The Influence of a Booster Seat on the Motion of the Reclined Small Female Anthropomorphic Test Device in Low-Acceleration Far-Side Lateral Oblique Impacts.

Belt-positioning booster (BPB) seats may prevent submarining in reclined child occupants in frontal impacts. BPB-seated child volunteers showed reduced lateral displacement in reclined seating in low-acceleration lateral-oblique impacts. As submarining was particularly evident in reclined small adult female occupants, we examined if a booster seat could provide similar effects on the kinematics of the small female occupant to the ones found on the reclined child volunteers in low-acceleration far-side lateral oblique impacts. The THOR-AV-5F was seated on a vehicle seat on a sled simulating a far-side lateral-oblique impact (80 deg from frontal, maximum acceleration ∼2 g, duration ∼170 ms). Lateral and forward head and trunk displacements, trunk rotation, knee-head distance, seatbelt loads, and head acceleration were recorded. Three seatback angles (25 deg, 45 deg, 60 deg) and two booster conditions were examined. Lateral peak head and trunk displacements decreased in more severe reclined seatback angles (25-36 mm decrease compared to nominal). Forward peak head, trunk displacements, and knee-head distance were greater with the seatback reclined and no BPB. Knee-head distance increased in the severe reclined angle also with the booster seat (>40 mm compared to nominal). Seat belt peak loads increased with increased recline angle with the booster, but not without the booster seat. Booster-like solutions may be beneficial for reclined small female adult occupants to reduce head and trunk displacements in far-side lateral-oblique impacts, and knee-head distance and motion variability in severe reclined seatback angles.

Motor vehicle collision characteristics and hospitalization outcomes associated with mild traumatic brain injury and concomitant whiplash injury.

OBJECTIVE: Few large studies have investigated the factors and outcomes related to concomitant injuries occurring alongside mild traumatic brain injury (mTBI) after motor vehicle collisions (MVCs). Thus, the objective of this study was to assess whether MVC characteristics predict which patients with mTBI will have concomitant whiplash injury, and whether concomitant whiplash injury affects care utilization for these patients. METHODS: This retrospective cohort study included 22,213 patients with mTBI after MVC identified from the American College of Surgeons Trauma Quality Programs dataset. A hierarchical logistic regression model was constructed to investigate patient and MVC factors associated with concomitant whiplash injury. Propensity score matching on whiplash status, in conjunction with a multivariable logistic regression model, assessed if concomitant whiplash affected odds of hospitalization. In the subgroup of patients who were hospitalized, associations with hospital length of stay (LOS) and discharge disposition were investigated. RESULTS: The median (IQR) age was 34 (24-51) years, with a median Glasgow Coma Scale score at presentation of 15 (15-15). Patients with concomitant whiplash were older (median 36 years vs 34 years, p = 0.03) and had higher rates of hospitalization (75% vs 64%, p < 0.001). In the hierarchical model for associations with concomitant whiplash injury, patients with blood alcohol content (BAC) greater than the federal driving limit had lower odds of concomitant whiplash (OR 0.63, 95% CI 0.49-0.81) along with those who had airbag deployment (OR 0.80, 95% CI 0.68-0.95), but seatbelt use was associated with greater odds (OR 1.41, 95% CI 1.16-1.71). After matching, concomitant whiplash was independently associated with increased odds of hospitalization (OR 1.67, 95% CI 1.40-1.99) while seatbelt use was associated with decreased odds (OR 0.88, 95% CI 0.81-0.95). Among hospitalized patients, concomitant whiplash was not associated with hospital LOS or discharge disposition. CONCLUSIONS: MVC characteristics such as alcohol consumption and airbag deployment were protective toward development of concomitant whiplash for mTBI patients, while seatbelt use was associated with higher risk. Concomitant whiplash increases the odds of hospitalization for mTBI patients but does not affect hospital LOS or discharge disposition, while seatbelt use is associated with lower rates of hospitalization and a more favorable hospital course. These findings provide context to injury patterns and care provision after a common mechanism of injury.

Driver Injury from Vehicle Side Impacts When Automatic Emergency Braking and Active Seat Belts Are Used.

As an advanced driver assistance system, automatic emergency braking (AEB) can effectively reduce accidents by using high-precision and high-coverage sensors. In particular, it has a significant advantage in reducing front-end collisions and rear-end accidents. Unfortunately, avoiding side collisions is a challenging problem for AEB. To tackle these challenges, we propose active seat belt pretensioning on driver injury in vehicles equipped with AEB in unavoidable side crashes. Firstly, records of impact cases from China's National Automobile Accident In-Depth Investigation System were used to investigate a scenario in which a vehicle is impacted by an oncoming car after the vehicle's AEB system is triggered. The scenario was created using PreScan software. Then, the simulated vehicles in the side impact were devised using a finite element model of the Toyota Yaris and a moving barrier. These were constructed in HyperMesh software along with models of the driver's side seatbelt, side airbag, and side curtain airbag. Moreover, the models were verified, and driver out-of-position instances and injuries were evaluated in simulations with different AEB intensities up to 0.7 g for three typical side impact angles. Last but not least, the optimal combination of seatbelt pretensioning and the timing thereof for minimizing driver injury at each side impact angle was identified using orthogonal tests; immediate (at 0 ms) pretensioning at 80 N was applied. Our experiments show that our active seatbelt with the above parameters reduced the weighted injury criterion by 5.94%, 22.05%, and 20.37% at impact angles of 90°, 105°, and 120°, respectively, compared to that of a conventional seatbelt. The results of the experiment can be used as a reference to appropriately set the collision parameters of active seat belts for vehicles with AEB.

Motor Vehicle Protective Device Usage Associated with Decreased Rate of Flail Chest: A Retrospective Database Analysis.

Background and Objectives: Protective equipment, including seatbelts and airbags, have dramatically reduced the morbidity and mortality rates associated with motor vehicle collisions (MVCs). While generally associated with a reduced rate of injury, the effect of motor vehicle protective equipment on patterns of chest wall trauma is unknown. We hypothesized that protective equipment would affect the rate of flail chest after an MVC. Materials and Methods: This study was a retrospective analysis of the 2019 iteration of the American College of Surgeons Trauma Quality Program (ACS-TQIP) database. Rib fracture types were categorized as non-flail chest rib fractures and flail chest using ICD-10 diagnosis coding. The primary outcome was the occurrence of flail chests after motor vehicle collisions. The protective equipment evaluated were seatbelts and airbags. We performed bivariate and multivariate logistic regression to determine the association of flail chest with the utilization of vehicle protective equipment. Results: We identified 25,101 patients with rib fractures after motor vehicle collisions. In bivariate analysis, the severity of the rib fractures was associated with seatbelt type, airbag status, smoking history, and history of cerebrovascular accident (CVA). In multivariate analysis, seatbelt use and airbag deployment (OR 0.76 CI 0.65-0.89) were independently associated with a decreased rate of flail chest. In an interaction analysis, flail chest was only reduced when a lap belt was used in combination with the deployed airbag (OR 0.59 CI 0.43-0.80) when a shoulder belt was used without airbag deployment (0.69 CI 0.49-0.97), or when a shoulder belt was used with airbag deployment (0.57 CI 0.46-0.70). Conclusions: Although motor vehicle protective equipment is associated with a decreased rate of flail chest after a motor vehicle collision, the benefit is only observed when lap belts and airbags are used simultaneously or when a shoulder belt is used. These data highlight the importance of occupant seatbelt compliance and suggest the effect of motor vehicle restraint systems in reducing severe chest wall injuries.

Improper Restraint Use in Pediatric Patients Involved in Motor Vehicle Collisions.

BACKGROUND: Motor vehicle collisions (MVCs) are the leading cause of unintentional death among children and adolescents; however, public awareness and use of appropriate restraint recommendations are perceived as deficient. We aimed to investigate the use of child safety restraints and examine outcomes in our community. METHODS: We retrospectively queried a level 1 trauma registry for pediatric (0-18 y) MVC patients from October 2013 to December 2018. Demographic and clinical variables were recorded. Data regarding appropriate restraint use by age group were examined. RESULTS: Four hundred thirty-four cases of pediatric MVC were identified. Overall, 53% were improperly restrained or unrestrained. Sixty-two percent of car seat age and 51% of booster age children were improperly restrained or unrestrained altogether. Fifty-nine percent of back seat riding, seatbelt age were improperly restrained/unrestrained, with 26% riding in the front. Fifty-one percent of seatbelt-only adolescents were not belted. Black, non-Hispanic children were more often improperly restrained/unrestrained compared to Hispanics (63% versus 48%, P = 0.001). Improperly restrained/unrestrained children had higher injury severity (10% versus 4% Injury Severity Score > 25, P = 0.021), require operative/interventional radiology (33% versus 19%, P = 0.001), and be discharged to rehabilitation or skilled nursing facility (5.2% versus 1.5%, P = 0.033). Mortality in adolescents was higher among those unrestrained (5.2% versus 0.8%, P = 0.034). CONCLUSIONS: Although efforts to improve adherence to restraint regulations have greatly increased in the last decade, more than half of children in MVC are still improperly restrained. Injury prevention services and community outreach is essential to educate the most vulnerable populations, especially those with infants and toddlers, on adequate motor vehicle safety measures in our community.

The Impact of Seatbelt Use on Trauma Outcomes in Adult Motor Vehicle Collision Patients With Rib Fractures: A National ACS-TQP-PUF Database Analysis.

BACKGROUND: Motor vehicle collisions (MVCs) are a leading cause of morbidity and mortality. However, there is limited evidence examining the effects seatbelt use has on MVC-related injuries and outcomes in patients with rib fractures. We aim to assess how seatbelt use affects associated injuries and outcomes in adult MVC patients with ≥2 rib fractures. METHODS: This retrospective study utilized the American College of Surgeons (ACS) Trauma Quality Programs (TQP) Participant Use File (PUF) Database. Drivers/passengers who sustained ≥2 rib fractures following an MVC and had an AIS ≤2 for extra-thoracic body regions were analyzed. Patients were then subdivided by presence of flail chest into two cohorts, which were subdivided according to injury severity score (ISS) and seatbelt use. Logistic and linear regression was used to assess the impact of seatbelt use on outcomes. RESULTS: Among both low and intermediate ISS classifications, restrained patients in the non-flail chest cohort had decreased incidence of pneumothorax, pulmonary contusion, and liver injury (P < 0.001). After adjusting for confounders, restrained patients (versus unrestrained) had decreased odds of pneumothorax (aOR = 0.91, P = <0.001) and acute respiratory distress syndrome (aOR=0.65, P = 0.02), while having increased odds of splenic laceration (aOR = 1.18, P = 0.003) (intermediate ISS group). Compared to unrestrained patients, restrained non-flail chest patients had a significantly decreased hospital length of stay (LOS) and intensive care unit LOS (P < 0.05). CONCLUSIONS: Seatbelt use may be protective against serious injuries in patients with ≥2 rib fractures, resulting in improved outcomes. Education programs should be developed to bolster seatbelt compliance.

Seat belt asphyxia as a lethal mechanism in motor vehicle crashes.

A 28-year-old driver was found dead in his car after impact with a truck. At the scene he was seated in the driver's seat partially hanging out of the vehicle with the sash component of the seatbelt tightly pressed into his neck. At autopsy there was evidence of neck compression with bilateral conjunctival petechial hemorrhages and fracture of the right superior horn of the thyroid cartilage. Limb fractures and internal injuries were not associated with significant hemorrhage. There was no evidence of brain trauma. Death was, therefore due to neck compression from the seatbelt demonstrating an additional rare lethal mechanism that may be encountered in vehicle crashes. External bruises and abrasions may not be present around the neck due to padding from clothing, however conjunctival petechiae and neck injuries are supportive of the diagnosis.

Power-Saving Design of Radio Frequency Identification Sensor Networks in Bus Seatbelt Monitoring Systems.

Seatbelt state monitoring is important in intercity buses for passenger safety. This paper discusses the issues and challenges in power-saving design of radio frequency identification (RFID) sensor networks in bus seatbelt monitoring. A new design approach is proposed in this work for low-power layout and parameter setting in RFID sensor nodes in hardware and software design. A one-to-many pairing registration method is suggested between the concentrator and the seat nodes. Unlike using extra computer software to write seat identification (ID) into an integrated circuit (IC) card, the node ID in this project can be stored into the concentrator directly, which can reduce intermediate operations and reduce development costs. The effectiveness of the proposed low-power design approach is verified by some experimental tests.

Airbag deployment and cervical spine injury in restrained drivers following motor vehicle collisions.

PURPOSE: Seatbelts and airbags are the most important devices protecting drivers from cervical spine injury (CSI) following motor vehicle collisions (MVCs). However, there have been few reports on the radiographic characteristics of CSI sustained by restrained, airbag-deployed drivers. METHODS: A single-center, retrospective observational study was conducted using prospectively acquired data. Between January 2011 and December 2017, 564 restrained drivers, whose vehicle had been severely damaged in MVCs, underwent whole-body computed tomography for evaluation of bodily injuries. The drivers were dichotomized into airbag (+) group (n = 218) and airbag (-) group (n = 139), after excluding 207 drivers in whom airbag deployment status was unknown. RESULTS: Eight and nine drivers sustained CSIs in the airbag (+) and airbag (-) group, respectively. The frequency of CSI did not differ significantly between the two groups (3.7% vs. 6.5%, p = 0.31). All eight CSIs in the airbag (+) group were classified as hyperextension injuries, and four of them sustained concomitant spinal cord injuries caused by dislocation. Within the airbag (+) group, the drivers with CSIs were significantly older than those without CSIs (65.2 ± 18.5 vs. 44.8 ± 18.7 years, p = 0.002). CONCLUSION: Although it is without doubt that the combination of seatbelt and airbag reduces the frequency and severity of CSIs following MVCs, the CSIs sustained in restrained, airbag (+) drivers may not always be mild, and elderly drivers may be at an elevated risk of CSI. In addition, the possibility of a causal role of airbags in CSI requires consideration in this population.

Seatbelt use and risk of major injuries sustained by vehicle occupants during motor-vehicle crashes: a systematic review and meta-analysis of cohort studies.

BACKGROUND: In 2004, a World Health Report on road safety called for enforcement of measures such as seatbelt use, effective at minimizing morbidity and mortality caused by road traffic accidents. However, injuries caused by seatbelt use have also been described. Over a decade after publication of the World Health Report on road safety, this study sought to investigate the relationship between seatbelt use and major injuries in belted compared to unbelted passengers. METHODS: Cohort studies published in English language from 2005 to 2018 were retrieved from seven databases. Critical appraisal of studies was carried out using the Scottish Intercollegiate Guidelines Network (SIGN) checklist. Pooled risk of major injuries was assessed using the random effects meta-analytic model. Heterogeneity was quantified using I-squared and Tau-squared statistics. Funnel plots and Egger's test were used to investigate publication bias. This review is registered in PROSPERO (CRD42015020309). RESULTS: Eleven studies, all carried out in developed countries were included. Overall, the risk of any major injury was significantly lower in belted passengers compared to unbelted passengers (RR 0.47; 95%CI, 0.29 to 0.80; I2 = 99.7; P = 0.000). When analysed by crash types, belt use significantly reduced the risk of any injury (RR 0.35; 95%CI, 0.24 to 0.52). Seatbelt use reduces the risk of facial injuries (RR = 0.56, 95% CI = 0.37 to 0.84), abdominal injuries (RR = 0.87; 95% CI = 0.78 to 0.98) and, spinal injuries (RR = 0.56, 95% CI = 0.37 to 0.84). However, we found no statistically significant difference in risk of head injuries (RR = 0.49; 95% CI = 0.22 to 1.08), neck injuries (RR = 0.69: 95%CI 0.07 to 6.44), thoracic injuries (RR 0.96, 95%CI, 0.74 to 1.24), upper limb injuries (RR = 1.05, 95%CI 0.83 to 1.34) and lower limb injuries (RR = 0.77, 95%CI 0.58 to 1.04) between belted and non-belted passengers. CONCLUSION: In sum, the risk of most major road traffic injuries is lower in seatbelt users. Findings were inconclusive regarding seatbelt use and susceptibility to thoracic, head and neck injuries during road traffic accidents. Awareness should be raised about the dangers of inadequate seatbelt use. Future research should aim to assess the effects of seatbelt use on major injuries by crash type.

Frequency and characteristics of traumatic brain injury in restrained drivers involved in road traffic accidents.

BACKGROUND: While seatbelt is an important device protecting drivers from traumatic brain injury (TBI), it has rarely been reported how often and in what circumstances restrained drivers sustain TBI after road traffic accident (RTA). Whole-body computed tomography (WBCT) for blunt trauma patients may provide a unique opportunity to investigate the frequency and characteristics of TBI sustained by restrained drivers. METHODS: A single-center, retrospective observational study was conducted using prospectively acquired data. Between January 2013 and December 2017, 409 restrained drivers (284 men/125 women, mean age of 45.0 ± 19.1 years) whose vehicle had been severely damaged in RTAs underwent WBCT for evaluation of injuries. Multivariate regression analysis was performed to identify variables predictive of TBI. Influence of collision patterns (frontal, lateral or rollover) on the frequency and severity of TBI was evaluated. Relationship between collision patterns and CT findings was also reviewed. RESULTS: Thirty-one restrained drivers (7.6%) sustained TBI after RTA. The distribution of Glasgow Coma Scale (GCS) scores among the 31 drivers was 15 in 9, 13-14 in 9, 9-12 in 4, and ≤ 8 in 9, indicating that the majority of TBIs were classifiable as mild. The frequency of TBI in alert and oriented drivers, i.e., those with a GCS score of 15, was 2.9%. Multivariate regression analysis showed that both altered mental status (OR, 4.933; 95% CI, 1.135-21.431) and loss of consciousness (OR, 6.492; 95% CI, 1.669-25.249) were associated with TBI. The frequency of TBI tended to be higher in drivers with rollover collision than those with frontal collision (6 vs. 13%, p = 0.07). Interhemispheric acute subdural hematoma and subcortical petechial hemorrhage seemed to be characteristic CT findings in drivers with frontal and lateral collision, respectively. CONCLUSIONS: The key finding of this study, i.e., that (1) TBI was observed in 7.6% of restrained drivers with severe vehicular damage, may provide useful information to neurosurgeons who take care of RTA victims. The majority of the TBIs were mild without need for neurosurgical intervention. While association may exist between type of collision and type of brain injury, further studies with prospective design are warranted.

A Comparative Analysis of the Injury Patterns and In-Hospital Mortality Rates of Belted and Unbelted Motor-Vehicle Occupants - Puerto Rico, January 2000 to December 2014.

OBJECTIVE: Motor vehicle collisions (MVCs) constitute a leading source of morbidity and mortality worldwide. Seatbelt use has been associated with reduced mortality in MVCs. In Puerto Rico, the impact of seatbelt use on MVC deaths has not been evaluated, although they represent a major public health threat. Therefore, this study aimed to assess the association between seatbelt use and in-hospital mortality at Puerto Rico Trauma Hospital (PRTH). MATERIALS AND METHODS: A retrospective cohort study of 2,685 MVC patients aged 1 to 96 years was conducted using the Trauma Registry at PRTH, with data collected from 2000 through 2014. The patient data included sociodemographic and clinical variables and outcomes. Logistic regression analyses were used to evaluate the mortality risk of patients of severe MVC-related trauma who had been wearing seatbelts and compare it to the risk sustained by their unbelted counterparts. RESULTS: Seatbelt use was more common in females than it was in males (71% vs.62%; p < 0.001) and more prevalent in older as opposed to younger patients (p < 0.001). Belted severe trauma victims suffered less frequently from head injuries than did their unbelted counterparts (p < 0.001). The proportions of patients with Glasgow coma scale (GCS) scores of 8 or lower (17% vs. 6%; p < 0.001) and Injury Severity Scores (ISSs) of 25 or higher (24% vs. 15%; p < 0.001) were greater for the unbelted group. Belted severe trauma victims had a 30% lower in-hospital mortality risk compared to their unbelted peers (ORunadj = 0.70; 95% CI: 0.52-0.92). After adjusting for confounders, this difference in risk was eliminated (ORadj = 1.04; 95% CI: 0.72-1.52). CONCLUSION: Our findings demonstrate that seatbelt use is associated with fewer head injuries, lower ISSs, and higher GCS scores. This suggests that using seatbelts mitigates trauma severity, thereby reducing the likelihood of in-hospital mortality for those MVC victims who were wearing seatbelts at the time of their accident.

The assessment of airbag deployment and seatbelt use in preventing facial injuries.

This study aimed to determine the effectiveness of airbags and seatbelts in the prevention of facial fractures and slight facial injuries in relation to the speed and kinetic energy experienced in frontal collisions. All cases of vehicle occupants who had been in frontal collisions and had subsequently been examined in the Institute for Emergency Medical Assistance and the Clinical Center of Montenegro in 2017 were analyzed. There were 29 cases of facial fractures (Group 1), 35 cases of slight facial injuries (including nondisplaced nasal fractures) (Group 2), and 26 cases of occupants who had suffered no facial injuries (control Group 3). In all assessed cases all of the subjects had been wearing a seatbelt and the airbag had deployed at the time of impact. A frontal collision is defined as a collision in which the principal force acts within a range of 90° from the longitudinal axis of the vehicle. Using the mass and the speed of the vehicles, the total kinetic energy (KE) of all frontal collisions being analyzed was calculated. The cut-off value of total KE in frontal collisions that were associated with either facial fractures or slight facial injury was estimated using a receiver operating characteristic (ROC) curve. The cut-off amounts of KE were then used to calculate the barrier equivalent velocity (BEV). The BEV for a vehicle of average mass was estimated to be 55.7 km/h (34.6 mph) in Group 1, and 49.2 km/h (30.6 mph) in Group 2. Airbags and seatbelts are effective in preventing facial injuries in vehicles of average mass that are traveling at speeds under 49.2 km/h (30.6 mph) at the point of impact, but they do not protect from facial fractures when the vehicle speed exceeds 55.7 km/h (34.6 mph).

Seatbelt paths of the pregnant women sitting in the rear seat of a motor vehicle.

PURPOSE: Seatbelt use during pregnancy is important to improve maternal and fetal survival after motor vehicle collisions. However, because the rear seatbelt of a motor vehicle tends to make contact with the neck, even if it is adequately used, some pregnant women sitting in the rear seat opt not to fasten the belt. The purpose of this study is to explore seatbelt-neck contact for pregnant women sitting in the rear seat of a motor vehicle. METHODS: We carried out an anthropometric study. Japanese women who were ≥30 weeks pregnant (n = 12) sat in the left side of the rear seat of a typical mid-size passenger sedan and fastened the seatbelt. Seating posture was investigated by measuring the coordinates of the anthropometric data points of the pregnant women (head, shoulder, hip joint, and knee joint). The belt path was analyzed by measuring the clearance between the belt and the sternum or navel. RESULTS: Among the 12 pregnant women at 33.9 week ± 3.3 week gestation, the shoulder belt deviated to the right side and subsequently contacted to the neck in four pregnant women (Contact group). The height of the Contact group was significantly shorter than that of Non-contact group (152.3 cm ± 3.0 cm vs. 159.0 cm ± 3.3 cm, p = 0.008). Regarding the relative position of the seatbelt to the subject's body, the distances from the top of the sternum to the center of the shoulder belt were significantly shorter in Contact group (3.9 cm ± 3.5 cm) than that in the Non-contact group (8.0 cm ± 1.6 cm, p = 0.03). However, no significant difference was found for the distance from the umbilicus to the center of the lap belt. CONCLUSION: Our findings show that because of short height and late term of pregnancy with protrusion of the abdomen, the shoulder belt deviates to the right or left, avoiding the protruded uterus, and subsequently makes contact with the neck. Seatbelt systems for rear seats need to be developed to improve passenger safety, especially for pregnant women.

Buckling up in Singapore: residency and other risk factors for seatbelt non-compliance - a cross-sectional study based on trauma registry data.

BACKGROUND: Seatbelt non-compliance is a problem in middle income countries, and little is known about seatbelt compliance in populations with a high proportion of non-residents. This study analyses the profile of seatbelt non-compliance in Singapore based on trauma registry data from five of the six public hospitals. METHODS: This is a cross-sectional study of seatbelt compliance of patients aged over 18 years, attending the emergency departments of five public hospitals in Singapore after road collisions from 2011-2014. Seatbelt data was obtained from paramedic and patient history. RESULTS: There were 4,576 patients studied. Most were Singapore citizens (83.4 %) or permanent residents (2.4 %), with the largest non-resident groups from Malaysia, India, and China. Overall seatbelt compliance was 82.1 %. On univariate analysis, seatbelt compliance was higher in older patients (OR 1.02, 95 % CI 1.001-1.021, p < 0.0001); drivers, followed by front passengers (OR 0.65, 95 % CI 0.51-0.83, p < 0.0001), were more compliant than rear passengers (OR 0.08, 0.06-0.09, p < 0.0001); occupants of larger vehicle types (buses, heavy transport vehicles, minibuses and vans) were more non-compliant compared to occupants of private cars and taxis. Morning peak travel (0700 h-0900 h) and being a non-resident were other risk factors for non-compliance. On multivariable analysis, older age (OR 1.01, 95 % CI 1.001-1.014, p = 0.03) was associated with compliance, while non-residents from China (OR 0.43, 95 % CI 0.18-0.99, p = 0.05), seat position (front passenger compared to driver, OR 0.64, 95 % CI 0.48-0.85, p = 0.002; rear passenger compared to driver, OR 0.067, 95 % CI 0.05-0.09, p < 0.0001), vehicle type (bus compared to car, OR 0.04, 95 % CI 0.017-0.11, p < 0.0001, van compared to car, OR 0.55, 95 % CI 0.36-0.83, p = 0.004), and travel at morning peak periods were independent predictors of seatbelt non-compliance. When the sub-group of drivers was analysed, only vehicle type was a significant predictor of seatbelt compliance, with bus drivers least likely to be compliant to seatbelts (multivariable analysis, OR 0.057 compared to cars, 95 % CI 0.019-0.18, p < 0.0001). CONCLUSIONS: While overall seatbelt compliance in our study is high, efforts can be made to increase compliance for morning rush hour passengers, rear seat passengers, and occupants of buses, heavy transport vehicles, and vans or pickups.

Understanding and Reducing Inconsistency in Seatbelt-Use Decisions: Findings from a Cardinal Decision Issue Perspective.

This article has two aims. The first is to present results that partly explain why some automobile drivers choose to use their seatbelts only part time, thereby exposing themselves to unnecessary risk. The second is to offer and illustrate the "cardinal decision issue perspective"((1)) as a tool for guiding research and development efforts that focus on complex real-life decision behaviors that can entail wide varieties of risk, including but not limited to inconsistent seatbelt use. Each of 24 young male participants drove an instrumented vehicle equipped to record continuously seatbelt use as well as other driving data. After all trips were finished, each participant completed an interview designed to reconstruct how he made randomly selected seatbelt-use decisions under specified conditions. The interview also examined whether and how drivers established "decision policies" regarding seatbelt use. Such policies were good predictors of inconsistent seatbelt use. Drivers who had previously adopted policies calling for consistent seatbelt use were significantly more likely than others to actually drive belted. Meta-decisions about seatbelt policy adoption appeared to rest on factors such as whether the driver had ever been asked to consider selecting a policy. Whether a driver made an ad hoc, on-the-spot seatbelt-use decision was associated with a perceived need to make such a decision. Finally, participants with full-time policies were especially likely to deploy their seatbelts by default, without recognizing the need to decide about belt use on a trip-by-trip basis. We end with recommendations for reducing inconsistencies in seatbelt use in actual practice.

Seatbelt usage: is there an association with obesity?

Wearing a seatbelt can prevent motor vehicle crash deaths. While primary seatbelt laws are designed to encourage vehicle passengers to wear seatbelts by allowing law enforcement officers to issue tickets when passengers do not wear seatbelts, discomfort may discourage obese individuals from wearing a seatbelt. The objective of this study is to assess the association between state-level obesity and seatbelt usage rates in the US, and to examine the possible role played by seatbelt laws in these associations. The strength of the association between obesity rates, seatbelt usage, and primary seatbelt laws at the state level is investigated using data from 2006 to 2011. Linear regression analysis is employed. This model estimates that increasing the obesity rate by 1% in a state where a primary seatbelt law (by which law enforcement officers can issue a ticket when seatbelts are not worn) is in effect is associated with a 0.06% decrease in seatbelt usage. However the same percentage of increase in the obesity rate in a state where no primary seatbelt law is in effect is associated with a 0.55% decrease in seatbelt usage. The magnitude of the statistical association between state obesity rates and state-level seatbelt usage is related to the existence of a primary seatbelt law, such that obesity has less impact on seatbelt usage in states where primary seatbelt laws are in effect.

Prediction of Placental Abruption of Pregnant Women Drivers with Various Collision Velocities, Seatbelt Positions and Placental Positions-Analysis with Novel Pregnant Occupant Model.

The aims of this study were as follows: the (a) creation of a pregnant occupant finite element model based on pregnant uterine data from sonography, (b) development of the evaluation method for placental abruption using this model and (c) analysis of the effects of three factors (collision speed, seatbelt position and placental position) on the severity of placental abruption in simulations of vehicle collisions. The 30-week pregnant occupant model was developed with the uterine model including the placenta, uterine-placental interface, fetus, amniotic fluid and surrounding ligaments. A method for evaluating the severity of placental abruption on this pregnant model was established, and the effects of these factors on the severity of the injury were analyzed. As a result, a higher risk of placental abruption was observed in high collision speeds, seatbelt position over the abdomen and anterior-fundal placenta. Lower collision speeds and seatbelt position on the iliac wings prevented severe placental abruption regardless of placental positions. These results suggested that safe driving and keeping seatbelt position on the iliac wings were essential to decrease the severity of this injury. From the analysis of the mechanism for placental abruption, the following hypothesis was proposed: a shear at adhesive sites between the uterus and placenta due to direct seatbelt loading to the uterus.

Assessing the prevailing driver seatbelt compliance at Madina Zongo junction in Accra, Ghana: An observational study.

OBJECTIVE: This study aimed to examine the prevailing driver seatbelt compliance at the Madina Zongo junction in Accra, Ghana. METHODS: An unobtrusive observational survey was conducted from 6 to 8 am and 5 to 7 pm on weekdays at randomly designated locations near the junction. A total of 3,054 vehicles were observed throughout the observation period. The data collected were analyzed with SPSS version 26. Cross-tabulations and Pearson's Chi-square test were employed for thorough analysis. RESULTS: The study revealed an overall seatbelt compliance rate of slightly over half (54.1%) among drivers, with the following breakdowns in various vehicle categories: large buses (76.2%), medium buses (98.1%), minibuses (44.0%), private cars (70.5%), taxi/uber (53.0%), and trucks (41.1%). Notably, seatbelt compliance was higher among females at 98.4%, compared to males at 49.2%. The study also identified a correlation between driver's gender and vehicle type with seatbelt compliance. Conversely, no significant association was found between seatbelt compliance and either the time of day or day of the week. CONCLUSIONS: The study offers significant findings regarding seatbelt usage trends at the Madina Zongo junction in Accra. These insights provide a basis for recommending targeted interventions such as policy decisions, public health campaigns, communication strategies, better enforcement, and road safety training programs. These interventions aim to raise awareness of unsafe attitudes and behaviors among drivers to improve seatbelt compliance and ultimately enhance road safety for all road users.

Proximal Interphalangeal Joint Fractures: Various Approaches to Fixation.

There are numerous operative and nonoperative options for the management of proximal interphalangeal joint fractures and fracture dislocations. The treatment of choice should be guided by the fracture pattern and joint stability. The authors highlight a contemporary option for open reduction and internal fixation techniques, but all the techniques presented are viable options under the right circumstances. It is also important to set patient expectations as most of these patients will note post-injury stiffness and potential functional limitations.