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Comparison of injuries sustained by drivers and pillion passengers in fatal head-on motorcycle collision accidents
Abstract
This study aimed to compare injuries sustained by motorcycle drivers with those sustained by pillion passengers in fatal head-on motorcycle collision accidents. We examined 84 cases of fatal head-on motorcycle collision accidents, causing 79 deaths of drivers and 19 deaths of pillion passengers, using medical and medico-legal examination records. The distribution of superficial injuries, characteristic injuries, injury severity as well as fatal causes was evaluated and compared using χ(2) tests. The results revealed a significant difference in the distribution of superficial injuries between drivers and passengers. The proportions of injuries in the hand and perineum regions were significantly higher in drivers than passengers. Some characteristic superficial injuries on the palms, chest, abdomen as well as the perineum areas were observed in drivers, while none of these characteristic injuries were observed in pillion passengers. Drivers were found to have suffered more severe chest and abdomen injuries than passengers. In addition, there was a higher incidence of fatalities involving run-over injuries for drivers compared with pillion passengers. The proportion of fatal injuries related to tumbling was higher for passengers than for drivers. Overall, our results revealed a difference in injury severity, superficial injury distribution and characteristic injuries between drivers and passengers. Few characteristic injuries were found in pillion passengers. These findings could help to guide medico-legal examinations, particularly in identifying drivers among victims involved in traffic accidents.
... The profile of motorcycle crash victims and other factors determining nature and severity of injuries have been studied, especially in developed countries [13,15,21,22]. Many recent reports indicate that motorcycle accident victims are young males [11,16,21,23] who display a unique pattern of injuries with a greater vulnerability of head and lower limbs [11,16,21,24]. Few reports have shown interest in the differential analysis of injuries and their severity between riders and passengers [16,21,24]. ...
... Many recent reports indicate that motorcycle accident victims are young males [11,16,21,23] who display a unique pattern of injuries with a greater vulnerability of head and lower limbs [11,16,21,24]. Few reports have shown interest in the differential analysis of injuries and their severity between riders and passengers [16,21,24]. While in developed countries, effective intervention plans are implemented with measurable results [25][26][27], low and middle income countries still lack the most basic epidemiological data. ...
... Limbs generally seem to be vulnerable to fractures, particularly the tibia and fibula [11,25,31,36]. However, very few reports compare riders and pillion passengers in terms of anatomical location and severity of injuries [21,24,26]. Contrary to our description of a greater vulnerability of the head in riders, Fitzharris et al. reported no or few differences between riders and passengers in terms of anatomical location and severity of injury [21]. ...
Background:
Low and middle-income countries carry over ninety per cent of the burden of injury related mortality and disability. Motorcycles are gradually becoming a major mode of transportation in Cameroon and other African countries in the absence of an organized public transport. Consequently, the contribution of motorcycle crash to injury-related deaths seems to be on the rise. Currently, data addressing motorcycle crash characteristics, pattern, and severity of motorcycle-related injuries in Cameroon are scarce. We hypothesised that head and limb injuries are the most frequent cause of morbidity and mortality and equally affect riders and pillion passengers.
Methods:
This hospital-based prospective pilot cohort analysis involving 405 motorcycle crashes and 621 injury victims was conducted in Laquintinie Hospital, a large centre located in an urban area in Cameroon. All motorcycle riders and passengers received in the emergency department over a 4 months period with an injury following a traffic related crash were included. Crash characteristics and type, anatomical location and severity of injuries were recorded and analysed comparing the pattern of injuries between riders and pillion passengers involved in motorcyclecrashes. This pilot analysis is expected to propose a snapshot of motorcycle injuries in Douala and will be followed by a larger analysis over a longer period.
Results:
We recorded a majority of motorcycle versus car and motorcycle versus motorcycle collisions. Most of these crashes occurred over the week-end and in the night. Helmet use was almost inexistent. We observed that females aged above 40 years represented the majority of pillion passengers. This accounted for the sex-ratio of 1.1/1. A total of 1311 injuries were identified in our patients, giving a mean of 2.1 injuries per victim. The head and the limbs were the most affected anatomical areas. Riders carried a higher risk of sustaining an injury to head and neck than pillion passengers. Riders and pillion passengers carried equal risk of injury to the lower limbs. Emergency room mortality was 4 · 3 % and riders were more likely to die than pillion passengers.
Conclusion:
This study has identified females aged above 40 years as a special vulnerable group in Douala. It also carries strong messages useful for the implementation of preventive measures and management of patients injured in motorcycle-related crash in general.
... Current literature on motorcycle accidents focuses mainly on comparison of injuries between unmatched motorcycle riders and pillions, where riders and pillions from different accidents were aggregated together and analysed. [4][5][6] In contrast, a matched study is one where every motorcycle rider is matched with his pillion (the passenger on the same motorcycle involved in the same accident), after which matched analysis is done on these matched pairs. The severity and distribution of injuries of matched pairs of riders and pillions has not been well studied. ...
... Current literature on motorcycle accidents focuses mainly on comparison of outcomes between unmatched groups of riders and pillions. [4][5][6] Few matched studies have been done in this area. Unmatched studies do not account for potential confounding by various factors that may influence the outcome such as the type and impact of collision, motorcycle characteristics, rider experience, amount of time to availability of medical aid, and other factors. ...
... In our review of the literature, the majority of unmatched pair studies have concluded that there is a difference in the injury severity between riders and pillions in motorcycle accidents. 4,6 In a Singapore study by Leong et al. it was reported that the mortality rate among young pillions was significantly higher than that IQR, interquartile range. among young riders. ...
Introduction:
Motorcyclists and their pillion riders are the most vulnerable group of road users in Singapore, accounting for 50% of all road traffic accident fatalities in 2011. This study aims to compare the severity and pattern of injuries between matched pairs of riders and pillions.
Methods:
Thirty-two matched pairs who presented to the A&E of an urban hospital from 1 August 2011 to 20 March 2012 were enrolled. Data were obtained from the hospital's trauma registry records, clinical records and accident victims were interviewed individually. Analysis was done using Stata 10 and considered rider-pillion pairs.
Results:
Thirty-one pairs agreed to participate. There was no statistically significant difference in the ISS between riders and pillions (p=0.25). There was no significant difference in the probability of survival, Revised Trauma Score, distribution of injuries, total duration of admission and ICU stay between riders and pillions. When one party of the matched pair sustained a head, face, thoracic, abdominal/pelvic, extremity or external injury, the likelihood that the other party had an injury in the same region was 31%, 14%, 10%, 14%, 56% and 68% respectively. Cohen's kappa values were 0.28, 0.15, 0.05, 0.17, 0.24 and -0.16 for the respective regions.
Discussion:
By comparing the severity and pattern of injuries between naturally matched pairs on the same motorcycle, one can account for potential confounding by the type and impact of collision, rider experience, amount of time to availability of medical aid, and other factors that may influence the outcome. Our study shows no statistically significant difference in the ISS and distribution of injuries between riders and pillions of matched pairs. Therefore, future health and insurance policies should provide equal coverage for both riders and pillions. Medical practitioners should approach riders and pillions similarly as there is no significant difference in their injury distribution. When one party of a matched pair presents with a head, extremity or external injury, care should be taken to look for an injury in the same region in the other party.
Conclusion:
Our study shows that there is no statistically significant difference in the ISS of riders and pillions. The pattern of injury is also similar. This study provides us useful information in the clinical management of motorcyclists and their pillions.
... 1 The latest statistics revealed that motorcyclists have 34-times higher risk of crash-related death per vehicle mile traveled compared with people driving other types of motor vehicles, and they are 8 times more likely to be injured. 2 Overall, motorcycle injuries are likely to be severe (Injury Severity Score 98); involve multiple anatomic areas including the head, abdomen, and thorax; and show a preponderance of musculoskeletal injuries in the form of fractures and dislocations. A mortality rate of 3% to 4% has been reported, and up to 20% required treatment at an intensive care unit. ...
... 3 Headon motorcycle accidents, one of the most common types of motorcycle-related accident, usually result in more serious injuries to motorcyclists than other motor-vehicle users. 2 Although bicycles have initially far lower speeds compared with motorcycles, they have the same instability. 4 There is an increased risk of head injury for motorcyclists and bicyclists compared with car occupants. ...
... This can cause a sudden deceleration of the motorcycle, catapulting the driver forward over the saddle. 2 The mechanism of injury resulting in death is usually the result of severe blunt force trauma, creating internal and external damage to the motorcyclist, especially head, neck, thoracic, and other axial-skeletal injuries. 14 Two impact stages generally occur in these accidents as well as in those involving bicyclists. ...
... Some of the first comprehensive studies on motorcycle crash injuries were conducted in the 1970s and called attention to the significant injury burden in these patients [4][5][6]. The existing literature has demonstrated that head trauma is the leading cause of death after a motorcycle crash [7][8][9][10][11][12]. ...
... This study found that passengers were less compliant with helmet use and that helmet offered greater protection against head injury in drivers as compared to passengers [34]. A limited number of other international single center studies compared the outcomes of motorcycle drivers and passengers [10,29,30,33,[41][42][43]. There is great variability in the reported outcomes, likely due to the small sample sizes in most studies. ...
Introduction
Contemporary trauma literature on injuries to motorcycle passengers is scarce. The aim of this study was to examine the injury patterns and outcomes of motorcycle passengers with regard to helmet use. We hypothesized that helmet utilization affects both injury type and outcomes.
Methods
The National Trauma Data Bank was queried for all motorcycle passengers who were injured in traffic accidents. Participants were stratified according to helmet utilization into helmeted (HM) and nonhelmeted (NHM) groups. Univariate and multivariate analyses were performed to compare the injury patterns and outcomes between the groups.
Results
A total of 22,855 patients were included for analysis, of which 57.1% (13,049) used helmet. The median age was 41 years (IQR 26–51), 81% were female, and 16% of patients required urgent operation. NHM had higher risk of major trauma (ISS > 15: 26.8% vs 31.6%, p < 0.001). The most frequently injured body region in NHM was the head (34.6% vs 56.9%, p < 0.001), whereas in HM patients was the lower extremities (65.3% vs 56.7%, p < 0.001). NHM patients were more likely to require admission to the ICU, mechanical ventilation, and had significantly higher mortality rate (3.0% vs 6.3%, p < 0.001). The strongest predictors of mortality were GCS < 9 on admission, hypotension on admission, and severe head injury. Helmet utilization was associated with decreased odds of death (OR 0.636; 95% CI 0.531–0.762; p < 0.001).
Conclusion
Motorcycle collisions can lead to significant injury burden and high mortality in motorcycle passengers. Middle-age females are disproportionally affected. Traumatic brain injury is the leading cause of death. Helmet use is associated with decreased risk of head injury and death.
... On the other hand, most fatal injuries resulting from falling off or vehicle evacuation happened to passengers. The rider and the pillion passengers were equally at risk of lower limb injuries [5]. An earlier study in Thailand found that the male gender, injuries to the elbow and forearm, open head wounds, and additional bone fractures were potential predictors [6]. ...
... This outcome differed from earlier ones that demonstrated indifference toward riders and passengers [5,10]. Certain factors could explain this result. ...
Motorcycle accidents accounted for the most common prevalence of Road traffic collision (RTC). Therefore, identifying the rider or passenger is crucial for ensuring fairness. However, patients who suffered from RTC frequently could not provide any information due to loss of consciousness, memory loss, or death. We aim to develop two separately multivariable prediction models based on the differences in the facture pattern and demographic data between the rider and passenger in collision with another vehicle and non-collision motorcycle accident. A total of 1,816 patients had fractures from motorcycle accidents. 1,583 and 233 were riders and passengers, respectively. After a multivariable logistic regression with stepwise backward elimination, six final predictors, including Age, sex, femur fracture, wrist and hand fracture, leg including ankle fracture, and pelvis and lumbar spine fracture, were required for the final models. The prediction models had an acceptable level of discrimination (auROCs of 0.79 and 0.77 for collision and non-collision accidents, respectively) and appeared well-calibrated. Overall, the prediction model is potentially useful as an assisting tool for identifying seat positions.
... The patient was the rider of the motorcycle in the vast majority of cases in our study (94.6%). This is higher than studies in China (Zhao et al. 2011;Xiong et al. 2016), Nigeria (Solagberu et al. 2006), and India (Prasannan and Sheeju 2015). It is possible that the higher percentage of riders in our study are due to the government-enforced restrictions on pillion-riding for law and order purposes in the city. ...
... These reflected the commonest sites of injury (the lower limb, head, and upper limb) as well as the commonest surgical procedures (fracture reduction, superficial debridement, and neurosurgery). The primary admitting services are similar to the study conducted in China (Xiong et al. 2016), while the commonest sites of injury tally with most studies (Solagberu et al. 2006;Alicioglu et al. 2008;Zhao et al. 2011;Prasannan and Sheeju 2015;Alghnam et al. 2019). However, with 95.9% patients discharged and with 96.3% of them having a full/healthy recovery, the outcomes of our study were generally positive. ...
Objective
Motorcyclists are frequently involved in road traffic accidents and may suffer polytraumatic injuries, contributing a substantial burden on healthcare systems particularly in lower-middle-income countries. This study aimed to describe patterns of injury, in-hospital course, and outcomes of road accident trauma in motorcyclists, including polytrauma, at a Trauma Facility in Pakistan.
Methods
A retrospective review was conducted by using relevant trauma codes to extract data from records for all victims presenting with motorcycle trauma between January 2018 and June 2019, to a tertiary care hospital in Pakistan. Data collected included victim characteristics, mechanism of accident, patterns of traumatic injury, management, in-hospital complications, and outcomes. Polytrauma was defined as traumatic injuries in two or more anatomic regions with abbreviated injury scale (AIS) ≥ 3. Multivariable logistic regression, adjusted for age, gender, and mechanism of accident, was performed to identify in-hospital complications and outcomes associated with polytrauma.
Results
A total of 514 victims, 90.9% male and 39.5% aged between 18-30 years, were included in this study. The victim was the motorcycle driver in 94.6% of cases. The most common mechanism of accident was motorcycle vs. other motor vehicle (56.2%). Patients were mostly admitted under the services of Orthopedic Surgery (50.8%) and Neurosurgery (30%), with common sites of injury being the lower extremity (42.6%), head (38.1%), and upper extremity (26.8%). Polytrauma occurred in 19.5% of victims. Patients were managed surgically in 77.3% of cases, with the most common procedure being open reduction of fractures (48.1%). Blood transfusion was required in 4.1% of patients. The commonest in-hospital complication was acute kidney injury (23.7%). The median length of stay was 3 days, and 4.1% of patients expired in the hospital. Polytrauma was significantly associated with the need for blood transfusion (2.642 [1.053–6.630]), AKI (2.212 [1.339–3.652]) and hospital length of stay (1.059 [1.025–1.094]), but not with mortality.
Conclusion
Although orthopedic injuries occur most frequently in motorcycle trauma, polytrauma necessitating multi-disciplinary management and complicating hospital stay is also common. Understanding patterns of injuries and management in motorcycle trauma will enable trauma teams in a developing country like Pakistan to devise evidence-based management protocols, especially for cases of polytrauma.
... Motorcyclists exhibit a higher risk of motor vehicle crashes (MVC) compared to other drivers, and fatal accidents occur most frequently as a consequence of severe head and/or thoracic trauma with multiple visceral injuries [1][2][3][4]. ...
... Collisions/crashes in which the front of a motor vehicle strikes the side of a two-wheeled vehicle or in which a two-wheeled vehicle drives into the side of a motor vehicle are very common [1,20]. During the accident, the contact with other vehicles or fixed objects, such as guardrails and/or trees, causes a sudden deceleration of the motorcycle and catapults the driver forward, sideways or in both directions, depending on the type of collision. ...
Traumatic fatal aortic rupture (FAR) is a common finding in victims of motor vehicle crashes (MVC), but its aetiology and mechanisms of production remain an issue of major concern, above all in motorcyclists. This study reports a series of cases obtained from a retrospective analysis of traumatic FARs occurring in motorcycle drivers, with the aim of defining the injury patterns and correlating them with the mechanisms of FAR production. Circumstantial, autopsy and histology data were collected through a retrospective analysis of post mortem examinations performed at the Institute of Legal Medicine of the University of Padova between 2014 and 2016. Among 151 traffic related victims, 8 were motorcycle drivers and displayed traumatic FAR and were thus included in the study. In 7 cases, the presence of abdominal/thoracic injuries suggested that the external compression due to the accident was at least a concurrent cause of FAR, being the predominant mechanism of aortic injury in 4 cases, through the "osseous pinch" or the "waterhammer effect" mechanisms. Our study highlights the well-known role of "preventative forensic pathology", which has become routinary in traffic medicine since many years, also for defining the points of impact and the injury patterns of motorcyclists sustaining traumatic FAR, thereby facilitating the development of new prevention strategies and devices. Further studies, however, are needed in order to widen the investigated population and to estimate the real number of victims for which traumatic FAR might hypothetically be prevented with specific countermeasures.
... Consistent with our findings, Yadollahi and Jamali also concluded that there was no statistically significant difference in the GCS between motorcycle riders and pillion passengers (Yadollahi and Jamali 2019). However, some studies have reported differences in injury severity between riders and pillion passengers (Leong et al. 2009;Zhao et al. 2011). ...
Objective:
Road traffic injury (RTI) is the second leading cause of death and disability, and motorcycle crashes rank as the first cause of traffic fatality in Iran. We aimed to compare various characteristics between traumatized motorcycle riders and pillion passengers registered with the National Trauma Registry of Iran (NTRI).
Methods:
This is a retrospective study of the NTRI, an ongoing multicenter trauma database built on a registry. This study included injured motorcyclists from six major trauma centers nationwide admitted between February 2017 and November 2023. Motorcyclists should have been hospitalized for RTIs and met the NTRI's inclusion criteria. We assessed patients regarding their demographics, clinical features, the pattern of injuries, and diverse in-hospital outcomes.
Results:
Of 54,342 registered patients in the NTRI, 7,594 motorcyclists were included. Of them, 6,636 (87.4%) were riders, and 958 (12.6%) were pillion passengers. Among all, 7165 (94.5%) were male, and 420 (5.5%) female (p < 0.001). Only 656 (9.9%) of riders and 24 (2.5%) of pillion passengers were wearing helmets (p < 0.001). Lone motorcyclist crashes led to injuries in 1,394 (21.2%) riders and 332 (35.5%) pillion passengers (p < 0.001). Glasgow Coma Scale (GCS) was 3 to 8 in 204 (3.1%) riders and 16 (1.7%) pillion passengers (p = 0.016). The most frequent pattern of poly-trauma was "head and thorax," with 43 (32.3%) riders and 5 (25.0%) pillion passengers (p = 0.362). Univariable logistic regression analysis showed that Intensive Care Unit (ICU) admission (OR = 0.78, CI 95% = 0.62 to 0.97, p = 0.028) and mechanical ventilation (OR = 0.58, CI 95% = 0.39 to 0.84, p = 0.004) were significantly lower in pillion passengers compared to motorcycle riders. After adjustment for age, gender, occupational status, and helmet use, being a rider or a pillion passenger didn't have a significant association with any of the in-hospital outcomes.
Conclusions:
Motorcycle riders and pillion passengers sustain the same injuries in terms of pattern, severity, and in-hospital outcomes. Therefore, healthcare providers can approach them similarly. Since there is a high number of underage riders and helmets are not used commonly, there should be more police enforcement in this case.
... Furthermore, kinematics and injury investigations of MTW pillion commuters involved in collisions have demonstrated that the ratio of fatalities is lower for riders in contrast to pillion passengers in some types of crashes. For example, pillion commuters die because of tumbling during a fatal head-on collision (Zhao et al. 2011). Similarly, it has been suggested that pillion commuters may contribute to crashes in the sense that they may endanger safety if they fail to react with the consistency of the motorcyclist (Harrop and Wilson 1982). ...
Objective:
This study aims to investigate comparative severity analysis of motorized two-wheeler (MTW) crashes based on drivers' liability using police-reported a crash data base.
Methods:
Using crash data from 2016 to 2020, this study examines and analyses the key factors affecting the severity of MTW injuries in Dehradun. For analysis, the ordinal logistic approach is used because severity levels are attributed with natural ordering. Differentiating from past studies, this research distinguished between collisions in which MTW crashes were considered as first party (crash in which MTW rider is accountable) and second person (crash in which MTW rider is a victim).
Results:
Result suggests that age, pillion passenger, type of collision, road network, and impacting vehicle increase the seriousness of a crash in both cases. However, crash day, crash time, and light condition were found to be significant in the case of second-party crashes. Similarly, crash seriousness tends to decrease in first-party crashes, whereas it increases in the context of second-party crashes.
Conclusion:
The statistical results were correlated with past studies to provide proper justification in order to provide a better understanding of small-displacement MTW fatal accidents in developing countries. Additionally, this research aids in the development of mitigation strategies and future research directions to improve the safety of MTW users.
... Musculoskeletal injuries including upper and lower extremity fractures comprise the most common injuries in both HMD and NHMD [30,31]. Overall, HMD sustained a higher injury burden to the torso as well as the extremities. ...
... Studies have found that head and facial injuries are the most commonly sustained fatal injuries in the pillion riders of two- 4,5 wheeler motorcycle accidents. In India, female pillion riders seated in side-saddle positions on two-wheelers have a high 6 likelihood of sustaining head injuries. ...
The number of road traffic fatalities increases each year. Many of these accidents involve riders and pillion riders of motorised two-wheelers. The study aimed to analyse fatal two-wheeler road traffic accidents and their association with regard to gender, seating position, mode of injury, the pattern of injuries and other parameters based on 73 pillion rider fatalities subjected to medico-legal autopsy. Most of the pillion decedents were females, accounting for 44 (60.27%) cases. Sidesaddle was the preferred seating position in 44 (60.27%) cases, of which 43 were female. Mode of injury in 36 (49.31%) cases was due to self-fall. Fractures were predominantly present in the posterior cranial fossa in 40.9% (18) females. Many of the cases were due to sudden brake applied by the rider, putting the side saddle rider in a vulnerable position as they cannot grip anything to prevent/break their fall, causing fatalities. Valuable suggestions have been proposed to promote safety measures and reduce mortality in pillion riders.
Keywords: Road traffic accident; Pillion rider; Injuries; Autopsy; Safety measures.
... But Wells et al. from New Zealand suggests crashes more in urban population (66%). 20 21 This observation is similar to most of the studies conducted on two wheeler accidental cases. 7,10 As most of the two wheelers are operated alone and logically the rider's over confidence is unchecked when driving alone and this fact is very well seen in the above observation ...
Road traffic accidents have become a major public health issue causing fatality and disabilities affecting and impacting the socio-economic development, an examination of the profiles of two-wheeler road traffic accidental injuries and a detailed forensic analysis is needed to reduce fatality and life altering disabilities.
In our present study done during a study period of 5 years from 2015 to 2019 the total number of autopsies reported to the mortuary was 930 cases, of which 233 deaths were due to two wheeler accidents. Male victims predominated (217) amounting to 93.1% when compared with female victims in a ratio of 13.5 : 1 and 70.0% (163) of the victims were from rural areas.
The cause of death in majority of cases was head injury in 157 (67.4%) cases. Fatal injuries were confined to a single region in 168 (72.1%) cases and to multiple regions in 65 (27.9%) cases. Skull fractures were noted in 148 cases with 70 cases of fissure fracture on calvaria alone and 30 cases of comminuted fracture. Haemorrhages were predominantly of subdural type in 160 cases, and subarachnoid type in 152 cases. About, 56.7% victims died in collision with 4 wheelers, 13.3% in collision with two wheelers, 15.0% due to collision with pedestrian, 2.1% victims died due to collision with 3 wheelers.
Driver clothes with fluorescent marks, day-time running lights for two wheelers and helmets in white or mild colors are suggested for easy noticability and to prevent collisions.
... This is in accordance with some of the studies done in other countries. [36,37] In this study, the analyzed group of patients was selected from a single tertiary care hospital. Because of that, the results may not represent the situation in other parts of the country. ...
... Some studies have shown the results contradictory to our observations, [33] while some shows no such significant difference. [34,35] Conversely some studies have shown a higher incidence of run-over injuries in drivers than in pillion riders, while getting more fatal injuries due to tumbling effect is higher in riders in pillion position. [33] The fine knowledge about different injury patterns will be essential for the clinical management of the patients and may also guide to distinguish the drivers from pillion riders in motorcycle crashes. ...
... Some studies have shown the results contradictory to our observations, [33] while some shows no such significant difference. [34,35] Conversely some studies have shown a higher incidence of run-over injuries in drivers than in pillion riders, while getting more fatal injuries due to tumbling effect is higher in riders in pillion position. [33] The fine knowledge about different injury patterns will be essential for the clinical management of the patients and may also guide to distinguish the drivers from pillion riders in motorcycle crashes. ...
... In this study, though totally the highest distribution of injuries were related to the head-and-neck, soft tissue & skin and extremities, lower extremities in particular; these results were similar to the findings from both matched and unmatched studies. 16,17,22 However, an observable difference in our study was the higher and more significant involvement of drivers with injuries to the abdomen, extremities, pelvis and spine, as well as their higher length of hospital stay. Generally, drivers had a higher injury severity and injury distribution compared to the passengers, despite the insignificance of other variables. ...
Purpose:
After car accident, motorcycle accident ranks as the second leading cause of traffic fatality in Iran. This study aimed to compare the severity and clinical presentations between drivers and passengers under the same injury circumstance.
Methods:
This study was conducted in the trauma center of Shiraz, Iran in 2017. Data on demographics, triage level, blood pressure, respiratory rate, Glasgow coma scale (GCS), injured body region, injury severity score (ISS), revised trauma score (RTS), and result of accident were compared between pairs of drivers and passengers. The agreement of any type of injury between drivers and passengers evaluated by Kappa test.
Results:
This study included 143 matched pairs of drivers and passengers. Most of the pairs (84.5%) did not use helmet and 77.2% of the riders do not have driving license. ISS was significantly higher in drivers than passengers. In the unmatched pairs, drivers and passengers showed no difference in sustaining injuries in the face, head & neck, chest and soft tissue, but drivers were found more likely to suffer from injuries in the abdomen, extremities, pelvis and spine than passengers. Once one part of the matched pair suffered injury in the head & neck, face, chest, abdomen, extremities and soft tissue & skin injury, the probability that the other part had an injury in the same region was 50%, 9%, 13%, 7%, 22% and 34% respectively. Kappa value for these body regions was 0.006, 0.009, -0.006, 0.068, 0.063 and 0.001, respectively, which was significant in abdomen and extremities.
Conclusion:
Although drivers had higher level of injury severity and some different injury distributions, we recommend equal treatment to drivers and passengers. We also recommend related authorities to develop policies on helmet use, driving license and third-party insurance.
... It is estimated that motorcycle riders have a 26-fold higher risk of death when involved in road traffic crashes than people driving other types of motor vehicle (NHTSA 2015). Motorcycle safety improvement has always been one of the topical issues in global traffic safety research (Allen et al. 2017;Lin and Kraus 2009;WHO 2015;Zhao et al. 2011). To improve the understanding of safety practices concerning motorcycle usage, a number of studies have been conducted to determine possible factors influencing the severity of injuries involving riders and pillion riders (Chiang et al. 2014;Kealla and Newstead 2012;Rifaat et al. 2012). ...
Aim
This study aims to determine risk factors associated with the injury severity of motorcycle users in Ghana.
Subject and methods
Data on all reported crashes involving motorcycle users in Ghana were analyzed. The data were extracted from the National Road Traffic Accident Database at the Building and Road Research Institute (BRRI) of the Council for Scientific and Industrial Research (CSIR). Generalized ordered logit models were specified separately for riders and pillion passengers to determine the relationship between injury severity, as an ordered categorical outcome, and a set of possible explanatory variables.
Results
The results from the model showed that the injury severity of both riders and pillion passengers was significantly influenced by the day of the week when the crash occurred, weather conditions, road geometry, location type, and traffic control. In addition, the injury severity of riders was also influenced by their age, presence of passenger, and light conditions, whilst the injury severity of pillion passengers was influenced by the time of the crash.
Conclusion
The findings from this study provide useful information to improve the understanding of risk factors associated with motorcycle user injury severity. Such data are also important to support the development of appropriate countermeasures to help prevent motorcycle crashes.
... 18 This finding, which is probably explained by motorcycle riders and passengers' great physical exposure and the absence of required regulation protection gear, supports our clusters' excellent performance. On the other hand, specifically for motorcycle passengers, the areas of the body closest within the first cluster were head 1 and 4, thorax 4 and limb injuries 5; and for the second cluster the areas were face 3, thorax 5, external body 3, abdomen 5 and limb injuries 4. Zhao et al. compared injuries sustained by motorcycle riders with the ones sustained by their passengers, and they found that for the latter, the most compromised was the head with an AIS of 4 or more, and the thorax and lower limbs had an AIS of 2 or 3. 19 The above results agree with our findings, although our clusters exhibited higher severity in areas as the thorax and limbs, in addition to a more frequently affected abdomen. Fitzharris et al., found that motorcycle passengers were more prone to sustaining injuries resulting from the crushing of their lower limbs in comparison with motorcycle riders. ...
Background
Traffic accidents are considered a public health problem and, according to the World Health Organization, currently is the eighth cause of death in the world. Specifically, pedestrians, cyclists and motorcyclists contribute half of the fatalities. Adequate clinical management in accordance with aggregation patterns of the body areas involved, as well as the characteristics of the accident, will help to reduce mortality and disability in this population.
Methods
Secondary data analysis of a cohort of patients involved in traffic accidents and admitted to the emergency room (ER) of a high complexity hospital in Medellín, Colombia. They were over 15 years of age, had two or more injuries in different areas of the body and had a hospital stay of more than 24 h after admission. A cluster analysis was performed, using Ward's method and the linfinity similarity measure, to obtain clusters of body areas most commonly affected depending on the type of vehicle and the type of victim.
Results
Among 2445 patients with traffic accidents, 34% (n = 836) were admitted into the Intensive Care Unit (ICU) and the overall hospital mortality rate was 8% (n = 201). More than 50% of the patients were motorcycle riders but mortality was higher in pedestrian-car accidents (16%, n = 34). The clusters show efficient performance to separate the population depending on the severity of their injuries. Pedestrians had the highest mortality after having accidents with cars and they also had the highest number of body parts clustered, mainly on head and abdomen areas.
Conclusions
Exploring the cluster patterns of injuries and body areas affected in traffic accidents allow to establish anatomical groups defined by the type of accident and the type of vehicle. This classification system will accelerate and prioritize ER-care for these population groups, helping to provide better health care services and to rationalize available resources.
... cases, victims fell down from the moving vehicle. Similar observations were noted by [11,12,13] Considering the cause of death in various road users, Head injury was the most common cause of death comprising of 98(43.75%) cases. ...
... HI could be associated with TBI (2). The head is the most common site with severe injury (3). ...
Motor vehicle and falling down are responsible for the most number of traumatic injuries. This study aimed to compare the characteristics of traumatic brain injury among accident and falling down cases. In this analytical cross- sectional study, data were collected from the records of cadavers who died due to accident or falling down and referred to Kahrizak dissection hall, Tehran forensic medicine organization during 2013. A total of 237 subjects (183 (77.2%) accident and 54 (22.8%) falling down) with a mean age of 35.62 (SD=15.75) were evaluated. A number of 213 (89.9%) were male. From accident group, scalp injury was seen in 146 (79.8%), scalp abrasion in 122 (66.7%), scalp laceration in 104 (56.8%), sub skull bruising in 176 (96.3%), skull fracture in 119 (65%), hemorrhage in 166 (90.7%), Subdural hemorrhage (SDH) in 155 (84.7%), Subarachnoid hemorrhage (SAH) in 161 (88%), Epidural hemorrhage (EDH) in 41 (22.4%), contusion in 140 (76.5%), and skull base fracture in 140 (76.5%) of cases. In falling down group scalp injury was seen in 42 (77.8%) cadavers, scalp abrasion in 38 (70.4%), scalp laceration in 30 (55.6%), sub skull bruising in 49 (90.7%), skull fracture in 39 (72.2%), Hemorrhage in 49 (90.7%), SDH in 43 (79.6%), SAH in 47 (87%), EDH in 10 (18.5%), contusion in 33 (61.1%), and skull base fracture in 39 (72.2%) of cases. There was no significant difference between these two groups (P Value> 0.05). Accident and falling down had no difference in terms of any injury or hemorrhage. © 2015 Tehran University of Medical Sciences. All rights reserved.
... Some studies used logistic regression analysis [10][11][12]. Although many studies on vehicle/pedestrian accidents were performed, the vehicles were usually hood-fronted (as opposed to flat-fronted) vehicles such as passenger cars, SUVs, and MPVs [13][14][15][16][17]. Few studies have focused on pedestrian injury patterns and risk in minibus collisions. ...
Background:
The minibus, with a nearly flat front, is widely used in China, especially in the underdeveloped regions, and results in large numbers of pedestrian injuries and deaths. The purpose of this study was to determine the injury patterns and risk for pedestrians involved in these crashes.
Material and methods:
We conducted an in-depth investigation of minibus/pedestrian accidents in Chongqing, China, occurring between September 2000 and April 2014. The enrolled pedestrians was classified into 3 groups: young (aged 14-44 years), middle-aged (aged 45-59 years), and elderly (aged over 60 years). Pedestrian injuries were coded according to the Abbreviated Injury Scale (AIS).
Results:
A total of 109 pedestrians, with an average age of 55.7±16.2 years, were injured or killed--30.3% were young, 23.9% were middle-aged, and 45.9% were elderly. Pedestrians hit by a minibus had a high proportion of head, chest, and extremity injuries--84.4%, 50.5%, and 52.3%, respectively. In addition, impact speeds in excess of 75 km/h all ultimately resulted in fatalities. At an impact speed of 30 km/h, the risk of pedestrian fatality and AIS3+ injury are approximately 12.0% and 37.2%, respectively. At 50 km/h the risks are 65.2% and 96.9%, respectively, and at 70 km/h the risks are 96.3% and 99.9%, respectively.
Conclusions:
A higher likelihood of chest injury was associated with being older and impact speed of over 40 km/h in minibus/pedestrian collision. Our data suggest that the injury patterns of pedestrians in minibus collisions differ from that in other vehicle/pedestrian collisions. These findings could contribute to better understanding of the injury patterns and risk of pedestrian in minibus collisions in China, which may play an important role in developing measures to improve traffic safety.
In India, motorised two-wheeler (TW) riders account for 44.5% of fatal road crashes. While factors affecting drivers have been studied, research on pillion riders' injury severity remains limited. The study aims to identify factors causing severe injuries to pillion riders by developing an accurate prediction model. The study includes machine learning (ML) models such as conditional inference tree, random forest (RF), gradient boosting, support vector machine, and a statistical model ordered probit for comparison. The study accounts for the imbalance in injury severity crash data by adopting data balancing techniques. Also, it recommends a combination of ML techniques, variable importance charts and individual conditional expectation plots for identifying key variables and their effects. The finding suggests that RF trained in up-sampled data performs better than the remaining models. The presence of a central divider on the road reduces fatal injuries to pillion riders. The likelihood of getting severe injury is higher during nighttime crashes, TW-HMV (truck or bus) collisions and hit-and-run crash cases where the colliding vehicle is unidentified. Older pillion riders are more vulnerable to sustaining fatal injuries in a crash. Crashes involving TWs hitting stationary objects and skidding are more fatal for pillion riders than other collision types.
The intricate interplay of exposure and speed leave motorcyclists vulnerable, leading to high mortality rates. During the collision, the driver and the passenger are usually projected away from the motorcycle, with variable trajectories or final positions. Injuries resulting from the crash can exhibit distinct and specific characteristics depending on the circumstances of the occurrence.
The aim of this study is to provide a systematic review of the literature on injuries sustained by motorcyclists involved in road accidents describing and analyzing elements that are useful for forensic assessment.
The literature search was performed using PubMed, Scopus and Web of Science from January 1970 to June 2023. Eligible studies have investigated issues of interest to forensic medicine about during traffic accidents involving motorcycle. A total of 142 studies met the inclusion criteria and were classified and analyzed based on the anatomical regions of the body affected (head, neck, thoraco-abdominal, pelvis, and limb injuries). Moreover, also the strategies for preventing lesions and assessing injuries in the reconstruction of motorcycle accidents were examined and discussed.
This review highlights that, beyond injuries commonly associated with motorcycle accidents, such as head injuries, there are also unique lesions linked to the specific dynamics of accidents. These include factors like the seating position of the passenger or impact with the helmet or motorbike components. The forensic assessment of injury distribution could serve as support in reconstructing the sequence of events leading to the crash and defining the cause of death in trauma fatalities.
Hanoi City is a typical motorcycle dominant city in Vietnam with a modal share of motorcycles of more than 80% and motorcycle riders involved in more than 70% of road fatalities. It is important to understand the major causes of motorcycle crash severity to suggest effective countermeasures. There have been studies elsewhere examining factors related to small-displacement motorcycle crash severity, but work in Vietnam is scarce. This study uses ordinal logistic regression to investigate contributory factors to the odds of severe crashes involving motorcycle riders. A distinction is made between crashes where motorcyclists are involved as the second party (i.e., as victims of the crash) on the one hand and as the first party (i.e., as the person responsible for causing the crash) on the other hand. Results show that age and gender of the first party person, size of the vehicle collided with, and presence of a pillion passenger significantly contribute to the severity of crashes in which motorcyclists are involved as the second party. Significant factors to the severity of crashes in which motorcyclists are involved as the first party are age, time of the crash, road class, size of the second party vehicle, pillion passenger presence, and riding speed. The findings contribute to a deeper understanding of fatal crashes with small-displacement motorcycles in a developing city. This study helps to identify countermeasures to improve road safety of small-displacement motorcycle riders.
This study aimed to identify factors associated with severe injury and mortality from road traffic accidents (RTA) among motorcycle and car users in southern Thailand. The data were obtained from the Office of Disease Prevention and Control, Thailand, for years 2008–2013. Chi-squared tests were used to assess associations between determinants and outcomes and these associations were then estimated after adjusting for possible confounding with other factors using logistic regression. Severe injury and mortality contributed 11.6% and 5% to RTA of motorcycle users, and 14.3% and 7.5% for car users. Among motorcycle users, male gender, older age, and not wearing a helmet increased severe injury and mortality rates, whereas drivers had more severe injuries than passengers. Older car users had higher severe injury and mortality rates, whereas not fastening seat belts had higher mortality. Safety device use should be made mandatory for both drivers and passengers. Male motorcycle users and the elderly should be focused on.
Background:
The objective of this study is to provide an up-to-date overview of the patterns of injuries, especially traumatic brain injury (TBI) caused by RTAs and to discuss some of the public health consequences.
Methods:
A scientific team was established to collect road traffic accidents occurring between 2013 and 2018 in Chongqing, Southwest China. For each accident, the environment-, vehicle-, and person- variables were analyzed and determined. The overall injury distribution and TBI patterns of four types of road users (driver, passenger, motorcyclist and pedestrian) were compared. The environmental and time distribution of accidents with TBI were shown by bar and pie chart. The risks of severe brain injury whether motorcyclist wearing helmets or not were compared and the risk factors of severe TBI in pedestrian were determined by odds ratio analysis.
Results:
This study enrolled 2131 accidents with 2741 persons of all kind of traffic participants, 1149 of them suffered AIS1+ head injury and 1598(58%) died in 7 days. The most common cause of deaths is due to head injury with 714(85%) and 1266(79%) persons died within 2 hours. Among 423 persons suffered both skull fracture and intracranial injury, 102 (24.1%) have an intracranial injury but no skull fractures, while none of the skull fractures without intracranial injury was found. Besides, motorcyclists without a helmet were at higher risks for all the brain injury categories. The risk of pedestrian suffering severe TBI at an impact speed of more than 70 km/h is 100 times higher than that with an impact speed of less than 40 km/h.
Conclusion:
It is urgently needed to develop a more reliable brain injury evaluation criterion for better protection of the road users. We believe that strengthening the emergency care to head injury at the scene is the most effective way to reduce traffic fatality.
In developing countries, motorcycles are one of the most important means of transportation, commonly used to reduce commuting times from home to workplace and vice versa. Summer temperature rises to 50 degrees a helmet should be able to protect the user from a heat stroke. A helmet should also have clear visibility in such extreme conditions and keep the rider well protected from the rain. A helmet that not only protects a skull injury but a brain injury also. The questionnaire used for this study included the questions regarding the perception and opinion of motorcyclists on price of helmet from the affordability point of view. Also, questions were included regarding comfort, vision, hearing, weight, vehicle control, range of view, mobile phone usage, the fit of the helmet, and law enforcement etc. Either they do not realize that a helmet can save them from serious injuries, or they like to take risks. Overloading is also another serious problem where a rider accommodates up to 4 or 5 persons on his bike including children and mostly all of them are not wearing any protective gear or helmet. Minimize the risk of their injuries and deaths caused by not wearing a helmet at all or wearing non-reliable helmets. It will be more useful for women and children who are at risk mainly for not wearing any helmet at all, this helmet will be comfortable for them and reduce the risk of injuries in an accident.
This paper predicts new issues of vehicle collision accidents in the environment of future intelligent traffic, and reviews the trend of smart occupant protection driven by the development of future traffic technology. In the future, connected vehicles and autonomous driving technologies will reduce occurrence rate of motor vehicle collision accidents. In vehicle platoon with high-speed and small following distance, if any small probability incident triggers an accident, large number of severe injuries will result in multiple-vehicle collisions at high-speed. On the positive aspect, future intelligent transportation technologies will achieve more reliable pre-crash sensing. Accurate information of occupant status and pre-crash warning will enable development of smart occupant restraint system that can provide tailored protection for occupants with different sitting postures, 收稿日期 / Received ： 2017-09-11。
Objective: Currently only five out of the fifty states in the United States (U.S.) have laws restricting the age of passengers permitted to ride on a motorcycle. This study sought to characterize the visits by patients under the age of 16 to US emergency departments (ED) for injuries sustained as a passenger on a motorcycle.
Methods: In this retrospective cohort study, data were obtained from the Nationwide Emergency Department Sample (NEDS) for the years 2006 to 2011. Pediatric patients who were passengers on a motorcycle that was involved in a crash were identified using ICD-9 External Cause of Injury codes. We also examined gender, age, disposition, regional differences, common injuries, and charges.
Results: Between 2006 to 2011, there were an estimated 9,689 visits to US EDs by patients under the age of 16 who were passengers on a motorcycle involved in a crash. The overall average patient age was 9.4 years, and they were predominately male (54.5%). The majority (85%) of these patients were treated and released. The average charges for discharged patients were 17,500,000 within the six years. The average cost for admission was 54 million. The most common primary injuries included superficial contusions, sprains and strains, upper limb fractures, open wounds of head, neck and trunk, and intracranial injuries.
Conclusion: Although there were only about 9,700 visits to US EDs for motorcycle crashes involving passengers less than 16 years old for 2006 to 2011, the total cost of visits that resulted in either ED discharge or hospital admission surmounted to over $71 million.
This paper presents a three-rider motorcycle accident which took place in a suburb of Chongqing China. In the accident, the motorcycle impacted the terminal of a bridge footpath and led to two riders died and one rider injured. After the accident, one rider received injuries around the groin area including the underbelly area and the perineum area. Another rider suffered from injuries only on the perineum areas. In medico-legal judgments, injuries around the groin area also called groin injuries in victims of motorcycle accidents are usually regarded as “fuel tank injuries” which are commonly found in drivers. But, the injuries around the groin area are sometimes confused with the perineum injuries. Therefore, the perineum injuries are often wrongly reckoned as the “fuel tank injuries” and used to identify the drivers too. Actually, passengers can sometimes suffer from perineum injuries in many head-on impacting motorcycle accidents. It is of vital matters to understand the differences between groin injuries and perineum injuries so that the real driver who should be responsible for the accident can be recognized. In this paper, the three-rider motorcycle accident was presented and the injury information of the three riders was studied in order to distinguish the real driver from the riders. We consider that the groin injury has some differences with the perineum injury and the latter should not always be related to the driver especially in high-speed head-on impacting motorcycle accidents. In addition, the injury on underbelly areas is important to identify the driver.
Since traffic accidents are an important problem in forensic medicine, there is a constant search for new solutions to help with an investigation process in such cases. In recent years there was a rapid development of post-mortem imaging techniques, especially post-mortem computed tomography (PMCT). In our work we concentrated on a potential advantage of PMCT in cases of motorcycle accident fatalities. The results of forensic autopsy were compared with combined results of the autopsy and PMCT to check in which areas use of these two techniques gives statistically important increase in number of findings. The hypothesis was confirmed in case of pneumothorax and fractures of skull, spine, clavicle, scapula, lower leg bones. As for majority of other bone fractures locations and brain injures there were single cases with pathologies visible only in PMCT, but too few to reach expected level of p-value. In case of injuries of solid organs and soft tissues statistical analysis did not confirmed any advantage of unenhanced PMCT use. On the whole it has been shown that PMCT used as an adjunct to forensic autopsy can cause an increase in information about vitally important regions in case of motorcycle accident fatalities.
Traffic crashes and consequent injuries represent a growing public health concern in India, particularly in light of increasing motorization. Motorised two-wheeled vehicles (MTV) constitute a large portion of the vehicle fleet in India. We report the crash characteristics and injury patterns among a cohort of MTV riders and pillions presenting to hospital post-crash.
Consecutive MTV riders and pillions, whether alive or dead, injured in a road traffic crash presenting to the emergency departments of two government hospitals and three branches of a private hospital in urban Hyderabad, India, were recruited to this study.
378 MTV users were enrolled to the study of whom 333 (88.1%) were male, 252 (66.7%) were riders and median age was 31.3 years. A total of 223 (59%) MTV users were injured in multi-vehicle crashes while one-third had a frontal impact. The majority (77%) were assessed as having a Glasgow coma score (GCS) of 13-15, 12% a GCS of 9-12 and 11% a GCS of 3-8. No difference was seen in the severity distribution of injuries based on GCS among riders and pillions. Open wounds and superficial injuries to the head (69.3%) and upper extremity (27%) and lower extremity (24%) were the most common injuries. 43 (11%) sustained an intracranial injury, including 12 (28%) with associated fracture of the bones of the head. There were few differences in types of injuries sustained by riders and pillions though riders had a significantly lower risk of crush injuries of the lower extremity than pillions (relative risk, RR 0.25, 95% CI 0.08-0.81) and female pillions were at a significantly lower risk of sustaining fractures of the lower extremity than male pillions (RR 0.30, 95% CI 0.09 - 0.94). Overall, 42 (11%) MTV users died, of which 42.8% died before reaching the hospital. Only 74 (19.6%) MTV users had worn a helmet correctly and failure to wear a helmet was associated with a five times greater risk of intracranial injury (RR 4.99, 95% CI 1.23-20.1). Of the 19 pre-hospital deaths, 16 (84%) had not worn a helmet.
Head injuries accounted for the major proportion of injuries sustained in MTV users. Non-helmet use was associated with increased risk of serious head injuries. The data presented on the nature and severity of injuries sustained by MTV users can assist with planning to deal with these consequences as well as prevention of these injuries given the high use of MTV in India.
A common crash configuration involving a motorcycle and another vehicle is termed the ‘approaching turn collision’, which occurs when a vehicle turns left into the path of an oncoming vehicle. Although research has explained some causes of approaching turn collisions, few studies have described injury outcomes specific to approaching turn collisions involving motorcycles. All fatally injured and a sample of over 3500 nonfatally injured motorcycle riders treated in one of 28 hospitals in 11 California counties were included in this analysis if the crash occurred in 1991 or 1992 and both a police crash report and matching medical diagnoses were available. Injuries sustained by motorcycle riders in approaching turn collisions were compared with injuries sustained by motorcycle riders in other crash types. Injuries occurring when the motorcycle was the left-turning vehicle were compared to those occurring when the car is the left-turning vehicle. Riders in approaching turn collisions had increased lower extremity and abdominal injuries, but less frequently had head, chest, and facial injuries than riders in other crash types. The average ISS score, percent fatally injured, and average number of days in the hospital were greater for riders in approaching turn collisions than riders in other crash types, except the head-on collision. Possible strategies to reduce injuries from approaching turn collisions are discussed. The complexity of turning actions, particularly judgements of speed, could potentially be an intervention point to reduce crash occurrence.
Per vehicle mile traveled, motorcycle riders have a 34-fold higher risk of death in a crash than people driving other types of motor vehicles. While lower-extremity injuries most commonly occur in all motorcycle crashes, head injuries are most frequent in fatal crashes. Helmets and helmet use laws have been shown to be effective in reducing head injuries and deaths from motorcycle crashes. Alcohol is the major contributing factor to fatal crashes. Enforcement of legal limits on the blood alcohol concentration is effective in reducing motorcycle deaths, while some alcohol-related interventions such as a minimal legal drinking age, increased alcohol excise taxes, and responsible beverage service specifically for motorcycle riders have not been examined. Other modifiable protective or risk factors comprise inexperience and driver training, conspicuity and daytime headlight laws, motorcycle licensure and ownership, riding speed, and risk-taking behaviors. Features of motorcycle use and potentially effective prevention programs for motorcycle crash injuries in developing countries are discussed. Finally, recommendations for future motorcycle-injury research are made.
We often refer to road fatalities without knowing exactly what injuries are responsible for them. Based on the Rhône Road Trauma Registry this paper sets out to describe the topography, nature and frequency of the fatal injuries sustained by car drivers. Mean annual mortality at the wheel of a car, computed by dividing the total number of drivers killed (n=383) by the population of the Rhône Département (1.6 million) during the period 1996-2004 was 5.41 males per 100,000 and 1.41 females per 100,000, with 78% of the casualties residing in the Département. A reduction has been observed since 2003. Three-quarters of the casualties died at the scene of the crash. The results confirm the effectiveness of seat belts. The observed lethality was 0.43% for unbelted drivers and 2.7% for belted drivers (RR=0.16 [0.12; 0.21]). The injuries were analyzed for the 287 killed drivers whose deaths could be explained by the described injuries (at least one AIS 4+ injury). Of these, 41% had an ISS of 75 (at least one AIS 6 injury), 21% had an ISS of between 40 and 74, 33% an ISS of between 25 and 40, and 6% an ISS of between 16 and 24. In the case of all the AIS 4+ injuries, the three most frequent locations for injuries were the thorax only (30% of casualties), the head only (23%) and a combination of the two (18%). Abdominal injuries occurred in only 10% of casualties and spinal injuries in 9% of casualties. In the thorax, the most common injury was flail chest with haemothorax or pneumothorax. In the case of the head, the most frequent injuries were to the brain (haemorrhage, haematoma and axonal injuries). Complex fractures of the base of the skull were the second most common craniocephalic injuries. In spite of the use of restraint devices, the thorax and head are still the priority vital areas for protection in the case of car drivers. For one in four of the fatalities, death cannot be explained by any of the injuries we know about. As road traffic accidents are considered to be a cause of death in their own right, autopsies are rarely performed in France on such fatalities. This means we do not know about any injuries that cannot be detected by an external examination of the cadaver.
In motorcycle accidents involving two riders, medicolegal identification of the driver is necessary when one or both riders die. It is particularly important in the latter case, because the survivor almost always insists that he or she was not driving. One characteristic injury that distinguishes the driver from the passenger is inguinal contusion-laceration (accompanied internally by pelvic fracture). This injury, caused by collision of the pelvis with the fuel tank, identifies the driver.
Lower extremity injuries are among the most common injuries sustained by motorcycle riders in crashes and often lead to extended and costly medical treatment and permanent disability. This study characterizes lower extremity injuries in a group of 700 motorcycle riders in crashes in Los Angeles County from July 1, 1988, through October 31, 1989. Motorcycle crash fatalities (n = 163) were identified through the Los Angeles County Coroner's office, and nonfatally injured riders (n = 537) were identified at four of the ten level I and level II trauma centers in the county. Lower extremity injuries were diagnosed in 301 (56%) of nonfatally injured and in 75 (46%) of fatally injured riders. Fractures were the most common lower extremity injury and were diagnosed in 52% and 42% of riders with nonfatal and fatal injuries, respectively. Over a third of all fractures were to the tibia or fibula. Drivers and passengers did not differ in their risk for lower extremity injuries. Multiple-vehicle collisions resulted in a higher risk of lower extremity injuries than did single-vehicle collisions. The highest risk for lower extremity fractures was observed among riders in broadside collisions in which another vehicle struck the motorcycle (risk ratio = 2.7). Modifications in vehicle design and rider apparel may prevent some lower extremity injuries in motorcycle crashes.
This report reviews the findings from 86 motorcycle accidents during a 1-year period at the Trauma Center "Bergmannsheil" in Bochum, Germany. A study of the case histories supplemented by telephone conversations yielded the following results: 90.7% of the patients were men, and the average age was 28.8 years; most of the accidents occurred in the 25- to 30-year-old age group (27.9%). Motorcycle accidents happened mostly during recreational rides on weekends in the summertime. Although there was a high rate of helmet use (98.8%), the head region was affected in 12 victims. Two patients died because of their severe head injuries (2.3%). Lower extremity injuries (46%), especially open tibia fractures (19.7%), were among the most common injuries sustained. Fractures of the distal radius constituted the largest portion of upper extremity injuries (18.8%). The average stay in our hospital was 35.4 days; 23.4% of the patients had to change jobs after the accident. Fifty percent of the crashes happened with motorcycles between 500 and 750 cc stroke volume. Although 34.5% possessed their driver's licenses for more than 8 years, they had not had much experience handling a motorbike. These results underline the fact that motorcycle accidents are sustained by young men in their working prime; as a result, these accidents pose a tremendous burden to individuals and society and every attempt should be made to offer highly qualified surgical and trauma care to minimize the damage to the motorbiker. A plea is made for more prevention measures like driver education, better road conditions, or legislative changes to prevent motorcycle crashes. The wearing of a helmet is strongly advocated.
All patients involved in motorcycle crashes admitted to various hospitals in the Yorkshire region of UK between January 1993 and December 1999 were retrospectively reviewed to identify the factors that are likely to predict a reduced survival. Of the 1239 patients requiring hospital admission, 74 died. The probability of reduced survival was estimated by a logistic regression model using independent variables such as head injury, thoracic trauma, abdominal injury, spinal injury and pelvic fracture and a compound variable of pelvic fracture combined with a long bone fracture. The odds ratio for head injury was 0.349, chest injury 0.39, abdominal injury 0.42, and the compound variable (pelvis plus a long bone fracture) 0.576. The mean injury severity score (ISS) in the fatal group was 35.96 compared to 12.2 in the group that survived (P<0.01). There was a significant difference in the Glasgow coma scale (GCS) between patients wearing a helmet and those that did not wear any protective headgear (P=0.0007). Head injury followed by chest and abdominal trauma were found to predict a reduced survival rate. Use of helmets should continue to be compulsory. Chest and abdominal injuries should be diagnosed and treated early to reduce mortality.
The paper presents final results of the studies concerning the usefulness of knee, ankle, hip, pelvis and neck injuries in reconstructing the circumstances of car-to-pedestrian accidents. Each type of injuries was evaluated with regard to possible reconstruction of the victim's position (upright or recumbent) at the moment of collision and in the upright hits-the side of the pedestrian's body hit. In each group, a chance of proper reconstruction of the pedestrian's location (which determined the frequency of injury pattern assumed as the typical one of a given position or impact side) and error risk (percentage of cases in which the injury pattern showed improper position or impact side) were calculated. These data were compared with similarly calculated possibilities of deducing based on the classical "bumper" injuries to soft tissues and "bending" fractures of the lower limb bone diaphyses. It was shown that the bone bruises within the knee epiphyses were very specific evidence for upright hits as they confirm the limb load by body mass at the moment of pathological dislocation of joint structures on impact. The evidential value of knee injuries was found to be similar to that of other "classical" methods based on bumper injuries or even higher in lateral and front hits. The injuries to the remaining structures were less frequently found and their correlation with the victim's position or impact side was lower. Nevertheless, once the whole complex of these injuries is taken into consideration the chances of proper reconstruction of the pedestrian-vehicle location increase and the risk of opinion error is minimized.
The objective of this study was to investigate characteristic injuries of pedestrians and bicyclists (unprotected) compared to motor vehicle occupants' (protected) in fatal traffic accidents. Cases of 664 fatal traffic accidents (371 pedestrians, 45 bicyclists, and 248 motor vehicle occupants) were collected from 1999 to 2001 using the database of the Forensic Institute in Budapest. Autopsy reports were analyzed. Location of injuries, blood alcohol levels, seasonal distribution and natural diseases influencing accident outcome were evaluated. For statistical analysis, odds ratio (OR) with 95% confidence interval (CI) was used by a conditional logistic regression. There were substantial differences in distribution of injuries suffered by pedestrians, bicyclists and motor vehicle occupants. Among pedestrians and bicyclists there was a higher rate of head injuries, such as skull fractures, epidural haemorrhage, subdural haemorrhage, brain contusion, and injuries of the lower extremities. Thoracic damages, such as traumatic aortic rupture, hemothorax, and abdominal damages, like liver rupture were dominant in motor vehicle occupants. Considering existing natural diseases, coronary artery disease was the only one with higher occurrence among motor vehicle occupants 24 (9.7%) compared with pedestrians and bicyclist 36 (8.6%). These results underline the importance of preventive strategies in transportation, pointing out that different methods are necessary to reduce fatal injuries of various traffic participants.
The fact that motorcycle users tend to be more vulnerable to injuries than those using other motorized vehicles may act synergistically with the complexity of conflicting movements between vehicles and motorcycles to increase injury severity in a junction-type accident. A junction-type collision tends to be more severe than a non-junction case due to the fact that some of the injurious crashes such as angle-collision commonly occur. Existing studies have applied several statistical modeling techniques to examine influential factors on the occurrences of different crashes among motorized vehicles but surprisingly very little has empirically explored whether a particular crash type, resulting from a junction-type accident, is more injurious to motorcyclists. This article attempts to investigate whether a particular collision is more deadly to motorcyclists conditioned on crash occurrence at T-junctions in the U.K., while controlling for environment, vehicle, and demographic factors.
The statistical modeling technique employed is the ordered probit models using the data extracted from the STATS19 accident injury database (1999-2004).
The modeling found determinants of injury severity among motorcyclists at T-junctions in the U.K. For example, an approach-turn/head-on collision is much more injurious to motorcyclists; and, those riding in early morning (i.e., 0000-0659) are more likely to be severely injured.
This study offers a guideline for future research, as well as insight into potential prevention strategies that might help moderate motorcyclist injuries.
This paper presents a two-rider motorcycle accident in which both riders received injuries around the groin area. In medico-legal autopsies, injuries around the groin area in victims of motorcycle accidents are usually regarded as a "fuel tank injury." Although fuel tank injuries are one of the most useful and important characteristics in determining injuries that have been found to be exclusive to the driver, our study reveals that passengers can also suffer from injuries around the groin area. To distinguish the driver from the passenger, we need to carefully consider each injury in both riders. In addition, we present bilateral traumatic testicular dislocation in the driver. We consider traumatic testicular dislocation as one of the important findings of fuel tank injuries in motorcycle accidents.
This paper presents the approach of computer simulation to clarify the questions faced by forensic experts about what causes the various injuries characteristic of two motorcycle victims, including the motorcycle driver and the back seat occupant on the motorcycle, and how to exactly confirm which one of them is the motorcycle driver. Two typical motorcycle-car accident cases were reconstructed to analyze the movement and the load of both the motorcycle driver and the back seat occupant in the collision course. In case one, the back seat occupant suffered fatal head injuries when he fell on the ground after being thrown higher than the motorcycle driver over the top of the car. In case two, the compressive force loaded by the right tibia of the back seat occupant was larger and more durative compared with the motorcycle driver; the back seat occupant suffered a bursting fracture injury of his right tibia. These results might be useful for forensic experts in dealing with similar motorcycle-car collision accidents in the future.
Injuries of motorcycle riders. (1) Fuel tank injury
- K Kurihara
- N Kuroda
- T Murai
- J Yanagida
K. Kurihara, N. Kuroda, T. Murai, J. Yanagida, Injuries of motorcycle riders. (1) Fuel tank injury, Res. Pract. Forens. Med. 31 (1988) 275–279.
Observation on characteristics of motor-cyclist injuries in traffic accidents, Chin
- J Lai
- B Mei
- T Zhang
- J Li
J. Lai, B. Mei, T. Zhang, J. Li, Observation on characteristics of motor-cyclist injuries in traffic accidents, Chin. J. Forensic Med. 18 (3) (2003) 139–141.