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Abstract

We sought to describe the fatalities to occupants of pickup truck cargo areas and to compare the mortality of cargo area occupants to passengers in the cab. From the Fatality Analysis Reporting System (FARS) files for 1987–1996, we identified occupants of pickup trucks with at least one fatality and at least one passenger in the cargo area. Outcomes of cargo area occupants and passengers in the cab were compared using estimating equations conditional on the crash and vehicle. Thirty-four percent of deaths to cargo occupants were in noncrash events without vehicle deformation. Fifty-five percent of those who died were age 15–29 years and 79% were male. The fatality risk ratio (FRR) comparing cargo area occupants to front seat occupants was 3.0 (95% Confidence Interval [CI]=2.7–3.4). The risk was 7.9 (95% CI=6.2–10.1) times that of restrained front seat occupants. The FRR ranged from 92 (95% CI=47–179) in noncrash events to 1.7 (95% CI=1.5–1.9) in crashes with severe vehicle deformation. The FRR was 1.8 (95% CI=1.4–2.3) for occupants of enclosed cargo areas and 3.5 (95% CI=3.1–4.0) for occupants of open cargo areas. We conclude that passengers in cargo areas of pickup trucks have a higher risk of death than front seat occupants, especially in noncrash events, and that camper shells offer only limited protection for cargo area occupants.

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... We found a high rate of ejection of passengers from the vehicle (90.9%), significantly higher than would be expected in RTCs involving closed sedan-type vehicles. Ejection from a vehicle is a significant mechanism of injury and associated with a diverse injury pattern and an increased risk of mortality and permanent disability.1516171819 In our cohort ejection was associated with a much higher mean ISS and an increased need for ICU admission compared with non-ejection. ...
... The commonest region injured was the head and neck. This is consistent with the findings of other case series, which found the head and neck to be the most common region injured in incidents involving passengers travelling in the back of a flat-bed truck.15161718 Although the head was the commonest site of injury, severe injuries to the torso, pelvis and long bones were also commonly sustained. ...
... Other than manufacturing double-cab vehicles to accommodate passengers inside the vehicle, little has been done to deal with the problem from an engineering point of view. Canopies do not offer significant protection, and occupants of enclosed cargo areas have a fatality risk 1.8 times higher than the occupants of the cab.45671516171819 In our series, three of the four patients travelling in an LDV with a canopy were ejected. ...
Article
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Introduction. Despite its inherently dangerous nature, the practice of transporting passengers in the cargo area of light delivery vehicles (LDVs) is widespread in South Africa. Objective. To review the patterns and outcome of injuries associated with events involving LDVs transporting passengers. Methods. All patients presenting to the Pietermaritzburg Metropolitan Trauma Service in KwaZulu-Natal Province following an event in which they had been travelling in the cargo area of an LDV between January 2011 and December 2012 were included in the audit. Results. A total of 66 patients were treated during the study period; 35% were children under the age of 18, and 90% were ejected from the LDV during the incident. The mean injury severity score (ISS) was 23. Collision events were associated with a higher mean ISS (33) than non-collision events (15) (p=0.008). The region most commonly injured was the head and neck, and 11% of victims sustained a permanent disability. The patients collectively spent 873 days in hospital and 70 days in an intensive care unit, and underwent 17 operations. Conclusion. Transporting passengers in the cargo area of an LDV is dangerous, as ejection from the vehicle resulting from a collision is associated with significant morbidity and mortality. Legislative initiatives to prevent this practice are required as part of an ongoing comprehensive injury prevention programme.
... For example, age and gender affect the risk of serious injury, along with not using safety devices [19] and sitting in the cab and the cargo area. Previous studies found that falls from pickup truck cargo areas were associated with severe injuries in children [23][24][25][26]. Children in the cab and the cargo pickup trucks were at greater risk of injury than children in other vehicles [27]. ...
... Moreover, the pickup was the most common vehicle type in road traffic accidents and was associated with the most injuries and deaths [18,23,30]. The severity of injuries and fatalities were also linked to the number of occupants in the vehicles, as found elsewhere [29,44], and carrying passengers in the cab and cargo area [24][25][26]30]. These risk factors could be preventable by enforcing the law more rigorously, coupled with the consideration of the use of state-of-the-art technology to help monitor real-time risky behavior. ...
... Event-based human error involved the non-use of seat belts, sitting in a place without safety devices such as the cargo area and the cab of the pickups, and being ejected from seats or vehicles. Similar event stage risk factors have been observed in other studies [24,25,27,30,45,46]. The severity of injuries and fatalities were also linked to the number of occupants in the vehicles, as found elsewhere [34], and carrying passengers in the cab and cargo area [24][25][26]. ...
Article
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Thailand has the second-highest rates of road traffic mortality globally. Detailed information on the combination of human, vehicle, and environmental risks giving rise to each incident is important for addressing risk factors holistically. This paper presents the result of forensic road traffic investigation reports in Thailand and determines risk factor patterns for road traffic injuries. Detailed forensic reports were extracted for 25 serious traffic accident events. The Haddon matrix was used to analyze risk factors in three phases stratified by four agents. The 25 events analyzed involved 407 victims and 47 vehicles. A total of 65.8% of victims were injured, including 14.5% who died. The majority (66.1%) of deaths occurred at the scene. Human-error-related factors included speeding and drowsiness. Passenger risks included not using the seat belt, sitting in the cargo area and the cab of pickups. Overloaded vehicles, unsafe car modifications, no occupant safety equipment and having unfixed seats were vehicular risks. Environmental risks included fixed objects on the roadside, no traffic lights, no guard rails, no traffic signs, and road accident black spots. At present, traffic accidents cause much avoidable severe injury and death. The outcome of this paper identifies a number of preventable risk factors for traffic injury, and importantly examines them in conjunction. Road traffic safety measures need to consider how human, vehicle, and environmental risks intersect to influence injury likelihood and severity. The Haddon matrix is useful in identifying these pre- and post-accident risk factors. Furthermore, the sustainable preventions of road traffic injury need to address these risks together with active law enforcement. Keywords: road traffic injury; risk factor; road traffic investigation; Haddon matrix
... The risk of rollover is heightened when goods are loaded on roofracks, as the center of gravity is raised even higher. Each additional passenger in the cargo area also raises the pickup's center of gravity, while their unrestrained weight movement further increases vehicle instability (Anderson et al. 2000). Banning overloaded vehicles, however, is unlikely to be successful in developing countries. ...
... Consequently, a high priority for further research is the real-world crash effectiveness of the canopy; more needs to be known about passenger injuries and the circumstances in which the most serious occur. Even with a canopy, injuries resulting from shifting cargo (Williams and Goins 1981), impact with the interior of the cargo area (Anderson et al. 2000), or the canopy becoming detached (Children's Safety Network 2005) could be expected. Ultimately, as Agran et al. (1994) warned, "there is no safe, crash-tested means of travel in the cargo areas of pickup trucks." ...
Article
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This paper regards the operation of rural public transport services provided bypickup trucks and minibuses in Cambodia. Presented are survey data revealing howpickup modifications, especially cargo area canopies, are used to increase passengerand cargo capacity. A particular emphasis is placed on the importance of pickuptransport services to economic activity. The results reveal that passengers travelingfor economic reasons constitute 66 percent of passengers and carry 77 percent ofthe cargo weight. Transport operators may be modifying vehicles in response totheir passengers’ commercial requirements. This paper highlights both the economicbenefits and safety risks of such modifications.
... These cabs provide a way to transport additional passengers without using the cargo area for passengers. The hazards of travel in the cargo area are well documented (Agran et al., 1990; Hamar et al., 1991; Bucklew et al., 1992; Agran et al., 1994; Anderson et al., 2000). ...
... Occupants coded as having an injury with unknown severity were assumed to have survived. The effect of seating in the rear seat, conditional on the specific crash and vehicle, was estimated using the method of Stijnen and van Houwelingen (1993), which we have previously applied to FARS data (Anderson et al., 2000). This method was used rather than more conventional regression methods because it estimates the log risk ratio and is valid with data having few observations per stratum. ...
Article
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We compared the fatality risk for occupants of rear passenger seats in extended cab and crew cab pickup trucks to the fatality risk for front seat occupants of the same vehicles using the (US) Fatality Analysis Reporting System (FARS) for 1982-1997. A 10-digit truncated vehicle identification number was used to classify the pickup trucks. The data were analyzed with an estimating equation for data having few observations per stratum. We identified 549 extended cab pickup trucks with one or more occupants of rear passenger seats and one or more occupant deaths. Occupants of rear passenger seats had a fatality risk 43% lower than front seat occupants (95% confidence interval 32% to 52%), controlling for age, sex, and restraint use. Occupants of rear seats of extended cabs in compact pickup trucks did not experience any higher fatality risk (relative to front-seat occupants of the same vehicles) than rear seat occupants of extended cabs in full-size pickup trucks and large 4-door crew cabs.
... 26 Matched cohort methods have been used in studies of the effects of seat belts, 7,27 air bags, 28-30 motorcycle helmets, 31-33 occupant seating position, [34][35][36] and pickup truck cargo area travel. 37 ...
Article
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We estimated the effectiveness of child restraints in preventing death during motor vehicle collisions among children 3 years or younger. We conducted a matched cohort study using Fatality Analysis Reporting System data from 1996 to 2005. We estimated death risk ratios using conditional Poisson regression, bootstrapping, multiple imputation, and a sensitivity analysis of misclassification bias. We examined possible effect modification by selected factors. The estimated death risk ratios comparing child safety seats with no restraint were 0.27 (95% confidence interval [CI] = 0.21, 0.34) for infants, 0.24 (95% CI = 0.19, 0.30) for children aged 1 year, 0.40 (95% CI = 0.32, 0.51) for those aged 2 years, and 0.41 (95% CI = 0.33, 0.52) for those aged 3 years. Estimated safety seat effectiveness was greater during rollover collisions, in rural environments, and in light trucks. We estimated seat belts to be as effective as safety seats in preventing death for children aged 2 and 3 years. Child safety seats are highly effective in reducing the risk of death during severe traffic collisions and generally outperform seat belts. Parents should be encouraged to use child safety seats in favor of seat belts.
... Matched cohort methods have been used to study the effects of seatbelts, 13 14 child restraints, 15 air bags, [16][17][18] pickup truck cargo area travel, 19 occupant seating position, [20][21][22] and motorcycle helmets. [23][24][25] An initial sample of passenger cars, minivans, pick-ups, and SUVs with model years 1990-2006 was assembled. ...
Article
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To estimate the effectiveness of booster seats and of seatbelts in reducing the risk of child death during traffic collisions and to examine possible effect modification by various collision and vehicle characteristics. A matched cohort study was conducted using data from the Fatality Analysis Reporting System. Death risk ratios were estimated with conditional Poisson regression, bootstrapped coefficient standard errors, and multiply imputed missing values using chained equations. Estimated death risk ratios for booster seats used with seatbelts were 0.33 (95% CI 0.28 to 0.40) for children age 4-5 years and 0.45 (0.31 to 0.63) for children aged 6-8 years (Wald test of homogeneity p<0.005). The estimated risk ratios for seatbelt used alone were similar for the two age groups, 0.37 (0.32 to 0.43) and 0.39 (0.34 to 0.44) for ages 4-5 and 6-8, respectively (Wald p = 0.61). Estimated booster seat effectiveness was significantly greater for inbound seating positions (Wald p = 0.05) and during rollovers collisions (Wald p = 0.01). Significant variability in risk ratio estimates was not observed across levels of calendar year, vehicle model year, vehicle type, or land use. Seatbelts, used with or without booster seats, are highly effective in preventing death among motor vehicle occupants aged 4-8 years. Booster seats do not appear to improve the performance of seatbelts with respect to preventing death (risk ratio 0.92, 95% CI 0.79 to 1.08, comparing seatbelts with boosters to seatbelts alone), but because several studies have found that booster seats reduce non-fatal injury severity, clinicians and injury prevention specialists should continue to recommend the use of boosters to parents of young children.
... Moreover, the pickup was the most common vehicle type in road traffic accidents and was associated with the most injuries and deaths. Severity of injuries and fatalities were also linked to the number of occupants in the vehicles, as found elsewhere [18], and carrying passengers in the cab and cargo area [19,20]. In fatal accidents, most victims died at the scene. ...
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Background – Thailand has the second highest rates of road traffic mortality globally. Detailed information on the combination of human, vehicle and environmental risks giving rise to each incident is important for addressing risk factors holistically. This paper presents the result of forensic road traffic investigation reports in Thailand and determines risk factor patterns for road traffic injuries. Methods – Detailed forensic reports were extracted for 25 serious traffic accident events. For each report, accidents were characterized by the number of vehicles, number and type of injuries and deaths, road user types, involvement of roadside hazards, medical care provided, and human, vehicular and environmental influences on the incident. The Haddon matrix was used to analyse risk factors in three phases (pre-event, event, post-event) stratified by four agents (human, vehicle, physical and socio-economic environment). Results - The 25 events analyzed involved 407 victims and 47 vehicles. 65.8% of victims were injured, including 22.0% who died. Median age of those injured was 27 years, and 28 years for fatalities. Vehicles crashing with fixed objects, and pickup-related crashes, accounted for the majority of accidents and deaths. Head or neck trauma was the main cause of death. The majority (61%) of deaths occurred at the scene. Human error-related factors included speeding, and drowsiness from night and long-distance driving. Passenger risks included not using seat belt, sitting in cargo area and the cab of pickups. Not having anyone trained in first aid on the scene, first aid being provided by bystanders, and delayed calls to Emergency Medical Services increased injury risk. Overloaded vehicles, unsafe car modifications, no occupant safety equipment, and having unfixed seats were vehicular risks. Environmental risks included fixed objects on the roadside, no traffic lights, no guard rails, no traffic sign, road accident black spots, and hazardous objects roadside. Conclusions - Thailand must address all three temporal phases of the Haddon model and all three factors – human, vehicle and environment. At present traffic accidents cause much avoidable severe injury and death. The Haddon matrix is useful to structure road traffic investigations, revealing multi-level factors common on Thai roads. Keywords: Road traffic injury, Risk factor, Road traffic investigation, Haddon matrix
... The fatality risk to children in the cargo area of pickup trucks has been well described. 114,115 The most significant hazard of travel in the cargo area of a pickup truck is ejection of a passenger in a crash or noncrash event (eg, sudden stop, turn, swerve, or loss of balance, as well as intentional or unintentional jumps and falls). It is fortunate that the number of children and adolescents younger than 18 years killed as passengers in the cargo area of pickup trucks has declined by more than 50% over the past decade, from more than 40 per year to less than 20 per year more recently. ...
Article
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Despite significant reductions in the number of children killed in motor vehicle crashes over the past decade, crashes continue to be the leading cause of death for children 4 years and older. Therefore, the American Academy of Pediatrics continues to recommend inclusion of child passenger safety anticipatory guidance at every health-supervision visit. This technical report provides a summary of the evidence in support of 5 recommendations for best practices to optimize safety in passenger vehicles for children from birth through adolescence that all pediatricians should know and promote in their routine practice. These recommendations are presented in the revised policy statement on child passenger safety in the form of an algorithm that is intended to facilitate their implementation by pediatricians with their patients and families. The algorithm is designed to cover the majority of situations that pediatricians will encounter in practice. In addition, a summary of evidence on a number of additional issues that affect the safety of children in motor vehicles, including the proper use and installation of child restraints, exposure to air bags, travel in pickup trucks, children left in or around vehicles, and the importance of restraint laws, is provided. Finally, this technical report provides pediatricians with a number of resources for additional information to use when providing anticipatory guidance to families.
... The cargo area in the rear of a truck does not meet occupant safety standards, yet it is too often used for transporting soldiers. In California, passengers in cargo area of pickup trucks were three times more prone to death in automobile accident than front seat occupants [5]. In United States, there is legal prohibition on carrying passengers in cargo space [6]. ...
Article
Full-text available
Background: Heterozygous transmission of gene for Haemoglobin S leads to sickle cell trait. Mostly the trait remains silent with no additional morbidity or mortality. When these persons migrate to higher altitudes, in times of high oxygen demand, some of them develop splenic infarction. This is a rare phenomenon and only 47 such cases had been reported till 2005. Methods: This study was conducted at an Indian military hospital serving the troops deployed in Kashmir valley at altitudes ranging from 5500 ft to 13000 ft. When two consecutive splenectomies for splenic abscesses, turned out to be sickling induced infarction histopathologically, we reviewed splenectomy specimens received in last six years for evidence of sickling. Result: Out of 33 splenectomies performed during the period of study, 22 were due to trauma (gun shot injury 11; splinter injury one and blunt injury 10). Of the rest eleven, who presented without any history of trauma, seven had evidence of vascular occlusion with aggregates of sickled red blood cells. In none, Gram stain or Periodic Acid Schiff stain revealed any bacterial or fungal colonies. One patient of splenic syndrome was found to have unrecognised sickle cell trait and he was managed conservatively. Conclusion: Sickle cell trait should be excluded before considering splenectomy in ethnically vulnerable patients presenting with splenic syndrome. An uncomplicated splenic infarction can be managed conservatively.
... The cargo area in the rear of a truck does not meet occupant safety standards, yet it is too often used for transporting soldiers. In California, passengers in cargo area of pickup trucks were three times more prone to death in automobile accident than front seat occupants [5]. In United States, there is legal prohibition on carrying passengers in cargo space [6]. ...
Article
Background: Regional Trauma Centre in the northern India receives the mortal remains of all fallen soldiers for embalming. Non enemy action deaths during counter insurgency operations (CI Ops) were analysed for planning preventive measures. Methods: Mortal remains received for embalming from Jan 1999 to Dec 2006 were analysed with respect to mode of injury, causation, body parts involved, fatality, seasonal variation and changing trends. Result: Accidents accounted for 3.02 deaths per thousand troops and environmental factors were responsible for 1.14 deaths per thousand troops deployed. Accidental deaths peaked in 2000, declined in 2001 and then remained more or less static. Of the accidental deaths, 88% were brought in dead and 12% died after reaching hospital. Road traffic accidents were the major killers accounting for 48.2%, followed by accidental discharge of weapon 35.5%. The latter is showing a rising trend from 8% of total accidents in 2001 to 65% in 2005 and 51% in 2006 (p<.01). Most (49.7%) of the deaths were below 25 years of age. Proportion of persons below 25 years was more in fatalities due to accidental gunshot wound. Amongst the road traffic accidents, 40% died of head injury and 51.2% due to multiple injuries. When deaths occurred due to accidental discharge of own weapon, 36.4% had brain injury and 22% heart injury. Of the environmental fatalities all but one were brought in dead. Majority were due to avalanches and landslides (51.2%), followed by earthquake (22.4%), lightning (12.8%), high altitude pulmonary oedema (10.4%) and hypothermia (3.2%). Most of the deaths due to avalanches occurred in February while all deaths due to earthquake were in October 2005. Of the deaths due to lightning, 75% occurred in April and May. Conclusion: Prevention of death caused by road traffic accidents, accidental discharge of weapon, avalanches and lightning will conserve manpower and add to operational preparedness.
... Greenland (39) extended these methods to modeling the paired Mantel-Haenszel risk ratio and illustrated the approach in an analysis of the association of motorcycle helmet use with death. This approach has been extended to accommodate more than two persons in each matched set; one study estimated the risk ratio of death for persons occupying a truck bed compared with those in the truck cab (42). ...
Article
This article reviews the design and analysis of matched cohort studies of injuries where exposed study subjects are matched to others not exposed. We focus on the situation in which data are available for the matched groups with at least one member who had the study outcome, but data are absent or incomplete for matched groups that have no members with the outcome. When matching is done in a case-control study, those with the outcome are matched to those without the outcome on certain confounder measures; this distorts the exposure status of the controls to be like that of the cases in regard to the matching variables (and perhaps other variables as well) (1). As a consequence, the selected controls may not represent the exposure experience of the entire population from which the cases were derived. Therefore, matching is a source of selection bias in a case-control study. The bias it produces can be removed in the analysis by accounting for the matching since, conditional on the values of the matching variables, controls will be representative of the source population. The consequence of one-to-one matching in a cohort study is different. A variable can be a confounder only if, in the study cohort, it is associated with but not affected by the exposure and is independently predictive of the outcome. If each exposed study subject is perfectly matched to an unexposed subject on the value of some variable, and if there is no subject loss or missing data, there will be no association of exposure with the matching variable in the data, and confounding by the matching variable will be eliminated (2). Confounding by the matching variable could still occur, however, if an imbalance arose between the exposed and unexposed study subjects; this might happen, for example, if follow-up were less complete for one group compared with the other, or if some records were omitted from the analysis because of missing data. Despite the potential of matching to prevent confounding in a cohort study and the potential of matching to sometimes increase study efficiency (2), it appears that this design is rarely used. For many cohort studies, matching exposed persons to one or several unexposed persons would be laborious. Furthermore, it might be wasteful in that matches might be unavailable for some potential cohort members. Today, cohort studies usually avoid matching, and the data are analyzed using regression methods that make it relatively easy to adjust for potential confounding factors that might otherwise be used for matching.
... The cargo area in the rear of a truck does not meet occupant safety standards, yet it is too often used for transporting soldiers. In California, passengers in cargo area of pickup trucks were three times more prone to death in automobile accident than front seat occupants [5]. In United States, there is legal prohibition on carrying passengers in cargo space [6]. ...
Article
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Background: Medical fraternity requisitions diagnostic tests for multiple reasons. More often than not, the tests lead to more tests either to exclude or to confirm doubts raised by the test results. These tests have an inherent morbidity, discomfort and cost. Growing expenditure on diagnostic tests without matching improvement in the health status warrants an internal audit of the laboratory utilization. Methods: A retrospective utility audit was done for certain routinely advised laboratory tests at a hospital. Blood urea estimation in annual / periodic medical examination (AME/ PME), bleeding and clotting time in pre-anaesthetic check-up and aspartate aminotransferase (AST) and antibodies to hepatitis C virus (anti-HCV) in diagnostic work-up of acute onset jaundice were included in the audit. Results: During the study period, 793 individuals underwent AME / PME and urea estimation did not provide any additional information in these cases which was not inferred by serum creatinine. Similarly, in diagnostic workup of acute onset jaundice, 6049 aspartate aminotransferase (AST) estimations in 1024 patients did not contribute anything more than what was inferred by alanine aminotransferase (ALT). Prevalence of anti HCV antibodies in acute onset jaundice in serving soldiers (11 out of 1225; 0.89%) though more than that in the blood donors from the same population (17 out of 4105; 0.41%) was less than anticipated false positives (18 out of 1225; 1.5%) as per the claimed specificity (98.5%) of the test kit. None of the 2766 bleeding and clotting time tests detected a bleeding or coagulation disorder. Conclusion: The study reveals significant overuse of the laboratory that may not be good for the patient and the organization in terms of direct and indirect costs due to false positive results. This laboratory overload adversely affects the quality and availability of laboratory results. Therefore, a test should only be advised, if positive or negative result would dictate a change in patient management.
... The fatality risk to children in the cargo area of pickup trucks has been well described. 117, 118 The most significant hazard of travel in the cargo area of a pickup truck is ejection of a passenger in a crash or noncrash event (eg, sudden stop, turn, swerve, or loss of balance, as well as intentional or unintentional jumps and falls). Fortunately, the number of children and adolescents younger than 18 years killed as passengers in the cargo area of pickup trucks has declined by more than 50% over the past decade, from more than 40 per year to fewer than 20 per year more recently. ...
Article
Despite significant reductions in the number of children killed in motor vehicle crashes over the past decade, crashes continue to be the leading cause of death to children 4 years and older. Therefore, the American Academy of Pediatrics continues to recommend the inclusion of child passenger safety anticipatory guidance at every health supervision visit. This technical report provides a summary of the evidence in support of 5 recommendations for best practices to optimize safety in passenger vehicles for children from birth through adolescence that all pediatricians should know and promote in their routine practice. These recommendations are presented in the revised policy statement on child passenger safety in the form of an algorithm that is intended to facilitate their implementation by pediatricians with their patients and families. The algorithm is designed to cover the majority of situations that pediatricians will encounter in practice. In addition, a summary of evidence on a number of additional issues affecting the safety of children in motor vehicles, including the proper use and installation of child restraints, exposure to air bags, travel in pickup trucks, children left in or around vehicles, and the importance of restraint laws, is provided. Finally, this technical report provides pediatricians with a number of resources for additional information to use when providing anticipatory guidance to families.
Article
Background Few studies have looked at how obesity affects injury outcomes among vehicle occupants involved in traffic collisions. Objective To estimate the association of obesity with death risk among drivers of passenger vehicles aged ≥16 and to examine effect modification by driver sex, driver seat belt use, vehicle type and collision type. Methods We conducted a matched-pair cohort study using data from the Fatality Analysis Reporting System. WHO body mass index (BMI) categories were calculated. Data were analysed using conditional Poisson regression. Results Estimated risk ratios (RRs) were slightly raised for underweight drivers (RR=1.19, 95% CI 0.86 to 1.63). RR increased with higher BMI categories and were 1.21 (0.98 to 1.49) for BMI 30–34.9, 1.51 (1.10 to 2.08) for BMI 35–39.9 and 1.80 (1.15 to 2.84) for BMI ≥40. Estimated BMI effects varied by gender. We found no meaningful variation across levels of vehicle type, collision type or seat belt use. Conclusions Findings from this study suggest that obese vehicle drivers are more likely to die from traffic collision-related injuries than non-obese occupants involved in the same collision. Education is needed to improve seat belt use among obese people, as is research to understand the potential role of comorbidities in injury outcomes.
Article
To guide interventions to prevent injuries to pickup-truck occupants, we characterized pickup truck ownership, drivers and use in the 1995 National Personal Transportation Survey, which collects travel data from the civilian noninstitutionalized population of the US. SUDAAN software was used to account for the complex nature of the sample. Pickup truck ownership was more common in households with more vehicles, in rural households, in households living in single family homes and mobile homes, and in middle-income households. Among US regions, pickup truck ownership was highest among households in the mountain west. Pickup truck ownership was greater in households with two adults, whether or not children or youths were present, but this was largely due to the number of vehicles in these households. Driving a pickup on the sample day was more frequent among men, among drivers with less education and among full-time workers. A higher proportion of trips to work, work-related trips, longer trips and trips with fewer people were by pickup truck. Seat belt use was lower among pickup truck drivers than drivers of other vehicles. For only 0.5% of households (those with three or more members and a pickup truck as their only vehicle), restrictions on travel in cargo areas might be burdensome. Restrictions on cargo area travel, strengthening existing seat belt laws and social marketing strategies might increase the safety of pickup truck occupants.
Article
To determine whether either the inclusion of adults in matched cohort studies of passenger vehicle occupants or modification of age effects by collision severity biases child restraint risk ratios biases estimate of child restraint effectiveness. Monte Carlo data simulations were conducted to represent 10,000 collision-involved vehicles carrying a mix of children and adults. The effects of age category, adult seat belt use, child seat belt use, and child safety seat use were set to known values. Age was a modifier of the adult and child seat belt risk ratios and of the safety seat RR, and crash severity was a modifier of the age RRs. We also created an association between restraint use and collision severity to confound the restraint-death risk associations. RRs were estimated using conditional Poisson regression and compared with the true values. Estimated RRs for death were identical to the simulated values. The average child safety seat RR was 0.42 (true value 0.42), and the average seat belt RRs for children were 0.54 (true value 0.54) for those aged 0-3 years and 0.61 (true value 0.61) for those aged 4-17. Age effects were also correctly estimated, 1.69 (true value 1.69) for those aged 0-3 and 1.35 (true value 1.35) for those aged 4-17. Neither the use of matched sets of adults and children nor the modification of age effects by collision severity biases estimates of child restraint effectiveness in matched cohort studies.
Article
Transporting manual labourers in the cargo area of heavy goods vehicles is a common practice in Singapore. Earlier studies have reported higher fatalities and more serious injuries in such unrestrained cargo area passengers compared with those sitting in the cabin of the vehicle. We conducted a case series of injured cargo area passengers presenting to the Emergency Department from 1 January 2006 to 31 December 2007. A total of 34 male casualties (mean age 29.7 years) were treated. They were injured in four separate heavy goods vehicle crashes during the study period. Patients who were nonresident manual labourers comprised 94.1%; 44.1% (15 patients) were ejected from the vehicle but despite this, the mean Injury Severity Score was 2.2 (SD 3.5). Three of the patients were admitted to hospital, with one patient (Injury Severity Score 22) requiring surgery and intensive care stay. The remaining patients were discharged from the Emergency Department, and there were no deaths. Six patients reattended the Emergency Department for unresolved pain from their injuries. A total of 173 absent-days were incurred. This report highlights the fact that cargo area passengers are at high risk of ejection, and they incur significant morbidity from their injuries with subsequent loss of productivity. In addition, heavy goods vehicle crashes are usually mass casualty events, severely taxing the receiving Emergency Department. Safer alternatives for mass transport of manual labourers are required.
Article
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Navajo motor vehicle mortality is the highest among the 12 Indian Health Service (IHS) administrative areas. In July 1988, the Navajo Nation enacted a primary enforcement safety belt use and a child restraint law. Assess the impact of the laws on the rate and severity of pediatric (0-19 years) motor vehicle injury resulting in hospitalizations in the Navajo Nation. Hospitalizations associated with motor vehicle related injury discharges were identified by International Classification of Diseases, 9th revision, CM E codes, 810-825 (.0,.1) from the Navajo IHS hospital discharge database. Age specific rates for the period before the law, 1983-88, were compared with those after enactment and enforcement, 1991-95. Severity of injury, measured by the abbreviated injury scale (AIS) score and new injury severity score (NISS), was determined with ICDMAP-90 software. Wilcoxon rank sum and chi(2) tests were used for analysis. Discharge rates (SE) for motor vehicle injury (per 100 000) decreased significantly in all age groups: 0-4 years (62 (7) to 28 (4)), 5-11 years (55.3 (6) to 26 (4)), and 15-19 years (139 (14) to 68 (7)); p=0.0001. In children 0-4 years, the median AIS score decreased from 1.5 (1,3) (25th, 75th centile) to 1 (1,2), p=0.06, and the median NISS decreased from 3.5 (1,9) to 2 (1,5), p=0.07. The proportion of children with NISS scores >4 decreased significantly for the 0-4 year age group (p=0.03). Concurrent with enactment of the Navajo Nation occupant and child restraint laws there was a reduction in the rate of motor vehicle related hospital discharges for children. Severity of injury declined in very young Navajo children. The effect of enactment and enforcement of this Native American child occupant restraint law may serve as an example of an effective injury control effort directed at Native American children.
Article
Death and injury on the nation's highways is a public health crisis, especially for youth and members of selected minority groups. The objective of this paper is to review the literature on behavioral and environmental factors that increase risk for traffic morbidity and mortality in populations at high risk. Each of the following is a risky traffic-related behavior: not wearing seat belts, not using child safety seats, not wearing bicycle or motorcycle helmets, driving after drinking, driving while fatigued or distracted, speeding, running red lights, and aggressive driving. Environmental factors that modify risk include urban sprawl, highway design, public policy, racism and economic inequality. High risk groups include youths, males, pickup truck drivers, urban dwellers, the elderly, African Americans, American Indians, and Alaska Natives. A comprehensive approach must be developed for reducing traffic-related risk of death and injury, especially in high risk populations.
Article
Falls from pickup truck cargo areas represent a unique mode of injury in children and adolescents. The goal of this study was to identify the neurological spectrum of injuries resulting from children riding in the back of pickup trucks. The authors undertook a retrospective review of the University of New Mexico Hospital trauma registry of data compiled over a 7-year period. Their goal was to identify instances in which a fall or ejection from a pickup truck cargo area was the mechanism of injury. The charts of pediatric patients (< or = 16 years of age) with neurological injuries were reviewed and analyzed. Seventy-three pediatric patients with injuries related to riding in the cargo areas of trucks were identified, of which 53 children (73%) had sustained neurological injuries. Among these 53 children, 64% sustained isolated head injuries, 15% isolated spine injuries, 9.4% combined spine and head injuries, 2% combined peripheral nerve, spine, and head injuries, 4% isolated peripheral nerve injuries, and 5.6% concussive events. In 53.4% of patients with neurological injuries the results of computed tomography (CT) examination were abnormal. In 36% of patients with Glasgow Coma Scale (GCS) scores of 14 to 15 there was evidence of intracranial hemorrhage on head CT scans. Injury Severity Scores were similar in the patients who were ejected and those who fell from cargo areas, but patients who were ejected had a lower mean GCS score than those who suffered falls (GCS score 12.5 and 14.3, respectively). Falls or ejections from pickup truck cargo areas result in a relatively high incidence of traumatic head, spine, and peripheral nerve injury. Head CT scanning should therefore be considered in pediatric patients with this mechanism of injury. Cargo area occupancy poses an unacceptable risk of injury and should be avoided.
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Transporting passengers in the cargo area of pickup trucks is a public health safety issue in the United States. Our study compared crashes involving passengers in the cargo area with those involving passengers in the cab. We obtained data for all injury events of pickup occupants for 1990 from the California Highway Patrol. A total of 702 traffic reports coded as having passengers riding in pickup truck beds involved 1,685 passengers in the cargo area and 865 in the cab. Significantly more events involving passengers in the cargo area occurred in summer in rural areas and were noncollisions than did events with only cab passengers. Crashes with passengers in the cargo area resulted in death in 5% of passengers. Of the drivers, 81% were male and 22% were younger than 20 years. Among the 1,685 passengers in the cargo area, 65% were male, 36% were younger than 15 years, and 30% were ages 15 to 19 years. Passengers in the cargo area were more frequently ejected and more seriously injured than their counterparts in the cab. Legislation to restrict travel in truck beds and the design of restraints for this area are some measures that may reduce the risk of injury.
Article
Objective. —To describe the case characteristics of a series of children poisoned with carbon monoxide while traveling in the back of pickup trucks.Design. —Pediatric cases referred for treatment of carbon monoxide poisoning with hyperbaric oxygen between 1986 and 1991 were reviewed. Those cases that occurred during travel in the back of pickup trucks were selected. Clinical follow-up by telephone interview ranged from 2 to 55 months.Setting. —A private, urban, tertiary care center in Seattle, Wash.Patients. —Twenty children ranging from 4 to 16 years of age.Intervention. —All patients were treated with hyperbaric oxygen.Main Outcome Measures. —Characteristics of the poisoning incident and clinical patient outcome.Results. —Of 68 pediatric patients treated for accidental carbon monoxide poisoning, 20 cases occurred as children rode in the back of pickup trucks. In 17 of these, the children were riding under a rigid closed canopy on the rear of the truck, while three episodes occurred as children rode beneath a tarpaulin. Average carboxyhemoglobin level on emergency department presentation was 18.2% ± 2.4% (mean ± SEM; range, 1.6% to 37.0%). Loss of consciousness occurred in 15 of the 20 children. One child died of cerebral edema, one had permanent neurologic deficits, and 18 had no recognizable sequelae related to the episode. In all cases, the truck exhaust system had a previously known leak or a tail pipe that exited at the rear rather than at the side of the pickup truck.Conclusions. —Carbon monoxide poisoning is a significant hazard for children who ride in the back of pickup trucks. If possible, this practice should be avoided.(JAMA. 1992;267:538-540)
Article
Travel in the back of pickup trucks has not been adequately addressed as an occupant protection issue. This study compares injuries sustained by children riding in the back of pickup trucks with those of children riding in the cab. Data were obtained from a multihospital monitoring system and the coroner in a single urban county. The series of injured children consisted of 290 children 0 through 14 years of age, 201 of whom had been riding in the cab and 89 in the back. Age distribution of the children demonstrated that it is most frequently the 10- to 14-year-olds who travel in the back. Children riding in the back were more frequently injured in noncrash events (absence of a collision), had more ejections, had more injuries, and sustained more severe injuries as measured by the Maximum Injury Score. With increased restraint use in the cab, it is likely that even greater differentials in injury severity and patterns would be realized. Education regarding the hazards of travel in the back of pickups and stronger legislation limiting the transport of children in the back of trucks are recommended. (JAMA. 1990;264:712-716)
Article
In certain epidemiological studies, subjects come from an underlying cohort of matched pairs, but only those pairs in which an outcome event occurs are ascertained. Such data can be analysed by using odds ratio modelling methods, but these methods present interpretational problems and do not use information from matched pairs in which both subjects experience the outcome. This paper presents a method which models the risk ratio and makes use of double-outcome pairs. The method is compared with conditional logistic regression in the analysis of the effectiveness of motorcycle helmets in preventing deaths in motorcycle accidents.
Article
The medical records of 50 patients who sustained injuries during falls or ejections from pickup truck beds and were admitted to the University of New Mexico Level I Trauma Center between January 1985 and December 1989 were retrospectively examined. Falls and ejections commonly involve young adults, and usually occur in the summer months during the afternoon or evening. Twenty-three individuals were thrown from the pickup truck bed during a motor vehicle collision and 27 simply fell out, and this distinction was not related to age or ethanol use. Although those thrown from the pickup truck bed during a crash were less severely injured (average ISS 15.4) than those who simply fell from the bed (average ISS 17.4), this difference was not statistically significant. Mortality was equal in these two groups, with three deaths occurring in each group. Overall, injuries incurred during falls and ejections were more serious than those incurred in MVCs (average ISS 16.5 vs. 14.5, p= 0.06). The head was the most frequently injured body region following falls or ejections (68%), followed by the extremities (46%), the face (28%), the thorax (22%), and the abdomen (10%). Every death in this series was attributed to a head injury. The overall mortality for the series was 12%. Sixteen additional fatalities from falls and ejections during the study period were discovered in a review of the records of the State Medical Examiner. The average age of this cohort was 24 years. Fifteen of these deaths were the result of falls rather than ejections (94%), and 13 were attributed to head injuries (81%). Although falls and ejections from pickup trucks are not common accidents, the severity of injuries produced in a largely pediatric population may argue for protective legislation. The frequency and lethality of head injuries may make the mandatory use of helmets a reasonable injunction, but because the utility of helmets, passenger restraints, and cabcovers are undocumented, the simple prohibition of passengers from cargo spaces might be more effective. (C) Williams & Wilkins 1992. All Rights Reserved.
Article
OBJECTIVE - To describe the case characteristics of a series of children poisoned with carbon monoxide while traveling in the back of pickup trucks. DESIGN - Pediatric cases referred for treatment of carbon monoxide poisoning with hyperbaric oxygen between 1986 and 1991 were reviewed. Those cases that occurred during travel in the back of pickup trucks were selected. Clinical follow-up by telephone interview ranged from 2 to 55 months. SETTING - A private, urban, tertiary care center in Seattle, Wash. PATIENTS - Twenty children ranging from 4 to 16 years of age. INTERVENTION - All patients were treated with hyperbaric oxygen. MAIN OUTCOME MEASURES - Characteristics of the poisoning incident and clinical patient outcome. RESULTS - Of 68 pediatric patients treated for accidental carbon monoxide poisoning, 20 cases occurred as children rode in the back of pickup trucks. In 17 of these, the children were riding under a rigid closed canopy on the rear of the truck, while three episodes occurred as children rode beneath a tarpaulin. Average carboxyhemoglobin level on emergency department presentation was 18.2% +/- 2.4% (mean +/- SEM; range, 1.6% to 37.0%). Loss of consciousness occurred in 15 of the 20 children. One child died of cerebral edema, one had permanent neurologic deficits, and 18 had no recognizable sequelae related to the episode. In all cases, the truck exhaust system had a previously known leak or a tail pipe that exited at the rear rather than at the side of the pickup truck. CONCLUSIONS - Carbon monoxide poisoning is a significant hazard for children who ride in the back of pickup trucks. If possible, this practice should be avoided.
Article
To the Editor.— The policy statement,1 "Children in Pickup Trucks," was useful and constructive. However, the statement failed to mention the exposure to carbon monoxide of children who ride in the back of pickup trucks and station wagon vans. We recently saw two healthy children who had developed acute carbon monoxide poisoning from a defective exhaust system after riding in the back seat of an air-conditioned station wagon van. Their initial carboxyhemoglobin levels were 21.3% and 10%, respectively.
Article
The medical records of 50 patients who sustained injuries during falls or ejections from pickup truck beds and were admitted to the University of New Mexico Level I Trauma Center between January 1985 and December 1989 were retrospectively examined. Falls and ejections commonly involve young adults, and usually occur in the summer months during the afternoon or evening. Twenty-three individuals were thrown from the pickup truck bed during a motor vehicle collision and 27 simply fell out, and this distinction was not related to age or ethanol use. Although those thrown from the pickup truck bed during a crash were less severely injured (average ISS 15.4) than those who simply fell from the bed (average ISS 17.4), this difference was not statistically significant. Mortality was equal in these two groups, with three deaths occurring in each group. Overall, injuries incurred during falls and ejections were more serious than those incurred in MVCs (average ISS 16.5 vs. 14.5, p = 0.06). The head was the most frequently injured body region following falls or ejections (68%), followed by the extremities (46%), the face (28%), the thorax (22%), and the abdomen (10%). Every death in this series was attributed to a head injury. The overall mortality for the series was 12%. Sixteen additional fatalities from falls and ejections during the study period were discovered in a review of the records of the State Medical Examiner. The average age of this cohort was 24 years. Fifteen of these deaths were the result of falls rather than ejections (94%), and 13 were attributed to head injuries (81%).(ABSTRACT TRUNCATED AT 250 WORDS)
Article
Death or injury resulting from crashes involving light trucks (ie, pickup trucks) is a significant problem. Data show that fatal crashes and occupant fatalities involving light trucks have steadily increased since 1983. This project describes vehicle crashes involving passengers riding in the beds of pickup trucks. Actual crashes were identified through the Fatal Accident Reporting System (FARS) of the National Highway Traffic Safety Administration. The 40 incidents studied involved 204 pickup truck passengers. Of these, 45 were killed, 107 sustained visible injuries or were carried from the scene, 6 had bruises and abrasions, and 2 had no visible injury but were briefly unconscious or had a documented complaint of pain. The risk of death among pickup truck passengers who were fully ejected from the vehicle was nearly six times that of passengers not fully ejected. Correspondingly, the risk of ejection from the truck was 26.7 times greater among occupants riding in the bed than occupants riding in the cab.
Article
Motor vehicle-related trauma is the leading cause of death in children in the United States. All states have pediatric restraint requirements for passenger vehicles to help prevent these deaths and injuries. Only a few states, however, possess safety laws or restrictions for passengers who ride in the back of pickup trucks. A retrospective review of medical records for a 40-month period revealed 40 patients whose injuries were a direct result of being a passenger in the cargo area (bed) of a pickup truck. Their injuries and other pertinent data are discussed. Representatives from the Highway Safety Commission of each state were surveyed about their specific highway safety laws. The responses revealed that all states and the District of Columbia have child restraint requirements for passenger automobiles, 34 states have adult restraint laws, but only 17 states have any type of restriction for passengers riding in the back of pickup trucks. Seventy-one percent of the states with pickup truck regulations include only the preschool-age child. Data from the National Highway Traffic Safety Administration concerning pickup trucks and passenger fatality are presented and discussed.
Article
Travel in the back of pickup trucks has not been adequately addressed as an occupant protection issue. This study compares injuries sustained by children riding in the back of pickup trucks with those of children riding in the cab. Data were obtained from a multihospital monitoring system and the coroner in a single urban county. The series of injured children consisted of 290 children 0 through 14 years of age, 201 of whom had been riding in the cab and 89 in the back. Age distribution of the children demonstrated that it is most frequently the 10- to 14-year-olds who travel in the back. Children riding in the back were more frequently injured in noncrash events (absence of a collision), had more ejections, had more injuries, and sustained more severe injuries as measured by the Maximum Injury Score. With increased restraint use in the cab, it is likely that even greater differentials in injury severity and patterns would be realized. Education regarding the hazards of travel in the back of pickups and stronger legislation limiting the transport of children in the back of trucks are recommended.
Article
No large-scale epidemiologic study to investigate how sex and age affect fatal trauma risk from the same impact has been possible previously because large numbers of people are rarely subject to sufficiently similar major physical insults. This paper describes such a study, made possible by two recent developments: first, the availability of a large data file, the Fatal Accident Reporting System, which gives information on more than one third of a million people fatally injured in traffic crashes; second, a new technique, the double-pair comparison method, which, by focusing on vehicles containing two occupants, at least one of whom is killed, allows appropriate inferences to be made from such data. Fatality risk versus sex and age was determined for ten categories of vehicle occupants (unbelted car drivers, helmeted motorcycle passengers, etc.). Similar effects were found for different occupants, indicating that basic physiologic response (not confined to traffic fatalities) is being measured. It is found that fatality risk is about 25% greater for females than for similar aged males from about age 15 to 45 years. At younger and older ages males are more at risk. For both sexes, fatality risk is least at age 20 years. At age 70 it is about three times what it is at age 20.
Article
A new method to determine how occupant characteristics affect fatality risk in traffic crashes is developed. The method, which uses data from the Fatal Accident Reporting System (FARS), focuses on two occupants, a "subject" occupant and an "other" occupant. The probabilities of a fatality to the subject occupant when that occupant has one of two characteristics are compared. The other occupant serves essentially a normalizing, or exposure estimating, role. The method uses only fatality frequency data--no external exposure information is required, and it is relatively free from uncertain assumptions. It has wide applicability; examples of potential applications include investigating car occupant fatality risk as a function of sex, age, alcohol use or motorcyclist fatality risk as a function of helmet use. The first application is to determining the effectiveness of safety belts in preventing car occupant fatalities, as described in the paper following this paper.
Article
A method for comparing death rates of groups of injured persons was developed, using hospital and medical examiner data for more than 2,000 persons. The first step was determination of the extent to which injury severity as rated by the Abbreviated Injury Scale correlates with patient survival. Substantial correlation was demonstrated. Controlling for severity of the primary injury made it possible to measure the effect on mortality of additional injuries. Injuries that in themselves would not normally be life threatening were shown to have a marked effect on mortality when they occurred in combination with other injuries. An Injury Severity Score was developed that correlates well with survival and provides a numerical description of the overall severity of injury for patients with multiple trauma. Results of this investigation indicate that the Injury Severity Score represents an important step in solving the problem of summarizing injury severity, especially in patients with multiple trauma. The score is easily derived, and is based on a widely used injury classification system, the Abbreviated Injury Scale. Use of the Injury Severity Score facilitates comparison of the mortality experience of varied groups of trauma patients, thereby improving ability to evaluate care of the injured.
Article
Standard categorical analysis is based on an unrealistic model for dose-response and trends and does not make efficient use of within-category information. This paper describes two classes of simple alternatives that can be implemented with any regression software: fractional polynomial regression and spline regression. These methods are illustrated in a problem of estimating historical trends in human immunodeficiency virus incidence. Fractional polynomial and spline regression are especially valuable when important nonlinearities are anticipated and software for more general nonparametric regression approaches is not available.
Article
We consider a relative risk and a risk difference model for binomial data, and a rate difference model for Poisson (person year) data. It is assumed that the data are stratified in a large number of small strata. If each stratum has its own parameter in the model, then, due to the large number of parameters, straightforward maximum likelihood leads to inconsistent estimates of the relevant parameters. By contrast to the logistic model, conditioning on the number of events per stratum does not help in eliminating the stratum nuisance parameters. We propose a pseudo likelihood method to overcome these consistency problems. The resulting pseudo maximum likelihood estimates can easily be computed with standard statistical software. Our approach gives a more general framework for the Mantel-Haenszel type estimators proposed in the literature. In the special case of a series of 2 x 2 tables, for the risk and rate difference models, our approach yields exactly these ad hoc Mantel-Haenszel estimators, while for the relative risk model it gives a close approximation of the Mantel-Haenszel relative risk estimator. For the regression models corresponding to the association measures relative risk, risk difference and rate difference, our method provides analogues of conditional logistic regression, which were not previously available.
Article
Background. We wanted to examine the circumstances under which CO intoxication occurs in a Norwegian population. Material and methods. Retrospective analysis of medicolegal autopsy reports from Mid-Norway (1979-2000), which included 100 fire victims, 51 cases of suicide after exposure to CO, and five unintentional cases of CO-related deaths. The great majority of the victims were men (86%). Results. CO-Hb levels in fire victims (81% men) showed a wide range; the median level was 59%. Among those above 50 years of age, 27% had CO-Hb levels below 40%. Previous myocardial infarction or severe coronary sclerosis were found in 90% of the elderly with a CO-Hb level below 30%. Of those committing suicide with CO, 94% were males, median age was 34, median CO-Hb level was 71%, and 45% had blood alcohol > 0.5. Unintentional CO intoxications occurred from CO leakage from paraffin stoves, charcoal grills and inhalation of exhaust inside a military vehicle. Interpretation. CO intoxication is frequent in fire victims and may occur even at lower CO-Hb levels in the elderly, especially in those with coronary heart disease. Intentional CO intoxication by exposure to motorcar exhaust is a relatively frequent suicide method among Norwegian males. CO exposure from fuel-burning equipment may be hazardous, particularly in confined sleeping areas.
Highway statistics 1996. Federal Highway Administration
  • M K Teets
Teets, M.K. (Ed.), 1997. Highway statistics 1996. Federal Highway Administration, Washington, DC. Tessmer, J., 1996. FARS Analytic Reference Guide: 1975 – 1996. US Department of Transportation, National Highway Traffic Safety Administration, Washington, DC.
Pickup truck bed-related traumatic brain injuries in Oklahoma, 1992-1995. Injury Update
  • J S Ferrer
  • P Archer
Ferrer, J.S., Archer, P., 1997. Pickup truck bed-related traumatic brain injuries in Oklahoma, 1992 – 1995.
FARS Analytic Reference Guide: 1975-1996. US Department of Transportation
  • J Tessmer