Driving impairment due to psychoactive substances and attention deficit disorder: A pilot study

Objective

Attention disorder and substance use disorder are linked to driving impairment and increased road crash involvement. This study explores attention deficits in a population of drivers found driving under the influence (DUI) of psychoactive substances.

Methods

A case-control study was conducted comparing subjects with a previous DUI episode (cases) to subjects who were negative for DUI offenses (controls). Personal, socio-demographic, and DUI data were collected for both groups. All subjects were administered the Continuous Performance Test-third edition (CPT-3), which measures dimensions of attention, including inattentiveness, impulsivity, sustained attention, and vigilance. Possible associations with a previous DUI episode, the use of illicit substances or excessive alcohol use, and road crash involvement were analyzed statistically.

Results

Overall, the study included 147 subjects (100 cases, 47 controls). The parameter distributions of detectability, probability of ADHD, and inattentiveness indicated statistical differences between the two groups. No attention deficits predicted substance use disorder or excessive alcohol consumption. Inattentiveness was an independent risk factor for previous road collision involvement.

Conclusions

The results suggest that alterations exist in some attention dimensions in a population of DUI subjects who were users of alcohol or other psychoactive substances and involved in road traffic crashes. The CPT-3 had successfully distinguished between the two study groups, and after validation, it could be useful in the process of reinstating a driver's license. Future research should expand the study sample to better understand the relevance of the proposed methodological approach in terms of prevention, rehabilitation, and the monitoring of subjects evaluated for driving eligibility requirements.

Learning With a Supervisor Who has Traffic Offences and Young Driver Crashes: The DRIVE Study 13-Year Follow-Up

PURPOSE

Young learner drivers commonly must record substantial supervised practice driving before independent licensure. Supervisory driver requirements can be limited or highly regulated, yet research is lacking on the effectiveness of different approaches. The current objective was to explore whether young drivers who were mostly supervised by someone who they perceived had traffic offences versus no offences had different crash records over a period of 13 years postlicensing.

METHODS

DRIVE is an Australian prospective cohort study of more than 20,000 drivers who were aged 17-24 years and newly licensed during 2003-2004. They completed detailed baseline questionnaires, including whether the person they identified as supervising their learner driving the most had perceived traffic offences in the past 12 months. Responses were linked to their state crash, hospitalization, and death records to 2016. A parametric survival model was created to calculate hazard ratios of time to crash for those reporting that their supervisor had 0 versus 1 and 0 versus 2+ perceived offences, adjusting for the participants' prior crash history and other covariates.

RESULTS

After adjusting for covariates, 369 participants reporting supervisory drivers with 2+ perceived offences, compared to 15,451 participants reporting no such offences, had up to 1.67 (95% confidence interval 1.10-2.53 at 6 months) times the rate of any crash for the first 2.5 years and up to 2.01 (95% confidence interval 1.26-3.19 at 3.5 years) times the rate of crashes resulting in injury for 5.5 years.

DISCUSSION

Although overall supervision by a driver with two or more perceived offences was low, further attention is needed to ensure improved supervised driving experiences, with mentoring programs and professional instructor partnerships worthy of exploration.

CBT program to reduce recidivism risk for road crashes among adolescents and young adults: Results of a randomized controlled study and prospects

Road crashes are the first cause of mortality for young adults aged 18-25 years and the human factor contributes to 90-95% of events. The present study was carried out to determine the efficacity of the ECARR2 recurrence prevention program among adolescents and young adults at high risk of having a new traffic crash in the following months. A total of 288 participants having had a traffic crash that required going to the emergency room, at high risk of accident recurrence (ECARR≥5) were randomly allocated to either the intervention group (n = 144) or the control group (n = 144).

Results

revealed that the risk of recurrence was highest during the first 6 months (66% of recurrences). In per-protocol analysis population, at 6 months after inclusion, the accident recurrence rate was 14.2% ± 3.3% in the intervention group, and 23.5% ± 4.0% in the control group. The intervention had an effect per se, independently of the other predictors (p = 0.020). This effect was mediated by the three interaction variables: BDI, Impulsive Behavior Scale lack of perseverance, and Orientation to Happiness engagement. It was therefore through these dimensions that the intervention had an effect. In conclusion, the ECARR score predicts the risk of recurrence, risk which is the highest during the first 6 months. Finally, results confirm the predictive validity of the ECARR scale. The ECARR score had an effect on the risk of recurrence regardless of group (p = 0.045) and was predictive of recurrence (p = 0.045).A brief psychological intervention such as ECARR2 program, offered to young people ar hight risk of having a new crash, just after the crash, seems to halve the risk of recurrence at 6 months. Future research should improve the brief psychological intervention and its access via a mobile application or few hours in high school or in a driving school given.

The road safety and risky behavior analysis of delivery vehicle drivers in China

The delivery industry has seen dramatic growth in demand and scale in China. Due to the stock limitations and delivery time restrictions, the couriers may commit traffic violations while delivering, resulting in a pessimistic road safety situation. This study aims to reveal critical factors that influence delivery vehicle crash risks. A cross-sectional structured questionnaire survey is conducted to collect demographic attributes, workload, work emotions, risky driving behavior, and road crash involvement data among 824 couriers in three developed regions of China. The collected data is then analyzed through an established path model to identify the contributing factors of delivery road crash risks and risky behaviors. The road crash risk level (RCRL) indicator is defined by taking into consideration both frequency and severity. While the risky behaviors are defined by both their frequency and correlations to crash risks. The results indicate that 1) Beijing-Tianjin Urban Agglomeration has the highest road crash frequency and RCRL; 2) distracted driving and wrong-lane-use are among the top three risky behaviors for both Yangtze River Delta Urban Agglomeration and Pearl River Delta Urban Agglomeration. For Beijing-Tianjin Urban Agglomeration, distracted driving, aggressive driving, and lack of protection are the top three risky behaviors; 3) time demand and personal efforts are important factors contributing to the cognitive workload of couriers; 4) objective workload can affect the cognitive workload and both workloads influence drivers' emotions (anxiety and anger); 5) the objective, cognitive workload, drivers' emotions influence the RCRL through their impacts on risky behavior but in different paths for three agglomerations. The findings highlight the importance of developing targeted countermeasures to reduce the delivery workers' workload, improve their performance on roads, and mitigate severe crash risks.

Profiling fatal and serious injury crashes in South Australia according to the Swedish transport administration model

OBJECTIVES

This article describes a study examining fatal road crashes in South Australia (SA) according to the safety model developed by the Swedish Road Administration (STA). The STA model is based on the biomechanical limits that human beings can tolerate and specifies a number of elements that must be present for "compliance" with the model: driving at or below the speed limit, driver not intoxicated by alcohol or drugs, vehicle occupants wearing a seatbelt, car with a EuroNCAP rating of 5 stars, car equipped with electronic stability control, and a road with an EuroRAP rating of 4 stars.

METHOD

The study used a sample of 105 fatal crashes in SA in 2010 and 2011 and a comparison sample of 136 serious injury crashes from 2014 to 2017.

RESULTS

It was found that there were high levels of noncompliance with all elements of the STA model, with multiple forms of noncompliance in a clear majority of fatal cases.

CONCLUSIONS

Considerable gains in safety could occur with greater penetration into the SA fleet of 5-star cars fitted with ESC and other vehicle safety technology, especially as the majority of both sets of crashes were of a type involving loss of vehicular control. It is also important to note that risky road user behavior was less common in the serious injury crashes and so a road safety strategy focusing on changing road user behavior will be ineffective for addressing the major factors contributing to non-fatal road trauma.

Effect of wearing a helmet on the occurrence of head injuries in motorcycle riders in Benin: a case-control study

Background

In Benin, motorcycles are the main means of transport for road users and are involved in more than half of crashes. This study aims to determine the effect of wearing a helmet on reducing head injuries in road crashes in Benin.

Methods

This case-control study took place in 2020 and focused on road trauma victims. The sample, consisting of 242 cases (trauma victims with head injuries) for 484 controls (without head injuries), was drawn from a database of traffic crash victims recruited from five hospitals across the country from July 2019 to January 2020. Four groups of independent variables were studied: socio-demographic and economic variables, history, behavioural variables including helmet use and road-related and environmental variables. To assess the shape of the association between the independent variables and the dependent variable, a descending step-by-step binary logistic regression model was performed using an explanatory approach.

Results

Fewer of the subjects with a head injury were wearing a helmet at the time of the crash 69.8% (95% CI = 63.6–75.6) compared to those without a head injury 90.3% (95% CI = 87.3–92.8). Adjusting for the other variables, subjects not wearing helmets were at greater risk of head injuries (OR = 3.8, 95% CI (2.5–5.7)); the head injury rating was 1.9 (95% CI = 1.2–3.3) times higher in subjects who were fatigued during the crash than among those who were not and 2.0 (95% CI = 1.2–3.3) times higher in subjects with no medical history.

Conclusion

Failure to wear a helmet exposes motorcyclists to the risk of head injuries during crashes. It is important to increase awareness and better target such initiatives at the subjects most at risk.

Is driving without a valid license associated with an increased risk of causing a road crash?

The aim of this study was to estimate the association between each cause of driving without a valid license (DWVL) and the risk of causing a road crash, considering driver, vehicle and environmental factors. A case-control study based on data from the Spanish Register of Road Accidents with Victims was carried out between 2014 and 2017. Cases included 28,620 drivers of moving private cars, vans and off-road vehicles involved in single crashes plus 50,100 drivers deemed responsible for clean collisions (i.e. those in which only one driver was labeled as responsible). In accordance with the quasi-induce exposure approach, drivers not responsible for clean collisions comprised the control group (N = 51,656). Logistic and multinomial regression models were used to estimate crude and adjusted Odds Ratios or Relative Risk Ratios between each reason for DWVL and the risk of being a case of all, single and multi-vehicle collisions. A significant association was found between all reasons for DWVL and the risk of causing a road crash. This association was particularly high for drivers with a suspended license and drivers who had never obtained a license. In these subgroups of drivers, the proportion of the relationship explained by high-risk driving behaviors is high. Our results support the need for applying continued strategies to identify and control these subgroups of drivers.

How many collateral casualties are associated with road users responsible for road crashes?

OBJECTIVE

To estimate the number of collateral casualties associated with road users considered responsible for a road crash.

METHOD

We analyzed the case series comprising all 790,435 road users involved in road crashes with victims in Spain from 2009 to 2013, recorded in a nationwide police-based registry. For each road user assumed to be responsible for a crash, we collected information relative to health outcomes in other people involved in it, and obtained the total number of collateral casualties per 100 road users considered responsible for the crash. We then estimated the strength of associations between sex, age and the number of collateral casualties generated by car drivers considered responsible for the crash, and calculated rate ratios and corresponding 95% confidence intervals.

RESULTS

Pedestrians responsible for crashes were associated with the lowest number of collateral casualties (13.1/100), whereas the highest number (153/100) was observed for bus drivers responsible for crashes. Car drivers were associated with 104.4/100 collateral casualties. The youngest and the oldest car drivers responsible for crashes were associated with 33% and 41% more deaths, respectively, than the 25-34 year old group. Male drivers were associated with 22% more collateral casualties than female drivers.

CONCLUSIONS

Regardless of the type of road user who was responsible for a road crash, their active contribution to the crash led to an additional number of collateral casualties in other, non-responsible users. The number and severity of collateral casualties were related to the type of vehicle and the number of people involved. These results are potentially useful to support the need to promote safer driver practices among subgroups of high-risk drivers.

Alcohol and illicit drugs in drivers involved in road traffic crashes in Italy. An 8-year retrospective study

This study aims to investigate the prevalence of alcohol and drugs of abuse in Italian drivers involved in road traffic crashes between 2011 and 2018. Toxicological analyses were performed on the whole blood of 7593 injured drivers. Alcohol and illicit drugs, namely tetrahydrocannabinol (THC; cut-off 2ng/ml), cocaine (cut-off 10ng/ml), illicit opiates (cut-off 10ng/ml) and amphetamines (amphetamine, methamphetamine, MDMA, MDA; cut-off 20ng/ml) were investigated. The age and gender of the driver, the time of the crash (weekend/weekday and day/night), the road crash year and Blood Alcohol Concentration (BAC) were also considered. The 16.2% of samples tested positive for alcohol, 2.5% for cocaine, followed by opiates (2.0%), cannabinoids (1.5%), and amphetamines (0.5%). The overall prevalence of alcohol and drugs was lower than those reported in previous epidemiological studies of the DRUID project. The year 2011 showed the highest prevalence of drug-positive cases (24.1%), while the lowest prevalence was found in 2016 (16.8%), after the update of the Road Traffic Law (RTL) that increased punishments for driving under the influence. A progressive increase in the number of alcohol-positive female drivers was observed from 2011 to 2018, and the highest prevalence was found in the 26-35-year-old age range. Illicit drugs showed the highest overall prevalence in drivers <26 years of age but, if considering single drugs, cocaine and opiates were mostly found in subjects older than 36 years of age. A higher percentage of drug-positive drivers was found on weekend nights for alcohol and on both weekend and weekday nights for drugs. The types of drugs used by drivers did not change during the studied period.

The road to recovery for vulnerable road users hospitalised for orthopaedic injury following an on-road crash

BACKGROUND

Pedestrians, cyclists and motorcyclists are vulnerable to serious injury due to limited external protective devices. Understanding the level of recovery, and differences between these road user groups, is an important step towards improved understanding of the burden of road trauma, and prioritisation of prevention efforts. This study aimed to characterise and describe patient-reported outcomes of vulnerable road users at 6 and 12 months following orthopaedic trauma.

METHODS

A registry-based cohort study was conducted using data from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) and included pedestrians, cyclists and motorcyclists who were hospitalised for an orthopaedic injury following an on-road collision that occurred between January 2009 and December 2016. Outcomes were measured using the 3-level EuroQol 5 dimensions questionnaire (EQ-5D-3 L), Glasgow Outcome Scale - Extended (GOS-E) and return to work questions. Outcomes were collected at 6 and 12 months post-injury. Multivariable generalized estimating equations (GEE), adjusted for confounders, were used to compare outcomes between the road user groups over time.

RESULTS

6186 orthopaedic trauma patients met the inclusion criteria during the 8-year period. Most patients were motorcyclists (42.8%) followed by cyclists (32.6%) and pedestrians (24.6%). Problems were most prevalent on the usual activities item of the EQ-5D-3 L at 6-months post-injury, and the pain/discomfort item of the EQ-5D-3 L at 12 months. The adjusted odds of reporting problems on all EQ-5D-3 L items were lower for cyclists when compared to pedestrians. Moreover, an average cyclist had a greater odds of a good recovery on the GOS-E, (AOR 2.75, 95% CI 2.33, 3.25) and a greater odds of returning to work (AOR = 3.13, 95% CI 2.46, 3.99) compared to an average pedestrian.

CONCLUSION

Pedestrians and motorcyclists involved in on-road collisions experienced poorer patient-reported outcomes at 6 and 12 months post-injury when compared to cyclists. A focus on both primary injury prevention strategies, and investment in ongoing support and treatment to maximise recovery, is necessary to reduce the burden of road trauma for vulnerable road users.

Prediction of responsibility for drivers and riders involved in injury road crashes

INTRODUCTION

Responsibility analysis allows the evaluation of crash risk factors from crash data only, but requires a reliable responsibility assessment. The aim of the present study is to predict expert responsibility attribution (considered as a gold-standard) from explanatory variables available in crash data routinely recorded by the police, according to a data-driven process with explicit rules.

METHOD

Driver responsibility was assessed by experts using all information contained in police reports for a sample of about 5000 injury crashes that occurred in France in 2011. Three statistical methods were used to predict expert responsibility attribution: logistic regression with L1 penalty, random forests, and boosting. Potential predictors of expert attribution referred to inappropriate driver actions and to external conditions at the time of the crash. Logistic regression was chosen to construct a score to assess responsibility for drivers and riders in crashes involving one or more motor vehicles, or involving a cyclist or pedestrian.

RESULTS

Cross-validation showed that our tool can predict expert responsibility assessments on new data sets. In addition, responsibility analyses performed using either the expert responsibility or our predicted responsibility return similar odds ratios. Our scoring process can then be used to reliably assess responsibility based on national police report databases, provided that they include the information needed to construct the score.

Behavioral influences on driver crash risks in Ghana: A qualitative study of commercial passenger drivers

OBJECTIVES

Though there is a growing body of literature on crash risks in the developed world, little is known about how well these models apply to motoring in developing countries, the context in which the majority of road traffic fatalities occur. This qualitative study explores factors perceived to influence crash risks for commercial drivers in Ghana.

METHOD

Twenty commercial drivers of varied ages and experience were sampled from 7 major lorry terminals in 3 regions (Greater Accra, Ashanti, and Volta) of Ghana. Data were collected through semistructured interviews.

RESULTS

The participants identified some issues that are shared with drivers in the developed world, though moderated by the Ghanaian context. These included work pressures (e.g., fatigued driving), speeding, distracted driving, and inadequate vehicle maintenance. Other factors identified by participants are less frequently considered in research addressing driving behavior in developed countries. These included aggressive competition over passengers and corruption (e.g., improper licensing practices), among others.

CONCLUSION

The findings have implications for building a research base to support the development of road safety policy and interventions in developing countries.

Sleep-related vehicle crashes on low speed roads

BACKGROUND

Very little is known about the characteristics of sleep related (SR) crashes occurring on low speed roads compared with current understanding of the role of sleep in crashes occurring on high speed roads e.g. motorways. To address this gap, analyses were undertaken to identify the differences and similarities between (1) SR crashes occurring on roads with low (≤60km/h) and high (≥100km/h) speed limits, and (2) SR crashes and not-SR crashes occurring on roads with low speed limits.

METHOD

Police reports of all crashes occurring on low and high speed roads over a ten year period between 2000 and 2009 were examined for Queensland, Australia. Attending police officers identified all crash attributes, including 'fatigue/fell asleep', which indicates that the police believe the crash to have a causal factor relating to falling asleep, sleepiness due to sleep loss, time of day, or fatigue. Driver or rider involvement in crashes was classified as SR or not-SR. All crash-associated variables were compared using Chi-square tests (Cramer's V=effect size). A series of logistic regression was performed, with driver and crash characteristics as predictors of crash category. A conservative alpha level of 0.001 determined statistical significance.

RESULTS

There were 440,855 drivers or riders involved in a crash during this time; 6923 (1.6%) were attributed as SR. SR crashes on low speed roads have similar characteristics to those on high speed roads with young (16-24y) males consistently over represented. SR crashes on low speed roads are noticeably different to not-SR crashes in the same speed zone in that male and young novice drivers are over represented and outcomes are more severe. Of all the SR crashes identified, 41% occurred on low speed roads.

CONCLUSION

SR crashes are not confined to high speed roads. Low speed SR crashes warrant specific investigation because they occur in densely populated areas, exposing a greater number of people to risk and have more severe outcomes than not-SR crashes on the same low speed roads.