A randomized controlled trial of the effectiveness of brief-CBT for patients with symptoms of posttraumatic stress following a motor vehicle crash. Prospective validation of an out-of-hospital decision rule to identify seriously injured children involved in motor vehicle crashes. Emergency department brief motivational interventions for alcohol with motor vehicle crash patients. Can high-risk older drivers be identified through performance-based measures in a Department of Motor Vehicles setting? Helmets for preventing head and facial injuries in bicyclists. Using a driving simulator to identify older drivers at inflated risk of motor vehicle crashes. Use of out-of-hospital variables to predict severity of injury in pediatric patients involved in motor vehicle crashes. Determining the validity of the AMA guide: A historical cohort analysis of the assessment of driving related skills and crash rate among older drivers. Acute stress disorder symptoms in children and their parents after pediatric traffic injury. Effect of community-based interventions on high-risk drinking and alcohol-related injuries. The Effect of Compensation on General Health in Patients Sustaining Fractures in Motor Vehicle Trauma Motor vehicle driving competencies and risks in teens and young adults with attention deficit hyperactivity disorder. Emergency physicians' knowledge and provision of child passenger safety information. Association of resident fatigue and distress with occupational blood and body fluid exposures and motor vehicle incidents. Cognitive training decreases motor vehicle collision involvement of older drivers. Minimal hepatic encephalopathy is associated with motor vehicle crashes: the reality beyond the driving test. A 10-year incidence of acute whiplash injuries after road traffic crashes in a defined population in northern Sweden. Symptomatic cervical disc herniation following a motor vehicle collision: return to work comparative study of workers' compensation versus personal injury insurance status. Geriatric trauma in the State of Illinois: substance use and injury patterns. Predictors of return to work following motor vehicle related orthopaedic trauma Random alcohol testing reduced alcohol-involved fatal crashes of drivers of large trucks. Extended work shifts and the risk of motor vehicle crashes among interns. Reducing alcohol-impaired driving in Massachusetts: the Saving Lives Program.
BACKGROUND Motor vehicle crashes ( MVCs ) are leading contributors to the global burden of disease . Patients attending accident and emergency ( A&E ) after an MVC may develop symptoms of posttraumatic stress disorder ( PTSD ) . There is evidence that brief cognitive behavioural therapy ( B-CBT ) can be effective in treating PTSD ; however , there are few studies of the use of B-CBT to treat PTSD in MVC survivors . AIMS This study examined the effects of B-CBT and a self-help program on the severity of psychological symptoms in MVC survivors at risk of developing PTSD . METHOD Sixty participants who attended A&E after a MVC were screened for PTSD symptoms and r and omized to a 4-weekly session B-CBT or a 4-week self-help program ( SHP ) booklet treatment conditions .  Psychological assessment s were completed at baseline ( 1-month post-MVC ) and posttreatment ( 3- and 6-month follow-ups ) by utilizing Impact of Event Scale-Revised ( IES-R ) and Hospital Anxiety and Depression Scale ( HADS ) . RESULTS There were significant improvements in the measures of anxiety , depression , and PTSD symptoms over time . Participants treated with B-CBT showed greater reductions in anxiety at 3-month and 6-month follow-ups , and in depression at 6-month follow-up . A comparison of effect size favoured B-CBT for the reduction of anxiety and depression symptoms measured by HADS . A high level of pretreatment anxiety and depression were predictive of negative outcome at 6-month follow-up in the SHP condition . There was no differential effect on PTSD symptoms measured by IES-R. CONCLUSIONS This trial supports the efficacy of providing B-CBT as a preventive strategy to improve psychological symptoms after an MVC OBJECTIVES To prospect ively vali date a previously published out-of-hospital clinical decision rule to identify seriously injured children involved in motor vehicle crashes ( MVCs ) . METHODS The authors selected 20 Los Angeles County Fire Department fire stations , based on pediatric MVC call volume and geographic diversity , and 21 associated hospitals for participation in the study . Immediately following an MVC call involving a pediatric patient aged 0 - 14 years , each engine/paramedic squad completed a data form ( 15 variables , including vital signs , Glasgow Coma Scale score , and vehicular and crash characteristics ) . This study was conducted over a 24-month period . Outcomes included : 1 ) " serious injury " as defined by an Injury Severity Score ( ISS ) > or = 16 ( primary outcome ) , and 2 ) need for specialized trauma care ( emergent intubation , major nonorthopedic operative intervention or death in the first 24 hours , or pediatric intensive care unit stay longer than 48 hours ) , as assessed by retrospective chart review . Accuracy measures and binominal confidence intervals ( CIs ) were calculated for the decision rule validation . RESULTS One hundred seventy-five children were prospect ively enrolled in the study ; 36 children were excluded due to lack of hospital participation or missing hospital charts . There were four children with ISS > or = 16 ( 3 % ) and six children requiring specialized trauma care ( 4 % ) . The sensitivities and specificities of the rule were : 100 % ( 95 % CI = 40 % to 100 % ) and 73 % ( 95 % CI = 65 % to 81 % ) for serious injury , and 83 % ( 95 % CI = 36 % to 100 % ) and 74 % ( 95 % CI = 65 % to 81 % ) for specialized trauma care , respectively . CONCLUSIONS Although definitive conclusions are limited by the sample size , the decision rule identified all seriously injured children involved in MVCs and had moderate specificity . The decision rule was less sensitive for identifying children requiring specialized trauma care . Larger validation studies are needed to adequately assess the utility of this rule before implementation STUDY OBJECTIVE This study compares the effect of a brief motivational intervention for alcohol plus a booster given to emergency department ( ED ) patients with subcritical injuries from a motor vehicle crash with the effect of brief motivational intervention for alcohol plus a booster in patients treated for non-motor vehicle crash-related injuries . METHODS A r and omized controlled trial ( n=539 ) was conducted at an urban Level I trauma center of brief intervention ( 1 ED session of brief intervention ) , brief motivational intervention for alcohol plus a booster ( 1 ED session plus booster session ) , or st and ard care for injured ED patients with an alcohol use problem who were being discharged home . At 12 months , alcohol-related negative consequences and injuries were measured . We performed a secondary analysis comparing motor vehicle crash-injured patients and non-motor vehicle crash-injured patients in the study sample . RESULTS Subcritically injured ED patients with harmful or hazardous alcohol use who received brief motivational intervention for alcohol plus a booster had fewer alcohol-related negative consequences and alcohol-related injuries than those receiving brief intervention or st and ard care at 12-month follow-up ( previously reported ) . A secondary analysis of this result showed that motor vehicle crash patients ( n=133 ) given brief motivational intervention for alcohol plus a booster ( n=34 ) had fewer alcohol-related injuries than those receiving st and ard care ( n=46 ; P = .001 ) . Moreover , there were no significant differences in alcohol-related injuries among the non-motor vehicle crash-injured patients who received brief intervention or st and ard care . CONCLUSION Brief motivational intervention for alcohol plus a booster is a useful intervention for subcritically injured ED patients with harmful or hazardous alcohol use . Its effects may be moderated by the cause of injury OBJECTIVES To evaluate the relationship between performance-based risk factors and subsequent at-fault motor vehicle collision ( MVC ) involvement in a cohort of older drivers . DESIGN Prospect i ve cohort study . SETTING Motor Vehicle Administration ( MVA ) field sites in Maryl and . PARTICIPANTS Of the 4,173 older drivers invited to participate in the study , 2,114 individuals aged 55 to 96 agreed to do so . These analyses focus on 1,910 individuals recruited through MVA field sites . MEASUREMENTS  Gross Impairment Screening Battery  , which included  Rapid Pace Walk , Head/Neck Rotation , Foot Tap , Arm Reach , Cued Recall , Symbol Scan , Visual Closure subtest of the Motor Free Visual Perception Test ( MVPT ) , Delayed Recall , and Trail Making Test with an Abbreviated Part A and  st  and ard Part B ; Useful Field of View ( UFOV ) subtest 2 ; a Mobility Question naire ; and MVC occurrence . RESULTS In drivers aged 55 and older with intact vision ( 20/70 far visual acuity and 140 degrees visual field ) , age , sex , history of falls , and poorer cognitive performance , as measured using Trails B , MVPT , and UFOV subtest 2 , were predictive of future at-fault MVC involvement . After adjusting for annual mileage , participants aged 78 and older were 2.11 as more likely to be involved in an at-fault MVC , those who made four or more errors on the MVPT were 2.10 times as likely to crash , those who took 147 seconds or longer to complete Trails B were 2.01 times as likely to crash , and those who took 353 ms or longer on subtest 2 of the UFOV were 2.02 times as likely to incur an at-fault MVC . Older adults , men , and individuals with a history of falls were more likely to be involved in subsequent at-fault MVCs . CONCLUSION Performance-based cognitive measures are predictive of future at-fault MVCs in older adults . Cognitive performance , in particular , is a salient predictor of subsequent crash involvement in older adults . High-risk older drivers can be identified through brief , performance-based measures administered in a MVA setting BACKGROUND : Each year , in the United states , approximately 900 persons die from injuries due to bicycle crashes and over 500,000 persons are treated in emergency departments . Head injury is by far the greatest risk posed to bicyclists , comprising one-third of emergency department visits , two-thirds of hospital admissions , and three-fourths of deaths . Facial injuries to cyclists occur at a rate nearly identical to that of head injuries . Although it makes inherent sense that helmets would be protective against head injury , establishing the real-world effectiveness of helmets is important . A number of case-control studies have been conducted demonstrating the effectiveness of bicycle helmets . Because of the magnitude of the problem and the potential effectiveness of bicycle helmets , the objective of this review is to determine whether bicycle helmets reduce head , brain and facial injury for bicyclists of all ages involved in a bicycle crash or fall . OBJECTIVES : To determine whether bicycle helmets reduce head , brain and facial injury for bicyclists of all ages involved in a bicycle crash or fall . SEARCH STRATEGY : We search ed The Cochrane Controlled Trials Register , MEDLINE , EMBASE , Sport , ERIC , NTIS , Exp and ed Academic Index , CINAHL , PsycINFO , Occupational Safety and Health , and Dissertations Abstract s. We checked reference lists of past review s and review articles , studies from government agencies in the United States , Europe and Australia , and contacted colleagues from the International Society for Child and Adolescent Injury Prevention , World Injury Network , CDC funded Injury Control and Research Centers , and staff in injury research agencies around the world . SELECTION CRITERIA : Controlled studies that evaluated the effect of helmet use in a population of bicyclists who had experienced a crash . We required that studies have complete outcome ascertainment , accurate exposure measurement , appropriate selection of the comparison group and elimination or control of factors such as selection bias , observation bias and confounding . DATA COLLECTION AND ANALYSIS : Five published studies met the selection criteria . Two abstract ors using a st and ard abstract ion form independently abstract ed data . Odds ratios with 95 % CI were calculated for the protective effect of helmet for head and facial injuries . Study results are presented individually . Head and brain injury results were also summarized using meta- analysis techniques . MAIN RESULTS : No r and omized controlled trials were found . This review identified five well conducted case control studies which met our selection criteria . Helmets provide a 63%-88 % reduction in the risk of head , brain and severe brain injury for all ages of bicyclists .  Helmets provide equal levels of protection for crashes involving motor vehicles ( 69 % ) and crashes from all other causes ( 68 % ) . Injuries to the upper and mid facial areas are reduced 65 % . REVIEW ER 'S CONCLUSIONS : Helmets reduce bicycle-related head and facial injuries for bicyclists of all ages involved in all types of crashes including those involving motor vehicles PROBLEM To develop appropriate assessment criteria to measure the performance of older drivers using an interactive PC-based driving simulator , and to determine which measures were associated with the occurrence of motor-vehicle crash . METHOD One hundred and twenty-nine older drivers residing in a metropolitan city volunteered to participate in this retrospective cohort study . Using the driving simulator , appropriate driving tasks were devised to test the older drivers , whose performances were assessed by 10 reliable assessment criteria . Logistic regression analysis was then undertaken to determine those criteria that influence the self-reported crash outcome . RESULTS As expected , driving skill of older drivers was found to decline with age . Over 60 % of the sample participants reported having at least one motor-vehicle crash during the past year . Adjusting for age in a logistic regression analysis , the cognitive abilities associated with the crash occurrence were working memory , decision making under pressure of time , and confidence in driving at high speed . SUMMARY The findings of this retrospective study indicated those individuals at inflated risk of vehicle crashes could be identified using the PC-based interactive driving simulator . Prospect i ve studies need to be undertaken to determine whether the driving simulator can predict future crash events . IMPACT ON INDUSTRY This study demonstrated an economical driving simulator approach to screen out problematic or unsafe older drivers before a more detailed but expensive road test is considered STUDY OBJECTIVE We sought to create a clinical decision rule , on the basis of variables available to out-of-hospital personnel , that could be used to accurately predict severe injury in pediatric patients involved in motor vehicle crashes as occupants . METHODS We analyzed the National Automotive Sampling System data base , a national probability sample , using pediatric patients up to 15 years old ( occupants only ) involved in motor vehicle crashes from January 1993 to December 1999 . The National Automotive Sampling System data base includes patients from regions throughout the country , weighted to represent a nationwide sample . Twelve out-of-hospital variables were used in classification and regression tree analysis to create a decision rule separating children with severe injuries ( Injury Severity Score [ ISS ] > or = 16 ) from those with minor injuries ( ISS < 16 ) . Misclassification costs and complexity parameters were selected to yield a decision tree with appropriate sensitivity and specificity for the identification of severely injured patients , while also being simple and practical for out-of-hospital use . Probability weights were used throughout the analysis to account for the sampling design and sampling weights . RESULTS Using a sample size of 8,392 children , we constructed a decision rule using 3 out-of-hospital variables ( Glasgow Coma Scale score , passenger space intrusion > or = 6 in [ > or = 15 cm ] , and restraint use ) to predict those patients with an ISS of 16 or more . Internal cross-validation was used to determine the sensitivity and specificity , yielding values of 92 % and 73 % , respectively , for the prediction of patients with an ISS of 16 or more . CONCLUSION Out-of-hospital variables available to field personnel could be used to effectively triage pediatric motor vehicle crash patients using the decision rule developed here . Prospect i ve trials would be needed to test this decision rule in actual use BACKGROUND Chronic health conditions associated with ageing can lead to changes in driving ability . The Canadian Driving Research Initiative for Vehicular Safety in the Elderly ( C and rive II ) is a 5-year prospect i ve study funded by the Canadian Institutes of Health Research aim ing to develop an in-office screening tool that will help clinicians identify potentially at-risk older drivers . Currently , no tools exist to directly predict the risk of motor vehicle collision ( MVC ) in this population . The American Medical Association ( AMA ) , in collaboration with the National Highway Traffic Safety Association , has design ed an opinion-based guide for assessing medical fitness to drive in older adults and recommends that physicians use the Assessment of Driving Related Skills ( ADReS ) as a test battery to measure vision , cognition and motor/somatosensory functions related to driving . The ADReS consists of the  Snellen visual acuity test , visual fields by confrontation test , Trail Making Test part B , clock drawing test , Rapid Pace Walk  , and  manual tests of range of motion and motor strength .  We used baseline data from the C and rive/Ozc and rive common cohort of older drivers to evaluate the validity of the ADReS subtests . We hypothesized that participants who crashed in the 2 years before the baseline assessment would have poorer scores on the ADReS subtests than participants who had not crashed . METHODS In the C and rive/Ozc and rive study , 1230 participants aged 70 years or older were recruited from 7 Canadian cities , 1 Australian city and 1 New Zeal and city , all of whom completed a comprehensive clinical assessment at study entry . The assessment included all tests selected as part of the ADReS. For this historical cohort study , data on all crashes ( at-fault and non-at-fault ) that occurred within 2 years preceding the baseline assessment were obtained from the respective licensing jurisdictions . Those who crashed were compared to those who had not crashed on their ADReS subtest scores using Pearson 's chi-squared test and Student 's t-test . RESULTS Sixty-three of the 1230 participants ( 5.1 % ) were involved in an MVC within the 2 years preceding the baseline assessment . Contrary to our hypothesis , there were no statistically significant associations between abnormal performance on the tests constituting the  ADReS  and history of crash in the previous 2 years ( p>0.01 ) . DISCUSSION We found that a history of crash in the previous 2 years was not associated with abnormalities on the subtests comprising the ADReS. This suggests the need for prospect i ve analyses of risk factors over time to establish sensitive , valid predictors of crash that can be incorporated in clinical practice guidelines OBJECTIVE The American Academy of Pediatrics highlights the important role of pediatricians in recognizing adverse child responses to tragic events , such as traffic crashes . One challenge in effectively identifying children and their parents with troubling psychological responses to trauma is that little is known about the normal range of acute psychological responses in children and their parents in the immediate aftermath of traumatic events , making identification of adverse child responses difficult . Within the first month after a traumatic event , individuals may display reexperiencing , avoidance , and hyperarousal symptoms as well as dissociation ( eg , feelings of unreality or emotional numbing ) . The presence of these responses , collectively known as acute stress disorder ( ASD ) , alerts providers to those who may be at risk for ongoing difficulties . For beginning to develop an evidence base to guide pediatric care providers in addressing acute traumatic responses , the aim of the current investigation was to describe systematic ally the range and type of symptoms of ASD in children and their parents after pediatric traffic injury . METHODS A prospect i ve cohort study was conducted of traffic-injured children , who were 5 to 17 years of age and admitted to the hospital for treatment of injuries from traffic crashes , and their parents . All children who met eligibility criteria between July 1999 and May 2000 were invited to participate in the study . After consent/assent was obtained , children and their custodial parents ( or guardians ) were interviewed within 1 month after injury via a structured assessment to determine the circumstances of the crash and the presence of ASD symptoms . Relevant demographic and clinical information ( eg , age , race , gender , date of injury ) was abstract ed from the medical records of subjects . A survey instrument to assess the presence of ASD symptoms was completed by both the child and his or her guardian . All children completed the  Child Acute Stress Question naire , and all parents completed the  Stanford Acute Stress Reaction Question naire . Responses were scored for the presence of dissociation , reexperiencing , avoidance , and /or hyperarousal symptoms as well as broad distress ( symptoms present in every category ) . RESULTS Symptoms of ASD were commonly observed in the children and parents . Eighty-eight percent of children and 83 % of parents reported having at least 1 clinical ly significant symptom ; this affected 90 % of the families . Broad distress was observed for a large minority : 28 % of children and 23 % of parents . No statistically significant association was found between child broad distress and either child age ( r = -0.12 ) or child injury severity score ( r = -0.05 ) . chi(2 ) analyses revealed no significant association between broad distress and child gender , child race , or mechanism of injury . No statistically significant association was found between parent broad distress and child age ( r = -0.06 ) or child injury severity score ( r = 0.09 ) . chi(2 ) analyses revealed no significant association between parent broad distress and child gender or parent presence at the crash scene . Associations were found between parent broad distress and race in that fewer white parents reported broad distress . In addition , mechanism of injury was associated with parent broad distress : more parents reported broad distress when their children were involved in pedestrian-motor vehicle crashes , and fewer parents reported broad distress when their children were injured in a bicycle fall . CONCLUSIONS Pediatric care providers can expect to see some ASD symptoms in most children and parents in the immediate aftermath of traffic-related injury . Brief education is appropriate to explain that these symptoms are normal reactions that are likely to resolve . If symptoms persist for > 1 month or are particularly distressing in their intensity , then referral for psychological care may be necessary for treatment of posttraumatic stress disorder . Given the high prevalence of pediatric traffic crashes and the underdiagnosis of posttraumatic stress disorder , probing for recent crash exposure might be appropriate during routine child health maintenance . The following are recommendations for pediatricians : 1 ) routinely call the family several days and 1 to 2 weeks after a traffic injury and ask about behavioral symptoms and family function ; 2 ) make use of the ongoing physician-patient relationship to explore symptom presence and intensity and any functional impairment in the injured child ; a brief office visit with the child and parents could serve this purpose ; 3 ) be sure to explore the effect that the child 's injury has had on the family ; remember that the parent 's experience posttraumatic stress symptoms after pediatric traffic-related injuries and these symptoms may limit the parent 's ability to support the child ; 4 ) provide supportive care and give families the opportunity to discuss the crash and their current feelings ; do not force families to talk about the crash ; 5 ) although any child in a traffic crash or his or her parent is at risk for posttraumatic symptomatology , regardless of injury severity , particular attention should be paid to the parents of child pedestrians who are struck by motor vehicles . These parents experience posttraumatic symptoms more commonly than parents of children in other traffic crashes CONTEXT High-risk alcohol consumption patterns , such as binge drinking and drinking before driving , and underage drinking may be linked to traffic crashes and violent assaults in community setting s. OBJECTIVES To determine the effect of community-based environmental interventions in reducing the rate of high-risk drinking and alcohol-related motor vehicle injuries and assaults . DESIGN AND SETTING A longitudinal multiple time series of 3 matched intervention communities ( northern California , southern California , and South Carolina ) conducted from April 1992 to December 1996 . Outcomes were assessed by 120 general population telephone surveys per month of r and omly selected individuals in the intervention and comparison sites , traffic data on motor vehicle crashes , and emergency department surveys in 1 intervention-comparison pair and 1 additional intervention site . INTERVENTIONS Mobilize the community ; encourage responsible beverage service ; reduce underage drinking by limiting access to alcohol ; increase local enforcement of drinking and driving laws ; and limit access to alcohol by using zoning . MAIN OUTCOME MEASURES Self-reported alcohol consumption and driving after drinking ; rates of alcohol-related crashes and assault injuries observed in emergency departments and admitted to hospitals . RESULTS Population surveys revealed that the self-reported amount of alcohol consumed per drinking occasion declined 6 % from 1.37 to 1 . 29 drinks . Self-reported rate of " having had too much to drink " declined 49 % from 0.43 to 0.22 times per 6-month period . Self-reported driving when " over the legal limit " was 51 % lower ( 0 . 77 vs 0.38 times ) per 6-month period in the intervention communities relative to the comparison communities . Traffic data revealed that , in the intervention vs comparison communities , nighttime injury crashes declined by 10 % and crashes in which the driver had been drinking declined by 6 % . Assault injuries observed in emergency departments declined by 43 % in the intervention communities vs the comparison communities , and all hospitalized assault injuries declined by 2 % . CONCLUSION A coordinated , comprehensive , community-based intervention can reduce high-risk alcohol consumption and alcohol-related injuries result ing from motor vehicle crashes and assaults . JAMA . 2000;284:2341 - 2347 Objectives : The receipt or pursuit of compensation after injury has been associated with poor outcomes . This study aims to determine the association between compensation-related factors and general health in patients with fractures sustained in motor vehicle trauma . Design : Prospect i ve survey . Setting : Metropolitan trauma centers . Patients / Participants : The study population was patients aged 18 years and older , presenting acutely with at least one fracture involving the long bones , pelvis , patella , talus , or calcaneus , result ing from motor vehicle trauma , and presenting acutely to 1 of 15 hospitals . Intervention : Patients were surveyed on admission to determine general factors , injury factors , and socioeconomic factors . Employment status at follow-up , compensation-related factors , and the main outcome variables were measured by survey at 6 months after injury . Multiple regression was used to determine significant predictors of outcome . Main Outcome Measurement : Physical and mental health summaries of the SF-36 General Health Survey . Results : Of the 306 patients recruited to the study , five were excluded , and completed question naires were available for 232 ( 75.8 % ) . Cl aim ing compensation was strongly associated with poor physical and mental health on univariate analysis , but it was not significant on multivariate analysis . The use of a lawyer in relation to the injury was the most significant variable associated with poor physical and mental health , after adjusting for other factors . Conclusions : Lawyer involvement , rather than pursuit of compensation , is associated with poor general health after fractures sustained in motor vehicle injuries . Although this may represent a direct effect , further research is recommended to determine the cause for this association PURPOSE To evaluate the motor vehicle driving knowledge , skills , and negative driving outcomes of older teens and young adults with attention deficit hyperactivity disorder ( ADHD ) . LOCATION A university medical center clinic for adult ADHD . SUBJECTS A total of 25 young adults with ADHD and 23 young adults without ADHD 17 to 30 years old drawn from the community and equated for age , gender , and educational level . MEASURES  Structured interview , behavior ratings by self- and others , video test of driving knowledge , computer simulated driving test , and official motor vehicle records .  RESULTS ADHD young adults were cited more often for speeding , were more likely to have had their licenses suspended , were involved in more crashes , were more likely to have had crashes causing bodily injury , and were rated by themselves and others as using poorer driving habits . Official driving records corroborated these negative outcomes . Although no group differences in driving knowledge were evident , young adults with ADHD had more crashes , scrapes , and erratic steering during the computer-stimulated driving test than did the control subjects . CONCLUSIONS Findings supported previous research suggesting that greater driving risks are associated with ADHD and suggested that ADHD does not interfere with driving knowledge so much as with actual performance ( motor control ) during vehicle operation OBJECTIVES While physicians provide discharge instructions to patients and families following emergency department ( ED ) visits , injury prevention information may not be routinely included in these instructions . This study assessed emergency physicians ' knowledge and provision of child passenger safety ( CPS ) information  to patients following motor vehicle crashes ( MVCs ) . METHODS This study was both a survey of emergency physician knowledge and provision of CPS information and an examination of frequency of CPS information in discharge instructions at a single institution . Members of the American Academy of Pediatrics ( AAP ) Section on Emergency Medicine were invited to participate in the survey . Respondents were asked about their provision of CPS information to patients and knowledge of national AAP CPS recommendations . The institutional ED medical record chart review assessed the frequency of written CPS information for patients of MVC-related visits who were discharged home . RESULTS There were 317 survey respondents from 1,024 eligible physicians , of whom 43 began but did not complete the survey . The data analyzed are from the 274 who completed the survey . While 85 % ( 95 % confidence interval [ CI ] = 81 % to 89 % ) of physicians believed that CPS information should be included in discharge instructions , only 36 % ( 95 % CI = 31 % to 42 % ) correctly answered all knowledge questions . Of the 51 self-identified division/department chiefs , 15 ( 29.4 % ; 95 % CI = 16.9 % to 41.9 % ) reported that their EDs routinely provide CPS information in discharge instructions for pediatric passengers in MVCs . For the medical record review , of the 152 r and omly selected MVC visits , 13 ( 8.6 % ; 95 % CI = 4.1 % to 13.0 % ) had documented CPS information in the discharge instructions . Patients with documented CPS information were younger , but there were no significant differences in race , sex , or maximum abbreviated injury scale score between patients with versus without CPS information . CONCLUSIONS While emergency physicians value the use of CPS information in discharge instructions following MVCs , they do not have adequate knowledge of , nor do they regularly disseminate , this information OBJECTIVE To evaluate the effect of resident physicians ' distress on their personal safety . PARTICIPANTS AND METHODS We conducted a prospect i ve , longitudinal cohort study of internal medicine residents at Mayo Clinic in Rochester , Minnesota . Participants completed surveys quarterly from July 1 , 2007 , through July 31 , 2011 , during their training period . Frequency of self-reported blood and body fluid ( BBF ) exposures and motor vehicle incidents was recorded . Associations of vali date d measures of quality of life , burnout , symptoms of depression , fatigue , and sleepiness with a subsequently reported BBF exposure or motor vehicle incident were determined using generalized estimating equations for repeated measures . RESULTS Data were provided by 340 of 384 eligible residents ( 88.5 % ) . Of the 301 participants providing BBF exposure data , 23 ( 7.6 % ) reported having at least 1 BBF exposure during the study period . Motor vehicle incidents were reported by 168 of 300 respondents ( 56.0 % ) , including 34 ( 11.3 % ) reporting a motor vehicle crash and 130 ( 43.3 % ) reporting a near-miss motor vehicle crash . Other than the low personal accomplishment domain of burnout , distress and fatigue at one time point exhibited no statistically significant associations with BBF exposure in the subsequent 3 months . However , diminished quality of life , burnout , positive screening for depression , fatigue , and sleepiness were each associated with statistically significantly increased odds of reporting a motor vehicle incident in the subsequent 3 months . CONCLUSION Exposures to BBF are relatively uncommon among internal medicine residents in current training environments . Motor vehicle incidents , however , remain common . Our results confirm the importance of fatigue and sleepiness to resident safety concerns . In addition , higher levels of distress may be contributory factors to motor vehicle crashes and other related incidents . Interventions design ed to address both fatigue and distress may be needed to optimally promote patient and resident safety OBJECTIVES To test the effects of cognitive training on subsequent motor vehicle collision ( MVC ) involvement of older drivers . DESIGN R and omized , controlled , multisite , single-blind clinical trial . SETTING Community-dwelling seniors at four U.S. sites : Birmingham , Alabama ; Baltimore , Maryl and ; Indianapolis , Indiana ; and State College , Pennsylvania . PARTICIPANTS Nine hundred eight older drivers ( mean age 73.1 ; 18.6 % African American ) who were r and omized to one of three cognitive interventions or a control condition .  INTERVENTIONS Up to 10 sessions of cognitive training for memory , reasoning , or speed of processing .  MEASUREMENTS State-recorded MVC involvement up to 6 years after study enrollment . RESULTS Speed-of-processing and reasoning training result ed in lower rates of at-fault collision involvement over the subsequent approximately 6-year period than controls . After adjusting for age , sex , race , education , mental status , health , vision , depressive symptoms , and testing site , participants r and omized to the speed-of-processing and reasoning interventions had an approximately 50 % lower rate ( per person-mile ) of at-fault MVCs than the control group ( rate ratio ( RR ) = 0.57 , 95 % confidence interval ( CI ) = 0.34 - 0.96 for speed of processing ) , and ( RR = 0.50 , 95 % CI = 0.27 - 0.92 for reasoning ) . There was no significant difference observed for the memory group . CONCLUSION Cognitive speed-of-processing and reasoning training result ed in a lower at-fault MVC rate in older drivers than in controls . Considering the importance of driving mobility , the costs of crashes , and the benefits of cognitive training , these interventions have great potential to sustain independence and quality of life of older adults . More research is needed to underst and the effects of different types and quantities of training UNLABELLED Patients with minimal hepatic encephalopathy ( MHE ) have impaired driving skills , but association of MHE with motor vehicle crashes is unclear . St and ard psychometric tests ( SPT ) or inhibitory control test ( ICT ) can be used to diagnose MHE . The aim was to determine the association of MHE with crashes and traffic violations over the preceding year and on 1-year follow-up . Patients with cirrhosis were diagnosed with MHE by ICT ( MHEICT ) and SPT ( MHESPT ) . Self and department-of-transportation (DOT)-reports were used to determine crashes and violations over the preceding year . Agreement between self and DOT-reports was analyzed . Patients then underwent 1-year follow-up for crash/violation occurrence . Crashes in those with/without MHEICT and MHESPT were compared . 167 patients with cirrhosis had DOT-reports , of which 120 also had self-reports . A significantly higher proportion of MHEICT patients with cirrhosis experienced crashes in the preceding year compared to those without MHE by self-report ( 17 % vs 0.0 % , P = 0.0004 ) and DOT-reports ( 17 % vs 3 % , P = 0.004 , relative risk : 5.77 ) . SPT did not differentiate between those with/without crashes . A significantly higher proportion of patients with crashes had MHEICT compared to MHESPT , both self-reported ( 100 % vs 50 % , P = 0.03 ) and DOT-reported ( 89 % vs 44 % , P = 0.01 ) . There was excellent agreement between self and DOT-reports for crashes and violations ( Kappa 0.90 and 0.80 ) . 109 patients were followed prospect ively . MHEICT patients had a significantly higher future crashes/violations compared to those without ( 22 % vs 7 % , P = 0.03 ) but MHESPT did not . MHEICT ( Odds ratio : 4.51 ) and prior year crash/violation ( Odds ratio : 2.96 ) were significantly associated with future crash/violation occurrence . CONCLUSION Patients with cirrhosis and MHEICT have a significantly higher crash rate over the preceding year and on prospect i ve follow-up compared to patients without MHE . ICT , but not SPT performance is significantly associated with prior and future crashes and violations . There was an excellent agreement between self- and DOT-reports OBJECTIVE To examine the annual incidence of acute whiplash injuries after road traffic crashes in a geographic catchment area in Northern Sweden during the period 2000 - 2009 . DESIGN Descriptive epidemiology determined by prospect ively collected data from a defined population . SETTING The study was conducted at a public hospital in Sweden . PARTICIPANTS The population of the hospital 's catchment area ( 136,600 inhabitants in 1999 and 144,500 in 2009 ) . METHODS At the emergency department , all injured persons ( approximately 11,000 per year ) were asked to answer a question naire about the injury incident . Data from the medical records also were analyzed . From 2000 - 2009 , 15,506 persons were injured in vehicle crashes . Persons who were subject to an acute neck injury within whiplash-associated disorder grade s 1 - 3 were included . The overall and annual incidences were calculated as incidence . Age , gender , type of injury event , and direction of impact were described . The incidences were compared with national statistics on insurance cl aims from 2003 , 2007 , and 2008 to detect changes in the proportions of cl aims . MAIN OUTCOME MEASURES The annual incidence of acute whiplash injuries . Secondary outcome measures were types of injury events , age and gender distribution , changes in the proportion of rear-end crashes during 2000 - 2009 , and changes in the proportion of insurance cl aims during 2003 - 2008 . RESULTS During 2000 - 2009 , 3297 cases of acute whiplash injury were encountered . The overall incidence was 235/100,000/year . The average yearly increase in incidence was 1.0 % . Women comprised 51.9 % and men 48.1 % of the injured . Car occupants ( 86.4 % ) and bicycle riders ( 6.1 % ) were most frequently injured . The proportion of rear-end crashes decreased from 55 % to 45 % from 2000 - 2009 . The proportion of insurance cl aims significantly decreased between 2003 and 2008 ( P < .0001 , χ(2 ) test ) . CONCLUSION The incidence of emergency department visits attributable to acute whiplash injuries after road traffic crashes have been relatively stable during the past decade in our area , except in 2007 and 2008 , when a peak occurred BACKGROUND CONTEXT Patients with approved workers ' compensation injuries receive guaranteed compensation for the duration of their injury , whereas patients with personal injury cl aims are only compensated , if at all , at the time of a successful settlement or trial verdict at a time point distant from their injury . PURPOSE This study compares the financial impact and loss of work patterns due to a workers ' compensation ( WC ) cl aim or personal injury in patients with a symptomatic cervical disc herniation result ing from a motor vehicle collision . STUDY DESIGN A prospect i ve study of patients who were seen by a single spine specialist between 1/2/96 and 9/1/01 . PATIENT SAMPLE A consecutive evaluation of 531 patients who were treated for a cervical pain syndrome caused by a motor vehicle collision . OUTCOME MEASURES Mechanism of injury and insurance type , ie , workers ' compensation or personal injury , was recorded for each patient as well as treatment response and return to work patterns . The data were analyzed using the two-way Z test . METHODS All patients were managed in a similar manner with noninvasive treatment initially , followed by injections , and finally surgical intervention in those who failed conservative measures . Return to work rates and work disability were determined at either final follow-up or at the last doctor 's visit before loss to follow-up . RESULTS 270 of 531 patients were diagnosed with a symptomatic one or two level disc herniation by a cervical magnetic resonance imaging scan . Fifty-four patients were insured through the workers ' compensation board , and 216 reported their crash as a personal injury cl aim . In the WC group the work disability at 3 months follow-up revealed a cumulative 2,262 total lost days of work ( average 37.1 days per person ) . At the point of maximal medical improvement ( MMI ) or 2-year follow-up , total days lost from work were 7,107 ( average 131.6 days per person . ) In the personal injury non-WC group , the 3-month follow-up of lost days of work was 1,093 days ( average 5.1 days per person . ) At 2 years follow-up , the total lost days of work were 6,206 ( average 28.7 days per person . ) CONCLUSIONS Participants compensated through the workers ' compensation system demonstrated a significant loss of days of work as compared with injured patients who received compensation by other means . This may be a reflection of the guaranteed method of compensation afforded to WC patients as opposed to patients who receive no form of financial support ( i.e. , personal injury ) during the recuperative process . Further analysis as to injury severity and a stratification of non-workers ' compensation reimbursement methods are needed to further improve the validity of this study As the elderly population increases and they lead more active and healthy lifestyles , their exposure to the threats of injury multiply . Undoubtedly , the geriatric population will comprise a growing percentage of trauma patients . The role of alcohol and drug use in geriatric trauma has not been clearly defined . The purpose of this study is to determine the incidence of  alcohol  and illicit drug  use in association with mechanism of injury in all elderly trauma patients presenting to level I and II trauma centers in the State of Illinois over 3 years . A retrospective analysis was performed on 3 years of data ( January 1 , 1994 to December 31 , 1996 ) , provided by the Illinois Department of Public Health as the Illinois Trauma Registry , which describes consecutive trauma patients presenting to level I and II trauma facilities in the State of Illinois . During the study period , there were a total of 134,846 trauma patient entries . Of these 32,382 ( 24.0 % ) were for patients 65 years of age or older . In those patients 65 and older , 1699 ( 5.2 % ) were tested for the presence of alcohol and 845 ( 49.7 % ) tested positive . Of the elderly patients who tested positive for alcohol , 71.8 % were considered intoxicated ( BAC > 80 mg/dL ) .  Urine toxicology screens  were performed on 1785 ( 5.5 % ) elderly trauma patients , and 208 ( 11.6 % ) were positive . Besides alcohol , benzodiazipines and opiates were the most frequently detected drugs . For elderly patients under the influence of alcohol falls ( 49.5 % ) and motor vehicle crashes ( 36.7 % ) were the most common mechanism of injury . For geriatric patients testing negative for alcohol , motor vehicle crashes were a much more common mechanism of injury than falls ( 65.0 % v 25.1 % ) . Falls were a much more common cause of injury in elderly patients using alcohol than in those not using alcohol . Alcohol and substance abuse are possibly significant factors in geriatric trauma . Although only 5 % of elderly trauma patients were tested for alcohol , nearly half had alcohol present on presentation to a trauma center , and the majority of these patients were intoxicated . Prospect i ve studies are needed to determine the true incidence of alcohol use/abuse in the geriatric trauma population and the need for routine alcohol screening of these patients . Detection of alcohol abuse in elderly trauma patients could help identify individuals in need of counseling and rehabilitative treatment . It may also reduce future injuries in these patients Background Work disability following motor vehicle related orthopaedic trauma is a significant contributor to the burden of injury and disease . Early identification of predictors for return to work ( RTW ) is essential for developing effective interventions to prevent work disability . The study aim was to determine the predictors ( including compensation related factors ) of time to RTW following motor vehicle related orthopaedic trauma . Methods Admitted patients were recruited prospect ively from two trauma hospitals with upper and /or lower extremity fractures following a motor vehicle crash . Baseline and follow up data were collected by written question naire . For baseline , this occurred in person within 2 weeks of injury . For follow up , this occurred by mail at six , 12 and 24 months . Additional demographic and injury-related information was retrieved from hospital data bases . Analysis involved : descriptive statistics ; logrank test to detect survival distributions of categorical variables ; and Cox proportional hazards regression models for risks of time to RTW using baseline characteristic and compensation related variables ( at 6 months ) . Results Of 452 study participants 334 ( 74 % ) were working pre-injury : results are based on this subset . Baseline characteristics were mean age 36 years ( 13.9 St and ard Deviation [ SD ] ) , 80 % male ; 72 % self-assessed very good-excellent pre-injury health , 83 % household income > AU$40,000 ( Australian Dollar ) . Follow up data was available for 233 ( 70 % ) , 210 ( 63 % ) , and 182 ( 54 % ) participants at six , 12 and 24 months respectively . Significant risks of a longer time to RTW were greater injury severity , as measured by the New Injury Severity Score ( NISS ) ( Hazards Rate Ratio [ HRR ] = 0.54 , 95 % CI 0.35 - 0.82 ) ; and lower occupational skill levels ( HRR = 0.53 , 95 % CI 0.34 - 0.83 ) . Significant risks of a shorter time to RTW were : recovery expectations for usual activities within 90 days ( HRR = 2.10 , 95 % CI 1.49 - 2.95 ) ; full-time pre-injury work hours ( HRR = 1.99 , 95 % CI 1.26 - 3.14 ) ; and very good self-assessed pre-injury health status ( HRR = 1.41 , 95 % CI 0.98 - 2.02 ) . Legal representation ( analysed at six months only ) was not associated with time to RTW . At each time period , there were 146 ( 63 % ) , 149 ( 71 % ) , and 137 ( 76 % ) working participants . Conclusions A longer time to RTW was associated with greater injury severity and lower occupational skill levels ; while a shorter time to RTW was associated with recovery expectations for usual activities within 90 days , full-time pre-injury work hours , and very good self-assessed pre-injury health status . Our findings reinforce existing research . There is an opportunity to trial interventions that address potentially modifiable factors . The issues surrounding legal representation are complex and require further research OBJECTIVE This study examined the impact of r and om alcohol testing , implemented on August 1 , 1994 , on the likelihood that the driver of a large truck involved in a fatal motor vehicle crash was alcohol-involved . METHOD Among fatal crashes , the  proportion of alcohol-positive large truck drivers ( intervention group )  was compared with the proportion of alcohol-positive light passenger vehicle drivers ( control group ) . Annual Fatality Analysis Reporting System ( FARS ) data ( 1988 - 2003 ) were compiled for each of the 50 states and Washington , D.C. , for the control and intervention groups . Using these pooled cross-sectional data , logistic regression modeled the likelihood that a driver was alcohol-positive ( blood alcohol concentration > 0 ) before compared with after r and om alcohol testing . We attributed the difference-in-difference ( the difference in likelihoods of being alcohol positive pretesting versus post-testing in large truck versus passenger vehicle drivers ) to the impact of r and om testing . RESULTS Drivers of large trucks were 18.6 % less likely to be alcohol-involved after r and om testing was implemented than before r and om testing ( odds ratio [ OR ] = 0.814 , 95 % confidence interval [ CI ] : 0.713 - 0.930 ) . The control group of passenger car drivers was 4.7 % less likely to be alcohol-involved after r and om testing was implemented ( OR = 0.953 , 95 % CI : 0.924 - 0.983 ) . The net reduction in the odds of alcohol involvement for drivers of large trucks was 14.5 % ( OR = 0.855 , 95 % CI : 0.748 - 0.976 ) . CONCLUSIONS Controlling for the general declining trend in alcohol-involved drivers in fatal crashes , r and om alcohol testing was correlated with a 14.5 % reduction in alcohol involvement among large truck drivers BACKGROUND Long work hours and work shifts of an extended duration ( > or = 24 hours ) remain a hallmark of medical education in the United States . Yet their effect on health and safety has not been evaluated with the use of vali date d measures . METHODS We conducted a prospect i ve nationwide , Web-based survey in which 2737 residents in their first postgraduate year ( interns ) completed 17,003 monthly reports that provided detailed information about work hours , work shifts of an extended duration , documented motor vehicle crashes , near-miss incidents , and incidents involving involuntary sleeping . RESULTS The odds ratios for reporting a motor vehicle crash and for reporting a near-miss incident after an extended work shift , as compared with a shift that was not of extended duration , were 2.3 ( 95 percent confidence interval , 1.6 to 3.3 ) and 5.9 ( 95 percent confidence interval , 5.4 to 6.3 ) , respectively . In a prospect i ve analysis , every extended work shift that was scheduled in a month increased the monthly risk of a motor vehicle crash by 9.1 percent ( 95 percent confidence interval , 3.4 to 14.7 percent ) and increased the monthly risk of a crash during the commute from work by 16.2 percent ( 95 percent confidence interval , 7.8 to 24.7 percent ) . In months in which interns worked five or more extended shifts , the risk that they would fall asleep while driving or while stopped in traffic was significantly increased ( odds ratios , 2.39 [ 95 percent confidence interval , 2.31 to 2.46 ] and 3.69 [ 95 percent confidence interval , 3.60 to 3.77 ] , respectively ) . CONCLUSIONS Extended- duration work shifts , which are currently sanctioned by the Accreditation Council for Graduate Medical Education , pose safety hazards for interns . These results have implication s for medical residency programs , which routinely schedule physicians to work more than 24 consecutive hours OBJECTIVES The purpose of this study ws to assess whether a community program begun in March 1988 that organized multiple city departments and private citizens could reduce  alcohol-impaired driving , related driving risks  , and  traffic deaths and injuries . METHODS Trends in fatal crashes and injuries per 100 crashes were compared in Saving Lives Program cities and the rest of Massachusetts from March 1984 through February 1993 . In annual roadside surveys conducted at r and omly selected locations , safety belt use among occupants of 54577 vehicles and travel speeds of 118442 vehicles were observed . Four statewide telephone surveys ( n = 15188 ) monitored self-reported driving after drinking . RESULTS In program cities relative to the rest of Massachusetts during the 5 program years in comparison with the previous 5 years , fatal crashes declined 25 % , from 178 to 120 , and fatal crashes involving alcohol decreased 42 % , from 69 to 36 . Visible injuries per 100 crashes declined 5 % , from 21.1 to 16.6 . The proportions of vehicles observed speeding and teenagers who drove after drinking were cut in half . CONCLUSIONS Interventions organized by multiple city departments and private citizens can reduce driving after drinking , related driving risks , and traffic deaths and injuries
Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC .
OBJECTIVE The aim of this meta- analysis was to determine the psychological impact associated with motor vehicle crash (MVC)-related physical injuries .