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Motor Vehicle Crash (motor + vehicle_crash)
Selected AbstractsFatal Injuries of US Citizens AbroadJOURNAL OF TRAVEL MEDICINE, Issue 5 2007Clare E. Guse MS Background US citizens are increasingly traveling, working, and studying abroad as well as retiring abroad. The objective of this study was to describe the type and scope of injury deaths among US citizens abroad and to compare injury death proportions by region to those in the United States. Methods A cross-sectional design using reports of US citizen deaths abroad for 1998, 2000, and 2002 on file at the US State Department was employed. The main outcome measures were the frequencies of injury deaths and proportional mortality ratios (PMRs) comparing deaths abroad to deaths in the United States. Results Two thousand eleven injury deaths were reported in the 3 years, comprising 13% of all deaths. The overall age-adjusted PMR for injury fatalities abroad compared to the United States was 1.6 (95% confidence interval 1.6,1.7). The highest age-adjusted PMRs for motor vehicle crashes were found in Africa (2.7) and Southeast Asia (1.6). The proportion of drowning deaths was elevated in all regions abroad. Conclusions Injuries occur at a higher proportion abroad than in the United States. Motor vehicle crash and drowning fatalities are of particular concern. Improved data quality and surveillance of deaths would help government agencies create more evidence-based country advisories. [source] Clinical and Economic Factors Associated with Ambulance Use to the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 8 2006Jennifer Prah Ruger PhD Background: Concern about ambulance diversion and emergency department (ED) overcrowding has increased scrutiny of ambulance use. Knowledge is limited, however, about clinical and economic factors associated with ambulance use compared to other arrival methods. Objectives: To compare clinical and economic factors associated with different arrival methods at a large, urban, academic hospital ED. Methods: This was a retrospective, cross-sectional study of all patients seen during 2001 (N= 80,209) at an urban academic hospital ED. Data were obtained from hospital clinical and financial records. Outcomes included acuity and severity level, primary complaint, medical diagnosis, disposition, payment, length of stay, costs, and mode of arrival (bus, car, air-medical transport, walk-in, or ambulance). Multivariate logistic regression identified independent factors associated with ambulance use. Results: In multivariate analysis, factors associated with ambulance use included: triage acuity A (resuscitation) (adjusted odds ratio [OR], 51.3; 95% confidence interval [CI] = 33.1 to 79.6) or B (emergent) (OR, 9.2; 95% CI = 6.1 to 13.7), Diagnosis Related Group severity level 4 (most severe) (OR, 1.4; 95% CI = 1.2 to 1.8), died (OR, 3.8; 95% CI = 1.5 to 9.0), hospital intensive care unit/operating room admission (OR, 1.9; 95% CI = 1.6 to 2.1), motor vehicle crash (OR, 7.1; 95% CI = 6.4 to 7.9), gunshot/stab wound (OR, 2.1; 95% CI = 1.5 to 2.8), fell 0,10 ft (OR, 2.0; 95% CI = 1.8 to 2.3). Medicaid Traditional (OR, 2.0; 95% CI = 1.4 to 2.4), Medicare Traditional (OR, 1.8; 95% CI = 1.7 to 2.1), arrived weekday midnight,8 AM (OR, 2.0; 95% CI = 1.8 to 2.1), and age ,65 years (OR, 1.3; 95% CI = 1.2 to 1.5). Conclusions: Ambulance use was related to severity of injury or illness, age, arrival time, and payer status. Patients arriving by ambulance were more likely to be acutely sick and severely injured and had longer ED length of stay and higher average costs, but they were less likely to have private managed care or to leave the ED against medical advice, compared to patients arriving by independent means. [source] Paediatric lap-belt injury: A 7 year experienceEMERGENCY MEDICINE AUSTRALASIA, Issue 1 2006Michael Shepherd Abstract Objective:, To highlight the injuries that result from lap-belt use and make recommendations for prevention, the recent experience of a regional paediatric trauma centre was reviewed. Methods:, Retrospective review of admissions to Starship Children's Hospital from 1996 to 2003, with significant injury following involvement in a motor vehicle crash, while wearing a lap-belt. Patients were identified from two prospectively collected databases and discharge coding data. Results:, In total, 19 patients were identified over the 7 year period. The morbidity sustained includes 15 patients with hollow viscus injury, 13 laparotomies, 7 spinal fractures, 2 paraplegia and 1 fatality. A total of 11 patients required laparotomy with a median delay of 24 h. Of patients in the present series, 58% were aged less than 8 years and thus were inappropriately restrained. Conclusions:, Lap-belt use can result in a range of life-threatening injuries or permanent disability in the paediatric population. The incidence of serious lap-belt injury does not appear to be decreasing. Morbidity and mortality could be reduced by the use of three-point restraints, age appropriate restraints and booster seats. [source] The Effect of Seatbelt Use on Injury Patterns, Disposition, and Hospital Charges for EldersACADEMIC EMERGENCY MEDICINE, Issue 12 2002Andrew Coley MD Objective: To study the relationships between seatbelt use and injury patterns, hospital charges, morbidity, and mortality in elder motor vehicle crash victims. Methods: A retrospective review of individuals at least 65 years old presenting to an urban emergency department (ED) after a motor vehicle crash. Results: Over a two-year period, 339 patients had documentation of seatbelt use or non-use at the time of the crash. Of these, 241 (71%) patients had been wearing a seatbelt and 98 (29%) had not. Elders not using seatbelts were more likely to require hospitalization (29% unbelted vs. 17% belted) and had a higher mortality rate. Injury patterns were different in the two groups. Emergency department charges were significantly different between belted and unbelted elders ($351 vs. $451, p = 0.01) and head computed tomography (CT) utilization was higher in the unbelted group (25.6% vs 12.7%, p = 0.005). Conclusions: Improved seatbelt compliance in elders can reduce injuries, hospitalization rates, ED charges, and mortality resulting from motor vehicle crashes. [source] A Comparison of Data Sources for Motor Vehicle Crash Characteristic AccuracyACADEMIC EMERGENCY MEDICINE, Issue 8 2000Robert J. Grant MD Abstract. Objective: To determine the accuracy of police reports (PRs), ambulance reports (ARs), and emergency department records (EDRs) in describing motor vehicle crash (MVC) characteristics when compared with an investigation performed by an experienced crash investigator trained in impact biomechanics. Methods: This was a cross-sectional, observational study. Ninety-one patients transported by ambulance to a university emergency department (ED) directly from the scene of an MVC from August 1997 to April 1998 were enrolled. Potential patients were identified from the ED log and consent was obtained to investigate the crash vehicle. Data describing MVC characteristics were abstracted from the PR, AR, and medical record. Variables of interest included restraint use (RU), air bag deployment (AD), and type of impact (TI). Agreements between the variables and the independent crash investigation were compared using kappa. Interrater reliability was determined using kappa by comparing a random sample of 20 abstracted reports for each data source with the originally abstracted data. Results: Agreement using kappa between the crash investigation and each data source was 0.588 (95% CI = 0.508 to 0.667) for the PR, 0.330 (95% CI = 0.252 to 0.407) for the AR, and 0.492 (95% CI = 0.413 to 0.572) for the EDR. Variable agreement was 0.239 (95% CI = 0.164 to 0.314) for RU, 0.350 (95% CI = 0.268 to 0.432) for AD, and 0.631 (95%= 0.563 to 0.698) for TI. Interrater reliability was excellent (kappa > 0.8) for all data sources. Conclusions: The strength of the agreement between the independent crash investigation and the data sources that were measured by kappa was fair to moderate, indicating inaccuracies. This presents ramifications for researchers and necessitates consideration of the validity and accuracy of crash characteristics contained in these data sources. [source] Age of Drinking Onset and Injuries, Motor Vehicle Crashes, and Physical Fights After Drinking and When Not DrinkingALCOHOLISM, Issue 5 2009Ralph W. Hingson Background:, Earlier age of drinking onset has been associated with greater odds of involvement in motor vehicle crashes, unintentional injuries, and physical fights after drinking. This study explores whether early drinkers take more risks even when sober by comparing potential associations between age of drinking onset and these outcomes after drinking relative to when respondents have not been drinking. Method:, From a national sample, 4,021 ever-drinkers ages 18 to 39 were asked age of drinking onset, not counting tastes or sips. They were also asked if they were ever in motor vehicle crashes, unintentionally injured, or in physical fights after drinking and when not drinking. GEE logistic regression models for repeated measures dichotomous outcomes compared whether odds ratios between age of onset and these adverse outcomes significantly differed when they occurred after drinking versus when not drinking, controlling for respondents' demographic characteristics, cigarette and marijuana use, family history of alcoholism, ever experiencing alcohol dependence, and frequency of binge drinking. Results:, Compared with persons who started drinking at age 21+, those who started at ages <14, 14 to 15, 16 to 17, and 18 to 20 had, after drinking, respectively greater odds: 6.3 (2.6, 15.3), 5.2 (2.2, 12.3), 3.3 (1.5, 7.3), and 2.2 (0.9, 5.1) of having been in a motor vehicle crash; 6.0 (3.4, 10.5), 4.9 (3.0, 8.6), 3.7 (2.4, 5.6), and 1.9 (1.2, 2.9) of ever being in a fight; and 4.6 (2.4, 8.7), 4.7 (2.6, 8.6), 3.2 (1.9, 5.6), and 2.3 (1.3, 4.0) of ever being accidentally injured. The odds of experiencing motor vehicle accidents or injuries when not drinking were not significantly elevated among early onset drinkers. The odds of earlier onset drinkers being in fights were also significantly greater when respondents had been drinking than not drinking. Conclusion:, Starting to drink at an earlier age is associated with greater odds of experiencing motor vehicle crash involvement, unintentional injuries, and physical fights when respondents were drinking, but less so when respondents had not been drinking. These findings reinforce the need for programs and policies to delay drinking onset. [source] Case Report: Fatal Apophysomyces elegans Infection Transmitted by Deceased Donor Renal AllograftsAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2010B. D. Alexander Two patients developed renal mucormycosis following transplantation of kidneys from the same donor, a near-drowning victim in a motor vehicle crash. Genotypically, indistinguishable strains of Apophysomyces elegans were recovered from both recipients. We investigated the source of the infection including review of medical records, environmental sampling at possible locations of contamination and query for additional cases at other centers. Histopathology of the explanted kidneys revealed extensive vascular invasion by aseptate, fungal hyphae with relative sparing of the renal capsules suggesting a vascular route of contamination. Disseminated infection in the donor could not be definitively established. A. elegans was not recovered from the same lots of reagents used for organ recovery or environmental samples and no other organ transplant-related cases were identified. This investigation suggests either isolated contamination of the organs during recovery or undiagnosed disseminated donor infection following a near-drowning event. Although no changes to current organ recovery or transplant procedures are recommended, public health officials and transplant physicians should consider the possibility of mucormycosis transmitted via organs in the future, particularly for near-drowning events. Attention to aseptic technique during organ recovery and processing is re-emphasized. [source] 3 Taking a History from the Challenging Patient in the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 2008Bruce Becker This exhibit will use DVD footage, written material, and live real-time interaction to demonstrate an innovative methodology to teaching residents and medical students to gain comfort and expertise in communicating with and taking a history from challenging patients in the ED. I teach this course at our institution every year. Professional actors with improvisational experience play out unscripted interactions with students based on a character or characters, a set scene, and predefined goals and endpoints. Their dialogue and choices evolve from the student's response and the tone, direction, and approach that the student takes. These scenarios are much more realistic and educational than OSCEs which are often described as artificial and flat. Some of the scenarios that I will present include: Daughter trying to make End-of-life choices for her mother, type A man with chest pain trying to sign out, a woman with "dental pain" who is seductive and drug-seeking, an intoxicated attending MD brought in from a motor vehicle crash (MVC) who uses power in a manipulative way. Many of the scenarios contain potential ethical, sexual, gender, racial issues that the student must address along with the medical problems. [source] Post-Traumatic Stress Disorder in Children and Adolescents With Motor Vehicle,Related InjuriesJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 3 2003Kathleen A. Zink MSN ISSUES AND PURPOSE Motor vehicle crashes account for the greatest number of childhood injuries, but there has been little study of the psychological responses. DESIGN AND METHODS This longitudinal, descriptive study included 143 children 7 to 15 years of age who experienced a motor vehicle,related injury. Parents/guardians completed the Child Behavior Checklist Behavioral Problem Scale. Each child and parent completed the post-traumatic stress disorder (PTSD) section of the Diagnostic Interview for Children and Adolescents at 2 and 6 months postinjury. RESULTS Twenty-two percent of the children met criteria for PTSD. There were no associations for presence or absence of PTSD with age, gender, race, injury, or cause of injury. PRACTICE IMPLICATIONS Children who are injured in motor vehicle crashes are at risk for PTSD. Anticipatory guidance about behavioral distress symptoms should be provided to parents of children who experience motor vehicle related injuries. [source] Fatal Injuries of US Citizens AbroadJOURNAL OF TRAVEL MEDICINE, Issue 5 2007Clare E. Guse MS Background US citizens are increasingly traveling, working, and studying abroad as well as retiring abroad. The objective of this study was to describe the type and scope of injury deaths among US citizens abroad and to compare injury death proportions by region to those in the United States. Methods A cross-sectional design using reports of US citizen deaths abroad for 1998, 2000, and 2002 on file at the US State Department was employed. The main outcome measures were the frequencies of injury deaths and proportional mortality ratios (PMRs) comparing deaths abroad to deaths in the United States. Results Two thousand eleven injury deaths were reported in the 3 years, comprising 13% of all deaths. The overall age-adjusted PMR for injury fatalities abroad compared to the United States was 1.6 (95% confidence interval 1.6,1.7). The highest age-adjusted PMRs for motor vehicle crashes were found in Africa (2.7) and Southeast Asia (1.6). The proportion of drowning deaths was elevated in all regions abroad. Conclusions Injuries occur at a higher proportion abroad than in the United States. Motor vehicle crash and drowning fatalities are of particular concern. Improved data quality and surveillance of deaths would help government agencies create more evidence-based country advisories. [source] The Effect of State Regulations on Motor Vehicle Fatalities for Younger and Older Drivers: A Review and AnalysisTHE MILBANK QUARTERLY, Issue 4 2001David C. Grabowski Policymakers have had a long-standing interest in improving the motor vehicle safety of both younger and older drivers. Although younger and older drivers share the distinction of having more crashes and fatalities per mile driven than other age groups, the problems posed by these two groups stem from different origins and manifest in different ways. A number of state-level policies and regulations may affect the number of motor vehicle crashes and fatalities in these two high-risk groups. A critical review of the existing literature in regard to the risk factors and the effects of various policy measures on motor vehicle crashes in these two high-risk populations provides direction for policymakers and high-priority areas of interest for the research community. [source] | ||||||||||