Frailty and injury causation

PURPOSE

: The current study will attempt to elucidate whether frailty has a role in motor vehicle crash injury causation.

METHODS

: The association between frailty and injury was studied among Crash Injury Research Engineering Network (CIREN) cases. The baseline "physical functioning" (PF) score of the SF-36 was used as a marker of frailty (i.e., PF score <75). Frailty associations with ISS and occupant, vehicular and crash factors were explored. Frailty association with delta V was analyzed among injured (i.e., brain, rib, or femur) belted occupants in frontal crashes to establish whether frailty confers a different risk of each particular injury.

RESULTS

: Frailty occurred in 13.7 % of the cohort (n=1,747). Median (q1-q3) ISS was 14.0 (10-22) among the frail and 17.0 (10-24) among the non frail (p=0.40). Frailty was significantly associated with advanced age, male gender, the presence of co-morbidities, extreme BMIs, frontal and near-side crashes and delta V < 45 km/h. Seat belt use and ISS<16 were not associated with frailty. Multiple linear regressions, adjusting for age, gender and BMI revealed a negative association between frailty and log delta V (coefficient -0.188, p=0.04) among those with rib fractures but not among those with brain injuries or femur fractures.

CONCLUSION

: PF score, a marker of frailty, is associated with similar ISS and lower delta V and is independently linked to lower delta V thresholds for some injuries (i.e. rib fractures) but not for others (i.e. brain injuries and femur fractures). These associations suggest a potential role of frailty in injury causation.

Pursuit of Licensure by Senior Drivers Referred by Police to a State Licensing Agency's Medical Advisory Board

In all fifty United States and the District of Columbia, police Requests for Re-examination (RRE) concerning fitness to driver are accepted by licensing agencies. This study assessed licensing outcomes of senior drivers, ≥75 years of age, who had RREs submitted to the Medical Advisory Board (MAB) of a Maryland Motor Vehicle Administration from March 2005 through April 2007. RRE traffic event information (including crashed, did not crash), driver demographic information, initial MAB recommendations (suspension vs no suspension), driving occupational therapists assessments, and drivers' pursuit of continued licensure were entered into a database. During the period of study, 475 RREs were referred to the MAB. The percent of referred senior drivers (n=240, 50.4%) was similar to that of younger drivers (n=235, 49.5%). A higher percentage of senior drivers retired from driving compared to younger drivers; being, 57.1% vs 23.8% (p <.01), respectively. Further analyses limited to the 240 senior drivers found: 139 (57.9%) were men, 150 (62.5%) were 75-84 years of age, 119 (49.5%) were noted to be disoriented at the traffic scene, 141 (58.8%) were involved in a crash, and 127 (52.9%) were initially suspended as the result of MAB review. The following factors were significantly related to retiring from driving, initial MAB suspension and greater age. Of the 127 drivers who were initially suspended, 82 (64.6%) retired from driving, and 45 (35.4%) pursued further licensure (p <0.01). In contrast, the percentage of non-suspended drivers who did or did not pursue further licensure was similar; being 48.7% vs 51.3%. Among drivers ≥85 years of age, 68.9% retired from driving, compared with 50% of the drivers who were 75 to 84 years of age (p <0.01) While not statisically significant, higher percentages of driving retirement were noted for the following: sex - a greater percentage of men compared to women (61.9% vs 49.5%); confusion at the traffic scene (confused, 57.1% vs non-confused, 42.9%); and crash involvement (56.7% who crashed, retired vs 43.3% of those who did not crash, retired). Overall, the most important finding of this study is that as a result of police referral, only one-fifth (20.4%) of senior drivers 75 years of age or older, continued to maintain their driving privilege. However, only 40 drivers (16.7%) retained their original driving privilege without added restrictions. The data suggest that senior drivers who are not medically fit to drive may be identified by police referrals to a licensing agency. Driving occupational therapy assessments and training, and additional driving restrictions are recommended to facilitate continuation of the driving privilege for some drivers.

The relationship between impaired driving crashes and beliefs about impaired driving: do residents in high crash rate counties have greater concerns about impaired driving?

OBJECTIVES

The purpose of this investigation was to examine the relationship between impaired driving crashes and public beliefs and concerns about impaired driving across each of Maryland's twenty-four counties (including Baltimore City). It was hypothesized that residents of counties that experience higher impaired driving crashes would express more concerns about impaired driving and perceive more risks about driving impaired than residents of counties that have lower rates of impaired driving.

METHODS

Data for alcohol impaired driving crashes were obtained for the years 2004-2006. These data were compared to public opinion data that was obtained annually by random-digit-dial telephone surveys from 2004 to 2007.

RESULTS

Concerns about drunk driving as well as perceptions of the likelihood of being stopped by the police if one were to drive after having too much to drink were related to counties with higher serious impaired driving crash rates, as were perceptions that the police and the legal system were too lenient. Perceptions about the likelihood of being stopped by the police were higher in those counties with more impaired driving enforcement activity.

CONCLUSION

Perceptions of concern appear to be shaped more by crash exposure than enforcement activity. Campaigns that address impaired driving prevention should substantially increase enforcement, strengthen the adjudication process of impaired drivers, and emphasize the potential seriousness of drinking-driving crashes in their promotional activities.

The association between age, injury, and survival to hospital among a cohort of injured motorcyclists

Despite the significant increase in mortality among older motorcyclists during the past decade, few studies have addressed specific injuries or mortality rates among all those injured. The purpose of this study is to describe the crash and injury characteristics among a cohort of motorcyclists injured in Maryland, and to determine the influence of age and crash type on mortality, injury patterns, and place of death (scene vs. hospital). Possible biases introduced by studying only those hospitalized are described. Based on the findings, specific injury prevention strategies for older vs. younger riders are proposed.

Life-altering outcomes after lower extremity injury sustained in motor vehicle crashes

BACKGROUND

Lower extremity injuries (LEIs) sustained in vehicular crashes result in physical problems and unexpected psychosocial consequences. Their significance is diminished by low Abbreviated Injury Scale scores.

METHODS

Drivers who sustained LEIs were identified as part of the Crash Injury Research and Engineering Network (CIREN) and interviewed during hospitalization, at 6 months, and at 1 year. All were occupants of newer vehicles with seatbelts and airbags.

RESULTS

Sixty-five patients were followed for 1 year. Injuries included mild brain injury (43%), ankle/foot fractures (55%), and bilateral injuries (37%). One year post-injury, 46% reported limitations in walking and 22% with ankle/foot fractures were unable to return to work. Depression (39%), cognitive problems (32%), and post-traumatic stress disorder (18%) were significant in the mild brain injury group.

CONCLUSIONS

Long-lasting physical and psychological burdens may impede recovery and alter the lifestyle of patients with LEI. These issues need to be addressed by trauma center personnel.

Consequences and costs of lower extremity injuries

Lower extremity injuries resulting from motor vehicle crashes are common and have become relatively more important as more drivers with newer occupant restraints survive high-energy crashes. CIREN data provide a greater level of clinical detail based on coding guidelines from the Orthopedic Trauma Association. These detailed data, in conjunction with long-term follow-up data obtained from patient interviews, reveal that the most costly and disabling injuries are those involving articular (joint) surfaces, especially those of the ankle/foot. Patients with such injuries exhibit residual physical and psychosocial problems, even at one year post-trauma.