Journal of Injury and Violence Research

A new approach in analyzing the accident severity of pedestrian crashes using structural equation modeling

Ali Tavakoli Kashani , Mahsa Jafari, Moslem Azizi Bondarabadi — Sun, 22 Nov 2020 00:00:00 +0000

Abstract:

Background: According to official statistics in Iran, there were 17000 fatalities in road traffic crashes in 2018 that 25% of all crash fatalities belong to pedestrians. In most of the researches related to pedestrians’ safety, one aspect of the traffic crash (e.g. the injury or crash severity) is almost considered for the investigation. In order to perform a complete study of the crash, accident size can be utilized which involves different aspects of the crash. Accident size is described in terms of the number of fatalities and injured individuals and the number of damaged and involved vehicles in a crash.

Method: According to the fact that accident size has multiple indicators and it is not measured directly, traditional methodologies cannot be applied. So, in the present study the effective factors on the accident size of pedestrian crashes are investigated through structural equation modeling. For the purpose of this study, 3718 pedestrian-involved crash data occurred in Isfahan province is used for the modeling. The independent variables are weather conditions, road surface conditions, time, horizontal and vertical alignments, road type and location, driver’s gender and age, vehicle type, pedestrian’s age, gender and clothing color.

Results: The results indicated that highways, the pedestrians’ invisibility, female and old-aged pedestrians, heavy vehicles, old-aged and female drivers are related to the increase of the accident size in pedestrian crashes. These results denote that the mentioned variables are associated with the higher number of injuries, fatalities, the higher number of involved and damaged vehicles in a crash.

Conclusion: Present study shows the importance of considering safety improvement measures in highways, educating the people in the society about the traffic safety, the separation of pedestrian and motor vehicle traffic flow and considering the old people in policies and programs for mitigating the accident size.

The value of the visual evoked potentials test in the assessment of the visual pathway in head trauma

Pejvak Azadi, Morteza Movassat, Mohammad Hosein Khosravi — Sat, 15 Aug 2020 00:00:00 +0000

Background: The research was done to evaluate the value of the visual evoked potentials test in the assessment of visual pathways function in cases with head trauma and minimal findings on routine testing.

Materials and Methods: A prospective case series evaluating use of visual evoked potentials testing in patients with a history of head trauma and suffering from visual symptoms with no significant clinical and neuroimaging findings, referred for further work up.

Results: Thirty-four patients with a history of head trauma and subsequent visual complaints were included. 27 cases (79.4%) were male and 7 cases (20.6%) were female. The mean elapsed time after the trauma was 47.6 weeks (range: 3.5 to 320 weeks). Twenty-five cases had unilateral and 9 cases had bilateral visual complaints. History of coma with mean duration of 12 days was present in 4 cases. The best-corrected visual acuity was less than 1 Log MAR (legally blind) in 21 eyes. In 4 eyes (12%) the relative afferent papillary defect test was positive. Mild to moderate optic disc pallor was present bilaterally in 4 cases and unilaterally in 3 cases. Hemorrhagic patches were reported on MRI in 2 cases; no other cases had pathologic MRI findings. In unilateral cases, there was a statistically significant difference between the involved eye-sided lobe and the sound eye-sided lobe implicit time and amplitude. In patients with bilateral complaints, by testing each eye, the VEP amplitudes of both eyes showed significant differences with the International Society for Clinical Electrophysiology of Vision standards, whereas the implicit times showed not-statistically significant differences.

Conclusion: The visual evoked potentials test shows not only additional diagnostic value, not seen on routine clinical and neuroimaging testing, but also rather a high validity in tracing visual disability in traumatic brain injury.

Evaluating implementation of WHO Trauma Care Checklist vs. modified WHO checklist in improving trauma patient clinical outcomes and satisfaction

Shahram Bidhendi, Alireza Ahmadi, Mona Fouladinejad, Shahrzad Bazargan-Hejazi — Sun, 16 Aug 2020 00:00:00 +0000

Background: Use of checklist in evaluation of trauma patients has been a critical component of improving the care process and reducing medical errors and increasing patient's quality of life. We aim to assess the impact of the modified World Health Organization Trauma Care Checklist (WHO TCC) on the management of pain, complications, mortality and patient satisfaction in trauma patients.

Methods: This was a randomized control trial (RTC). Trauma patients referred to the trauma center and met the eligibility criteria were randomly assigned into three study groups. Group 1 were patients who received trauma care without using the WHO checklist, and only by the standard of care. Group 2 were patients who received trauma care according to the WHO's checklist, and group 3 were patients received trauma care according to the WHO's modified checklist. We used independent t-test and chi-square tests to assess the association between the study variables with checklist groups. The significance level of tests was set for p-value less than 0.05.

Results: We observed patients’ level of pain, Injury Severity Score (ISS), Glasgow Coma Criterion (GCS) and patient satisfaction significantly improved across the checklist groups, but more so in the modified checklist group (P less than 0.001). Similarly, findings reveal significant relationships between all clinical characteristics of the patients and checklist groups, except for a CT Scan of the spinal cord. We were unable to establish any significant associations between the checklist groups and the majority of the selected trauma care process measures, except for missed injury (p = 0.001).

Conclusions: Both the WHO TCC and the WHO modified checklist, in the initial assessment and during the treatment and care processes, enhance patients’ clinical outcomes. However, patients in the modified checklist compared to WHO TCC reported a higher level of satisfaction. Implications and future directions are discussed.

Risk factors associated with road traffic injuries at the prone-areas in Kampala city: a retrospective cross-sectional study

Tue, 29 Sep 2020 00:00:00 +0000

Background: Road traffic injuries (RTIs) pose a disproportionate public health burden in the low and middle-income countries (LMICs) like Uganda, with 85% of all the fatalities and 90% of all disability-adjusted life years lost reported worldwide. Of all RTIs which are recorded in Uganda, 50% of cases happen in Kampala —the capital city of Uganda and the nearby cities. Identifying the RTI prone-areas and their associated risk factors can help to inform road safety and prevention measures aimed at reducing RTIs, particularly in emerging cities such as Kampala.

Methods: This study was based on a retrospective cross-sectional design to analyze a five year (2011 – 2015) traffic crash data of the Uganda Police Force.

Results: Accordingly, 60 RTI prone-areas were identified to exist across the Kampala. They were ranked as low and high risk areas; 41 and 19, respectively and with the majority of the latter based in the main city center. The bivariate analysis showed a significant association between identified prone-areas and population flow (OR: 4.89, P–value: 0.01) and traffic flow time (OR: 9.06, P–value: 0.01). On the other hand, the multivariate regression analysis only showed traffic flow time as the significant predictor (OR: 6.27, P–value: 0.02) at identified RTI prone-areas.

Conclusions: The measures devised to mitigate RTI in an emerging city like Kampala should study thoroughly the patterns of traffic and population flow to help to optimize the use of available resources for effective road safety planning, injury prevention and sustainable transport systems.