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Commentary: Air bags: Looking ahead through the rearview mirror

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ANNALS OF EMERGENCY MEDICINE 2003年第2期42卷 286-288页

作者： Martinez, R Department of Emergency Medicine School of Medicine Emory University Atlanta GA USA.

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ANNALS OF EMERGENCY MEDICINE 2001年第4期38卷 415-422页

作者： McCammon, K United Hosp Ctr Dept Emergency Med Clarksburg WV 26301 USA

Impaired driving continues to be a major factor in many injuries and fatalities on our nation's highways. In 1998, alcohol was involved in 38% of all fatal crashes, contributing to 15,935 deaths. The combination of improved public awareness and strong legal sanctions for driving under the influence has been shown to reduce the incidence of impaired driving. A few states have instituted new statutes for mandatory health Care reporting of impaired drivers who have been involved in motor vehicle crashes. Current-research into establishing emergency department-based effective, efficient, and "user-friendly" methods for screening, intervention, and referral on behalf of the problem drinker offers promise for emergency physicians to become empowered to better manage this individual and public health problem. Emergency physicians may soon need to reassess their role in reducing the occurrence of alcohol-related motor vehicle crashes through widespread screening, intervention, and referral of these patients.

关键词：事故预防事故交通/预防和控制事故交通/统计学和数值数据年龄分布急诊室医院发病率一级预防/组织和管理规划制订危险因素存活率分析青少年成年人儿童儿童学龄前女(雌)性人类男(雄)性

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Maxillofacial injuries in the pediatric patient

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ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY ORAL RADIOLOGY AND ENDODONTICS 2000年第2期90卷 126-134页

作者： Haug, RH Foss, J Univ Kentucky Coll Dent Div Oral & Maxillofacial Surg Lexington KY 40536 USA Metrohlth Med Ctr Cleveland OH USA

Approximately 22 million children are injured in the United States annually. Children are uniquely susceptible to craniofacial trauma because of their greater cranial-mass-to-body ratio. The pediatric population sustains 1% to 14.7% of all Facial fractures. The majority of these injuries are encountered by boys (53.7% - 80%) who are involved in motor vehicle accidents (up to 80.2%). The incidence of other systemic injury concomitant to facial trauma is significant (10.4% - 88%). The management of the pediatric patient with maxillofacial injury should take into consideration the differences in anatomy and physiology between children and adults, the presence of concomitant injury, the particular stage in growth and development (anatomic, physiologic, and psychologic), and the specific injuries and anatomic sites that the injuries affect. This comprehensive review, based on the last 25 years of the world's English-speaking surgical literature, presents current thoughts on the anatomic and physiologic differences between adults and children, a synopsis of childhood growth and development, and an overview of state-of-the-art management of the pediatric patient who has sustained maxillofacial injury.

关键词：事故交通/统计学和数值数据虐待儿童/统计学和数值数据骨折固定术/方法生长上颌面部发育上颌面部损伤/流行病学上颌面部损伤/病因学上颌面部损伤/外科学参考值性别比率软组织损伤/流行病学软组织损伤/病因学软组织损伤/外科学牙损伤/流行病学牙损伤/病因学牙损伤/外科学美国/流行病学青少年儿童儿童学龄前女(雌)性人类婴儿男(雄)性

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Exploratory study of incident vehicle crashes among older drivers

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JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES 2000年第1期55卷 M22-M27页

作者： Sims, RV McGwin, G Allman, RM Ball, K Owsley, C Univ Alabama Div Gerontol & Geriat Med Birmingham AL USA Univ Alabama Dept Med Ctr Aging Birmingham AL 35294 USA Univ Alabama Sch Publ Hlth Dept Epidemiol Birmingham AL 35294 USA Univ Alabama Dept Surg Sect Trauma Burns & Surg Crit Care Birmingham AL 35294 USA Univ Alabama Dept Ophthalmol Birmingham AL 35294 USA Univ Alabama Dept Psychol Birmingham AL 35294 USA Birmingham Dept Vet Affairs Med Ctr Birmingham AL USA

Background, As the number of older adult drivers increases, distinguishing safe from unsafe older adult drivers will become an increasing public health concern. We report on the medical and functional factors associated with vehicle crashes in a cohort of Alabama drivers, 55 years old and older. Methods. This prospective study involved 174 older adults, on whom demographic, medical, functional, and physical performance data were collected in 1991. Subjects were then followed through 1996 for incident vehicle crashes. Results. Sixty-one subjects experienced between one and four police-reported vehicle crashes during the study period. Following adjustment for age, race, days driven per week, and gender, Cox proportional-hazards models showed the following variables to be associated with crash involvement: reported difficulty with yardwork or light housework (relative risk [RR] = 2.1;95% confidence interval [CI] 1.1,4.0;p = .02), or opening ajar(RR = 3.1;95% CI 1.4, 6.7;p = .004);at least one crash before 1991 (RR = 2.1;95% CI 1.2, 3.7;p = .008);using hypnotic medication (RR = 2.9;95% CI 1.3, 6.6;p = .0 1 );self-reported stroke or transient ischemic attack (RR = 2.7;95% CI 1.1, 6.6;p = .03);scoring within the depressed range on the Geriatric Depression Scale (RR = 2.5;95% CI 1.1, 6.0;p = .03), and failing the useful field-of-view test (RR = 1.9;95% CI 1.0, 3.5;p = .05). Conclusions, Variables related to function, medication use, affect, neurological disease, and visuocognitive skills were associated with vehicle crash involvement in this cohort. Our findings suggest that multifactorial assessments are warranted to identify at-risk older drivers.

关键词：事故交通/统计学和数值数据日常生活活动亚拉巴马/流行病学汽车驾驶卡方分布队列研究药物疗法老年人身心健康评价健康状况比例危险度模型前瞻性研究危险因素老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Factors associated with severity of motorcycle injuries among young adult riders

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ANNALS OF EMERGENCY MEDICINE 2003年第6期41卷 783-791页

作者： Lin, MR Chang, SH Huang, WZ Hwang, HF Pai, L Taipei Med Univ Inst Injury Prevent & Control Taipei 110 Taiwan Natl Taiwan Univ Sch Publ Hlth Dept Publ Hlth Taipei 10764 Taiwan Harvard Univ Sch Publ Hlth Dept Biostat Boston MA 02115 USA Natl Taipei Coll Nursing Dept Nursing Taipei Taiwan Natl Def Med Ctr Dept Publ Hlth Taipei Taiwan

Study objective: A cohort of 4,729 junior college students in Taiwan was studied to determine risk factors for increased severity of motorcycle injuries. Methods: Crash characteristics were collected by using self-administered questionnaires soon after a student was involved in a motorcycle crash. The proportional odds model with generalized estimating equations, with correlated ordinal responses for collisions categorized into not injured, mildly injured, and severely injured categories, was used to determine the odds of injury severity. Results: A total of 1,889 motorcycle crashes involving 1,284 persons occurred over a 20-month period from November 1994 to June 1996. There were 1,339 noninjuries, 474 mild injuries, and 76 severe injuries. The adjusted odds ratio (OR) of rural to urban roads having a greater level of injury severity was 1.64. Compared with noncollisions, collisions with a moving car (adjusted 011=11.76), a parked car (adjusted OR 1.90), or another stationary object (adjusted OR=2.31) increased the odds for a greater level of injury severity. Riders using Sanyang (adjusted OR=1.63) and Yamaha (adjusted OR=1.39) motorcycles had greater odds of being involved in a crash with a greater level of injury compared with those riding Kymco motorcycles. Darkness (adjusted OR=1.65) and greater speeds (adjusted OR=1.63 to 4.69) also increased the odds of greater injury severity. Conclusion: At the time of motorcycle crashes, factors such as being on rural roads, collisions with a heavier object, some motorcycle makes, darkness, and greater speeds increased the severity of motorcycle injuries among these young adult riders.

关键词：事故交通/统计学和数值数据饮酒头部防护装置摩托车/统计学和数值数据危险因素台湾/流行病学创伤和损伤/流行病学青少年成年人女(雌)性人类男(雄)性

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Jaw fractures in Enugu, Nigeria, 1985-95

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BRITISH JOURNAL OF ORAL & MAXILLOFACIAL SURGERY 1999年第2期37卷 106-109页

作者： Oji, C Univ Nigeria Teaching Hosp Dept Oral & Maxillofacial Surg Enugu Nigeria

A retrospective analysis of 900 patients with jaw fractures of the facial bones during the period January 1985 - December 1995 indicated that 747(83%) resulted from road traffic accidents, 75(8.4%) from interpersonal violence, 39(4.3%) from accidents during sporting events, and 36(4%) from occupational accidents, while the causes of 3(0.3%) were not stated. The left side of the face,vas affected more often than the right. The mandible was twice as likely to be fractured as the zygomaticomaxillary complex. The symphysis-body-angle and the condylar region were the most common sites of fracture of the mandible, while the zygoma was the area most often affected in the middle third of the face. Most maxillofacial fractures occurred in the age group 21-30 years, and the lo,vest among those over 60, Three times as many men were affected as women. We conclude that there Is high incidence of fractures of the facial bones caused by traffic accidents in our environment and, in all age groups, men were more likely to be affected than women.

关键词：事故职业/统计学和数值数据事故交通/统计学和数值数据年龄因素运动损伤/流行病学面骨/损伤颌骨折/流行病学颌骨折/病因学上颌骨骨折/流行病学尼日利亚/流行病学回顾性研究性别因素暴力/统计学和数值数据颧骨骨折/流行病学青少年成年人老年人儿童儿童学龄前女(雌)性人类婴儿男(雄)性中年人

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Pedestrian versus motor vehicle accidents: An analysis of 5,000 patients

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JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 1999年第4期189卷 343-348页

作者： Peng, RY Bongard, FS Univ Calif Los Angeles Harbor Med Ctr Sch Med Dept SurgDiv Trauma & Crit Care Torrance CA 90509 USA

Background: Pedestrian versus motor vehicle accidents are associated with substantial morbidity and mortality. Previous studies have examined pedestrian injury profiles on an individual hospital basis and have been limited by small patient populations. The objective of this study was to examine the demographics and injury profiles of pedestrian versus motor vehicle accidents in a large trauma system. Study Design: Five thousand pedestrians injured by motor vehicles whose records were entered in a centralized county trauma database were reviewed retrospectively over 3 years. Patients were grouped by age: pediatric (less than 15 years), adult (15 to 65 years), and elderly (older than 65 years). The main outcome measures included mortality, hospital stay, ICU stay, Injury Severity Score, Glasgow Coma Scale, Revised Trauma Score, level of residual disability, and payer source. Results: The pediatric group represented 38.1% of the study population, adults 53.9%, and the elderly 8.0%. Mortality was highest among the elderly (27.8%), followed by adults (8.1%) and children (3.1%). Overall, the pediatric group had the lowest Injury Severity Score (6.8 +/- 0.2, mean +/- SEM), the highest Revised Trauma Score (7.5 +/- 0.9), and the highest Glasgow Coma Scale (13.9 +/- 0.1). Hospital stay (4.9 +/- 0.2 days) and ICU stay (4.6 +/- 0.3 days) were also shortest in this age group. Among all patients, injuries included musculoskeletal (34.3%), head and neck (30.0%), external (24.4%), abdomen and pelvis (3.9%), chest (2.4%), spine (1.8%), and other (3.2%). Operations were required in 11%: orthopaedic (67%), thoracic (2%), abdominal(11%), neurosurgical or head (6%), and other (14%). At the time of discharge, 78% of patients had a temporary disability, 4% had a permanent handicap, and only 16% were functioning at preadmission capacity. Among those with identifiable payer sources, 45% were state or federal, 25% were cash or self-pay, 18% of patients belonged to an HMO or had a group carr

关键词：事故交通/死亡率事故交通/统计学和数值数据格拉斯哥昏迷量表损伤严重度评分洛杉矶/流行病学回顾性研究创伤和损伤/流行病学青少年成年人老年人儿童女(雌)性人类男(雄)性中年人

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Adults and children in severe motor vehicle crashes: A matched-pairs study

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ANNALS OF EMERGENCY MEDICINE 2000年第4期36卷 340-345页

作者： Corneli, HM Cook, LJ Dean, JM Univ Utah Coll Med Dept Pediat Salt Lake City UT USA Univ Utah Coll Med Intermt Injury Control Res Ctr Salt Lake City UT USA

Study objective: Many articles report seat belt injuries to children. This study examines the effect of child versus adult age and seat belt use on outcome in severe motor vehicle crashes. Methods: A population-based data set of all motor vehicle crashes statewide was analyzed by using matched-pairs logistic regression. Subjects were participants in motor vehicle crashes in which at least one occupant was killed or hospitalized and at least one was a child (age <15 years). Only passengers in cars, vans, and the front of light trucks were considered. Unique matched pairs were formed of one adult and one child from the same vehicle. The main outcome measure was death or hospitalization. Covariates were seat belt use and front or back seat position. Results: Overall, 413 pairs were analyzed. Seat belt use in these severe crashes was low for children and adults (40% versus 45%). Children more often sat in the back seat (74% versus 31% for adults). Risk of death was similar (7% for children and 8% for adults), but the percentage killed or hospitalized differed (13% for children and 28% for adults;odds ratio [OR] 2.5;95% confidence interval [CI] 1.8 to 3.7). After controlling for seat belt use and seat position, adults remained at a similarly increased risk compared with children (OR 2.6;95% CI 1.6 to 4.2). The back seat was much safer than the front seat (OR 5.5;95% CI 3.7 to 8.1). An adult's nonuse of restraints was strongly predictive of a child's nonuse. Conclusion: Seat belts were at least as protective for children as for adults, but only 40% of the children in these severe crashes were restrained.

关键词：事故交通/死亡率事故交通/统计学和数值数据年龄分布 Logistic模型配对分析安全带/利用青少年成年人老年人儿童儿童学龄前人类中年人

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Motorcycle casualties sustained during Daytona Beach bike week 2000: Lessons learned

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ANNALS OF EMERGENCY MEDICINE 2003年第6期41卷 792-797页

作者： Kanny, D Schieber, RA Jones, BH Ryan, GW Sorensen, BJ Dept Hlth & Human Serv US Publ Hlth Serv Ctr Dis Control & Prevent Epidemiol Program OffEpidem Intelligence Serv Atlanta GA USA Dept Hlth & Human Serv US Publ Hlth Serv Ctr Dis Control & Prevent Natl Ctr Injury Prevent & ControlDiv Unintent In Atlanta GA USA Dept Hlth & Human Serv US Publ Hlth Serv Ctr Dis Control & Prevent Natl Ctr Injury Prevent & ControlOff Stat & Prog Atlanta GA USA Volusia Cty Hlth Dept Daytona Beach FL USA

Study objective: In March 2000, an estimated 500,000 people attended an annual motorcycle rally in Daytona Beach, FL, where approximately 64,000 residents live year-round. The media reported 15 deaths during this 10-day event. To more, comprehensively assess the extent of trauma and need for emergency medical care we, investigated all motorcycle crashes, regardless of outcome. Methods: Motorcycle-related crash data from local medical examiner, hospital, emergency medical services (EMS), and police sources were linked. Frequencies of crashes, injuries, hospitalizations, and deaths were determined, and EMS use data were analyzed. Results: During Bike Week 2000, 570 people were involved in 281 motorcycle-related crashes. Two hundred thirty (40%) people were injured, of which 147 (64%) sought treatment in emergency departments, 72 (31%) were hospitalized, and 11 (5%) died. In crashes between motorcycles and passenger cars, individuals exposed as motorcycle Occupants were 8.7 times more likely to be injured than car occupants (95%, confidence limit 1.7, 15.7). Of 205 EMS dispatches for motorcycle-related crashes, two thirds resulted in transport to an ED. Data needed to assess known risk factors (eg, alcohol use, speed, lack of helmet use) were not routinely ascertained at either the Crash site or ED. Conclusion: Although fatalities first called attention to the problem, nonfatal injuries outnumbered deaths 20:1. The manpower resources of civil service and health resources could become overwhelmed or exhausted in circumstances in which many people are injured or killed throughout a relatively long period. The situation deserves future study. Better risk factor surveillance is needed to help prevent crashes.

关键词：事故交通/统计学和数值数据救护车/统计学和数值数据佛罗里达/流行病学摩托车/统计学和数值数据成年人女(雌)性人类男(雄)性中年人

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The epidemiology of open long bone fractures

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INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED 1998年第7期29卷 529-534页

作者： Court-Brown, CM Rimmer, S Prakash, U McQueen, MM Royal Infirm Edinburgh EH3 9YW Midlothian Scotland

Open long bone fractures occur with a frequency of 11.5 per 100 000 persons per year. They are more common in males and they have a bimodal age distribution. Open fractures of the tibial diaphysis are the commonest, but open femoral diaphyseal, distal femoral and proximal tibial fractures tend to occur in the most seriously injured patients. Lower limb open fractures are move severe than open fractures of the upper limbs. Not only is the soft tissue damage less in open upper limb fractures, but there are fewer associated musculoskeletal injuries. (C) 1998 Elsevier Science Ltd. All rights reserved.

关键词：事故交通/统计学和数值数据年龄分布四肢/损伤股骨骨折/流行病学前臂损伤/流行病学骨折开放性/流行病学肱骨骨折/流行病学苏格兰/流行病学胫骨骨折/流行病学成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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