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BACKGROUND: Unintentional injuries are a leading cause of death among children aged 1-19 years worldwide. Systematic reviews assessing various risk factors for different childhood injuries have been published previously. However, most of the related literature does not distinguish minor from severe or fatal injuries. This study aims to describe and summarize the current knowledge on the determinants of severe and fatal childhood unintentional injuries and to discuss the differences between risk factors for all injuries (including minor injuries) and severe and fatal injuries. The study also aims to quantify the reduction in childhood injuries associated with a reduction in exposure to some of the identified risk factors in the Canadian population. METHODS: A systematic review and meta-analysis will be conducted by searching MEDLINE, Embase, CINAHL, and Web of Science. Observational and experimental cohort studies assessing children and adolescents aged ≤ 19 years old and determinants of severe and fatal unintentional injury, such as personal behaviors, family and environmental characteristics, and socioeconomic and geographic context, will be eligible. The main outcome will be a composite of any severe or fatal unintentional injuries (including burns, drowning, transport-related injuries, and falls). Any severity measurement scale will be accepted as long as severe cases require at least one hospital admission. Two authors will independently screen for inclusion, extract data, and assess the quality of the data using the Cochrane ROBINS-E tool. Meta-analysis will be performed using random effects models. Subgroup analyses will examine age subgroups and high- vs low-income countries. Sensitivity analysis will be conducted after restricting analyses to studies with a low risk of bias. Attributable fractions will be computed to assess the burden of identified risk factors in the Canadian population. DISCUSSION: Given the numerous determinants of childhood injuries and the challenges that may be involved in identifying which individuals should be prioritized for injury prevention efforts, this evidence may help to inform the identification of high-risk children and prevention interventions, considering the disproportionate consequences of severe and fatal injuries. This evidence may also help pediatric healthcare providers prioritize counseling messaging. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023493322.
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Revisiones Sistemáticas como Asunto , Heridas y Lesiones , Humanos , Niño , Factores de Riesgo , Heridas y Lesiones/mortalidad , Canadá/epidemiología , Adolescente , Lesiones Accidentales/mortalidad , Preescolar , LactanteRESUMEN
Background and Objectives: Accidental home injuries among older adults are increasing globally, but reporting is limited. This study aims to establish foundational data for program development and policies to prevent accidental injuries at home in older adults by using data on the occurrence of accidental injuries at home and analyzing the risk factors of mortality due to accidental injuries among adults aged 65 years and older. Materials and Methods: This retrospective study used data from the community-based Severe Trauma Survey in South Korea. This study identified general, injury-related, and treatment-related characteristics of older adults who were transported to the emergency department with accidental injuries at home. Single-variable and multiple logistic regression analyses were used to identify risk factors for mortality after injury. Results: The majority of older adults in this study who experienced accidental injuries at home were aged 75 to 84 (42.8%) and female (52.8%), with 1465 injured from falls and slips (68.0%). Risk factors for mortality included older age (≥85 years) (ORs 2.25, 95% CI 1.47-3.45), male sex (ORs 1.60, 95% CI 1.15-2.20), mechanism of injury (falls or slips vs. contact injury, ORs 6.76, 95% CI 3.39-13.47; airway obstruction vs. contact injury, ORs 13.96, 95% CI 6.35-30.71), higher severity (moderate vs. mild, ORs 2.56, 95% CI 1.45-4.54; severe vs. mild, ORs 12.24, 95% CI 6.48-23.12; very severe vs. mild, ORs 67.95, 95% CI 38.86-118.81), and receiving a blood transfusion (ORs 2.14, 95% CI 1.24-3.67). Conclusions: Based on these findings, the home and community environments where older adults live should be inspected and monitored, and in-home accidental injury prevention strategies should be developed tailored to the characteristics of older adults' risk factors and their injury-related characteristics.
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Lesiones Accidentales , Humanos , República de Corea/epidemiología , Masculino , Estudios Retrospectivos , Femenino , Anciano , Factores de Riesgo , Anciano de 80 o más Años , Lesiones Accidentales/epidemiología , Lesiones Accidentales/mortalidad , Accidentes Domésticos/estadística & datos numéricos , Accidentes Domésticos/mortalidad , Estudios de Cohortes , Accidentes por Caídas/estadística & datos numéricos , Accidentes por Caídas/mortalidad , Modelos LogísticosRESUMEN
INTRODUCTION: Crossbow injuries are rare but carry significant morbidity and mortality, and there is limited evidence in the medical literature to guide care. This paper reviews the case reports and case series of crossbow injuries and looks for trends regarding morbidity and mortality based on the type of arrow, anatomic location of injury, and intent of injury. METHODS: Multiple databases were searched for cases of crossbow injuries and data were abstracted into a spreadsheet. Statistics were done in SPSS. RESULTS: 358 manuscripts were returned in the search. After deduplication and removal of nonclinical articles, 101 manuscripts remained. Seventy-one articles describing 90 incidents met the inclusion criteria. The mean age was 36.5 years. There were 10 female and 79 male victims. Fatality was 36% for injuries by field tip arrows and 71% for broadhead arrows, p = .024. Assaults were fatal in 84% of cases, suicides in 29%, and accidental injuries in 17%, p < .001. Mortality was similar for wounds to the head and neck (41%), chest (42%), abdomen (33%), extremities (50%), and multiple regions, p = .618. CONCLUSIONS: Crossbows are potentially lethal weapons sold with fewer restrictions than firearms. Injuries caused by broadhead arrows are more likely to be fatal than injuries from field tip arrows. The anatomic location of injury does not correlate with fatality. More than half of crossbow injuries are due to attempted suicide, with a high case-fatality rate.
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Armas , Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Adulto Joven , Armas/estadística & datos numéricos , Adolescente , Lesiones Accidentales/mortalidad , Lesiones Accidentales/epidemiologíaRESUMEN
OBJECTIVES: To characterise unintentional injury-related hospitalisation and mortality amongst older adults (aged 50+ years) in the Lakes and Bay of Plenty District Health Boards of Aotearoa New Zealand and to examine whether hospitalisation patterns differed by ethnicity. METHODS: This observational study analysed unintentional injury-related hospitalisations and deaths among older adults between 2014 and 2018. Routinely collected national data sets were used to calculate annualised, age-standardised injury rates. The independent variable of interest was ethnicity (Maori or non-Maori). RESULTS: There were 11,834 unintentional injury-related hospitalisations in the study period (n = 1444 for Maori). Overall, there was no significant difference in the age-standardised hospitalisation rate between Maori and non-Maori (Standardised Rate Ratio [SRR] = 0.96 [95% CI 0.90, 1.02]). Falls were the most common mechanism of injury among Maori and non-Maori overall (50% and 71%) and relative risks of falls increased with age. Non-Maori were 57% less likely to be hospitalised for unintentional poisoning than Maori (SRR = 0.43, [0.34, 0.59]). CONCLUSIONS: The mechanisms of injury, and variation in unintentional injury-related hospitalisation rates between Maori and non-Maori, change throughout older age, and incidence increase0073 with age. Falls cause significant injury-related hospitalisations for older Maori and responsive injury prevention and rehabilitation efforts are warranted to achieve equitable health outcomes.
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Hospitalización , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Accidentes por Caídas/estadística & datos numéricos , Lesiones Accidentales/mortalidad , Lesiones Accidentales/etnología , Factores de Edad , Causas de Muerte , Hospitalización/estadística & datos numéricos , Nueva Zelanda/epidemiología , Factores de Riesgo , Heridas y Lesiones/mortalidad , Heridas y Lesiones/etnología , Pueblo MaoríRESUMEN
BACKGROUND: The aim of this study was to evaluate the performance of the Sequential Organ Failure Assessment (SOFA) score and the newly introduced criteria, traumasis, defined as a SOFA score 2 or more among trauma patients. METHODS: Consecutive adult traffic collision patients who were admitted to the study hospital emergency department (ED) from January 2017 to December 2018 were enrolled retrospectively in the study. The primary outcome was in-hospital death. The SOFA score was calculated using relevant initial ED data. Traditional risk scores for trauma patients, such as the injury severity score (ISS), the revised trauma score (RTS), and the trauma injury severity score (TRISS), were also calculated. RESULTS: A total of 927 patients were available for analysis, of whom 46 died (5.0%). The median SOFA score was 1.0 (interquartile range [IQR], 0.0-3.0). A total of 417 patients (45.0%) were identified as having traumasis (SOFA score ≥ 2), of whom 44 died (10.6%). The area under the receiver operating characteristic (AUROC) curve of the SOFA score (0.91; 95% confidence interval [CI] 0.87-0.95) was comparable with that of the TRISS (0.88; 95% CI, 0.84-0.93) and better than that of the ISS(0.81; 95% CI 0.75-0.86) and the RTS (0.82; 95% CI 0.75-0.90). The sensitivity, specificity, positive predictive value and negative predictive value of the traumasis criteria for the primary outcome were 95.7%, 63.0%, 11.9%, and 99.6%, respectively. The net reclassification improvement for the comparison between the traumasis criteria and major trauma criteria (ISS ≥ 15) was 0.69 (95% CI, 0.55-0.82; p < 0.001). The multivariate Cox regression model showed that the SOFA score (adjusted hazard ratio [aHR] 1.52; 95% CI 1.37-1.67) and traumasis (aHR 11.40; 95% CI 2.70-48.13), respectively, was independently associated with higher in-hospital mortality. CONCLUSION: The SOFA score can be used as a reliable tool for predicting in-hospital death among traffic collision patients. The newly introduced criteria, traumasis, may be used as a risk-stratification and quality-control criteria among patients with trauma, similar to the sepsis criteria among patients with infectious disease.
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Lesiones Accidentales/diagnóstico , Insuficiencia Multiorgánica/diagnóstico , Puntuaciones en la Disfunción de Órganos , Lesiones Accidentales/mortalidad , Adulto , Anciano , Área Bajo la Curva , Femenino , Mortalidad Hospitalaria , Hospitalización , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Insuficiencia Multiorgánica/mortalidad , Modelos de Riesgos Proporcionales , Curva ROC , Estudios Retrospectivos , Factores de Riesgo , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: Convertible cars have existed since among the first automobiles, and the lack of substantial roof structure creates some safety concerns. Though crash tests have demonstrated that convertibles can resist excessive intrusion in front and side crashes and that strong A-pillars and roll bars can help maintain survival space in rollovers, little work has been done examining the real-world crash experience of these vehicles. The objective of this study was to compare the crash experience of recent convertibles with nonconvertible versions of the same cars using the most recent crash data. METHODS: Crash and exposure data were obtained from the U.S. Department of Transportation and IHS Markit, respectively. Rates of driver deaths and police-reported crash involvements were compared for 1- to 5-year-old convertible cars and their nonconvertible versions during 2014-2018. Exposure measures included registered vehicle years (RVY) and vehicle miles traveled (VMT). These rates were compared using the standardized mortality ratio to account for possible differences in exposure distribution. Crash circumstances (e.g., point of impact, rollover, ejection) and behavioral outcomes (e.g., speeding, alcohol impairment, seat belt use) were compared for drivers killed in crashes. RESULTS: Convertibles had lower driver death rates and police-reported crash involvement rates on the basis of both RVY and VMT. However, the differences in driver death rates were not statistically significant. Driver deaths per 10 billion VMT were 11% lower for convertibles, and driver involvement in police-reported crashes per 10 million VMT was 6% lower. On average, convertibles were driven 1,595 fewer miles per year than the nonconvertible versions of these cars. Among fatally injured drivers, convertibles had slightly higher rates of ejection, and behavioral differences were minimal. The number of rollovers was small and their rate did not substantially differ between convertibles and their nonconvertible versions. CONCLUSIONS: Safety concerns associated with convertibles' retractable roof structures were not supported by the results of this study.
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Lesiones Accidentales/mortalidad , Accidentes de Tránsito/mortalidad , Automóviles/estadística & datos numéricos , Cinturones de Seguridad/estadística & datos numéricos , Viaje/estadística & datos numéricos , Lesiones Accidentales/prevención & control , Accidentes de Tránsito/prevención & control , Preescolar , Seguridad de Productos para el Consumidor/normas , Humanos , Lactante , Policia , Medición de Riesgo , Estados UnidosRESUMEN
PURPOSE: This research examined road traffic injury mortality and morbidity disparities across of country development status, and discussed the possibility of reducing country disparities by various actions to accelerate the pace of achieving Sustainable Development Goals target 3.6 - to halve the number of global deaths and injuries from road traffic accidents by 2020. METHODS: Data for road traffic mortality, morbidity, and socio-demographic index (SDI) were extracted by country from the estimates of the Global Burden of Disease study, and the implementation of the three types of national actions (legislation, prioritized vehicle safety standards, and trauma-related post-crash care service) were extracted from the Global Status Report on Road Safety by World Health Organization. We fitted joinpoint regression analysis to identify and quantify the significant rate changes from 2011 to 2017. RESULTS: Age-adjusted road traffic mortality decreased substantially for all the five SDI categories from 2011 to 2017 (by 7.52%-16.08%). Age-adjusted road traffic mortality decreased significantly as SDI increased in the study time period, while age-adjusted morbidity generally increased as SDI increased. Subgroup analysis by road user yielded similar results, but with two major differences during the study period of 2011 to 2017: (1) pedestrians in the high SDI countries experienced the lowest mortality (1.68-1.90 per 100,000 population) and morbidity (110.45-112.72 per 100,000 population for incidence and 487.48-491.24 per 100,000 population for prevalence), and (2) motor vehicle occupants in the high SDI countries had the lowest mortality (4.07-4.50 per 100,000 population) but the highest morbidity (428.74-467.78 per 100,000 population for incidence and 1025.70-1116.60 per 100,000 population for prevalence). Implementation of the three types of national actions remained nearly unchanged in all five SDI categories from 2011 to 2017 and was consistently stronger in the higher SDI countries than in the lower SDI countries. Lower income nations comprise the heaviest burden of global road traffic injuries and deaths. CONCLUSION: Global road traffic deaths would decrease substantially if the large mortality disparities across country development status were reduced through full implementation of proven national actions including legislation and law enforcement, prioritized vehicle safety standards and trauma-related post-crash care services.
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Lesiones Accidentales/epidemiología , Lesiones Accidentales/mortalidad , Accidentes de Tránsito/estadística & datos numéricos , Países en Desarrollo/estadística & datos numéricos , Peatones/estadística & datos numéricos , Desarrollo Sostenible , Lesiones Accidentales/prevención & control , Accidentes de Tránsito/legislación & jurisprudencia , Accidentes de Tránsito/prevención & control , Humanos , Incidencia , Renta/estadística & datos numéricos , Morbilidad , Prevalencia , Factores Socioeconómicos , Desarrollo Sostenible/tendencias , Factores de TiempoRESUMEN
PURPOSE: Trauma has been called the neglected disease of modern society. According to WHO, fall is the second major cause of trauma or deaths resulting from unintentional accidents. The aim of this study was to investigate the different types of fall according to International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) in hospitalized patients visiting specialized accident and trauma hospitals of Mashhad, Iran. METHODS: This was a cross sectional retrospective study performed between March 20, 2013 and March 20, 2014. The research population consisted of all medical records of patients for fall injuries in three specialized accident and trauma hospitals. ICD-10 was adopted to categorize all types of falls (w00-w19). The results obtained were analyzed by SPSS 16. RESULTS: Altogether 7,448 cases were included. The codes w18 (fall on same level) and w09 (fall involving playground equipment) with the frequencies of 1,856 and 1,303, respectively in both genders had the maximum number of falls. The maximum percentage of mortality has been related to "fall on and from ladder"," fall from cliff "and "fall on same level involving ice and snow". CONCLUSION: As falls can cause irrecoverable injuries including mortality of people, thus health authorities and policymakers should take preventive measures given the causes of falls and the root of this type of injuries, so that the costs resulting from this cause and its injuries can be reduced.
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Accidentes por Caídas/prevención & control , Accidentes por Caídas/estadística & datos numéricos , Lesiones Accidentales/epidemiología , Lesiones Accidentales/etiología , Hospitalización/estadística & datos numéricos , Accidentes por Caídas/mortalidad , Lesiones Accidentales/mortalidad , Adolescente , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Clasificación Internacional de Enfermedades , Irán/epidemiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
As lethal events associated with wheelchair use are poorly reported in the literature, a search was undertaken of the Forensic Science South Australia (FSSA), Australia, autopsy database over a 20-year period for all cases where individuals who were wheelchair bound were found dead either in or beside their chairs. There were 16 cases, ranging in age from 30 to 92 years (M = 58.6 years) and with a male-to-female ratio of 9:7. There were six accidents that involved burns, asphyxia, a fall and impact with a vehicle; three suicides that involved drowning and asphyxia; a single homicide involving drowning; a single undetermined case; and five cases due to medical conditions such as cerebral palsy with choking, ischaemic heart disease and pulmonary thromboembolism. Individuals who use wheelchairs may die from a wide variety of both unnatural and natural causes. Wheelchair users may be predisposed to specific types of accidents because of significant underlying physical impairment or serious diseases that may limit their ability either to move away from danger or to perform self-rescues. Morbidity and mortality associated with underlying medical conditions may be contributed to by the structure, stability and motility of wheelchairs.
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Lesiones Accidentales/mortalidad , Personas con Discapacidad , Suicidio , Silla de Ruedas , Adulto , Anciano , Anciano de 80 o más Años , Causas de Muerte , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Parked vehicles can create deadly environments for young children who are left unattended. This study was a descriptive analysis to describe circumstances leading to death in children left unattended in parked motor vehicles in India. Between 2011 and 2018, there were 16 incidents that resulted in 28 fatalities across India, mostly in the summer months. The majority of children (19/28) were aged 4-6 years, of whom 25 (89%) gained access to unattended vehicles and became accidentally locked in. Hyperthermia-related deaths are a poorly recognised type of vehicular injury in India; there has been no analysis to describe circumstances leading to such fatalities.
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Lesiones Accidentales/mortalidad , Hipertermia/mortalidad , Vehículos a Motor/estadística & datos numéricos , Niño , Preescolar , Femenino , Humanos , India/epidemiología , Lactante , Masculino , Persona de Mediana Edad , Estaciones del AñoRESUMEN
PURPOSE: To determine the trends with fatally or otherwise injured pedestrians lying on the road and the relationship to hit-and-run incidents in Japan. METHODS: We extracted data for 2012-2016 from the records of the Institute for Traffic Accident Research and Data Analysis, Japan, a nationwide traffic accident database. All the injured and fatally injured pedestrians were selected. We examined the levels of pedestrian injury, vehicle speed immediately before the collision, whether or not the pedestrian was lying on the road, and hit-and-run incidents. Chi-square test was employed to make a statistical comparison between the two groups. RESULTS: The database contained data on 286,383 pedestrian casualties and 7256 fatalities; 8.3% of fatalities (602 persons) and 0.6% of casualties (1827 persons) involved pedestrians lying on the road. The rates of fatalities and severe injuries were significantly higher for pedestrians who were lying on the road than for those who were not. Hit-and-run incidents were evident in 4.0% of casualties and 7.3% of fatalities. The rate of hit-and-run cases was also significantly higher among pedestrians who were lying on the road. Among fatally injured pedestrians not lying on the road, the rates with speeds of ≥30 km/h did not differ significantly between hit-and-run and other cases. However, when the pedestrians were lying on the road, the rate was significantly increased in hit-and-run cases. CONCLUSION: This is the first report to focus on pedestrians lying on the road and being involved in hit-and-run incidents. In addition to preventing hit-and-run incidents, prevention of pedestrians lying on the road could also decrease fatalities.
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Lesiones Accidentales/epidemiología , Lesiones Accidentales/etiología , Accidentes de Tránsito/legislación & jurisprudencia , Accidentes de Tránsito/estadística & datos numéricos , Víctimas de Crimen/estadística & datos numéricos , Bases de Datos Factuales , Peatones/estadística & datos numéricos , Postura , Lesiones Accidentales/mortalidad , Lesiones Accidentales/prevención & control , Accidentes de Tránsito/prevención & control , Adulto , Femenino , Humanos , Japón/epidemiología , Masculino , Factores de Tiempo , Índices de Gravedad del TraumaRESUMEN
INTRODUCTION: death from injuries is a global public health problem. Ninety percent occur in low- and middle-income countries like Nigeria. This study aimed to determine the burden and demographic characteristics of injury-related death in Enugu, Nigeria. METHODS: this is a retrospective study of injury-related deaths in Enugu over a 7-year period. Standardized forms were used to collect data from autopsy reports archived in the Forensic Unit of Enugu State University Teaching Hospital, Enugu and a descriptive analysis of collected data performed. RESULTS: of the Coroner deaths examined in the period reviewed, 1,067 (86.9%) were injury-related. The male-to-female ratio was 5.2: 1. Mean age of victims was 34.2 ± 14.3years and range was 8 months to 86 years. Most victims (56.7%) aged 21-40 years. Accidents accounted for most deaths (53.2%) followed by homicide (44.3%). Road traffic deaths (51.4%), cult/gang violence (20.8%) and robbery (14.7%) were the commonest. Suicide (0.5%) and domestic violence (0.7%) were the least. More females died in domestic incidents while more males died in all other circumstances. Firearm (56.7%) was the most common weapon followed by knife (19%). Knife and wood (28.7% each) were the commonest weapons in domestic violence. Generally, fatal incidents occurred more in the day-time (65.5%). Most robberies (80.4%) occurred at night. Most cult/gang killings (75.2%) and robberies (81.7%) occurred in public places and at homes respectively. CONCLUSION: injury is the highest source of Coroner's death in Enugu. Efforts to curb it are insufficient. A definitive policy on the prevention and management of injury-related deaths is needed.
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Lesiones Accidentales/epidemiología , Homicidio/estadística & datos numéricos , Suicidio/estadística & datos numéricos , Violencia/estadística & datos numéricos , Lesiones Accidentales/mortalidad , Accidentes de Tránsito/mortalidad , Accidentes de Tránsito/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Causas de Muerte , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Estudios Retrospectivos , Adulto JovenRESUMEN
PURPOSE: Motorcycle accident is a major cause of road traffic injuries and the motorcyclists are considered as vulnerable road users. The present study aimed to determine the epidemiological characteristics of fatal motorcycle crashes in Iran. METHODS: In this cross-sectional study, a total of 28,356 motorcycle traffic fatalities registered in the Legal Medicine Organization of Iran were analyzed during the period between March 2011 and March 2017. The examined variables included demographic characteristics, helmet use, crash mechanisms, crash location, position state, type of counterpart vehicle, cause of death and place of death. In the study, road traffic mortalities involving drivers and/or passenger of motorcycles were included. Cases or events registered without these conditions were excluded from the study. To analyse the data, SPSS statistics 25 and GraphPad Prism 8 softwares were used. RESULTS: Of the 122,682 fatal traffic injury cases, 28,356 (23.1%) were motorcycle users, of whom 95.3% were male and 4.7% were female. Most of the motorcycle fatalities belonged to the age group of 18-24 years (29.1%). Head trauma was the major cause of death (59.0%). Also, the overall proportion of safety helmet use among motorcycle crash victims was estimated at 37.4%. Most of the road traffic crash cases (46.8%) happened out of city and half of people (49.9%) died in hospital. About 77.4% of the victims were motorcycle riders and 21.1% were pillion passengers. The highest rate of mortality belonged to the self-employed (38.4%) and then workers (21.8%) and students (10.2%). In addition, most fatalities occurred in people with low education (77.5%) and the least occurred in university graduates (5.5%). Among 31 provinces of Iran, Fars had the highest (9.3%) occurrence rate and Kohgiluyeh and Buyer-Ahmad had the lowest (0.5%). Most of the crash mechanisms were due to motorcycle-vehicle crashes (80.2%), followed by rollover (9.8%). CONCLUSION: Comprehensive public education and special rules are needed to reduce the rate of deaths in motorcycle crashes.
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Lesiones Accidentales/epidemiología , Lesiones Accidentales/mortalidad , Accidentes de Tránsito/mortalidad , Accidentes de Tránsito/estadística & datos numéricos , Motocicletas , Lesiones Accidentales/prevención & control , Accidentes de Tránsito/prevención & control , Adolescente , Adulto , Niño , Estudios Transversales , Escolaridad , Femenino , Dispositivos de Protección de la Cabeza/estadística & datos numéricos , Educación en Salud , Humanos , Irán/epidemiología , Masculino , Persona de Mediana Edad , Sistema de Registros , Adulto JovenRESUMEN
BACKGROUND: The predictive value of platelet-to-lymphocyte ratio (PLR) in acute illness is well known, but further evaluation is needed in traffic accident patients. METHODS: This retrospective observational study enrolled consecutive adult patients involved in traffic accidents who were admitted to the study hospital's emergency department during 1 year. The initial platelet and lymphocyte counts after arrival at the emergency department were the variables of interest. The primary outcome was in-hospital mortality. Data on baseline characteristics, comorbidities, and physiological and laboratory variables were collected. Multivariate Cox proportional hazard modelings were used to identify the variables independently associated with the outcome. RESULTS: A total of 1,522 traffic accident patient were screened, and 488 patients were enrolled. In all, 43 (8.8%) patients died in the hospital. The median PLR was 115.3 (interquartile range 71.3;181.8). The in-hospital mortality rate of the 1st tertile of PLR (21.5%) was significantly higher than the rates of the 2nd (2.5%) and 3rd (2.5%) tertiles. The area under the receiver operating characteristic curve of PLR for in-hospital survival was 0.82 (95% confidential interval [CI], 0.74-0.89), which was greater than that of lymphocyte count (0.72; 95% CI 0.63-0.81) and platelet count (0.67; 95% CI 0.57-0.76). The Kaplan-Meier curves showed a significant difference in survival between the tertiles (p<0.001). The Cox regression model showed that the 2nd tertile of PLR was independently associated with lower in-hospital mortality (adjusted hazard ratio 0.30; 95% CI, 0.09-0.98), compared to the 1st tertile. CONCLUSION: PLR was significantly associated with an increased risk of in-hospital mortality in admitted adult traffic accident patients.
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Lesiones Accidentales/sangre , Accidentes de Tránsito/estadística & datos numéricos , Mortalidad Hospitalaria , Lesiones Accidentales/etiología , Lesiones Accidentales/mortalidad , Anciano , Femenino , Humanos , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Recuento de PlaquetasRESUMEN
PURPOSE: Road traffic accidents (RTAs) are a public health issue and cost a lot to individuals, families, communities and nations. Trauma care systems in India are at a nascent stage of development. There is gross disparity between trauma services available in various parts of the country. Rural area in India has inefficient services for trauma care, due to the varied topography, financial constraints, and lack of appropriate health infrastructure. The present study is to study the trends of occurrence of RTA cases by month, week and time of accident occurrence as well as to research the types of vehicle involved in accidents and other various risk factors related to them. METHODS: During 1st January 2017 to 31st December 2017, a hospital-based and cross-sectional study of RTA victims was conducted. The patients were admitted in emergency department of Uttar Pradesh University of Medical Sciences, Saifai, Etawah, when stabilized, they were shifted to the orthopaedics and surgery ward. RESULTS: In the study, 654 road accident victims were included, of which the majority were males (77.5%) and the most of them belonged to rural (67%). RTA victims according to the month of occurrence majority were found in January (12.5%) and evening was time of a day with maximum accidents (32.1%). Mortality cases of RTA victims based on type of road user and it shows decreasing trend of mortality of motorcyclists (54.2%) followed by pedestrian (25.1%). CONCLUSION: There should be control over people driving vehicles under the influence of alcohol and drivers over-speeding and rash driving on urban roads as well as rural village roads.
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Lesiones Accidentales/epidemiología , Accidentes de Tránsito/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Centros de Atención Terciaria/estadística & datos numéricos , Lesiones Accidentales/mortalidad , Lesiones Accidentales/prevención & control , Accidentes de Tránsito/prevención & control , Adolescente , Adulto , Conducción de Automóvil , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Estaciones del Año , Tiempo , Adulto JovenRESUMEN
BACKGROUND: Spatial disorientation, poor situational awareness, and aerodynamic stalls are often causal/contributory to general aviation accidents. To mitigate against the occurrence of these mishaps Cirrus Aircraft has, since 2002, introduced advanced avionics into their piston airplanes (Cirrus SR20/22). These airplanes are also certificated to more rigorous crashworthiness tests than legacy aircraft approved prior to these standards being codified. Herein, using for comparison two legacy aircraft fleets manufactured prior to 2002, we determined whether a reduced mishap rate for all accidents or relating to the aforementioned causes/contributing factors and/or diminished injury severity for survivable accidents were evident for Cirrus SR20/22 airplanes.METHODS: Accidents (2008-2017) involving Cirrus SR20/22 airplanes (manufactured 2002 or later) and Beechcraft 35/36 (Bonanza) and Mooney 20 models (both manufactured no later than 2001) (14CFR Part 91 rules) were identified (N = 136, 259, 164, respectively) from the NTSB database. Statistical analyses used Poisson distribution/contingency tables/ t- and Mann-Whitney tests.RESULTS: For each year within the 2013-2017 timespan the Cirrus SR20/22 all-accident rate was diminished 39-75% relative to both legacy fleets. Temporally, the fraction of fatal Cirrus SR20/22 accidents, initially higher, declined 50% achieving a lower, or comparable, proportion to the two legacy airframes. Fatal accident rates involving spatial disorientation/situational awareness/aerodynamic stalls were > 80% lower for Cirrus SR20/22 airplanes. For survivable mishaps, Cirrus SR20/22 aircraft showed a lower proportion (0.13 compared with 0.20-0.35) of fatal/serious injuries.CONCLUSION: Toward improving legacy aircraft safety, owners should be encouraged to upgrade their avionics for mitigating against the occurrence of such human-factor-related mishaps and install airbags to minimize injury severity.Boyd DD, Howell C. Accident rates, causes, and occupant injury involving high-performance general aviation aircraft. Aerosp Med Hum Perform. 2020; 91(5):387-393.
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Lesiones Accidentales , Accidentes de Aviación/estadística & datos numéricos , Aeronaves/estadística & datos numéricos , Lesiones Accidentales/epidemiología , Lesiones Accidentales/mortalidad , HumanosRESUMEN
The automatic emergency braking (AEB) system is an effective intelligent vehicle active safety system for avoiding certain types of collisions. This study develops a national-level safety impact evaluation model for this intelligent vehicle function, including the potential maximum impact and realistic impact. The evaluation model was firstly applied in China to provide insights into Chinese policymaking. Road traffic fatality and severe injury trends, the proportion of different collision types, the effectiveness of collision avoidance, and the AEB market penetration rates are considered in the potential maximum impact scenario. Furthermore, the AEB activation rate and the technology's technical limitations, including its effectiveness in different weather, light, and speed conditions, are discussed in the realistic scenario. With a 100% market penetration rate, fatalities could be reduced by 13.2%, and injuries could be reduced by 9.1%. Based on China's policy, the market penetration rate of intelligent vehicles with AEB is predicted to be 34.0% in 2025 and 60.3% in 2030. With this large market penetration rate increase of AEB, the reductions in fatalities and severe injuries are 903-2309 and 2025-5055 in 2025; and 1483-3789 and 3895-7835 in 2030, respectively. Considering AEB's activation rate and its three main limitations, the adjusted realistic result is approximately 2/5 of the potential maximum result.
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Lesiones Accidentales/prevención & control , Accidentes de Tránsito/prevención & control , Automatización , Conducción de Automóvil , Desaceleración , Equipos de Seguridad , Lesiones Accidentales/mortalidad , Accidentes de Tránsito/mortalidad , Humanos , Formulación de Políticas , Tiempo (Meteorología)RESUMEN
Importance: Previous studies have suggested that patients with cancer may be at an increased risk of death from unintentional injury, but to our knowledge, no large studies have examined the rates of death from unintentional injury among patients with cancer. Objective: To characterize the incidence of death from unintentional injury among patients with cancer in the United States. Design, Setting, and Participants: This retrospective cohort study included patients diagnosed with a first primary cancer between January 1, 1973, and December 31, 2015, identified from the Surveillance, Epidemiology, and End Results (SEER) program data. Comparisons with the general US population were based on mortality data collected by the National Center for Health Statistics. Analyses were performed from February 1, 2019, to August 15, 2019. Main Outcomes and Measures: Rates and standardized mortality ratios (SMRs) of death from unintentional injury among patients with cancer. Results: A total of 8â¯271â¯020 patients with cancer were included in this study (50.2% female; mean [SD] age, 63.0 [15.7] years). Among them, 40â¯599 deaths from unintentional injury were identified. The rates of death from unintentional injury were 81.90 per 100â¯000 person-years among patients with cancer and 51.21 per 100â¯000 person-years in the corresponding US general population. The SMR of death from unintentional injury was 1.60 (95% CI, 1.58-1.61). Higher rates of death from unintentional injury were associated with increasing age at diagnosis (≥80 years; rate ratio [RR], 2.91; 95% CI, 2.84-2.98; P < .001), male sex (RR, 1.69; 95% CI, 1.66-1.73; P < .001), American Indian or Alaskan Native population (RR, 1.48; 95% CI, 1.30-1.68; P < .001), and being unmarried (RR, 1.23; 95% CI, 1.18-1.28; P < .001). Rates of death from unintentional injury were the highest in patients with cancers of the liver (200.37 per 100â¯000 person-years), brain (175.04 per 100â¯000 person-years), larynx (148.78 per 100â¯000 person-years), and esophagus (144.98 per 100â¯000 person-years). The SMRs were the highest in the first month after cancer diagnosis. Conclusions and Relevance: This study found that the incidence of death from unintentional injury among patients with cancer was significantly higher than that in the general population in the United States. The rates of death from unintentional injury varied by age, sex, race/ethnicity, marital status, cancer site, disease stage, and time since diagnosis. The findings suggest that death from unintentional injury among patients with cancer requires further attention and that initiatives to identify patients at risk and to develop targeted prevention strategies should be prioritized.
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Lesiones Accidentales/complicaciones , Lesiones Accidentales/mortalidad , Neoplasias/complicaciones , Neoplasias/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Estados Unidos/epidemiología , Adulto JovenRESUMEN
Unintentional injuries pose a great risk for human health in China. Few studies have focused on unintentional injuries at national level from urbanization perspective. The panel data of mortality rate of transportation accidents (TA), fall and drowning and sinking (DS) is investigated, and urbanization development index is collected. Global Moran's I and linear regression of panel data are applied to determine the spatial distribution and spatial influencing factors of unintentional injuries. The results are the following: (1) The unintentional injury such as TA, fall, and DS shows clear non-uniformity of spatial distribution and relative immobility through time. (2) A 10,000 tons increase in SO2 emission amount (SO2 EA) and emission of smoke and dust (ESD) can result in 15.7 and 12.5 increases in TA death in eastern region, respectively. Meanwhile, A 10,000 tons increase in NOx emission amount can cause 15.1 increase in TA death in western region. For every 100 billion yuan increase in GDP, the fall death can reduce by 8.4 in central region. One bed increase in number of hospital beds per 10,000 population (NHBP) is favorable for decreasing in fall death by 16.7 in eastern region. However, increase in number of workers enjoying industrial injury (NEWII) does not reduce the fall death in eastern region. (3) For every 1 ten thousand people increase in number of students in ordinary high schools (NSOHS) is conductive to reducing DS death by 7.8 in the western region. Our findings show that there exist spatial differences for urbanization influencing TA, fall, and DS death in eastern, western, and central regions. This study is expected to provide a reference for unintentional injuries control in those three regions.