The ROARI project - Road Accident Acute Rehabilitation Initiative: a randomised clinical trial of two targeted early interventions for road-related trauma.

OBJECTIVES: To determine the effectiveness of an Early Rehabilitation Intervention (ERI ) versus a Brief Education Intervention (BEI) following road trauma. PRIMARY OBJECTIVE: return to work or usual activities at 12 weeks (for minor/moderate injury) and 24 weeks for major injury. SECONDARY OBJECTIVES: Reduction in pain, anxiety, depression, disability and incidence of Post Traumatic Stress Disorder and improved quality of life. DESIGN: A multi-site single-blinded stratified randomized clinical trial (RCT). METHODS: 184 patients (92 in each arm) were recruited over 18 months and followed for 12 weeks (minor/moderate injury) and 24 weeks (major injury). Screening questionnaires at 2-4 weeks and follow-up interviews by phone for all outcome measures were undertaken. For those in the ERI group with a positive screen for high risk of persistent symptoms, an early assessment and intervention by a Rehabilitation Physician was offered. Those in the BEI group were sent written information and advised to see their GP. RESULTS: 89.4% of injuries were mild in this cohort. At 12 weeks 73.8% and 69.1% of patients in the ERI and the BEI groups respectively had returned to work or usual activities. There were no significant differences between the two intervention groups with respect to the primary or any secondary outcome measures. CONCLUSION: This is the first RCT of an ERI following road trauma in Australia. A targeted ERI is as effective as a BEI in assisting those with mild/moderate trauma to return to work or usual activities.

A cross-sectional study of the prevalence of medical conditions as contributors to road crashes in South Australia.

OBJECTIVES: With the population of Australians aged 85 or older expected to double by 2042 and the association of increased age with the greater likelihood of having medical conditions, the potential for an increase in the number crashes caused by medical conditions is of concern. This study aims to understand the prevalence of medical conditions contributing to road crashes and the characteristics of these crashes, in order to guide development of strategies to mitigate the risks and harms involved. METHOD: The sample consisted of 1,934 active road users (drivers, motorcyclists, cyclists, pedestrians) injured in crashes on South Australian roads who were admitted to the Royal Adelaide Hospital over the period 2014 to 2017. RESULTS: The findings indicate that 9.2% of hospital admission cases were directly caused by a medical condition or acute medical event, with loss of consciousness, attempted suicide, and seizures the most commonly observed. Crashes attributed to a medical condition were more likely to involve older drivers and those with a greater number of preexisting medical conditions. CONCLUSION: Medical conditions or acute medical events are a significant contributor to road crashes. Common crash types involving medical conditions or events - single vehicle, hit object - indicate that vehicle technologies such as lane keeping assist and autonomous emergency braking, and infrastructure treatments such as roadside barriers, may help to prevent crashes in which a driver experiences a medical event. Monitoring of drivers with medical conditions should continue, while the benefits of social policies that reduce reliance on private motor vehicles for transport should also be explored.

Driving impairment due to psychoactive substances and attention deficit disorder: A pilot study.

Objective: Attention disorder and substance use disorder are linked to driving impairment and increased road crash involvement. This study explores attention deficits in a population of drivers found driving under the influence (DUI) of psychoactive substances. Methods: A case-control study was conducted comparing subjects with a previous DUI episode (cases) to subjects who were negative for DUI offenses (controls). Personal, socio-demographic, and DUI data were collected for both groups. All subjects were administered the Continuous Performance Test-third edition (CPT-3), which measures dimensions of attention, including inattentiveness, impulsivity, sustained attention, and vigilance. Possible associations with a previous DUI episode, the use of illicit substances or excessive alcohol use, and road crash involvement were analyzed statistically. Results: Overall, the study included 147 subjects (100 cases, 47 controls). The parameter distributions of detectability, probability of ADHD, and inattentiveness indicated statistical differences between the two groups. No attention deficits predicted substance use disorder or excessive alcohol consumption. Inattentiveness was an independent risk factor for previous road collision involvement. Conclusions: The results suggest that alterations exist in some attention dimensions in a population of DUI subjects who were users of alcohol or other psychoactive substances and involved in road traffic crashes. The CPT-3 had successfully distinguished between the two study groups, and after validation, it could be useful in the process of reinstating a driver's license. Future research should expand the study sample to better understand the relevance of the proposed methodological approach in terms of prevention, rehabilitation, and the monitoring of subjects evaluated for driving eligibility requirements.

Network-wide road crash risk screening: A new framework.

Network-wide road crash risk screening is a crucial issue for road safety authorities in governing the impact of road infrastructures over road safety worldwide. Specifically, screening methods, which also enable a proactive approach (i.e., pinpointing critical segments before crashes occur), would be extremely beneficial. Existing literature provided valuable insights on road network screening and crash prediction models. However, no research tried to quantify the risk of crash on the road network by considering its main components together (i.e., probability, vulnerability, and exposure). This study covers this gap by a new framework. It integrates road safety factors, prediction models and a risk-based method, and returns the risk value on each road segment as a function of the probability of a crash occurrence and the related severity as well as the exposure model. Next, road segments are ranked according to the risk value and classified by a five-level scale, to show the parts of road network with the highest crash risk. Experiments show the capability of this framework by integrating base map data, context information, road traffic data and five years of real-world crash data records of the whole non-urban road network of the Province of Brescia (Lombardy Region - Italy). This framework introduces a valid support for road safety authorities to help identify the most critical road segments on the network, prioritise interventions and, possibly, improve the safety performance. Finally, this framework can be incorporated in any safety managerial system.

Reducing crash risk for young drivers: Protocol for a pragmatic randomised controlled trial to improve young driver sleep.

Background: Road trauma is a leading cause of death and disability for young Australians (15-24 years). Young adults are overrepresented in crashes due to sleepiness, with two-thirds of their fatal crashes attributed to sleepy driving. This trial aims to examine the effectiveness of a sleep extension and education program for improved road safety in young adults. Methods: Young adults aged 18-24 years (n = 210) will be recruited for a pragmatic randomised controlled trial employing a placebo-controlled, parallel-groups design. The intervention group will undergo sleep extension and receive education on sleep, whereas the placebo control group will be provided with information about diet and nutrition. The primary outcomes of habitual sleep and on-road driving performance will be assessed via actigraphy and in-vehicle accelerometery. A range of secondary outcomes including driving behaviours (driving simulator), sleep (diaries and questionnaire) and socio-emotional measures will be assessed. Discussion: Sleep is a modifiable factor that may reduce the risk of sleepiness-related crashes. Modifying sleep behaviour could potentially help to reduce the risk of young driver sleepiness-related crashes. This randomised control trial will objectively assess the efficacy of implementing sleep behaviour manipulation and education on reducing crash risk in young adult drivers.

Development of crash prediction models by assessing the role of perpetrators and victims: a comparison of ANN & logistic model using historical crash data.

Road traffic injuries cost countries 3% of their annual GDP. In developing countries like India, every year around 150,000 people die on roads. The type of vehicles involved in a crash contribute majorly to the outcome of casualty (injury/death). Barring few studies, literature are less regarding the role of vehicle as perpetrator and victim on road crash fatalities. Historical crash data has been used in the present study to examine the role of vehicles (both as perpetrator & victim). The study reveals that victim's effect is more as compared to perpetrator/accused for determining the outcome of crash. Heavy vehicles as perpetrator, and self-hitting vehicles along with pedestrians as victims have higher fatality rates. Binary logistic regression and artificial neural network (ANN) has been utilized for developing prediction models. Binary logistic model predicted around 75% of outcomes correctly with default cut-off value (0.5). However, based on reported crash data, where 19% of total crashes lead to deaths, 0.19 has been proposed as cut-off value which increases the accuracy of the predictions. Accuracy of ANN technique directly depends on the number of crashes reported for a definite pair of perpetrator and victim and the type of validation technique used (Holdback/K-Fold) along with the type of hidden layer chosen for the study based on different types of sigmoid activation function. ROC curves in ANN suggest that the analysis can predict 75% of the outcomes which can be increased by deleting the pairs of vehicles which are present/have occurred in very less number. A comparison has been made between the two techniques based on their advantages and limitations. The developed models can be used as safety indicators based on composition of traffic flow on urban roads.

Mobile phone penalties and road crashes: Are changes in sanctions effective?

INTRODUCTION: Road crashes are a major, preventable cause of death and serious injury. Being distracted by a mobile phone while driving can increase the risk of a crash by three to four times and increase crash severity. To reduce distracted driving, on 1 March 2017 the penalty for using a hand-held mobile phone while driving in Britain doubled to £200 and six penalty points. METHOD: We examine the effects of this increased penalty on numbers of serious or fatal crashes over 6 weeks either side of the intervention using Regression Discontinuity in Time. RESULTS: We find no effect of the intervention, suggesting the increased penalty is not effective in reducing the more serious road crashes. CONCLUSIONS: We rule out an information problem and an enforcement effect, concluding the increase in fines was insufficient to change behaviour. With very low detection rates of mobile phone use, our result could occur if the perceived certainty of punishment remained very low after the intervention. PRACTICAL APPLICATION: Future technology will increase the ability to detect mobile phone usage, and there may be fewer road crashes if the solution is to raise awareness of such technology and publicise numbers of offenders caught. Alternatively, a mobile phone blocking application could avert the problem.

Association between High Ambient Temperatures and Road Crashes in an Australian City with Temperate Climate: A Time-Series Study, 2012-2021.

(1) Background: High ambient temperatures are associated with increased morbidity and mortality rates, and some evidence suggests that high temperatures increase the risk of road crashes. However, little is known regarding the burden of road crashes attributable to no-optimal high temperatures in Australia. Therefore, this study examined the effects of high temperatures on road crashes using Adelaide in South Australia as a case study. (2) Methods: Ten-year daily time-series data on road crashes (n = 64,597) and weather during the warm season (October-March) were obtained between 2012 and 2021. A quasi-Poisson distributed lag nonlinear model (DLNM) was used to quantify the cumulative effect of high temperatures over the previous five days. The associations and attributable burden at moderate and extreme temperature ranges were computed as relative risk (RR) and attributable fraction. (3) Results: There was a J-shaped association between high ambient temperature and the risk of road crashes during the warm season in Adelaide, and pronounced effects were observed for minimum temperatures. The highest risk was observed at a 1 day lag and lasting for 5 days. High temperatures were responsible for 0.79% (95% CI: 0.15-1.33%) of road crashes, with moderately high temperatures accounting for most of the burden compared with extreme temperatures (0.55% vs. 0.32%). (4) Conclusions: In the face of a warming climate, the finding draws the attention of road transport, policy, and public health planners to design preventive plans to reduce the risk of road crashes attributable to high temperatures.

Prevalence of fatigue while driving among two-wheeled vehicle drivers and associated factors: Exploratory approach from secondary analysis based on hospital data, Benin.

Fatigue while driving is one of the risk factors of road crashes. It's still poorly considered in interventions because of insufficient literature. In addition, the literature on this issue doesn't focus on two-wheelers, the most frequent users in the Benin context. The study examined the prevalence of fatigue while driving among two-wheeled vehicle drivers and the related factors. It's a secondary baseline data analysis from a cohort of road crash victims recruited from five hospitals in Benin. Data were collected from July 2019 to January 2020. Patients who identified themselves as drivers during the accident were included. Data on individual characteristics, including fatigue status in the moments preceding the collision, and other risk factors and environmental settings, were extracted. We used multivariate logistic regression. Among the respondents, 12.20% (95% CI=10.20-14.53) reported fatigue in the moments preceding the collision. The odds of fatigue while driving were significantly higher in male drivers (aOR=3.60; 95% CI=1.08-11.98), during professional trips (aOR=2.09; 95% CI=1.30-3.37), in non-helmet wearers (aOR=1.85; 95% CI=1.09-3.13), in users of stimulants (aOR=3.13; 95% CI=1.50-6.54), in those with a history of chronic diseases (aOR=1.95; 95% CI=1.16-3.27), at dusk (aOR=4.22; 95% CI=2.22-8.02), at night (aOR=6.90; 95% CI=3.95-12.05), and on Inter-State National Roads (aOR=2.01; 95% CI=1.18-3.43). Fatigue is a risk factor for road crashes in Benin, associated with other risk factors that highlight particularly vulnerable profiles and groups. Integrating prevention policies based on these cumulative risk factors will result in efficiency improvements.

Understanding the factors of road crash severity in Benin: a matched case-control study.

Background: In Benin, due to the unavailability of comprehensive data on road crashes, road safety policies are mainly based on partial statistics provided by the police. These remain unreliable in terms of injury severity and risk factors. This study aims to determine the factors influencing the severity of injuries after a road crash in Benin. Methods: The present nested case-control study, matched for age and sex, was based on a hospital cohort of road crash victims set up in five hospitals in Benin between July 2019 and January 2020. A sample of severely injured patients according to the Abbreviated Injury Scale (cases) was compared to non-severely injured patients (controls). Results: The severe crash occurred mainly during the night between 8 p.m. and midnight (36.2% of cases vs. 24.4% of controls) and on main roads (57.8% of cases vs. 34.7% of controls). Factors associated with injury severity were the time of the crash: night between 8 p.m. and midnight [Adjusted Odd Ratio (AOR): 2.1; CI 95%: 1.4-3.2], major roads (national interstate roads and national roads) (AOR: 2.8; CI 95%: 2.0-4.0) and non-work-related travel (AOR: 1.8; CI 95%: 1.2-2.7). Conclusions: Factors associated with road crash severity in Benin were night-time, main roads, and non-work related travel. Raising user awareness about compliance with traffic rules and improving public lighting, especially along main roads could help reduce the number of serious injuries.

Profile of low and middle-income countries with increases versus decreases in road crash fatality population rates and necessity of motorcycle safety.

INTRODUCTION: Road crash fatalities have increased significantly in Low- and Middle- Income Countries (LMICs) between 2006 and 2016. This study presents how road safety characteristics have changed in LMICs by comparing data over time and relationships between the road crash fatality increase and a wide range of data from LMICs. Parametric and nonparametric methods are used to test significance. METHOD: There were 35 countries in the Latin America and Caribbean region, the Sub-Saharan Africa region, the East Asia and Pacific region, and the South Asia region, where the population rate of road crash fatalities consistently increased as per country reports, World Health Organization and Global Burden of Disease estimates. In these countries, the proportion of fatalities involving motorcycles (including powered two or three-wheelers) substantially increased (44%) over the same time (statistically significant). In these countries, the helmet-wearing rate was only 46% for all passengers. These patterns were not observed in LMICs with decreasing population fatality rates. RESULTS: Motorcycle helmet usage rates strongly correlate with decreasing fatalities per 10,000 motorcycles in Low-Income Countries (LICs) and LMICs. Effective interventions (including increasing helmet usage) are urgently needed for motorcycle crash trauma in LMICs, especially where the economy and motorization rapidly grow. National strategies for motorcycle safety, conforming to the Safe System principles, are recommended. CONCLUSIONS: For evidence-based policy formulation, there is a need to continue strengthening data collection, sharing, and use.

The road safety and risky behavior analysis of delivery vehicle drivers in China.

The delivery industry has seen dramatic growth in demand and scale in China. Due to the stock limitations and delivery time restrictions, the couriers may commit traffic violations while delivering, resulting in a pessimistic road safety situation. This study aims to reveal critical factors that influence delivery vehicle crash risks. A cross-sectional structured questionnaire survey is conducted to collect demographic attributes, workload, work emotions, risky driving behavior, and road crash involvement data among 824 couriers in three developed regions of China. The collected data is then analyzed through an established path model to identify the contributing factors of delivery road crash risks and risky behaviors. The road crash risk level (RCRL) indicator is defined by taking into consideration both frequency and severity. While the risky behaviors are defined by both their frequency and correlations to crash risks. The results indicate that 1) Beijing-Tianjin Urban Agglomeration has the highest road crash frequency and RCRL; 2) distracted driving and wrong-lane-use are among the top three risky behaviors for both Yangtze River Delta Urban Agglomeration and Pearl River Delta Urban Agglomeration. For Beijing-Tianjin Urban Agglomeration, distracted driving, aggressive driving, and lack of protection are the top three risky behaviors; 3) time demand and personal efforts are important factors contributing to the cognitive workload of couriers; 4) objective workload can affect the cognitive workload and both workloads influence drivers' emotions (anxiety and anger); 5) the objective, cognitive workload, drivers' emotions influence the RCRL through their impacts on risky behavior but in different paths for three agglomerations. The findings highlight the importance of developing targeted countermeasures to reduce the delivery workers' workload, improve their performance on roads, and mitigate severe crash risks.

Investigating the effect of road condition and vacation on crash severity using machine learning algorithms.

Investigating the contributing factors to traffic crash severity is a demanding topic in research focusing on traffic safety and policies. This research investigates the impact of 16 roadway condition features and vacations (along with the spatial and temporal factors and road geometry) on crash severity for major intra-city roads in Saudi Arabia. We used a crash dataset that covers four years (Oct. 2016 - Feb. 2021) with more than 59,000 crashes. Machine learning algorithms were utilized to predict the crash severity outcome (non-fatal/fatal) for three types of roads: single, multilane, and freeway. Furthermore, features that have a strong impact on crash severity were examined. Results show that only 4 out of 16 road condition variables were found to be contributing to crash severity, namely: paints, cat eyes, fence side, and metal cable. Additionally, vacation was found to be a contributing factor to crash severity, meaning crashes that occur on vacation are more severe than non-vacation days.

CBT program to reduce recidivism risk for road crashes among adolescents and young adults: Results of a randomized controlled study and prospects.

Road crashes are the first cause of mortality for young adults aged 18-25 years and the human factor contributes to 90-95% of events. The present study was carried out to determine the efficacity of the ECARR2 recurrence prevention program among adolescents and young adults at high risk of having a new traffic crash in the following months. A total of 288 participants having had a traffic crash that required going to the emergency room, at high risk of accident recurrence (ECARR≥5) were randomly allocated to either the intervention group (n = 144) or the control group (n = 144). Results: revealed that the risk of recurrence was highest during the first 6 months (66% of recurrences). In per-protocol analysis population, at 6 months after inclusion, the accident recurrence rate was 14.2% ± 3.3% in the intervention group, and 23.5% ± 4.0% in the control group. The intervention had an effect per se, independently of the other predictors (p = 0.020). This effect was mediated by the three interaction variables: BDI, Impulsive Behavior Scale lack of perseverance, and Orientation to Happiness engagement. It was therefore through these dimensions that the intervention had an effect. In conclusion, the ECARR score predicts the risk of recurrence, risk which is the highest during the first 6 months. Finally, results confirm the predictive validity of the ECARR scale. The ECARR score had an effect on the risk of recurrence regardless of group (p = 0.045) and was predictive of recurrence (p = 0.045).A brief psychological intervention such as ECARR2 program, offered to young people ar hight risk of having a new crash, just after the crash, seems to halve the risk of recurrence at 6 months. Future research should improve the brief psychological intervention and its access via a mobile application or few hours in high school or in a driving school given.

Learning With a Supervisor Who has Traffic Offences and Young Driver Crashes: The DRIVE Study 13-Year Follow-Up.

PURPOSE: Young learner drivers commonly must record substantial supervised practice driving before independent licensure. Supervisory driver requirements can be limited or highly regulated, yet research is lacking on the effectiveness of different approaches. The current objective was to explore whether young drivers who were mostly supervised by someone who they perceived had traffic offences versus no offences had different crash records over a period of 13 years postlicensing. METHODS: DRIVE is an Australian prospective cohort study of more than 20,000 drivers who were aged 17-24 years and newly licensed during 2003-2004. They completed detailed baseline questionnaires, including whether the person they identified as supervising their learner driving the most had perceived traffic offences in the past 12 months. Responses were linked to their state crash, hospitalization, and death records to 2016. A parametric survival model was created to calculate hazard ratios of time to crash for those reporting that their supervisor had 0 versus 1 and 0 versus 2+ perceived offences, adjusting for the participants' prior crash history and other covariates. RESULTS: After adjusting for covariates, 369 participants reporting supervisory drivers with 2+ perceived offences, compared to 15,451 participants reporting no such offences, had up to 1.67 (95% confidence interval 1.10-2.53 at 6 months) times the rate of any crash for the first 2.5 years and up to 2.01 (95% confidence interval 1.26-3.19 at 3.5 years) times the rate of crashes resulting in injury for 5.5 years. DISCUSSION: Although overall supervision by a driver with two or more perceived offences was low, further attention is needed to ensure improved supervised driving experiences, with mentoring programs and professional instructor partnerships worthy of exploration.

Effects of design consistency on run-off-road crashes: An application of a Random Parameters Negative Binomial Lindley model.

Run-off-road crashes are one of the most common crash types, especially in rural roadway environments contributing significantly to fatalities and severe injuries. These crashes are complex and multi-dimensional events, and factors like road geometry, driver behaviour, traffic characteristics and roadside features contribute to their occurrence, separately or interactively. Sudden changes in road geometry, in particular, can influence driver behaviour, and therefore, in developing a micro-level crash risk model for run-off-road crashes, one of the challenges is incorporating the effects of driver behaviour (disaggregated information) that may arise from the variations in road geometry (aggregated information). This study aims to examine the interaction between road geometry and driver behaviour through a set of measures for design consistency on two-lane rural roads. Multiple data sources, including crash data for 2014-18, traffic data, probe speed data and roadway geometric data, for twenty-three highways in Queensland, Australia, have been fused for this study. Seventeen types of design consistency measures with regard to alignment consistency, operating speed consistency and driving dynamics are tested. A run-off-road crash risk model is estimated by employing the Random Parameters Negative Binomial Lindley regression framework, which accounts for excess zeros in the crash counts and captures the effects of unobserved heterogeneity in the parameter estimates. Results indicate that the geometric design consistency capturing the interaction between driver behaviour and operational factors better predicts run-off-road crashes along rural highways. In addition, roadside attributes like clear zone width, infrastructures, terrain, and roadway remoteness also contribute to run-off-road crashes. The findings of the study provide a comprehensive understanding of the influence of variations in roadway geometry on driver behaviour and run-off-road crashes along rural highways.

Profiling fatal and serious injury crashes in South Australia according to the Swedish transport administration model.

OBJECTIVES: This article describes a study examining fatal road crashes in South Australia (SA) according to the safety model developed by the Swedish Road Administration (STA). The STA model is based on the biomechanical limits that human beings can tolerate and specifies a number of elements that must be present for "compliance" with the model: driving at or below the speed limit, driver not intoxicated by alcohol or drugs, vehicle occupants wearing a seatbelt, car with a EuroNCAP rating of 5 stars, car equipped with electronic stability control, and a road with an EuroRAP rating of 4 stars. METHOD: The study used a sample of 105 fatal crashes in SA in 2010 and 2011 and a comparison sample of 136 serious injury crashes from 2014 to 2017. RESULTS: It was found that there were high levels of noncompliance with all elements of the STA model, with multiple forms of noncompliance in a clear majority of fatal cases. CONCLUSIONS: Considerable gains in safety could occur with greater penetration into the SA fleet of 5-star cars fitted with ESC and other vehicle safety technology, especially as the majority of both sets of crashes were of a type involving loss of vehicular control. It is also important to note that risky road user behavior was less common in the serious injury crashes and so a road safety strategy focusing on changing road user behavior will be ineffective for addressing the major factors contributing to non-fatal road trauma.

Addressing the association between driving with an expired vehicle inspection certificate and injury severity after a crash.

OBJECTIVES: The aim of this study was to quantify the association between driving a vehicle with an expired vehicle inspection certificate (DEVIC) and the severity of injuries sustained by drivers involved in collisions. METHODS: A cohort study was designed to compare the incidence of minor injuries, major injuries, and deaths between DEVIC and non-DEVIC drivers involved in collisions. We selected all 51,305 non-responsible drivers (i.e., drivers who did not commit an error or infraction) involved in clean collisions (those in which only one driver in multivehicle collisions committed a traffic infraction or error) from the population of drivers of four-wheeled motor vehicles involved in crashes recorded in the National Register for Road Traffic Accident Victims in Spain from 2014 to 2017. RESULTS: DEVIC was not related with a greater severity of drivers' injuries. The adjusted estimates for the association between DEVIC and major injuries or death yielded an odds ratio of 0.91 (0.66-1.25), compared to no injuries or minor injuries, and a relative risk ratio of 0.90 (0.65-1.24) compared to no injuries. CONCLUSIONS: Although we have not found an association between DEVIC and drivers' injury severity, the study limitations does not allow us to discard the usefulness of periodic vehicle inspection in reducing the risk of more severe injury among drivers involved in road crashes.

Effect of wearing a helmet on the occurrence of head injuries in motorcycle riders in Benin: a case-control study.

BACKGROUND: In Benin, motorcycles are the main means of transport for road users and are involved in more than half of crashes. This study aims to determine the effect of wearing a helmet on reducing head injuries in road crashes in Benin. METHODS: This case-control study took place in 2020 and focused on road trauma victims. The sample, consisting of 242 cases (trauma victims with head injuries) for 484 controls (without head injuries), was drawn from a database of traffic crash victims recruited from five hospitals across the country from July 2019 to January 2020. Four groups of independent variables were studied: socio-demographic and economic variables, history, behavioural variables including helmet use and road-related and environmental variables. To assess the shape of the association between the independent variables and the dependent variable, a descending step-by-step binary logistic regression model was performed using an explanatory approach. RESULTS: Fewer of the subjects with a head injury were wearing a helmet at the time of the crash 69.8% (95% CI = 63.6-75.6) compared to those without a head injury 90.3% (95% CI = 87.3-92.8). Adjusting for the other variables, subjects not wearing helmets were at greater risk of head injuries (OR = 3.8, 95% CI (2.5-5.7)); the head injury rating was 1.9 (95% CI = 1.2-3.3) times higher in subjects who were fatigued during the crash than among those who were not and 2.0 (95% CI = 1.2-3.3) times higher in subjects with no medical history. CONCLUSION: Failure to wear a helmet exposes motorcyclists to the risk of head injuries during crashes. It is important to increase awareness and better target such initiatives at the subjects most at risk.

Effect of Periodic Vehicle Inspection on Road Crashes and Injuries: A Systematic Review.

This systematic review was conducted to determine the effect of periodic motor vehicle inspections on road crashes and injuries, compared to less exposure to periodic inspections or no inspections. The Medline, Web of Science, and Scopus databases were used to search the literature. Ecological studies were specifically excluded. A reverse search of the results with these databases and of other identified narrative reviews was also performed. Of the 5065 unique references initially extracted, only six of them met the inclusion criteria and were selected for review: one experimental study, two cohort studies with an internal comparison group, two cohort studies without a comparison group, and one case-control study. Two authors independently extracted the information and assessed the quality of each study. Due to the heterogeneity of the designs and the intervention or comparison groups used, quantitative synthesis of the results was not attempted. Except for the case-control study, which showed a significant association between road crashes and the absence of a valid vehicle inspection certificate, the other studies showed either a small reduction in crash rates (around 9%), no association, or a higher crash rate in vehicles with more inspections. In all observational studies, the risk of residual confounding bias was significant and could have explained the results. Therefore, although the research reviewed here suggests that periodic inspection may be associated with a slight reduction in road crashes, the marked heterogeneity along with probable residual confounding in most reports prevented us from establishing causality for this association.