The pattern of maxillofacial fractures associated with rollover accidents: A 7-year retrospective study

BACKGROUND/AIM

This study aimed to assess the incidence and pattern of maxillofacial fractures and related demographic data in the victims of rollover crashes.

PATIENTS AND METHODS

This retrospective study was based on medical records of patients who sustained maxillofacial injuries following rollover accidents. Investigated data included age, gender, accident date and time, accident cause, seat belt usage, airbag deployment, road type, anatomical location of the facial fracture, and treatment approach.

RESULTS

Among the 147 patients who met the inclusion criteria, the most prevalent age groups were 20-30 (36.7%) and 30-40 (32.7%) years, with a mean age of 33.6 ± 9.7 years. The male-to-female ratio was 6:1. Most crashes occurred in March, August, and July. These accidents involved 69.4% light vehicles and 39.6% heavy vehicles. The leading causes of rollover crashes were speeding (58.5%) followed by distracted driving (21.1%) and traffic rule violations (13.6%). The most prevalent injuries were fractures of the maxillary sinus wall (40.8%), nasal bones (39.5%), zygomaticomaxillary complex (36.1%), and the mandible (32.6%). Surgical intervention was necessary for 44.2% of patients, while 12.9% of cases underwent close reduction, and 42.9% did not require any surgical intervention. The occurrence of nasal bone fractures was significantly lower in cases where seat belts were worn and zygomatic arch fractures were less frequent in incidents with airbag deployment.

CONCLUSIONS

In rollover crashes, the midface is the most vulnerable anatomical location. Utilization of seat belts and airbag deployment has the potential to prevent nasal bone and zygomatic arch fractures.

Effective factors of severity of traffic accident traumas based on the Haddon matrix: a systematic review and meta-analysis

Objective

This study aims to investigate the factors affecting the severity of trauma caused by traffic accidents based on martrix Haddon; a systematic review and meta-analysis.

Methods

In this study searched five international databases in this study, including Medline/PubMed, ProQuest, Scopus, Web of Knowledge, and Google Scholar, for published articles by the end of 2022. Data were entered into the statistical program and analyses were performed using STATA 17.0 software. Odds ratio (OR) values were computed for severity accidents.

Results

Results of study showed that among the risk factors related to the host, not using helmet increased the risk of injury severity by 3.44 times compared to people who have used helmets (OR Not using helmet/Using helmet = 3.44, 95% CI: 2.27-5.00, P=0.001, I2=0.00%). Also, crossing over a centre divider has a protective role for the risk of injury severity compared to undertaking (OR crossing over a centre divider/undertaking=0.39, 95% CI: 0.20-0.75, P=0.01, I2=25.79%). in terms of the type of accident, accident of car-car reduces the risk of injury severity by 23% compared to accident of car-pedestrian (OR accident of car-car/accident of car-pedestrian=0.77, 95% CI: 0.61-0.96, P=0.02, I2=0.00%).

Conclusions

It is necessary to pay attention to the intersection of human, vehicle and environmental risks and their contribution and how they interact. Based on the Haddon matrix approach, special strategies can be designed to prevent road damage. Safety standards for vehicles should also be addressed through stricter legal requirements and inspections.

Pediatric Facial Fracture in Garhwal Himalayan Region of Uttarakhand State: A Retrospective Study

Background

Pediatric facial fractures are fairly uncommon injuries and comprise less than 15% of all facial fractures in the literature.

Objectives

To analyze the pattern of pediatric facial fractures and compare the results with similar studies performed in India and the rest of the world.

Materials and Methods

A total of 231 patients were admitted for the treatment of maxillofacial fractures. Data on etiology, anatomical location, mode of treatment, duration of stay, and X-ray advice were recorded.

Results

Pediatric trauma comprised 27% of the total population. The most common cause of injury was road traffic accident (RTA), that is, 28 (43.8%) patients.

Conclusion

The incidence of pediatric facial trauma is high in the hilly Garhwal-Himalayan region of Uttarakhand state in India as compared to other states of India.

Prehospital care and interfacility transfer of trauma patients before reaching the emergency of a level-1 trauma care center

Background

Management of trauma patients includes prevention, prehospital care, appropriate resuscitation at a hospital, definitive treatment, and rehabilitation. Timely and adequate care for a trauma patient is paramount, which can dramatically impact survival. This study was planned to assess the proportion of patients who failed to receive adequate prehospital care before reaching our institute.

Materials and Methods

A retrospective study was conducted in the trauma and emergency department of a level-1 trauma center in eastern India from February to April 2022. The demographic profile, vital parameters, injury, mode of transport, travel duration, referring hospital, and any interventions as per airway/breathing/circulation/hypothermia were collected.

Results

The records of a hundred-two patients who were brought to the trauma and emergency department in the study period were reviewed. Road traffic accident involving two wheelers was the leading cause of injury. Eighty-three percent of the patients were referred from other health centers, of which 49 were referred from district headquarters hospitals. Only three patients out of 14 had been provided with an oropharyngeal airway for whom endotracheal intubation was indicated. Only one among the 41 patients needing Philadelphia collar actually received. Sixteen patients were provided supplemental oxygen out of the 35 for whom it was indicated. Out of 68 patients in whom intravenous cannulation and fluid administration were indicated, only 35 patients had received it. Out of 31 patients with fractures, none were provided immobilization.

Conclusion

The care of the trauma patients with respect to airway, breathing, circulation, and fracture immobilization was found to be grossly inadequate, emphasizing the need of structured and protocol based prehospital trauma care.

Successful treatment of xanthoma disseminatum with pulsed dye laser: A case report

Xanthoma disseminatum is a rare form of non-Langerhans cell histiocytosis with limited treatment options due to its unknown aetiology and diffuse skin lesions. This case report presents the successful treatment of a 31-year-old male with severe pan-facial xanthoma disseminatum lesions following a facial burn and traumatic brain injury resulting from a car accident. After 5 sessions of monthly pulsed dye laser treatment, there was a clinically significant reduction in the lesions. Over the course of 3 years, the patient underwent a series of monthly pulsed dye laser treatments, and the lesions were almost cleared. These findings suggest that pulsed dye laser therapy may offer an effective treatment option for managing xanthoma disseminatum. This is the first report on use of the pulsed dye laser for treatment of xanthoma disseminatum.

A Case of Massive Retroperitoneal Hematoma After High-Energy Trauma

A 66-year-old female suffered from high-energy trauma due to a traffic accident, resulting in injuries to the iliac artery and the superior mesenteric artery. She underwent endovascular embolization for vascular occlusion and an open surgical procedure to control bleeding from the superior mesenteric artery. A substantial retroperitoneal hematoma was observed on the right side, making primary closure challenging. A hematoma evacuation procedure was performed using a right retroperitoneal approach, successfully relieving the compression from the posterior aspect.

Breast Reconstruction after Blunt Breast Trauma: Systematic Review and Case Report Using the Ribeiro Technique

Blunt breast trauma occurs in 2% of blunt chest injuries. This study aimed to evaluate the evidence on breast reconstruction after blunt trauma associated with the use of a seat belt. Also, we describe the first case of breast reconstruction using the Ribeiro technique. In November 2022, a systematic search of MEDLINE, EMBASE, and Google Scholar databases was conducted. The literature was screened independently by two reviewers, and the data was extracted. Our search terms included breast, mammoplasty, blunt injury, and seat belts. In addition, we present the case of a woman with a left breast deformity and her reconstruction using the inferior Ribeiro flap technique. Six articles were included. All included studies were published between 2010 and 2021. The studies recruited seven patients. According to the Teo and Song classification, seven class 2b cases were reported. In five cases a breast reduction was performed in the deformed breast with different types of pedicles (three superomedial flaps, one lower flap, one superior flap). Only one case presented complications. The case here presented was a type 2b breast deformity in which the lower Ribeiro pedicle was used successfully without complications during follow-up. Until now there has been no consensus on reconstructive treatment due to the rarity of this entity. However, we must consider surgical treatment individually for each patient. We believe that the Ribeiro technique is a feasible and safe alternative in the treatment of posttraumatic breast deformities, offering very good long-term results.

The association between diabetes and safe driving: A systematic search and review of the literature and cross-reference with the current guidelines

AIMS

We conducted this review to characterize the quality of evidence about associations between diabetes and safe driving and to evaluate how these findings are reflected within current guidelines available to support clinicians and their patients with diabetes.

METHODS

The first stage entailed a systematic search and review of the literature. Evidence surrounding harms associated with diabetes and driving was identified, screened, extracted and appraised for quality utilizing the Newcastle Ottawa Scales (NOS). Next, relevant guidelines regarding driving and diabetes were sourced and summarized. Finally, the identified guidelines were cross-referenced with the results of the systematic search and review.

RESULTS

The systematic search yielded 12,461 unique citations; 52 met the criteria for appraisal. Fourteen studies were rated as 'high', two as 'medium' and 36 as 'low'. Studies with ratings of 'high' or 'medium' were extracted, revealing a body of inconsistent methods and findings. These results, cross-referenced with the guidelines, suggest a lack of agreement and a limited evidence base to justify recommendations.

CONCLUSIONS

The results presented emphasize the need for a better understanding of the impacts of diabetes on safe driving to inform evidence-based guidelines.

Partial isolated tear of the popliteus tendon following an in-car traffic accident: A rare cause of knee pain: A CARE-compliant case report

RATIONALE

Lesions caused by traffic accidents are often microscopic and minimal; therefore, their diagnosis can be easily overlooked. Moreover, when it is a rarely reported type of lesion, it can be even more easily undiagnosed. Isolated popliteal injuries are uncommon and have rarely been reported.

PATIENT CONCERNS

In this case study, we describe a right partially isolated popliteus tendon rupture that was undiagnosed for 2 years in a patient with posterior knee pain after an in-car traffic accident. A 49-year-old female patient presented with right knee pain that had persisted for 2 years and was initiated after an in-car traffic accident. The patient's right knee pain aggravated while standing and walking. Six months after the accident, her pain was confined to the posterolateral aspect of the knee and subsequently spread throughout her right knee. The pain score was 4 on a numerical rating scale. Physical examination revealed tenderness in the posterolateral corner of the right knee. Additionally, right knee pain was reported in the terminal range of knee flexion during the passive range of motion test. Radiographs of the right knee showed normal findings.

DIAGNOSES

A T2-weighted proton density sagittal and coronal knee magnetic resonance imaging revealed a partial-thickness tear with intrasubstance ganglion cysts at the musculotendinous junction of the popliteus tendon. No other abnormalities were observed in the patient.

INTERVENTION

Conservative treatment involved strengthening exercises and functional rehabilitation programs.

OUTCOMES

Six months later, the knee pain almost completely subsided.

LESSONS

Musculoskeletal injuries caused by traffic accidents are frequently overlooked. Therefore, a detailed examination should be conducted for an accurate diagnosis. Clinicians should consider the possibility of popliteal tendon injuries in patients with posterior knee pain.

Consistently High Frequency of Scooter Injuries in Children-Retrospective Data Analysis in a Level I Trauma Centre

The aim of this retrospective study was to present an epidemiological overview of paediatric nonelectric-scooter-related injuries, focusing on changes in injury mechanism and frequency. A retrospective, descriptive data analysis at a Level I trauma centre, including patients aged from 0 to 18 years injured by riding nonelectric scooters, was performed. The observation period ranged from January 2015 to December 2022. The total study population consisted of 983 (mean age: 7.9 ± 4.0 years) children and adolescents, with most patients being male (800/983; 81.4%). The frequency of nonelectric scooter injuries was relatively consistent over the observation period. Patients sustained mostly minor injuries (lacerations, bone contusions, sprains) (527/983; 53.6%), followed by head injuries (238/983; 24.5%), limb fractures (166/983; 16.9%) and trunk injuries (52/983; 5.3%). However, a few patients sustained severe injuries, including skull fractures (7/238; 2.9%), intracranial haematoma (4/238; 1.7%) or lacerations of abdominal organs (4/52; 7.7%). This study presented a consistently high frequency of scooter injuries in children. Children under 15 years were the most affected by scooter-related injuries. Although most injuries were minor, serious injuries occurred that should not be underestimated. Hence, we emphasise the use of protection gear and recommend raising awareness among parents and children.

Effectiveness of Integrative Korean Medicine Treatment in Patients with Traffic-Accident-Induced Acute Low Back Pain and Mild Adult Scoliosis

We investigated the effectiveness of integrative Korean medicine treatment in patients with pre-existing scoliosis who received inpatient care for traffic-accident-induced acute LBP. We selected 674 patients diagnosed with scoliosis between 1 January 2015, and 30 June 2021, using lumbar spine (L-spine) imaging, across four Korean medicine hospitals in Korea for a retrospective chart review and sent them a questionnaire-based follow-up survey. The primary outcome was a numeric rating scale (NRS) score of LBP. The secondary outcomes were the Oswestry Disability Index (ODI), 5-level EuroQol 5-dimension (EQ-5D-5L), and patient global impression of change (PGIC) scores. In total, 101 patients responded to the follow-up survey. NRS scores decreased from 4.86 (4.71-5.02) to 3.53 (3.17-3.90) from admission to discharge, subsequently decreasing to 3.01 (2.64-3.38) (p < 0.001) at the last follow-up. Similarly, ODI scores decreased from 35.96 (33.08-38.85) to 22.73 (20.23-25.24) and 14.21 (11.74-16.67) (p < 0.001), respectively. Approximately 87.1% of patients were satisfied with their inpatient care. There were no significant differences in the degree of improvement according to the severity of scoliosis. Integrative Korean medicine treatment can improve pain, lumbar dysfunction, and quality of life in patients with traffic-accident-induced acute low back pain and pre-existing mild scoliosis.

Foreign Body Implanted Into the Penis During Traffic Accident

Although there are some reports describing foreign body implantation into the penis by intentional manipulation, no records about patients got aware of it many years after traffic accidents. A 29-year-old male patient had been severely injured in a traffic accident 13 years ago. Following a coma state for several months, he had no any symptom for a long time. Four years later, he got aware of the inconvenience on the ventral side of his penis during erection. His partner had also complained of pain during coitus. When he was admitted to our clinic, there was a semi-mobile, fibrous dense 2x2 cm knob on the ventral side of the penis consisting of a coronal sulcus. Under local anesthesia, we got out of a piece of glass. He was discharged after enough follow-up periods without complication. The interesting point of this case was not the clinical condition of the patient; it was that no one could consider a coma patient would have a complaint of penis injury several years later. This case showed us, one more time, how important the complete physical examination was.

The impact of rurality on child road traffic death in high-income countries

INTRODUCTION

Despite the importance of child road traffic death, a limited number of studies have investigated rural child road traffic death in high income countries.

OBJECTIVE

This review estimated the impact of rurality on child road traffic deaths and other potential risk factors in high-income countries.

DESIGN

We searched Ovid, MEDLINE, CINAHL, PsycINFO and Scopus databases and extracted studies focusing on the association between rurality and child road traffic death published between 2001 and 2021. Available data were extracted and analysed, to evaluate the impact of rurality on child road traffic death and explore other risk factors of child road traffic deaths.

FINDINGS

We identified 13 studies for child road traffic death between 2001 and 2021. Eight studies reported the impact of rurality on child road traffic death, and all of them alleged that the mortality rate and injury rate of children was significantly higher on rural road than on urban road. The impact of rurality varied between studies, from 1.6 times to 15 times higher incidence of road traffic death in rural areas. Vehicle type, speeding cars, driver loss of control, alcohol and drug use road environment were identified as risk factors of child road traffic death. Conversely, ethnicity, seat belts, nondeployed airbag, child restraint, strict driver licence system, camera law and accessibility of trauma centres were considered protective factors. Other factors, including age, gender and teen passengers, appeared ambiguous for child road traffic death.

DISCUSSION

Rurality is one of the most important risk factors of child road traffic death. Therefore, we should consider the impact that rurality has on child road death and resolve the gap between rural and urban areas in order to prevent child road traffic death effectively.

CONCLUSION

The findings of this literature review will assist policy-makers to prevent child road traffic death by focusing on rural regions.

Work-related and non-work-related fatal road accidents: Assessment of psychoactive substance use in commuting

Commuting road traffic collisions (RTCs) are one of the main causes of occupational death worldwide, including Italy. Among the prominent yet relatively understudied personal risk factors in the subpopulation of workers, there is the use of psychoactive substances. Since the phenomenon of driving under alcohol and drugs effects in the commuter sub-population has so far been poorly studied, we carried out a study by comparing results obtained from the analysis of commuters and non-commuters. The percentage of commuting RTCs victims was 10.4% out of all the RTCs. Commuter victims were mostly men, 51-60 years-old, motorcyclists (32.1%) or car drivers (28.6%), employees, deceased during Fridays and Saturdays, in the afternoon (35.7%) and in the evening (32.1%). It was possible to perform toxicological analyses in 60.7% of commuter cases: approximately 40% tested positive, always and only for ethanol (median Blood Alcohol Concentration, BAC, of about 1.03 g/L). Values above the legal limit were observed in 23.5% of the toxicological samples analyzed from commuter accidents. Our findings contribute to bridging the gap in knowledge in the area of RTCs and commuting and emphasize the importance of carrying out toxicological investigations, with possible repercussions on both insurance issues and public health strategies, which are relevant for analyzing the phenomenon structurally.

Pedestrian Deaths During the COVID-19 Pandemic

The COVID pandemic provides a natural experiment examining how a 50-60% reduction in pedestrian activity might lead to a reduction in pedestrian deaths. We assessed whether the reduction in pedestrian deaths was proportional to a one-to-one matching presumed in statistics correlating mobility with fatality. The primary analysis examined New York (largest city in US), and the validation analysis examined Toronto (largest city in Canada). We identified pedestrian activity in each location from the Apple Mobility database, normalized to the baseline in January 2020. We calculated monthly pedestrian deaths from the Vision Zero database in each city with baseline data from 3 prior years. We found a large initial reduction in pedestrian deaths during the lockdown in New York that was transient and not statistically significant during the summer and autumn despite sustained reductions in pedestrian activity. Similarly, we found a large initial reduction in pedestrian deaths during the lockdown in Toronto that was transient and not sustained. Together, these data suggest the substantial reductions in pedestrian activity during the COVID pandemic have no simple correlation with pedestrian fatality counts in the same locations. An awareness of this finding emphasizes the role of unmeasured modifiable individual factors beyond pedestrian infrastructure or other structural contributors.

Changes in Self-Regulation and the Predictors of Quality of Life 3 Months After Extremity Injury: A Prospective Study

This prospective study aimed to examine self-regulation' changes (illness representations and coping strategies) and predictors of quality of life 3 months after hospital discharge. A total of 157 patients with extremity injuries from two hospitals in Indonesia completed the survey 3 months post-discharge. The results showed that patients demonstrated more positive illness representations, better coping strategies, and better quality of life 3 months post-discharge than prior discharge. Hierarchical multiple regression analysis revealed that patients' symptom identity, personal control, and treatment control were significant predictors of quality of life 3 months after extremity injury. Patients with negative perceptions of their injury-related symptoms, personal control, and treatment control at hospital discharge were at higher risk of impaired quality of life 3 months post-discharge than those with positive perceptions. Therefore, clinicians should assess and modify patients' illness representations before discharge from the hospital to achieve a better prognosis for post-injury quality of life.

Trauma Characteristics Associated with E-Scooter Accidents in Switzerland-A Case Series Study

E-scooters have gained popularity worldwide in the last few years. Due to the increase in users, more accidents related to e-scooters can be observed. The present study aimed to analyse epidemiological data, characteristics, and severity of injuries in patients admitted to a Level I trauma centre in Switzerland (Inselspital Bern, University Hospital Bern) after accidents associated with e-scooters. This retrospective case series evaluated 23 patients who presented to the University Hospital of Bern between 1 of May 2019 and 31 of October 2021 after an e-scooter accident. Data were collected on patient demographics, time and cause of the accident, speed, alcohol consumption, helmet use, type and localisation of injury, number of injuries per patient, and outcome. Men were most frequently affected (61.9%). The mean age was 35.8 (STD 14.8) years. Slightly more than half (52.2%) of all accidents were self-inflicted. Most accidents were reported during the night (7 p.m. to 7 a.m., 60.9%) and in summer (43.5%). Alcohol consumption was reported in 43.5% of cases, with a mean blood alcohol level of 1.4 g/l. Most injuries were observed in the face (25.3%) and head/neck area (20.25%). Skin abrasions (56.5%) and traumatic brain injury (43.5%) were the most common types of traumata in terms of total number of patients. Only in one case it was reported that a protective helmet had been worn. Five patients required hospitalisation and four patients underwent surgery. Three patients underwent emergency orthopaedic surgery, and one patient underwent emergency neurosurgery. E-scooter accidents result in a significant number of facial and head/neck injuries. E-scooter riders would potentially benefit from a helmet to protect them in the event of an accident. Additionally, the results of this study indicate that a significant number of e-scooter accidents in Switzerland occurred under the influence of alcohol. Prevention campaigns to raise awareness of the risks of driving e-scooters under the influence of alcohol could help prevent future accidents.

Advanced emergency braking system reduces the risk of motor vehicle collisions caused by falling asleep while driving in patients with untreated obstructive sleep apnea

Obstructive sleep apnea leads to excessive daytime sleepiness and cognitive dysfunction, which are risk factors for motor vehicle collisions. We aimed to clarify if vehicles with an advanced emergency braking system could reduce motor vehicle collisions caused by falling asleep while driving among patients with untreated obstructive sleep apnea. We enrolled patients with untreated obstructive sleep apnea who underwent polysomnography. The questionnaires included the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, history of drowsy driving accidents, and use of an advanced emergency braking system. Multivariate analysis was performed, and odds ratios and 95% confidence intervals were calculated. This study included 1097 patients (mean age, 51.2 ± 12.9 years). Collisions caused by falling asleep while driving were recorded in 59 (5.4%) patients, and were more frequently observed in vehicles without an advanced emergency braking system (p = 0.045). Multivariate analysis showed that these collisions were associated with use of an advanced emergency braking system (odds ratio [95% confidence interval]: 0.39 [0.16-0.97], p = 0.04), length of driving (2.79 [1.19-6.50], p = 0.02), total sleep time (2.40 [1.62-3.55], p < 0.0001), sleep efficiency (0.94 [0.90-0.98], p = 0.003) and periodic limb movement index (1.02 [1.01-1.03], p = 0.004). The collision risk caused by falling asleep while driving in vehicles with an advanced emergency braking system was significantly lower. This study indicates that advanced emergency braking systems may be a preventive measure to reduce motor vehicle collisions among patients with untreated obstructive sleep apnea.

Older Adult Pedestrian Injury in Rhode Island, 2017-2020

OBJECTIVE

To understand the epidemiology and clinical outcomes of older adult pedestrian injury in Rhode Island.

METHODS

Descriptive univariate analysis of data from Rhode Island Hospital's trauma registry on patients admitted for pedestrian-related injuries between 2017-2020.

RESULTS

The rate of pedestrian injury in older adults was 1.5 times the rate in adults age 18-49. Injured older adult pedestrians experienced a higher rate of serious adverse events during hospitalization (18.0%) than their younger counterparts (10.3%) and had almost twice the mortality rate (14.9% versus 7.6%). Across ages, pedestrian injury rates are higher in densely populated areas, and those injured disproportionately are male and have comorbid alcohol and substance use disorders.

CONCLUSIONS

The increased risk of pedestrian injury in older adults is evident and necessitates intervention. Further research is warranted on the root causes of higher pedestrian injury and mortality rates among older adults.

Impact of the COVID-19 pandemic on epidemiology, treatment, and outcome of major trauma in Japan in 2020: a retrospective observational nationwide registry-based study

Aim

The nationwide impact of the coronavirus disease (COVID-19) pandemic on major trauma in Japan is unknown. The nationwide registry-based data of the Japanese Trauma Data Bank were analyzed to elucidate the impact of COVID-19 on the epidemiology, treatment, and outcomes of major trauma patients.

Methods

Among patients transported directly from the injury site by ambulance with an Injury Severity Score of ≥16, we compared patients managed from April to December in 2019 to those managed from April to December in 2020.

Results

In total, 9792 patients were included in this study (2019, n = 5194; 2020, n = 4598). There were no significant differences in age or sex, but there were significant differences between 2019 and 2020 in the rates of "self-injury (suicide)", "motor vehicle accident", "fall from height", "fall down", and "fall to the ground", which are factors associated with patient age. Injury severity in 2019 and 2020 did not differ to a statistically significant extent, but the rate of major spinal injury increased. The time of prehospital care significantly increased in 2020 compared to 2019. There was no noticeable change in hospital treatment or in-hospital mortality between 2019 and 2020.

Conclusion

This study suggests that the COVID-19 pandemic might have altered the injuries of major trauma; however, medical services for major trauma were well supplied in Japan in 2020.

Quality Assessment of the Road Traffic Health and Safety Apps with a Focus on the Five Rights of Information Management

Objective

The expansion of mobile applications as a tool for road traffic health and safety may develop several issues from the perspective of information management. Quality assessment of these apps, especially from an information system management perspective, appears inevitable, as their possible low quality may cause irreversible injury or fatal consequences. This study aimed to evaluate the quality of the apps in the three subcategories of road traffic safety apps (including Accident Record and Report (ARR), Distraction Management (DM), and Vehicle Operating, Fixing, and Maintenance (VOFM)) using the Mobile Application Rating Scale (MARS), which rates 23 evaluation criteria organized in five domains (Engagement, Esthetics, Information, and Subjective Quality) with particular attention to the five rights framework of health information system.

Method

The researchers retrieved road traffic health and safety mobile apps from Google Play. First, the domain expert panel (n= 7) (from disciplines of HIM and medical informatics) was formed. They scrutinized and discussed the MARS items and mapped them into the five rights framework of information quality. Moreover, the researchers assigned the apps to the information system or decision support system category. Two researchers independently reviewed the apps and conducted the qualitative content analysis to categorize them into ARR, DM, and VOFM classes. Finally, the quality of the apps was assessed using the MARS rating scale (max=5) in terms of 1) app classification category with a descriptive aim; 2) app subjective and objective quality categories comprised of engagement, functionality, esthetics, and information sections; and 3) an optional app-specific section. The mean scores for the subjective quality, objective quality, and app-specific sections were calculated separately for each mobile app. A score ≥ 3.0 was considered acceptable.

Results

A total number of 42 apps met the criteria for the assessment. The average objective quality scores were computed as 2.6, 2.2, and 3.0 for the ARR, DM, and VOFM apps, respectively. Therefore, the quality of the apps in the ARR and DM subgroups was not acceptable. Moreover, the quality of the apps in the VOFM subcategory was considered moderate. Furthermore, the subjective quality and app-specific sections of apps in the ARR and DM categories were less than moderate. Most apps had the potential of an information system or decision support system. Also, the criteria measured by MARS could be mapped to the five rights framework of information management.

Conclusion

The findings of this study revealed the existing gaps in three subcategories of road traffic safety apps. Considering the multiple criteria of the MARS and having in mind the framework of five rights, developers of the apps may develop better products in road traffic health and safety.

A two-phase clustering approach for traffic accident black spots identification: integrated GIS-based processing and HDBSCAN model

Identifying black spots effectively and accurately is a pivotal and challenging task to improve road traffic safety. A novel black spot identification model is proposed by integrating the GIS-based processing with hierarchical density-based spatial clustering of applications with noise. Additionally, the optimal clustering parameters are determined based on an internal validation indicator called the density-based clustering validation index to minimize the impact of subjectivity in parameter selection. The model is validated by collecting 3536 accident data from 1 August to 31 October 2020 in Hangzhou, China, and eventually identifies 39 black spots. The results show that: (1) The number of accidents contained in black spots account for 75% of all accidents, while the length of network in the black spots only account for 23.26% of the total road network length. (2) Compared with the conventional density-based spatial clustering of applications with noise model and K-means model, the proposed model achieves the best performance with more accidents gathered per unit road length. (3) The sample survey with 6 onsite of the identified black spots indicates that the proposed model has high recognition accuracy and recommend these sites for further investigation.

Bovine hydroxyapatite-based scaffold accelerated the inflammatory phase and bone growth in rats with bone defect

Hydroxyapatite (HA) is a biomaterial widely used to treat bone defect, such as due to traffic accident. The HA scaffold is obtained from synthetic HA or natural sources, such as bovine hydroxyapatite (BHA). This study aims to compare the characteristics and in vivo performance of BHA-based and HA-based scaffolds. For this purpose, the scaffold was formulated with gelatin (GEL) and characterised by SEM-EDX, FTIR and mini autograph. The defect model was carried out on the femur area of Wistar rats classified into three animal groups: defect, HA-GEL and BHA-GEL. Postoperatively (7, 14 and 28 days), the bone was radiologically evaluated, and stained with haematoxylin-eosin, anti-CD80 and anti-CD163. The BHA-GEL scaffold showed a regular surface and spherical particle shape, whereas the HA-GEL scaffold exhibited irregular surface. The BHA-GEL scaffold had higher pore size and compressive strength and lower calcium-to-phosphorus ratio than the HA-GEL scaffold. In vivo study showed that the expression of CD80 in the three experimental groups was not significantly different. However, the expression of CD163 differed significantly between the groups. The BHA-GEL group showed robust expression of CD163 on day 7, which rapidly decreased over time. It also showed increased osteoclasts, osteoblasts and osteocytes cell count that contributed to the integrity of the defect area. In conclusion, the BHA-based scaffold exhibited the desired physical and chemical characteristics that benefit in vivo performance versus the HA-based scaffold. Thus, the BHA-based scaffold may be used as a bone graft.

Multiobjective optimization algorithm for accurate MADYMO reconstruction of vehicle-pedestrian accidents

In vehicle-pedestrian accidents, the preimpact conditions of pedestrians and vehicles are frequently uncertain. The incident data for a crash, such as vehicle deformation, injury of the victim, distance of initial position and rest position of accident participants, are useful for verification in MAthematical DYnamic MOdels (MADYMO) simulations. The purpose of this study is to explore the use of an improved optimization algorithm combined with MADYMO multibody simulations and crash data to conduct accurate reconstructions of vehicle-pedestrian accidents. The objective function of the optimization problem was defined as the Euclidean distance between the known vehicle, human and ground contact points, and multiobjective optimization algorithms were employed to obtain the local minima of the objective function. Three common multiobjective optimization algorithms-nondominated sorting genetic algorithm-II (NSGA-II), neighbourhood cultivation genetic algorithm (NCGA), and multiobjective particle swarm optimization (MOPSO)-were compared. The effect of the number of objective functions, the choice of different objective functions and the optimal number of iterations were also considered. The final reconstructed results were compared with the process of a real accident. Based on the results of the reconstruction of a real-world accident, the present study indicated that NSGA-II had better convergence and generated more noninferior solutions and better final solutions than NCGA and MOPSO. In addition, when all vehicle-pedestrian-ground contacts were considered, the results showed a better match in terms of kinematic response. NSGA-II converged within 100 generations. This study indicated that multibody simulations coupled with optimization algorithms can be used to accurately reconstruct vehicle-pedestrian collisions.

Research on the Circumstances of a Car-Cyclist Collision, Based on the Trajectory of the Cyclist's Movement after the Collision

This article examines a simulated collision between a car and a cyclist, assessing the trajectory of the cyclist's movement after the impact, namely the throwing distances and angles of the cyclist and bicycle. Information about the car and cyclist models used for the study is provided. Special software PC CRASH 8.1 for the analysis and reconstruction of traffic accidents was used to simulate a car-cyclist collision. Simulations of car-cyclist collisions were carried out, with different speeds for the car and the cyclist, and locations at the time of the impact. The movement of a bicycle after a crash tends to be irregular and is dependent on various parameters that are usually not possible to evaluate. Therefore, the parameters of the movement of the bicycle after the collision (the throwing angle and the distance) usually do not allow determination of the speed of the car before the accident. The movement of the cyclist after impact was more informative for determining the speed of the car before the accident. For example, when there was an angle of 30°, 60°, or 90° between the longitudinal axes of the car and the cyclist, there was a clear dependence between the speed of the car and the cyclist's throwing distance, and usually also between the speed of the car and the cyclist's throwing angle. Thus, in such cases, it is possible to determine approximately the initial speed of the car before the collision, based on the trajectory of the cyclist's movement after the impact, namely his throwing distance and angle. In cases of real traffic accidents, with knowledge of the location of the car-cyclist collision and the position of the cyclist after the traffic accident, the speed of the car before the accident can be determined according to the abovementioned dependencies. Thus, the proposed methodology could be used in the reconstruction and examination of traffic accidents.

Mortality and negative outcomes of opioid use and opioid use disorder: a 6-year follow-up study

BACKGROUND AND AIMS

There is a paucity of data on outcomes of opioid use disorder (OUD) from low- and middle-income countries. We aimed to investigate the mortality as well as negative social and health outcomes in a 6-year follow-up study of a cohort of individuals with opioid use, including those with OUD, in Iran.

DESIGN AND SETTING

Participants with opioid use initially interviewed in late 2011 in the Iranian National Mental Health Survey (IranMHS)-a household survey of 15-64-year-old population-were followed-up in early 2018.

PARTICIPANTS

All respondents (n = 236) who had reported use of any opioids at least five times during the 12-month period prior to the index interview were included in the study.

MEASUREMENTS

Composite International Diagnostic Interview (CIDI) version 2.1 was used for assessment of opioid use and OUD at baseline. Vital status in the follow-up was ascertained through contact with participants/informants, primarily via telephone calls and also through the death registration systems. Weighted incidence rates of negative consequences of opioid use (e.g. incarceration, suicide attempts, violent behavior) were estimated for those who were interviewed.

FINDINGS

Seven (3.3%) of the 236 participants with opioid use including four (3.1%) of the 136 with OUD had died by the time of the follow-up interview, resulting in death rates of 0.49 [95% confidence interval (CI) = 0.21-1.38] and 0.53 (95% CI = 0.16-2.62) per 100 person-years, respectively. Overall, 35.0% of participants with opioid use and 44.0% of those with OUD among the 145 individuals interviewed at follow-up experienced non-fatal serious adverse outcomes.

CONCLUSIONS

In Iran, opioid use and opioid use disorder are associated with increased mortality and other adverse outcomes.

Assessment of seat-belt related injuries using the FORTIS forensic system

This study presents (1) a case of an injury to an unbelted passenger and (2) the possibilities of proving the occurrence of injuries to traffic accident participants. We demonstrate the case of an injury to a passenger who failed to fasten her seat belt, and question whether her injuries would have been equally serious if she had fastened her seat belt. Theoretical bases and methods for the interdisciplinary procedure of medical examiners using the PC Fortis program and technical analysts of traffic accidents using the PC Crash program are presented. Furthermore, individual practical steps are documented, the result showing that the injuries to the passenger would have occurred, but, to a minimum extent, i.e., 6.9% of the original injuries, which would have not exceeded the legal limit for damage to health.

Risk of Mortality in Association with Pregnancy in Women Following Motor Vehicle Crashes: A Systematic Review and Meta-Analysis

The aim of the study was to provide a systematic review and meta-analysis of studies examining the association between mortality risk and motor vehicle crashes (MVCs) in pregnant women compared with nonpregnant women. We used relevant MeSH terms to identify epidemiological studies of mortality risk in relation to MVCs from PubMed, Embase, and MEDLINE databases. The Newcastle–Ottawa Scale (NOS) was used for quality assessment. For comparison of mortality from MVCs between pregnant and nonpregnant women, the pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random effects model. The eight studies selected met all inclusion criteria. These studies included 14,120 injured victims who were pregnant at the time of the incident and 207,935 victims who were not pregnant. Compared with nonpregnant women, pregnant women had a moderate but insignificant decrease in mortality risk (pooled OR = 0.68, 95% CI = 0.38–1.22, I² = 88.71%). Subgroup analysis revealed that the pooled OR significantly increased at 1.64 (95% CI = 1.16–2.33, I² < 0.01%) for two studies with a similar difference in the mean injury severity score (ISS) between pregnant and nonpregnant women. Future studies should further explore the risk factors associated with MVCs in pregnant women to reduce maternal mortality.

[Forensic medical characteristics of fatal injuries in a traffic accident in the car cabin]

The study objective is to identify the most common fatal injuries in car accidents and observe the trends of the proportion of deaths at the scene, in an ambulance, and a hospital. We analyzed all forensic examination reports (protocols) of those who died in the car due to a traffic accident in Moscow from 2018 to 2020. Male drivers died 15 times more often than female drivers, and male passengers died twice as often as females. Most of the victims were young and middle-aged. Both drivers and passengers most commonly had traumatic brain injury with fractures of the bones of the vault and base of the skull, intracranial hemorrhages, crushing, and dislocation of the damaged brain. At the scene of traffic accidents, the cause of death was fatal bodily injuries. An increased risk of fatal traffic accidents was identified in autumn and winter.

Role of Health Sector in Road Traffic Injuries Prevention: A Public Health Approach

Background:

Although the main burden of the Road Traffic Injuries (RTIs) is on the health sector, compared with other sectors, no clear definition is available about its role in the prevention of the RTIs. So this study has been performed to define the role of the health sector in the prevention of RTIs –before the incidence.

Methods:

In this qualitative study with a grounded theory approach, the possible roles of the health sector in the prevention of the RTIs were identified in three phases. At the first stage of the study, the roles of the health system in the prevention of the RTIs identified from the literature. In the next step, semi-structured interviews (ranged from 45 to 90 minutes) with 42 experts were done for identifyingroles. Finally, Consensus attained on the identified roles by using the Delphi technique and with the participation of 30 experts.

Results:

Literature review and interviews resulted in 42 and 86 roles for the health sector in the prevention of the RTIs, respectively. After removing the duplicates and merging the similar, 46 roles were entered into Delphi. Five roles excluded in the Delphi leaving 41 roles in 7 dimensions of communications (6 roles), intra-sector cooperation (9 roles), inter-sector leadership (6 roles), evaluation (6 roles), research (5 roles), education (3 roles), and health-specific issues (6 roles).

Conclusions:

It seems that the health sector can help an impressing reduction of the RTIs by playing the roles identified in this study, which the most important of them is Communication/Informing role. So first the general public and then the health sector itself would benefit from it.

Factors Affecting Death and Severe Injury in Child Motor Vehicle Passengers

Saving children from motor vehicle collisions is a high priority because the injury rate among motor vehicle passengers has been increasing in Japan. This study aimed to examine the factors that influence death and serious injury in child motor vehicle passengers to establish effective preventive measures. To identify these factors, we performed a retrospective study using a nationwide medical database. The data of child motor vehicle passengers younger than 15 years (n = 1084) were obtained from the Japanese Trauma Data Bank, registered from 2004 to 2019. Physiological variables, outcomes, and injury severity were compared between fatal and non-fatal patients and between those with and without severe injuries. Multivariate logistic regression analysis was performed to determine factors affecting fatality and severe injury. The Glasgow Coma Scale score (odds ratio (OR): 1.964), body temperature (OR: 2.578), and the Abbreviated Injury Scale score of the head (OR: 0.287) were identified as independent predictors of a non-fatal outcome. Systolic blood pressure (OR: 1.012), the Glasgow Coma Scale score (OR: 0.705), and Focused Assessment with Sonography for Trauma positivity (OR: 3.236) were identified as independent predictors of having severe injury. Decreasing the severity of head injury is the highest priority for child motor vehicle passengers to prevent fatality and severe injury.

A Single-Center Retrospective Study on the Effects of Korean Medicine in 342 Traffic Accident Cases

Objectives

In South Korea, traffic accident victims can be treated under automobile insurance coverage. Korean medicine (KM) clinics have reported the largest number of automobile insurance fee claims among medical institutions. This study investigated the status of the KM automobile insurance system in a single KM clinic.

Methods

We retrospectively surveyed the medical charts of 342 traffic accident patients treated at the Jisung KM clinic between January 2009 and June 2017.

Results

Most of the patients were men and in their 30s. The most common method of locating the clinic was an internet search. The most common traffic accident type was collision between vehicles (83.63%), with 70.76% of patients visiting during the most acute phase. The major disease codes included S434, M4836, F072, S0600, and S3350. The most frequent treatment period was within 1 month of the accident, and most patients received 10 or fewer treatments. The mean treatment duration and number of treatments were 37.68 ± 45.11 days and 11.68 ± 10.63 treatments, respectively. The initial pain numerical rating scale (NRS), 7.32 ± 0.96, decreased to 3.57 ± 1.40 at the end of treatment, with a symptom improvement score of 1.87 ± 0.60. Regarding sex, age, disease duration, location at the time of the accident, presence of additional and psychological symptoms, and chuna, there were statistically significant differences in treatment duration and number of treatments. A higher number of treatments and the longer treatment duration was associated with a higher initial NRS, lower post-treatment NRS, and better improvement score. Since the introduction of traffic accident (TA) pharmacopuncture, the rate of use of a single type of pharmacopuncture increased; however, no significant differences in treatment duration and number, NRS before and after treatment, and improvement score were observed between treatment groups before and after TA pharmacopuncture. No adverse reactions were observed for any treatment.

Conclusion

This study confirmed the previous findings of a high treatment effect of KM under automobile insurance. We also observed significant correlations based on a detailed medical status, which may explain the increasing use of KM in the automobile insurance system. Additional multi-center studies in different regions are needed.

Drinking and Night-Time Driving May Increase the Risk of Severe Health Outcomes: A 5-Year Retrospective Study of Traffic Injuries among International Travelers at a University Hospital Emergency Center in Thailand

Road traffic injury (RTI) is a leading cause of death in developing countries. This burden affects not only locals, but also international travelers. Data on international travelers with RTIs in Thailand, especially from a medical perspective, are limited. This study aimed to analyze the factors associated with severe health outcomes following RTIs among international travelers at a university hospital emergency center in Thailand from January 2015 to December 2019. The retrieved data consisted of demographics, risks, preventive factors, and health outcomes. The severity of outcome was classified as fatality, hospitalization, or non-severe. A multinomial logistic regression model was used to identify the possible determinants of severity of health outcome among international travelers with RTI. A total of 720 travelers with RTIs (69% males; 82.5% were Southeast Asian) were included, with a mean age of 28.5 years. Of these, 144 (20%) had severe health outcomes: 64 (9%) fatalities and 80 (11%) hospitalizations. The level of severity of outcome was not associated with travelers’ demographics, but was associated with conventional risk factors, i.e., motorcycle use, alcohol/drug use, night-time driving, and less use of seatbelt/helmet. In a multinomial logistic regression analysis, alcohol drinking (adjusted odds ratio (AOR) 2.53, 95% confidence interval (CI) 1.41–4.55) and night-time driving (AOR 2.54, 95% CI 1.36–4.75) were associated with hospitalization. Patients who had a history of tetanus vaccination were less likely to die (AOR 0.37, 95% CI 0.17–0.81). In conclusion, one-fifth of RTIs resulted in severe health outcomes, and 9% were fatal. Road safety campaigns in Thailand should target travelers of all nationalities. Interventions that enhance travelers’ safety practices and proper preparation for road accidents should be explored further.

Analysis of Vehicle Collision on an Assembled Anti-Collision Guardrail

Traffic accidents such as vehicle collisions with bridge guardrails occur frequently. These accidents cause damage to the driver and the vehicle as well as the bridge. A new type of assembled anti-collision guardrail is proposed in this study. LS-DYNA is a nonlinear display dynamic analysis software used to evaluate the safety of a new type of assembled anti-collision guardrail. A specific, numerically analyzed model of vehicle–guardrail collision is established using LS-DYNA. The energy distribution–time curve of the vehicle collision process is obtained. After comparison with measured data from the vehicle collision test, the model of vehicle–guardrail collision is verified as being correct. Based on this, we analyze the process of a vehicle collision on the assembled anti-collision guardrail. The result shows that the assembled anti-collision guardrail proposed in this paper can better change the trajectory of a moving vehicle and can prevent the vehicle from falling off the bridge. From the car body collision results, the assembled anti-collision guardrail for bridges proposed in this paper can reduce vehicle damage and can protect the driver effectively. From the analysis of the main girder stress on the bridge, an anti-collision guardrail installed on an existing bridge will not cause damage to the main girder during a collision. In order to study the influence of the four parameters on the anti-collision effect, we carried out a comparative calculation of multiple working conditions. The results show that the new type of assembled anti-collision guardrail has good protective performance under different working conditions.

Screening major trauma patients for prevalence of illicit drugs

INTRODUCTION

Australasian emergency departments (ED) routinely test patient alcohol levels following major trauma, but assessment for illicit drugs is uncommon.

METHODS

A prospective cross-sectional study of major motor-vehicle-related trauma patients attending both adult major trauma centres in Victoria, Australia. All eligible patients had point-of-care saliva testing to determine the prevalence of common illicit drugs.

RESULTS

Over 12 months, 1411 patients were screened, 36 refused (2.6%) and 63 were excluded. Of the final 1312 cases included, 173 (13.2%; 95% confidence interval 11.5, 15.1) tested positive to at least one illicit substance, with 133 (76.9%; 69.7, 82.8) positive for meth/amphetamines. One in five had more than one illicit substance detected. Patients testing positive were most frequently in motor vehicles (91.9% vs. 85.6%) and least frequently cyclists (2.3% vs. 4.2%) or pedestrians (5.2% vs. 10.3%), compared to those testing negative. They were younger (mean age 35.4 vs. 43.1 years), more likely to arrive overnight (27.2% vs. 12.1%) or after single vehicle crashes (54.3% vs. 42.3%). Although the initial disposition from ED did not differ, those testing positive were more likely to re-present within 28 days (13.9% vs. 5.4%).

DISCUSSION AND CONCLUSIONS

A high prevalence of potentially illicit substances among patients presenting with suspected major trauma supports the need for urgent preventive strategies. The low rate of patient refusal and large numbers screened by ED staff suggests that point-of care testing for illicit substances in major trauma is acceptable and feasible. This study and ongoing surveillance may be used to inform driver education strategies.

Predicting the molecular mechanism of glucosamine in accelerating bone defect repair by stimulating osteogenic proteins

OBJECTIVES

Bone defect is serious condition that is usually caused by traffic accident. Chitosan is a polymer developed as a scaffold to treat bone defect. However, the mechanism by which chitosan can accelerate bone growth in defect area is still unclear. This study aims to identify proteins which are crucial to the osteogenic properties of chitosan monomer using an in silico study.

METHODS

Molecular docking was carried out on chitosan monomer, which are d-glucosamine and glucosamine 6-phosphate units against bone morphogenetic protein 2 (BMP-2), fibronectin, fibroblast growth factor (Fgf), and phosphate transporter (PiT) using AutoDock Vina. Ligand preparation was carried out using Chem3D version 15.0.0.106, while protein preparation was performed using AutoDockTools version 1.5.6.

RESULTS

The results showed that glucosamine 6-phosphate had the best binding affinity with fibronectin and PiT, which was -5.7 kcal mol^-1 on both proteins, while d-glucosamine had the best binding affinity with PiT (-5.2 kcal mol^-1).

CONCLUSIONS

This study suggests that the osteogenic properties of chitosan may be due to the presence of bonds between glucosamine units and fibronectin and/or PiT. However, in vitro studies need to be done to prove this.

Prediction of posttraumatic stress disorder by acute stress disorder in traffic accident survivors

BACKGROUND/AIM

To investigate the predictive effect of different symptoms of early acute stress disorder (ASD) on posttraumatic stress disorder (PTSD) in traffic accident survivors.

MATERIALS AND METHODS

A total of 206 traffic accident survivors were assessed with the Acute Stress Disorder Scale (ASDS) within 2-23 days after accidents, as well as with 17-item PTSD Checklist-Specific Stressor Version (PCL-S) during 4-12 months after accidents. All into the first group of subjects by senior surgeon assessment, based on the clinical, radiological and laboratory examination, excluded traumatic brain injuries and mild brain injury. And then, assessmented by clinical psychological practitioner.

RESULTS

The severity of ASD can significantly predict the severity of PTSD symptoms. ASD reexperience symptoms and avoidance symptoms can significantly predict PTSD reexperience symptoms and avoidance symptoms. ASD hyperarousal symptoms can significantly predict PTSD hyperarousal symptoms.

CONCLUSIONS

ASD and PTSD are common psychological disorders among traffic accident survivors. ASD can predict the symptoms and severity of PTSD.

Medicolegal Evaluation of Long-Term Respiratory Functions in Patients Injured Due to Traffic Accidents

Aim

Blunt chest trauma is a frequent injury in developing countries, with motor vehicle accidents being the most common cause. Most studies about the effects of post-traumatic injuries on pulmonary functions are related to the acute phase. The aim of this study is to compare the effect of injury type on pulmonary function tests as a long-term disability in patients with severe chest trauma due to traffic accidents.

Methods

In our study, 53 patients were admitted to the Forensic Expert Council with the aim of determining the disability ratio at least six months after the traffic accident. All patients who had a respiratory function test because of respiratory symptoms and whose reporting period was completed were appreciated. A retrospective examination of the forensic committee reports, types of injuries, and current pulmonary function test results were analyzed and the data were evaluated by using the Statistical Package for the Social Sciences (SPSS) 22.0 program (IBM Corp, Armonk, NY).

Results

Thirty-two (32) of the patients were male while 21 were female. Their average age was 39.88 ± 15.29. Sixty-six percent (66%; n: 35) of the cases were injured due to in-vehicle traffic accidents, 18.9% (n: 10) due to motorcycle accidents, 15.1% (n: 8) due to non-vehicle traffic accidents. The number of cases with costa fractures was 47 and 74.4% of these cases had three or more rib fractures. The mean forced expiratory volume in 1 second/forced vital capacity ratio (FEV1/FVC-Tiffeneau-Pinelli index) was calculated as 85.3% ± 9.45, and the average FVC was 84.3 ± 14.98%. The average number of rib fractures in all patients was 3.41 ± 2.24. It was observed that tube thoracostomy was performed in seven of 12 cases with FEV1/FVC below 80%, and the average number of rib fractures was 3.75. In 20 cases where the FVC average was below 80%, the mean number of rib fractures was 3.8, and tube thoracostomy was performed in 10 of these cases. The highest FEV1 value was 116%, and the lowest FEV1 value was 35%. The FEV1 value of 23 cases was between 75% and 95%. The highest FEV1/FVC value was 113% and the lowest FEV1/FVC value was 50%. The FEV1/FVC values of 38 cases were between 80% and 100%. 

Conclusions

In our study, most patients achieve near-complete recovery in pulmonary function tests; the impact of pre-existing pulmonary compromise on recovery is less known. The number of rib fractures can reflect the severity of the blunt trauma but it would not necessarily predict the resulting pulmonary function. These results are consistent with the previous studies. Further larger prospective studies are required to investigate different factors affecting prognosis.

Reality of traffic injuries attributable to preceding decreased level of consciousness

Aim

Although decreased level of consciousness (DLOC) while driving may lead to serious accidents involving drivers and people around them, including passengers and pedestrians, few studies have assessed traffic injuries attributable to preceding DLOC. We aimed to identify factors suggestive of a DLOC preceding traffic injury during initial examination.

Methods

This study included 193 drivers who were brought to our facility during the 1‐year period from January to December 2018. The drivers were divided into those with and without DLOC for comparison and analysis. Data on age, sex, causes of DLOC, and medical history were retrospectively reviewed from medical records.

Results

Of these 193 drivers, 58 (30.1%) had experienced preceding DLOC. The following factors suggested possible episodes of preceding DLOC: a single‐vehicle accident (odds ratio [OR] 3.59; 95% confidence interval [CI] 1.76–7.34; P < 0.001) and histories of hypertension (OR 2.64; 95% CI 1.13–6.15; P = 0.0248) and psychiatric disorders (OR 3.49; 95% CI 1.08–11.3; P = 0.0370). The causes of DLOC were endogenous diseases in 20 drivers (34.3%), dozing off episodes in 19 (32.8%), and acute alcohol intoxication in 11 (19.0%).

Conclusion

Before traffic accidents, 30.1% of drivers experienced DLOC. Single‐vehicle accidents and histories of hypertension and psychiatric disorders were factors suggestive of preceding DLOC.

Traumatic brain injury as vulnerability factor for the development of psychological disorders in a prospective single-event trauma traffic accident sample

Primary Objective: Traumatic brain injuries (TBIs) present a relevant problem among individuals involved in traffic accidents. The aim of this study was to investigate the impact of TBI on the development of psychological symptoms after a traffic accident.Research Design: This cohort study investigates, whether individuals involved in traffic accidents with TBI are more likely to develop psychological illness than those without TBI.Measures and Procedures: 59 men (patients: n= 19, controls: n= 40) and 64 women (patients: n= 21, controls n= 43) participated in the study (Mean age: M= 40.23; SD = 13.19; Injury severity score ISS: M= 6.48, SD = 5.99). The psychological distress was compared between the two groups using t-tests. The impact of ISS, number and duration of surgeries were regarded using regression analyses.Main Outcomes and Results: No indications for a heightened risk of psychological disorders in patients with TBI were found. The treatment at the hospital had no measurable influence on the development of psychological disorders. Nevertheless, in the Dexamethasone-suppression-test there was an increased stress load of patients with TBI caused by injury severity and operations.Conclusions: TBIs do not seem to cause psychological illness directly but the number of surgeries and the injury severity can influence the stress load which is associated with psychological symptoms.

Post-traumatic stress disorder of children with traffic accidents and their parents in Japan

BACKGROUND

Children who survive traffic accidents, and their parents, may develop post-traumatic stress disorder (PTSD) or related symptoms (depression or anxiety), which can hinder the children's development and the parents' ability to provide effective care. In Japan, the PTSD incidence rate following traffic accidents and its related factors remain unclarified.

METHOD

Participants were 79 children and 104 parents. The children were aged 3-18 years when injured. From August-December 2015, participants completed a self-reported questionnaire survey that comprised the 15-item Post-traumatic Stress Symptoms for Children and the Japanese version of the Impact of Event Scale-Revised. The children's Injury Severity Score (ISS) was also obtained from their medical records. Correlations, analyses of variance, and multiple regression analyses were conducted.

RESULTS

Among the children and the parents, 10.2% and 22.1% were deemed to be at high risk of PTSD, respectively. Their stress scores were significantly positively correlated with each other and negatively correlated with children's age at the time of the accident. Parents who witnessed their children's accidents and those whose children were hospitalized were more stressed. Neither the children's nor the parents' risk for PTSD was associated with the ISS and the amount of time since the accident.

CONCLUSIONS

A system that simultaneously works with children and parents, to support both parties' psychological recovery is required. To ensure psychological care post-injury, it is necessary to evaluate PTSD risk, regardless of injury severity. Implementing preventive and early interventions can prove more valuable than awaiting natural recovery.

The Effectiveness and safety of T-MSAT on inpatients with acute low back pain caused by traffic accidents: A protocol for randomized controlled trial

BACKGROUND

Presentation of musculoskeletal symptoms, such as pain, discomfort, or disability, caused by a traffic accident (TA) is a common occurrence. However, studies on treatment and management of sudden low back pain (LBP) caused by a TA are very scarce, while studies on the effectiveness of motion style acupuncture therapy (MSAT) used on such patients are also rare. Accordingly, a randomized controlled trial (RCT) is planned to assess the effectiveness and safety of MSAT using traction (T-MSAT) for the treatment of pain and functional problems in patients with acute LBP caused by a TA.

METHODS

This study will be conducted at Jaseng Hospital of Korean Medicine in South Korea, using a two-armed, parallel, assessor-blinded RCT design. The study population will consist of 100 participants who will be randomly assigned in a 1:1 ratio to either the T-MSAT+integrative Korean medicine therapy (IKMT) group or IKMT control group. The treatment will be applied continuously for 3 days after admission. The primary outcome will be the difference between the numeric rating scale (NRS) scores at admission and immediately after treatment on the fourth day of admission. Secondary outcomes will include visual analogue scale (VAS) for LBP and radiating leg pain; NRS for radiating leg pain; lumbar active range of motion; Oswestry Disability Index (ODI); Patient Global Impression of Change (PGIC); the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5-K); and 12-item short-form health survey (SF-12).

DISCUSSION

This study is a RCT to assess the effectiveness and safety of T-MSAT for acute LBP caused by a TA. The findings could be used by healthcare-related policy makers and clinicians in primary care institutions, which are frequently visited by patients suffering from LBP caused by a TA.

Predicting and Interpreting Spatial Accidents through MDLSTM

Predicting and interpreting the spatial location and causes of traffic accidents is one of the current hot topics in traffic safety. This research purposed a multi-dimensional long-short term memory neural network model (MDLSTM) to fit the non-linear relationships between traffic accident characteristics and land use properties, which are further interpreted to form local and general rules. More variables are taken into account as the input land use properties and the output traffic accident characteristics. Five types of traffic accident characteristics are simultaneously predicted with higher accuracy, and three levels of interpretation, including the hidden factor-traffic potential, the potential-determine factors, which varies between grid cells, and the general rules across the whole study area are analyzed. Based on the model, some interesting insights were revealed including the division line in the potential traffic accidents in Shenyang (China). It is also purposed that the relationship between land use and accidents differ from previous researches in the neighboring and regional aspects. Neighboring grids have strong spatial connections so that the relationship of accidents in a continuous area is relatively similar. In a larger region, the spatial location is found to have a great influence on the traffic accident and has a strong directionality.

Trajectory of the Victims of Overland Transport Accidents: From Prehospital to Hospital Care

Objective

The aim is to evaluate the trajectory of the victims of ground transportation accidents from the prehospital care to the hospital.

Methods

The sample consisted of 1,264 patients collected from the prehospital care, from June 2015 to June 2016. The trajectory was analyzed by the difference in the average time elapsed between the call and the hospital entrance. The Mann–Whitney and Kruskal–Wallis tests were used, adopting a significance level of 5% and 95% confidence.

Results

Patients had a mean age of 31.2 years, Glasgow Coma Scale of 14.8 points, and 24.8 days of hospitalization. It is characterized predominantly masculine, conductive of the vehicle, being the motorcycle prevalent; most of them wore a helmet/seat belt and no alcohol. The association between the average time of care and the characteristics related to the victim was significant: the use of the belt/helmet, alcoholism, and type of discharge and relative to the accident: area of occurrence, period of the week, shift of occurrence, type of prehospital care, and other party involved.

Conclusion

The characteristics related to ground transportation accident interfere in the time of prehospital care to the hospital, which can influence the prognosis.

Comparative analysis of two almost identical traffic accidents

In the Czech Republic, 1 500 suicides are committed in average per year approximately. Only in a small percentage has been used vehicle as a tool. Prove suicidal intent in a fatal road accident has been difficult, but mostly these accidents have similar characteristics - impact with tree or similar fixed obstacle, non - use of seat belt, absence of brake traces, etc. The aim of this paper is to present and analyse two almost identical traffic accidents - identical location, identical vehicle type. While one of these was fatal (but not proven suicide), the second accident was not fatal, but with suicidal intent. Data were obtained as a part of the Czech In-depth Study conducted by Transport Research Centre. Data from In-depth Accident Analysis provide a comprehensive view of all the factors related to a particular accident and serve to identify the characteristics leading to the crash occurrence.

The Research Trends of Pharmacopuncture Therapy on Cervical Pain Caused by Traffic Accidents

Objectives

The purpose of this study is to comprehensively review Korean domestic studies and investigate the research trends of pharmacopuncture therapy on cervical pain caused by traffic accidents.

Methods

Domestic studies between February 1999 and May 2020 from four Korean databases were searched with combinations of keywords ‘cervical pain’, ‘traffic accident’, ‘whiplash injury’, and ‘pharmacopuncture’.

Results

17 studies were selected for review, including 7 randomized controlled trials, 5 retrospective observational studies, 3 case reports, and 2 non-randomized controlled trials. Each study was reviewed by published year, study type, types of pharmacopuncture solutions, selected acupuncture points, dosage of pharmacopuncture solutions, frequency of treatment, concurrent treatments, outcome measurements, and the effectiveness of pharmacopuncture therapy. The results are as follows (1) It showed that the total number of published studies had increased slightly in the last 10 years compared to the previous decade. (2) The pharmacopuncture solutions used in the studies were in the following order Bee-Venom (蜂毒), Jungsongouhyul (中性瘀血), Hwangryunhaedoktang (黃連解毒湯) and Soyeom (消炎). Frequently used acupuncture points were GB20, GV21, A-shi point, GV16, EX-B2, and SI15 in order. (3) The most commonly used total injection dosage was 1.0 cc at a time, and the frequency of treatment was twice a week. (4) Concurrent treatments such as acupuncture, herbal medication, physical therapy and Chuna manual therapy were performed in all 17 studies. (5) Pharmacopuncture therapy showed positive effects on cervical pain caused by traffic accidents in all 17 studies reviewed.

Conclusion

Pharmacopuncture therapy was effective in cervical pain caused by traffic accidents in all 17 studies selected. Further studies will be needed using more larger scales and more objective data to confirm the effectiveness of pharmacopuncture therapy and to generalize its application.

Relative risk of injury due to alcohol consumption in car and motorcycle drivers

Background

There is strong evidence that a substantial number of fatal as well as nonfatal injuries in road traffic accidents result from alcohol consumption and abuse.

Aims

To examine the relationship between blood alcohol concentration and characteristics of injury in trauma patients admitted to a major teaching hospital.

Methods

This was a cross-sectional investigation of trauma characteristics among 38 435 car and motorcycle drivers referred to the South of Iran Trauma Center between October and March 2018. A log-binomial regression model was used to evaluate the relative risk of each covariate on the Injury Severity Score.

Results

There were 253 patients (7.78%) with alcohol consumption. Also, blood alcohol level was positive in 8.66% and 6.93% of car and motorcycle drivers, respectively. The ISS in alcohol consumers and nonconsumers was 6.34 (standard deviation; 8.73) and 4.12 (7.78), respectively, which was significantly higher in the alcohol consumers (t test = 12.96, P < 0.001). Therefore, alcohol consumption was a significant factor in increasing the relative risk of injury, which was 2.83 units more than among drivers who had not consumed alcohol.

Conclusions

Our findings show that the police and law enforcement agencies have a responsibility to enforce stricter rules to reduce drink driving and the burden of trauma on the healthcare system.

[The actual problems of traumatism in the Russian Federation]

In 2005-2018, marked decreasing of morbidity of trauma, intoxications and other outcomes of impact of external causes in the Russian Federation was registered. In the Ural Federal Okrug, the rate of decreasing was the lowest and made up to 1.3%. In the subjects of the Federal District, the highest rates are registered in the Kurgan and Chelyabinsk Oblast. In 2010-2017, mortality from external causes decreased most intensively in the North Western Federal Okrug - up to 40.6% and least intensively in the South Federal Okrug up to 28.4%. The mortality of traffic accidents decreased most markedly up to 2.1 times from 22.4 to 10.5 cases per 100 thousand of the population. There is decreasing in indices of traumatism and trauma mortality in most territories of the Russian Federation. In recent years, slowdown of this trend is present that testifies the necessity of further development of measures targeting organization of medical care of the injured based on organization of traumatological centers for all injured, and not only those ones of traffic accidents.

A Case of Fatal Stanford Type A Aortic Dissection Caused by a Traffic Accident with Low Energy Impact

A seemingly healthy 84-year-old female pedestrian was mildly bumped by a car, and she hit her left shoulder, flank, and lower legs when she fell down on a street. She was conscious and stable when transferred to an emergency room. She had no sign of any major injuries except minor lacerations on her legs. Repeated evaluations including chest X-ray, ECG, and focused assessment with sonography for trauma did not reveal any abnormal findings. While waiting for discharge, she started having mild chest discomfort. Unexpectedly, the third echocardiogram showed mild pericardial effusion, and a CT with contrast showed aortic dissection in the ascending aorta and infra-left subclavian aortic dissection. She was immediately transferred by a helicopter to a tertiary trauma center for emergent repair surgery. Considering the site of dissections, progression of existing intrinsic intimal tear triggered by energy impact was suspected. However, traumatic causes could not be excluded. Extra caution and diligence should be exercised when examining elderly patients in blunt trauma.

The Predictors of Driving Cessation among Older Drivers in Korea

Background: As the elderly population and the number of older drivers grow, public safety concerns about traffic accidents involving older drivers are increasing. Approaches to reduce traffic accidents involving older drivers without limiting their mobility are needed. This study aimed to investigate the driving cessation (DC) rate among older Korean adults and predictors of DC based on the comprehensive mobility framework. Method: In this cross-sectional study, data from 2970 to 10,062 older adults over 65 years old from the 2017 National Survey of Elderly People were analyzed in April 2020. Multivariate logistic regression analyses were conducted to identify the predictors of DC. Results: Residential area, an environmental factor, was a strong predictor of DC (Odds Ratio (OR) 2.21, 95% Confidential Interval (CI) 1.86–2.62). Older drivers living in an area with a metro system were 2.21 more likely to stop driving than those living in an area without a metro system. Other demographic, financial, psychosocial, physical, and cognitive variables also predicted DC. Conclusion: Environmental factors were strong predictors of older adults’ DC. Therefore, political and environmental support, such as the provision of accessible public transportation, is essential to increase the DC rate among older adults to increase public safety without decreasing their mobility.