Injury Patterns in Vehicle Crashes: The Significance of Occupant Seating Position.

OBJECTIVES:  Investigating patterns among the outcomes of patients involved in motor vehicle accidents (MVAs) can provide information necessary to guide targeted interventions to improve road traffic safety. Our purpose is to identify any differences between passenger and driver injury severity and overall clinical course after MVAs. METHODS:  We performed a retrospective review and analysis of 3,693 patients involved in MVAs from 2016 to 2021. We divided the data into two groups, drivers and passengers, and compared the Injury Severity Score (ISS), Revised Trauma Score (RTS) on admission, days in the Intensive Care Unit (ICU), length of hospital stay (LOS), post Emergency Department (ED) disposition, discharge (DC) disposition, and signs of life on arrival (SOLA) to the ED. We compared mean ISS, New Injury Severity Score (NISS), RTS, length in ICU and LOS using a student's T-test and SOLA, post-ED and DC disposition using Chi-square analysis. RESULTS:  We did not find any statistically significant difference in ISS, RTS, days in ICU, LOS, or SOLA between the drivers and passengers. However, we did find a statistically significant difference in the post-ED (X2= 113.743, p=<0.0001) and DC disposition (X2=41.172, p=<0.0001) of drivers and passengers. After the ED and DC, more passengers were transferred to a higher level of care than expected, while the inverse was true for drivers. The number of drivers discharged to Skilled Nursing Facilities (SNFs) was also higher than expected, further contributing to the observed difference in DC disposition.  Conclusion: Our study found no statistically significant difference between driver and passenger injury severity, length of hospital stay, days in ICU, and SOLA after an MVA. The clinical courses of the two groups were found to be significantly different based on post-ED and DC disposition data. We identified limitations, such as a relatively small sample size and insufficient data on specific car seat locations for passengers, underscoring the need for a more nuanced exploration. Future research must broaden its scope to encompass diverse crash scenarios, vehicle design and safety technologies, seat belt dynamics, and age- and gender-specific vulnerabilities.

Prevalence of alcohol and drugs among drivers killed in road traffic crashes in Norway during 2011-2020.

OBJECTIVE: Driving under the influence of alcohol or drugs is one of the main contributing causes of serious road traffic crashes (RTCs). This study aimed to investigate the involvement of alcohol and drugs in driver fatalities in Norway during 2011-2020 and compare the findings with data from the previous decade. METHODS: We linked the results of forensic toxicology testing for alcohol and the 17 most commonly used drugs assigned with legal limits with data on fatal road traffic crashes obtained from Statistics Norway and the Norwegian Public Roads Administration. RESULTS: The number of fatalities had decreased significantly since the previous decade, while the proportion of drivers and riders tested for alcohol and drug use increased. Blood alcohol concentrations at the legal limit or higher were found in 14.4% and psychoactive drugs were detected in 15.8% of the cases; 10.7% tested positive for illicit drugs, and 10.1% for medicinal drugs. The most prevalent illicit drugs were tetrahydrocannabinol (7.9%) and amphetamine/methamphetamine (4.7%), whereas the most prevalent medicinal drugs were clonazepam (3.7%) and diazepam (2.2%). CONCLUSIONS: There was a marked reduction in the number of motor vehicle drivers killed in RTCs compared with the previous decade, and also a reduction in the prevalence of alcohol. For other substances, there were no marked changes in the prevalence.

Prevalence and lifestyle-associated risk factors of metabolic syndrome among commercial motor vehicle drivers in a metropolitan city in Ghana.

INTRODUCTION: commercial motor vehicle drivers are at risk of metabolic syndrome (MetS) due to the nature of their work as they tend to go to work early, work for more hours, have irregular dietary habits and patterns, have little sleep and live sedentary lifestyle. The study sought to determine the prevalence and lifestyle-related risk factors of MetS among commercial taxi drivers around Kwame Nkrumah University of Science and Technology (KNUST) campus, in the Kumasi metropolis, Ghana. METHODS: a cross-sectional survey was conducted among 100 commercial taxi drivers in 3 selected taxi ranks around KNUST campus. Fasting blood lipid and fasting blood glucose levels, blood pressure and anthropometric characteristics were determined using WHO and NCEP-ATP III criteria. Lifestyle-related risk factors of MetS were assessed using a semi-structured questionnaire and dietary pattern was assessed using food frequency questionnaire. Bivariate analysis and linear correlation were used to determine the relationship between lifestyle practices and MetS. RESULTS: the prevalence of diabetes, high blood pressure, dyslipidemia, overweight and obesity were 12%, 63%, 40%, 32% and 13% respectively. The prevalence of MetS was 5% according to NCEP-ATP III (2005) criteria. The lifestyle behaviours of the drivers were, alcohol intake, irregular dietary pattern, long working hours, lack of exercise and tiredness due to driving. Tobacco use (R = 0.405, p = 0.041) and time of supper (R = 0.931, p = 0.047) were related with MetS among the participants. CONCLUSION: though prevalence of MetS (5%) was low among the drivers, the need for intervention to promote positive lifestyle change and curb the high prevalence of overweight/obesity, diabetes, high blood pressure and dyslipidemia is necessary to improve the health of the drivers and the safety of passengers.

Auditory effect of noise exposures among commercial and non-commercial light motor vehicle drivers: A comparative cross-sectional study in Lucknow city.

CONTEXT: Noise-induced hearing loss, one of the most common and preventable occupational hazard, occurs due to repeated and continuous exposure of loud noise, A single exposure of an impulse of noise at the level of 130--140 dB or long and repeated exposures to loud sounds to an average level of 85 dB or higher for an 8-h period can cause permanent loss of hearing. AIMS: To study and compare hearing loss over different audiometric frequencies among autorickshaw and non-commercial institutional personal car drivers. SETTINGS AND DESIGN: This was a cross-sectional comparative study conducted at a tertiary medical college, located in Lucknow during October 2017-November 2018. METHODS AND MATERIALS: The sample size was calculated using EpiInfo7. We took a sample size of 300 drivers, out of which 150 three-wheeler autorickshaw drivers (Tempo), that is, group I and 150 non-commercial car drivers, that is, group II were selected. STATISTICAL ANALYSIS USED: For statistical analysis, "Chi-square test of independence" and student's t-tests were used. RESULTS: The mean age at which drivers in group I and group II started work was 23.91 ± 7.63 years an d 23.60 ± 5.58 years, respectively. The mean hearing loss in Group I was 21.15 ± 8.65 dB and in group II it was 13.34 ± 5.79 dB. CONCLUSIONS: Autorickshaw drivers who were exposed to louder noise, that is, autorickshaw drivers in group I had more sensory neural hearing loss than the non-commercial car drivers, that is, group II.

High risk of obstructive sleep apnea, insomnia, and daytime sleepiness among commercial motor vehicle drivers.

PURPOSE: We investigated the prevalence of sleep problems, such as obstructive sleep apnea (OSA), insomnia, and daytime sleepiness in commercial motor vehicle (CMV) drivers compared with that in the general population. METHODS: This is a cross-sectional study comparing sleep habits and sleep problems in 110 truck drivers with 1001 matched controls from the general population. The assessment was based on self-administered questionnaires that included the Berlin questionnaire, the insomnia severity index, and the Epworth sleepiness scale (ESS). Multivariate regression analysis was performed to determine whether CMV drivers were independently associated with these sleep problems compared with controls. RESULTS: The prevalence of a high risk of OSA and insomnia was 35.5% and 15.2%, respectively, in CMV drivers, which was significantly higher than in controls with a prevalence of 12.2% and 4.1%, respectively (P < 0.001 for both). Although CMV drivers showed higher ESS scores than controls, the prevalence of daytime sleepiness did not differ between the two groups (19.1% vs. 16.8%, P = 0.54). After adjusting for covariates, CMV drivers had 3.68 times higher odds (95% CI 2.29-5.84) of OSA and 2.97 times higher odds (95% CI, 1.46-6.06) of insomnia compared with controls. However, the degree of daytime sleepiness was not independently associated with CMV drivers. CONCLUSIONS: The prevalence of OSA and insomnia in CMV drivers was higher than that in the general population. Daytime sleepiness was associated with increased BMI, depression, OSA, and short sleep duration, regardless of CMV driving as an occupational factor.

Screening for Obstructive Sleep Apnea in Commercial Drivers Using EKG-Derived Respiratory Power Index.

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) is common in commercial motor vehicle operators (CMVOs); however, polysomnography (PSG), the gold-standard diagnostic test, is expensive and inconvenient for screening. OSA is associated with changes in heart rate and voltage on electrocardiography (EKG). We evaluated the utility of EKG parameters in identifying CMVOs at greater risk for sleepiness-related crashes (apnea-hypopnea index [AHI] ≥ 30 events/h). METHODS: In this prospective study of CMVOs, we performed EKGs with concurrent PSG, and calculated the respiratory power index (RPI) on EKG, a surrogate for AHI calculated from PSG. We evaluated the utility of two-stage predictive models using simple clinical measures (age, body mass index [BMI], neck circumference, Epworth Sleepiness Scale score, and the Multi-Variable Apnea Prediction [MVAP] score) in the first stage, followed by RPI in a subset as the second-stage. We assessed area under the receiver operating characteristic curve (AUC), sensitivity, and negative posttest probability (NPTP) for this two-stage approach and for RPI alone. RESULTS: The best-performing model used the MVAP, which combines BMI, age, and sex with three OSA symptoms, in the first stage, followed by RPI in the second. The model yielded an estimated (95% confidence interval) AUC of 0.883 (0.767-0.924), sensitivity of 0.917 (0.706-0.962), and NPTP of 0.034 (0.015-0.133). Predictive characteristics were similar using a model with only BMI as the first-stage screen. CONCLUSIONS: A two-stage model that combines BMI or the MVAP score in the first stage, with EKG in the second, had robust discriminatory power to identify severe OSA in CMVOs.

Investigation of Obstructive Sleep Apnea Using Portable Monitors and Health Check Data in Japanese Drivers.

AIMS: The identification and appropriate management of commercial motor vehicle (CMV) drivers with unrecognized obstructive sleep apnea (OSA) is a major public health concern and priority; OSA among drivers has not been fully investigated in Japan, and a better understanding of this undiagnosed disease is warranted. Therefore, we evaluated the prevalence of OSA and the factors related to apnea-hypopnea index (AHI) in Japanese CMV drivers. METHODS: This retrospective study included 1309 Japanese CMV drivers aged 40-69 years. All the subjects received type Ⅳ portable sleep monitors (PMs) with Epworth Sleepiness Scale (ESS) and a periodic health check including anthropometrical and laboratory measurements, and a questionnaire of medical history, smoking status, and life style, following which variables related to AHI were analyzed. RESULTS: Of all the subjects, 23.9% had moderate to severe OSA (AHI ≥15). Age, body mass index (BMI), LogeHbA1c and diastolic blood pressure (DBP) showed significance with AHI in 1309 subjects. The following factors were found to have significant odds ratio (OR) for AHI of ≥15 in 1309 subjects: age, ESS, DBP, and LogeHbA1c. CONCLUSION: Notably, drivers with undiagnosed OSA exist. In these subjects, AHI was related to obesity, hypertension, and diabetes. For the early diagnosis and intervention of OSA, BMI, blood pressure, and HbA1c measurements may be helpful, particularly for drivers. Furthermore, when performing an objective assessment of the suspected OSA, evaluating these parameters during routine medical check-ups may be useful and feasible in the detection of drivers with latent OSA.

Red-light running rates at five intersections by road user in Changsha, China: An observational study.

The red-light running rate by type of road users has not been reported in China so far. We conducted an observation study to report the violation rate in Changsha, China. Portable digital devices were used to record red-light running violations at five selected intersections. The observation was performed for three days (weekday, weekend and holiday), four time periods per day and an hour per time period (peak and off-peak hours in the morning and in the afternoon). Violation rate was calculated as number of violations divided by total number of vehicles/pedestrians×100%. We used adjusted violation rate ratio (VRR) to quantify the effects of type of day and time period based on Poisson model. Totally, 162,124 vehicles (including motor vehicles, motorcycles and bicycles) and 31,649 pedestrians were recorded. The red-light running rate was 0.14% for motor vehicle drivers, far lowering than those for motorcyclists (18.64%), bicyclists (18.74%) and pedestrians (18.54%). The rate on holiday was 1.89 times that on weekday for drivers. The rate for motorcyclists was high in off-peak hours (adjusted VRR: 1.11), but low on weekend and on holiday (adjusted VRRs: 0.80 and 0.65). The rate for bicyclists was 32% lower on weekend than on weekday. For pedestrians, the rates were high on weekend and holiday and in off-peak hours (adjusted VRR: 1.09, 1.67 and 1.30). The red-light running rate of motor vehicle drivers is far lower than those for motorcyclists, bicyclists and pedestrians. The effects of type of day and time period on violation rate vary with road users, indicating the type of day and time period should be considered when developing and implementing interventions to reduce red-light running of different road users.

Examen oftálmico para trámite de la licencia de conducción en Santiago de Cuba / Ophthalmic test for the procedure to obtain a driving licence in Santiago de Cuba

Se evaluó la experiencia acumulada durante los años 2003-2009 por la Comisión Municipal de Chequeo Oftalmológico de Santiago de Cuba; grupo de trabajo evaluador de los aspirantes a obtener la licencia de conducción, que radica en el Policlínico Docente Frank País García. En tal sentido, el examen ocular a los presuntos futuros conductores reviste suma importancia, de modo que constituye una gran responsabilidad, tanto para el médico como para los interesados, que esa revisión de la agudeza visual se realice con la calidad requerida y periódicamente para brindar una mayor seguridad en la vía pública. En el municipio de Santiago de Cuba, donde se dispone de vastos conocimientos prácticos al respecto y capital humano capacitado, se han logrado buenos resultados hasta el 2010; éxito en esta esfera que se ha extendido a las restantes comisiones de la provincia y contribuido a alcanzar la excelencia en los servicios.

The experience gathered during the years 2003-2009 from the Municipal Committee of Ophthalmic Examination in Santiago de Cuba was assessed; this work group is settled in the Teaching General Hospital Frank País Garcia and evaluates the candidates for obtaining a driving license. In this way, the ophthalmic test to the presumptive future drivers involves great significance, so it constitutes a great responsibility for both, the doctor and the interested person, to carry out this ophthalmic examination with the required quality and periodically, to provide a major safety in the public highway. In the municipality of Santiago de Cuba, where wide practical knowledge on the topic and qualified human staff is stipulated. Good results have been achieved up to 2010 in Santiago de Cuba municipality where wide practical knowledge and qualified human staff exist; and this success was broaden to the other committees of the province, which has contributed to reach excellence on the services.