Search Results (86)

Aim: Older adult pedestrians are at greater risk of severe injuries than younger pedestrians due to gradual physical changes and coexisting medical conditions. This leads to longer hospital stays, increased mortality risk, and higher inpatient costs. Focusing on the aging population, this study explores the characteristics and injury profiles of pedestrian crossing accidents in the capital city of Bern, Switzerland. Methods: Our retrospective cohort study comprised adult patients admitted to our ED between 1 January 2013 and 31 December 2023, as crossing (or zebra crossing)-related pedestrian victims. Two cohorts were formed on the basis of age < 65 and ≥65 years and compared according to the setting of the accident, type, pattern of the injury, and clinical outcomes (short-term mortality, ICU/hospital length of stay). Results: Of a total of 124 patients, 31.5% (n = 39) of patients were elderly (65+ group). In contrast to the younger patients, the aging population was predominantly admitted as inpatients (64.1% vs. 35.3%, p = 0.001) and was hospitalised in the intensive care unit (20.5% vs. 6%, p = 0.020). Older patients were more likely to be polytraumatised (41% vs. 11.8%, p = 0.001) and to have been tossed or hurled than patients under 65 years (75% vs. 47.3%, p = 0.016). Fractures of the upper extremities (17.9% vs. 4.7%, p = 0.016), pelvis (30.8% vs. 9.4%, p = 0.003), and thoracic spine (12.8% vs. 2.4%, p = 0.019) were significantly more common in the elderly population. Intracranial haemorrhage (35.9% vs. 17.6%, p = 0.026), abdominal trauma (17.9% vs. 5.9%, p = 0.035), and relevant vessel damage (30.8% vs. 3.5%, p < 0.001) were also significantly higher in geriatric patients. Trauma indices were slightly more increased in the older population than in the younger group (ISS; p = 0.004 and AIS > 2 of chest and thoracic spine; abdomen, pelvic contents, and lumbar spine; extremities & bony pelvis p < 0.05). The 65+ group had a longer length of hospital stay (p = 0.001) and ICU stay (p = 0.002). A hospital stay longer than 7 days was also significantly more common in elderly individuals (p = 0.007). In-hospital (15.4% vs. 1.2%, p = 0.001) and 30-day mortality (17.9% vs. 1.2%, p < 0.001) were significantly higher in patients over 65 years of age. Conclusion: In our study, the impact of pedestrian crossing accidents was more severe in the elderly, as indicated by the severity of injuries, hospitalisation rate, longer length of hospital and ICU stays, and higher mortality rates. These findings underline the importance of developing tailored strategies to reduce crosswalk accidents and to optimise management approaches for these vulnerable patients. Full article

Background/Objectives: Due to its potent local anesthetic and vasoconstrictive properties, cocaine is sometimes used in otolaryngologic surgical interventions. However, cocaine topical administration is not always adequately documented by practitioners, which can lead to serious legal consequences, particularly in the context of drug-impaired driving (DUID) investigations. This study retrospectively analyzes five road accident cases where cocaine was detected in biological samples after medical interventions. Case descriptions: Following pedestrian–car, or car–car accidents, five distinct patients aged between 30 and 84 years underwent maxillofacial surgery due to significant injuries. Given the severity of the accident and the circumstances, the police requested blood toxicological analysis to determine whether the patients were under the influence of psychoactive substances at the moment of the accidents. Results: The five cases described in this manuscript had blood cocaine concentrations exceeding the Swiss legal limit for drivers (15 µg/L). Since no information was initially provided about the medical use of cocaine after the crash, recreational use of cocaine was suspected. However, subsequent investigations confirmed that the cases involved medical administration. Conclusions: After sinonasal procedures involving the topical application of cocaine, patients may yield positive results on urine and blood drug tests, potentially resulting in serious legal repercussions, including the withdrawal of their driving license. Therefore, practitioners should thoroughly document the medical use of topical cocaine, particularly in DUID cases. These results also raise questions about the benefit–risk ratio of such use, considering that alternatives exist. Full article

With declining physical functions, elderly pedestrians face a significantly higher risk of severe injuries and fatalities in traffic accidents. This study investigates the factors influencing injury severity among elderly pedestrians using traffic accident reports collected by the Shaanxi Chang’an University Traffic Accident Evidence Identification Center, covering nationwide cases from 2023 to 2024. By analyzing 2351 accident reports involving pedestrians aged 60 and above, 31 feature variables closely related to accident severity were selected to build a predictive model based on the XGBoost algorithm. Additionally, the SHAP method was employed to perform feature attribution analysis on the model’s key variables. The experimental results show that: (1) the model achieved 86% accuracy, 83% precision, 87% recall, and an F1 score of 85%, demonstrating the reliability of XGBoost in predicting injury severity among elderly pedestrians. (2) Global analysis identified collision speed, injury location, and driver awareness as the main factors influencing injury severity. However, the key factors differ across accidents of different severity levels. (3) The effect of the same factor also varies by severity level. For example, driver awareness reduces the likelihood of minor injuries but has less impact on severe injuries or fatalities. This study provides a theoretical foundation for developing traffic safety policies targeting elderly pedestrians and contributes to effectively reducing the severity of injuries in elderly pedestrian traffic accidents. Full article

This study investigates the severity of injuries sustained by over seven million participants involved in road traffic incidents in Poland between 2015 and 2024, with a view to supporting sustainable mobility and the United Nations Sustainable Development Goals. Road safety is a crucial dimension of sustainable development, directly linked to public health, urban liveability, and the socio-economic costs of transportation systems. Using a harmonised participant-level dataset, this research identifies key demographic, behavioural, and environmental factors associated with injury outcomes. A novel five-level injury severity variable was developed by integrating inconsistent records on fatalities and injuries. Descriptive analyses revealed clear seasonal and weekly patterns, as well as substantial differences by participant type and driving licence status. Pedestrians and passengers faced the highest risk, with fatality rates more than five times higher than those of drivers. An XGBoost classifier was trained to predict injury severity, and SHAP analysis was applied to interpret the model’s outputs at the feature level. Participant role emerged as the most important predictor, followed by driving licence status, vehicle type, lighting conditions, and road geometry. These findings provide actionable insights for sustainable road safety interventions, including stronger protection for pedestrians and passengers, stricter enforcement against unlicensed driving, and infrastructural improvements such as better lighting and safer road design. By combining machine learning with interpretability tools, this study offers an analytical framework that can inform evidence-based policies aimed at reducing crash-related harm and advancing sustainable transport development. Full article

Background/Objectives: Traumatic brain injuries (TBI) account for over a third of all injury-related deaths, predominantly due to motor vehicle collisions (MVC). This study provides a comprehensive analysis of TBI trends in Eastern Massachusetts, focusing on injuries resulting from motorcycle MVCs (mMVC), non-motorcycle MVCs (nmMVC), and pedestrian-vehicle strikes (PVS). Methods: A retrospective analysis was conducted on TBI patients admitted between 2010 and 2020 to Boston Medical Center. TBI severity was assessed using the Glasgow Coma Scale (GCS) on admission (mild: 13–15, moderate: 9–12, severe: 3–8), and outcomes were determined by discharge disability scales. Descriptive and inferential statistics evaluated patient profiles, TBI severity, and group differences. Results: Among the 2901 identified TBI cases from MVCs, 14.1% were mMVCs, 55.1% nmMVCs, and 30.8% PVS. Mortality rates were 3.7% for mMVCs, 2.1% for nmMVCs, and 8.9% for PVS. In 2017, nmMVC-related TBIs decreased by 50% and PVS-related TBIs by 35% (p < 0.01). The PVS group tended to be older (mean age 41.0 years) and more racially diverse, with Asian patients overrepresented. The mMVC group had a significantly skewed gender distribution, with 91% male. TBI severity also varied significantly, with the mMVC and PVS groups experiencing more severe TBIs compared to the nmMVC group (p < 0.001). Discharge outcomes, as assessed by the Cerebral Performance Category (CPC) scale, differed across cohorts (p = 0.0005), with the PVS group showing the most severe outcomes and the nmMVC group demonstrating the highest rate of return to previous function (CPC 0: 5.6%). Conclusions: Our study revealed significant differences in injury severity and outcomes based on the type of vehicular collision. Notably, Asian patients were disproportionately affected by PVS. Older PVS patients exhibited higher mortality rates, while severe TBIs were more common among male mMVC patients. In contrast, nmMVC patients showed better recovery outcomes. Coinciding with the implementation of Boston’s Vision Zero initiative in 2017, decreases in both nmMVC-related and PVS-related TBIs were observed; however, other contributing factors may have also influenced this decline. These findings highlight the urgent need for targeted public health strategies to mitigate TBI risks across diverse populations. Full article

Road traffic accidents are a leading cause of injury and death among adolescents, making road safety education crucial. This study assesses the performance of and users’ opinions on the Route 2 School (R2S) traffic safety education program, designed for secondary school students (13–17 years) in Belgium. The program incorporates gamified e-learning modules containing, among others, podcasts, interactive 360° visuals, and virtual reality (VR), to enhance traffic knowledge, situation awareness, risk detection, and risk management. This study was conducted across several cities and municipalities within Belgium. More than 600 students from school years 3 to 6 completed the platform and of these more than 200 students filled in a comprehensive questionnaire providing detailed feedback on platform usability, preferences, and behavioral risk assessments. The results revealed shortcomings in traffic knowledge and skills, particularly among older students. Gender-based analysis indicated no significant performance differences overall, though females performed better in risk management and males in risk detection. Furthermore, students from cities outperformed those from municipalities. Feedback on the R2S platform indicated high usability and engagement, with VR-based simulations receiving the most positive reception. In addition, it was highlighted that secondary school students are high-risk groups for distraction and red-light violations as cyclists and pedestrians. This study demonstrates the importance of gamified, technology-enhanced road safety education while underscoring the need for module-specific improvements and regional customization. The findings support the broader application of e-learning methodologies for sustainable, behavior-oriented traffic safety education targeting adolescents. Full article

Autonomous vehicles are expected to reduce traffic accident casualties, as driver distraction accounts for 90% of accidents. These vehicles rely on sensors and controllers to operate independently, requiring robust security mechanisms to prevent malicious takeovers. This research proposes a novel approach to assessing the impact of cyber-attacks on autonomous vehicles and their surroundings, with a strong focus on prioritizing human safety. The system evaluates the severity of incidents caused by attacks, distinguishing between different events—for example, a pedestrian injury is classified as more critical than a collision with an inanimate object. By integrating deep neural network technology with feature engineering, the proposed system provides a comprehensive impact assessment. It is validated using metrics such as MAE, loss function, and Spearman’s correlation through experiments on a dataset of 5410 samples. Beyond enhancing autonomous vehicle security, this research contributes to real-world attack impact assessment, ensuring human safety remains a priority in the evolving autonomous landscape. Full article

Pedestrian safety at crosswalks remains a critical concern as traffic accidents frequently result from drivers’ failure to yield, leading to severe injuries or fatalities. In response, various jurisdictions have enacted pedestrian priority laws to regulate driver behavior. Nevertheless, intersections lacking clear traffic signage and environments with limited visibility continue to present elevated risks. The scarcity and difficulty of collecting data under such complex conditions pose significant challenges to the development of accurate detection systems. This study proposes a CyclicGAN-based loop-learning framework, in which the learning process begins with a set of manually annotated images used to train an initial labeling model. This model is then applied to automatically annotate newly generated synthetic images, which are incorporated into the training dataset for subsequent rounds of model retraining and image generation. Through this iterative process, the model progressively refines its ability to simulate and recognize diverse contextual features, thereby enhancing detection performance under varying environmental conditions. The experimental results show that environmental variations—such as daytime, nighttime, and rainy conditions—substantially affect the model performance in terms of F1-score. Training with a balanced mix of real and synthetic images yields an F1-score comparable to that obtained using real data alone. These results suggest that CycleGAN-generated images can effectively augment limited datasets and enhance model generalization. The proposed system may be integrated with in-vehicle assistance platforms as a supportive tool for pedestrian-crossing detection in data-scarce environments, contributing to improved driver awareness and road safety. Full article

Epidemiological analysis has revealed key insights into the frequency, severity, and circumstances surrounding subway-to-pedestrian incidents; however, there remains a lack of available impact test data specific to this impact type that can be used in modelling and countermeasure design studies. To address this gap, nine controlled impact tests were conducted using a cylindrical headform to derive force–penetration relationships for foam, as well as foam encased in 1 mm aluminium or 3 mm ABS shells. These relationships were validated in MADYMO multibody simulations. Building on a previous multibody computational study of subway-to-pedestrian collisions this research evaluates three passive countermeasure designs using a reduced simulation test matrix: three impact velocities (8, 10, and 12 m/s) and a trough depth of 0.75 m. In subway collisions, due to the essential rigidity of a subway front relative to a pedestrian, it is the pedestrian stiffness characteristics that primarily dictate the contact dynamics, as opposed to a combined effective stiffness. However, the introduction of energy-absorbing countermeasures alters this interaction. Results indicate that modular energy-absorbing panels attached to the train front significantly reduced the Head Injury Criterion (HIC) (by 90%) in the primary impact and pedestrian-to-wheel contact risk (by 58%), with greater effectiveness when a larger frontal area was covered. However, reducing primary impact severity alone did not substantially lower total fatal injury risk. A rail-guard design, used in combination with frontal panels, reduced secondary impact severity and led to the largest overall reduction in fatal injuries. This improvement came with an expected increase in hospitalisation-level outcomes, such as limb trauma, reflecting a shift from fatal to survivable injuries. These findings demonstrate that meaningful reductions in fatalities are achievable, even with just 0.5 m of available space on the train front. While further development is needed, this study supports the conclusion that subway-to-pedestrian fatalities are preventable. Full article

Background: Electric motorized rental scooters (ES) were introduced in Italy in 2019 as an alternative form of urban transportation, aiming to reduce traffic congestion and air pollution. As their popularity has grown, a parallel increase in ES-related injuries has been observed. This study aims to investigate the types and patterns of ES-related injuries and to identify potentially modifiable risk factors. Methods: We conducted a retrospective analysis of all consecutive patients admitted to the Emergency Department of Policlinico Umberto I in Rome between January 2020 and December 2022 following ES-related trauma. Collected data included demographics, injury mechanisms and types, helmet use, Injury Severity Score (ISS), blood alcohol levels, and patient outcomes. Results: A total of 411 individuals presented to the Emergency Department due to ES-related injuries, either as riders or pedestrians. The mean age was 31 years (range: 2–93); 38 patients (9%) were under 18 years of age. Fifty-six accidents (14%) occurred during work-related commutes. Only three riders (0.7%) wore helmets, and nine patients (2%) had blood alcohol levels > 0.50 g/L. Cranial injuries (134 cases, 32%) and upper limb fractures (93 cases, 23%) were the most frequently reported serious injuries. The mean ISS was 4.5; 17 patients (4%) had an ISS ≥ 16. A total of 270 orthopedic injuries and 118 (29%) maxillofacial injuries were documented. Head trauma was reported in 115 patients (28%), with 19 cases classified as severe traumatic brain injuries. Twenty-three patients (5.5%) were hospitalized, three (0.7%) required intensive care, and one patient (0.2%) died. Conclusions: ES-related injuries are becoming increasingly common and present a significant public health concern. A nationwide effort is warranted to improve rider safety through mandatory helmet use, protective equipment, alcohol consumption control, and stricter enforcement of speed regulations. Full article

Background: Road traffic injuries (RTIs) significantly contribute to disability and death in Qatar. This observational study aimed to explore RTI mortality and injury severity trends from 2011 to 2022. Methods: Data from the national trauma database were analyzed retrospectively for mortality rates, injury severity, and characteristics of the injured populations over the years (2011–2022). Results: RTIs represented around 61.3% (n = 12,644) of 20,642 trauma hospitalizations over 12 years. The aggregate RTI mortality rate decreased from 12 to 8 per 100,000 persons, with a mean patient age of 31.8 years. The sum of deaths was 2464, comprising 1022 (41%) in-hospital and 1442 (59%) out-of-hospital fatalities. Among in-hospital deaths, bike-related mortalities totaled 35 (3%), motorcycle-related mortalities 53 (5%), motor vehicle mortalities 561 (55%), and pedestrian mortalities 373 (36%). Based on the injury severity score (ISS), RTIs were divided into four categories, namely, mild (ISS: 1–9), moderate (ISS: 10–15), severe (ISS: 16–24), and fatal (ISS: 25–75). The ISS ranged from 12 to 14, while the median ranged from 10 to 12. The injury frequency showed that mild injuries comprised 40.6% (4545), moderate injuries 26.2% (2934 subjects), and severe 16.7% (1873 subjects). Profound injuries accounted for 13.3% (1490 subjects). Severe and fatal injuries combined dropped from 30% in 2011 to 25% by 2022. Inversely, moderate injuries increased from 24% to 30%, representing a downward trend of the injury severity. Motorcycle-related injuries rose from around 3% to 28% between 2011 and 2022. Motor vehicle and pedestrian injuries declined from about 67% to 54% and 27% to 15%, respectively. Winter, Autumn, Spring, and Summer accounted for 27%, 26%, 24%, and 23% of the total injuries (11,153), respectively. Conclusions: RTI in-hospital mortality and injury severity decreased over the study period. Injury prevention programs should target frequent injury seasons and high-risk populations, such as motorcyclists. Full article

Road traffic accidents (RTAs) are a leading cause of morbidity and mortality worldwide, frequently resulting in traumatic brain injuries (TBIs), skull fractures, and spinal injuries. This manuscript examines the forensic aspects of head trauma caused by RTAs, focusing on the role of autopsy and imaging in diagnosing and characterizing injuries. Through a systematic review of the literature, the study highlights the mechanisms of injury, including high-speed collisions, whiplash, and pedestrian impacts, and explores their pathological consequences, such as subarachnoid hemorrhage, intracranial hemorrhage, and diffuse axonal injury. The differentiation between traumatic and non-traumatic conditions, such as aneurysmal subarachnoid hemorrhage, is emphasized to ensure accurate clinical and forensic assessments. Advances in imaging technologies, particularly virtopsy, are discussed for their potential in non-invasive documentation and analysis of head injuries, while limitations of this approach are acknowledged. Furthermore, the manuscript underscores the importance of preventive measures, including helmet and seatbelt use, vehicle safety innovations, and improved road design, in reducing the incidence and severity of RTAs. By integrating clinical, forensic, and preventive perspectives, this study provides a comprehensive framework for understanding and addressing the burden of head trauma related to RTAs. Full article

In traffic accidents, elderly individuals face a significantly higher risk of mortality compared with other age groups. To investigate the factors contributing to elderly pedestrian accidents and their impact on injury severity, 1420 motor vehicle/elderly pedestrian collisions from the 2019–2023 Chinese Traffic Accident Deep Investigation Database were analyzed using the FP-growth algorithm. This analysis identified 5594 association rules across 28 types of variables within 4 categories of influencing factors. Logistic regression results indicate that pedestrian age, collision speed, time of occurrence, and accident location are significant factors affecting the mortality rate of elderly pedestrians in traffic accidents. Specifically, pedestrian age and collision speed significantly influence mortality rates. As collision speed increases, the mortality rate rises markedly. For elderly pedestrians aged 60 and above, the mortality rate increases by 3.7% with each additional year of age. Moreover, accidents occurring at night, in suburban areas, or in villages are associated with a higher mortality rate. This study offers scientific support for the formulation of safety measures aimed at improving the traffic safety of elderly pedestrians. Full article

Background/Objectives: The incidence of pedestrian traffic injuries is an escalating concern for public health worldwide. Particularly in fast-developing nations, such as Saudi Arabia, these injuries form a significant portion of trauma-related healthcare challenges. This study aims to explore age-specific differences in trends, seasonal variations, and the overall impact of pedestrian traffic injuries in Riyadh, Saudi Arabia, with a focus on injury characteristics and clinical outcomes. Methods: The study conducted a retrospective analysis using data from the Saudi Trauma Registry (STAR) covering the period between August 2017 and December 2022. It employed descriptive statistics, chi-square tests, and multivariable linear regression analyses to explore demographic trends, characteristics of injuries, and hospital-based outcomes. Results: This study analyzed data from 1062 pedestrian injury cases, revealing key demographic and clinical patterns. Most incidents occurred on weekdays (71.9%) and during nighttime hours (63.3%), with seasonal peaks observed from April to June (30.4%). The lower extremities (27.5%) and head (21.3%) were the most frequently injured body regions. ICU admissions were more common among individuals aged 30–40, females, and those with head or chest trauma, while higher in-hospital mortality was associated with patients over 60 years old, transport by private or police vehicles, and extended ICU and hospital stays. Approximately 25.6% of cases required ICU care, with an overall in-hospital mortality rate of 4.9%. Conclusions: This study provides an in-depth analysis of pedestrian traffic injuries treated at a trauma center in Riyadh, highlighting significant demographic, temporal, and clinical patterns. Understanding these trends is essential for optimizing resource allocation and improving emergency care outcomes. Furthermore, the identified age-specific risk factors and seasonal variations underscore the critical need for targeted interventions and policy enhancements to improve road safety and reduce the burden of pedestrian injuries. Full article

Background: Despite improvements in technology and safety measures, injuries from collisions involving motor vehicles (CIMVs) continue to be prevalent. Therefore, our goal is to investigate the different patterns of head injuries associated with CIMVs. Method: This is a single-center, retrospective study of patients with motor vehicle-related trauma between 1 January 2016–31 December 2023. Patients were identified based on the International Classification of Diseases (ICD) injury codes and the Abbreviated Injury Severity (AIS) for body region involvement. Result: 536 patients met the inclusion criteria. The majority of the injured population includes pedestrians (46.8%), followed by motorcycle drivers (25.2%), bicyclists (18.7%), and motor vehicle drivers (9.3%). The male-to-female ratios for bicyclists and motorcyclists were 13.7:1 and 11.9:1, respectively, which is higher compared with motor vehicle occupants and pedestrians, with ratios of 2.3:1 and 1.5:1. Patients with blunt trauma (99.63%) were higher than penetrating trauma (0.37%). In most cases, the head had the highest AIS score, with a mean of 3.7. Additionally, the median Injury Severity Score (ISS) was 20. Skull fractures were the most prevalent, followed by hemorrhages, lacerations, contusions, and abrasions. Conclusions: The most prevalent injuries were head injuries and fractures. Fractures were the most common, followed by hemorrhage, laceration, contusion, and abrasion. These findings underscore the high incidence of TBI and fractures in such CIMVs, highlighting the need for targeted trauma interventions and the need for injury prevention strategies to mitigate these severe outcomes. Full article