Risk factors of mortality in road traffic injury patients with acute respiratory distress syndrome

Background Among the deaths due to trauma, about one half of the patients suffer from road traffic injury （RTI）. Most of RTI patients complicate acute respiratory distress syndrome （ARDS） and severe multiple injuries. ARDS is a major contributor to morbidity and mortality in trauma patients. Although many injuries and conditions are believed to be associated with ARDS independent risk factors in trauma patients, their relative importance in development of the syndrome are undefined. We hypothesize that not all of the traditional risk factors impacting mortality are independently associated with patients strictly identified by traffic injury. This study aimed to sieve distinctive risk factors in our RTI population, meanwhile, we also hypothesize that there may exist significantly different risk factors in these patients.Methods This was a retrospective cohort study regarding RTI as a single cause for emergency intensive care unit （EICU） admission. Patients identified as severe RTI with post-traumatic ARDS were enrolled in a prospectively maintained database between May 2002 and April 2007 and observed. Twenty-three items of potential risk impacting mortality were calculated by univariate and multivariate Logistic analyses in order to find distinctive items in these severe RTI patients. Results There were 247 RTI patients with post-traumatic ARDS admitted to EICU during the study period. The unadjusted odds ratio （OR） and 95% confidence intervals （CI） of mortality were associated with six risk factors out of 23： APACHE II score, duration of trauma factor, pulmonary contusion, aspiration of gastric contents, sepsis and duration of mechanical ventilation. The adjusted ORs with 95% Cl were denoted with respect to surviving beyond 96 hours EICU admission （APACHE II score, duration of trauma factor, aspiration of gastric contents）, APACHE II score beyond 20 EICU admission （duration of trauma factor, sepsis, duration of mechanical ventilation） and mechanical ventilation beyond 7 days EICU admission （duration of trauma factor and sepsis）. Conclusions We have retrospectively demonstrated an adverse effect of six different risk factors out of 23 items in mortality of post-traumatic ARDS within severe RTI patients and, moreover, gained distinct outcomes in stratified patients under real emergency trauma circumstance. An impact of APACHE II score and pulmonary contusion contributing to prediction of mortality may exist in prophase after traffic injury. Sepsis is still a vital risk factor referring to systemic inflammatory response syndrome, infection, and secondary multiple organs dysfunction. Eliminating trauma factors as early as possible becomes the critical therapeutic measure. Aspiration of gastric contents could lead to incremental mortality due to severe ventilation associated pneumonia. Long-standing mechanical ventilation should be constrained on account of severe refractory complications.

Road traffic injury mortality and morbidity by country development status, 2011- 2017

Purpose:This research examined road traffic injury mortality and morbidity disparities across of country development status,and discussed the possibility of reducing country disparities by various actions to accelerate the pace of achieving Sustainable Development Goals target 3.6 e to halve the number of global deaths and injuries from road traffic accidents by 2020.Methods:Data for road traffic mortality,morbidity,and socio-demographic index(SDI)were extracted by country from the estimates of the Global Burden of Disease study,and the implementation of the three types of national actions(legislation,prioritized vehicle safety standards,and trauma-related post-crash care service)were extracted from the Global Status Report on Road Safety byWorld Health Organization.We fitted joinpoint regression analysis to identify and quantify the significant rate changes from 2011 to 2017.Results:Age-adjusted road traffic mortality decreased substantially for all the five SDI categories from 2011 to 2017(by 7.52%e16.08%).Age-adjusted road traffic mortality decreased significantly as SDI increased in the study time period,while age-adjusted morbidity generally increased as SDI increased.Subgroup analysis by road user yielded similar results,but with two major differences during the study period of 2011 to 2017:(1)pedestrians in the high SDI countries experienced the lowest mortality(1.68e1.90 per 100,000 population)and morbidity(110.45e112.72 per 100,000 population for incidence and 487.48e491.24 per 100,000 population for prevalence),and(2)motor vehicle occupants in the high SDI countries had the lowest mortality(4.07e4.50 per 100,000 population)but the highest morbidity(428.74e467.78 per 100,000 population for incidence and 1025.70e1116.60 per 100,000 population for prevalence).Implementation of the three types of national actions remained nearly unchanged in all five SDI categories from 2011 to 2017 and was consistently stronger in the higher SDI countries than in the lower SDI countries.Lower income nations comprise the heaviest burden of global road traffic injuries and deaths.Conclusion:Global road traffic deaths would decrease substantially if the large mortality disparities across country development status were reduced through full implementation of proven national actions including legislation and law enforcement,prioritized vehicle safety standards and trauma-related postcrash care services.

Evaluating the short-term effect of ambient temperature on non-fatal outdoor falls and road traffic injuries among children and adolescents in China: a time-stratified case-crossover study

studies have suggested that non-optimal temperatures may increase the risk of injury,epidemiological studies focusing on the association between temperature and non-fatal injury among children and adolescents are limited.Therefore,we investigated the short-term effect of ambient temperature on non-fatal falls and road traffic injuries(RTIs)among students across Jiangsu Province,China.Meteorological data and records of non-fatal outdoor injuries due to falls and RTIs among students aged 6–17 were collected during 2018–2020.We performed a time-stratified case-crossover analysis with a distributed lag nonlinear model to examine the effect of ambient temperature on the risk of injury.Individual meteorological exposure was estimated based on the address of the selected school.We also performed stratified analyses by sex,age,and area.A total of 57322 and 5455 cases of falls and RTIs were collected,respectively.We observed inverted U-shaped curves for temperatureinjury associations,with maximum risk temperatures at 18℃(48th of daily mean temperature distribution)for falls and 22℃(67th of daily mean temperature distribution)for RTIs.The corresponding odds ratios(95%confidence intervals)were 2.193(2.011,2.391)and 3.038(1.988,4.644)for falls and RTIs,respectively.Notably,there was a significant age-dependent trend in which the temperature effect on falls was greater in older students(P-trend<0.05).This study suggests a ignificant association between ambient temperature and students’outdoor falls and RTIs.Our findings may help advance tailored strategies to reduce the incidence of outdoor falls and RTIs in children and adolescents.

Prehospital road traffic injuries among the elderly in Beijing, China： data from the Beijing Emergency Medical Center, 2004-2010

Background Road traffic injuries （RTIs） are a worldwide issue associated with increasing development and motorization. However, statistical studies do not include any analyses of Beijing＇s geriatric population. Using data from the Beijing Emergency Medical Center, we present the main characteristics of traffic injuries involving the elderly in Beijing. We also provide objective information for those concerned with the safety of traffic systems and the prevention of traffic injuries. Methods In a longitudinal, retrospective study, data were collected on 1706 victims aged 65 years and older who sustained traffic injuries in Beijing between 2004 and 2010. Personal information, time of injury event, emergency care response time, road user type, striking vehicle type, injury site, and severity of injury were analyzed using ;~2 tests and Logistic regression analysis. Results The annual rate of traffic injuries was 21.80 per 100 000 elderly people in Beijing, and the morbidity rate decreased from 2004 to 2010 （P 〈0.001）. The mean age was （72.92＋5.67） years, and 911 （53.40%） of the victims were male. The majority of victims sustained head and lower limb injuries and were classified as being of medium severity. Traffic collisions occurred most frequently in the daytime excluding rush hours; these collisions included being hit by a car （85.64%） and pedestrian victim injuries （79.19%）. Our statistical analysis found three factors for injury severity： abdominal injuries （P 〈0.001）, number of injury sites （P=0.027）, and head injuries （P=0.034）. The decline in traffic injuries is due to a decrease in victims aged 65-74 years and pedestrians; the sevedty of RTIs also decreased. Conclusions This study highlights the declining trend in traffic injuries among older adults in Beijing. However, traffic injuries remain a serious public health problem for the elderly and effective measures are required to reduce their incidence.

Are High School Students Ready to Stop the Bleed from Injuries? Needs Assessment in a Low Resource Country

Background: Life-threatening bleeding is a major cause of trauma-related deaths. Stop the Bleed—Active bleeding control (ABC) program in Hyderabad recently showed that lay first responders can be effectively trained. However, the willingness of high school students to train in bleeding control is unknown. We report Stop the Bleed training needs assessment from high schools in India and estimate the potential multiplier effect. Methods: A cross-sectional survey was conducted from 12 randomly selected schools in Hyderabad. The study was to understand current knowledge, skills and willingness to get trained and respond to life-threatening bleeding from injuries. 107 Participants (35 Teachers and 72 students) were purposively selected for telephonic interviews with a structured questionnaire. Results: Response rate was 93% overall. 80% of participants have never been trained in bleeding control. 84% reported willingness to be trained, train others and help bleeding victims. All the teachers reported that stop the bleed training would be useful in high schools. 70.6% of teachers recommended that training could start from middle school (10 to 15 years), 47% preferred the online training mode. Only 20% of participants had prior training in lifesaving first aid and 32% did not know the number of emergency medical services (EMS). Each trained participant has the potential to train 3 to 4 people at the household level and perhaps more at the community level. Conclusion: The surveyed schools in Hyderabad do not have the knowledge, skills, or training curriculum in Stop the Bleed. Students and teachers are willing to be trained and train others, with great potential for a “multiplier-effect” in the community.

Experts’ perspectives on the application of public-private partnership policy in prevention of road traffic injuries

Purpose: Successful application experiences on public-private partnership (PPP) in different countries, suggest that PPP could be an option in road traffic injury (RTI) prevention. The present study aims at investigating the applicability of PPP policy in RTI prevention in Iran based on the experts’ perspectives.Methods: This is a qualitative study with grounded theory approach which has been conducted in Tabriz University of Medical Sciences, Iran in 2018. The participants were 22 experts in the field of RTIs selected using purposive sampling method. Data were collected by semi-structured interviews and analyzed with content-analysis method.Results: The results were classified under 5 main themes (applicability, scopes and services, challenges, advantages, and strategies) for applying PPP policy and 37 sub-themes. Due to the prevalence of RTIs, the present challenges in public sector, existence of qualified private sector, and successful experiences in other areas, there are opportunities for private sector partnership in prevention of RTIs. Private sector could participate in different scopes and services regarding RTI prevention, including road construction and maintenance, maintenance and provision of vehicles safety and public education. The main challenges including legislation issues, ambiguities in collaboration, political and organizational unsustain-ability, government’s financial hardship and lack of experienced experts in the field of RTI. However, there are significant advantages including high efficiency in program implementation, covering the weaknesses of public sector, effective and efficient management on application of PPP in RTI prevention. The strategies include identifying and prioritizing the assignable activities, identifying the qualified private sector, developing PPP policies and legal frameworks, creating a common language between public and private parties, trying to meet the expectations of the private sector by public sector, developing a comprehensive and sound contract, and cultivating public culture to accept private sector in the field of RTI prevention.Conclusion: This study sought to determine whether PPP could be used as strategy to reduce the burden of RTIs in Iran. But it requires a lot of preliminary studies to provide the context and conditions for applying this policy.

Lumbar and neck injuries of occupants in different reclining postures

Purpose:With the increasing level of automation in automobiles,the advent of autonomous vehicles hasreduced the tendency of drivers and passengers to focus on the task of driving.The increasing automation in automobiles reduced the drivers'and passengers'focus on driving,which allowed occupants tochoose a more relaxed and comfortable sitting position.Meanwhile,the occupant's sitting position wentfrom a frontal,upright position to a more relaxed and reclined one,which resulted in the existing restraint systems cannot to keep occupants safe and secure.This study aimed to determine the effects ofdifferent reclining states on occupants'lumbar and neck injuries.Methods:This is an original research on the field of automotive safety engineering.Occupants indifferent initial sitting positions(25°,35°,45°,and 55°)were adapted to changes in seat back angle andrestraint systems and placed in the same frontal impact environment.Neck injury indexes,lumbar axialcompression force and acceleration,as well as occupant dynamic response during the impact,werecompared in different sitting positions.The injury response and kinematic characteristics of occupants indifferent reclining positions were analyzed by the control variable method.Results:As the sitting angle increased,the occupant's head acceleration decreased,and the forward-leanangle decreased.Occupants in the standard sitting position had the greatest neck injury,with an Nij of0.95,and were susceptible to abbreviated injury scale 2+cervical medullary injuries.As the seatbackangle increased,the geometric position of the lumbar spine tended to be horizontal,and the impact loadtransmitted greater forces to the lumbar spine.The occupant's lumbar injury was greatest in the lyingposition,with a peak axial compression force on the lumbar region of 5.5 KN,which was 2.3 KN greaterthan in the standard sitting position.Conclusion:The study of occupant lumbar and neck injuries based on different recline states can providea theoretical basis for optimizing lumbar evaluation indexes,which is conducive to the understanding ofthe lumbar injury mechanism and the comprehensive consideration of occupant safety protection.

The common road safety approaches:A scoping review and thematic analysis

Purpose:Comparison of effective road safety approaches with those of relatively similar countries can be used to identify possibilities for safety improvement.Since there is no clear and comprehensive study of countries'current and successful approaches to road safety in the world,the aim of this study was to identifying common road safety approaches in the world.Methods:This study was performed using scoping review and thematic analysis.The study followed the approach proposed by Arksey and O'Malley.In this study all articles were selected without time limit by searching in the following databases:Web of Science,PubMed,Scopus,ProQuest,and Embase.An initial search of 5612 papers was found and finally,20 papers met the inclusion criteria and were analyzed.Results:There were different road safety approaches in different countries around the world,which were classified in three themes:traditional approach,systemic approach,and vision zero.The traditional approach includes the sub-theme of the road-user approach,and the causal approach.The systemic approach also includes sub-themes of sustainable safety,safety system,and the United Nations plan for decade of action,Conclusion:A systemic approach to road safety seems to be welcomed by most developed and developing countries,and a paradigm shift towards a safe system has taken place.Also,given the successful results of implementing vision zero in leading countries,most countries are trying to design and implement this approach.Finally,the choice and implementation of road safety approaches varies according to the principles,priorities and infrastructure of each country.

Epidemiologic study of traffic crash mortality among motorcycle users in Iran(2011-2017)

Purpose:Motorcycle accident is a major cause of road traffic injuries and the motorcyclists are consid ered as vulnerable road users.The present study aimed to determine the epidemiological characteristics of fatal motorcycle crashes in Iran.Methods:In this cross-sectional study,a total of 28,356 motorcycle traffic fatalities registered in the Legal Medicine Organization of Iran were analyzed during the period between March 2011 and March 2017.The examined variables included demographic characteristics,helmet use,crash mechanisms,crash location,position state,type of counterpart vehicle,cause of death and place of death.In the study,road traffic mortalities involving drivers and/or passenger of motorcycles were included.Cases or events registered without these conditions were excluded from the study.To analyse the data,SPSS statistics 25 and GraphPad Prism 8 softwares were used.Results:Of the 122,682 fatal traffic injury cases,28,356(23.1%)were motorcycle users,of whom 95.3%were male and 4.7%were female.Most of the motorcycle fatalities belonged to the age group of 18-24 years(29.1%).Head trauma was the major cause of death(59.0%).Also,the overall proportion of safety helmet use among motorcycle crash victims was estimated at 37.4%.Most of the road traffic crash cases(46.8%)happened out of city and half of people(49.9%)died in hospital.About 77.4%of the victims were motorcycle riders and 21.1%were pillion passengers.The highest rate of mortality belonged to the selfemployed(38.4g)and then workers(21.8%)and students(10.2%).In addition,most fatalities occurred in people with low education(77.5%)and the least occurred in university graduates(5.5%).Among 31 provinces of Iran,Fars had the highest(9.3%)occurrence rate and Kohgiluyeh and Buyer-Ahmad had the lowest(0.5%).Most of the crash mechanisms were due to motorcycle-vehicle crashes(80.2%),followed by rollover(9.8%).Conclusion:Comprehensive public education and special rules are needed to reduce the rate of deaths in motorcycle crashes.

Driver sleepiness,fatigue,careless behavior and risk of motor vehicle crash and injury:Population based case and control study

Background： A few studies have been conducted to determine the relationship between road motor vehicle crashes （MVC） and serious injuries related to tiredness, fatigues and sleeping. Aim： To determine the effects of aggressive behaviour, driver sleepiness and fatigue on MVC and related injuries among Turkish population. Design and setting： Population-based case and control study conducted at the accident emergency departments of hospitals and roads. Subjects： 515 car drivers involved in crashes with injury were admitted to hospital and 1030 car drivers involved while driving on public roads as control group during the study period. Methods： The Manchester driver behaviour questionnaire （DBQ） measured the aberrant driving behaviours leading to accidents. Participants completed a fatigue severity scale （FSS） and Stanford Sleeping questionnaire an epworth scale with items related to socio-demographic information, driving experiences, adherence to traffic laws （such as speed limits and seat belt）, and drivers＇ driving records. Results： In a representative sampling, participant＇s age ranged from 25 to 65 and the mean and standard deviation were 36.5 _＋ 7.8 for cases and 37.0 4- 8.0 for controls. There was a significant difference in both group of drivers regarding BMI, level of education, marital status, driving experience, seat belt use, excessive speed limits, physical activity number of sleeping hours, mobile phone use, and cigarette smoking habit （p = 0.017）. Also, there was a significant higher mean score on all the DBQ violation questions among case group in comparison with the control group （p 〈 0.001）. Further, cases had higher prevalence of Epworth sleeping disorders （p 〈 0.001） and fatigue severity （p - 0.003） compared to control drivers. Multivariate logistic regression revealed that excessive speed, fatigue, lapses, errors, Stanford sleepiness score, violations, mobile phone use and Epworth sleepiness scale were significantly associated with injury involvement in vehicle crash, after adjusting for driving experience and annual mileage. Conclusion： The current study confirmed that drivers with chronic fatigue, acute sleepiness, and careless driver behavior may significantly increases the risk of road crash which can be lead to serious injury.