Injury patterns of seniors in traffic accidents: A technical and medical analysis

AIM:To investigate the actual injury situation of seniors in traffic accidents and to evaluate the different injury patterns.METHODS:Injury data,environmental circumstances and crash circumstances of accidents were collected shortly after the accident event at the scene.With these data,a technical and medical analysis was performed,including Injury Severity Score,Abbreviated Injury Scale and Maximum Abbreviated Injury Scale.The method of data collection is named the German InDepth Accident Study and can be seen as representative.RESULTS:A total of 4430 injured seniors in traffic accidents were evaluated.The incidence of sustaining severe injuries to extremities,head and maxillofacial region was significantly higher in the group of elderly people compared to a younger age(P<0.05).The number of accident-related injuries was higher in the group of seniors compared to other groups.CONCLUSION:Seniors are more likely to be involved in traffic injuries and to sustain serious to severe injuries compared to other groups.

Injury Pattern among Road Traffic Accidents’ Victims in Najran City, Saudi Arabia

Traffic accidents constitute the substantial cause of disability and mortality in the young Saudi individuals reaching horrible figures. The aim of this study was to review and identify the pattern of injury among road traffic accident (RTA) victims as well as the peak time of accidents and their implications. This retrospective hospital-based cross-sectional study was carried out in the period between April 2016 to March 2017 in King Khalid Hospital, Maternity and Children Hospital and Najran General Hospital, Najran, Saudi Arabia. All RTA victims admitted to the emergency departments of the pre-mentioned hospitals. Data collected from 435 Saudis and non-Saudis’ files were statistically analyzed with regard to age, gender, the timing of road traffic accidents, injury pattern, and neurological deficits incidence. Most of the RTAs’ cases (92%) were male victims with the highest peak in the age group 20 - 29 years. 58% of the RTAs happened in the evening (6:00 PM-9:00 PM) while 20% occurred in the morning. Head injury represented the most frequent pattern (36%) followed by the spinal injury (23%), lower limb injury (23%), upper limb injury (20%), thoracic injury (17%), pelvic injury and abdominal injury (8%). 4.4% of RTAs resulted in death whilst 9% of cases experienced neurological deficits. In conclusion, young male drivers in Najran recorded the highest frequency of RTAs. Initiation of road safety education and expansion of speed detectors (Saher) system deployment is highly recommended.

Parametric analysis of craniocerebral injury mechanism in pedestrian trafficaccidents based on finite element methods

Purpose:The toughest challenge in pedestrian traffic accident identification lies in ascertaining injurymanners.This study aimed to systematically simulate and parameterize 3 types of craniocerebral injuryincluding impact injury,fall injury,and run-over injury,to compare the injury response outcomes ofdifferent injury manners.Methods:Based on the total human model for safety(THUMS)and its enhanced human model THUMShollow structures,a total of 84 simulations with 3 injury manners,different loading directions,andloading velocities were conducted.Von Mises stress,intracranial pressure,maximum principal strain,cumulative strain damage measure,shear stress,and cranial strain were employed to analyze the injuryresponse of all areas of the brain.To examine the association between injury conditions and injuryconsequences,correlation analysis,principal component analysis,linear regression,and stepwise linearregression were utilized.Results:There is a significant correlation observed between each criterion of skull and brain injury(p<0.01 in all Pearson correlation analysis results).A 2-phase increase of cranio-cerebral stress andstrain as impact speed increases.In high-speed impact(>40 km/h),the Von Mises stress on the skull waswith a high possibility exceed the threshold for skull fracture(100 MPa).When falling and makingtemporal and occipital contact with the ground,the opposite side of the impacted area experienceshigher frequency stress concentration than contact at other conditions.Run-over injuries tend to have amore comprehensive craniocerebral injury,with greater overall deformation due to more adequate kinetic energy conduction.The mean value of maximum principal strain of brain and Von Mises stress ofcranium at run-over condition are 1.39 and 403.8 MPa,while they were 1.31,94.11 MPa and 0.64,120.5 MPa for the impact and fall conditions,respectively.The impact velocity also plays a significant rolein craniocerebral injury in impact and fall loading conditions(the p of all F-test<0.05).A regressionequation of the craniocerebral injury manners in pedestrian accidents was established.Conclusion:The study distinguished the craniocerebral injuries caused in different manners,elucidatedthe biomechanical mechanisms of craniocerebral injury,and provided a biomechanical foundation forthe identification of craniocerebral injury in legal contexts.

Numerical Reconstruction and Injury Biomechanism in a Car- Pedestrian Crash Accident

Objective To reconstruct a car-pedestrian crash accident using numerical simulation technology and explore the injury biomechanism as forensic evidence for injury identification. Methods An integration of multi-body dynamic, finite element (FE), and classical method was applied to a car-pedestrian crash accident. The location of the collision and the details of the traffic accident were determined by vehicle trace verification and autopsy. The accident reconstruction was performed by coupling the three-dimensional car behavior from PC-CRASH with a MADYMO dummy model. The collision FE models of head and leg, developed from CT scans of human remains, were loaded with calculated dummy collision parameters. The data of the impact biomechanical responses were extracted in terms of von Mises stress, relative displacement, strain and stress fringes. Results The accident reconstruction results were identical with the examined ones and the biomechanism of head and leg injuries, illustrated through the FE methods, were consistent with the classical injury theories. Conclusion The numerical simulation technology is proved to be effective in identifying traffic accidents and exploring of injury biomechanism.

Risk factors and predictive model of cerebral edema after road traffic accidents-related traumatic brain injury

Purpose:Cerebral edema(CE)is the main secondary injury following traumatic brain injury(TBI)caused by road traffic accidents(RTAs).It is challenging to be predicted timely.In this study,we aimed to develop a prediction model for CE by identifying its risk factors and comparing the timing of edema occurrence in TBI patients with varying levels of injuries.Methods:This case-control study included 218 patients with TBI caused by RTAs.The cohort was divided into CE and non-CE groups,according to CT results within 7 days.Demographic data,imaging data,and clinical data were collected and analyzed.Quantitative variables that follow normal distribution were presented as mean±standard deviation,those that do not follow normal distribution were presented as median(Q1,Q3).Categorical variables were expressed as percentages.The Chi-square test and logistic regression analysis were used to identify risk factors for CE.Logistic curve fitting was performed to predict the time to secondary CE in TBI patients with different levels of injuries.The efficacy of the model was evaluated using the receiver operator characteristic curve.Results:According to the study,almost half(47.3%)of the patients were found to have CE.The risk factors associated with CE were bilateral frontal lobe contusion,unilateral frontal lobe contusion,cerebral contusion,subarachnoid hemorrhage,and abbreviated injury scale(AIS).The odds ratio values for these factors were 7.27(95%confidence interval(CI):2.08-25.42,p=0.002),2.85(95%CI:1.11-7.31,p=0.030),2.62(95%CI:1.12-6.13,p=0.027),2.44(95%CI:1.25-4.76,p=0.009),and 1.5(95%CI:1.10-2.04,p=0.009),respectively.We also observed that patients with mild/moderate TBI(AIS≤3)had a 50%probability of developing CE 19.7 h after injury(χ^(2)=13.82,adjusted R2=0.51),while patients with severe TBI(AIS>3)developed CE after 12.5 h(χ^(2)=18.48,adjusted R2=0.54).Finally,we conducted a receiver operator characteristic curve analysis of CE time,which showed an area under the curve of 0.744 and 0.672 for severe and mild/moderate TBI,respectively.Conclusion:Our study found that the onset of CE in individuals with TBI resulting from RTAs was correlated with the severity of the injury.Specifically,those with more severe injuries experienced an earlier onset of CE.These findings suggest that there is a critical time window for clinical intervention in cases of CE secondary to TBI.

IMPACT和CRASH模型对创伤性颅脑损伤患者预后评估价值的比较研究

背景国际颅脑损伤预后临床测试研究(IMPACT)和重型颅脑损伤后皮质类固醇的随机化研究(CRASH模型是国际上具有影响力的创伤性颅脑损伤(TBI)预后预测模型,需要继续开发,完善和持续的外部验证,以确保对不同环境的普适性。目的同时在中国TBI人群中进行验证IMPACT和CRASH模型的预后评估价值并进行比较。方法选取2017—2019年在郑州大学附属郑州中心医院内接受治疗的TBI患者210例为研究对象,收集纳入患者的基本信息。随访观察患者14 d存活情况和6个月格拉斯哥预后评分(GOS),随访截止时间为2021年6月,终止事件为中途失访。绘制受试者工作特征曲线(ROC曲线)评估IMPACT和CRASH模型对TBI患者预后的预测效能,计算ROC曲线下面积(AUC)。采用Brier评分评价模型的校准度。结果患者平均年龄(54.0±17.4)岁,分别绘制IMPACT模型与CRASH模型预测TBI患者预后的ROC曲线,结果显示IMPACT核心模型、CT模型、实验室模型预测TBI患者6个月GOS预后不良的AUC分别为0.807(95%CI=0.747~0.866,P<0.001)、0.843(95%CI=0.789~0.897,P<0.001)、0.845(95%CI=0.793~0.897,P<0.001),Brier评分分别为0.179、0.164、0.161;IMPACT核心模型、CT模型、实验室模型预测TBI患者6个月死亡的AUC分别为0.868(95%CI=0.816~0.919,P<0.001)、0.896(95%CI=0.851~0.941,P<0.001)、0.892(95%CI=0.850~0.935,P<0.001),Brier评分分别为0.151、0.144、0.136。CRASH基本模型、CT模型预测TBI患者6个月GOS预后不良的AUC分别为0.747(95%CI=0.682~0.813,P<0.001)、0.766(95%CI=0.703~0.829,P<0.001),Brier评分分别为0.306、0.308;CRASH基本模型、CT模型预测TBI患者14 d死亡的AUC分别为0.791(95%CI=0.723~0.860,P<0.001)、0.797(95%CI=0.728~0.865,P<0.001);Brier评分分别为0.348、0.383。结论对于TBI患者的预后,IMPACT模型整体较CRASH模型显示出较好的预测能力。

A Workable Solution for Reducing the Large Number of Vehicle and Pedestrian Accidents Occurring on a Yellow Light

Traffic intersections are incredibly dangerous for drivers and pedestrians. Statistics from both Canada and the U.S. show a high number of fatalities and serious injuries related to crashes at intersections. In Canada, during 2019, the National Collision Database shows that 28% of traffic fatalities and 42% of serious injuries occurred at intersections. Likewise, the U.S. National Highway Traffic Administration (NHTSA) found that about 40% of the estimated 5,811,000 accidents in the U.S. during the year studied were intersection-related crashes. In fact, a major survey by the car insurance industry found that nearly 85% of drivers could not identify the correct action to take when approaching a yellow traffic light at an intersection. One major reason for these accidents is the “yellow light dilemma,” the ambiguous situation where a driver should stop or proceed forward when unexpectedly faced with a yellow light. This situation is even further exacerbated by the tendency of aggressive drivers to inappropriately speed up on the yellow just to get through the traffic light. A survey of Canadian drivers conducted by the Traffic Injury Research Foundation found that 9% of drivers admitted to speeding up to get through a traffic light. Another reason for these accidents is the increased danger of making a left-hand turn on yellow. According to the National Highway Traffic Safety Association (NHTSA), left turns occur in approximately 22.2% of collisions—as opposed to just 1.2% for right turns. Moreover, a study by CNN found left turns are three times as likely to kill pedestrians than right turns. The reason left turns are so much more likely to cause an accident is because they take a driver against traffic and in the path of oncoming cars. Additionally, most of these left turns occur at the driver’s discretion—as opposed to the distressingly brief left-hand arrow at busy intersections. Drive Safe Now proposes a workable solution for reducing the number of accidents occurring during a yellow light at intersections. We believe this fairly simple solution will save lives, prevent injuries, reduce damage to public and private property, and decrease insurance costs.

Analysis of Thorax Injuries in 112 Death Cases Caused by Traffic Accidents

Objective: To explore the characteristics and mechanisms of serious injuries of chest caused by road traffic accidents. Methods: Totally 112 autopsy cases with chest injuries in the urban of Jingzhou road traffic accidents were collected. Systematic review and analysis of the general information, postmortem examinations and assessments of chest injury had carried out from Feb. 2016 to Mar. 2018. Results: Average age of the victims was 52.2 years and the ratio of male to female deaths was 2.39:1. The proportion of motor-cyclists and pedestrians increased significantly. The overwhelming majority of accident vehicles were motorcycles and bicycles. Fractures of ribs and pulmonary contusion were the most common injuries. Craniocerebral and abdominal injuries were the most common associated injuries. Conclusion: Fractures of ribs and pulmonary contusion were the most common features of fatal road traffic injuries, often associated with vitreoretinal damage and serious multiple damages. These features reflect the characteristics of great violence in traffic accidents, which provides the evidence of identification of violent injuries.

Factors and Pattern of Injuries Associated with Road Traffic Accidents in Hilly District of Nepal

Introduction: In 21st century, road traffic accidents (RTA) are considered as increasing epidemic of non-communicable disease which is abandoned and needs special attention to prevent them. The aim of this study was to assess the factors and pattern of injuries associated with road traffic accidents. Methods: A cross sectional study was conducted among 112 RTA victims and 56 drivers in Palpa District of Nepal. The association of factors and pattern of injuries with exposure to accidents was assessed using Fisher’s exact test. Bivariate logistic regression examined the association between driving and socio-demographics factors and exposure to road accidents. Results: Of 112 RTA victims, 50% were in the age group of 21 to 40 years and 71.4% were male. Drivers who were in the age less than or equal to 30 years were more likely (OR: 3.6;95% CI: 1.0, 14.3) to expose to an accident than those who were above 30 years. Similarly, those having driving speed less than 40 km/hr were less likely to expose to an accident than those with speed 40 - 60 km/hr (OR: 6.0;95% CI: 0.8, 73.5) and those with speed more than 60 km/hr (OR 7.8;95% CI: 1.0, 100.1). Moreover, the driving experience was also found positively associated (OR: 5.6;95% CI: 1.1, 35.5) with the exposure to an accident. Conclusion: Being in younger age group, male gender, morning time, the driving speed, driving experiences, and driving hours on the road were positively associated with RTA. The efforts should be made to enforce laws in control of speed targeting experienced drivers and those with younger age groups.

Postmortem MSCT Diagnosis of Whiplash Injuries in a Traffic Accident：A Case Report and Review of the Literature

A 45-year-old male car driver died in a traffic accident of four cars rear-end collision on the highway.He was found to have died after a respiratory and cardiac arrest at the scene.No sign of skin injuries was observed from the external inspection.The autopsy was not permitted by the family members because of the local culture.Multislice computed tomography(MSCT)was applied to the current case,showing dislocation of C3~4cervical vertebrae withⅡdegree,C4vertebral plate fractures,and spinal stenosis.Post-mortem MSCT confirmed the diagnosis as whiplash injuries.MSCT was verified to be effective in showing the severity of whiplash injuries,thus providing certain objective evidence for medicolegal expertise.

3D Finite Element Model of Human Knee Injuries in the Traffic Accident

Objective To explore the injury mechanism of the human knee in a traffic accident by establishing a 3D finite element(FE) model. Methods The FE model, composed of femur, tibia, fibula, patella, meniscus, knee ligaments and surrounding soft tissues, was reconstructed by CT scanning data from a male volunteer. Validation was performed by the lateral impact simulation, and the stress and strain results were obtained to be compared with those previously reported for injury prediction. Results The results derived from the FE model were found to be similar with those previously reported, most of the ligaments and meniscus wounded at 40 m/s collision, which was readily observed. Conclusion The simulation results generated by FE model can be effectively used for the injury mechanism analysis of initial contact.

基于交通事故案例的3岁儿童乘员损伤机制研究

目的通过再现真实交通事故案例探究3岁儿童乘员碰撞损伤机制。方法应用车辆有限元模型和图斯特3岁儿童乘员损伤仿生模型(TUST IBMs 3YO-O),再现CIREN数据库中的交通事故案例,通过综合分析Δv、车辆质量和变形能反求碰撞前车辆的速度,设置碰撞仿真试验再现案例所描述的儿童乘员损伤,分析损伤机制。结果TUST IBMs 3YO-O模型完整地再现出碰撞事故中儿童乘员的损伤。儿童乘员头部运动学响应与生物力学响应表现出差异性,儿童乘员胸腔内部组织器官生物力学响应表明其没有出现损伤,但是胸部3 ms合成加速度达到54 g,超出阈值。结论未来乘员安全评价需要引入生物力学参数。应用高生物逼真度的人体生物力学模型再现交通事故中乘员损伤,不仅更加清晰观察事故中乘员的运动学响应,深度分析碰撞损伤机制,还为数字化评估提供参考依据,也将为儿童乘员保护装置研发和安全法规制定提供参考。

考虑建成环境的电动自行车事故严重程度致因分析

为探究考虑建成环境影响下,电动自行车交通事故严重程度的影响因素,本文从事故属性、骑行者属性、对象车辆及驾驶员属性、道路属性及建成环境属性这5个方面,选取18个影响电动自行车交通事故严重性的潜在变量。在此基础上,构建考虑均值及方差异质性的随机参数Logit模型,利用边际效应量化显著变量对事故严重程度的影响差异。基于北京市近5年电动自行车事故抽样数据进行实证研究,结果表明:事故时段19:00-次日7:00、骑行者年龄大于40岁、重(大)型货车、到最近医院的距离增大及恶劣天气等因素会增加电动自行车事故严重程度。建成环境属性中,到最近医院的距离在死亡事故中的参数为服从正态分布的随机参数,路段及恶劣天气会增大其均值异质性,驾驶员年龄为(40,60]岁会增大其方差异质性;其他属性中,一般城市道路在受伤事故中的参数为服从正态分布的随机参数,路段会增大其均值异质性。研究结果可以为降低电动自行车事故严重程度提供理论支撑。

人车碰撞事故中人地碰撞损伤研究进展

为了解人车碰撞事故中人地碰撞损伤的研究进展,并对可行的人地碰撞损伤防护方法做出展望。本文从人车碰撞事故特征、人体损伤评价指标、人体损伤来源、人地碰撞损伤影响因素及人地碰撞损伤防护方法5个方面回顾了已有研究成果,并对已有研究中存在的问题进行讨论,就人地碰撞防护方法的发展作出展望。人地碰撞损伤研究仍然存在许多不成熟的地方,特别是人地碰撞损伤的致伤机理和影响因素方面仍须开展深入的研究。通过回顾现有的人地碰撞损伤防护技术指出,未来可从优化车辆前部形状、安装行人安全装置以及控制车辆制动等方面来降低行人损伤风险。大部分事故中碰撞速度为中低速,而在低车速下的人地碰撞损伤不容忽视,可通过控制车辆制动降低人地碰撞损伤。此外,人地碰撞损害评价指标仍存在不足。本文可为后续更好地开展人地碰撞损伤致伤机理及防护方法的研究提供参考。

建成环境对交叉口行人事故严重程度异质性影响

为探索建成环境及其他因素对行人事故伤害严重程度的影响,通过建立均值和方差异质性随机参数Logit模型对交叉口行人事故严重程度进行异质性分析。利用行人碰撞事故数据,从行人、驾驶员、车辆、道路、环境、时间、建成环境7个方面筛选出27个影响因素,通过弹性系数分析显著变量对事故严重程度的影响程度。结果表明:地铁站可达性为“存在”是随机参数,车辆状态为“其他”会减小该随机参数的均值,降低交叉口行人事故严重程度;方差与“下午”显著相关,此变量会使随机参数的离散程度增加,分布变宽,随机性增加;不同用地类型与交叉口类型对行人事故严重程度的影响具有显著差异,用地类型为商业区、地铁站的可达性为“存在”时,交叉口行人发生交通事故的概率与伤害严重程度降低;行人有不当行为等因素显著增加了交叉口行人事故严重程度。研究结果为制定交叉口建成环境的优化改善措施提供参考和依据。

货车-两轮车前碰撞事故中骑行者运动学响应及损伤分析

为探究货车-两轮车前部碰撞事故中参与双方速度对骑行者运动学响应与损伤的影响,基于MADYMO软件开展事故重建并进行了分析。建立了货车和两轮车的多体碰撞模型,对一起货车前部碰撞两轮车事故进行了事故重建;使用验证后的模型进行了25组不同速度下的全因子仿真试验;分析了不同碰撞速度和骑行速度对骑行者运动学响应和损伤的影响。研究结果表明,骑行者身体旋转幅度会随着两轮车及货车车速的升高而增加;当货车速度超过20 km/h时,骑行者头部损伤指标(Head Injury Criterion,HIC)与胸部3 ms加速度将超过阈值;而当货车速度超过25 km/h时,骑行者下肢接触力也超过阈值;货车速度处于30~40 km/h时,相同货车速度下,骑行者头部HIC值出现随着两轮车速度的增加而升高的趋势,而胸部加速度出现相反的趋势。

基于交通事故深度调查数据的行人头部损伤特征研究

基于未来出行交通事故场景研究(Future Mobile Traffic Accident Scenario Study,FASS)数据库中135例人车碰撞事故深度调查数据,对造成行人头部损伤的来源及车速对头部损伤来源的影响进行了统计分析。采用Spearman相关系数检验法,建立了车辆速度区间与头部平均MAIS的回归模型。结果表明,行人头部致伤物主要来源于车辆,占比约58%,其次为地面,占比约40%。行人事故中,碰撞车速对行人头部损伤来源的分布情况有一定的影响,当车速低于30 km/h时,行人头部损伤主要来源为地面,当车速为[30,50]km/h时,车辆和地面对行人头部造成的损伤风险相近,当车速高于50 km/h时,行人头部损伤主要致伤物来源为车辆。因此,在进行交通损伤流行病学研究、交通损伤事故数据库构建时,特别是在中低速碰撞中,应重视地面对头部造成损伤的风险。

低等级公路货车路侧事故乘员伤害评估方法

为定量评估低等级公路货车路侧事故风险,降低路侧事故损失,使用PC-Crash软件进行仿真试验,研究在不同圆曲线半径、边坡坡度、驶出速度和路基高度的条件下轻型货车和重型货车驶入路侧的事故严重程度。以加速度损伤指标ASI作为乘员伤害评估指标,分别建立了低等级公路直线段和曲线段货车路侧事故乘员损伤程度计算模型。利用Fisher最优分割法,根据ASI有序数据样本,划分了低等级公路货车路侧事故严重度等级并计算了加速度损伤指标ASI阈值,提出了低等级公路货车路侧事故严重度评价标准。研究结果表明:加速度损伤指标ASI与车速和路基高度之间体现出类似于正线性变化趋势;加速度损伤指标ASI与边坡坡度之间体现出类似于指数函数变化趋势;加速度损伤指标ASI与圆曲线半径之间体现出类似于幂函数变化趋势;相比于车速和路基高度,边坡坡度的增加更容易导致车辆冲出路外发生路侧事故,增加路侧事故严重程度;圆曲线半径的增大虽然可以减少路侧事故的严重程度,但其影响相对较小。

常见道路交通事故损伤在交通行为方式司法鉴定中的辨识与运用

道路交通事故涉案者交通行为方式鉴定是道路交通事故痕迹物证综合鉴定的重要内容,其涉及多学科交叉知识。具有认定交通行为方式的典型特征损伤、痕迹物证和运动轨迹可作为交通行为方式判断的关键性依据,能够得出认定性的意见。在道路交通事故中,因车辆碰撞造成涉案者不同程度的损伤,通过损伤的形态及对损伤机制的分析,能够客观地判断涉案者的交通行为方式。其中,典型特征损伤更是起到了关键证据的作用。通过梳理、归纳十种常见典型特征损伤的形态、致伤方式及鉴定实践,探讨如何辨识和运用典型特征损伤的关键证据;结合符合性成立条件,综合判断涉案者交通行为方式,以期对司法鉴定实践提供参考。

快速反应院前急救对交通事故致严重多发伤患者的效果

目的 分析快速反应院前急救在交通事故致严重多发伤患者的应用效果。方法 选取2021年2月至2023年2月于泉州市急救指挥中心治疗的80例交通事故致严重多发伤患者,随机分为两组,试验组(40例)院前急救护理中采用快速反应模式,对照组(40例)急救护理中采用常规模式,对比两组意识障碍、日常生活活动能力、体征指标、急诊各环节时间及患者满意度。结果 试验组意识障碍、日常生活活动能力、体征指标水平改善情况明显优于对照组(P <0.05);试验组院前急救反应、接收、评估、转运、核血备血、预检分诊、到达手术室或重症监护室、医师到诊时间均短于对照组(P <0.05);试验组患者或其家属满意度高于对照组(P <0.05)。结论 对交通事故致严重多发伤患者实施快速反应院前急救处理具有良好的应用效果,能有利于缩短患者的院前急救反应时间等急诊各环节时间,改善患者的体征状况、生活能力,提升患者满意度。