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March 9, 2001

• The domestic iron: A danger to young children. Gaffney P. J Accid Emerg Med, 200005; 17(3):199-200.
  
  OBJECTIVES: To study the epidemiology of thermal injury caused by the domestic iron in children 5 years old or less. METHODS: Retrospective review of case notes held in the accident and emergency (A & E) department of a large teaching hospital over a 36 month period. Data regarding demographics, site and extent of injury, mechanism of injury and outcome were retrieved. RESULTS: 62 thermal injuries were identified in 59 patients. Of these, 60 were contact burns and two were scalds. The male to female ratio was 2:1. The mean age was 24 months. Fifty five per cent were aged between 1 and 2 years old. The hand was the commonest site of injury (63%) and, of these, two thirds were on the palm. Interestingly 10% occurred on the face. Iron contact burns accounted for 23.5% of all contact burns in this age group over this period. The majority of contact burns were partial thickness and most were less than 1% body surface area. Inadequate supervision is a recurring theme in many of these cases. A suspicion of non-accidental injury was raised in 10 cases and confirmed in nine of these. CONCLUSIONs: Iron burns are common in young children, particularly boys aged between 1 and 2 years old. Most can be treated in the A & E clinic. The potential for serious injury does exist. Non-accidental injury always needs to be considered. Efforts at prevention and increasing public awareness are needed.

• Paralysis from sport and diving accidents. Schmitt H,Gerner HJ. Clin J Sport Med. 2001; 11(1):17-22.
  
  OBJECTIVE: To examine the causes of sport-related spinal cord injuries that developed into paraplegia or tetraplegia, and to compare data from different sports with previous studies in the same geographical region. DESIGN: A retrospective epidemiological study and comparison with previous studies. SETTING: The Orthopedic Department, specializing in the treatment and rehabilitation of paralyzed patients, at the University of Heidelberg, Germany. PARTICIPANTS: Between 1985 and 1997, 1,016 cases of traumatic spinal cord injury presented at the Orthopedic Department at the University of Heidelberg: 6.8% were caused by sport and 7.7% by diving accidents. MAIN OUTCOME MEASURES: Sport-related spinal cord injuries with paralysis. RESULTS: A total of 1.016 cases of traumatic spinal cord injury were reviewed. Of these, 14.5% were caused by sport accidents (n = 69) or diving accidents (n = 78). Age of patients ranged from 9 to 52 years. 83% were male. 77% of the patients developed tetraplegia, and 23%, paraplegia. 16 of the sport accidents resulted from downhill skiing, 9 resulted from horseback riding, 7 from modern air sports, 6 from gymnastics, 5 from trampolining, and 26 from other sports. Previous analyses had revealed that paraplegia had mainly occurred from gymnastics, trampolining, or high diving accidents. More recently, however, the number of serious spinal injuries caused by risk-filled sports such as hang gliding and paragliding has significantly increased (p = 0.095), as it has for horseback riding and skiing. Examinations have shown that all patients who were involved in diving accidents developed tetraplegia. An analysis of injury from specific sports is still under way. CONCLUSIONS: Analysis of accidents resulting in damage to the spinal cord in respect to different sports shows that sports that have become popular during the last 10 years show an increasing risk of injury. Modern air sports hold the most injuries. Injury-preventing strategies also are presented.

• Prevention effectiveness of rollover protective structures--Part I: Strategy evolution. Myers ML, Pana-Cryan R. J Agric Saf Health, 2000; 6(1):29-40.
  
  This is the first of three articles that evaluate the health and economic consequences of the use of rollover protective structures (ROPS) on agricultural tractors. The effectiveness of ROPS delivered through alternative intervention strategies is the subject of the three-part study. This part of the study reviews and assesses the evolution of interventions that are known to prevent injuries incurred as a result of tractor overturns. The method used is historical analysis framed against a prevention effectiveness model used by the U.S. Centers for Disease Control and Prevention. Two intervention strategies were found to be potentially effective in preventing injuries from tractor overturns. These strategies are either to install a ROPS on tractors that lack a ROPS or to replace the tractor with one that has a ROPS already mounted. Other prevention factors include the effectiveness and use of seat belts and the integrity of the ROPS system during an overturn.



• Prevention effectiveness of rollover protective structures--Part II: Decision analysis. Myers ML, Pana-Cryan R. J Agric Saf Health, 2000; 6(1):41-55.
  
  This is the second of three articles that evaluate the consequences of using rollover protective structures (ROPS) on agricultural tractors. It presents the results of a decision analysis that compares three strategies for preventing injuries when agricultural tractors without ROPS overturn. The three strategies examined are "do nothing", "install ROPS", and "replace tractor". The strategies are implemented over a five-year period and health outcomes expressed as fatal and nonfatal injuries are calculated over a 23-year period. The "do nothing" strategy would result in 1,450 fatalities and 1,806 nonfatal injuries, while the "install ROPS" strategy would prevent 1,176 fatalities and 957 nonfatal injuries, and the "replace tractor" strategy would prevent 1,188 fatalities and 967 nonfatal injuries. The latter two strategies reflect more than an 80% reduction in fatalities and about 53% reduction in nonfatal injuries. The study does not consider overturn injuries that result from tractors lacking ROPS and for which ROPS are unavailable.



• Prevention effectiveness of rollover protective structures--Part III: Economic analysis. Pana-Cryan R, Myers ML. J Agric Saf Health, 2000; 6(1):57-70.
  
  The purpose of this part of the study is to assess the costs and benefits of either installing rollover protective structures (ROPS) on tractors lacking ROPS and for which ROPS are available or replacing the tractors with newer ROPS-equipped ones, relative to doing nothing. The methods used are cost-effectiveness and cost-benefit analyses. The cost-effectiveness analysis shows that compared to the "do nothing" strategy, the "install ROPS" strategy would cost $489,373 per injury averted and the "replace tractor" strategy would cost $14.3 million per injury averted over a 23-year period. The cost-benefit analysis shows that compared to the "do nothing" strategy, the "install ROPS" strategy would save society $1.5 billion while the "replace tractor" strategy would cost society $18.7 billion. While both the "install ROPS" and the "replace tractor" strategies are effective at saving lives and preventing injuries, this study has concluded that the preferred strategy in terms of cost-effectiveness is to "install ROPS" on tractors lacking them and for which ROPS are available.



• Initial rollover effectiveness evaluation of an alternative seat belt design for agricultural tractors. Rains GC. J Agric Saf Health, 2000; 6(1):13-27.
  
  A test program was conducted to determine the effectiveness of a seat belt restraint in preventing occupant movement in a rollover accident. A baseline type-2 seat belt (pelvic and torso restraint), and an improved type-2 seat belt restraint, both designed to restrict occupant motion in a rollover accident, were tested in a rollover restraints tester (RRT). Each seat belt was placed on a H-III 50th percentile male dummy and testing conducted at a single roll rate and two D-ring adjustment positions. Each test simulated what was approximately a 260 degrees per second rollover parallel to the longitudinal axis of the tractor with the top of the ROPS impacting the ground after 180 degrees of roll. Forces on the dummy's head and neck were measured, and video was taken to measure the head motion in the x-, y-, and z-axis of the dummy. The average vertical, forward, and lateral head movement in the baseline seat belt was 144, 222, and 184 mm, respectively, when the adjustable D-ring anchorage supporting the shoulder belt was in its lowest position. At the lowest D-ring height, the shoulder belt became ineffective and the seat belt performance became similar to a type-1 restraint (required for tractors with ROPS) resulting in increased vertical, forward, and lateral movement. The improved restraint reduced vertical head movement by as much as 75% without increasing head and neck loads above established injury criteria. Testing seat belts for rollover effectiveness will become increasingly important as seat belt usage on tractors with ROPS increases.

• Relationship between impact velocity and injuries in fatal pedestrian-car collisions. Karger B, Teige K, Buhren W, DuChesne A. Int J Legal Med 2000; 113(2):84-8.
  
  The most common type of fatal pedestrian-car collision, i.e. a passenger car with a wedge or pontoon shaped front striking an erect adult with this front, was investigated. A reliable calculation of the impact velocity range by a technical expert and a comprehensive autopsy suitable for traffic accidents were performed in every case. A total of 47 fatalities form the material of this study and the impact velocities varied between 18 and 142 km/h. Primary and secondary injuries did not show a relationship to impact velocity. The occurrence of four types of indirect injuries revealed a clear relationship to impact velocity, i.e. spinal fractures, ruptures of the thoracic aorta, inguinal skin ruptures and dismemberment of the body. Important parameters such as the type of car, impact velocity range and indirect injuries are listed for each individual case. Because of the limited number of cases, the impact velocity ranges (3-30 km/h) instead of mean values were considered. A cautious interpretation of the data can be summarized in the following conclusions: If there is no spinal fracture, the velocity was below 70 km/h and probably below 50 km/h. Aortic and inguinal skin ruptures are always present if the velocity was above 100 km/h but never occurred below 50-60 km/h. If dismemberment occurs, the velocity was above 90 km/h. Consequently, an estimation of the impact velocity from the presence or absence of indirect injuries is possible in pedestrian-car collisions of the type examined. However, the selection criteria applied in this study and additional parameters influencing the collision dynamics have to be considered carefully.



• The motor vehicle collision injury syndrome. Mamelak M. Neuropsychiatry Neuropsychol Behav Neurol, 2000; 13(2):125-35.
  
  OBJECTIVE: The objective of this study was to examine the central nervous system changes that may occur after acceleration/deceleration injuries in motor vehicle accidents. BACKGROUND: Occupants of motor vehicles involved in a collision often develop a disabling syndrome consisting of head, neck, and back pain; impaired short-term memory and concentration; fatigue and a loss of stamina; poor balance; and a change in personality. Injury victims experience a loss of motivation, emotional lability, and a decrease in libido. The major features of this injury syndrome are subjective, and there usually are few objective findings on physical examination. The pathogenesis of this syndrome is poorly understood, but it is hypothesized that the collision impact produces an inertial strain injury to the anterior regions of the brain which depresses the functions of the frontotemporal lobes, at the same time, sensitizing somatosensory neural afferent systems. Damage to the orbital surfaces of the frontotemporal lobes, in particular, impairs the gating mechanisms that normally limit sensory input to the brain and further promotes central sensitization. The psychiatric disorders that emerge in the wake of these injuries are likely grounded in these pathologic events. METHOD: The current literature on the biomechanics of head injury and the associated brain imaging findings in minor head injury are reviewed. A summary of some of the biochemical sequelae of strain injury to the brain is also provided, with an emphasis on the changes in energy metabolism and excitatory amino acid release. CONCLUSIONS: Early intervention to arrest the injury-induced metabolic cascade, and treatment with agents that activate cerebral metabolism may mitigate the symptoms of this injury syndrome.



• Alcohol consumption and mortality rates from traffic accidents, accidental falls, and other accidents in 14 European countries. Skog OJ. Addiction. 2001; 96 Suppl 1:S49-58.
  
  AIMS: To evaluate the effects of changes in aggregate alcohol consumption on fatal motor vehicle traffic accidents, accidental falls, and other accidents in 14 western European countries after 1950, and to compare traditional beer, wine and spirits countries. DESIGN, SETTING AND PARTICIPANTS: The countries were sorted into three groups. Gender-specific, age-adjusted annual mortality rates (15-69 years) were analyzed in relation to per capita alcohol consumption, utilizing the Box-Jenkins technique for time series analysis. All series were different to remove long-term trends. The results of the analyses of individual countries were pooled within each group of countries to increase the statistical power. MEASUREMENTS: Overall accident mortality data for 5-year age groups were converted to age-adjusted mortality rates for the age group 15-69 years, using a European standard population. Data on per capita alcohol consumption were converted to consumption per inhabitant 15 years and older. FINDINGS: For male accidental falls, the analyses uncovered a statistically significant association with alcohol consumption in northern and central Europe, but not in southern Europe. Among females the association was insignificant in all regions. For male traffic accidents, significant relationships were uncovered in central and southern Europe, but not in northern Europe. Among females the effect was significant only in central Europe. For the remaining fatal accidents a significant relationship was found for north European males only. CONCLUSION: The association between aggregate alcohol consumption and rates of fatal accidents is mainly due to traffic accidents in central and southern Europe, and to falls and other accidents in northern Europe.



• Accident prototypical scenarios, a tool for road safety research and diagnostic studies. Fleury D, Brenac T. Accid Anal Prev. 2001; 33(2):267-76.
  
  The concept of prototypical accident scenario has been used since the late 1980s in French road safety research. A prototypical scenario can be defined as a prototype of the accident process corresponding to a series of accidents which are similar in terms of the chain of facts and causal relationships found throughout the various accident stages. This concept provides a means of combining and generalizing the knowledge obtained from accident case studies, based on in-depth investigation methods or on detailed analyses of police reports. Applications of this concept are developed in both the field of traffic accident research and safety studies (diagnoses) in preparation for engineering measures or local safety policies. This paper presents the prototypical scenario concept, its theoretical background, and the way it is used for safety research and studies.



• Fatal traffic accidents among trailer truck drivers and accident causes as viewed by other truck drivers. Hakkanen H, Summala H. Accid Anal Prev. 2001; 33(2):187-96.
  
  Causality factors, the responsibility of the driver and driver fatigue-related factors were studied in fatal two-vehicle accidents where a trailer truck driver was involved during the period of 1991-1997 (n = 337). In addition, 251 long-haul truck drivers were surveyed in order to study their views regarding contributing factors in accidents involving trucks and the development of possible countermeasure against driver fatigue. Trailer truck drivers were principally responsible for 16% of all the accidents. Younger driver age and driving during evening hours were significant predictors of being principally responsible. In addition, the probability of being principally responsible for the accident increased by a factor of over three if the driver had a chronic illness. Prolonged driving preceding the accident, accident history or traffic offence history did not have a significant effect. Only 2% of the drivers were estimated to have fallen asleep while driving just prior to the accident, and altogether 4% of the drivers had been tired prior to the accident. Of the drivers 13% had however, been driving over 10 h preceding the accident (which has been criminally punishable in Finland since 1995 under the EC regulation) but no individual factors had a significant effect in predicting prolonged driving. The surveyed views regarding causes of truck accidents correspond well with the accident analysis. Accidents were viewed as being most often caused by other road users and driver fatigue was viewed to be no more than the fifth (out of eight) common cause of accidents. The probability of viewing fatigue as a more common cause increased significantly if the driver had experienced fatigue-related problems while driving. However, nearly half of the surveyed truck drivers expressed a negative view towards developing a technological countermeasure against driver fatigue. The negative view was not related to personal experiences of fatigue-related problems while driving.



• Age and gender patterns in motor vehicle crash injuries: importance of type of crash and occupant role. Tavris DR, Kuhn EM, Layde PM. Accid Anal Prev. 2001; 33(2):167-72.
  
  To evaluate the interaction of gender, age, type of crash, and occupant role in motor vehicle crash injuries leading to hospitalization, we analyzed 1997 Wisconsin hospital discharge data for patients with primary E-code diagnoses of motor vehicle injuries. The overall ratio of males to females (M/F ratio) hospitalized for motor vehicle crash injuries was 1.33 (95% confidence interval (CI): 1.26-1.41). The M/F ratio varied by type of crash and differed for passengers and drivers. For injuries sustained in collisions between vehicles, the M/F ratio was 0.96 (95% CI: 0.87-1.05); in loss of control accidents the M/F ratio was 1.95 (95% CI: 1.76-2.17). Within each type of crash, the M/F ratio for drivers was similar to that for the entire type; the M/F ratio for passengers was about half of the type total. Expressed as rates of hospitalization per 100,000 people in the general population, hospitalizations of drivers in collisions with another motor vehicle increased steeply in males, but not in females, beginning at about age 70. For drivers in loss of control crashes, male rates exceeded female rates in all age groups, with peaks in the groups 15-24 and 85-89. For passengers, injury rates from collisions with other motor vehicles were greater for females, especially in the elderly, and injury rates from loss of control crashes were similar for both genders, with peaks at 15-24 and 85-94. The higher fatality of men in loss of control motor vehicle crashes, compared to women, suggests an important area for further investigation.

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