ProjectDRIVE: study protocol for a randomized controlled trial to improve driving practices of high-risk teen drivers with a traffic violation.

BACKGROUND: Teen drivers with a traffic violation are at increased risk for crashes and crash-related injuries; however, most parent-focused interventions target teen drivers with supervised learner's permits. Very few interventions are implemented at the probationary driver's license stage or target high-risk teen drivers, such as those with traffic violations. This paper describes the protocol of ProjectDRIVE, A Randomized Controlled Trial to Improve Driving Practices of High-Risk Teen Drivers with a Traffic Violation, which targets improving parent-teen communication about safe driving practices to reduce unsafe driving behaviors and traffic violation recidivism of teen drivers cited for traffic violation. METHODS: Teen drivers (ages 16 or 17) cited for a moving violation and the parent/legal guardian most involved with the teen's driving are recruited from juvenile traffic courts following their required court hearing. After completing informed consent/assent, enrolled dyads are randomized into one of three groups using stratified block randomization: control, device feedback only, or device feedback plus parent communication training. Participating dyads are followed for 6 months with 3 months of active intervention. Using in-vehicle device and smartphone application technology, the study provides real-time and cumulative driving feedback to intervention teens and collects continually recorded, objectively measured driving outcome data throughout the teen's study participation. Primary outcomes include rates of risky driving events and unsafe driving behaviors per 1000 miles driven. Secondary outcomes include traffic violation recidivism up to 12 months following study completion and frequency and quality of parent-teen communication about safe driving practices. DISCUSSION: Through partnership with the local juvenile traffic courts, this study integrates recruitment and randomization into existing court practices. Successfully completing this study will significantly impact juvenile traffic court's practices and policies by informing judges' decisions regarding the driving safety programs they refer to teens to prevent motor vehicle crashes and crash-related injuries and deaths. Trial registration The study was registered on ClinicalTrials.gov Registry (NCT04317664) on March 19, 2020, https://clinicaltrials.gov/study/NCT04317664 and updated on April 27, 2021. This protocol was developed per the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) Checklist.

Predictors of rural driver self-reported passing behaviors when interacting with farm equipment on the roadway.

Background: Crashes involving farm equipment (FE) are a major safety concern for farmers as well as all other users of the public road system in both rural and urban areas. These crashes often involve passenger vehicle drivers striking the farm equipment from behind or attempting to pass, but little is known about drivers' perceived norms and self-reported passing behaviors. The objective of this study is to examine factors influencing drivers' farm equipment passing frequencies and their perceptions about the passing behaviors of other drivers. Methods: Data were collected via intercept surveys with adult drivers at local gas stations in two small rural towns in Iowa. The survey asked drivers about their demographic information, frequency of passing farm equipment, and perceptions of other drivers' passing behavior in their community and state when approaching farm equipment (proximal and distal descriptive norms). A multinomial logistic regression model was used to estimate the relationship between descriptive norms and self-reported passing behavior. Results: Survey data from 201 adult drivers showed that only 10% of respondents considered farm equipment crashes to be a top road safety concern. Respondents who perceived others passing farm equipment frequently in their community were more likely to report that they also frequently pass farm equipment. The results also showed interactions between gender and experience operating farm equipment in terms of self-reported passing behavior. Conclusions/Implications: Results from this study suggest local and state-level norms and perceptions of those norms may be important targets for intervention to improve individual driving behaviors around farm equipment.

Rates and predictors of teen driver crash culpability.

BACKGROUND: Motor-vehicle crash risk is highest among teen drivers. Despite a wealth of research on the topic, there are still many contributors to these crashes that are not well understood. The current study sought to examine the contribution of graduated driver licensing (GDL) restrictions, sex, age, roadway circumstances, and citation history to teen drivers' crash culpability. METHOD: Crash system data from the Iowa Department of Transportation were linked with traffic-related charges from the Iowa Court Information System. Crashes involving teens aged 14 to 17 years between 2016 and 2019 were analyzed (N = 19,847). Culpability was determined using the driver contributing circumstances from the crash report. Moving and non-moving traffic citations issued prior to the date of each crash were considered. A multivariable logistic regression model was constructed to examine predictors of crash culpability. RESULTS: Teen drivers were determined to be culpable for more than two thirds of crashes (N = 13,604, 68.54%). Culpability was more prevalent among males, younger teens, in rural areas, in the presence of reported roadway contributing circumstances, during hours of restricted nighttime driving, and among teens with citation histories that included both moving and non-moving citations. Similarly, multivariable model results indicated that the likelihood of culpability was higher among males, in rural areas, and at each stage of GDL compared to teen drivers with unrestricted licenses. While drivers with a history of both moving and non-moving violations were more likely to be culpable, those with a history of only moving or only non-moving violations were less likely to be culpable compared to those with no violation history. CONCLUSION: Sex, crash location, and GDL stage were associated with teen driver crash culpability. A singular prior moving or non-moving violation may play a protective role in teen crash culpability.

Informing traffic enforcement leniency and discretion: Crash culpability and the effectiveness of written warnings versus citations.

OBJECTIVES: Deterrence of risky driving behavior is important for the prevention of crashes and injuries. Traffic law enforcement is a key strategy used to decrease risky driving, but there is little evidence on the deterrent effect of issuing warnings versus citations to drivers regarding the prevention of future crashes. The purpose of this study was to 1) investigate the difference between citations and written warnings in their association with future crash culpability and 2) investigate whether drivers who were issued written warnings or citations have different associations with future crash culpability likelihood than those without prior citations or written warnings. METHODS: Data for this study included Iowa Department of Transportation crash data for 2016 to 2019 linked to data from the Iowa Court Case Management System. A quasi-induced exposure method was used based on driver pairs involved in the same collision in which one driver was deemed culpable and one was non-culpable. Conditional logistic regression models were constructed to examine predictors of crash culpability. The main independent variable was traffic citation and warnings history categorized into moving warning, non-moving warning, moving citation, non-moving citation, or no citation or warning in the 30 days prior to the crash. RESULTS: The study sample included a total of 152,986 drivers. Among drivers with moving violations, previously cited drivers were more likely to be crash culpable than previously warned drivers (OR = 1.64, 95% CI = 1.29-2.08). Drivers with prior non-moving citations were less likely to be the culpable party in a crash than a driver who had no recent warnings or citations (OR = 0.72, 95% CI = 0.58-0.89). Drivers with prior warnings (moving or non-moving) did not appreciably differ in crash culpability relative to drivers who had not received any citations or warnings in the previous 30 days. CONCLUSIONS: Drivers with prior moving citations were more likely to be culpable in a future crash than drivers with prior moving warnings, which may relate to overall driving riskiness as opposed to effectiveness of citations in deterring risky driving behaviors. Results from this study also suggest that officer discretion was being appropriately applied by citing the riskiest drivers, while giving lower risk drivers warnings. Results from this study may be useful to support strengthening of state driver improvement programming.

Direct medical charges of all parties in teen-involved vehicle crashes by culpability.

BACKGROUND: Motor vehicle crashes among teen drivers often involve passengers in the teen's vehicle and occupants of other vehicles, and the full cost burden for all individuals is largely unknown. This analysis estimated direct hospitalisation and emergency department charges for teen-involved crashes by teen culpability, comparing charges for the teen driver, passengers and occupants of other vehicles. METHODS: Probabilistic linkage was performed to link the Iowa police crash reports with Iowa emergency department and Iowa hospital inpatient data. Teen drivers aged 14-17 involved in a crash from 2016 through 2020 were included. Teen culpability was determined through the crash report and examined by teen and crash characteristics. Direct medical charges were estimated from charges through linkage to the Iowa hospital inpatient and the Iowa emergency department databases. RESULTS: Among the 28 062 teen drivers involved in vehicle crashes in Iowa between 2016 and 2020, 62.1% were culpable and 37.9% were not culpable. For all parties involved, the inpatient charges were $20.5 million in culpable crashes and $7.2 million in non-culpable crashes. The emergency department charges were $18.7 million in teen culpable crashes and $6.8 million in teen non-culpable crashes. Of the $20.5 million total inpatient charges in which a teen driver was culpable, charges of $9.5 million (46.3%) were for the injured teen driver and $11.0 million (53.7%) for other involved parties. CONCLUSIONS: Culpable teen-involved crashes lead to higher proportions of injury and higher medical charges, with most of these charges covering other individuals in the crash.

Prevalence of workplace violence against young workers in the United States.

BACKGROUND: Workers under the age of 25 may be at particular risk for workplace violence, given their predominant employment in the high-risk retail and service industries. Little research exists, however, that estimates the scope of the problem within this population. To fill this gap, we conducted the first national study of workplace violence against young people in the United States. METHODS: We analyzed survey data collected via telephone interview from a national sample of 1031 young workers ages 14 through 24 who held a formal job in the last 12 months. Weighted frequencies were calculated and χ2 tests of significance were used to detect differences between groups. RESULTS: Many youth experience workplace violence (60%). Verbal abuse of the sort that made victims feel scared and unsafe (53%) and sexual harassment (24%) were the most commonly reported forms of violence. Females were more likely than males to experience workplace violence overall (p < 0.001) and sexual harassment (p < 0.001) in particular. Males were more likely to experience verbal abuse (p < 0.001). Workplace violence was most prevalent among workers in healthcare settings and eating and drinking places. The occupation with the highest prevalence of workplace violence was customer service. CONCLUSIONS: Workplace violence is common among young workers in the United States and more widespread than prior estimates have suggested. This study is the first to provide a true national prevalence estimate of the problem of workplace violence among young workers ages 14 to 24 in the United States. These findings should be used to locate areas of concern and target resources where they are needed most to address this significant problem.

Optimizing sobriety checkpoints to maximize public health benefits and minimize operational costs.

BACKGROUND: Sobriety checkpoints are a highly effective strategy to reduce alcohol-impaired driving, but they are used infrequently in the USA. Recent evidence from observational studies suggests that using optimized sobriety checkpoints-operating for shorter duration with fewer officers-can minimize operational costs without reducing public health benefits. The aim of this research was to conduct a pilot study to test whether police can feasibly implement optimized sobriety checkpoints and whether researchers can examine optimized sobriety checkpoints compared to usual practice within a non-randomized controlled trial study design. METHODS: The study site was the Town of Apex, NC. We worked with Apex Police Department to develop a schedule of sobriety checkpoints during calendar year 2021 that comprised 2 control checkpoints (conducted according to routine practice) and 4 optimized checkpoints staffed by fewer officers. Our primary operations aim was to test whether police can feasibly implement optimized sobriety checkpoints. Our primary research aim was to identify barriers and facilitators for conducting an intervention study of optimized sobriety checkpoints compared to usual practice. A secondary aim was to assess motorist support for sobriety checkpoints and momentary stress while passing through checkpoints. RESULTS: Apex PD conducted 5 of the 6 checkpoints and reported similar operational capabilities and results during the optimized checkpoints compared to control checkpoints. For example, a mean of 4 drivers were investigated for possibly driving while impaired at the optimized checkpoints, compared to 2 drivers at control checkpoints. The field team conducted intercept surveys among 112 motorists at 4 of the 6 checkpoints in the trial schedule. The survey response rate was 11% from among 1,045 motorists who passed through these checkpoints. Over 90% of respondents supported sobriety checkpoints, and momentary stress during checkpoints was greater for motorists who reported consuming any alcohol in the last 90 days compared to nondrinkers (OR = 6.7, 95%CI: 1.6, 27.1). CONCLUSIONS: Results of this study indicate the sobriety checkpoints can feasibly be optimized by municipal police departments, but it will be very difficult to assess the impacts of optimized checkpoints compared to usual practice using an experimental study design.

State-level education policies: Opportunities for secondary prevention of child maltreatment.

BACKGROUND: Exposure to child maltreatment creates risk for adverse social, health, and economic outcomes across generations. The socioecological model posits the well-being of individuals, including children and youth, is shaped by the larger systems they exist in. Employing state-level policies to position school settings to effectively identify and intervene in instances of child maltreatment is an important secondary prevention opportunity. OBJECTIVE: This study examines the relationship between state-level policies that call for school based trainings to promote the recognition of and response to child maltreatment, and states' annual rates of substantiated child maltreatment reports. METHODS: Relevant policies were identified and abstracted to generate measures of policy presence and comprehensiveness. The National Child Abuse and Neglect Data System was used to derive rates of substantiated child maltreatment reports by state and year. Child maltreatment rates were the dependent variable and policy measures were the primary explanatory variables in a difference-in-differences (DD) model series with state-level clustering and year-fixed effects. RESULTS: The DD model series suggest significant, positive relationships between the presence of policies calling for school-based recognition and response training and child abuse (IRR 1.140, p = 0.04) as well as child physical abuse outcomes (IRR 1.150, p = 0.05). Sensitivity analyses suggest the relationships between policy presence and abuse outcomes were stronger for children than for adolescents. CONCLUSION: These findings suggest that related policies may be effective secondary prevention tools for child maltreatment.

Unintended reductions in assaults near sobriety checkpoints: A longitudinal spatial analysis.

BACKGROUND: Sobriety checkpoints are a form of proactive policing in which law enforcement officers concentrate at a point on the roadway to systematically perform sobriety tests for all passing drivers. We investigated whether sobriety checkpoints unintentionally reduce assaults in surrounding areas. METHODS: Exposures of interest were sobriety checkpoints conducted by the Los Angeles Police Department between 2012 and 2017. Comparison units were matched 1:2 to sobriety checkpoints, selected as the same point location temporally lagged by exactly ±168 hours. The outcome was the density of police-reported assaults around the checkpoint location. RESULTS: In mixed effects regression analyses, assault incidence was lower when sobriety checkpoints were in operation compared to the same location ±168 hours [b= -0.0108, 95% CI: (-0.0203, -0.0012)]. CONCLUSIONS: Sobriety checkpoints were associated with decreased assault incidence, but estimated effect sizes were small and effects did not endure long after checkpoints ended.

Traumatic head injuries in Moldova: a cross-sectional analysis of medical registry data.

AIM: The aims of this study were to evaluate the demographics and crash profiles of road traffic-related traumatic brain injury (TBI) patients treated at two emergency departments in the Republic of Moldova, and to identify areas for prevention.

Should we throw the book at 'em? Charge combinations and conviction rates among alcohol-influenced drivers involved in motorcycle crashes.

INTRODUCTION: Motorcycle fatality rates are increasing, and impaired driving is a major contributing factor. Impaired driving laws are a main component of state efforts to reduce drunk driving, but motorcycle crash charge and conviction outcomes have yet to be studied. The purpose of this study was to evaluate driver charge and conviction outcomes following alcohol-related motorcycle crashes. METHODS: Data for this study were drawn from Iowa crash, charge, and conviction data from 2011 to 2018. The study sample included 480 alcohol-influenced drivers (428 motorcyclists and 52 other vehicle drivers) involved in motorcycle crashes. Driver crash-related charges were categorized by type: Alcohol, Moving Violations, and Administrative/Miscellaneous. Factors associated with convictions were determined and estimated with multivariable logistic regression models. The main factor of interest was charge combination. RESULTS: Over three-quarters (78.5%) of the 480 alcohol-influenced drivers in crashes received any charge type and 68.1% received an alcohol-related charge. Among drivers with any charge, 88.6% were convicted, and among drivers with alcohol charges, 87.2% were convicted on an alcohol charge. After adjusting for BAC, drivers with a combination of Alcohol, Administrative, and Moving Violation charges had more than three times the odds of conviction of any charge compared to drivers with alcohol only charges (OR = 3.21, 95% CI = 1.00-10.26). However, charge combinations had little impact on alcohol-related convictions. CONCLUSIONS: Convictions were more likely when the impaired driver was charged with multiple types of offenses than with a single offense. An increased variety of charges was not associated with greater rates of conviction on alcohol-specific charges, which had high conviction rates overall. PRACTICAL APPLICATIONS: Law enforcement officers should be informed that lesser infractions impact driver conviction outcomes in alcohol-related crashes and procedures for issuing charges should be evaluated to assure equitable enforcement and to hold drivers accountable for unsafe driving behaviors.

United States' teen dating violence policies: summary of policy element variation.

As teen dating violence (TDV) has gained attention as a public health concern across the United States (US), many efforts to mitigate TDV appear as policies in the 50 states in the form of for programming in K-12 schools. A keyword search identified 61 state-level school-based TDV policies. We developed an abstraction form to conduct a content analysis of these policies and generated descriptive statistics and graphic summaries. Thirty of the policies were original and 31 were additions or revisions of policies enacted by 17 of the 30 states previously. Of a possible score of 63, the minimum, mean, median, and maximum scores of currently active policies were 3.0, 17.7, 18.3, and 33.8, respectively. Results revealed considerable state-to-state variation in the presence and composition of school-based TDV policies. Opportunity for improving policies was universal, even among those with most favorably scores.

The "Boyfriend Loophole" and Intimate Partner Homicides: A Longitudinal Analysis Using the National Violent Death Reporting System.

Intimate partner homicides (IPHs) often occur in the context of violent relationships, and firearms often facilitate lethal outcomes. Accordingly, policies have been implemented to reduce firearm access among individuals with histories of intimate partner violence (IPV) or violent propensities. There is considerable variation, however, in the enactment and implementation of such state-level firearm protection laws. Some states fail to extend IPV-related firearm related protections to dating partners, creating what has been referred to elsewhere as the "boyfriend loophole", or what will be referred to here as the "partner loophole". The goal of this analysis was to examine trends in National Violent Death Reporting System (NVDRS) data to assess the relationship of IPHs among unmarried victims in association with state partner loopholes. State policies were abstracted to identify partner loopholes. A series of negative binomial generalized estimating equations were performed using lagged policy variables, year fixed-effects, robust standard errors, and errors clustered by state. Model findings suggest that increased firearm access is related to higher rates of unmarried IPH victimization, however, the associations between the presence of a partner loophole and IPH rates amongst unmarried victims varied between racial subgroups. Significant, protective relationships with closed partner loopholes were identified for the IPH rates amongst white unmarried victims, however, not amongst victims of color. The partner loophole policies considered here, and other individual IPV-related and/or firearm-related policies may be an important component of protections, however, our findings suggest they are not independently sufficient to equitably reduce the burden of IPH. Continuing to develop public health and policy evaluation literature will be essential to progressing towards a policy landscape and cultural environment that are equitably protective.

Child safety restraint patterns in Moldova.

OBJECTIVE: The Republic of Moldova has one of the European region's highest road traffic injury rates and also has an increase in motorization and exposure of children as vehicle passengers. This study describes child restraint use, and parents' knowledge and attitudes toward child restraint based on observations in Chisinau, the country's capital and largest city. The study aims to describe the use of child restraints and to compare data with existing standards of good practice. METHODS: An observational study on child safety restraint use was conducted in 2018. Observational sites included 22 early education institutions, where drivers (n = 611) and child passengers (n = 710) were observed. Observations were conducted as motor vehicles parked or pulled to a stop near the early education institutions and included a driver survey on knowledge and attitudes toward restraint legislation and child safety behavior. RESULTS: Of the 710 child passengers observed, 462 (65.1%) were appropriately restrained, 145 (20.4%) were seated in restraints inappropriate for the child and 103 (14.5%) of children were unrestrained. Younger children (0-3 year-old) were 7 times more likely to be properly restrained compared with children with ages between 4 and 6 (OR 1.92, 95% CI 1.15 to 3.22). Two-thirds out of 609 observed drivers with full study data, N = 431 (70,8%), knew about the mandatory legislation on using child safety restraints in the Republic of Moldova. The drivers using child safety restraints responded that they used them because of their safety features, and the major reason for nonuse was high price/affordability. CONCLUSION: This study, the first to document child safety restraint use among children, indicates that much progress has been made, in that the majority of children are restrained and most drivers of children are aware of safety policies. However, progress can be made to increase knowledge and motivation to safely transport children, and to ensure safety seats are affordable and available. These data will be an important foundation on which to advocate for increased safety activities, child restraint policies, educational approaches in Moldova and to monitor progress over time.

Farm Vehicle Following Distance Estimation Using Deep Learning and Monocular Camera Images.

This paper presents a comprehensive solution for distance estimation of the following vehicle solely based on visual data from a low-resolution monocular camera. To this end, a pair of vehicles were instrumented with real-time kinematic (RTK) GPS, and the lead vehicle was equipped with custom devices that recorded video of the following vehicle. Forty trials were recorded with a sedan as the following vehicle, and then the procedure was repeated with a pickup truck in the following position. Vehicle detection was then conducted by employing a deep-learning-based framework on the video footage. Finally, the outputs of the detection were used for following distance estimation. In this study, three main methods for distance estimation were considered and compared: linear regression model, pinhole model, and artificial neural network (ANN). RTK GPS was used as the ground truth for distance estimation. The output of this study can contribute to the methodological base for further understanding of driver following behavior with a long-term goal of reducing rear-end collisions.

Epidemiological characteristics of injury in Georgia: A one-year retrospective study.

INTRODUCTION: Injury is a major health problem worldwide and a leading cause of death and disability. Disability caused by traumatic injury is often severe and long-lasting. Injuries place a large burden on societies and individuals in the community, both in cost and lost quality of life. Progress in developing effective injury prevention programs in developing countries is hindered by the lack of basic epidemiological injury data regarding the prevalence of traumatic injuries. The aim of this research was to describe the epidemiological characteristics of injury in all hospitals in Georgia. METHODS: The database of the National Center for Disease Control and Public Health of Georgia for 2018, which includes all hospital admissions, was used to identify injury cases treated in hospitals. Cases were included based on the S and T diagnosis coded of ICD-10. RESULTS: A total of 25,103 adult patients were admitted for an injury, of whom 14,798 (59%) were males and 10,305 (41%) were females, between the ages of 18 and 108 years old. The highest prevalence was among the age group 25-44 years old (n = 8654; 34%), followed by 45-64 years old (n = 6852; 27%). The main mechanism of injury was falls (n = 13,932; 55%) and exposure to mechanical forces (n = 2701; 11%). Over 1,50% (n = 379) of injuries resulted in death after hospitalization. The median hospital length of stay (LOS) was 2 days. There was a significant association between age, mechanism of injury, type of injury, performed surgical interventions, and longer LOS. CONCLUSION: Injuries are prevalent throughout the life course and cause substantial hospitalization time. This research can help focus prevention efforts can focus on the demographic and injury causes that are most prevalent.

A profile of traumatic brain injury within hospital emergency departments - a retrospective study in the Republic of Moldova.

Background: Traumatic brain injury (TBI) is a critical public health and socio-economic problem throughout the world, making epidemiological monitoring of incidence, prevalence, and outcome of TBI necessary. TBI is a major cause of mortality and morbidity in adolescents, young adults, and the elderly, one of the leading causes being road traffic accidents. Methods: A retrospective study was conducted among patients with TBI within 2 medical institutions from Chisinau municipality: Emergency Medicine Institute (EMI) and Valentin Ignatenco Municipal Children's Hospital (MCH). A questionnaire was applied, completed on the basis of medical records according to the International Classification of Diseases (ICD) 10 codes. The collection period was August, 1 - October 31, 2018. Data were uploaded using the existing electronic data collection tool - Red Cap and analyzed through Microsoft Excel. Data collection was performed by a resident neurosurgery and a scientific researcher. The ethics committee's approval has been obtained. Results: There have been identified 150 patients: 57 cases (38.5%) of TBI among children and 93 cases (61.5%) among adults aged between 18-73 years old. A large majority (62%) of head injuries were among patients from the urban area (most in adults - 60% and males - 74%). The most common mechanisms of head injury were falls (53.3%) and road traffic injuries (24%), followed by assault (14.7%) and struck by/or against (8%). The distributions by place of occurrence highlighted that most injuries occurred at home (33.4%) and transport area (25.3%). Most head injuries were registered among men 121(81.2%) with a predominance of minor Glasgow Coma Scale (GCS) (65.1%), followed by moderate GCS (9.4%), while in women all cases with GCS minor (18.8%). Conclusion: The data obtained could be useful for the hospital administration in managing the necessary resources and for conducting information campaigns among the high-risk groups.

Pediatric Unintentional Fall-Related Injuries in a Statewide Trauma Registry.

OBJECTIVES: The purpose of the study was to evaluate patterns of fall-related injury through childhood and identify risk factors for more severe fall-related injuries with the goal of informing targeted prevention strategies for different ages. METHODS: The study population consisted of pediatric patients in the Iowa Trauma Registry from January 1, 2010, to December 31, 2014, who sustained an unintentional fall-related injury (N = 3856 patients). Multinomial logistic regression analysis was used to predict injury severity. Adjusted odds ratios were calculated characterizing the relationship between fall severity and age, sex, race, and fall type. RESULTS: More males (62%) sustained a fall-related injury during the study period when compared with females (38%; P < 0.0001). Head injuries were the most common type of injury in the younger than 1 year age group (77%), whereas fractures were the predominant injury type in all other age groups, followed by head injuries. Those younger than 1 year (adjusted odds ratio, 4.0; 95% confidence interval, 2.36-6.90) and aged 15 to 18 years (adjusted odds ratio, 1.9; 95% confidence interval, 1.17-3.03) were more likely to have an Injury Severity Score of ≥16 than those aged 10 to 14 years. CONCLUSIONS: Recommendations and prevention strategies need to focus on specific risk factors to reduce the harm of multilevel falls. As we have shown, patterns of fall injuries presenting to trauma hospitals differ by age, thus suggesting that prevention strategies focus on specific age groups.

Association of traumatic brain injury severity and time to definitive care in three low-middle-income European countries.

BACKGROUND: Low-middle-income countries experience among the highest rates of traumatic brain injury in the world. Much of this burden may be preventable with faster intervention, including reducing the time to definitive care. This study examines the relationship between traumatic brain injury severity and time to definitive care in major trauma hospitals in three low-middle-income countries. METHODS: A prospective traumatic brain injury registry was implemented in six trauma hospitals in Armenia, Georgia and the Republic of Moldova for 6 months in 2019. Brain injury severity was measured using the Glasgow Coma Scale (GCS) at admission. Time to definitive care was the time from injury until arrival at the hospital. Cox proportionate hazards models predicted time to care by severity, controlling for age, sex, mechanism, mode of transportation, location of injury and country. RESULTS: Among 1135 patients, 749 (66.0%) were paediatric and 386 (34.0%) were adults. Falls and road traffic were the most common mechanisms. A higher proportion of adult (23.6%) than paediatric (5.4%) patients had GCS scores indicating moderate (GCS 9-11) or severe injury (GCS 0-8) (p<0.001). Less severe injury was associated with shorter times to care, while more severe injury was associated with longer times to care (HR=1.05, 95% CI 1.01 to 1.09). Age interacted with time to care, with paediatric cases receiving faster care. CONCLUSIONS: Implementation of standard triage and transport protocols may reduce mortality and improve outcomes from traumatic brain injury, and trauma systems should focus on the most severe injuries.

Trends in pediatric passenger restraint use by rurality and age in Iowa, 2006-2019.

OBJECTIVE: Pediatric restraint use has increased over time in the United States, but motor vehicle crashes remain a leading cause of death for children under age 18. Age-appropriate use of safety restraints (safety seats, booster seats, seat belt) and statewide child restraint laws can greatly reduce injury or death in the event of a crash. Surveillance of pediatric restraint use and compliance with policy can inform prevention efforts. This study aims to examine time trends in pediatric restraint use and compliance with pediatric passenger laws in Iowa by rurality and age. METHODS: Fourteen years of Iowa observational pediatric restraint use data (2006-2019) are included in this cross-sectional study. Proportions of restrained youth by year, age, and rurality (rural, urban) were calculated. Log-linear models were used to compute the Annual Percent Change (APC) by year to explore trends in restraint use over time by rurality and by age group. RESULTS: A total of 42,007 observed pediatric passengers with complete data from 2006 to 2019 were included in this study. Restraint use increased across all years and all age groups observed, with the largest increases among the older pediatric age groups. However, restraint use was consistently highest among the youngest child passengers. With all study years combined, the odds of being compliantly restrained were 13% lower in rural areas (OR = 0.87, 95% CI = 0.80, 0.95) compared to urban areas. CONCLUSIONS: Restraint use was lower in rural areas and among older pediatric passengers, suggesting targeted efforts to increase restraint use among these groups may have the greatest impact on overall occupant protection.