Urban drinking and driving: comparison of electric scooter and bicycle related accidents in facial fracture patients

Background: In recent years, electric scooters (e-scooter) have emerged as an alternative mode of urban transport due to their availability and effortless use. However, e-scooter-related trauma and injuries, especially to the head, have received wide media coverage and raised public concern about their safety. We aim to determine and compare clinically relevant variables, incidence, and severity between bicycle and e-scooter-related facial fractures and potential protective measures for injury prevention. Material and methods: This retrospective study comprised all patients admitted to a tertiary trauma center with bicycle or e-scooter-related facial fractures between January 2019 and October 2020. Patient- and injury-related variables, including demographics, injury mechanisms, helmet use, influence of alcohol, types of facial injuries, types of other injuries, given treatment, and hospital stay, were collected, analysed, and compared between bicycle and e-scooter injuries. Results: Altogether 169 patients with facial fractures, 124 bicycle-related injuries (73.4%) and 45 e-scooter-related injuries (26.6%) were included. Alcohol involvement was significantly higher in e-scooter patients (88.9%) than in bicycle patients (31.5%) (p<0.001). Driving under the influence of alcohol was associated with driving without a helmet in both groups (p<0.001). In multivariate analyses, e-scooter accidents were 18 times more likely to occur under the influence of alcohol (OR 17.85, p<0.001) and were more likely to involve collision with a stationary object (OR 3.81, p=0.028). E-scooter patients were significantly younger (OR 0.95, p<0.001) and had significantly more cranial fractures (OR 10.15, p=0.014) than bicycle patients. (AU)

Conducir con presencia de alcohol en España en 2018 / Driving with a positive test result for alcohol in Spain in 2018

OBJETIVO: La asociación entre alcohol y lesiones por colisiones de tráfico es bien conocida. Nuestro objetivo fue analizar la frecuencia de conducir con presencia de alcohol en las pruebas de control en carretera, considerando diversas concentraciones de alcohol en aire espirado, así como conducir con la presencia de sólo alcohol o alcohol junto con drogas. MÉTODOS: Se ha realizado un estudio transversal en una muestra representativa de los conductores de vehículos de motor en vías públicas españolas, excluyendo ciclistas y conductores de vehículos de más de 3500 kg en 2018. En el estudio se han incluido 2.881 conductores. Los datos fueron analizados con el programa estadístico SPSS 24.0. RESULTADOS: El 10,9% (95% IC, 9,8-12,1) de los conductores fueron casos positivos a alguna sustancia: la presencia de alcohol (solo, sin ninguna otra sustancia) se observó en el 3,9% (3,2-4,6), y alcohol más alguna otra sustancia en el 0,8% (0,6-1,3). El 2,1% (1,6-2,7) de los conductores presentó un nivel de alcohol en aire espirado superior al límite legal (>0,25 mg/L) permitido a los conductores (excepto noveles y profesionales). El 0,4% (0,2-0,7) de los conductores conducían con una concentración de alcohol en aire espirado >0,60 mg/L. Conducir con presencia de alcohol y drogas se observa en dos de cada diez casos positivos a alcohol. CONCLUSIONES: Conducir con presencia de alcohol es frecuente entre los conductores españoles, y no debieran pasar desapercibidos aquellos que conducen después de haber consumido alcohol y drogas

OBJECTIVE: The association between alcohol and traffic collision injuries is well established. Our objective was to analyze the frequency of driving with a positive result in on-road tests for alcohol with considering different concentrations of alcohol in exhaled air, as well as driving while positive only for alcohol or for alcohol and drugs. METHODS: In 2018, a cross-sectional study was carried out in a representative sample of motor vehicle drivers on Spanish public roads, excluding cyclists and drivers of vehicles weighing more than 3,500 kg. 2,881 drivers were included in this study. Data was analysed with the statistics program SPSS 24.0. RESULTS: 10.9% (95% CI, 9.8-12.1) of the drivers were positive cases for any substance: In 3.9% (3.2-4.6) alcohol alone (i.e., without any other substance), and in 0.8% (0.6-1.3) alcohol plus another substance, were observed. 2.1% (1.6-2.7) of the drivers had a level of alcohol in expired air higher than the legal allowed limit for drivers (>0.25 mg/L, that excluding novice and profesional drivers). 0.4% (0.2-0.7) of the drivers had an alcohol concentration in expired air >0.60 mg/L. Driving with the presence of alcohol and drugs is observed in two out of ten positive cases for alcohol. CONCLUSIONS: Driving while positive for alcohol is common among Spanish drivers, and drivers positive for alcohol and drugs should not be ignored

¿Qué hacer en los casos que dan positivo a metadona en los controles de drogas en carretera? La experiencia de España / What to do when drivers test positive for methadone in roadside drug tests? The Spanish Experience

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¿La presencia de cannabis en saliva es suficiente para confirmar la conducción bajo sus efectos? / Presence of cannabis in saliva: enough to confirm driving under its effects?

Actualmente en España, la presencia de drogas en saliva se considera suficiente para confirmar la conducción bajo sus efectos, aunque la concentración que se obtenga sea muy cercana a los límites de sensibilidad del sistema analítico. Este planteamiento, eminentemente legal, supone aceptar que no existe un umbral de concentración por debajo del cual la droga no afecta a la conducción y que la concentración en saliva es un parámetro fiable para valorar su efecto. En el caso del cannabis, algunos estudios experimentales en humanos y en conductores detenidos en la vía pública, han propuesto concentraciones de tetrahidrocannabinol en sangre a partir de las cuales se producen efectos que pueden afectar la conducción de vehículos. Sin embargo, las correlaciones entre concentraciones de tetrahidrocannabinol en saliva y sangre muestran una amplia variabilidad. Para resolver la discordancia entre estos dos tipos de muestras, algunos países han harmonizado su legislación estableciendo valores presuntivos de cannabis en saliva al mismo tiempo que unos valores límite de concentración en sangre a partir de los cuales se consideran claramente afectadas las capacidades en la conducción. En este trabajo consideramos que la ley española de seguridad vial, siguiendo la tendencia adoptada por otros países, debería establecer un valor límite para el cannabis y otras drogas de abuso en sangre, que permitiera evidenciar que el conductor no solamente las ha consumido, sino que conduce bajo los efectos de las misma

In Spain today, the presence of drugs in saliva is considered sufficient to confirm driving under its effects, although the concentration obtained is near the threshold limits of the analytic system. This legal approach entails accepting that there is no concentration threshold below which the drug does not affect driving capacity, and that oral fluid concentration is a reliable parameter to value its effect. In the case of cannabis, some experimental studies in humans and in intercepted drivers have sug-gested blood tetrahydrocannabinol concentrations from which effects that can affect driving are observed. Furthermore, correlation between tetrahydrocannabinol concentration in oral fluid and in blood shows a high variability. To resolve disagreement between these types of samples, some countries have harmonized their legislation establishing presumptive oral fluid cannabis values at the same time as blood concentration limit values from which it can be clearly considered that driving capacities are affected. In this work, we consider that the Spanish road safety law should, following trends adopted by other countries, establish a limit value for cannabis and other abused drugs, which allows evidence that the driver has not only consumed the drug, but is also driving under its effects