedestrians. Additionally, empirical evidence shows that alcohol intoxication impairs road-crossing judgements. Besides some limited early research, much is unknown about the global prevalence and determinants of alcohol-impaired walking. Understanding alcohol-impaired walking will support health promotion initiatives and injury prevention. The present investigation has three aims: (1) compare the prevalence of alcohol-impaired walking across countries; (2) identify international groups of pedestrians based on psychosocial factors (i.e., Theory of Planned Behaviour (TPB) and perceptions of risk); and (3) investigate how segments of pedestrians form their intention for alcohol-impaired walking using the extended TPB (i.e. subjective norm, attitudes, perceived control, and perceived risk). A cross-sectional design was applied. The target behaviour question was "have you been a pedestrian when your thinking or physical ability (balance/strength) is affected by alcohol?" to ensure comparability across countries. Cluster analysis based on the extended TPB was used to identify groups of countries. Finally, regressions were used to predict pedestrians' intentions per group. A total of 6,166 respondents (Age M(SD) = 29.4 (14.2); Males = 39.2%) completed the questionnaire, ranging from 12.6% from Russia to 2.2% from Finland. The proportion of participants who reported never engaging in alcohol-impaired walking in the last three months ranged from 30.1% (Spain) to 83.1% (Turkey). Four groups of countries were identified: group-1 (Czech Republic, Spain, and Australia), group-2 (Russia and Finland), group-3 (Japan), and group-4 (final ten countries including Colombia, China, and Romania). Pedestrian intentions to engage in alcohol- impaired walking are predicted by perceptions of risk and TPB-psychosocial factors in group-1 and group-4. Favourable TPB-beliefs and low perceived risk increased alcohol-impaired walking intentions. Conversely, subjective norms were not significant in group-2 and only perceived risk predicted intention in group-3. The willingness of pedestrians to walk when alcohol-impaired differs significantly across the countries in this study. Perceived risk was the only common predictor among the 16 countries.
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Affiliation(s)
| | | | | | | | - Daniel Demant
- Queensland University of Technology (QUT), Australia; University of Technology Sydney, Australia
| | - Duy Q Nguyen-Phuoc
- The University of Danang - University of Science and Technology, Vietnam
| | | | | | | | - J E Rod
- Queensland University of Technology (QUT), Australia
| | | | | | | | | | | | | | | | | | | | | | - Rui Mendes
- Polytechnic Institute of Coimbra, Portugal
| | | | | | | | | | | | | | | | | | | | - Mark King
- Queensland University of Technology (QUT), Australia
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Schwebel DC, Hasan R, Griffin R, Hasan R, Hoque MA, Karim MY, Luo K, Johnston A. Reducing distracted pedestrian behavior using Bluetooth beacon technology: A crossover trial. ACCIDENT; ANALYSIS AND PREVENTION 2021; 159:106253. [PMID: 34126275 PMCID: PMC8384715 DOI: 10.1016/j.aap.2021.106253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 04/21/2021] [Accepted: 06/05/2021] [Indexed: 05/27/2023]
Abstract
BACKGROUND The number of fatal pedestrian injuries in the United States has steadily increased over the past decade. Multiple factors likely contribute to this trend, but the growth of pedestrians distracted by mobile devices is widely hypothesized to play a major role. Existing strategies to reduce distracted pedestrian behavior are few and mostly ineffective. The present study evaluated StreetBit, a mostly-passive primary prevention program to reduce distracted pedestrian behavior by alerting distracted pedestrians directly on their smartphone when they approach an intersection, reminding them to attend to traffic as they crossed. METHODS 385 individuals who regularly crossed a target street corner at an urban university downloaded StreetBit on their phones and participated in a crossover design study whereby the app was inactive for 3 weeks (baseline behavior phase), actively provided alerts for 3 weeks (intervention phase), and then was inactive again for 4 weeks (post-intervention phase). User distraction while crossing the intersection was collected electronically for a total of 34,923 street-crossing events throughout the 10-week study. RESULTS In crude (unadjusted) models, participant distraction was similar across all phases of the research; this result was maintained after adjusting for potential covariates as well as after conducting a sensitivity analysis limited to data from only week 3 of each study intervention phase. In a model stratified by phone/warning type and baseline distraction rates, Android phone users who received a warning that blocked the full screen and had a high baseline distraction rate (≥75% distracted crossings) had a 64% decreased odds of distraction during the alert phase (OR 0.36, 95% CI 0.25-0.51) and a 52% decreased odds of distraction during the post-intervention phase (OR 0.48, 95% CI 0.25-0.94). Users reported positive impressions about the StreetBit app in a post-intervention survey. DISCUSSION StreetBit, an innovative app designed to prevent distracted pedestrian behavior through a mostly-passive primary prevention strategy relying on intrusive reminders, proved effective among smartphone users who received a warning blocking the full screen and who were frequently distracted at baseline, but not among other users. The results appear to reflect the confluence of two influencing factors. First, due to software development limitations, visually-distracted Android users received a highly intrusive app warning that blocked their smartphone screen whereas iOS users received a less intrusive banner notification blocking a small upper portion of the screen. Second, most users were curious to see if the app was functioning properly, creating artificially-inflated estimates of distraction as users purposefully watched their phones when crossing. Thus, our results indicate promise for StreetBit as an effective intervention and warrant continued software development and empirical testing.
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Affiliation(s)
| | | | | | | | | | | | - Kevin Luo
- University of Alabama at Birmingham, USA
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7
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Tonellato DJ, Ransohoff JR, Nash C, Melanson SEF, Petrides AK, Tolan NV, Goldberg SA, Boyer EW, Chai PR, Erickson TB. Traumatic pedestrian and bicyclist injuries associated with intoxication. Am J Emerg Med 2021; 45:192-195. [PMID: 33046308 PMCID: PMC7884480 DOI: 10.1016/j.ajem.2020.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Drug and alcohol use are risk factors for trauma among operators of motor vehicles and contribute to trauma in pedestrians and bicyclists. We describe the prevalence of drug and alcohol use and clinical consequences in a cohort of pedestrians and bicyclists with trauma. METHODS We analyzed a 25-month data set of 916 trauma team activations from January 2017-January 2019 at an urban, level I trauma center. Blood ethanol levels and urine toxicology screens were obtained in 94 pedestrian and bicyclist trauma activations. We compared pedestrians or bicyclists with a positive urine or blood screen (n = 69) to those with negative screens (n = 25). We conducted a retrospective chart review to determine mechanism of injury, injury pattern, and disposition from the emergency department (ED). RESULTS Overall, 38 (55%) of injured patients with positive screen were pedestrians and 31 (45%) were bicyclists. Fentanyl was the most commonly detected drug (n = 38; 40%), followed by opiates (n = 27; 29%), and tetrahydrocannabiol (THC) (n = 23; 25%). Twenty-one patients were positive for ethanol. Pedestrians and bicyclists with positive toxicology screens were significantly more likely to sustain fractures (p < .01), require an operative procedure (p < .05), or intensive care unit admission (p < .05). CONCLUSION Our study builds on previous literature which suggests that intoxicated bicyclists and pedestrians suffer frequent and more severe injury than their sober counterparts. Public health campaigns should educate bicyclists and pedestrians about the risks of cycling or walking in areas of road traffic while under the influence of alcohol or illicit drugs.
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Affiliation(s)
- D J Tonellato
- Department of Emergency Medicine, Division of Medical Toxicology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America.
| | - J R Ransohoff
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - C Nash
- Department of Emergency Medicine, Division of Medical Toxicology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - S E F Melanson
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - A K Petrides
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - N V Tolan
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - S A Goldberg
- Department of Emergency Medicine, Division of Medical Toxicology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - E W Boyer
- Department of Emergency Medicine, Division of Medical Toxicology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America; The Fenway Institute, Boston, MA, United States of America
| | - P R Chai
- Department of Emergency Medicine, Division of Medical Toxicology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America; The Fenway Institute, Boston, MA, United States of America; Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States of America; Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, United States of America
| | - T B Erickson
- Department of Emergency Medicine, Division of Medical Toxicology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America; Harvard Humanitarian Initiative, Harvard University, Cambridge, MA, United States of America
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8
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Pasnin LT, Gjerde H. Alcohol and drug use among road users involved in fatal crashes in Norway. TRAFFIC INJURY PREVENTION 2021; 22:267-271. [PMID: 33724110 DOI: 10.1080/15389588.2021.1887854] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To study the prevalence of alcohol and drugs in biological samples from drivers, motorcycle riders, bicyclists, and pedestrians involved in fatal road traffic crashes (RTCs) during 2016-2018 in Norway, both among fatally injured victims and those who survived fatal RTCs. METHODS Anonymous information was extracted from police data. No personal data were recorded. RESULTS There were 330 fatal RTCs with 349 killed road users and 384 survivors during the study period; this included 179 passengers who were excluded from the study. In total, 90% of the studied killed road users and 67% of the survivors were investigated for alcohol or drug use by analyzing biological samples. Alcohol or drugs in concentrations above the legal limits were detected in 21% of the analyzed samples. The proportion impaired by alcohol or drugs (blood alcohol concentrations equal to or greater than 0.05%, or drug concentrations above equivalent limits) was highest among killed bicyclists (43%), higher than among killed pedestrians (24%), car and van drivers (28%) and motorcyclists (20%), and significantly higher than among drivers who survived fatal crashes (4%). CONCLUSIONS Impairment due to use of alcohol or drugs was often a contributing factor among bicyclists, pedestrians and motor vehicle drivers who died in RTCs. Driving under the influence of alcohol or drugs was more often a contributing factor in cases where the motor vehicle driver was killed than in cases where the driver survived.
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Affiliation(s)
| | - Hallvard Gjerde
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
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9
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Lasota D, Al-Wathinani A, Krajewski P, Goniewicz K, Pawłowski W. Alcohol and Road Accidents Involving Pedestrians as Unprotected Road Users. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8995. [PMID: 33276696 PMCID: PMC7729452 DOI: 10.3390/ijerph17238995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/29/2020] [Accepted: 12/01/2020] [Indexed: 11/16/2022]
Abstract
According to the World Health Organization (WHO), more than half of all road fatalities involve vulnerable road users, i.e., pedestrians, cyclists, and motorcyclists. Poland is classified as one of the European Union (EU) countries marked by low road safety, with a higher frequency of accidents involving pedestrians compared to other EU countries (31% of all fatalities). Among unprotected road users, a significant group of victims are pedestrians, who are often under the influence of alcohol. This study aims to analyze the impact of alcohol on the risk of occurrence and consequences of road accidents among pedestrians. The source of data was the medical documentation of the Department of Forensic Medicine of the Medical University of Warsaw. In more than half of pedestrian deaths, the presence of alcohol was found; regardless of the place of the event and the place of death, among the victims under the influence of alcohol, males dominated; the average age of the victims under the influence of alcohol was significantly lower compared to the average age of sober victims, with younger victims being significantly more likely to die at the scene of the accident, especially in rural areas; significantly higher alcohol concentrations were found in males, in victims who died at the scene of the accident, and with victims of accidents in rural areas. Among pedestrian traffic accident fatalities, the most numerous group comprised young men under the influence of alcohol. In rural areas, a higher percentage of pedestrian victims died at the scene as a result of excessive alcohol consumption. These areas should be subject to intensive preventive measures to increase the safety of pedestrians as unprotected road users.
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Affiliation(s)
- Dorota Lasota
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Ahmed Al-Wathinani
- Department of Emergency Medical Services, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Paweł Krajewski
- Department of Forensic Medicine, Medical University of Warsaw, 00-001 Warsaw, Poland;
| | - Krzysztof Goniewicz
- Department of Aviation Security, Military University of Aviation, 08-521 Dęblin, Poland;
| | - Witold Pawłowski
- Department of Emergency Medicine, Medical University of Lublin, 20-081 Lublin, Poland
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10
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Lasota D, Al-Wathinani A, Krajewski P, Mirowska-Guzel D, Goniewicz K, Hertelendy AJ, Alhazmi RA, Pawłowski W, Khorram-Manesh A, Goniewicz M. Alcohol and the Risk of Railway Suicide. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7003. [PMID: 32987939 PMCID: PMC7578964 DOI: 10.3390/ijerph17197003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 12/20/2022]
Abstract
Suicide is one of the ten most common causes of death in the world. Of all deaths from suicide, 22% can be attributed to the use of alcohol, which means that every fifth suicide would not occur if alcohol were not consumed by the population. People under the influence of alcohol choose more radical and effective methods of dying by suicide, e.g., throwing themselves under a moving vehicle, such as a train. The presented analysis aimed to determine important risk factors affecting railway suicide in Poland and their relation to the state of alcohol intoxication of the victims, and the relationship between ethyl alcohol consumption and the phenomenon of suicide. Documentation obtained from the Department of Forensic Medicine at the Medical University of Warsaw, in the form of death registers and forensic medical records concerning examination and autopsy, was analyzed. This made it possible to identify suicide victims from among pedestrian victims of railway accidents recorded during the period under study. The research was carried out using unidimensional and multidimensional statistical analyses with IBM SPSS Statistics, version 25. Sober suicide victims were statistically significantly older than victims under the influence of alcohol; alcohol concentration was correlated with the age of the victims-the older the victims were, the higher the alcohol concentration. A significantly higher number of deaths attributed to suicide by sober victims was observed in autumn compared to other seasons. Multidimensional analysis showed a statistically significant effect of age and season on the probability of dying by suicide under the influence of alcohol-this probability decreases with the age of the victims and is also significantly lower in autumn. The observed relationship between age and the presence of alcohol in suicide victims can be the cause of railway suicides. Knowledge of the mechanisms of seasonal variability of suicidal behavior can help to develop effective strategies to prevent railway suicides. It is necessary to improve the system of reporting railway suicides, as only reliable statistics provide the possibility of assessing both the scale of the problem and the effectiveness of actions taken.
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Affiliation(s)
- Dorota Lasota
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Banacha 1b Street, 02097 Warsaw, Poland;
| | - Ahmed Al-Wathinani
- Department of Emergency Medical Services, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh 11451, Saudi Arabia; (A.A.-W.); (R.A.A.)
| | - Paweł Krajewski
- Department of Forensic Medicine, Medical University of Warsaw, 50368 Warsaw, Poland;
| | - Dagmara Mirowska-Guzel
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Banacha 1b Street, 02097 Warsaw, Poland;
| | - Krzysztof Goniewicz
- Department of Aviation Security, Military University of Aviation, 08521 Dęblin, Poland;
| | - Attila J. Hertelendy
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL 33174, USA;
| | - Riyadh A. Alhazmi
- Department of Emergency Medical Services, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh 11451, Saudi Arabia; (A.A.-W.); (R.A.A.)
| | - Witold Pawłowski
- Department of Emergency Medicine, Medical University of Lublin, 20081 Lublin, Poland; (W.P.); (M.G.)
| | - Amir Khorram-Manesh
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, Gothenburg University, 41345 Gothenburg, Sweden;
- Department of Development and Research, Armed Forces Center for Defense Medicine, Västra Frölunda, 42676 Gothenburg, Sweden
| | - Mariusz Goniewicz
- Department of Emergency Medicine, Medical University of Lublin, 20081 Lublin, Poland; (W.P.); (M.G.)
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Lasota D, Goniewicz M, Kosson D, Ochal A, Krajewski P, Tarka S, Goniewicz K, Mirowska-Guzel D. Effects of ethyl alcohol on injuries severity according to injury severity scales in pedestrian fatal injury in traffic crashes. Int J Inj Contr Saf Promot 2019; 27:112-120. [PMID: 31524049 DOI: 10.1080/17457300.2019.1665551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The dominant cause of injuries in traffic crashes. A significant portion of them affects victims under the influence of ethyl alcohol. The goal of the studies was to assess the correlation between the state of sobriety and the severity of injuries expressed by injury severity scales in fatal pedestrian victims of traffic crashes. Research Material and Method: The data were obtained from the Warsaw Medical University's Department of Forensic Medicine. The analysis covered the data for 2009-2013 and included 200 fatal pedestrian victims hit by passenger cars. The assessment of the effect of risk factors on injury severity expressed in terms of injury severity scales such as Life Threat Indicator (LTI), International Classification based Injury Severity Score (ICISS), Injury Severity Score (ISS) and New Injury Severity Score (NISS), was made using adequately selected methods of statistical analysis. RESULTS As alcohol concentration increases in women, the values of LTI, ICISS-10 and ICISS-15 decrease, which denotes more severe injuries. In the ISS and NISS, the effect of alcohol concentration on the severity of injuries turned out to be negligible. However, these injuries are significantly heavier in women than in men. According to all the scales used, the older the victims, the milder injuries cause their death. CONCLUSIONS The studies show that ethyl alcohol concentration may harm injury severity, especially in the case of women. The assessment of the severity of injuries in traffic crash victims is significantly influenced by their age and gender. The more risk factors the scale takes into consideration, the more precise is the assessment.
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Affiliation(s)
- Dorota Lasota
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | - Mariusz Goniewicz
- Department of Emergency Medicine, Medical University of Lublin, Lublin, Poland
| | - Dariusz Kosson
- Department of Anesthesiology and Intensive Care, Division of Teaching, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Ochal
- Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Lublin, Poland
| | - Paweł Krajewski
- Chair and Department of Forensic Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Sylwia Tarka
- Chair and Department of Forensic Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | - Dagmara Mirowska-Guzel
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
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The effect of ethyl alcohol on the severity of injuries in fatal pedestrian victims of traffic crashes. PLoS One 2019; 14:e0221749. [PMID: 31504039 PMCID: PMC6736251 DOI: 10.1371/journal.pone.0221749] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 08/14/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction A substantial percentage of traffic crashes involve people under the influence of ethyl alcohol. In such circumstances, we speak of the possible effect of ethanol upon trauma outcomes. The present research aimed to assess the state of sobriety fatal pedestrian victims and the correlation between the level of sobriety and the severity of injuries. Research material and method The data was obtained from the Warsaw Medical University’s Department of Forensic Medicine. The analysis covered the data for the period of 2009–2013; it encompassed 158 fatal pedestrian victims hit by passenger cars. The appropriate methods of statistical analysis were applied. Results The majority of the fatal pedestrian victims were individuals under the influence of ethyl alcohol (72.15%). Significant correlations were observed between the concentration of ethyl alcohol and the victims’ gender (p<0.0001) and age (p = 0.0026). The analysis showed that pedestrians under the influence of ethyl alcohol more often died on the scene (78.95%). Conclusions Pedestrians under the influence of ethyl alcohol are a significant group of victims of traffic crashes. Ethyl alcohol is not an independent factor affecting the severity of injuries. A higher percentage of pedestrian victims die on the scene, especially in rural areas.
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