Motorcycle helmet visor-related facial injury and its potential mechanism of injury: Evidence-based case study.

Objectives: We encountered an unusual facial laceration wound in relation to motorcycle helmet visor use during our clinical practice. We aimed to assess the prevalence of this unusual facial injury among motorcyclists who sustained facial injuries in selected hospitals and to determine the possible mechanism involved. Methods: We used our prospective cross-sectional substudy involving injured motorcyclists presenting at major trauma hospitals in Southern Klang Valley, Malaysia, between March 2010 and March 2011. of 391 subjects with facial injuries, 2 male motorcyclists sustained this laceration. The wounds were assessed and we believed that each was associated with the helmet visor. One of the visors was collected and the edge was inspected using scanning electron microscopy (SEM). Results: The prevalence of this unusual injury was 0.51% (95% confidence interval, 0.002-0.012) among motorcyclists who sustained facial injuries. Both cases were involved in a head-on collision with their colliding partners and their helmets were intact throughout the crash. The visor in case 1 was intact, but the visor in case 2 was broken. SEM analysis showed that the visor in case 1 had a potential cutting surface. We postulated that with helmet rotation in the forward and downward position and with some degree of visor bending or with a dislodged visor, the sharp-edged visor could potentially severely lacerate the face. Conclusion: This injury affects facial aesthetics and early referral to the facial surgery team is advocated. Documentation of the mechanism of injury, the patient's helmet and visor is obligatory, so that this information can be delivered to the regional road safety authority for preventive measures.

Cyclist exposure to the risk of car door collisions in mixed function activity centers: A study in Melbourne, Australia.

OBJECTIVE: The objective of this study is to describe key risks related to dooring collisions on roads in mixed function activity centers by examining video footage recorded onboard the bicycles of cyclists riding through this road environment. The study aims to enhance our understanding of the risk associated with cyclist door collisions on these roads and to provide a focus for future studies that aim to identify measures that enhance cyclist safety. METHOD: The study measured 4 key risk exposures (per hour and kilometer), namely, on-street parked cars and 3 conditions associated with parked cars being accessed or egressed: door opened (a) after the cyclist passes (give-way event); (b) in the path of the cyclist without collision (obstruction event); and (c) in the path of the cyclist with collision (collision event). Exposure to the risk factors was measured using video footage recorded onboard the bicycles of adult cyclists (n = 25) as they rode through this road environment. The average speed of cyclists was also estimated from these video data and related to the measures of exposure. RESULTS: The cycling experiences of the participants were observed over 3 h 58 min and 84.0 km. On average, the sample was exposed to 1,166 parked car events per hour (55 per kilometer), 6.9 give-way events per hour (0.3 per kilometer), 2.3 obstruction events per hour (0.1 per kilometer), and no collision events. There were 9 instances of obstruction events. In most cases, the cyclist was clearly visible (n = 7; 77.8%) and modified his or her position to avoid the door (n = 8; 88.9%). Moreover, the door was opened by the driver in nearly all cases (n = 8; 88.9%), primarily to exit the vehicle (n = 4; 44.4%) or enter the vehicle (n = 3; 33.3%). The average speed of cyclists was 22.7 km/h (SD = 4.1 km/h), and average speed tended to reduce as exposure to parked car events increased. CONCLUSION: Cyclists seldom interact with a vehicle occupant accessing or egressing a parked car, yet a concerning proportion of these interactions involve the occupant opening the door in the path of the cyclist, rather than waiting for the cyclist to pass. This suggests that there is still considerable need to identify measures that increase the likelihood that a vehicle occupant will look for cyclists before opening the car door, particularly in road environments where longer-term solutions such as physical separation are not readily achieved.

Geospatial analysis of cyclist injury trends: an investigation in Melbourne, Australia.

OBJECTIVE: This study applied geospatial analysis to explore spatial trends in cycling-related injury in Melbourne, Australia, in order to identify an area where injury density was reducing against expectation. The crash characteristics and cycling environment of the identified area were examined to better understand factors related to cycling safety. METHOD: Two methods were used to examine spatial trends in cycling-related injury. Firstly, cycling injury density was calculated using a kernel density estimation method for the years 2000 to 2011. This was used to examine patterns in injury density across Melbourne over an extended time period. Secondly, absolute change in injury density was calculated between 2005 and 2011. From this, a geographical area presenting a reduced injury density was selected for a case study, and crash characteristics of the area were obtained for the observational period. This led to discussion on which changes to the cycling environment, if any, may be associated with the reduced injury rate. RESULTS: Injury density in Melbourne had been progressively increasing between 2000 and 2011, with a nearly 3-fold increase in the peak injury density over that period. Decreases were observed in some locations between 2005 and 2011, and a geographical area to the southeast of Melbourne experienced a more significant decrease than others. This appeared to be associated with a combination of behavior and road infrastructure change, although a lack of data to verify change in cycling exposure prevented more definitive associations from being established. CONCLUSION: The apparent positive response of the injury rate to behavior and road infrastructure interventions is promising, yet the injury rate is unlikely to achieve the government's road safety target of 30% reduction in serious injuries by 2022. Moreover, the number of injuries sustained at the most common crash location appears to be increasing. Further research is necessary to discern which specific features of the urban road infrastructure have an effect on the risk of injury to a cyclist and which combination of features is consistent with a safe cycling environment.

Self-reported wayfinding ability of older drivers.

Some older drivers experience difficulties driving whilst wayfinding in unfamiliar areas. Difficulties in wayfinding have been associated with poorer driving performance and reduced driving mobility. The objective of the current study was to identify cognitive and demographic predictors in older drivers of perceived wayfinding difficulty, avoidance of unfamiliar areas and the use of wayfinding strategies. Five hundred and thirty-four drivers aged 65 years and over (excluding those with dementia or Parkinson's disease) completed a mail-out survey. Drivers commonly reported difficulties with wayfinding, with 59.5% reporting their abilities as poor or fair rather than good. Those significantly more likely to report difficulty were older, reported poorer health and cognition, and had less driving experience. A small proportion of drivers reported regularly avoiding unfamiliar areas (13.8%); these drivers were significantly more likely to be female and to report poorer wayfinding abilities. The most common wayfinding strategies regularly used by older drivers were using a street directory whilst driving (61.9%) and pulling over to check the map (55.1%). Regular passenger guidance (23.9%) or use of a navigation system (9.9%) was less common. The implications of this study are wide and include collecting further information about: (1) the role of cognitive processes in wayfinding ability; (2) the relationship between perceived wayfinding difficulty and restriction of driving in unfamiliar areas; and (3) older drivers' preferences for different wayfinding strategies.

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

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

Crash risk of older female drivers--contributing factors.

Using data from i) a self-administered survey of 673 older female drivers, and ii) a case-control study of 48 crash-involved and 44 non crash-involved older female drivers, some factors that may predict crash involvement were identified. Survey data gathered self-reported information on demographic characteristics, health status, travel patterns and driving practices. A battery of functional performance assessments were administered by trained experimenters in the case-control study, and participants completed a second detailed self-administered questionnaire. Factors found to predict crash involvement included driving characteristics such as being the main driver in the household, not highly confident of being a safe driver, experiencing difficulty driving in unfamiliar areas and having problems with the driving style of other drivers. In addition, low attentional, cognitive and motor skills and presence of multiple medical conditions were significant predictors of crash involvement.

Crossing roads safely: an experimental study of age differences in gap selection by pedestrians.

The over-representation of older pedestrians in serious injury and fatal crashes compared to younger adults may be due, in part, to age-related diminished ability to select gaps in oncoming traffic for safe road-crossing. Two experiments are described that examine age differences in gap selection decisions in a simulated road-crossing environment. Three groups of participants were tested, younger (30-45 years), young-old (60-69 years) and old-old (>75 years). The results showed that, for all age groups, gap selection was primarily based on vehicle distance and less so on time-of-arrival. Despite the apparent ability to process the distance and speed of oncoming traffic when given enough time to do so, many of the old-old adults appeared to select insufficiently large gaps. These results are discussed in terms of age-related physical, perceptual and cognitive limitations and the ability to compensate for these limitations. Practical implications for road safety countermeasures are also highlighted, particularly the provision of safe road environments and development of behavioural and training packages.