The Association Between Home and Crash Site Social Vulnerability on Injury and Mortality After Motor Vehicle Crashes: Implications for Traffic Policy.

INTRODUCTION: There is a growing body of literature that shows geographic social vulnerability, which seeks to measure the resiliency of a community to withstand unforeseen disasters, may be associated with negative outcomes after traumatic injury. For motor vehicle collisions (MVCs) specifically, it is unknown how the resources of a patient's home environment may interact with resources of the environment where the crash occurred. METHODS: We merged publicly available crash data from the state of Michigan with the Michigan Trauma Quality Improvement dataset. A social vulnerability index (SVI) score was calculated for each ZIP code and was then cross-referenced between the location of the MVC (Crash-SVI) and the patient's home address (Home-SVI). SVI was divided into quintiles, with higher numbers indicating greater vulnerability. Adjusted logistic regression models using least absolute shrinkage and selection operator for feature selection and regularization were performed sequentially using patient, vehicular, and environmental variables to identify associations between Home-SVI and Crash-SVI, with mortality and injury severity score (ISS) greater than 15 (ISS15). RESULTS: Between January 2020 and December 2022, a total of 14,706 patients were identified. Most MVCs (75.3% of all patients) occurred in the second through fourth quintiles of SVI. In all cases, Crash-SVI occurred most frequently within the same quintile as the patient's Home-SVI. Average crash speed limits showed a significant negative association with increasing SVI. On adjusted logistic regression, there were significantly increased odds of mortality for the fifth quintile of Home-SVI in comparison to the first quintile when adjusted for patient factors; but this lost significance after the addition of vehicular or environmental variables. In contrast, there were decreased odds of ISS15 for the highest quintiles of Crash-SVI in all logistic regression models. CONCLUSIONS: Geographic social vulnerability markers were associated with lower MVC-associated injury severity, perhaps in part because of the association with lower speed limit in these areas.

Implications of using administrative healthcare data to identify risk of motor vehicle crash-related injury: the importance of distinguishing crash from crash-related injury.

BACKGROUND: Administrative healthcare databases, such as Medicare, are increasingly used to identify groups at risk of a crash. However, they only contain information on crash-related injuries, not all crashes. If the driver characteristics associated with crash and crash-related injury differ, conflating the two may result in ineffective or imprecise policy interventions. METHODS: We linked 10 years (2008-2017) of Medicare claims to New Jersey police crash reports to compare the demographics, clinical diagnoses, and prescription drug dispensings for crash-involved drivers ≥ 68 years with a police-reported crash to those with a claim for a crash-related injury. We calculated standardized mean differences to compare characteristics between groups. RESULTS: Crash-involved drivers with a Medicare claim for an injury were more likely than those with a police-reported crash to be female (62.4% vs. 51.8%, standardized mean difference [SMD] = 0.30), had more clinical diagnoses including Alzheimer's disease and related dementias (13.0% vs. 9.2%, SMD = 0.20) and rheumatoid arthritis/osteoarthritis (69.5% vs 61.4%, SMD = 0.20), and a higher rate of dispensing for opioids (33.8% vs 27.6%, SMD = 0.18) and antiepileptics (12.9% vs 9.6%, SMD = 0.14) prior to the crash. Despite documented inconsistencies in coding practices, findings were robust when restricted to claims indicating the injured party was the driver or was left unspecified. CONCLUSIONS: To identify effective mechanisms for reducing morbidity and mortality from crashes, researchers should consider augmenting administrative datasets with information from police crash reports, and vice versa. When those data are not available, we caution researchers and policymakers against the tendency to conflate crash and crash-related injury when interpreting their findings.

Mechanisms and risk factors associated with spinal cord injury, facet fracture, and level of dislocation, in occupants with cervical spine dislocations sustained in motor vehicle crashes.

OBJECTIVE: Motor vehicle crashes (MVCs) are the leading cause of cervical spine dislocation. The mechanisms underlying this injury are unclear, limiting the development of injury prevention devices and strategies. MVC databases contain occupant, medical, vehicle, and crash details that are not routinely collected elsewhere, providing a unique resource for investigating injury mechanisms and risk factors. In this study, a comprehensive standalone analysis of cervical spine dislocations captured in MVC databases was performed. METHODS: Epidemiologic, biomechanical, and injury data were extracted from three MVC databases. Logistic regression models were developed to determine the occupant, vehicle, and crash characteristics, as well as the global (inertial or impact) and regional (flexion, compression, etc.) loading mechanisms associated with the level of cervical spine dislocation (axial or sub-axial), and the occurrence of spinal cord injury (SCI) or facet fracture concomitant to dislocation. RESULTS: There was no association between global or regional injury mechanisms and the level of cervical spine dislocation. Sub-axial dislocations were typically due to head/face impact with the airbag or upper interior components, or a result of seatbelt restraint of the torso. Higher occupant age, lower BMI, partial/no ejection, and frontal and side configuration crashes (compared to rollovers) were associated with a higher likelihood of sub-axial, versus axial, dislocation. Amongst all dislocations, an increased likelihood of SCI was associated with impact injuries, airbag non-deployment, and complete ejection, while concomitant facet fracture was associated with the presence of regional compression. Severe crashes, partial ejections, and "utility vehicles" and "vans and trucks" (compared with "passenger vehicles") were associated with a higher risk of facet fracture concomitant to sub-axial dislocation. CONCLUSION: The findings of this study may be used to inform the loading modes to be simulated in future ex vivo or computational models seeking a better understanding of cervical spine dislocations.

Impact of Safety Device Features Upon Motor Vehicle Collision Facial Fracture Traumas: A Five-Year Retrospective Study in the Appalachian Tri-State Area.

Motor vehicle collisions (MVCs) represent a significant public health concern, contributing to substantial morbidity and mortality globally. Despite advancements in vehicle safety technology, the impact of safety measures on facial fractures in MVCs remains poorly understood, especially in regions with diverse road conditions like the Appalachian tri-state area. This retrospective study analyzed data from two regional level II trauma centers in Appalachia, focusing on MVC-related facial fractures and safety device usage from January 2017 to December 2021. Descriptive statistics and logistic regression models were employed to assess associations between safety devices and injury outcomes. The study comprised 85 participants, categorized into groups based on safety device usage. Results indicated no significant differences in demographic characteristics, injury severity, surgical intervention rates, or specific facial fractures among groups. These findings challenge some previous research suggesting the protective effects of safety devices on facial fractures in MVCs, underscoring the complex nature of injury prevention in this context. While limitations such as retrospective data collection and sample size constrain generalizability, this study contributes valuable insights for informing injury prevention strategies and trauma care practices in Appalachia and beyond.

Risk and Protective Factors for Injury in Adult Front- and Rear-Seated Motor Vehicle Occupants in New York State.

Although seatbelt use is known to reduce motor vehicle occupant crash injury and death, rear-seated adult occupants are less likely to use restraints. This study examines risk and protective factors associated with injury severity in front- and rear-seated adults involved in a motor vehicle crash in New York State. The Crash Outcome Data Evaluation System (CODES) (2016-2017) was used to examine injury severity in front- and rear-seated occupants aged 18 years or older (N = 958,704) involved in a motor vehicle crash. CODES uses probabilistic linkage of New York State hospitalization, emergency department, and police and motorist crash reports. Multivariable logistic regression models with MI analyze employed SAS 9.4. Odds ratios are reported as OR with 95% CI. The mortality rate was approximately 1.5 times higher for rear-seated than front-seated occupants (136.60 vs. 92.45 per 100,000), with rear-seated occupants more frequently unrestrained than front-seated occupants (15.28% vs. 1.70%, p < 0.0001). In adjusted analyses that did not include restraint status, serious injury/death was higher in rear-seated compared to front-seated occupants (OR:1.272, 1.146-1.412), but lower once restraint use was added (OR: 0.851, 0.771-0.939). Unrestrained rear-seated occupants exhibited higher serious injury/death than restrained front-seated occupants. Unrestrained teens aged 18-19 years old exhibit mortality per 100,000 occupants that is more similar to that of the oldest two age groups than to other young and middle-aged adults. Speeding, a drinking driver, and older vehicles were among the independent predictors of serious injury/death. Unrestrained rear-seated adult occupants exhibit higher severe injury/death than restrained front-seated occupants. When restrained, rear-seated occupants are less likely to be seriously injured than restrained front-seated occupants.

Characteristics of Pediatric Concussion across Different Mechanisms of Injury in 5 through 12-Year-Olds.

OBJECTIVE: To investigate characteristics of sport-related concussion (SRC), recreation-related concussion (RRC), and nonsport or recreation-related concussion (non-SRRC) in patients 5 through 12 years old, an understudied population in youth concussion. STUDY DESIGN: This observational study included patients aged 5 through 12 years presenting to a specialty care concussion setting at ≤28 days postinjury from 2018 through 2022. The following characteristics were assessed: demographics, injury mechanism (SRC, RRC, or SRRC), point of healthcare entry, and clinical signs and symptoms. Kruskal-Wallis and chi-square tests were used to assess group differences. Posthoc pairwise comparisons were employed for all analyses (α = 0.017). RESULTS: One thousand one hundred forty-one patients reported at ≤28 days of injury (female = 42.9%, median age = 11, interquartile range (IQR) = 9-12) with the most common mechanism being RRC (37.3%), followed by non-SRRC (31.9%). More non-SRRCs (39.6%) and RRC (35.7%) were first seen in the emergency department (P < .001) compared with SRC (27.9%). Patients with RRC and non-SRRC were first evaluated at specialists 2 and 3 days later than SRC (P < .001). Patients with non-SRRC reported with higher symptom burden, more frequent visio-vestibular abnormalities, and more changes to sleep and daily habits (P < .001) compared with RRC and SRC (P < .001). CONCLUSIONS: In concussion patients 5 through 12 years, RRCs and non-SRRC were more prevalent than SRC, presenting first more commonly to the emergency department and taking longer to present to specialists. Non-SRRC had more severe clinical features. RRC and non-SRRC are distinct from SRC in potential for less supervision at time of injury and less direct access to established concussion health care following injury.

Work-related crashes in rideshare drivers in the United States.

INTRODUCTION: Motor vehicle crashes (MVCs) are the leading cause of work-related deaths in the United States. The increasing popularity of the competitive rideshare market and the lack of oversight over workforce health and safety limits understanding of the current occupational hazards and associated risk factors faced by this precarious workforce. The objective of this analysis was to determine what the personal, social and occupational risk factors for work-related crashes in rideshare drivers are in the United States and suggest further research required to understand occupational health risks and opportunities for interventions. MATERIAL AND METHODS: We conducted a survey of a convenience sample of rideshare and taxi drivers using an online questionnaire. Rideshare respondents (n = 277) were recruited through an email that was distributed to people who subscribe to TheRideshareGuy.com. We examined the general characteristics of rideshare drivers by history of work-related MVCs and logistic regression models were used to determine major predictors of MVCs. RESULTS: Of 276 rideshare drivers that reported their crash history, one-third (n = 91, 33%) reported being involved in a work-related crash. Results from a multivariable logistic regression model showed rideshare MVCs were more likely in older drivers (aOR for 10 year increases in age, 1.55, p = 0.001), if drivers undertook 10 or more rideshare trips per day (aOR 1.84, p = 0.041), frequently or very frequently were driving on unfamiliar roads (aOR 1.72, p = 0.048) and driving whilst tired (aOR 3.03, p = 0.003). CONCLUSION: Precarious workers and health and safety is emerging as a major area of research focus. There is a unique opportunity to explore the occupational health risks in rideshare drivers to provide interventions that encourage growth of a healthy and fit rideshare workforce and promote work practices and future regulations aimed at improving safe work practices. PRACTICAL APPLICATIONS: This analysis paints a complex picture of personal and occupational factors that are associated with MVCs in rideshare drivers suggesting that additional policy development related to occupational health and safety of rideshare drivers could be constructive.

Epilepsy and driving: A preliminary survey of people with epilepsy at an epilepsy clinic in China.

BACKGROUND: Driving is an important part of the daily life for most adults, and restrictions on driving can significantly affect the quality of life for people with epilepsy. This study aimed to investigate the current driving status of patients at an epilepsy clinic in China. METHOD: Study participants were administered a survey by a questionnaire including the demographic and clinical characteristics of seizure, driving-related questions and attitudes to driving. RESULTS: A total of 101 patients responded the survey. Among 33(32.7%) who hold the driving license, 20 (60.6%) still drive, 3 had seizures while driving, and the rate of traffic accidents was 0. There was no significant difference in seizure frequency and type of medication between patients with and without the driving license, but compliance with medication was significantly better for those who held the driving license. CONCLUSIONS: One-third of people with epilepsy hold the driving license and good drug compliance is a favorable factor for driving. Standardizing different levels of restriction on driving for people with epilepsy is urgently needed.

Longitudinal Assessment of Hair Cortisol as a Predictor of Psychological Symptoms During COVID-19.

BACKGROUND: There is a lack of evidence regarding enduring psychoneuroendocrine changes following an initial traumatic event, particular in the presence of an ongoing stressor. The coronavirus pandemic presents an opportunity to explore this matter. Consequently, the purpose of the present study was to investigate the impact of the ongoing pandemic (2021) on individuals, who experienced a first-time motor vehicle crash (MVC) at least 6 years earlier. To this end, we hypothesized that hair cortisol concentrations (HCC) following a first-time traumatic event positively predict symptoms of depression. METHOD: We investigated N = 69 individuals (18 - 65 yrs.), who were victims of a MVC during 2010 - 2014. Hair strands were collected 10 days (t1) and 3 months after the MVC (t2), as well during the pandemic in 2021 (t3). To assess symptoms of depression, the participants filled out the Beck Depression Inventory at t1 - t3 and were additionally interviewed (Structured Clinical Interview for DSM-IV Axis I) at t1 and t2. Exclusion criteria conveyed a lifetime or acute mental disorder (incl. past trauma exposure). RESULTS: Elevated pre-pandemic HCC following adversity (i.e., MVC) significantly predicted symptoms of depression in adults during the coronavirus pandemic (BDI: ß =.44, p =.010, R2 =.20), even after controlling for confounders. HCC significantly decreased over time, while in average psychological symptoms remained consistent. CONCLUSION: Cortisol dysregulation in the past presents an enduring vulnerability to ongoing stress. In this regard, vulnerable groups may benefit from preventive measures. This finding validates the predictive power of HCC and extended past evidence in this regard, at the same time reinforcing the concept of the diathesis-stress model.

Evaluation of pre-hospital cannabis exposure and hospital opioid utilization in a trauma population: A retrospective cohort.

PURPOSE: Cannabis utilization has increased over time for recreational and medical purposes due to its legalization or decriminalization. The effects of cannabis use on opioid utilization are not well understood. The primary objective was to evaluate the total opioid utilization, measured in morphine milligram equivalents (MME), in hospitalized trauma patients that tested positive for tetrahydrocannabinol (THC) on a urine drug screen (UDS). METHODS: This was a retrospective, cohort study in a level 1 trauma center between 10/17/17 and 12/31/19. Adult trauma patients (aged 15 years and older) who had a UDS completed within 48 h of hospital arrival were eligible for inclusion. Patients were excluded for a hospitalization >14 days, death within 24 h, severe alcohol withdrawal, prescribed cannabinoids, high daily opioid use prior-to-arrival, or transitioned to hospice or palliative care. Group assignments were determined based on the presence or absence of THC on the UDS. RESULTS: The analysis included 750 patients with 160 (21 %) THC positive patients. The population were primarily male (64.6 %), median age of 56 years [IQR 35-72], with blunt (93 %) injuries from motor vehicle crash or falls (79 %). The THC group was more likely to have other substances present, including amphetamines, benzodiazepines, opiates, and cocaine. The THC group had a higher median injury severity score (10 [IQR 5-17] vs. 9 [5-14], p = 0.0056), and maximum abbreviated injury score (3 [IQR 2-3] vs. 2 [IQR 2-3], p = 0.0009). The THC group had a total higher median opioid utilization during the hospitalization (155 [IQR 68-367] vs. 62 [IQR 13-175] MME; p < 0.0001), which included higher opioid use in the emergency department, floor, and intensive care unit. There were no significant differences in secondary outcomes except the THC group was more likely to receive an opioid prescription at discharge and more likely to require mechanical ventilation. Based on multivariable regression analyses, other variables were associated with increased opioid utilization. CONCLUSION: Pre-existing THC exposure may be associated with an increased hospital opioid utilization in a trauma population. However, other variables may also play a role in opioid utilization.

Speed kills? Quantifying the association between police traffic stops, types of stops, and motor vehicle collisions.

BACKGROUND: Motor vehicle crashes (MVCs) are a leading cause of traumatic death and injury. Police traffic stops (PTS) are a common approach to enforcing motor vehicle laws intended to prevent MVCs. However, it is unclear which types of PTS are most effective. This study examined the relationship of PTS subtypes among municipal police patrols on non-interstate roads and MVCs and MVC-related deaths. METHODS: PTS subtype data were characterized from six North Carolina cities: Charlotte, Durham, Fayetteville, Greensboro, Raleigh, and Winston-Salem. The primary outcomes of this study were yearly non-interstate MVC and MVC-related death rates per 100 population. The data were analyzed as balanced time-series cross-sectional data. The statistical analysis accounted for time-dependent and city-dependent confounding. We used a two-way fixed effects model to analyze the relationship between PTS and MVC or MVC-related deaths. We also utilized the difference in difference (DID) analysis to analyze if the reduction of PTS following a 2012 policing administrative change in Fayetteville had an association with MVC or MVC-related deaths. RESULTS: We found no significant overall association between non-interstate PTS and MVCs (Coeff: -0.00006; p = 0.43) or MVC-related deaths (Coeff: -0.00011; p = 0.15). Panel regression suggested no significant relationship between MVCs and MVC-related deaths and PTS related to driving while impaired (p = 0.36), safe movement violation (p = 0.43), or seatbelt violations (p = 0.17). However, speed limit violations (Coeff: -0.00025; p = 0.032) and stop-light/sign violations (Coeff: -0.00147; p = 0.017) related to PTS significantly reduced MVC-related deaths. The DID regression showed no significant impact on MVCs (p = 0.924) or MVC-related deaths (0.706) before and after the police reform period. CONCLUSIONS: The evidence regarding the absence of an overall association and any association with most PTS subtypes suggest that PTS are not effective for MVC death prevention. Policymakers may proceed with exploring modifications to policing efforts without detriments to public safety as defined by MVC and MVC-related deaths. LEVEL OF EVIDENCE: Retrospective epidemiological study, level IV.

Subjective and Objective Improvement in a 39-Year-Old Male Suffering From Severe Chronic Pain and Disability Using Chiropractic BioPhysics® Protocols Following Rear-Impact Motor Vehicle Crash With a 10-Month Long-Term Follow-Up.

We present the case of a patient receiving structural rehabilitation following a rear-impact motor vehicle collision (MVC). Medications did not alleviate the symptoms of the crash injuries. Resolution of injury-caused pain and disability was found following postural and structural rehabilitation treatment. A 39-year-old male was injured in a rear-impact collision between two very large vehicles. Severe migraine headaches, neck pain, and radiculopathy, as well as lower back pain, were the result of the crash. Patient-reported outcomes (PROs) demonstrated that the symptoms were causing severe disability and poor health-related quality of life (HRQoL) measures. Radiographs found spine alignment abnormalities consistent with rear impact MVC. Chiropractic Biophysics® (CBP®) structural rehabilitation was performed. Following a treatment regimen involving strengthening weakened and damaged muscles, postural and spinal traction, postural spinal manipulative therapy (SMT), and home therapies resulted in the resolution of the symptoms. All outcome measures demonstrated improvement, including Short-Form 36 question health questionnaire (SF-36), quadruple visual analog scale (QVAS), headache disability index (HDI), neck disability index (NDI), revised Oswestry disability index (RODI), as well as significant measured improvements found on radiographs. Spine pain and altered alignment are frequent results of MVCs. If left uncorrected, these abnormalities increase the likelihood of chronic pain and disability. Combined low back pain (LBP), neck pain (NP), headache (HA), and radiculopathy, as found in our subject, significantly pre-dispose the individual to poor HRQoL, years lived with disability (YLDs) and increased the global burden of disease (GBD). Physicians who treat injured patients should have a repeatable, reliable, valid, and efficacious method to reduce pain, increase range of motion (ROM), improve spine alignment, and improve the performance of activities of daily living (ADLs). Further, larger studies of injured patients are necessary to determine if the CBP® protocol reduces GBD caused by MVC injuries.

Non-operative management strategy for blunt pulmonary artery pseudoaneurysm: A case report.

Traumatic pulmonary artery pseudoaneurysms (PAP) are rare findings and are often associated with penetrating trauma to the chest. We present a case of a pulmonary artery pseudoaneurysm following blunt trauma. A 49-year-old man presented after a motor vehicle collision. Contrast enhanced computed tomography scans of the neck, chest, abdomen, and pelvis were obtained demonstrating a proximal right pulmonary artery pseudoaneurysm, small volume hemopericardium, left first rib fracture, and focal non-flow limiting dissection of left subclavian artery. For the management of right PAP, we adopted a non-operative management strategy with an esmolol infusion for strict heart rate and blood pressure control. An echocardiogram was obtained the next day revealing no cardiac tamponade. Angiography of the chest was done after 24 h which showed stable appearance of the right PAP and hemopericardium. Patient was discharged home on hospital day 11.

Special Report from the CDC: Provider knowledge and practices around driving safety and fall prevention screening and recommendations for their older adult patients, DocStyles 2019.

INTRODUCTION: Falls and motor-vehicle crashes (MVCs) are leading causes of unintentional injury deaths among older adults (65+) in the United States. Injury prevention resources exist to help healthcare providers reduce fall and MVC risk among older adult patients. However, awareness of these resources among healthcare providers is unclear. METHODS: Questions were included in the 2019 DocStyles survey that assessed healthcare provider awareness of three injury prevention resources: (1) the American Geriatrics Society's (AGS's) Clinician's Guide to Assessing and Counseling Older Drivers, (2) the Clinical Assessment of Driving Related Skills (CADReS), and (3) the Centers for Disease Control and Prevention's (CDC) Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. We also explored the circumstances and current practices for counseling older adult patients on fall prevention and driving safety. RESULTS: Only 20% of providers reported awareness of any of the injury prevention resources. Providers were more likely to report either screening for fall risk or unsafe driving when an older adult presented with a fall concern (74.5%) or driving concern or recent crash (85.1%), compared to annual screening for fall risk (67.7%) or driving safety (47.7%). More providers reported discussing the increased fall or MVC risk associated with patient medications, referring patient for driving fitness evaluations, or discussing alternative transportation options with the patient after adverse events or patient-initiated concerns compared to routine annual discussions. CONCLUSION: Healthcare gaps persist in the screening and assessment of older adult risk factors for falls and unsafe driving. Limited provider awareness of clinical resources related to preventing older adult falls and unsafe driving may be contributing to these healthcare gaps. PRACTICAL APPLICATIONS: Improving healthcare provider awareness of these resources could help them identify older adults at risk of a fall or MVC and promote injury prevention efforts in their clinical practices.

The effect of social media campaign on parental knowledge, attitudes and practices regarding the use of children car seats in the Gulf region.

BACKGROUND: Motor vehicle crashes (MVCs) are the leading cause of child deaths in the Gulf Cooperation Council. This study aimed to investigate the effect of a social media educational campaign on parents' knowledge of child safety seats. METHODS: We conducted a pre-post interventional study as an online educational module in Arabic and English. The module link was shared on social media and was accompanied by a pre-post survey that included questions about demographics, knowledge, and practices of car seat use. RESULTS: A total of 303 participants completed the campaign, with 23.8% fathers and 76.2% mothers answered the survey. The majority of participants were from Saudi Arabia (95.7%), while 4.3% were from other Gulf Cooperation Council (GCC) countries. Most parents agreed on the importance of organizing awareness campaigns and having a law to enforce the use of car seats. The pre-survey mean knowledge score was 11.64, which significantly increased to 13.1 in the post-survey (p < 0.001). CONCLUSIONS: The intervention of the educational campaign through social media resulted in a significant increase in parents' knowledge and awareness of the importance of using car seats correctly. This study highlights the potential effectiveness of social media campaigns in improving parents' knowledge and awareness of child safety seats.

Non-Surgical Management of Upper Cervical Instability via Improved Cervical Lordosis: A Case Series of Adult Patients.

Injury to the head and neck resulting from whiplash trauma can result in upper cervical instability (UCIS), in which excessive movement at C1 on C2 is observed radiologically. In some cases of UCIS there is also a loss of normal cervical lordosis. We postulate that improvement or restoration of the normal mid to lower cervical lordosis in patients with UCIS can improve the biomechanical function of the upper cervical spine, and thus potentially improve symptoms and radiographic findings associated with UCIS. Nine patients with both radiographically confirmed UCIS and loss of cervical lordosis underwent a chiropractic treatment regimen directed primarily at the restoration of the normal cervical lordotic curve. In all nine cases, significant improvements in radiographic indicators of both cervical lordosis and UCIS were observed, along with symptomatic and functional improvement. Statistical analysis of the radiographic data revealed a significant correlation (R2 = 0.46, p = 0.04) between improved cervical lordosis and reduction in measurable instability, determined by C1 lateral mass overhang on C2 with lateral flexion. These observations suggest that enhancing cervical lordosis can contribute to improvement in signs and symptoms of upper cervical instability secondary to traumatic injury.

Pedestrian Deaths During the COVID-19 Pandemic.

The COVID pandemic provides a natural experiment examining how a 50-60% reduction in pedestrian activity might lead to a reduction in pedestrian deaths. We assessed whether the reduction in pedestrian deaths was proportional to a one-to-one matching presumed in statistics correlating mobility with fatality. The primary analysis examined New York (largest city in US), and the validation analysis examined Toronto (largest city in Canada). We identified pedestrian activity in each location from the Apple Mobility database, normalized to the baseline in January 2020. We calculated monthly pedestrian deaths from the Vision Zero database in each city with baseline data from 3 prior years. We found a large initial reduction in pedestrian deaths during the lockdown in New York that was transient and not statistically significant during the summer and autumn despite sustained reductions in pedestrian activity. Similarly, we found a large initial reduction in pedestrian deaths during the lockdown in Toronto that was transient and not sustained. Together, these data suggest the substantial reductions in pedestrian activity during the COVID pandemic have no simple correlation with pedestrian fatality counts in the same locations. An awareness of this finding emphasizes the role of unmeasured modifiable individual factors beyond pedestrian infrastructure or other structural contributors.

Fatal Motor Vehicle Crashes in Upstate and Long Island New York: The Impact of High Visibility Seat Belt Enforcement on Multiple Risky Driving Behaviors.

Despite an observed daytime front-seat seat belt use that exceeds 90%, nearly half of motor vehicle occupants who die in New York State (NYS) each year are not wearing a seat belt. Crash outcomes were examined by occupant, vehicle, environmental and traffic enforcement patterns related to the annual Click It or Ticket high visibility seat belt enforcement campaign. Three periods of enforcement were examined: pre-enforcement, peri-enforcement (during/immediately after), and post-enforcement. Of the 14.4 million traffic citations, 713,990 (5.0%) were seat belt violations. Relative risk with 95% CI was assessed using deaths from the Fatality Analysis Reporting System (FARS) and SAS Glimmix 9.4 software. Mortality was lower peri-enforcement (32.9%) compared to pre- (40.9%) or post-enforcement (37.1%) (p < 0.001) and tended to be elevated in low enforcement response areas (43.6%). Fatalities were 30% lower (0.7, 95% CI 0.6−0.9) during peri-enforcement in models adjusted for demographics, law coverage, enforcement response, rural, weekend, impairment, speeding, and vehicle type. Adjusted mortality was higher in rural (1.9, 1.6−2.6), alcohol-involved (1.8, 1.4−2.9), and speeding-involved (2.0, 1.7−2.5) crashes. Peri-enforcement alcohol- and speed-involved fatalities tended to be lower in restrained, unrestrained and occupants missing belt status. The finding of lower mortality in both belted and unbelted occupant's peri-enforcement­in the context of fewer fatal speed and alcohol-involved crashes­suggests that the mechanism(s) through which high visibility seat belt enforcement lowers mortality is through impacting multiple risky driving behaviors.

The Impact of Flame Burn Injuries on Patients Who Sustain Mild Injuries From Motor Vehicle Crashes.

BACKGROUND: The purpose of this study was to determine the differences in patient outcomes between motor vehicle crash (MVC) victims with an ISS < 15 and those with a similar ISS and a flame burn injury. METHODS: Data for patients involved in a MVC with a GCS ≥12 and an ISS < 15 with and without flame burn injury were reviewed from the American College of Surgeons National Trauma Data Bank between 2007 and 2017. International Classification of Diseases-9 and -10 revisions and External Injury Codes were used to identify patients who were divided into MVC only (Group 1) and MVC with additional flame burn injury (Group 2). In-hospital mortality was the primary outcome whereas secondary outcomes included ICU admission, ICU length of stay (LOS), hospital LOS, sepsis, deep vein thrombosis, acute respiratory distress syndrome, and pneumonia. Simple linear regression was used in the form of odds ratios to investigate risk factors for mortality and secondary outcomes. RESULTS: The mean LOS and ICU LOS were longer in Group 2 (5.9 vs 4.0 days, p-value <0.001, and 1.2 vs 0.6 days, p-value <0.001, respectively), with more patients being admitted to the ICU as well (22.9% vs 17.3%, p-value <0.001). Also, there were significantly higher rates of pneumonia (0.8% vs 0.5%, p-value 0.0014), deep vein thrombosis (0.6% vs 0.4%, p-value 0.028), and acute respiratory distress syndrome (0.5% vs 0.3%, p-value 0.004) in Group 2. Patients in Group 1 were older and more likely had hypertension, congestive heart failure, and COPD. There was no significant difference in mortality between Groups by odds ratios (OR 0.85, p-value 0.743) or raw percentages (0.3% vs 0.3%, p-value = 0.874). CONCLUSION: MVC victims with mild injuries who also sustain a burn injury are more likely to require admission to the ICU regardless of their comorbidities and more likely to develop respiratory complications, especially pneumonia and an increase in ICU and hospital LOS.

Traffic crash changes following transitions between daylight saving time and standard time in the United States: New evidence for public policy making.

INTRODUCTION: This study examined the impact of daylight saving time changes on traffic crashes in the United States. Using a data-driven regression analysis approach, the study analyzed 2014-2016 crash data from six states spanning all four major time zones in the contiguous United States. METHOD: The researchers developed regression models for a number of analysis scenarios and by days of week separately. Based on the crash data, the team used an eight-week impact period for the spring time change and a four-week impact period for the fall time change. RESULTS: The regression analysis showed that the spring time change was followed by an overall crash reduction of 18% during the eight-week period immediately after the time change, with a considerably higher crash reduction for freeway crashes (24%), rural crashes (24%), or non-intersection crashes (21%). The time change back to SDT in fall was followed by a 6% overall crash increase during the following four weeks, with considerably higher increases for freeway crashes (15%), non-intersection crashes (9%), nighttime crashes (28%), single-vehicle crashes (28%), and crashes in urban areas (12%). This study provides additional insights, including in many cases more comprehensive knowledge on how the changes to and from DST each year affect roadway traffic crashes. PRACTICAL APPLICATIONS: The findings of this project further add to the current understanding on how the time changes affect public health in the form of traffic crashes. They also serve as additional evidence for public policy makers to better weigh the benefits and impacts associated with the time changes in the United States for relevant policy makings.