Evaluation of the effectiveness of daytime running lights (DRLs).

INTRODUCTION: Many studies have found that daytime running lights (DRLS) are effective in reducing daytime multi-vehicle crashes. From an Australian perspective, while studies exist using data from other jurisdictions, there has been uncertainty about how effective DRLs would be under Australian environmental conditions, which can differ from other parts of the world. In addition, in recent years DRLs have become a standard feature of many new vehicles. The objective of this work was to utilize Australian crash data to estimate the impact of DRLs on casualty crash risk reflecting the Australian crash population and local conditions. It also aimed to broadly examine the real-world crash-based effectiveness of DRLs currently present in the light vehicle fleet. METHOD: The study utilized police reported casualty crash data for crashes that occurred during 2010-2017. The analysis used induced exposure methods, which offers the potential to assess the relationship between crash risk and DRL fitment by intrinsically controlling for confounding factors. RESULTS: It was found that DRL fitment can reduce the overall risk of being involved in a non-nighttime multi-vehicle crash where vehicle visibility may be a factor in crash causation by a statistically significant 8.8%. Estimated crash reductions were higher at dawn or dusk and in higher speed zones. CONCLUSION: Results provide clear evidence that mandating DRLs on all new vehicles would likely lead to reductions in the overall crash risk of the fleet through accelerating fitment through the fleet. PRACTICAL APPLICATION: DRL fitment can reduce the overall risk of being involved in a non-night-time multi-vehicle crash where vehicle visibility may be a factor in crash causation. Governments should consider a DRL mandate on all new vehicle models, including all variants to accelerate the process of fitment through the fleet. This would likely lead to reductions in the overall crash risk of the fleet.

Trends in mortality outcomes of hospital-admitted injury in Victoria, Australia 2001-2021.

Due to advancements in trauma treatment methods, it is expected that survivability of hospital-admitted injuries gradually improves over time. However, measurement of trends in all-cause injury survivability is complicated by changes in case mix, demographics and hospital admission policy. The aim of this study is to determine trends in hospital-admitted injury survivability in Victoria, Australia, taking case-mix and patient demographics into account, and to explore the potential impact of changes in hospital admission practices. Injury admission records (ICD-10-AM codes S00-T75 and T79) between 1 July 2001 and 30 June 2021 were extracted from the Victorian Admitted Episodes Dataset. ICD-based Injury Severity Score (ICISS) calculated from Survival Risk Ratios for Victoria was used as an injury severity measure. Death-in-hospital was modelled as a function of financial year, adjusting for age group, sex and ICISS, as well as admission type and length of stay. There were 19,064 in-hospital deaths recorded in 2,362,991 injury-related hospital admissions in 2001/02-2020/21. Rates of in-hospital death decreased from 1.00% (866/86,998) in 2001/02 to 0.72% (1115/154,009) in 2020/21. ICISS was a good predictor of in-hospital death with an area-under-the-curve of 0.91. In-hospital death was associated with financial year (Odds Ratio 0.950 [95%CI 0.947, 0.952]), in logistic regression modelling adjusted for ICISS, age and sex. In stratified modelling, decreasing injury death trends were observed in each of the top 10 injury diagnoses (together constituting > 50% of cases). Admission type and length of stay were added to the model: these did not alter the effect of year on in-hospital death. In conclusion, a 28% reduction in rates of in-hospital deaths in Victoria was observed over the 20-year study period, in spite of aging of the injured population. This amounts to 1222 additional lives saved in 2020/21 alone. Survival Risk Ratios therefore change markedly over time. A better understanding of the drivers of positive change will help to further reduce the injury burden in Victoria.

Early diagnosis and management of arterio-ureteral fistulas: A literature review.

OBJECTIVES: Arterio-ureteralfistula (AUF) is an infrequent but potentially life-threatening condition. The aim of this study was reviewing the literature to build a flow-chart useful for an early and effective diagnosis and treatment of this pathology. MATERIALS AND METHODS: A literature search in PubMed was conducted. In addition, retrieved articles were cross-referenced. Data parameters included oncologic, vascular and urological history, diagnostics, treatment, and follow up were collected using a standard template by 2 independent reviewers. RESULTS: A total of 140 cases of AUF out of 172 available in the literature at the time of the review, were considered. All patients presented gross hematuria. Chronic indwelling ureteral catheter (CIUC); history of pelvic surgery (HPS) and history of pelvic radiotherapy (HRT) were present respectively in 81%, 62.1%and 58.6% of the sample. The most predominant location of AUF was at the common iliac artery ureteral crossing. Angiography with provocative measures had the highest diagnostic sensitivity (50%) and endovascular treatment with stent-graft placement across the fistula is the current state of the art treatment choice. CONCLUSIONS: Failure to diagnose can postpone a potentially life-saving targeted therapy and lead to complications. The identifi-cation of the Trifecta hematuria, history of pelvic surgery (HPS) and history of pelvic radiotherapy (HPR) would allow the identity-fication of patients at high risk of AUF, who may benefit from more sensitive early diagnostic investigations such as CT angiography and provocative angiography. The treatment of choice in case of AUF to date consist in endovascular prosthesis placement.

International classification of disease based injury severity score (ICISS): A data linkage study of hospital and death data in Victoria, Australia.

BACKGROUND: Surveillance of severe injury incidence and prevalence using ICD-based injury severity scores (ICISS) requires valid, locally applicable diagnosis-specific survival probabilities (DSPs). This study aims to derive and validate ICISS in Victoria, Australia, and compare various ICISS methodologies in terms of accuracy and calculated severe injury prevalence. METHODS: This study used injury admissions (ICD-10-AM coded) from the Victorian Admitted Episodes Database (VAED) linked with death data (Cause of Death - Unit Record Files: CODURF). Using design data (July 2008 - June 2014; n = 720,759), various ICISS scales were derived, based on (i) in-hospital and (ii) three-month mortality. These scales were applied to testing data (July 2014 - December 2016; n = 334,363). Logistic regression modelling was used to determine model discrimination and calibration. RESULTS: In the design data, there were 6,337(0.9%) hospital deaths and 17,514(2.4%) three-months deaths; in the testing data, there were 2,700(0.8%) hospital deaths and 8,425(2.5%) three-month deaths. Newly developed ICISS scales had acceptable to outstanding discrimination, with Area Under the Curve ranging from 0.758 to 0.910. Age-specific ICISS scales were superior to general ICISS scales in model discrimination but inferior in model calibration. Calculated severe injury (ICISS ≤0.941) prevalence in the testing data ranged from 2% to 24%, depending on which mortality outcomes were used to calculate DRGs. CONCLUSIONS: This study provides local, validated ICISS scores that can be used in Victoria. It is recommended that age group stratified ICISS based on the worst-injury method is used. From the comparison of various ICISS scores, reflecting the range of ICISS permutations that are currently in use, care should be taken to compare ICISS methodology before comparing severe injury prevalence per population, injury cause, and time trends.

Oncological and functional outcomes of extraperitoneal laparoscopic radical prostatectomy: An 18-years, single-center experience.

OBJECTIVE: To present a retrospective analysis on the oncological and functional outcomes of a single-center experience on a large series of extraperitoneal laparoscopic radical prostatectomies (eLRP) with an extended follow-up. MATERIALS AND METHODS: Herein we present a retrospective review of patients who underwent eLRP. Oncological and functional follow-up data were collected by means of outpatient visits and telephone interviews, assessing overall mortality and biochemical recurrence-free survival. Patients with clinical T4 stage prostate cancer (PCa), previous surgery for benign prostatic hyperplasia (BPH), previous androgen deprivation, radiotherapy, concomitant chemotherapy and/or experimental therapies, and with insufficient follow-up data were excluded. Preoperative data recorded were age, body mass index, ultrasound prostate volume, preoperative PSA and clinical stage of PCa. Operative data (operative time, nerve sparing technique and any perioperative complication) and pathological findings were obtained by consulting the surgical and pathological reports. Oncological and functional follow-up were collected during follow-up visits and telephone interview. RESULTS: Between January 2001 and December 2019, overall 938 eLRP were performed at our Institution. The median follow-up was 132 months. 69.7% of the patients had complete dataset. The estimated overall biochemical recurrence (BCR)-free survival was 71.4% at 5 years and 58.9% at 10 years. Cancer specific survival was 84,5%. Erectile function was preserved in the most of patients as postoperative IIEF-5 score within 12 months after surgery was > 12 in the 82.1%. About the urinary incontinence, 0.76% of the patients presented severe incontinence (continued and persistent loss of urine) and 7.0% were mildly incontinent (using up to one pad per day). Conclusions; eLRP has shown oncological and functional results comparable to other minimally invasive techniques and to open radical prostatectomy (ORP), with favorable perioperative outcomes than the open technique and a reduced complication rate.

Retrospective evaluation of vehicle whiplash-reducing head restraint systems to prevent whiplash injury in Victoria, Australia.

Head restraint systems specifically engineered to reduce the impact of whiplash injury in the event of a rear-end collision were introduced in the late 1990s with the aim of reducing whiplash injury risk that went 'beyond simple geometric improvements' to head restraints. Whilst studies have shown that whiplash-reducing head restraint systems are highly effective in reducing whiplash injury, these were based on a limited range of systems including Toyota's Whiplash Injury Lessening (WIL) seating system, Volvo's Whiplash Injury Prevention System (WHIPS) and the Saab Active Head Restraint (SAHR) and have generally focussed on Swedish crash and insurance data. However, there has been no broad real-world crash-based evaluation of the effectiveness of whiplash-reducing head restraint systems currently present in the vehicle fleet that validates the results of these studies in other populations. The objective of this study was to undertake a retrospective evaluation of vehicle whiplash-reducing head restraint systems to prevent whiplash injury using real-world crash data linked to insurance claims data in Victoria, Australia. It was found that whiplash-reducing head restraint systems are associated with a statistically significant reduction in the odds of driver and front seat passenger whiplash injury in a vehicle struck in a rear-end collision of 11.6 % (95 % CI 0.20 %, 21.6 %). The results indicate that whiplash-reducing head restraint systems are an effective technology for reducing the risk of whiplash injury to drivers and front seat passengers in a vehicle struck in a rear-end collision. Considering that around a quarter of all casualty crashes involving passenger and light commercial vehicles are rear-end, the fitment of whiplash-reducing head restraint systems to all vehicles as a standard safety feature would likely see a significant reduction in the incidence of whiplash injury.

Understanding fatal older road user crash circumstances and risk factors.

OBJECTIVE: This study used medicolegal data to investigate fatal older road user (ORU) crash circumstances and risk factors relating to four key components of the Safe System approach (e.g., roads and roadsides, vehicles, road users, and speeds) to identify areas of priority for targeted prevention activity. METHODS: The Coroners Court of Victoria's Surveillance Database was searched to identify coronial records with at least one deceased ORU in the state of Victoria, Australia, for 2013-2014. Information relating to the ORU, crash characteristics and circumstances, and risk factors was extracted and analyzed. RESULTS: The average rate of fatal ORU crashes per 100,000 population was 8.1 (95% confidence interval [CI] 6.0-10.2), which was more than double the average rate of fatal middle-aged road user crashes (3.6, 95% CI 2.5-4.6). There was a significant relationship between age group and deceased road user type (χ2(15, N = 226) = 3.56, p < 0.001). The proportion of deceased drivers decreased with age, whereas the proportion of deceased pedestrians increased with age. The majority of fatal ORU crashes involved a counterpart (another vehicle: 59.4%; fixed/stationary object: 25.4%), and occurred "on road" (87.0%), on roads that were paved (94.2%), dry (74.2%), and had light traffic volume (38.3%). Road user error was identified by the police and/or coroner for the majority of fatal ORU crashes (57.9%), with a significant proportion of deceased ORU deemed to have "misjudged" (40.9%) or "failed to yield" (37.9%). CONCLUSIONS: Road user error was the most significant risk factor identified in fatal ORU crashes, which suggests that there is a limited capacity of the Victorian road system to fully accommodate road user errors. Initiatives related to safer roads and roadsides, vehicles, and speed zones, as well as behavioral approaches, are key areas of priority for targeted activity to prevent fatal older road user crashes in the future.

Using medico-legal data to investigate fatal older road user crash circumstances and risk factors.

OBJECTIVE: This study used medico-legal data to investigate fatal older road user (ORU, aged 65 years and older) crash circumstances and risk factors relating to 4 key components of the Safe System approach (e.g., roads and roadsides, vehicles, road users, and speeds) to identify areas of priority for targeted prevention activity. METHOD: The Coroners' Court of Victoria's (CCOV) Surveillance Database was searched to identify and describe the frequency and rate per 100,000 population of fatal ORU crashes in the Australian state of Victoria for 2013-2014. Information relating to the deceased ORU, crash characteristics and circumstances, and risk factors was extracted and analyzed. RESULTS: One hundred and thirty-eight unintentional fatal ORU crashes were identified in the CCOV Surveillance Database. Of these fatal ORU crashes, most involved older drivers (44%), followed by older pedestrians (32%), older passengers (17%), older pedal cyclists (4%), older motorcyclists (1%), and older mobility scooter users (1%). The average annual rate of fatal ORU crashes per 100,000 population was 8.1 (95% confidence interval [CI], 6.0-10.2). In terms of the crash characteristics and circumstances, most fatal ORU crashes involved a counterpart (98%), of which the majority were passenger cars (50%) or fixed/stationary objects (25%), including trees (46%) or embankments (23%). In addition, most fatal ORU crashes occurred close to home (73%), on-road (87%), on roads that were paved (94%), on roads with light traffic volume (37%), and during low-risk conditions: between 12 p.m. and 6 p.m. (44%), on weekdays (80%), during daylight (75%), and under dry/clear conditions (81%). Road user (RU) error was identified by the police and/or the coroner for the majority of fatal crashes (55%), with a significant proportion of deceased ORUs deemed to have failed to yield (54%) or misjudged (41%). CONCLUSIONS: RU error was the most significant factor identified in fatal ORU crashes, which suggests that there is a limited capacity of the road system to fully accommodate RU errors. Initiatives related to safer roads and roadsides, vehicles, speed zones, as well as behavioral approaches are key areas of priority for targeted activity to prevent fatal ORU crashes in the future.

Influence of voluntary standards and design modifications on trampoline injury in Victoria, Australia.

PURPOSE: To examine the influence of the voluntary Australian trampoline standard (AS 4989-2006) and market-driven design modifications on relevant trampoline injuries. METHODS: Trend and intervention analysis on frequencies and proportions of hospital-treated trampoline-related injury in Victoria, Australia, extracted from the Victorian Emergency Minimum Dataset from 1 July 1999 to 30 June 2013. The injuries relevant to the AS were contact with spring and frame, and multiple-user injury. Falls from trampolines were relevant for netted trampolines, a market-driven modification. RESULTS: Frequency of all trampoline injuries increased by 11.4% (95% CI 10.0% to 11.7%) on average each year. Spring and frame, and fall injuries increased to a lesser extent (8.7%, 95% CI 6.9% to 9.8% and 7.3%, 95% CI 5.8% to 8.3%, respectively). Multiple-user injuries increased by 21.0% (95% CI 16.3% to 21.9%). As a proportion of all trampoline injuries, spring and frame injury and falls injury decreased, while multiple-user injuries increased. The intervention analysis showed no significant change in spring and frame injuries associated with the AS (p=0.17). A significant increase was found for multiple-user injuries (p=0.01), in particular for the 0-year to 4-year age group (p<0.0001), post 2007. CONCLUSIONS: There was little evidence for an effect of the voluntary standard on spring and frame injury and none for multiple-user injury. Netted trampolines appear to be associated with a decrease in falls from trampolines but an increase in injuries to multiple users. A mandated trampoline safety standard and a safety campaign including warnings about multiple users is recommended. Continued monitoring of injury data will be required.

Pedestrian Injury Outcome as a Function of Vehicle Market Group in Victoria, Australia.

OBJECTIVE: Pedestrians are among the most vulnerable road users in terms of their risk of serious injury when involved in a collision with a vehicle. In Australia, around 200 pedestrians are killed in road crashes annually and over 2,000 are seriously injured. The objective of the current study was to analyze pedestrian death and injury risk by body region across 10 light passenger and commercial vehicle market groups in Victoria, Australia. METHODS: This study utilized police-reported crash data linked to insurance injury compensation claims data during the period 2001-2010 to determine whether pedestrian injury outcome is a function of colliding vehicle type. Logistic regression models were developed to measure the risk of pedestrian death or injury as a function of vehicle market group for 4 body region groupings, namely, all body regions; the head, face, or neck; the thorax; and the lower extremities (including pelvis). RESULTS: Analysis focused on head, face, or neck injury found that pedestrians struck by small cars, people movers, large sport utility vehicles (SUVs), vans, or utility vehicles had statistically significantly higher odds of death or injury compared to large cars. When the analysis focused on thoracic injury, it was again found that pedestrians struck by large SUVs and vans had statistically significantly higher odds of death injury compared to large cars. In particular, the odds of death or thoracic injury is 74.4% higher for large SUVs compared to large cars. Analysis focused on lower extremity injury found no market group with statistically significant different odds of death or injury compared to large cars at the 5% level; however, medium cars and vans were found to have statistically significantly lower odds of death or lower extremity injury at the 10% level. CONCLUSIONS: The results suggest that the increasing popularity of vehicles such as SUVs has the potential to lead to an increase in the level of pedestrian road trauma. With the general trend toward the use of larger vehicles, the results provide validation of the importance of improved vehicle design and the incorporation of new pedestrian safety features.

Evaluation of vehicle side airbag effectiveness in Victoria, Australia.

Side airbag systems were first introduced into vehicles around 1995 to help protect occupants from injury in side impact crashes. International studies have shown that side airbags are effective in reducing the risk of death and injury, however, serious injuries can still occur even when side airbags deploy. The objective of this study was to use detailed injury information from insurance injury compensation claims data linked to Police reported crash data to determine the effectiveness of side airbags in reducing the risk of death or injury for occupants involved in side impact crashes in Victoria, Australia based on the specific body regions that side airbag systems are designed to protect. It was found that head and torso-protecting dual airbag systems designed to protect the head, neck, face, chest and abdomen are highly effective in reducing driver death or injury due to near side crashes. They were associated with a statistically significant reduction of 41.1% (25.9%, 53.2%) in the odds of death or injury across all body regions; and a 48.0% (28.0%, 62.4%) reduction in the odds of death or injury to the head, neck, face, chest and abdomen. The study did not find any evidence that torso-protecting airbags alone are effective in reducing death or injury. Analysis results indicate that head and torso-protecting side airbag systems in vehicles are a highly effective technology for reducing the risk of death or injury to vehicle occupants in near side crashes. The magnitude of the injury reduction benefits estimated indicate that fitment of this technology to all vehicles should be a high priority and will yield significant savings in overall road trauma.

First return to work following injury: does it reflect a composite or a homogeneous outcome?

OBJECTIVE: To test whether return to work as a binary (yes/no) outcome that includes all persons who returned to work regardless of mode of return reflects a composite or a homogeneous outcome in a cohort of workers who have sustained acute orthopaedic trauma resulting in hospitalisation. METHODS: Prospective cohort study. One hundred and sixty-eight participants were recruited and followed for 6 months. The study achieved 89% follow-up. Baseline data were obtained at study recruitment and participants were further surveyed by phone at three timepoints during the study. Polytomous logistic regression was used to simultaneously examine the association between potential predictors and different modes of first return to work (RTW). A test of the equality of the ORs associated with the independent predictor variables was also undertaken. RESULTS: Of the 152 participants with full follow-up, 46 (30%) returned first to full duties, 58 (38%) returned first to modified work and 48 (32%) did not return to work during the study period. Significant determinants of the two modes of return to work were different. A test of the equality of ORs indicated that the relative ORs for the difference in the slope coefficients for five of the 10 independent factors in the two polytomous logistic regression sub-models corresponding to each mode of return to work were statistically significant. This raises the likelihood that first RTW reflects a composite rather than a homogeneous outcome. CONCLUSION: The study provides evidence that RTW may reflect a composite outcome when it includes different modes of first RTW. The identified predictive factors appear to exert different mechanisms of action depending on the mode of RTW. The findings suggest that the different modes of RTW may need to be considered independently. The results of the study have potentially important implications for research and insurance practice.

The impacts of functional performance, behaviour and traffic exposure on road-crossing judgements of young children.

Using data from i) a simulated road-crossing task, ii) a battery of functional performance assessments, and iii) a survey of parents, some factors that may predict poor road-crossing skill were identified. Children aged between 6 and 10 years made road-crossing decisions in a simulated road environment in which time gap and speed of approaching vehicles were manipulated. Functional performance was examined using a range of tools designed to assess cognitive, perceptual, attentional and executive functioning. Parents also provided information on physical activity, exposure to traffic and road safety education. The results suggest that children predominantly made decisions based on distance gap and that younger children (6-7 year olds) were 12 times more likely than older children (8-10 year olds) to make critically incorrect (or unsafe) crossing decisions. Factors found to be associated with incorrect crossing decisions included lower perceptual, attentional, cognitive and executive performance, and independent travel. There were no gender differences associated with incorrect crossing decisions. This study has used a novel and safe way to identify 'at risk' groups of children and the findings have been used to develop and evaluate a practical educational and training program aimed at improving essential skills and strategies to cross roads safely amongst 'at risk' children.