A systematic review of the impact of brain tumours on risk of motor vehicle crashes.

PURPOSE: Brain tumours are associated with neurocognitive impairments that are important for safe driving. Driving is vital to maintaining patient autonomy, despite this there is limited research on driving capacity amongst patients with brain tumours. The purpose of this review is to examine MVC risk in patients with brain tumours to inform development of clearer driving guidelines. METHODS: A systematic review was performed using Medline and EMBASE. Observational studies were included. The outcome of interest was MVC or measured risk of MVC in patients with benign or malignant brain tumours. Descriptive analysis and synthesis without meta-analysis were used to summarise findings. A narrative review of driving guidelines from Australia, United Kingdom and Canada was completed. RESULTS: Three studies were included in this review. One cohort study, one cross-sectional study and one case-control study were included (19,135 participants) across United States and Finland. One study evaluated the incidence of MVC in brain tumour patients, revealing no difference in MVC rates. Two studies measured MVC risk using driving simulation and cognitive testing. Patients found at higher risk of MVC had greater degrees of memory and visual attention impairments. However, predictive patient and tumour characteristics of MVC risk were heterogeneous across studies. Overall, driving guidelines had clear recommendations on selected conditions like seizures but were vague surrounding neurocognitive deficits. CONCLUSION: Limited data exists regarding driving behaviour and MVC incidence in brain tumour patients. Existing guidelines inadequately address neurocognitive complexities in this group. Future studies evaluating real-world data is required to inform development of more applicable driving guidelines. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO 2023 CRD42023434608.

Unsafe Practices of Motorcycle Riders in El Petén, Guatemala: A Community Observational Study and a Retrospective Institutional Review.

INTRODUCTION: Outcomes from trauma at the major referral hospital [Hospital Nacional de San Benito (HNSB)] in El Petén, Guatemala, have not been analyzed. Empirical evidence demonstrated a high number of motorcycle accidents (MAs). We hypothesized a large incidence of head trauma with poor outcomes in MAs compared to all other forms of blunt trauma. METHODS: Our hypothesis was tested by performing a community observational study and a retrospective chart review in El Petén, Guatemala. An independent observer catalogued 100 motorcycle riders on the streets of El Petén for riding practices as well as helmet utilization. HNSB does not have electronic medical records. For this study, we performed a retrospective chart review of randomly selected nonconsecutive trauma admission at HNSB between March 2018 and June 2023. Blunt trauma was compared between MAs versus all others. Variables were examined by parametric and nonparametric tests as well as contingency table analyses. RESULTS: Most motorcycles riders involved multiple individuals (2.61 ± 0.79/motorcycle). Seventy riders included children (median = 1.0 [Q1-Q3 range = 1.0-3.0]/motorcycle). Overall, only three riders were wearing helmets. Forty-one were women. Of patients presenting to HNSB with trauma, 91 charts were reviewed (33.0 [20.0-37.0] y old; male 89%), 76.7% were blunt, and 23.3% were penetrating trauma. Within blunt trauma, 57.1% were MAs versus 42.9% all others; P = 0.13. MAs were younger (29.5 [20.0-37.0] versus 34.0 [21.8-45.8] y old; P < 0.05) and of similar gender (male 82.5% versus 96.6%; P = 0.1). More MAs had a computed tomography (70.0% versus 30.0%; P < 0.01) and they were more likely to present with head trauma (72.5% versus 46.7%; P = 0.04) but similar Glasgow Coma Scale (15.0 [13.5-15.0] versus 15.0 [12.5-15.0]; P = 0.7). MAs were less likely to require surgical intervention (37.5% versus 56.7%; P = 0.05) but had similar hospital length of stay (4.0 [2-6] versus 4.0 [2-10.5] d; P = 0.5). CONCLUSIONS: Unsafe motorcycle practices in El Petén are staggering. Most trauma at HNSB is blunt, and likely from MAs. More patients with MAs presented with head trauma. However, severe trauma might be transferred to higher level hospitals or mortality might occur on scene, which will need further investigations. Assessment of mortality from trauma admissions is ongoing. These findings should lead to enforcement of safe motorcycle practices in El Petén, Guatemala.

Ocular injuries associated with motor vehicle accidents: long term effects on quality of life.

PURPOSE: To describe the prevalence and outcome of motor vehicle accidents-associated ocular injuries. METHODS: A survey of patients who presented to the emergency room at a level 1 trauma center with motor vehicle accidents-associated ocular injuries. A patient questionnaire and review of clinical notes were conducted for all patients. RESULTS: Of 274 motor vehicle accident victims with ocular injuries who presented to the emergency room, 40 (15%) responded to the survey. Over half of them were driving a vehicle, and most reported wearing a seat belt or a helmet. Most ocular injuries were mild. The most common injuries were bone fractures, subconjunctival hemorrhage, eyelid involvement and corneal injury. Most respondents had no change in vision and perceived their ocular involvement as a minor part of their injury. Most respondents returned to work and to driving within a year. CONCLUSION: Our study sheds light on the details and extent of ocular involvement and the visual ability to perform daily activities following motor vehicle accidents.

The Role of Obesity in Motor Vehicle Injuries and Fatalities in the Pediatric Population: A Systematic Review.

PURPOSE: A systematic review done to evaluate obesity as a risk factor for injuries and mortality in motor vehicle accidents (MVAs) in the pediatric population, as there has not been a systematic review done in over 10 years. This study aims to update the literature regarding obesity as a risk factor for injuries in MVAs in the pediatric population. MATERIALS AND METHODS: A systematic review was conducted according to the PRISMA guidelines with strict inclusion and exclusion criteria, resulting in the use of 3 total articles to analyze obesity as a risk factor for overall injury and mortality in the pediatric population. RESULTS: Zaveri et al demonstrated a statistically significant, but weak, decrease in the odds of extremity injury in overweight patients ages 2 to 17 years old (odds ratio [OR] = 0.6, 95% confidence interval [CI] = 0.4-1.0, P ≤ 0.05). On the other hand, Pollack et al and Haricharan et al found an increase in extremity injury in the obese population, in ages 9 to 15 years (OR = 2.54, 95% CI = 1.15-5.59, P ≤ 0.05), and 10 to 17 years (Age 10-13: OR = 6.06, 95% CI = 2.23-16.44, P ≤ 0.05, Age 14-17 OR = 1.44, 95% CI = 1.04-2.00, P ≤ 0.05), respectively. Haricharan et al also found an increase in thoracic injuries in obese children, ages 2 to 13 and increased risk of head/face/neck injury in obese children ages 2 to 5 (OR = 3.67, 95% CI = 1.03-13.08, P ≤ 0.05), but a decreased risk of head injury in obese children ages 14 to 17 (OR = 0.33, 95% CI = 0.18-0.60, P ≤ 0.05). CONCLUSIONS: There are sparse data that are conflicting, regarding the effect of obesity on extremity injuries in the pediatric population. Obesity is not protective against thoracic, head, or abdominal injuries. However, it was found to be a risk factor for trunk injuries in ages 2 to 13, as well as head/face/neck injuries for ages 2 to 5. Since the literature is so sparse, further research is warranted in these areas.

Assessing the Cushion Effect: A Systematic Review and Meta-Analysis of the Role of Obesity in Motor Vehicle Injuries and Fatalities.

PURPOSE: A systematic review and meta-analysis were done to evaluate the effect of obesity in injury and mortality due to motor vehicle accidents. MATERIALS & METHODS: The systematic review consisted of 20 studies meeting the inclusion criteria. The meta-analysis was conducted on these studies to analyze obesity as a risk factor for specific injuries, as well as overall injury and mortality compared to non-obese patients. RESULTS: The data revealed that obesity was associated with increased lower extremity injuries (odds ratio [OR] = 1.44, 95% confidence interval [CI] = 1.19-1.69, P ≤ 0.05), neck injuries (OR = 3.38, 95% CI = 1.58-5.19, P ≤ 0.05), and overall mortality (OR = 1.51, 95% CI = 1.40-1.61, P ≤ 0.05). When stratified for obesity class with class I as BMI >30.1-34.9, class II BMI 35-39.9, and class III BMI >40, only class II (OR = 1.20, 95% CI = 1.15-1.24, P ≤ 0.05) and class III (OR = 1.49, 95% CI = 1.30-1.68, P ≤ 0.05) were associated with increased mortality risk. No significant differences were seen with head, upper extremity, thoracic, abdominal, or pelvic injuries. CONCLUSION: Obesity is a risk factor in motor vehicle accidents for fatality and injury, specifically lower extremity and neck injuries.

Prevalence of medical factors related to aging among older car drivers: a multicenter, cross-sectional, descriptive study.

AIM: An increasing number of older adults in Japan are at an increased risk of road traffic crashes. This study aimed to investigate the prevalence of potential underlying medical factors that increase the risk of road traffic crashes among older people. METHODS: This cross-sectional observational study was conducted in 11 medical institutions in Japan using self-administered questionnaires and physical examination from January to May 2021. The background and social data, data on the use of nursing care insurance, and clinical data suggestive of polypharmacy, sarcopenia, cognitive impairment, and frailty/oral frailty were obtained. The prevalence of these factors was compared between everyday and occasional drivers. RESULTS: Data of 127 patients were collected; their median (interquartile range) age was 73 (70-78) years. Of the total participants, 82 were men (64.6%) and 45 were women (35.4%). There were 77 everyday drivers and 50 occasional drivers. Of these, 121 (95.3%) had not applied for nursing care insurance, but the numbers of those who required help 1 and 2 were 1 (0.8%) and 3 (2.4%), respectively. Prevalence of medical factors was as follows: polypharmacy, 27.6%; sarcopenia, 8.7%; dementia, 16.4%; frailty, 15.0%; and oral frailty, 54.3%; it was not significantly different between every day and occasional drivers. Intention to return the car license was significantly higher among the occasional drivers (2.6% vs. 14.0%; odds ratio: 6.7, 95% confidence interval: 1.2-70.6, p = 0.024). CONCLUSION: We uncovered the prevalence of medical factors that can be associated with road traffic crashes among Japanese older people aged ≥ 65 years in our community.

Serious Transport Accidents in Tourette Syndrome or Chronic Tic Disorder.

BACKGROUND: It is unknown whether individuals with tic disorders are at increased risk for serious transport accidents. OBJECTIVES: The aim of this study was to investigate the risk for injuries or death caused by transport and motor vehicle accidents in individuals with Tourette syndrome or chronic tic disorder. METHODS: This population-based, sibling-controlled cohort study included all individuals aged ≥18 years living in Sweden between 1997 and 2013 (N = 6,127,290). A total of 3449 individuals had a registered diagnosis of Tourette syndrome or chronic tic disorder in the Swedish National Patient Register. We also identified 2191 families with full siblings discordant for tic disorders. Cox proportional hazards regression modeling was used to estimate the risk for injuries or deaths as a result of transport accidents in individuals with a lifetime diagnosis of Tourette syndrome or chronic tic disorder compared with unexposed individuals and siblings. RESULTS: Individuals with tic disorders had a higher risk for transport injuries or death compared with the general population (adjusted hazard ratio, 1.50 [95% confidence interval: 1.33-1.69]) and their unaffected siblings (adjusted hazard ratio, 1.41 [95% confidence interval: 1.18-1.68]). The risks were similar across sexes. The exclusion of most psychiatric comorbidities did not alter the magnitude of the estimates. However, the risks were no longer significant after exclusion of individuals with comorbid attention deficit hyperactivity disorder. CONCLUSIONS: The marginally increased risk for serious transport accidents in tic disorders is mainly driven by attention deficit hyperactivity disorder comorbidity. Improved detection and management of attention deficit hyperactivity disorder symptoms in this patient group are warranted. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Individual prediction of motor vehicle accidents for patients with epilepsy.

The objective of the study was to design a clinically useful tool to predict the risk of seizure-related motor vehicle accidents (MVAs) for people with epilepsy (PWE). Participants were patients who visited our epilepsy center in West China Hospital from October 2012 to October 2019 and were divided into a primary cohort and a validation cohort. Ultimately, we included 525 patients in the primary cohort and 86 patients in the validation cohort. Proportional hazard regression was performed to measure the prognostic factors of car accidents. The outcome was used to create a nomogram model. The final model had 7 factors, with a C-index of 0.85 (95% CI, 0.80-0.91), to predict the possibility of non-MVA for PWE. For the validation cohort, the C-index was 0.83 (95% CI, 0.72-0.95). This nomogram model can offer more individualized advice to PWE who are still driving by estimating the risk of car accidents.

Excessive daytime sleepiness and associations with sleep-related motor vehicle accidents: results from a nationwide survey.

OBJECTIVE/BACKGROUND: Insufficient sleep can have fatal consequences, and up to 30% of motor vehicle accidents (MVAs) are related to driving when drowsy. The objective of this study was to investigate how sleep quality and excessive daytime sleepiness (EDS) affect falling asleep while driving and sleep-related MVAs/near-misses. PARTICIPANTS/METHODS: A population-wide sample of Saudi adults was surveyed. The questionnaire gathered data on sleep quality, EDS (Epworth Sleepiness Scale), and episodes of falling asleep while driving and sleep-related MVAs/near-misses in the previous year. Univariable and multivariable analyses were used to assess associations. RESULTS: A total of 19% (902/3802) and 10% (474/4229) of respondents had fallen asleep while driving or had a sleep-related MVA/near-miss in the preceding year, respectively. Being male, married, having a shorter sleep duration, being an office worker, having poor subjective sleep quality, and having moderate or severe EDS were associated with an increased risk of having fallen asleep while driving in the previous year. Younger age, male gender, having worse subjective sleep quality [OR 2.11 (95% CI 1.36-3.29); p < 0.0001 for "very bad" sleep quality], and having moderate or severe EDS [ESS ≥ 13; OR 1.90 (95% CI 1.38-2.60); p < 0.0001 and OR 2.39 (95% CI 1.56-3.67); p < 0.0001, respectively] were associated with having had/nearly had an accident due to being tired or falling asleep while driving in the previous year. CONCLUSIONS: Sleepy driving and sleep-related accidents/near-misses are common in Saudi Arabia, and sleep quality and EDS contribute to the burden of MVAs. Further efforts are required to quantify the contribution of sleepiness to MVAs to develop and prioritize interventions to prevent MVA-related injuries and death.

The Self-perception of Text-message Dependency Scale (STDS): Psychometric update based on a United States sample.

BACKGROUND: Some have suggested that text messaging is an addictive behavior. However, this characterization is uncertain, partly due to lack of well-validated measures of text messaging attitudes and behaviors. One standard instrument for measuring text messaging attitudes and behaviors is the Self-perception of Text-message Dependency Scale (STDS), though the psychometric properties of this scale have only been examined with a sample of Japanese youth. OBJECTIVES: The primary objective of this study was to evaluate the STDS in the United States to determine its utility as a measure of text messaging dependence. We were interested in examining the factor structure and determining the extent to which this scale would correlate with two important outcome measures: motor vehicle accidents (MVAs) and moving violations. METHODS: We analyzed data from 468 adults (age 18-74; 274 women) recruited via Amazon's Mechanical Turk (mTurk) service. Participants completed the STDS and provided information about their driving-related incidents in the past year. RESULTS: First we performed a confirmatory factor analysis, which supported the instrument's original factor structure. Then we tested the relationship between scores on the STDS and two important variables, MVAs and moving violations. We found that the STDS significantly correlated with both MVAs and moving violations. CONCLUSION: The present study confirms that the STDS is a potentially useful instrument for studying texting dependence in the United States and with adults of all ages. The instrument may be particularly useful in predicting motor vehicle outcomes.

Citizens' Juries, Liquid Democracy and Legislative Reform of Australian Compulsory Insurance Schemes for Injury Compensation after Motor Vehicle Accidents.

In 2017/2018 the Australian Capital Territory held its first citizens' jury to deliberate changes to the Territory's Compulsory Third Party (CTP) insurance scheme, for injury compensation after motor vehicle accidents. Such citizens' juries were designed to aid the transition to next-generation parliamentary processes (such as liquid democracy - citizen direct electronic voting on laws or individual transfer of their vote to respected politicians) by enabling a variety of key stakeholders and interests to be actively represented in the process of statutory development. In effect such a process is a democratic alternative to the current model of corporate lobbyists covertly influencing the legislative process. This column investigates how the citizens' jury chose one from four proposed CTP models. It then critiques how, following the jury's recommendation, the Australian Capital Territory Government introduced the Motor Accidents Injuries Bill 2018 (ACT). Once enacted, this is designed to create a "no-fault" expedited scheme, but on our analysis, at the cost of certain adverse outcomes. These include greatly reducing an injured person's entitlements to fair compensation, a "whole person impairment threshold" that limits entitlements to treatment and care, wage loss and compensation for pain and suffering, removing the right to compensation for gratuitous care, and giving the insurance companies unfettered power over the provision of entitlements.

Trends in pediatric liver transplant donors and deceased donor circumstance of death in the United States, 2002-2015.

While much of the discussion regarding expanding the donor pool for pediatric liver transplantation has surrounded the use of technical variant grafts, little attention has been directed toward changes in the deceased donor population. The aim of this study was to investigate trends in the circumstance of the death of deceased donors used for pediatric liver transplantation. All pediatric liver transplant recipients transplanted between 2002 and 2015 were identified in the UNOS database and were categorized based on the donor circumstance of death. There was no significant correlation between year of transplantation and number of pediatric liver transplants performed, pediatric donors, split livers, or living donors. There was a significant downward trend in donors from motor vehicle fatalities and an upward trend in suicide, non-MVA, and death due to natural causes. There was also an upward trend in drowning, one of the most common mechanisms of death among non-MVA in 2015. While the number of donors who died in MVA has fallen, the number of deceased donors who died from suicide, natural causes, and non-MVA, especially drowning, has increased, maintaining the overall number of pediatric deceased donor livers transplanted.

Cortical surface area reduction in identification of subjects at high risk for post-traumatic stress disorder: A pilot study.

OBJECTIVE: Victims of motor vehicle accidents often develop post-traumatic stress disorder, which causes significant social function loss. For the difficulty in treating post-traumatic stress disorder, identification of subjects at high risk for post-traumatic stress disorder is essential for providing possible intervention. This paper aims to examine the cortical structural traits related to susceptibility to post-traumatic stress disorder. METHODS: To address this issue, we performed structural magnetic resonance imaging study in motor vehicle accident victims within 48 hours from the accidents. A total of 70 victims, available for both clinical and magnetic resonance imaging data, enrolled in our study. Upon completion of 6-month follow-up, 29 of them developed post-traumatic stress disorder, while 41 of them didn't. At baseline, voxelwise comparisons of cortical thickness, cortical area and cortical volume were conducted between post-traumatic stress disorder group and trauma control group. RESULTS: As expected, several reduced cortical volume within frontal-temporal loop were observed in post-traumatic stress disorder. For cortical thickness, no between-group differences were observed. There were three clusters in left hemisphere and one cluster in right hemisphere showing decreased cortical area in post-traumatic stress disorder patients, compared with trauma controls. Peak voxels of the three clusters in left hemisphere were separately located in superior parietal cortex, insula and rostral anterior cingulate cortex. CONCLUSION: The finding of reduced surface area of left insula and left rostral anterior cingulate cortex suggests that shrinked surface area in motor vehicle accident victims could act as potential biomarker of subjects at high risk for post-traumatic stress disorder.

Understanding variability in driving recommendations for patients with seizures.

BACKGROUND: There is lack of consensus regarding driving restrictions for patients with epilepsy. Regulations vary by state. New York State (NYS) recommends driving restrictions for one year in a person with an episode of loss of consciousness (LOC), with physician discretion. Often, providers make recommendations to permit their patients to drive after a shorter seizure-free period than proposed guidelines. The prevalence and reasons behind more lenient recommendations have not been elucidated. METHODS: Forty-one neurologists were surveyed anonymously in Nassau County, New York. They were questioned about the length of recommended driving restrictions (≤1, 3, 6, or ≥12months) that they typically provide to patients with suspected seizures in different clinical scenarios and overall reasons for doing so. Data about level of training, setting of practice, use of antiepileptic drug (AED) levels, and electroencephalogram (EEG) were also collected. RESULTS: Of the 41 neurologists surveyed, 72% reported recommending driving restrictions <12months for patients who experienced LOC, without a confirmed diagnosis of seizure. The majority also recommended driving restriction of <12months for other scenarios including acute symptomatic seizure, exclusively simple partial seizures, nocturnal seizures, psychogenic nonepileptic seizures (PNES), and seizures occurring with or during AED reduction. The most common rationale was to improve patient autonomy and independence. Less than a third of neurologists estimated that the majority of their patients were noncompliant with driving recommendations. CONCLUSION: We found that many neurologists' recommendations for limiting driving for patients with seizure-related episodes are shorter than those recommended by NYS. Furthermore, as there are no specific guidelines for questionable epileptic scenarios and seizures occurring nocturnally or without LOC, this appears to contribute to substantial variability in the duration of recommended driving restrictions. This opens a broad discussion about approaches towards advising driving limitations in order to protect public and patient safety while maintaining patient autonomy.

Chronic Pain Types Differ in Their Reported Prevalence of Post -Traumatic Stress Disorder (PTSD) and There Is Consistent Evidence That Chronic Pain Is Associated with PTSD: An Evidence-Based Structured Systematic Review.

Objectives: The hypotheses of this systematic review were the following: 1) Prevalence of post-traumatic stress disorder (PTSD) will differ between various types of chronic pain (CP), and 2) there will be consistent evidence that CP is associated with PTSD. Methods: Of 477 studies, 40 fulfilled the inclusion/exclusion criteria of this review and were grouped according to the type of CP. The reported prevalence of PTSD for each grouping was determined by aggregating all the patients in all the studies in that group. Additionally all patients in all groupings were combined. Percentage of studies that had found an association between CP and PTSD was determined. The consistency of the evidence represented by the percentage of studies finding an association was rated according to the Agency for Health Care Policy and Research guidelines. Results: Grouping PTSD prevalence differed ranging from a low of 0.69% for chronic low back pain to a high of 50.1% in veterans. Prevalence in the general population with CP was 9.8%. Of 19 studies, 16 had found an association between CP and PTSD (84.2%) generating an A consistency rating (consistent multiple studies). Three of the groupings had an A or B (generally consistent) rating. The veterans grouping received a C (finding inconsistent) rating. Conclusion: The results of this systematic review confirmed the hypotheses of this review.

Outcomes after Motor Vehicle Trauma: Transfers to Level I Trauma Centers Compared with Direct Admissions.

BACKGROUND: The multilevel designation system given to U.S. trauma centers has proven useful in providing injury-level-appropriate care and guiding field triage. Despite the system, patients are often transferred to Level I trauma centers for higher-level care/specialized services. OBJECTIVES: The objective of this study is to assess whether there is a difference in outcomes of patients transferred to Level I centers compared with direct admissions. METHODS: The Nationwide Inpatient Sample was queried to identify patients involved in motor vehicle accidents, using International Classification of Diseases, Ninth Revision, Clinical Modification E-codes. Patients that were admitted to Level I trauma centers were identified using American College of Surgeons or American Trauma Society designations. RESULTS: There were 343,868 patients that met inclusion criteria. Of these patients, 29.2% (100,297) were admitted to Level I trauma centers, 5.7% (5691) of which were identified as trauma transfers. The lead admitting diagnosis for transfers was pelvic fracture (11.5%). Caucasians were 2.62 times as likely to be transferred as African-Americans (confidence interval 2.32-2.97), and 3.71 times as likely as Hispanics (confidence interval 3.25-4.23). Despite transfer patients having higher adjusted severity scores and higher adjusted risk of mortality, there were no differences in mortality (p = 0.95). CONCLUSIONS: Nationally, trauma transfers do not have an increase in mortality when compared with directly admitted patients, despite a higher adjusted severity of illness and higher adjusted risk of mortality.

Factors predicting outcome in whiplash injury: a systematic meta-review of prognostic factors.

BACKGROUND: Whiplash injuries are among the leading injuries related to car crashes and it is important to determine the prognostic factors that predict the outcome of patients with these injuries. This meta-review aims to identify factors that are associated with outcome after acute whiplash injury. MATERIALS AND METHODS: A systematic search for all systematic reviews on outcome prediction of acute whiplash injury was conducted across several electronic databases. The search was limited to publications in English, and there were no geographical or time of publication restrictions. Quality appraisal was conducted with A Measurement Tool to Assess Systematic Reviews. RESULTS: The initial search yielded 207 abstracts; of these, 195 were subsequently excluded by topic or method. Twelve systematic reviews with moderate quality were subsequently included in the analysis. Post-injury pain and disability, whiplash grades, cold hyperalgesia, post-injury anxiety, catastrophizing, compensation and legal factors, and early healthcare use were associated with continuation of pain and disability in patients with whiplash injury. Post-injury magnetic resonance imaging or radiographic findings, motor dysfunctions, or factors related to the collision were not associated with continuation of pain and disability in patients with whiplash injury. Evidence on demographic and three psychological factors and prior pain was conflicting, and there is a shortage of evidence related to the significance of genetic factors. CONCLUSIONS: This meta-review suggests an association between initial pain and anxiety and the outcome of acute whiplash injury, and less evidence for an association with physical factors. LEVEL OF EVIDENCE: Level 1.

Trends in Socioeconomic Inequalities in Motor Vehicle Accident Deaths in the United States, 1995-2010.

Motor vehicle accident (MVA) mortality has been declining overall, but little is known about trends by socioeconomic position. We examined trends in education-related inequalities in US MVA death rates from 1995 to 2010. We used mortality data from the National Center for Health Statistics and population estimates from the Current Population Survey, and we calculated vehicle- and person-miles traveled using data from the National Household Travel Survey. We used negative binomial regression to estimate crude and age-, sex-, and race-adjusted mortality rates among adults aged 25 years or more. We found larger mortality decreases among the more highly educated and some evidence of mortality increases among the least educated. Adjusted death rates were 15.3 per 100,000 population (95% confidence interval (CI): 10.7, 19.9) higher at the bottom of the education distribution than at the top of the education distribution in 1995, increasing to 17.9 per 100,000 population (95% CI: 14.8, 21.0) by 2010. In relative terms, adjusted death rates were 2.4 (95% CI: 1.7, 3.0) times higher at the bottom of the education distribution than at the top in 1995, increasing to 4.3 times higher (95% CI: 3.4, 5.3) by 2010. Inequality increases were larger in terms of vehicle-miles traveled. Although overall MVA death rates declined during this period, socioeconomic differences in MVA mortality have persisted or worsened over time.

Epileptic auras and their role in driving safety in people with epilepsy.

The aim of our study was to evaluate the role of auras in preventing motor vehicle accidents (MVAs) among patients with medically refractory epilepsy. The Multicenter Study of Epilepsy Surgery database was used to perform a case-control study by identifying patients who had seizures while driving that led to MVAs (cases) and those who had seizures while driving without MVAs (controls). We compared presence of reliable auras and other aura-related features between the two groups. Two hundred fifteen of 553 patients reported having seizure(s) while driving; 74 were identified as "controls" and 141 as "cases." The two groups had similar demographic and clinical features. The presence of reliable auras was not different between the two groups (67% in cases vs. 65% in controls; odds ratio [OR] 0.89, 95% confidence interval [CI] 0.49-1.61, p = 0.76). In addition, the groups did not differ in the proportion of patients who reported longer (>1 min) auras (OR 0.7, 95% CI 0.28-1.76, p = 0.47), or who thought that their auras were of sufficient duration to be protective (OR 1.19, 95% CI 0.62-2.00, p = 0.77). Our study questions the long-held belief of a protective role of reliable auras against MVAs in people with epilepsy.

Motor vehicle accidents and obstructive sleep apnea syndrome: A methodology to calculate the related burden of injuries.

The association between motor vehicle accidents (MVAs) and obstructive sleep apnea syndrome (OSAS) has always been quantified as risk of MVAs for individual drivers with OSAS. We evaluated the expected injured patients per year attributable to OSAS-dependent MVAs in a general population. By combining OSAS prevalence and OSAS-dependent MVAs odds ratio, we assessed the population attributable fraction (PAF), an epidemiological tool that can be used to quantify the proportion of road traffic injuries (RTIs) attributable to OSAS. For an apnea hypopnea index >5, the weighed median and combined average of OSAS prevalence were 4.4 (95% confidence interval (CI): 3.7-7.5) and 4.7 (95% CI: 4.2-5.2), respectively; values of risk of OSAS-dependent MVAs were 2.83 (95% CI: 2.72-3.08) and 2.52 (95% CI: 2.07-3.08), respectively. The PAF showed weighed median and combined average values of 6.6 (95% CI: 4.3-9.8) and 7.3% (95% CI: 6.0-13.5), respectively. Our results show that about 7% of RTIs for a population of male drivers involved in MVAs are attributable to OSAS. This value can be used to assess the potential impact, on the reduction of incidence of the motor vehicle injuries, of prevention programs aimed at reducing the number of subjects with an undiagnosed and/or untreated OSAS.