ORCID Profile
0000-0002-7284-0127
Current Organisations
Neuroscience Research Australia
,
George Institute for Global Health
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Research Topics
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Public Health and Health Services | Public Health and Health Services not elsewhere classified | Automotive Safety Engineering | Epidemiology | Other Behavioural And Cognitive Sciences | Automotive safety engineering | Road Transportation and Freight Services | Public Policy | Biomedical Engineering | Biomechanical Engineering | Automotive Engineering | Public health | Public health not elsewhere classified | Injury prevention
ANZSRC Socio-Economic Objective (SEO)
Road Safety | Transport Equipment not elsewhere classified | Injury control | Clinical Health (Organs, Diseases and Abnormal Conditions) not elsewhere classified | Road safety |
Related Links
Publications
The management of blunt pancreatic injury in children in New South Wales
Publisher: Cold Spring Harbor Laboratory
Date: 28-07-2023
DOI: 10.1101/2023.07.26.23292584
Abstract: Blunt pancreatic injury is uncommon but associated with considerable morbidity. The optimal management strategy for children with this injury remains unclear, with laparotomy rates in North America of up to 55%. This has not been studied at a population level in Australia. This study aimed to examine the management of children with blunt pancreatic injury in New South Wales (NSW), Australia. Using the NSW Admitted Patient Data Collection from 2001 to 2019, we identified patients years old with blunt pancreatic injury. Cases were categorised as undergoing non-operative or operative management. Patient and injury characteristics and outcomes were compared between non-operative and operative groups. Independent predictors of operative management were identified using multivariable logistic regression. 139 cases were identified: 37 (26.6%) underwent operative management, of whom 11 (29.7%) had a pancreas-specific operation. Two-thirds were managed at a paediatric trauma centre. Operation rates were highest in adult trauma centres, although treatment outside a paediatric trauma centre overall was not associated with operative management. Independent predictors of operative management were high-grade pancreatic injury, hollow viscus injury and transfusion. Morbidity and mortality were 30.2% and 1.4%, respectively. Blunt pancreatic injury continues to carry substantial morbidity. Operation rates in NSW are lower than those reported in North America, with similar outcomes. Unlike other solid organ injuries, most children are managed at paediatric trauma centres. Future studies should investigate factors driving management decisions in the Australian context, with the aim of developing paediatric guidelines promoting non-operative management. Operation rates for children with BPI were much lower than reported in international studies, with comparable morbidity and lower mortality. Operation rates were highest at ATCs, although, overall, children with BPI managed outside PTCs were not more likely to undergo an operation. Penetrating pancreatic injury is rare compared to the US, likely reflecting that firearm-related injury in Australia remains uncommon.
Sex differences evident in self-reported but not objective measures of driving
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.AAP.2017.11.011
Abstract: It has been consistently reported that women self-regulate their driving more than men. Volunteer drivers aged 75 years and older from the suburban outskirts of Sydney, Australia joined a longitudinal study in 2012-2014. GPS in-vehicle monitoring was used to objectively measure driving and surveys of driving patterns. The study included 343 drivers (203/343, 59% men) with an average age of 80 years. Our results revealed that men were 3.85 times more likely to report driving beyond their local shire during the past year (95% CI 2.03-5.72) and 1.81 times more likely to report that they do not avoid night driving (95% CI 1.21-3.22). In contrast sex was not predictive of any objective measure of driving during a one-week period of monitoring. These findings suggest that men and women report different self-regulation practices but that actual driving exposure is quite similar. These findings can inform strategies to promote safe mobility.
Exploring Infant Fall Events Using Online Parenting Discussion Forums: Infodemiology Study (Preprint)
Publisher: JMIR Publications Inc.
Date: 22-10-2021
Abstract: alls represent the most common mechanism of injury requiring hospitalization among children under 12 months, and they commonly result in traumatic brain injury. Epidemiological studies exploring infant falls demonstrate the experienced burden, but they lack contextual information vital to the development of preventive interventions. he objective of this study was to examine contextual information for falls involving children under 12 months, using online parenting discussion forums. nline parenting forums provide an unobtrusive rich data source for collecting detailed information about fall events. Relevant discussions related to fall incidents were identified and downloaded using site-specific Google Search queries and a programming script. A qualitative descriptive approach was used to analyze the incidents and categorize contextual information into “precursor events” and “influencing factors” for infant falls. e identified 461 infant fall incidents. Common fall mechanisms included falls from furniture, falls when being carried or supported by someone, falls from baby products, and falls on the same level. Across the spectrum of fall mechanisms, common precursor events were infant rolling off, infant being alone on furniture, product misuse, caretaker falling asleep while holding the infant, and caretaker tripping/slipping while carrying the infant. Common influencing factors were infant’s rapid motor development, lapses in caretaker attention, and trip hazards. he findings define targets for interventions to prevent infant falls and suggest that the most viable intervention approach may be to target parental behavior change. Online forums can provide rich information critical for preventive interventions aimed at changing behavior.
Comparing consequences of using two different definitions for body regions for the improvement of personal protective equipment for powered two-wheelers.
Publisher: Informa UK Limited
Date: 30-10-2019
Neck Loads During Head-First Entries into Trampoline Dismount Foam Pits: Considerations for Trampoline Park Safety
Publisher: Springer Science and Business Media LLC
Date: 05-04-2022
DOI: 10.1007/S10439-022-02945-W
Abstract: Serious cervical spine injuries have been documented from falls into foam pits at tr oline parks. To address the lack of evidence on how foam pits should be designed for mitigating neck injury risk, this study aimed to quantify neck loads during head-first entry into varying foam pit designs. An instrumented Hybrid III anthropomorphic test device was dropped head-first from a height of up to 1.5 m into three differently constructed foam pits, each using a different mechanism to prevent direct contact between the falling person and the floor (foam slab, tr oline or net bed). Measured neck loads were compared to published injury reference values. In the simplest, foam-only pit design, increasing foam depth tended to reduce peak compressive force. At least one injury assessment reference metric was exceeded in all pit conditions tested for 1.5 m falls, most commonly the time-dependent neck compression criterion. The results highlight the importance of adequate foam depth in combination with appropriate pit design in minimizing injury risk. The risk of cervical spine injury may not be reduced sufficiently with current foam pit designs.
Naturalistic rapid deceleration data: Drivers aged 75 years and older
Publisher: Elsevier BV
Date: 12-2016
Exploring the potential of behaviour theory-informed digital intervention for infant fall prevention : a mixed method longitudinal study (Preprint)
Publisher: JMIR Publications Inc.
Date: 17-03-2023
DOI: 10.2196/47361
Identifying individual-based injury patterns in multi-trauma road users by using an association rule mining method
Publisher: Elsevier BV
Date: 2022
DOI: 10.1016/J.AAP.2021.106479
Abstract: In many road crashes the human body is exposed to high forces, commonly resulting in multiple injuries. This study of linked road crash data aimed to identify co-occurring injuries in multiple injured road users by using a novel application of a data mining technique commonly used in Market Basket Analysis. We expected that some injuries are statistically associated with each other and form In idual-Based Injury Patterns (IBIPs) and further that specific road users are associated with certain IBIPs. First, a new injury taxonomy was developed through a four-step process to allow the use of injury data recorded from either of the two major dictionaries used to document anatomical injury. Then data from the Swedish Traffic Accident Data Acquisition, which includes crash circumstances from the police and injury information from hospitals, was analysed for the years 2011 to 2017. The injury data was analysed using the Apriori algorithm to identify statistical association between injuries (IBIP). Each IBIP were then used as the outcome variable in logistic regression modelling to identify associations between specific road user types and IBIPs. A total of 48,544 in iduals were included in the analysis of which 36,480 (75.1%) had a single injury category recorded and 12,064 (24.9%) were considered multiply injured. The data mining analysis identified 77 IBIPs in the multiply injured s le and 16 of these were associated with only one road user type. IBIPs and their relation to road user type are one step on the journey towards developing a tool to better understand and quantify injury severity and thereby improve the evidence-base supporting prioritisation of road safety countermeasures.
Can Age or Height Define Appropriate Thresholds for Transition to Adult Seat Belts? An Analysis of Observed Seat Belt Fit in Children Aged 7–12 Years
Publisher: MDPI AG
Date: 28-01-2022
Abstract: This study aimed to investigate associations between demographic, anthropometric and vehicle factors and the fit of adult seat belts in children aged 7–12 years in passenger vehicles. Seat belt fit was assessed by inspection of 7–12-year-old children in their own cars. Logistic regressions examined associations between anthropometric and vehicle factors on achieving good seat belt fit. There were 40 participants included in the analysis, with 16 (40%) having good overall belt fit. The odds of achieving good overall seat belt fit increased by 15% (OR 1.15, 95% CI 1.04–1.27) with every centimeter increase in height and increased by 5% with every one-month increase in age (OR 1.045, 95% CI 1.001–1.10). Controlling for vehicle factors, neither age or height was significantly associated with overall good belt fit, and the discriminatory power of models including these metrics to predict good belt fit was 73% (AUC 0.73, 95% CI 0.55–0.91) and 74% (AUC 0.74, 95% CI 0.58–0.91). The results suggest that taller and older children have a better chance of achieving a good seat belt fit. However, with variations in seat geometry between vehicles, no single simple metric clearly defines an appropriate transition to the adult seat belt.
Differences in participant characteristics and observed child restraint use between population-based and restraint fitting service samples
Publisher: Informa UK Limited
Date: 16-08-2023
Barriers to correct child restraint use: A qualitative study of child restraint users and their needs
Publisher: Elsevier BV
Date: 11-2018
Toward a Behavior Theory–Informed and User-Centered Mobile App for Parents to Prevent Infant Falls: Development and Usability Study (Preprint)
Publisher: JMIR Publications Inc.
Date: 27-04-2021
Abstract: alls account for approximately 50% of infant injury hospitalizations, and caretaker behavior is central to preventing infant falls. Behavior theory–informed interventions for injury prevention have been suggested, but to date, few have been reported. The potential of using smartphones for injury prevention intervention delivery is also underexploited. his study aims to develop a behavior theory– and evidence-based as well as user-centered digital intervention as a mobile app for parents to prevent infant falls following agile development practices. nfant falls while feeding was selected as the fall mechanism to demonstrate the approach being taken to develop this intervention. In phase 1, the Behaviour Change Wheel was used as a theoretical framework supported by a literature review to define intervention components that were then implemented as a mobile app. In phase 2, after the person-based approach, user testing through think-aloud interviews and comprehension assessments were used to refine the content and implementation of the intervention. he target behaviors identified in phase 1 were adequate rest for the newborn’s mother and safe feeding practices defined as prepare, position, and place. From behavioral determinants and the Behaviour Change Wheel, the behavior change functions selected to achieve these target behaviors were psychological capability, social opportunity, and reflective motivation. The selected behavior change techniques aligned with these functions were providing information on health consequences, using a credible source, instruction on performing each behavior, and social support. The defined intervention was implemented in a draft Android app. In phase 2, 4 rounds of user testing were required to achieve the predefined target comprehension level. The results from the think-aloud interviews were used to refine the intervention content and app features. Overall, the results from phase 2 revealed that users found the information provided to be helpful. Features such as self-tracking and inclusion of the social and environmental aspects of falls prevention were liked by the participants. Important feedback for the successful implementation of the digital intervention was also obtained from the user testing. o our knowledge, this is the first study to apply the Behaviour Change Wheel to develop a digital intervention for child injury prevention. This study provides a detailed ex le of evidence-based development of a behavior theory–informed mobile intervention for injury prevention refined using the person-based approach.
Accuracy of medical and ambulance record restraint and crash data information for child occupants
Publisher: BMJ
Date: 02-2008
Abstract: To correlate the accuracy of information on children's restraint usage and crash characteristics recorded with medical data using in-depth crash investigation. Restraint and crash information within the medical and ambulance records is often available, but information on the accuracy of this data is limited. Comparison of restraint and crash characteristic data from medical and ambulance records with that obtained from in-depth crash investigation studies, for a case series of child occupants aged 2-8 years involved in motor vehicle crashes. When restraint type, seating position, impact severity, and impact direction data were recorded in either the medical record or ambulance records, it tended to be at least partially correct. However, incompleteness or absence of specifics of restraint use and crash information in the medical record (7-17%) was common. Ambulance records were often not available (39%), but this data was more often complete (78-100%) and accurate (52-89%), when available, possibly due to the use of a standardized pro-forma. Ambulance and hospital records data can provide information on restraint type and usage for child occupants in motor vehicle crashes, as well as crash information. The use of a standardized pro-forma may encourage more complete and accurate reporting of restraint and crash data.
The Need for Enhanced Protocols for Assessing the Dynamic Performance of Booster Seats in Frontal Impacts
Publisher: Informa UK Limited
Date: 27-02-2009
DOI: 10.1080/15389580802493155
Abstract: The primary objective of this work was to examine variations in the level of crash protection provided by different models of high-back booster seats in frontal impact. Secondary objectives included examination of the influence that specific belt positioning features have on the ability of a booster to achieve and maintain good seat belt fit and the relationship between dummy loads, motion, and belt fit, both statically (pre-impact) and dynamically (during impact). Seventeen different models of high-back booster seats were subjected to simulated frontal impacts on a rebound crash sled. The TNO P10 dummy, instrumented to measure head and chest accelerations and targeted to allow head motion tracking, was used in these tests. Three high-speed cameras were used to record dummy motion. Associations between pre-impact seat belt geometry, the dynamic seat belt fit, and dummy response were examined. Clear variations were observed in the level of protection provided by the booster seats tested. Specifically, there were variations in the ability to provide and maintain good seat belt fit. Only three of the seventeen booster seats provided good sash (shoulder) and lap belt fit during dynamic testing. All seventeen boosters had a "sash guide." Sash guide type did not appear to influence the dynamic belt fit. However, the location of the guide and ultimately where on the shoulder the sash was positioned pre-impact did influence the dynamic sash fit. Anti-submarine clips (ASCs) that work to position the lap belt low on the abdomen were also found to maintain good lap belt fit during the dynamic tests. However, two booster seats without ASCs were also able to maintain good dynamic lap belt fit, although the mechanism of this behavior is less clear. Though there was a relationship between head excursion, head acceleration and the pre-impact static position of the sash belt (shoulder belt), there was no relationship between dummy response and the overall ability of a booster seat to provide and maintain both good sash and lap belt fit. Booster seats aim to achieve a good seat belt fit for children too small to use the adult seat belt. Variations in dynamic seat belt fit observed among these seventeen commercially available booster seats demonstrate the need for regulatory protocols that incorporate assessment of dynamic seat belt fit. With current technologies, visual examination of the seat belt during dynamic testing is the best method for assessing this performance.
Accessory child safety harnesses: Do the risks outweigh the benefits?
Publisher: Elsevier BV
Date: 2010
DOI: 10.1016/J.AAP.2009.07.011
Abstract: Accessory child safety harnesses are available in some countries as alternative restraints for young children or as an accessory restraint used with booster seats. Their use, in Australia at least, is becoming more common. There have been concerns that the risk of misuse of these restraints outweighs any potential benefit this system might have over a retractable lap-shoulder belt system used with a booster seat. However to date there is no evidence to confirm or deny this. This study used laboratory simulated frontal crash tests to examine the performance of accessory child safety harness systems compared to the lap-shoulder belt when used alone and when used with two common designs of Australian booster seat. The performance of the child safety harness system when misused was also investigated. The results demonstrate that the correctly used child safety harness system performed no better than the lap-shoulder system, and in fact allows for a greater risk of submarining. Furthermore, one common form of child safety harness misuse, where the harness is over-tightened causing the lap belt to be positioned high over the abdomen, allowed extremely undesirable dummy motion. This involved gross submarining and direct contact between the harness system and the dummy's neck. These findings suggest that the risks associated with accessory child safety harness systems most likely outweigh any potential benefits, in frontal impacts at least.
Child restraint headrest and belt routing design features and their association with child passenger behavior and restraint misuse
Publisher: Informa UK Limited
Date: 27-07-2022
DOI: 10.1080/15389588.2022.2098280
Abstract: Ergonomic design of child restraint systems (CRS) may facilitate optimal travel behavior and crash protection of child passengers during motor vehicle trips. However there have been few studies examining the relationship between CRS design and child passenger travel behavior. The aim of this study was to examine whether associations between CRS design features and child passenger behavior exist during real-world, everyday vehicle trips. Video from a naturalistic driving study (NDS) was analyzed in this study. Families drove an instrumented study vehicle for approximately two weeks with at least one child aged between one and eight years traveling in their own forward-facing (FF) CRS or belt positioning booster (BPB). Video for one child passenger was randomly selected from each trip for analysis. Video was coded for five-second epochs at nine time points (5%, 17%, 25%, 30%, 50%, 53%, 75%, 89% and 95% of trip length). Two types of child passenger travel behaviors were identified by manual review of the video and audio recordings: (i) optimal/suboptimal head position and (ii) correct/incorrect use of the internal harness/shoulder belt. Video screenshots were used to characterize CRS design features. Random effects logistic regression models were used to examine the associations between specific CRS design features and the travel behaviors of interest, whilst accounting for clustering of data by child and trip. Suboptimal head position was associated with the absence of a height adjustable headrest and a narrow headrest wing width in FFCRS. Incorrect harness use in a FFCRS was associated with the absence of an adjustable headrest, in addition to headrest features such as wing width and depth. In BPBs, a reduction in suboptimal head position was associated with the absence of a sash belt guide, however no restraint design features were associated with incorrect shoulder belt use. Some CRS design features may influence undesirable child passenger travel behavior. These early findings support enhanced and user-centric CRS design as a likely important mechanism to improve child passenger safety.
Children and motorcycles: A systematic review of risk factors and interventions
Publisher: BMJ
Date: 13-02-2018
DOI: 10.1136/INJURYPREV-2016-042262
Abstract: To (i) identify person, vehicle and environmental risk factors for injury among children using motorcycles, and (ii) identify and appraise studies of interventions designed to reduce the occurrence or severity of injury among children using these vehicles. A systematic approach was used to collate data from published and grey literature globally on risk factors for motorcycles injury, and studies reporting evaluation of interventions to counter this injury. Academic data sets and public search engines (including Google and Yahoo!) were used. Websites of major conferences, organisations and networks were also searched. Finally, researchers and units working in this area were also contacted by email or phone seeking relevant research. All study types were eligible, excluding clinical case studies. The Haddon Matrix was used as a framework for synthesising the data. The review revealed that robust investigations of risk factors for injury among children using motorcycles are relatively scarce, and there are few interventional studies reporting effectiveness of countermeasures to this problem. Epidemiological literature is generally limited to discussion of human factors, and less attention has been given to vehicle and environmental factors. Furthermore, much of the literature is commentaries and descriptive studies. There has been little rigorous study of risk factors unique to children riding motorcycles. This first attempt at extensively reviewing literature related to risk factors and interventions for children and motorcycles using the Haddon Matrix as a framework clearly highlights need for more rigorous study as information is lacking in all cells of this matrix.
Child restraint use in low socio-economic areas of urban Sydney during transition to new legislation.
Publisher: Elsevier BV
Date: 2013
DOI: 10.1016/J.AAP.2012.08.002
Abstract: Child restraints protect a young child against injury in crashes but best practice child restraint use is low in Australia, particularly among lower socio-economic groups. We investigated factors associated with restraint use to inform the development of education and distribution programmes to support new Australian legislation on child passengers among families in low socio-economic areas of metropolitan Sydney. We interviewed a parent or carer of 1160 children aged 2-5 years enrolled at one of 28 early childhood centres in low socio-economic areas of urban Sydney. Appropriate child restraint use was defined as a forward facing child restraint (FFCR) for 2-3 year olds and a FFCR or booster seat for children aged 4 years or more. Predictors of self-reported appropriate use were explored using logistic regression. Analysis was conducted on one child from each family in the target age range (2-5 years): 586 (51%) were male and the mean age was 3.5 (Standard Deviation 0.8) years. There were 432 (45%) families with annual income below $60,000, 248 (22%) spoke a language other than English at home and 360 (33%) had 3 or more children. Fifty-four percent of carers indicated that their 2-3 year old children travelled in a FFCR. Inappropriate use among children in this age group was more likely when the carer was <36 years (odds ratio (OR) 1.62, 95% confidence interval (CI) 1.08-2.45), in families with ≥3 children (OR 1.64, 95% CI 1.10-2.44) and when the carer believed that a booster seat was just as safe as a FFCR (OR 2.98, 2.05-4.32). Eight-eight percent of carers of 4-5 year olds reported use of a booster seat or FFCR. Non-use was associated with low household income (OR 3.10, 95% CI 1.67-5.75), in families with ≥3 children (OR 2.03, 95% CI 1.09-3.76) and families where a language other than English is spoken at home (OR 2.39, 95% CI 1.10-5.21). Non-English speaking families had less awareness of the new law and poorer knowledge of safety benefits of child restraints. They also had lower household incomes and more concerns about cost of child restraints and booster seats. These findings can inform development of interventions to promote best practice child restraint use, which will reach non-English speaking families in this region. They also confirm the importance of economic and logistic barriers to best practice child restraint use.
Restraint Factors and Child Passenger Deaths in New South Wales, Australia
Publisher: MDPI AG
Date: 12-02-2020
Abstract: Inappropriate or incorrect use of child restraints can influence crash injury outcome. This study examined the role of restraint factors in child passenger deaths and the effect of legislation requiring appropriate restraint systems up to 7 years old. Data for child (0–12 years) passenger deaths occurring in New South Wales (NSW) from 2007 to 2016 were collected by the child death review team including photographs, reports of in-depth crash investigation, witness reports and medical reports. Restraint use, type of restraint, appropriateness of the restraint for the age of the child and correctness of restraint use were examined. The primary contributor to death was determined in each case. Sixty-four child passengers died in NSW during the data period. Twenty-nine (29/64, 45%) were properly restrained. Thirteen children (13/64, 20%) were unrestrained. In 20 cases (20/64, 31%), children were using a restraint that was either inappropriate for their age (6) or not used correctly (14). Restraint factors were a primary contributor in 22 (22/64, 34%) child deaths. Compared to pre-legislation, appropriate restraint use was more common post-legislation (13/22. 59% vs. 30/42, 71%). However, incorrect use was also greater (3/22, 14% vs. 11/42, 26%). Interventions targeting increasing restraint use and reduction of common ‘use’ errors are needed to prevent further restraint factor-related deaths.
The relationship between Motorcycle Rider Behaviour Questionnaire scores and crashes for riders in Australia
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.AAP.2017.03.007
Abstract: Motorcycle riders are over-represented in road fatalities in Australia. While riders represent 18% of the road users killed each year, motorcycle registrations constitute only 4.5% of the registered vehicle fleet. The Motorcycle Rider Behaviour Questionnaire (MRBQ) was developed with a view toward understanding behaviours likely to be associated with crash risk. These include behaviours that are either intentional (such as violations of road and speed regulations and stunts) or unintentional (such as errors relating to traffic or control of the motorcycle), as well as protective behaviours related to use of safety equipment. The dual aims of the current study were, first, to determine the appropriate structure of a modified version of the MRBQ for use in a representative s le of riders in Australia and, second, to understand which MRBQ factors are associated with crash involvement. A stratified s ling procedure was undertaken to ensure the socio-economic status of local government area, age and gender of the s le was representative of the broader population of riders in New South Wales, Australia. The s le consisted of 470 riders (males=89%). Exploratory factor analysis revealed a 29-item, five factor structure was suitable on the Australian data encompassing traffic errors, speed violations, protective gear, control errors and stunts. Overall, riders reported relatively safe behaviours, with frequent use of protective gear and infrequent aberrant behaviours. However, even though infrequent, violations of speed and errors related to control of the motorcycle increased the odds of near-crash involvement, whilst stunt behaviours were associated with increased odds of crash involvement. Interventions and countermeasures need to target these specific behaviours.
Management of paediatric splenic injury in the New South Wales trauma system
Publisher: Elsevier BV
Date: 2017
DOI: 10.1016/J.INJURY.2016.11.005
Abstract: Since the 1980's, paediatric surgeons have increasingly managed blunt splenic injury (BSI) in children non-operatively. However, studies in North America have shown higher operation rates in non-paediatric centres and by adult surgeons. This association has not been examined elsewhere. To investigate the management of BSI in New South Wales (NSW) children, to determine the patient and hospital factors related to the odds of operation. Secondarily, to investigate whether the likelihood of operation varied by year. Children age 0-16 admitted to a NSW hospital between July 2000 and December 2011 with a diagnosis of BSI were identified in the NSW Admitted Patient Data Collection, and linked to deaths data from Registry of Births Deaths and Marriages, and Bureau of Statistics. The operation rate was calculated and compared between different hospital types. Univariable analysis was used to determine patient and hospital factors associated with operative management. The difference in the odds of operation between the oldest data (July 2000-December 2005) and most recent (January 2006-December 2011) was also examined. Multivariable logistic regression with stepwise elimination was then performed to determine likelihood of operative management according to hospital category and era, adjusting for potential confounders. 955 cases were identified, with 101(10.6%) managed operatively. On multivariable analysis, factors associated with operation included age (OR 1.11, 95% CI 1.01-1.18, p<0.05), massive splenic disruption (OR 3.10, 95% CI 1.61-6.19, p<0.001), hollow viscus injury (OR 11.03, 95% CI 3.46-34.28, p<0.001) and transfusion (OR 7.70, 95% CI 4.54-13.16, p<0.001). Management outside a paediatric trauma centre remained significantly associated with operation, whether it be metropolitan adult trauma centre (OR 4.22 95% CI 1.70-10.52, p<0.01), rural trauma centre (OR 3.72 95% CI 1.83-7.83, p<0.001) or metropolitan local hospital (OR 5.23, 95% CI 1.22-18.93 p<0.05). Comparing the 2 eras, the overall operation rate fell, although not significantly, from 12.9% to 8.7% (OR 1.3, 95% CI 0.89-243 p=0.13) CONCLUSION: While Paediatric Surgeons have wholeheartedly adopted non-operative management, away from paediatric centres, children in NSW are still being operated on for BSI unnecessarily. While the factors at play may be complex, further evaluation of the management and movement of injured children within the broad NSW trauma system is required.
Frontal crash seat belt restraint effectiveness and comfort accessories used by older occupants
Publisher: Informa UK Limited
Date: 09-12-2019
Identify the key characteristics of pedestrian collisions through in-depth interviews: a pilot study
Publisher: Informa UK Limited
Date: 31-01-2021
User-driven design of child restraint information to reduce errors in use: A pilot randomised controlled trial
Publisher: BMJ
Date: 17-09-2020
DOI: 10.1136/INJURYPREV-2019-043380
Abstract: Incorrect use of child restraints is a long-standing problem that increases the risk of injury in crashes. We used user-centred design to develop prototype child restraint instructional materials. The objective of this study was to evaluate these materials in terms of comprehension and errors in the use of child restraints. The relationship between comprehension and errors in use was also explored. We used a parallel-group randomised controlled trial in a laboratory setting. The intervention group (n=22) were provided with prototype materials and the control group (n=22) with existing instructional materials for the same restraint. Participants installed the restraint in a vehicle buck, secured an appropriately sized mannequin in the restraint and underwent a comprehension test. Our primary outcome was overall correct use, and our secondary outcomes were (1) comprehension score and (2) percent errors in the installation trial. There was 27% more overall correct use (p=0.042) and a higher mean comprehension score in the intervention group (mean 17, 95% CI 16 to 18) compared with the control group (mean 12, 95% CI 10 to 14, p .001). The mean error percentage in the control group was 23% (95% CI 16% to 31%) compared with 14% in the intervention group (95% CI 8% to 20%, p=0.056). For every one point increase in comprehension, there was an almost 2% (95% CI −2.7% to −1.0%) reduction in errors (y=45.5–1.87x, p value for slope .001). Consumer-driven design of informational materials can increase the correct use of child restraints. Targeting improved comprehension of informational materials may be an effective mechanism for reducing child restraint misuse.
Are we doing what works to prevent unintentional injury in Australian children?
Publisher: BMJ Publishing Group Ltd
Date: 03-2021
Near-miss crashes and other predictors of motorcycle crashes: Findings from a population-based survey
Publisher: Informa UK Limited
Date: 12-12-2018
DOI: 10.1080/15389588.2018.1536822
Abstract: Crash and injury surveillance studies have identified a range of rider-related factors, including age, sex, licensure, training and experience, as being associated with motorcycle crash risk. The aim of this study was to establish whether these previously identified factors were associated with crash involvement in an Australian-based population. Data obtained from motorcyclists recruited from road authority licensing offices in a population-based survey design were analyzed. In addition to descriptive analysis, survey logistic regression was used to examine predictors of self-reported motorcycle crashes. A statewide population prevalence study of motorcyclists in New South Wales, Australia, was conducted using a multistage stratified random s ling plan. Participants (n = 503) represented 47% of eligible riders invited to participate. The distribution of responses was weighted to represent the population based on motorcycle registrations as a proxy for active motorcyclists, adjusted for age, sex, and variations in s le size and population density between survey sites. This analysis investigated factors associated with having crashed in the past 12 months. The key predictors of increased crash risk included frequent near-crash experiences (6-10) in the past year (adjusted odds ratio [OR These findings provide important population-level information and insights about risk exposure for motorcyclists. Taking a more tailored approach to data collection meant that factors associated with crash involvement were identified that are not commonly observed in studies relying on administrative data. In particular, the study highlights the importance of near-crash experiences as warnings to riders and the need to use such experiences as learning opportunities to improve their riding style and safety.
Paediatric off‐road vehicle injury in rural and regional Australia
Publisher: Wiley
Date: 06-2021
DOI: 10.1111/AJR.12735
Abstract: Off‐road riding of quad bikes and motorcycles is common among children across rural and remote Australia, but is a significant source of injury and hospitalisation. An in‐depth analysis of paediatric off‐road vehicle crashes was undertaken to inform injury prevention countermeasures by characterising injury patterns and sources of injury. This is a prospective in‐depth case series. Participants are children aged 16 and under who have been hospitalised due to injury sustained from the use of an off‐road motorcycle or quad bike in New South Wales, Australia. Crash investigation techniques (medical data, structured interview, vehicle and crash site inspection) were used to ascertain details of the crash event, protective gear, injury information and contributory factors. Thirty children were recruited, 27 boys and 3 girls, ranging in age from 4 to 16 years, having crashed on off‐road motorcycles (n = 27) or quads (n = 3). Most (73.3%) were participating in unstructured social riding. A total of 67 separate injuries were observed, with overall Injury Severity Scores between 1 and 35. There were high rates of wearing helmets and motorcycle‐specific garments. The most commonly injured areas were the upper and lower extremities. The most common sources of injury were from impacting the ground, obstacles/other riders or the vehicle. This study demonstrates the patterns of riding and injury in rural paediatric off‐road vehicle riders, occurring despite high rates of helmet rotective gear use. This underscores the need for investigation into the injury mitigation and fit properties of protective gear and the inherent risks for physically and developmentally maturing children.
Management of splenic injury in children and young adults: a survey of surgeons investigating factors responsible for variations in care using the Theoretical Domains Framework
Publisher: Cold Spring Harbor Laboratory
Date: 28-07-2023
DOI: 10.1101/2023.07.26.23293058
Abstract: Objective: To identify differences in practice and behavioural drivers in adult and paediatric surgeons related to the management of splenic injury in children and young people. Background: Despite the existence of guidelines, there are variations in the care of children with splenic injuries. There are no specific guidelines for the care of young adults, who may be managed according to either paediatric or adult practices. The drivers of variation in trauma management between adult and paediatric surgeons have not been examined through an implementation science lens. Methods: The COM-B model of behaviour and theoretical domains framework were used to construct a survey which was delivered to a cross-section of adult general surgeons and paediatric surgeons working in public hospitals throughout NSW, Australia. The capability, opportunity, and motivation for management decisions were analysed. Outcome variables were compared between the practitioner groups. Statistical significance was set at p 0.05. Results: Eighty (26.4%) responses met the inclusion criteria. Significant differences between adult and paediatric surgeons were identified in terms of: capability (surgeon training and experience) opportunity (hospital, personnel, and resources) and motivation (comfort with splenic injury care at different ages). In managing splenic injury, pediatric surgeons tended to follow pediatric guidelines while adult surgeons followed adult guidelines, making some adjustments for age. All agreed guidelines had the potential to improve care. Conclusions: This study identified several behavioural drivers for observed variations in the care of splenic injury in children and young adults. The results indicate that contextually relevant guidelines for managing splenic injury in children and young people across any setting may be needed to reduce disparities in care. These should be underpinned by interventions designed to further address the drivers of surgeon behaviour to optimise uptake. Furthermore, splenic injury care is a clinical indicator of the quality of trauma care more broadly. Addressing variation in its care has the potential to translate to other trauma system improvements. Unwarranted variations in splenic injury management have been reported. This is the first examination of surgeon behaviour in the provision of trauma care through an implementation science lens. Differences in the capability, opportunity, and motivation of surgeons in providing evidence-based care to children and young adults with splenic injury were found. Contextually relevant guidelines, underpinned by supporting interventions addressing these behavioural drivers, are needed to reduce disparities in care.
Injury from falls in infants under one year.
Publisher: Wiley
Date: 26-06-2017
DOI: 10.1111/JPC.13568
Abstract: Falls in infants are a common cause of injury. Compared to older children, infants under age one are likely to have distinctive causation and injury patterns, as they are pre-mobile or have limited independent mobility and falls are more directly the responsibility of the care giver. There is little known about the mechanistic factors, predictors of injury and injury patterns in this age group. We conducted a retrospective review of infants under age one who presented after a fall to a paediatric trauma centre in Sydney, Australia. Circumstances and mechanisms of the fall, injury patterns, burden of investigations and outcomes were analysed. Over a 3-year period (2011-2013), 916 infants presented following a fall. One hundred and six (11.6%) were admitted and there was one death. Head injury was the most common reason for admission (85%). While there were severe and critical head injuries (Abbreviated Injury Scale 4-5) these were infrequent (2% of presentations). All admitted cases involved a short distance fall. Patients dropped by others were three times more likely to be admitted than infants presenting following other fall types (95% CI 1.9-4.8). Compared to other mechanisms, patients who fell from furniture had significantly longer hospital stays. Fall mechanisms involving infants being dropped by adults, and falls from beds or couches carry the highest clinical burden. These mechanisms should be targets for injury prevention and inform the design of safe equipment and environments for babies.
A novel method for quanitifying comfort in child passengers demonstrates an association between child restraint comfort and errors in use of booster seats
Publisher: Informa UK Limited
Date: 26-05-2017
DOI: 10.1080/15389588.2017.1312358
Abstract: Misuse of child restraint systems is a widespread and long-standing problem impacting risk of injury and death in car crashes. Discomfort has been suggested as a causative factor for misuse, particularly in errors introduced by children while they use the restraints. However, the relationship between comfort and errors in use has never been studied. In this study we examine the reliability and sensitivity of a newly developed observational method for assessing comfort in children in vehicles. We then use this method to examine the relationship between comfort and errors in use of booster seats. A novel method was developed for assessing comfort by counting fidgeting and postural adjustment behaviors to derive a Discomfort Avoidance Behavior (DAB) score. The sensitivity of the DAB score was examined by observing children in four different seating conditions designed as "comfortable" and "uncomfortable" (Part 1). Paired-s les t-tests were used to compare differences in DAB between seating conditions. The reliability of the DAB score was assessed by calculating the intraclass correlation coefficient (ICC) between DAB scores recorded by different researchers. The association between comfort and correctness of use was examined by observing children using booster seats (Part 2). The association between DAB score and number of usage errors was tested using linear regression analysis. Participants were children ages 4-8 years. Fourteen children participated in Part 1 and 15 children in Part 2. The DAB score was sensitive to changes in seat condition (p < 0.01), and was repeatable between different researchers (ICC 0.98, 95% confidence interval [CI] 0.954-0.991). Increases in DAB were associated with increases in the number of use errors among children using booster seats (errors in use = 3.89 × DAB - 2.18, p < 0.0001). The DAB score is a reliable and valid measure of comfort of children in child restraints but could be improved by incorporating a measurement of postural positioning. Comfort, as characterized by fidgeting and postural adjustment behaviors, is associated with correct use of child restraints. The broader implication is that this confirms ergonomic design of child restraints as important for minimizing errors in use. There is a need for further study of the impact of specific restraint design features on comfort experienced by children.
Population-Level Incidence and Use-Related Factors of Comfort and Orthopedic Accessories Among Older Vehicle Occupants in NSW, Australia
Publisher: SAGE Publications
Date: 29-08-2020
Abstract: The proportion of people aged 65 years and older regularly traveling in motor vehicles continues to grow worldwide. In a previous convenience s le, we observed many older people using comfort accessories when traveling in vehicles, and these may contribute to the known increased risk of injury in crashes among older people. In this study, we aimed to estimate population-level use of these devices and examine associations between demographic, health, and travel behavior factors and their use. The point estimate of self-reported use of comfort accessories was 25.7% (95% confidence interval [CI] = [19.6%, 31.9%]). Cushions on the vehicle seat were the most common type used (14.3%, 95% CI = [9.7%, 19.0%]), and increasing age, female gender, and frequent vehicle travel were significantly associated with their use. Less frequently used were seat belt padding (10.5%, 95% CI = [6.3%, 14.6%]) and back/neck supports (6.5%, 95% CI = [2.7%, 10.2%]). Back/neck and multiple area pain were significantly associated with the use of the latter.
Population-level estimates of child restraint practices among children aged 0-12 years in NSW, Australia
Publisher: Elsevier BV
Date: 11-2010
DOI: 10.1016/J.AAP.2010.07.006
Abstract: This cross-sectional study provides population-referenced data on the restraints used and the extent of incorrect restraint use, among child vehicle passengers aged 0-12 years in NSW, Australia. A multistage stratified cluster s ling plan was used to randomly select vehicles from baby/child health clinics, pre-schools/day care centres, and primary schools across NSW to undergo detailed inspection of restraints used by child occupants within those vehicles. Overall, there were very high restraint usage rates (>99% of s led children) but fewer than one quarter of children were using the correct size-appropriate restraints. Incorrect use (51.4%) was as common as inappropriate use (51.2%). Incorrect use was highest among users of dedicated child restraint systems (OR 16.0, 95% CI 6.9-36.0), and was more likely among those using size-appropriate restraints than those using inappropriate restraints (OR 1.8 95% CI 1.1-3.2) and among convertible restraints than those designed for a single mode of use (OR 1.5 95% CI 1.2-1.7). As incorrect use substantially reduces the protection from injury that is offered by child restraints, it is important that future strategies to reduce casualties among child occupants target both inappropriate and incorrect use.
Fatal head injury in children: A new approach to scoring axonal and vascular damage
Publisher: Springer Science and Business Media LLC
Date: 23-07-1999
Abstract: As part of a multidisciplinary study of brain damage in children fatally injured in motor vehicle accidents, a simple method to quantify and visualise the distribution and extent of injury has been developed. Vascular and axonal injury were assessed using coronal brain sections stained for haematoxylin and eosin, or reacted immunohistochemically for beta-amyloid precursor protein. Subsequent analysis was carried out using NIH Image software, and the resulting information is displayed in schematic diagrams. These summary diagrams simply and clearly show the distribution of injury in both the coronal and horizontal planes. This technique offers an advantage over previous scoring methods in that it provides both a quantitative and a visual summary of the distribution and extent of brain injury. This information can then be used to compare the injury distribution and severity with estimated impact points and acceleration data.
A matched-cohort analysis of belted front and rear seat occupants in newer and older model vehicles shows that gains in front occupant safety have outpaced gains for rear seat occupants
Publisher: Elsevier BV
Date: 11-2010
DOI: 10.1016/J.AAP.2010.06.002
Abstract: Previous studies have suggested that rear seat occupants are at lower risk of serious injury and death in crashes. However, over the last 10-15 years there have been significant changes in front seat safety systems. The aim of this study was to determine whether there is still a benefit for rear seated occupants compared to front seat occupants. A matched-cohort approach, using data on restrained occupants from the US National Automotive S ling System (data years 1993-2007), was adopted. Conditional poisson regression modeling was used to evaluate the relative risk of AIS3+ injury in front (passenger and driver) and rear seat occupants, in vehicles of model year 1990-1996 compared to newer vehicles. Occupant age, belt type, and intrusion were additional variables in the model. The relative risk of AIS3+ injury for front and rear occupants was influenced by age and model year. For those aged 16-50 years in older vehicles, the front and rear seat offered similar levels of protection (RR=1.14, CI=1.09-1.19), however in newer model vehicles (1997-2007), the rear seat carried a higher risk of injury (RR=1.98, CI=1.90-2.06). For adults over 50 years, the rear seat carried a higher risk in both older and newer vehicles, and for 9-15 year olds, the rear seat carried a lower risk. These findings suggest that safety for front seat occupants has improved over the last decade, to the point where, for occupants over 15 years of age, the front seat is safer than the rear seat. While the benefit of rear seating for children aged 9-15 years has decreased over time, they are still at lower risk in the rear seat.
The prevalence of crash risk factors in a population-based study of motorcycle riders
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.INJURY.2016.03.033
Abstract: Motorcyclists represent an increasing proportion of road traffic casualties but, while factors associated with crashes are readily identifiable, little is known about the prevalence of those risk factors in the motorcycling population. A stratified random-s ling frame was used to survey the population of registered motorcycles owners in New South Wales (NSW) when they attended motor registry offices. The postal codes in the State database of registered motorcycle were used to stratify the population into quartiles based on socioeconomic characteristics and to determine s le weights. Participants (n=506) represented 47% of eligible riders approached. On average participants were aged 43, rode 7h/week and had 17 years of riding experience. Estimates based on multiple ownership rates suggest motorcycle registration numbers exceed the active riding population by approximately 15%. Less than half rode under 101km/week, 25% rode over 300km/week and just 42% rode every day. More rode frequently for leisure (70%) than for commuting (53%) and over half rarely rode in dark (52%) or wet (67%) conditions. Most wore protective clothing - helmets (100%), jackets (82%), pants (56%), boots (57%) and gloves (73%). Those with traffic infringements (32%) were mostly for driving (25%), not riding (10%) offences. In the past year, 13% had one or more motorcycle crashes including minor spills and 76% one or more near-crash experiences. The youngest riders (15-19) reported the highest rates of exposure in kilometres, hours, frequency of riding and commuting. They also reported lower crash involvement (3%) but more near-crashes (80%). This study provides an account of the prevalence of key risk factors across age groups in a population of active motorcycle riders in NSW. Novice riders were represented in all age groups although most novices were under 40 years. These data can be used to guide the development of targeted countermeasures aimed at improving motorcycling safety for riders of different age groups.
Mitigating fuel tank syndrome pelvic injuries - is there potential for rider worn protectors?
Publisher: Informa UK Limited
Date: 10-06-2022
DOI: 10.1080/15389588.2022.2072834
Abstract: The aim of this study was to investigate the feasibility of rider-worn pelvis protection for mitigating injury risk when contacting the motorcycle fuel tank in a crash. A newly developed test apparatus was designed and constructed to simulate the interaction between a rider's pelvis and the motorcycle fuel tank in a frontal crash. Impacts were performed at a velocity of 18 km/h into four motorcycle fuel tanks. Further testing used a rigid fuel tank surrogate and the pelvis surrogate in an unprotected condition and with a series of impact protector prototypes. A subset of prototype s les was also tested at varying tank angles (30°, 37.5°, 45°) and impact speeds (8.5 km/h, 13 km/h, 18 km/h). Analysis of variance was used to determine whether the protector prototypes reduced pelvis response compared to unprotected. Resultant peak pelvis acceleration was reduced by three pelvis impact protector prototypes compared to an unprotected condition. The reduction in peak acceleration occurred without a significant change in the peak pelvis rotational velocity. The pattern of protector performance was consistent at varying fuel tank angles but only reduced the pelvis response at the highest impact speed tested of 18 km/h. The results indicate that there may be potential for using pelvis impact protection to mitigate injury risk by absorbing and/or distributing impact energy that would otherwise be transmitted to the rider's pelvis. However, due to the current paucity in understanding of pelvis biomechanics to anteroposterior loading, it is unknown whether the pelvis acceleration reductions achieved would prevent injury.
Crash characteristics of older pedestrian fatalities: Dementia pathology may be related to ‘at risk’ traffic situations
Publisher: Elsevier BV
Date: 05-2008
DOI: 10.1016/J.AAP.2007.10.006
Abstract: Older people are over represented among pedestrian casualties, and cognitive decline is an often cited possible contributory factor. Cognitive decline and dementia are intimately associated, however the role dementia might play in older pedestrian crashes has received little attention. This study describes crash characteristics for 52 fatally injured older pedestrians in the Sydney metropolitan area. It investigates the relationship between the extent of neurofibrillary tangles (NFT), a hallmark of Alzheimer's disease in the brain, and particular crash situations. The results demonstrate crash characteristics that are similar to that reported in other studies of older pedestrians. Furthermore, the results suggest that cognitive decline associated with dementia related neuropathology may be associated with specific crash situations. Compared to older pedestrians with no, or low NFT, those with moderate to high NFT were more likely to be: at least partially responsible for the incident injured while in low complexity situations involved in impacts with reversing vehicles impacted in near lanes of traffic and struck by a vehicle off road. While described as trends only (p<0.2), these findings highlight areas of concern for older pedestrians and suggest potential targets for engineering and behaviour-based countermeasures aimed at reducing casualty numbers among older pedestrians.
The burden of hospitalized sports-related injuries in children: an Australian population-based study, 2005–2013
Publisher: Springer Science and Business Media LLC
Date: 12-2018
Family day care educators as a source of child car safety information for parents
Publisher: Informa UK Limited
Date: 09-07-2016
Influence of child restraint system design features on comfort, belt fit and posture
Publisher: Elsevier BV
Date: 08-2020
Seat belt use and fit among drivers aged 75 years and older in their own vehicles
Publisher: Informa UK Limited
Date: 09-07-2016
DOI: 10.1080/15389588.2015.1052420
Abstract: This article aims to describe seat belt wearing patterns and quality of seat belt fit among drivers aged 75 years and older. A secondary aim is to explore associations between body shape, comfort, and seat belt use patterns. This is an observation and survey study of a cohort of 380 drivers aged 75 years and over. During home visits, photographs were taken of the drivers in their vehicles for later analysis of belt fit and a short survey was also administered to collect demographic data and information about seat belt use and comfort. Seat belt fit and use of belt and seat accessories were analyzed from the photographs. Data from 367 participants with photographs were analyzed. Whereas 97% reported using a seat belt and 90% reported their seat belt to be comfortable, 21% reported repositioning their seat belt to improve comfort. Good sash and lap belt fit were achieved in 53 and 59% of participants, respectively, but only 35% achieved overall good fit. Both poor sash and lap belt fit were observed in 23% of participants. Drivers who were in the obese category had over twice the odds (95% confidence interval [CI], 1.2-4.1) of having a poor lap belt fit than those in the normal body mass index [BMI] range, and drivers who were overweight had 1.8 times the odds (95% CI, 1.1-2.9) of having poor lap belt fit. Older females also had twice the odds (95% CI, 1.3-3.5) of poor lap belt fit compared to older males, regardless of BMI. Sash belt fit did not vary significantly by BMI, stature, or gender. However older drivers who reported that they had not made any adjustments to the D-ring height had 1.7 times the odds of having poor sash belt fit than those who made adjustments (1.2-2.9). Females were 7.3 times more likely to report comfort problems than males (95% CI, 3.2, 16.3) but there was no association between reported comfort and BMI or seat belt fit. Drivers who reported comfort problems had 6 times the odds (3.2-13.6) of also reporting active repositioning of the belt. The results suggest that older drivers face challenges in achieving comfortable and correct seat belt fit. This may have a negative impact on crash protection. Belt fit problems appear to be associated with body shape, particularly high BMI and gender. There is a need for further investigation of comfort accessories in the interim, older drivers and occupants should be encouraged to use features such as D-ring adjusters to improve sash belt fit.
Relationship between skin abrasion injuries and clothing material characteristics in motorcycle crashes
Publisher: Elsevier BV
Date: 09-2015
Variations in Rear Seat Cushion Properties and the Effects on Submarining
Publisher: Informa UK Limited
Date: 25-01-2011
DOI: 10.1080/15389588.2010.523099
Abstract: This study aims to investigate the effects of seating posture and seat cushion properties on submarining risk for rear seated children. An instrumented 6-year-old Hybrid III dummy restrained by an inertial-reel 3-point seat belt was subjected to simulated frontal impacts (Δv=28.8 km/h, peak acceleration=16 g). Dummy motion was captured using high-speed digital video. Head acceleration, neck loads, chest deflection, pelvic rotation, and femur displacement were used to assess submarining. Factors investigated included pre-impact seating posture, seat cushion length, stiffness of the seat cushion foam, and the inclination of the seat cushion. The most severe submarining was observed when the dummy was seated in a slouched posture where pelvic rotation was over 3 times greater than in the upright seating posture. Though the standard seat cushion with the dummy seated in the upright posture recorded the lowest values of pelvic rotation and femur displacement, it is unlikely that a child will sit in such a posture. The shortened seat cushion increased femur displacement by 19 percent compared to the standard test seat, but it offers good pre-impact belt position. Submarining occurred in cases where the front edge of the seat collapsed during interactions with the dummy's buttocks. These data suggest that shortening the rear seat cushion alone will not necessarily prevent submarining, but this does allow improved seated posture of the occupant, thus reducing submarining risk. This study has also shown that the collapse of the front edge of the seat cushion is a critical factor in submarining risk.
Developing behavioural theory grounded and user-centred mobile app to prevent infant falls
Publisher: BMJ Publishing Group Ltd
Date: 03-2021
Program fidelity measures associated with an effective child restraint program: Buckle-Up Safely.
Publisher: American Public Health Association
Date: 03-2015
Abstract: Objectives. We sought to identify the program fidelity factors associated with successful implementation of the Buckle-Up Safely program, targeting correct use of age-appropriate child car restraints. Methods. In 2010, we conducted a cluster randomized controlled trial of 830 families with children attending preschools and long day care centers in South West Sydney, New South Wales, Australia. Families received the Buckle-Up Safely program in the intervention arm of the study (13 services). Independent observers assessed the type of restraint and whether it was used correctly. Results. This detailed process evaluation showed that the multifaceted program was implemented with high fidelity. Program protocols were adhered to and messaging was consistently delivered. Results from multilevel and logistic regression analyses show that age-appropriate restraint use was associated with attendance at a parent information session hosted at the center (adjusted odd ratio [AOR] = 3.66 95% confidence interval [CI] = 1.61, 8.29) and adversely affected by the child being aged 2 to 3 years (AOR = 0.14 95% CI = 0.07, 0.30) or being from a family with more than 2 children (AOR = 0.34 95% CI = 0.17, 0.67). Conclusions. Findings highlight the importance of parents receiving hands-on education regarding the proper use of age-appropriate child restraints.
Restraint use and seating position among child car passengers: An observational study in Shanghai
Publisher: Elsevier BV
Date: 11-2011
DOI: 10.1016/J.AAP.2011.06.014
Abstract: Child passenger restraint practices in China are poorly characterized and few direct observational studies have been performed. This study aims to describe child passenger restraint use and to investigate factors influencing the restraint practices. A cross-sectional observational study was conducted at toll-gates in Shanghai during an 11-day period in June in 2009. A pro-forma observation checklist was used to collect data related to restraint use by child passengers aged ≤ 12 years, restraint use by drivers, and the number of child passengers traveling in passenger cars registered in Shanghai. Adjusted risk ratios (RR) comparing those children who were properly rear seated with those in other positions (front seat, on adult's lap) and any restraint use with no restraint use were evaluated using multivariate binomial regression with robust variance estimation. Among 967 children observed, 44.1% of children were in suboptimal seating positions (i.e., 12.2% in the front seat and 31.9% in adult laps) and 93.9% were unrestrained. Children aged ≤ 4 years (RR: 0.35, 95% Confidence Interval: 0.28-0.44), and those who were the only child in a car (RR: 0.84, 95% confidence interval: 0.74-0.96) had a lower likelihood of being properly rear seated. Children traveling with unrestrained drivers (RR: 0.09, 95% confidence interval: 0.01-0.60) were less likely to be restrained. This study demonstrates low restraint use and common suboptimal seating positions for child passengers in China and relates these to driver restraint use. These findings support the need for targeted programs to improve child restraint practices in China.
Perils of using speed zone data to assess real-world compliance to speed limits
Publisher: Informa UK Limited
Date: 15-06-2017
DOI: 10.1080/15389588.2017.1315636
Abstract: Real-world driving studies, including those involving speeding alert devices and autonomous vehicles, can gauge an in idual vehicle's speeding behavior by comparing measured speed with mapped speed zone data. However, there are complexities with developing and maintaining a database of mapped speed zones over a large geographic area that may lead to inaccuracies within the data set. When this approach is applied to large-scale real-world driving data or speeding alert device data to determine speeding behavior, these inaccuracies may result in invalid identification of speeding. We investigated speeding events based on service provider speed zone data. We compared service provider speed zone data (Speed Alert by Smart Car Technologies Pty Ltd., Ultimo, NSW, Australia) against a second set of speed zone data (Google Maps Application Programming Interface [API] mapped speed zones). We found a systematic error in the zones where speed limits of 50-60 km/h, typical of local roads, were allocated to high-speed motorways, which produced false speed limits in the speed zone database. The result was detection of false-positive high-range speeding. Through comparison of the service provider speed zone data against a second set of speed zone data, we were able to identify and eliminate data most affected by this systematic error, thereby establishing a data set of speeding events with a high level of sensitivity (a true positive rate of 92% or 6,412/6,960). Mapped speed zones can be a source of error in real-world driving when examining vehicle speed. We explored the types of inaccuracies found within speed zone data and recommend that a second set of speed zone data be utilized when investigating speeding behavior or developing mapped speed zone data to minimize inaccuracy in estimates of speeding.
Triggering algorithm based on inevitable collision states for autonomous emergency braking (AEB) in motorcycle-to-car crashes
Publisher: IEEE
Date: 06-2015
Does injury pattern among major road trauma patients influence prehospital transport decisions regardless of the distance to the nearest trauma centre? - A retrospective study
Publisher: Springer Science and Business Media LLC
Date: 13-02-2019
Motorcycle fuel tanks and pelvic fractures: A motorcycle fuel tank syndrome
Publisher: Informa UK Limited
Date: 07-2016
DOI: 10.1080/15389588.2015.1136061
Abstract: Pelvic injuries are a serious and commonly occurring injury to motorcycle riders involved in crashes, yet there has been limited research investigating the mechanisms involved in these injuries. This study aimed to investigate the mechanisms involved in pelvic injuries to crashed motorcyclists. This study involved in-depth crash investigation and 2 convenience-based data sets were used. These data sets investigated motorcycle crashes in the Sydney, Newcastle, and Adelaide regions. Participants included motorcycle riders who had crashed either on a public road or private property within the study areas. The mechanism of injury and the type of injuries were investigated. The most frequent cause of pelvic injuries in crashed motorcyclists was due to contact with the motorcycle fuel tank during the crash (85%). For riders who had come into contact with the fuel tank, the injury types were able to be grouped into 3 categories based on the complexity of the injury. The complexity of the injury appeared to increase with impact speed but this was a nonsignificant trend. The pelvic injuries that did not occur from contact with the fuel tank in this s le differed in asymmetry of loading and did not commonly involve injury to the bladder. They were commonly one-sided injuries but this differed based on the point of loading however, a larger s le of these injuries needs to be investigated. Overall improvements in road safety have not been replicated in the amelioration of pelvic injuries in motorcyclists and improvements in the design of crashworthy motorcycle fuel tanks appear to be required.
A randomized trial to evaluate the effectiveness of an individual, education-based safe transport program for drivers aged 75 years and older
Publisher: Springer Science and Business Media LLC
Date: 05-02-2013
Reconstruction of crashes involving injured child occupants: The risk of serious injuries associated with sub-optimal restraint use may be reduced by better controlling occupant kinematics
Publisher: Informa UK Limited
Date: 04-2007
DOI: 10.1080/15389580600990352
Abstract: To determine whether injuries to sub-optimally restrained child occupants in real-world crashes were likely to be preventable by alternative restraint usage practices and to assess the usefulness of crash reconstruction for exploring injury mechanisms in child occupants. Real-world crashes in which child occupants sustained significant injuries were reconstructed on a laboratory crash sled using the Hybrid III family of child dummies. Alternative restraint scenarios and cases in which children were not seriously injured were also simulated to compare dummy kinematics and dynamic responses in optimal restraint configurations. Restraint misuse was associated with greater motion of the dummy torso and head during crashes, often allowing contact between the child and the vehicle interior, resulting in injury. Poor pre-crash posture for a child inappropriately restrained in an adult belt appeared to worsen the geometry of the sash (shoulder) belt, resulting in a cervical injury due to direct interaction with the belt. Dynamic dummy data did not appear to discriminate between injury and non-injury cases. Dummy kinematics suggest that injuries in which inappropriate use and misuse were a factor were less likely if the most appropriate restraint was used correctly. Adequately controlling the head and upper body of the child occupant was seen to prevent undesirable interactions with the vehicle interior and restraint system, which were associated with injury in the real world. Neck forces and moments and injury criteria calculated from these did not predict injury reliably.
Increase in best practice child car restraint use for children aged 2-5 years in low socioeconomic areas after introduction of mandatory child restraint laws.
Publisher: Elsevier BV
Date: 08-2024
Abstract: To examine changes in child car restraint practices in low socioeconomic areas following the introduction of mandatory child car restraint legislation in New South Wales (NSW), Australia. Data from two cross-sectional studies of child car restraint use at pre-schools, early childhood centres and primary schools before and after the introduction of legislating mandatory age-appropriate car restraint use for children up to the age of seven years was used in this analysis. All included observations were from local government areas with socioeconomic status in the lowest 30% of urban Sydney. Children aged 2-5 years were observed in their vehicles as they arrived at observation sites (107 pre-legislation, 360 post-legislation). Multilevel logistic regression was used to examine changes in observed age-appropriate and correct use of car restraints. Age-appropriate car restraint use was higher post-legislation than pre-legislation. After controlling for child's age, parental income, language spoken at home and adjusting for clustering, the odds of children being appropriately restrained post-legislation were 2.3 times higher than in the pre-legislation s le, and the odds of them being correctly restrained were 1.6 times greater. Results indicate an improvement in car restraint practices among children aged 2-5 in low socioeconomic areas after introduction of child restraint laws. Implications : Despite improvements observed with enhanced legislation, further efforts are required to increase optimal child car restraint use.
A qualitative approach using the integrative model of behaviour change to identify intervention strategies to increase optimal child restraint practices among culturally and linguistically diverse families in New South Wales
Publisher: BMJ
Date: 26-05-2012
DOI: 10.1136/INJURYPREV-2011-040211
Abstract: To qualitatively explore barriers to optimal child restraint use using the integrative behaviour change model in culturally and linguistically erse (CALD) communities in New South Wales (NSW), Australia. A semi-structured discussion was used to conduct 11 language specific focus groups in Arabic, Assyrian, Cantonese, Mandarin, Vietnamese and Turkish. Translated transcriptions were analysed using the major concepts of the integrative behaviour change model. Restraint use intent among CALD community carers is related to perceived safety of their children and complying with the law. While most participants appreciated the safety benefits of correct and appropriate use, a minority did not. Child restraint legislation may positively influence social norms, and enforcement appears to increase parental self-efficacy. However, concerns over child comfort may negatively influence both norms and self-efficacy. There are clear deficits in knowledge that may act as barriers as well as confusion over best practice in safely transporting children. Large family size, vehicle size and cost appear to be real environmental constraints in CALD communities. Determinants of intent and deficits in knowledge in this erse range of CALD communities in NSW Australia are similar to those reported in other qualitative studies regardless of the population studied. This indicates that key messages should be the same regardless of the target population. However, for CALD communities there is a specific need to ensure access to detailed information through appropriate delivery strategies and languages. Furthermore, practical constraints such as cost of restraints and family size may be particularly important in CALD communities.
Older drivers in Australia and advanced vehicle technologies: What are their opinions? A qualitative study
Publisher: Elsevier BV
Date: 07-2023
Spinal injury in motor vehicle crashes: Elevated risk persists up to 12 years of age
Publisher: BMJ
Date: 26-03-2009
Abstract: To determine whether age is associated with serious spinal injury in paediatric motor vehicle occupants, after controlling for crash-related factors. Retrospective record review. All motor vehicle passengers aged 0-16 years treated at two major children's hospitals from 1999 to 2004 with ICD-10 codes for spinal trauma. Injury outcomes were categorised as minor and serious. Minor injuries were analogous to AIS 1 injuries. Serious injuries were those that posed some risk to the integrity of the spinal column or cord. 72 cases were identified (58 or = 12 years of age). Using logistic regression to adjust for confounders, including crash severity and crash type, age <12 years was found to be significantly associated with serious spinal injury. Compared to older children, children aged less than 12 years were more likely to sustain serious spinal injury (OR 7.1, 95% CI 1.2 to 42.9). Children up to age 12 have an elevated risk of serious spinal injury in car crashes. This age breakpoint may reflect the adequacy of seat belt fit, and use of adult seatbelts alone before age 12 may increase a child's risk of serious spinal injury. An association between age and serious spinal injury should also be considered in the triage of paediatric motor vehicle occupants.
Validation of the abrasion resistance test protocols and performance criteria of EN13595: The probability of soft tissue injury to motorcycle riders by abrasion resistance of their clothing
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.JSR.2017.02.001
Abstract: Motorcyclists represent an increasing proportion of road users globally and are increasingly represented in crash statistics. Soft tissue injuries are the most common type of injuries to crashed motorcyclists. These injuries can be prevented through the use of protective clothing designed for motorcycle use. However, the quality of such clothing is not controlled in many countries around the world. A European Standard was developed to assess the performance of clothing but as this is not mandatory, clothing certified to this Standard is difficult to obtain. Given the importance of this Standard, and that it has been validated only once, further validation work is required. In-depth crash investigation data were used to investigate the relationship between the abrasion resistance performance of clothing and real-world injury outcome. Clothing was collected from riders who crashed on public roads in Sydney and Newcastle, Australia. This clothing was tested according to the EU Standard and the time to hole was recorded. Hospital medical records were reviewed and the association between a rider suffering a soft tissue injury and the time-to-hole for the garment was examined. The probability of soft tissue injury for Level 1 Standard garments was between 40-60%, but more than 60% of garments tested failed to meet the minimum requirement. The findings of this study provide qualified support for the Standard, with a marginal association between time-to-hole and injury being found. This work supports the need for improved safety performance and an increased number of high performing garments being available to motorcyclists.
Short Communications from AAAM's 59th Annual Scientific Conference
Publisher: Informa UK Limited
Date: 05-10-2015
A Comparison of Alternative Anchorage Systems for Child Restraints in Side Impacts
Publisher: SAE International
Date: 12-11-1997
DOI: 10.4271/973303
Children in Adult Seat Belts and Child Harnesses: Crash Sled Comparisons of Dummy Responses
Publisher: SAE International
Date: 12-11-1997
DOI: 10.4271/973308
Distribution and Type of Crash Damage to Motorcyclists’ Clothing: Validation of the Zone Approach in the European Standard for Motorcycle Protective Clothing, EN13595
Publisher: Informa UK Limited
Date: 28-03-2014
DOI: 10.1080/15389588.2013.838672
Abstract: Though the use of protective clothing reduces the risk of injury for motorcycle riders, not all protective clothing performs the same in crashes. A European Standard for motorcycle protective clothing (EN13595) was released in 2002 that specifies 4 zones in motorcycle clothing with different levels of protective qualities and 4 different test methods for assessing damage resistance. This project examined damage location and type in clothing worn by riders following a crash to establish the distribution of impact points and validate the zones described in EN13595. Data from 117 crashed motorcycle riders collected during crash investigation were examined. These data included medical data and clothing inspections and contained 576 cases of clothing damage. To ensure that the impact point distribution included all possible contact locations, an additional 433 distinct injury locations were examined where injury had occurred but clothing was either undamaged or not present at that location. Descriptive techniques were used in the analysis. The majority of damage occurred in areas covering the extremities or pelvic girdle (93%), with most occurring on the wrists and hands (18%) and ankles and feet (18%). Clothing regions covering the shoulder (10%), forearm (10%), elbow (9%), thigh (7%), lower leg (6%), and pelvic-hip region (5%) were also frequently damaged. Other body regions contributed only 8 percent of damage seen. Analysis of distinct injury locations demonstrated a similar distribution of impact. The most common types of clothing damage were abrasion, accounting for 69 percent, and torn material, which accounted for 26 percent of all damage. Further, the majority of material abrasion and tearing occurred in regions corresponding to zone 1, followed by zones 2, 3, and then 4. There were very few instances (3%) of burst and cut damage. The results are in agreement with the general concept of the zones used in the EU Standard. However, these results indicate that minor adjustments may be warranted. In particular, the number of impacts to the forearm and lower leg suggest that these regions might be better protected by considering the whole regions as zone 1or 2 rather than the multiple regions as currently indicated in the EU Standard. However, the subjective nature of determining the zone in which damage (and/or injury) occurred limits these findings and any others that attempt to validate the zone principles using real-world data. Further validation requires consideration of the severity of impact at different zones.
Paediatric injury from indoor trampoline centres.
Publisher: BMJ
Date: 15-08-2016
DOI: 10.1136/INJURYPREV-2016-042071
Abstract: Indoor tr oline parks are increasing as a source of injuries among children. We conducted a prospective cohort study, with semi-structured interview and medical record review, of children aged <17 years presenting to a paediatric emergency department following an injury at an indoor tr oline park. In a 6-month period in 2014, 40 such children (55% female) presented to the department. Common mechanisms were in idual jumpers falling while attempting a somersault or trick, landing awkwardly on an obstacle such as a ball or protective padding, and multiple users on a single tr oline. Most sustained soft tissue injuries (n=22, 55%) and fractured bones (n=15, 37.5%). One child sustained an unstable cervical fracture/dislocation. Unlike domestic tr olines, where the majority of injuries occur from falling off, most tr oline-park injuries occur on the tr oline surface. These differences require injury prevention strategies that engage children, carers and businesses to meet best practice design and management standards.
Assessment of Vehicle and Restraint Design Changes for Mitigating Rear Seat Occupant Injuries
Publisher: Informa UK Limited
Date: 26-11-2014
DOI: 10.1080/15389588.2013.867433
Abstract: Investigate the combined effects of belt geometry, seat substructure, and seat belt pretensioners and load limiters on rear seat occupant injury risk. An instrumented Hybrid III 5th percentile adult female dummy was subjected to simulated frontal impacts (Δv = 45.8 km/h, peak acceleration = 27.1 g). Testing was conducted on a rear seat of a typical family sedan with modifications allowing for adjustment in upper anchorage position, mounting of an antisubmarining seat pan, and the use of seat belt pretensioners with load limiters. Dummy seated posture had the strongest effect on submarining. Seat belt pretensioners with load limiters reduced head and femur excursion and decreased chest injury measurements but did not prevent submarining. The antisubmarining seat pan, on the other hand, prevented submarining in one case but could not prevent submarining with the dummy in a slouched posture. Upper anchorage position resulting in poor belt geometry was shown to increase both chest injury measures and submarining. The results from this study demonstrate the importance of an upright seated posture and the potential benefits of including adjustable upper anchorages to allow good sash belt fit, antisubmarining seat pans, belt buckles positioned near the seat bight, and seat belts with pretensioners and load limiters for rear seat occupants. These data can be used to inform the design of a system of restraints to reduce injuries to rear seat occupants.
Toward a Behavior Theory–Informed and User-Centered Mobile App for Parents to Prevent Infant Falls: Development and Usability Study
Publisher: JMIR Publications Inc.
Date: 20-12-2021
DOI: 10.2196/29731
Abstract: Falls account for approximately 50% of infant injury hospitalizations, and caretaker behavior is central to preventing infant falls. Behavior theory–informed interventions for injury prevention have been suggested, but to date, few have been reported. The potential of using smartphones for injury prevention intervention delivery is also underexploited. This study aims to develop a behavior theory– and evidence-based as well as user-centered digital intervention as a mobile app for parents to prevent infant falls following agile development practices. Infant falls while feeding was selected as the fall mechanism to demonstrate the approach being taken to develop this intervention. In phase 1, the Behaviour Change Wheel was used as a theoretical framework supported by a literature review to define intervention components that were then implemented as a mobile app. In phase 2, after the person-based approach, user testing through think-aloud interviews and comprehension assessments were used to refine the content and implementation of the intervention. The target behaviors identified in phase 1 were adequate rest for the newborn’s mother and safe feeding practices defined as prepare, position, and place. From behavioral determinants and the Behaviour Change Wheel, the behavior change functions selected to achieve these target behaviors were psychological capability, social opportunity, and reflective motivation. The selected behavior change techniques aligned with these functions were providing information on health consequences, using a credible source, instruction on performing each behavior, and social support. The defined intervention was implemented in a draft Android app. In phase 2, 4 rounds of user testing were required to achieve the predefined target comprehension level. The results from the think-aloud interviews were used to refine the intervention content and app features. Overall, the results from phase 2 revealed that users found the information provided to be helpful. Features such as self-tracking and inclusion of the social and environmental aspects of falls prevention were liked by the participants. Important feedback for the successful implementation of the digital intervention was also obtained from the user testing. To our knowledge, this is the first study to apply the Behaviour Change Wheel to develop a digital intervention for child injury prevention. This study provides a detailed ex le of evidence-based development of a behavior theory–informed mobile intervention for injury prevention refined using the person-based approach.
Validation of the principles of injury risk zones for motorcycle protective clothing
Publisher: Elsevier BV
Date: 09-2014
DOI: 10.1016/J.JSR.2014.04.003
Abstract: The distributions of motorcycle crash impacts and injuries were compared to the four impact risk zones and protective performance specified in the European Standard for motorcycle clothing (EN 13595). Crashed motorcyclists' (n=117) injuries and clothing damage were categorized by body area into the four risk zones. Three levels of protection were defined: protective clothing with impact protection, protective clothing only and non-protective clothing. The distribution of impact/injury sites corresponded to the predictions of EN 13595, with the proportion of all injuries decreasing from 43.9% in Zone 1, to 18.0%, 16.7%, and 11.5% in Zones 2 to 4, respectively. Protective clothing modified the distribution of injuries with substantially more injuries (OR=2.69, 95% CL: 20.1-3.59) at unprotected impact sites. These findings support an appropriate framework for determining performance specifications for the manufacture of motorcycle clothing that will effectively reduce the risk of injury in crashes.
Behind the Wheel: Predictors of Driving Exposure in Older Drivers
Publisher: Wiley
Date: 06-2015
DOI: 10.1111/JGS.13440
Abstract: To explore and deepen understanding of factors influencing driving exposure for older drivers. Cross-sectional. Baseline data on function and driving exposure from 1 week of driving were evaluated. A convenience s le of 380 drivers aged 75 and older, residing in northwest Sydney, was recruited. Participants were required to be the primary drivers of their own vehicle. Driver function was evaluated using the DriveSafe and DriveAware clinic-based assessments to measure visual attention to the driving environment and awareness of driving ability. Demographic information was obtained through interview. An in-vehicle monitoring device with data logger and GPS receiver, was used to measure driving exposure in 362 of 380 participants' vehicles. Driving exposure outcomes were total distance driven, furthest distance traveled from home, and average trip length. Factors influencing these exposure outcomes were analyzed using generalized linear regression. Drivers typically drove 100 km in local and surrounding areas during the week. Function was predictive of all driving exposure outcomes. Drivers with lower levels of function drove fewer kilometers and took shorter trips closer to home. Age, health status, and personal circumstance (e.g., rural residence) also influenced exposure, but sex did not. Using objective measures, this study provides evidence that function, age, health status, and personal circumstance influence driving exposure of older drivers. Understanding how older people use driving to preserve their independence is important for exploring safe driving strategies for older people.
The Scope and Nature of Injuries to Rear Seat Passengers in NSW Using Linked Hospital Admission and Police Data
Publisher: Informa UK Limited
Date: 28-03-2014
DOI: 10.1080/15389588.2013.833662
Abstract: To compare the pattern of injuries to front and rear seat occupants and test the hypothesis that rear seat passengers of different ages sustain different patterns of injury. Patients admitted to a hospital following involvement in a crash in New South Wales (NSW) Australia between 2005 and 2007 were identified using International Classification of Diseases (10th edition [ICD10]) codes. Hospital admissions data were linked with NSW police crash data using probabilistic techniques. The profiles and patterns of injury of front and rear seat passengers were compared. Logistic regression was used to examine how age influenced the pattern of injury among rear seat passengers. Sixty-three percent of hospital admissions were linked with police records. One in 5 passengers were rear seat passengers. There were more unrestrained occupants in the rear (7%) compared to drivers (3%) and front seat passengers (2%). Younger (9-15 years) injured passengers were seated in the rear more often than in the front passenger position and older injured passengers (>50 years) were seated more often in the front passenger position than in the rear (15% rear compared to 5% front aged 9-15 years 22% rear compared to 37% front aged >50 years χ(2), P 50 years) rear passengers had 6.3 times the odds of sustaining thoracic injuries (95% confidence interval [CI], 2.6-15.0) and lower odds (odds ratio [OR] = 0.4, 95% CI, 0.2-0.9) of sustaining abdominal/lumbar injuries than the youngest occupants (9-15 years).The odds of sustaining a head injury did not vary with age, and the odds of sustaining thoracic, abdominal, or lower extremity injuries did not differ significantly between rear seat passengers aged 16-50 years and 9-15 years. The findings suggest that there is a need for enhanced protection for rear seat passengers, because they have proportionally more fatal injuries than front-seated occupants. The frequency of abdominal injury and the differences between injury patterns observed in front seat passengers suggests a potential benefit from adding abdominal injury risk assessment to rear seat occupant protection test protocols. There is also scope to improve chest protection for older rear seat passengers.
Exploring child car passenger safety practices in China: Experience from a parental survey in Shanghai
Publisher: BMJ
Date: 28-09-2012
DOI: 10.1136/INJURYPREV-2011-040049
Abstract: Little is known about child passenger safety practice in China. This study aims to describe child passenger seating and restraint practice in Shanghai. Information on 970 children enrolled in five randomly selected kindergartens in the Songjiang and Pudong districts of Shanghai was collected from a parental survey during 2008-2009. The adjusted rate ratios for optimal (rear-seated alone) versus suboptimal seating position (including front-seated or sitting in adult laps) and restraint use versus non-use of restraints among child passengers were evaluated using multivariate binomial regression. Suboptimal seating position (16.9%) and non-use of restraints (60.8%) was common among child passengers. Younger age (≤4 years) and having parents who are licensed drivers decreased the likelihood of being rear-seated alone whereas having a tertiary-educated mother increased the likelihood of a child being seated optimally. Compared with unlicensed parents, guardian parents who have a driver's licence were more likely to use restraints for their child passengers. This study suggests restraint non-use and suboptimal seating position are common for child passengers in the Songjiang and Pudong districts of Shanghai, and identifies risk factors influencing restraint use and seating position choice for child passengers. There is an urgent need to improve child passenger safety in China and these findings indicate potential targets for educational interventions in the absence of child restraint laws.
Child restraint use and parental perceptions of comfort
Publisher: Informa UK Limited
Date: 07-2016
DOI: 10.1080/15389588.2016.1142078
Abstract: Suboptimal child restraint use includes incorrect and/or inappropriate restraint use and increases the risk of injury. Comfort has been suggested as an important factor impacting on optimal use of restraints by children. This article aims to examine the relationships between parent reported comfort and restraint misuse and age-appropriate restraint choice. This is an analysis of data from a cross sectional observation study of child restraint use in New South Wales. Logistic regression was used to model the relationship between parent-reported comfort and restraint misuse and age-appropriate restraint choice. There was no significant relationship between either parent-reported comfort and restraint misuse or parent-reported comfort and age-appropriate restraint choice. Parent perceptions of comfort of children in child restraints do not appear to be associated with incorrect child restraint use or age appropriate restraint choice. It is possible that the actual comfort of the child may be related to incorrect use but this remains to be tested. Further investigation of the relationship between parent-perceived comfort and the actual comfort of the child, as well as the impact of child comfort on optimal child restraint use is warranted.
Design and sled testing of a high back booster seat prototype offering improved side impact protection
Publisher: Informa UK Limited
Date: 04-2005
A process evaluation protocol for examining the impact of instructions for correct use of child car seats designed through a consumer-driven process and evaluated in a field-based randomised controlled trial
Publisher: MDPI AG
Date: 23-06-2020
Abstract: The incorrect use of child car seats is common, with significant negative effects on crash protection for child passengers. There is currently little evidence for effective, practical countermeasures for incorrect use. The provision of clear and comprehensible materials on correct use supplied with restraints at the point of sale could be highly cost-effective and achieve similar benefits to restraint-fitting services or hands-on training however, routinely supplied instructions in their current form are frequently difficult to understand. We are conducting a randomised controlled trial of the consumer-driven redesign of instructional materials, consisting of an instruction sheet, swing tags and online training videos. This paper presents the protocol that will be used in an innovate process evaluation that will use the primary outcome of overall serious misuse assessed at six months, together with a survey and semi-structured interviews to determine fidelity, dose and outcomes for all intervention participants. The study will assess intervention delivery and external factors that may impact the effectiveness of the intervention, including experience, health literacy, confidence and attitudes. When it has been conducted, this process evaluation will provide enhanced understanding of the mechanisms through which the intervention works or not, aspects of the implementation process key to success of the intervention and insight into how external factors influence the success of the intervention.
Exploring the potential of behaviour theory-informed digital intervention for infant fall prevention, a mixed method longitudinal study (Preprint)
Publisher: JMIR Publications Inc.
Date: 17-03-2023
Abstract: alls are the most common hospitalised injury mechanism of children under 1 year, and currently, there are no targeted prevention interventions. Prevention of falls in children of this age requires changes in behaviour of their caregivers, and theoretically informed digital behaviour change interventions (DBCI) may provide a unique mechanism for achieving effective intervention. However, user acceptance and the ability of DBCI to affect the required changes in behaviour are critical to their likely success. he objective of the study was to evaluate a behaviour theory-informed digital intervention developed following a user-centred approach for user experience, the potential for this intervention to prevent infant falls, and its impact on behavioural drivers underpinning fall risk in young children. arents of infants were recruited aged year were recruited and asked to use the intervention for 3 months. A pre-post longitudinal design was followed to examine the change in the potential to reduce the risk of falls after 3-month exposure to the intervention. Post-intervention data on behavioural drivers for fall prevention, user acceptability and engagement with the app, were also collected. Interviews were conducted to explore user experience and to identify any areas for further improvement of the intervention. total of 62 parents participated in the study. A statistically significant effect on the potential to reduce falls was observed post-intervention. The effect was higher for new parents. Parents agreed the intervention targeted most of the target behaviour drivers. Behaviour drivers and intervention impact on potential for fall prevention had a positive correlation. The intervention demonstrated good levels of acceptability. Feedback from participants was mostly positive, and the primary area identified for further improvement was widening the scope of the intervention. his study demonstrated the promise of a newly developed digital intervention on reducing the risk of infant falls, particularly among new parents. It also showed a positive influence of the DBCI on drivers of parental behaviours important for fall reduction among infants. Acceptability of the app was high, and important insights were gained from users about how to further improve the app.
Evaluation of an education, restraint distribution, and fitting program to promote correct use of age-appropriate child restraints for children aged 3 to 5 years: a cluster randomized trial.
Publisher: American Public Health Association
Date: 12-2012
Abstract: Objectives. We evaluated an education, distribution, and fitting program for increasing age-appropriate and correct child restraint use. Methods. We performed a cluster randomized trial involving 28 early childhood education centers in low socioeconomic status areas in Sydney, Australia. The main outcome was optimal restraint use defined as age-appropriate restraints, installed into the vehicle correctly and used correctly. Results. One service withdrew after randomization, so data are presented for 689 child passengers, aged 3 to 5 years, from 27 centers. More children attending intervention centers were optimally restrained (43% vs 31% P = .01 allowing for clustering). More 3-year-olds were using forward-facing seats rather than booster seats, more 4- to 5-year-olds were using booster seats instead of seat belts alone, and there were fewer errors in use at intervention centers. Among non–English-speaking families, more children attending intervention centers were optimally restrained (43% vs 17% P = .002 allowing for clustering). Conclusions. The program increased use of age-appropriate restraints and correct use of restraints, which translates to improved crash injury protection. Multifaceted education, seat distribution, and fitting enhanced legislation effects, and the effect size was larger in non–English-speaking families.
Head excursion in frontal impacts is lower in high back booster seats than in forward facing child seats with internal harnesses designed for children up to 8 years of age
Publisher: Informa UK Limited
Date: 25-03-2022
DOI: 10.1080/15389588.2022.2048825
Abstract: It is often assumed that a child restraint with a five or six-point internal harness provides greater protection for children in frontal crashes than a booster seat with a lap-sash seat belt. However, most research comparing these restraint types has focused on protection for children aged up to approximately 3-4 years of age. Recently, harnessed child restraints for older children up to approximately 8 years of age have become available, but there is little data on their performance compared to booster seats for children over 4 years of age. This study aimed to compare frontal crash performance of a series of harnessed child restraints for children aged 4-8 years to booster seats. Four large harnessed child restraints (Type G in the Australian Standard, AS/NZS 1754:2013) and six high back booster seats (Type E in AS/NZS 1754:2013) were tested in frontal impact on a deceleration sled. Head and pelvis accelerations were recorded and head excursions were measured from high speed video. Head excursion was an average of 92 mm greater in the large harnessed child restraints than the high back booster seats. The initial position of the head in Type G restraints, an average of 58 mm further forward compared to Type E boosters, was the main contributor to the larger head excursion during impact. Conversely, peak head accelerations in the impact phase were, on average, 37.2 g lower in the large harnessed child restraints than the high back booster seats. These data suggest that recommendations for harnessed restraints and booster seats for children aged 4-8 years is not as obvious as is sometimes assumed. Harnessed restraints allow greater head excursion in frontal impacts, potentially increasing the chances of head impacts, especially in vehicles with limited clearance between the restraint and the seat in front. The likelihood, and types of, incorrect use that occur in each restraint type, the vehicle occupant space, and the restraint's crash performance under ideal conditions should be considered in recommending restraints for these older children.
Predictors of older drivers' involvement in high-range speeding behavior
Publisher: Informa UK Limited
Date: 18-12-2017
DOI: 10.1080/15389588.2016.1225297
Abstract: Even small increases in vehicle speed raise crash risk and resulting injury severity. Older drivers are at increased risk of involvement in casualty crashes and injury compared to younger drivers. However, there is little objective evidence about older drivers' speeding. This study investigates the nature and predictors of high-range speeding among drivers aged 75-94 years. Speed per second was estimated using Global Positioning System devices installed in participants' vehicles. High-range speeding events were defined as traveling an average 10+km/h above the speed limit over 30 seconds. Descriptive analysis examined speeding events by participant characteristics and mileage driven. Regression analyses were used to examine the association between involvement in high-range speeding events and possible predictive factors. Most (96%, 182/190) participants agreed to have their vehicle instrumented, and speeding events were accurately recorded for 97% (177/182) of participants. While 77% (136/177) of participants were involved in one or more high-range events, 42% (75/177) were involved in greater than five events during 12-months of data collection. Participants involved in high-range events drove approximately twice as many kilometres as those not involved. High-range events tended to be infrequent (median = 6 per 10,000 km IQR = 2-18). The rate of high-range speeding was associated with better cognitive function and attention to the driving environment. This suggests those older drivers with poorer cognition and visual attention may drive more cautiously, thereby reducing their high-range speeding behavior.
Improved protection for children in forward-facing restraints during side impacts
Publisher: Informa UK Limited
Date: 06-2005
DOI: 10.1080/15389580590931608
Abstract: This study aims to determine the potential for improved child occupant protection in side impacts that can be obtained using rigid and semi-rigid anchorage systems and the addition of energy-absorbing padding in the side structures of child restraints. This study uses a comprehensive set of simulated side impacts to evaluate the potential for improved side impact protection in forward-facing child restraints. Factors investigated included methods of anchoring the restraint to the vehicle, energy-absorbing materials in the side structure of restraints, and design features of the restraints such as side wing geometry and seat belt routing. The results show clearly that completely rigid lower attachment of restraints offers the potential for great reductions in head injury risk, which anchorage systems employing a combination of a rigid anchorage bar and webbing attached to a child restraint cannot match. The addition of energy absorbing material in the side structure of restraint systems is effective when the head is fully contained within an adequately designed side wing structure. For restraints anchored by seat belts and loop style semi rigid anchorage straps, belt routing has the potential to significantly affect occupant head excursion. The results suggest that current child restraint standards and consumer testing protocols do not adequately encourage best practice design of child restraints for side impact protection.
Predictors of older drivers' involvement in high-range speeding behavior
Publisher: Informa UK Limited
Date: 18-12-2017
DOI: 10.1080/15389588.2016.1225297
Abstract: Even small increases in vehicle speed raise crash risk and resulting injury severity. Older drivers are at increased risk of involvement in casualty crashes and injury compared to younger drivers. However, there is little objective evidence about older drivers' speeding. This study investigates the nature and predictors of high-range speeding among drivers aged 75-94 years. Speed per second was estimated using Global Positioning System devices installed in participants' vehicles. High-range speeding events were defined as traveling an average 10+km/h above the speed limit over 30 seconds. Descriptive analysis examined speeding events by participant characteristics and mileage driven. Regression analyses were used to examine the association between involvement in high-range speeding events and possible predictive factors. Most (96%, 182/190) participants agreed to have their vehicle instrumented, and speeding events were accurately recorded for 97% (177/182) of participants. While 77% (136/177) of participants were involved in one or more high-range events, 42% (75/177) were involved in greater than five events during 12-months of data collection. Participants involved in high-range events drove approximately twice as many kilometres as those not involved. High-range events tended to be infrequent (median = 6 per 10,000 km IQR = 2-18). The rate of high-range speeding was associated with better cognitive function and attention to the driving environment. This suggests those older drivers with poorer cognition and visual attention may drive more cautiously, thereby reducing their high-range speeding behavior.
A comparison of the management of blunt splenic injury in children and young people—A New South Wales, population-based, retrospective study
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.INJURY.2017.08.023
Abstract: The importance and safety of non-operative management (NOM) of Blunt Splenic Injury (BSI) has been established in children and adults over recent decades. However, studies have shown higher operation rates in adults. There is international evidence that when children are managed in adult centres, operation rates are higher while adolescents in paediatric centres, are operated on in line with paediatric guidelines. This difference between children and young adults, and the factors responsible, have not been examined in New South Wales (NSW). To use NSW hospital and mortality data to compare the characteristics of BSI in patients aged 0-16 to those aged 17-25, and determine factors related to operative management (OM) and splenic salvage in each group. Patients age 0-25 between July 2000 and December 2011, with a diagnosis of BSI, were identified in the NSW Admitted Patient Data Collection, and linked to deaths data from Registry of Births Deaths and Marriages and Bureau of Statistics. Operation rate was compared between the two groups. Univariable analysis was used to determine factors associated with OM. Multivariable logistic regression with stepwise elimination was then performed to determine likelihood of OM according to age group, adjusting for potential confounders. 1986 cases were identified, with 422 (21.2%) managed operatively - 101/907 children (11.1%) and321/1079 (29.7%)young adults(p<0.001). Of these, 59 (58%) children underwent splenectomy compared with 233 (73%) young adults (p<0.001). OM increased significantly after the age of 12 (p=0.03), and the percentage almost tripled in the teenage years, coinciding with a higher proportion admitted to adult centres. OM doubled again in young adults(p<0.001), all of whom were managed away from paediatric centres. On multivariable analysis, factors significantly associated with operation included age over 16 (OR 2.82, 95%CI 2.10-3.81), splenic injury severity, associated thoracic, liver, pancreatic and hollow viscus injury, and blood transfusion. While Paediatric Surgeons have wholeheartedly adopted non-operative management, away from paediatric centres, it is possible children and young people in NSW are undergoing operation unnecessarily. Further evaluation of the surgeon attitudes and institutional factors involved in the management of injured children and young people within the broad NSW trauma system is required.
Quality of harness fit for normal and low birthweight infants observed among newborns in infant car seats
Publisher: BMJ
Date: 15-07-2016
DOI: 10.1136/INJURYPREV-2016-042069
Abstract: Child restraint fit is important for crash protection. For newborns, standards universally require a rear-facing restraint and some upper limit on size, but historically there has been no specification of a lower design limit and there is concern over whether low birthweight infants (LBW) are adequately restrained. The aim of this study was to determine the quality of harness fit for newborns of low and normal weight in a range of modern child restraints. A convenience s le of infants (1.657-4.455 kg) were recruited from the postnatal ward and special care nursery <1 week from discharge. Infants (n=84) were assessed for harness fit in rear-facing-only restraints, convertible rear/forward restraints and a subset were assessed in a restraint specifically designed to accommodate LBW infants. Measures of harness fit were based on shoulder strap, crotch strap and buckle positioning. Less than 20% of infants achieved good harness fit, regardless of whether they were categorised as low (<2.5 kg) or normal weight. Rear-facing-only restraints were less likely to provide good fit than convertible restraints, in all measures of fit other than shoulder strap width. The proportions of infants achieving good fit were greater in the restraint designed for LBW infants than other restraint types. Poor accommodation continues to be a problem for LBW infants but is rectified in specifically designed restraints. Better specification of harness configuration for all rearward-facing restraints may be required to ensure adequate accommodation of normal birthweight infants.
Associations between vision impairment and driving and the effectiveness of vision-related interventions: protocol for a systematic review and meta-analysis
Publisher: BMJ
Date: 11-2020
DOI: 10.1136/BMJOPEN-2020-040881
Abstract: Driving is one of the main modes of transport with safe driving requiring a combination of visual, cognitive and physical skills. With population ageing, the number of people living with vision impairment is set to increase in the decades ahead. Vision impairment may negatively impact an in idual’s ability to safely drive. The association between vision impairment and motor vehicle crash involvement or driving participation has yet to be systematically investigated. Further, the evidence for the effectiveness of vision-related interventions aimed at decreasing crashes and driving errors has not been synthesised. A search will be conducted for relevant studies on Medline (Ovid), EMBASE and Global Health from their inception to March 2020 without date or geographical restrictions. Two investigators will independently screen abstracts and full texts using Covidence software with conflicts resolved by a third investigator. Data extraction will be conducted on all included studies, and their quality assessed to determine the risk of bias using the Joanna Briggs Institute Critical Appraisal Tools. Outcome measures include crash risk, driving cessation and surrogate measures of driving safety (eg, driving errors and performance). The results of this review will be reported using the Preferred Reporting Items for Systematic Review and Meta-Analysis guideline. Meta-analysis will be undertaken for outcomes with sufficient data and reported following the Meta-analyses of Observational Studies in Epidemiology guideline. Where statistical pooling is not feasible or appropriate, narrative summaries will be presented following the Synthesis Without Meta-analysis in systematic reviews guideline. This review will only report on published data thus no ethics approval is required. Results will be included in the Lancet Global Health Commission on Global Eye Health, published in a peer-reviewed journal and presented at relevant conferences. CRD42020172153.
Energy attenuation performance of impact protection worn by motorcyclists in real-world crashes
Publisher: Informa UK Limited
Date: 28-04-2017
DOI: 10.1080/15389588.2017.1311014
Abstract: Laboratory studies have demonstrated that impact protectors (IP) used in motorcycle clothing can reduce fracture severities. While crash studies have reported IP are associated with reduced likelihood of soft tissue injury, there is little evidence of their effectiveness in reducing fracture likelihood. This discrepancy might be related to IP quality. There are mandatory requirements for IP supplied with protective clothing in Europe, but not elsewhere. This study examines the energy attenuation performance of IP used by Australian riders. IP were harvested from clothing worn by crashed riders admitted to hospital. The IP were examined and energy attenuation properties were determined using EN 1621-1 test procedures. Impact injury was identified from medical records and defined as fractures, dislocations, and avulsions that occurred following impact to the rider's shoulders, elbows, hips, and/or knees. Fisher's exact test was used to examine the relationship between meeting the EN 1621-1 energy attenuation requirements and impact injury. The association between the average and maximum transmitted force, and impact injury was examined using generalized estimating equations. Motorcycle riders were recruited as part of an in-depth crash study through three hospitals in New South Wales, Australia, between 2012 and 2014. Riders were interviewed, and engineers conducted site, vehicle, and clothing inspections. Clothing was collected, or identical garments were purchased. Clothing was inspected for 62 riders. Of these, 19 wore clothing incorporating 76 IP. Twenty-six of these were impacted in the crash event. Almost all impacted IP (96%) were CE marked, and most (83%) met Level 1 energy attenuation requirements of EN 1621-1 when tested. Of the 26 impacted IP, four were associated with impact injuries, including midshaft and distal clavicle fractures and a scapula and olecranon fracture. No associations between meeting EN 1621-1 requirements and impact injury were found (p = 0.5). There was no association between average force transmitted and impact injury (95% CI: 0.91-1.24) however, as maximum force transmitted increased, the odds of impact injury increased (95% CI: 1.01-1.2). These results indicate a high probability of impact injury at 50 kN, the limit of maximum transmitted force specified in EN 1621-1. The allowable transmitted force of EN 1621-1 may be too high to effectively reduce the probability of impact injury. This is not surprising, given human tolerance levels that are reported in literature. Reducing the force limit below the reported fracture tolerance limits might be difficult with current technology. However, there is scope to reduce the EN 1621-1 maximum limit of 50 kN transmitted force. A reduction in the maximum force limit would improve rider protection and appears feasible, as 77% of tested IP recorded a maximum force <35 kN. This level of transmitted force is estimated to be associated with <20% probability of impact injury. While the performance of IP available to Australian riders is not regulated, most IP was CE marked. The results indicate a significant association between maximum transmitted force, tested according to EN 1621-1 procedures, and impact injury. Further investigation of the EN 1621-1 requirements may be warranted. This work will interest those targeting protective equipment for motorcyclists as a mechanism for reducing injury to these vulnerable road users.
Out of the silos: embedding injury prevention into the Sustainable Development Goals
Publisher: BMJ
Date: 11-09-2020
DOI: 10.1136/INJURYPREV-2020-043850
Abstract: Globally, unintentional injuries contribute significantly to disability and death. Prevention efforts have traditionally focused on in idual injury mechanisms and their specific risk factors, which has resulted in slow progress in reducing the burden. The Sustainable Development Goals (SDGs) represent a global agenda for promoting human prosperity while respecting planetary boundaries. While injury prevention is currently only recognised in the SDG agenda via two road safety targets, the relevance of the SDGs for injury prevention is much broader. In this State of the Art Review, we illustrate how unintentional injury prevention efforts can be advanced substantially within a broad range of SDG goals and advocate for the integration of safety considerations across all sectors and stakeholders. This review uncovers injury prevention opportunities within broader global priorities such as urbanisation, population shifts, water safeguarding and corporate social responsibility. We demonstrate the relevance of injury prevention efforts to the SDG agenda beyond the health goal (SDG 3) and the two specific road safety targets (SDG 3.6 and SDG 11.2), highlighting 13 additional SDGs of relevance. We argue that all involved in injury prevention are at a critical juncture where we can continue with the status quo and expect to see more of the same, or mobilise the global community in an ‘Injury Prevention in All Policies’ approach.
Updated population-level estimates of child restraint practices among children aged 0-12 years in Australia, ten years after introduction of age-appropriate restraint use legislation
Publisher: Cold Spring Harbor Laboratory
Date: 18-03-2022
DOI: 10.1101/2022.03.17.22272591
Abstract: To determine child restraint practices approximately 10 years after introduction of legislation requiring correct use of age-appropriate restraints for all children aged up to 7 years. A stratified cluster s le was constructed to collect observational data from children aged 0-12 years across the Greater Sydney region of NSW. Methods replicated those used in a similar 2008 study. Population weighted estimates for restraint practices were generated, and logistic regression used to examine associations between restraint type, and child age with correct use accounting for the complex s le. Almost all children were appropriately restrained (99.3%, 95% CI 98.4-100). However, less than half were correctly restrained (No error = 27.3%, 95% CI 10.8-43.8, No serious error = 43.8%, 95% CI 35.0-52.7). For any error , the odds of error decreased by 39% per year of age (OR 0.61, 95% 0.46-0.81), and for serious error by 25% per year (OR 0.75 95% CI 0.60-0.93). The findings demonstrate a substantial increase in appropriate child restraint, but no real change in correct use. Given the negative impact incorrect use has on crash protection, continuing high rates of incorrect use may reduce effectiveness of legislative change on injury reduction.
A novel approach to study the health consequences of road crashes
Publisher: Elsevier BV
Date: 12-2017
Injury patterns of rear seat occupants in frontal impact: An in-depth crash investigation study
Publisher: BMJ
Date: 09-12-2016
DOI: 10.1136/INJURYPREV-2015-041715
Abstract: Rear seat occupants are now at a higher risk of injury relative to front seat occupants and there is a need for enhanced protection. This study aimed to examine the pattern of injury, injury mechanisms and injury sources to restrained motor vehicle rear seat occupants involved in a frontal impact. Cases involving restrained rear seat occupants aged 9 years and older involved in frontal crashes were prospectively collected from in-depth crash investigations collected in New South Wales and Victoria, Australia, between 2000 and 2010. Structured occupant and driver interviews were conducted to ascertain crash parameters, medical records were reviewed and detailed injury descriptions were recorded using the abbreviated injury scale (AIS). Vehicle and scene inspections were also conducted and injury sources determined. The dataset included 29 rear seat occupants aged 9-80 years. AIS2+ injuries were most commonly observed in the chest and abdomen. Chest injuries were more commonly observed in older occupants, while abdominal and thoracolumbar spine injuries were mostly observed in younger occupants. The seat belt was the most common source of injury to rear seat occupants. The seat belt is the most common source of injury to rear seat passengers in frontal impact with variations in injury with age. There is a need to provide appropriate belt fit and better control seat belt loads for rear seat passengers. This could be achieved, at least in part, with existing technologies currently used in front seat positions, although novel technologies may also be useful.
Predictors of older drivers’ involvement in rapid deceleration events
Publisher: Elsevier BV
Date: 2017
DOI: 10.1016/J.AAP.2016.10.010
Abstract: Rapid deceleration occurs when substantial force slows the speed of a vehicle. Rapid deceleration events (RDEs) have been proposed as a surrogate safety measure. As there is concern about crash involvement of older drivers and the effect of age-related declining visual and cognitive function on driving performance, we examined the relationship between RDEs and older driver's vision, cognitive function and driving confidence, using naturalistic driving measures. Participants aged 75 to 94 years had their vehicle instrumented for 12 months. To minimise the chance of identifying false positives, accelerometer data was processed to identify RDEs with a substantial deceleration of >750 milli-g (7.35m/s
Comparative analysis of off-road vehicle crashes in children: motorcycles versus quad bikes.
Publisher: BMJ
Date: 13-07-2022
Abstract: To characterise and compare off-road motorcycle and quad bike crashes in children in New South Wales (NSW), Australia. A retrospective, cross-sectional study was performed of children aged 0-16 years, admitted to hospitals in NSW, from 2001 to 2018 following an injury sustained in an off-road motorcycle or quad bike crash, using linked hospital admissions, mortality and census data.Motorcycle and quad bike injuries were compared regarding: demographics incidence body region injured and type of injury injury severity based on the survival risk ratio length of stay and mortality. There were 6624 crashes resulting in hospitalisation 5156 involving motorcycles (77.8%) and 1468 involving quad bikes (22.2%). There were 10 fatalities (6 from motorcycles and 4 from quad bikes). The rates of injury declined over the study period for motorcycles, but not for quad bikes.Motorcycle riders were more likely than quad bike riders to have lower limb injuries (OR 1.49, p<0.001) but less likely to have head/neck (OR 0.616, p<0.001), abdominal (OR 0.778, p=0.007) and thoracic (OR 0.745, p=0.003) injuries. Quad bike crashes resulted in higher injury severity (mean International Classification Injury Severity Score 0.975 vs 0.977, p=0.03) and longer hospital stay (mean 2.42 days vs 2.09 days, p=0.01). There are significant differences between quad bike and motorcycle crashes in injury type and affected body region. While quad bike injuries in children were more severe, there were almost four times more hospitalisations from motorcycles overall. The overall larger burden of motorcycle crashes suggests a greater focus of injury prevention countermeasures for two-wheeled riders is needed.
The effect of correct cross-chest clip use on injury outcomes in young children during motor vehicle crashes
Publisher: Informa UK Limited
Date: 23-02-2018
DOI: 10.1080/15389588.2017.1410545
Abstract: Traffic crashes have high mortality and morbidity for young children. Though many specialized child restraint systems improve injury outcomes, no large-scale studies have investigated the cross-chest clip's role during a crash, despite concerns in some jurisdictions about the potential for neck contact injuries from the clips. This study aimed to investigate the relationship between cross-chest clip use and injury outcomes in children between 0 and 4 years of age. Child passengers between 0 and 4 years of age were selected from the NASS-CDS data sets (2003-2014). Multiple regression analysis was used to model injury outcomes while controlling for age, crash severity, crash direction, and restraint type. The primary outcomes were overall Abbreviated Injury Score (AIS) 2+ injury, and the presence of any neck injury. Across all children aged 0-4 years, correct chest clip use was associated with decreased Abbreviated Injury Scale (AIS) 2+ injury (odds ratio [OR] = 0.44, 95% confidence interval [CI], 0.21-0.91) and was not associated with neck injury. However, outcomes varied by age. In children <12 months old, chest clip use was associated with decreased AIS 2+ injury (OR = 0.09, 95% CI, 0.02-0.44). Neck injury (n = 7, all AIS 1) for this age group only occurred with correct cross-chest clip use. For 1- to 4-year-old children, cross-chest clip use had no association with AIS 2+ injury, and correct use significantly decreased the odds of neck injury (OR = 0.49 95% CI, 0.27-0.87) compared to an incorrectly used or absent cross-chest clip. No serious injuries were directly caused by the chest clips. Correct cross-chest clip use appeared to reduce injury in crashes, and there was no evidence of serious clip-induced injury in children in 5-point harness restraints.
Extent and Distribution of Vascular Brain Injury in Pediatric Road Fatalities
Publisher: Mary Ann Liebert Inc
Date: 09-2001
DOI: 10.1089/089771501750451776
Abstract: This study used a multidisciplinary approach to examine the brains of pediatric road trauma fatalities in the Sydney area over a 3-year period. The brains of 32 children (0-16 years) were examined: 20 pedestrians, nine passengers, and three cyclists. The extent and distribution of brain injury was assessed, peak linear head acceleration determined, and the severity of brain damage was compared to that previously reported for adults using the same scoring method. Skull fractures (20/32) and subarachnoid haemorrhage (22/32) were the commonest head injuries. In general, the neuropathology was similar to that seen in adults, with a high percentage of damage in the corpus callosum and gliding contusions within the subcortical white matter. Intracerebral hemorrhage was relatively rare. For frontal and occipital head impacts, the corpus callosum was the most injured part of the brain, followed by the deep central structures and the temporal lobes, whereas for lateral impacts, the injuries were more evenly distributed. Comparison of the current data for children with the vascular injury sector scores reported for adults suggests that the brains of children are more severely damaged for the same peak linear head acceleration.
Exploration of older drivers’ speeding behaviour
Publisher: Elsevier BV
Date: 10-2016
Restraint Use and Injury Patterns of Young Drivers and Passengers Admitted to Hospitals in New South Wales, Australia
Publisher: SAGE Publications
Date: 2014
DOI: 10.3141/2425-06
Abstract: Australians aged 17 to 25 years who travel in cars have a high risk of death and injury in crashes despite mandatory seat belt laws, graduated licensing programs for young drivers, and stringent enforcement. This analysis examined characteristics and injury outcomes of occupants aged 17 to 25 years injured in crashes in New South Wales, Australia. The study focused on restraint use. A linked hospital and police record data set for car occupants admitted to hospitals between 2005 and 2007 was used. Descriptive techniques were used to compare the characteristics of injured occupants of ages 17 to 25 years with those of older occupants and logistic regression was used to test the associations. Only 87% of injured young adults were wearing seat belts. Young adults were more likely than were their older counterparts to be in severe crashes, crashes that involved loss of control, crashes that involved single and older vehicles, and crashes when they were seated in the rear. Young adults also had more head, abdominal or lower torso, and neck injuries and fewer thoracic injuries than did older occupants. Young females were more likely to have been in newer vehicles and less likely to have been in more severe crashes than were young males. Young females also had fewer head injuries and more abdominal or lower torso injuries than young males had. Greater effort is required to increase the use of restraints and modern vehicles among young adults, to encourage industry to improve rear passenger protection, and to increase understanding of the factors that underpin the high involvement of young people in single-vehicle and loss-of-control crashes.
Association between different restraint use and rear-seated child passenger fatalities: A matched cohort study
Publisher: American Medical Association (AMA)
Date: 03-11-2008
DOI: 10.1001/ARCHPEDI.162.11.1085
Abstract: To investigate the association between restraint use and death in rear-seated child passengers and to examine whether the estimated association varies by restraint type and age. Matched cohort study. All reported crashed passenger vehicles with at least 2 rear-seated child passengers of whom at least 1 died from the US Fatality Analysis Reporting System for 1998 to 2006. Rear-seated child passengers aged 2 to 6 years. Three models of restraint use: (1) no restraint use, any restraint use (2) no restraint use, recorded improper restraint use (including improper use of seat belts or child restraints, use of shoulder-only seat belts, and use of an unknown type of restraint), any other restraint use and (3) no restraint use, improper restraint use, seat belts, and child restraints. Main Outcome Measure Death within 30 days of a crash. Compared with no restraint use, being restrained reduced the risk of death in rear-seated child passengers (relative risk [RR], 0.33 95% confidence interval [CI], 0.22-0.49). Compared with improper restraint use, any other restraint use reduced the risk of death (RR, 0.46 95% CI, 0.20-0.63). The RR of death for using child restraints compared with seat belts was 0.91 (95% CI, 0.57-1.14). Child restraints performed slightly better in fatality risk reduction in children aged 2 to 3 years (RR, 0.24 95% CI, 0.09-0.33) than in children aged 4 to 6 years (RR, 0.32 95% CI, 0.11-0.44) compared with traveling unrestrained. This study demonstrates the protective effects of restraints for child passengers and highlights the importance of using restraints correctly.
Serious injury is associated with suboptimal restraint use in child motor vehicle occupants
Publisher: Wiley
Date: 24-05-2006
DOI: 10.1111/J.1440-1754.2006.00870.X
Abstract: To investigate the relationship between restraint usage and injury outcome in child motor vehicle occupants aged 2-8 years. Retrospective case review of all child occupants presenting at the Children's Hospital at Westmead between July 2002 and January 2005 subsequent to a motor vehicle crash. Injury severity was assessed in terms of the Abbreviated Injury Scale (AIS), by age and type of restraint. Data were collected for 152 child occupants aged 2 and 8 years. While nearly all children (94%) used some restraint, most (82%) used a suboptimal form of restraint. Injury severity between optimally restrained children and suboptimally restrained children differed significantly (Fisher's exact test, P<0.001), with suboptimally restrained children receiving a greater proportion of moderate to severe (AIS 2+) injuries. No optimally restrained child sustained an AIS 2+ injury. A total of 82% of child occupants aged 2-8 years involved in crashes were suboptimally restrained. All children who sustained serious injuries were suboptimally restrained. There is a need to encourage correct use of the most appropriate restraint for child motor vehicle occupants in order to reduce the number and severity of injuries in these road users.
Can child restraint product information developed using consumer testing sustain correct use 6 months after child restraint purchase? Study protocol for a cluster randomised controlled trial
Publisher: BMJ
Date: 07-03-2019
DOI: 10.1136/INJURYPREV-2017-042571
Abstract: With long-standing and widespread high rates of errors in child restraint use, there is a need to identify effective methods to address this problem. Information supplied with products at the point of sale may be a potentially efficient delivery point for such a countermeasure. The aim of this study is to establish whether product materials developed using a consumer-driven approach reduce errors in restraint use among purchasers of new child restraint systems. A cluster randomised controlled trial (cRCT) will be conducted. Retail stores (n=22) in the greater Sydney area will be randomised into intervention sites (n=11) and control sites (n=11), stratified by geographical and socioeconomic indicators. Participants (n=836) will enter the study on purchase of a restraint. Outcome measures are errors in installation of the restraint as observed by a trained researcher during a 6-month follow-up home assessment, and adjustment checks made by the parent when the child is placed into the restraint (observed using naturalistic methods). Process evaluation measures will also be collected during the home visit. An intention-to-treat approach will be used for all analyses. Correct use and adjustment checks made by the parent will be compared between control and intervention groups using a logistic regression model. The number of installation errors between groups will be compared using Poisson regression. This cRCT will determine the effectiveness of targeted, consumer-driven information on actual error rates in use of restraints. More broadly, it may provide a best practice model for developing safety product information. ACTRN12617001252303p Pre-results.
Naturalistic speeding data: Drivers aged 75 years and older
Publisher: Elsevier BV
Date: 09-2016
“He’s the Number One Thing in My World”: Application of the PRECEDE-PROCEED Model to Explore Child Car Seat Use in a Regional Community in New South Wales
Publisher: MDPI AG
Date: 10-10-2017
Child restraint system misuse and/or inappropriate use in Australia
Publisher: Informa UK Limited
Date: 04-06-2009
DOI: 10.1080/15389580902856392
Abstract: Motor vehicle crashes are one of the leading causes of child death and acquired disability. Child restraint systems (CRS) for vehicles are designed to provide specialized protection for child occupants in the event of a crash. However, the effectiveness of a CRS is critically dependent on: correct installation of the CRS in the vehicle, the correct harnessing of the child in the CRS, and use of an appropriate CRS. The current study aimed to investigate the incidence misuse and/or inappropriate use of CRS through a CRS inspection program in the Australian states of New South Wales (NSW), Victoria (VIC), Queensland (QLD), South Australia (SA), Western Australia (WA), and Tasmania (TAS). Participants were recruited through an advertisement for free CRS inspections displayed at childcare centers, kindergartens, community centers, hospitals, and child expos. At each inspection, the CRS fitting specialist inspected and reported to the owner of the CRS on the installation of the child restraint(s) and/or system(s) and any fitting faults and/or concerns with the fitting and/or use if the child restraint(s) and or system(s). The following results are based on the inspection of 1386 vehicles, in which there were 1995 restraints. Of all the restraints inspected, the majority (79%) were reported as having at least one instance of misuse. The most common forms of misuse included harness strap errors such as the straps being adjusted, faulty, twisted, and/or incorrectly positioned (38%) seat belt errors such as the seatbelt being incorrectly routed, twisted, and/or incorrectly adjusted (32%) missing or incorrect fitting of gated buckle/locking clip (23%) the need for a missing sash guide (8%) tether errors such as the tether being incorrectly routed and/or adjusted (7%) inappropriate use of a CRS for the size of the child (6%) anchor errors such as the anchor was fitted incorrectly or not the correct type (5%) and the H Harness(1) being used incorrectly (5%). In addition, there were significant differences across restraint types in terms of the proportion of restraints with CRS misuse or fitment errors, chi(2) (2) = 51.42, p < 0.001. The rate of misuse was highest for the forward-facing CRS (88%), compared to infant seats (67%) and booster seats or cushions (63%). The results show that CRS misuse and fitment errors are widespread in Australia. Based on the findings of this study, it is recommended that educational and awareness materials and programs that provide information on the safety benefits associated with correct CRS use (as well as the injury risk associated with CRS misuse) be developed for both parents and children.
Seat belt repositioning and use of vehicle seat cushions is increased among older drivers aged 75 years and older with morbidities
Publisher: Wiley
Date: 30-07-2017
DOI: 10.1111/AJAG.12349
Abstract: Good seat belt fit and positioning is important for crash protection. Older drivers experience problems in achieving good seat belt fit and often reposition seat belts and/or use seat cushions. Comfort influences these behaviours. This work examines the impact of functional morbidities on belt positioning and accessory use and whether comfort mediates this relationship METHODS: Mediation analysis was used to examine the relationship between morbidities affecting physical function, comfort, belt repositions and seat cushion use among 380 drivers aged 75 years and older. Musculoskeletal morbidities increase the likelihood of seat belt repositioning (OR 1.37, 95% CI 1.12-1.67) and comfort partially mediates this relationship (P = 0.03). Morbidities of any type also increase the likelihood of seat cushion use (OR 1.15 95% CI 1.04-1.27), but comfort plays no role in this relationship (P = 0.87). Greater awareness among older drivers is needed, to ensure behavioural modifications do not impair their crash protection.
1C.005 Using online parenting discussion forums for understanding fall injury mechanisms in infants
Publisher: BMJ Publishing Group Ltd
Date: 03-2021
Buckle up safely: a cluster randomised trial to evaluate the effectiveness of a pre-school based program to increase appropriate use of child restraints.
Publisher: Springer Science and Business Media LLC
Date: 06-01-2011
Effects of a Safe Transportation Educational Program for Older Drivers on Driving Exposure and Community Participation: A Randomized Controlled Trial
Publisher: Wiley
Date: 09-12-2016
DOI: 10.1111/JGS.14550
Abstract: To ascertain whether a safe-transportation program can change driving exposure while maintaining community participation of older drivers. Randomized controlled trial. Northwest Sydney. Drivers aged 75 and older (mean 80 ± 4) (n = 380). Intervention group participated in an in idualized, one-on-one safe-transportation program adapted from the Knowledge Enhances Your Safety curriculum. A registered occupational therapist delivered the intervention in two sessions held approximately 1 month apart. An in-vehicle monitoring device hardwired into participants' vehicles measured driving exposure. Community participation was measured using the Keele Assessment of Participation. A staging algorithm based on the Precaution Adoption Process Model measured behavior change toward increased and sustained driving self-regulation. Main outcomes were distance driven per week over 12 months and community participation. Secondary outcomes were behavior change, depressive symptoms, and alternate transportation use. Generalized estimating equations were used to model effect on driving exposure, adjusting for weekly measures, and ordinal regression was used to analyze differences in behavior change profiles between groups using an intention-to-treat approach. Participants were randomized after baseline assessment-190 each to the intervention and control groups. One hundred eighty-three of 190 completed the intervention and 366 of 380 completed the study. On average, participants drove 140 ± 167 km/wk. Although there was no significant difference between the groups in distance driven per week over 12 months (between-group difference -5.5 km, 95% confidence interval (CI) = -24.5-13.5 km, p = .57), intervention group participants showed greater readiness to engage in self-regulatory driving practices, such as reporting avoiding driving at night or at rush hours, than control group participants (odds ratio (OR) = 1.6, 95% CI = 1.1-2.3, P = .02). At 12 months, use of alternate transportation was similar (between-group difference 0.1, 95% CI = -1.4-1.6, P = .90). Although there was no difference in community participation (between-group difference -0.1, 95% CI = -0.6-0.3, P = .59), older drivers with low function in the intervention group were 3.1 times as likely to report depressive symptoms (95% CI = 1.04-9.2, P = .04) than those with low function in the control group. An in idualized safe-transportation program can promote behavior change but did not translate to significant differences in weekly mileage after 12 months. Longer follow-up may detect changes over time.
Dynamic frontal crash performance of old and used child restraint systems
Publisher: Informa UK Limited
Date: 25-08-2021
DOI: 10.1080/15389588.2021.1958208
Abstract: To examine the effect of age on the dynamic performance of child restraint systems in frontal crashes. A s le of used (3-269 months from manufacture) and newly purchased child restraints were subjected to frontal crash simulations of more than 56 km/h and peak deceleration approximately 33 g on a deceleration sled. Restraints were monitored for evidence of damage before and after each impact. Anthropometric test device (ATD) head and chest responses and peak head excursions were recorded for rearward facing restraints using the Q1 ATD and for forward facing restraints and booster seats using the Q6 ATD. The influence of restraint age on peak 3 ms head acceleration, HIC15, head excursion, peak 3 ms chest acceleration and restraint damage were analyzed. In all impacts, the ATD remained within the restraint and secured to the test bench demonstrating the crash protection offered by the old and used restraints. There was no apparent relationship between ATD responses and restraint age for any restraint type. Older forward facing restraint systems had a very modest increase in forward head excursion (R Overall, degradation in restraint dynamic performance in older restraints, including some that are much older than the currently recommended 10-year lifetime, is minimal. However newer restraints may provide better protection due to marginal improvements in restraint design over time. Furthermore, the results of this study confirm previous recommendations that restraints should not be re-used after crash involvement.
Buckle up safely (shoalhaven): a process and impact evaluation of a pragmatic, multifaceted preschool-based pilot program to increase correct use of age-appropriate child restraints.
Publisher: Informa UK Limited
Date: 28-03-2014
DOI: 10.1080/15389588.2013.833328
Abstract: To conduct a process and impact evaluation of a multifaceted education-based pilot program targeting correct use of age-appropriate restraints in a regional setting with a high proportion of Aboriginal and Torres Strait Islander families. The program was delivered in 2010 in 3 early learning centers where 31 percent of the children were of Aboriginal and Torres Strait Islander descent. Each component of the program was assessed for message consistency and uptake. To measure program effectiveness, participating children were matched 1:1 by age, language spoken at home, and annual household income with 71 children from the control arm of a contemporaneous trial. The outcome measure in the control and program centers (a 4-category ordinal scale of restraint use) was compared using ordinal logistic regression accounting for age of the parent. Process evaluation found that though program components were delivered with a consistency of message, uptake was affected by turnover of all staff at one center and by parents experiencing difficulty in paying for subsidized restraints at each of the centers. Impact evaluation found that children from the centers receiving the program had nearly twice the odds of being in a better restraint category than children matched from the control group (adjusted odds ratio [ORadj] = 2.06, 95% confidence interval [CI], 1.09-3.90). This was a pragmatic study reflecting the real-life issues of implementing a program in preschools where 57 percent of families had a low income and turnover of staff was high. Despite these issues, impact evaluation showed that the integrated educational program showed promise in increasing correct use of age-appropriate restraints. The findings from this pilot study support the use of an integrated educational program that includes access to subsidized restraints to promote best practice child restraint use among communities that include a high proportion of Aboriginal and Torres Strait Islander families in New South Wales. Future trials in similar settings should consider offering more support in centers with high turnover of staff and offering alternative methods of payment when families experience financial difficulties in purchasing the subsidized restraints. If proven in larger trials, this approach could reduce death and injuries in child passengers in this vulnerable group.
Cross-chest clips in child restraints: A crash testing study
Publisher: Informa UK Limited
Date: 21-08-2019
Adolescent transport and unintentional injuries: a systematic analysis using the Global Burden of Disease Study 2019
Publisher: Elsevier BV
Date: 08-2022
Assessing the performance of motorcyclists’ impact protectors in simulated ATD knee and shoulder impacts
Publisher: Informa UK Limited
Date: 17-02-2019
DOI: 10.1080/15389588.2018.1540867
Abstract: Fractures are a common injury among motorcycle riders and can have serious health implications. Impact protection (IP) has been designed to help prevent fractures, yet there are conflicting opinions as to whether this IP does in fact help prevent fractures in real-world crashes. This work aimed to (1) use simulated dummy impacts to examine whether existing types of IP could reduce the force transferred to the underlying bone to below fracture tolerance levels and (2) investigate whether current European Standard (EN 1621-1) test procedures for impact protectors designed for motorcyclists are sufficient to ensure fracture protection. Twenty-three shoulder and 7 knee IP specimens were tested using a 23-kg impactor contacting axially along the clavicle and femur of an anthropomorphic test device (ATD) at an energy level corresponding to the fracture tolerance of these bones. Sixteen IP specimens were the same as those worn by motorcycle riders involved in crashes where injury outcome was known (knee: n = 3 shoulder: n = 13) and the IP had been previously tested to EN 1621-1. Other IP tested represented a wide range of IP available for purchase at a motorcycle accessory store. Double and triple layers of IP were also tested. Energy attenuated during the dummy impacts was compared to energy attenuated when tested to EN 1621-1. Of the 23 shoulder IP tested, the average percentage reduction of transferred force to the shoulder from the baseline test was 7.6 ± 4.8%. The percentage reduction of transferred force to the knee from the baseline was 43.9 ± 7.5%. The entire group of knee IP tested reduced the transferred force to the knee to below the 10-kN injury threshold for the femur. There was a positive but nonsignificant correlation between the ATD test and the EN 1621-1 impact test performance, suggesting that the European standard test method likely provides a good indication of IP performance. However, given the low correlation coefficient, the relationship between IP performance in the European standard test method and injury protection remains unclear. Though the energy attenuation test method in the European standard may be an appropriate approach, distinct differences in injury protection performance observed between knee and shoulder IP indicate that there may be a need for different performance criteria for IP designated to protect different body regions.
Shoulder height labeling of child restraints to minimize premature graduation
Publisher: American Academy of Pediatrics (AAP)
Date: 09-2010
Abstract: We hypothesized that parents and caregivers would make better judgments about child restraint fit if shoulder height labeling was used to communicate appropriate child restraint transition times. Participants were recruited at a shopping center in New South Wales, Australia, and were observed choosing restraints, with and without shoulder height labels indicating appropriate restraint fit, for each of 2 test mannequins (representing a 3-year-old child and a 5-year-old child). Demographic and child restraint use experience data also were collected. Generalized estimating equations were used to examine associations between labeling condition and participant's judgment of restraint appropriateness. Participants (N = 86) made significantly fewer errors in judging restraint appropriateness for the test mannequins when the restraints included shoulder height labels (P & .001). Depending on label format, the odds that a participant would always make the correct decision were 5.2 (95% confidence interval: 2.7–9.8) to 3.7 (95% confidence interval: 2.0–6.9) times greater when shoulder height labels were included than when they were not. The use of shoulder height labels on child safety seats and booster seats is an effective means of communicating child restraint fit to parents and caregivers.
Thermal and cardiovascular strain imposed by motorcycle protective clothing under Australian summer conditions
Publisher: Informa UK Limited
Date: 24-09-2016
DOI: 10.1080/00140139.2015.1082632
Abstract: Motorcycle protective clothing can be uncomfortably hot during summer, and this experiment was designed to evaluate the physiological significance of that burden. Twelve males participated in four, 90-min trials (cycling 30 W) across three environments (25, 30, 35 °C [all 40% relative humidity]). Clothing was modified between full and minimal injury protection. Both ensembles were tested at 25 °C, with only the more protective ensemble investigated at 30 and 35 °C. At 35 °C, auditory canal temperature rose at 0.02 °C min(-1) (SD 0.005), deviating from all other trials (p 38.5 °C) and profound hyperthermia (>40.0 °C) were predicted to occur within 105 min (SD 20.6) and 180 min (SD 33.0), respectively. Profound hyperthermia might eventuate in ~10 h at 30 °C, but should not occur at 25 °C. These outcomes demonstrate a need to enhance the heat dissipation capabilities of motorcycle clothing designed for summer use in hot climates, but without compromising impact protection. Practitioner's Summary: Motorcycle protective clothing can be uncomfortably hot during summer. This experiment was designed to evaluate the physiological significance of this burden across climatic states. In the heat, moderate (>38.5 °C) and profound hyperthermia (>40.0 °C) were predicted to occur within 105 and 180 min, respectively.
A longitudinal investigation of the predictors of older drivers' speeding behaviour
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.AAP.2016.04.006
Abstract: There is little objective evidence about the extent older drivers' are involved in speeding or factors that may influence this behaviour. Particular concern exists for the increasing number of older drivers with poor or declining cognitive and visual function. This study investigates whether a reduction in speeding forms part of the self-restrictive driving behaviour evident when older drivers experience poor cognitive and visual function. Driving data over 12 months were collected from 182 volunteers aged 75-94years. Driving speed was estimated using Global Positioning System location, and speed limit data was based on a service-provider database. Speed events were defined as driving 1km/h or more, with 3% tolerance, above a single speed limit, averaged over 30s. Almost all participants (99%) were involved in speed events. While, 16-31% of participants experienced a meaningful decline in cognitive or visual function during the 12-months, these declines were not predictive of a change in speed events. Our results indicate speeding behaviour in this age group was highly prevalent, but less so for the oldest drivers whereby the rate of speed events was 7% lower per year older (IRR=0.93, 95%CI=0.89-0.96). Older drivers with worse function were less involved in speed events (unadjusted for distance driven) during 12 months of observation. Weekly distance driven decreased over the year by approximately 0.45km with every week of monitoring for these older drivers. When distance driven was taken into account, decreased function was not predictive of involvement in speed events, indicating the reduction in speed events may be achieved by older drivers with lower function reducing distance driven. These results are important for developing policy to address speeding behaviour of the growing population of older drivers to reduce the incidence of crashes and resulting casualties.
The characteristics of incorrect restraint use among children traveling in cars in New South Wales, Australia
Publisher: Informa UK Limited
Date: 26-08-2010
DOI: 10.1080/15389588.2010.481770
Abstract: This study aims to provide population estimates of incorrect restraint use among children aged 0-12 traveling in cars in New South Wales (NSW) and describe the errors occurring in different restraint types. Observations of randomly selected children and restraints were conducted in situ by trained researchers at sites statewide. Observation sites were randomly selected using a multistage stratified s le plan. Restraint use errors were recorded and analyzed by severity of error and restraint type using complex survey analysis techniques. One in two children was incorrectly restrained, and 38 percent in a serious manner. Multiple errors were common (31% of children). Both installation and "securing" errors were common, with installation errors more common in convertible restraints (rearward-facing/forward-facing restraints and forward-facing restraints/booster seats) than single-mode restraints (odds ratio [OR] 4.3 95% confidence interval [CI] 1.7-10.8). Multiple errors were more common in convertible restraints (OR 3.6 95% CI 1.9-7.0). The most frequently observed errors were excessive seat belt slack (>25 mm), incorrect belt routing, nonengagement of the seat belt buckle, very loose harness (>25 mm slack), harness off the shoulder, nonuse of belt guides, sash belt worn under the arm, and very twisted harnesses and belts (>2 twists). For rearward- and forward-facing restraints the highest priorities in terms of frequency and degradation in crash protection are errors related to harness use. For booster seat users the most important are those related to correct seat belt and belt guide use. For seat belt users, errors related to correct positioning of the sash belt are key. The results indicate that many errors are currently occurring in the way children are using restraints, as well as problems associated with the way child restraint systems are installed in vehicles. Incorrect use is particularly problematic in convertible restraints (rearward-facing/forward-facing restraints and forward-facing restraints/booster seats). Different priorities, in terms of the frequency and potential degradation in crash protection due to incorrect use for different restraint types, exist and these are important for those designing countermeasures to this problem.
Behind the wheel confidence and naturalistic measures of driving exposure among older drivers
Publisher: SAGE Publications
Date: 2015
DOI: 10.3141/2516-06
Abstract: Driving confidence is thought to influence driving exposure among older drivers and may affect driver safety. Studies to date have relied primarily on self-reported measures of driving exposure to explore this relationship. The objective of this study was to explore the relationship between confidence and actual driving exposure among drivers aged 75 years and older. A cross-sectional analysis of survey data (function, confidence, personal circumstances) and naturalistic measures of driving exposure was conducted with 380 older drivers in northwest Sydney, Australia. Driving exposure, including total distance traveled, radius of travel from home, average trip distance, and nighttime driving, was measured for 1 week. The mean age of participants was 80 years. More males (n = 230) than females (n = 150) were enrolled. Successful instrumentation was achieved for 362 of 380 vehicles. Driving confidence was found to be independently associated with the farthest distance traveled from home, average trip distance, and night driving. Older drivers with lower confidence took shorter trips, stayed closer to home, and were less likely to drive at night. This study provided evidence of a responsive process in which drivers with lower confidence and poorer function were found to have different patterns of driving—specifically, driving in familiar areas, during daylight hours, and closer to home. It is likely that drivers in later life change their driving patterns to preserve safety and mobility. This understanding will help policy makers and educators shape responsive programs that help older drivers drive safely for as long as possible.
Adopting child restraint laws to address child passenger injuries: Experience from high income countries and new initiatives in low and middle income countries
Publisher: Elsevier BV
Date: 06-2015
Behind the Wheel: Process Evaluation of a Safe-Transport Program for Older Drivers Delivered in a Randomized Controlled Trial
Publisher: SAGE Publications
Date: 22-11-2018
Abstract: This process evaluation explores relationships between program outcomes and intervention implementation in a trial evaluating “Behind the Wheel,” an education-based safe-transport program for older drivers. Participants (intervention group) were 190 Sydney drivers aged ⩾75 years ( M = 80 ± 4years). Process measures included fidelity, dose delivered, and received. Outcomes were self-reported driving regulation and objectively measured driving exposure. Relationships were explored using regression models. Older drivers who took ownership of driving retirement and self-regulation by developing plans were more likely to reduce their weekly driving, (β = 38 km, 95% confidence interval (CI) = [7.5,68.7]), and night driving (β = 7 km, 95% CI = [3.5, 10.4]). Drivers of older age (odds ratio [ OR] = 1.1/year older, 95% CI = [1.05, 1.3]) had greater odds of developing driving retirement plans. Female drivers ( OR = 2.7,95% CI = [1.1, 6.9]), drivers with poorer function ( OR = 1.2/5-point decrease on DriveSafe, 95% CI = [1.04, 1.4]), and worse health ( OR = 1.2/additional medication, 95% CI = [1.02, 1.5]) had greater odds of developing safe mobility plans. This program had greatest impact with older, lower functioning drivers. A stronger message was delivered and received, as intended, to older drivers with lower function and poorer health. Our logic model can help channel resources to drivers who benefit most.
Child Restraint Fitting Stations reduce incorrect restraint use among child occupants
Publisher: Elsevier BV
Date: 05-2011
DOI: 10.1016/J.AAP.2010.12.021
Abstract: This study evaluated the effectiveness of the NSW Restraint Fitting Station Network in preventing incorrect use of rearward facing and forward facing child restraints. The way children used restraints was observed randomly as they arrived at observation sites during a cross-sectional ecological study across New South Wales, Australia. Trained researchers examined restraint system installation once the child left the vehicle. A structured interview was also conducted with the driver. Logistic regression was used to examine the association between parental report of ever having the restraint checked at a Restraint Fitting Station and whether or not the restraint was used correctly, while controlling for potential confounders and accounting for the complex s le design. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. The results demonstrated that children of respondents who did not use Restraint Fitting Stations were 1.8 times more likely to be incorrectly using their restraints (95% CI 1.1-2.8) than children of Restraint Fitting Station users. Regardless of whether or not a Restraint Fitting Station had been used, there was a trend towards a greater likelihood of incorrect restraint use as the length of restraint ownership increased (OR 1.3 95% CI 1.0-1.7). These results are important for developing strategies aimed at reducing child occupant casualties by reducing the rate of incorrect restraint use, and support programs encouraging the use of Restraint Fitting Stations and similar services as a countermeasure to incorrect use.
Comparative performance of rearward and forward-facing child restraint systems with common use errors: Effect on crash injury risk for a 1-year-old occupant
Publisher: Informa UK Limited
Date: 19-01-2022
DOI: 10.1080/15389588.2021.2012168
Abstract: To compare how errors in child restraint use influence crash injury risk in rearward and forward-facing restraints for a 1-year old occupant. Three convertible child restraint systems (CRS) were subjected to frontal dynamic sled tests at 56 km/h in rearward-facing and forward-facing modes in a correct use (baseline) condition and in five incorrect use conditions: loose securing belt, loose harness, partial harness use, top tether slack, and three minor errors. Excursion, head, and chest 3 ms resultant acceleration, HIC15, and neck forces and moments of a Q1 anthropomorphic test device (ATD) seated in the restraints were measured. The effect of incorrect use on each outcome and restraint type was analyzed. The influence of errors varied across different outcome variables, the three restraints tested and orientation modes. Excursion increased in four of five incorrect use conditions in both rearward and forward-facing orientations. A very loose harness increased four of five outcome variables in at least one forward-facing restraint, whereas only excursion was increased when rearward-facing. Overall, there tended to be a more negative effect of incorrect use (demonstrated through increases in outcome variables compared to the baseline) in the forward-facing orientation. Overall, errors in use tended to have a larger negative impact on forward-facing restraints than rearward-facing restraints. Given the widespread nature of errors in use, this adds further weight to arguments to keep children rearward-facing to 12 months of age and older. The results also highlight a variation in response to errors across differently designed restraints, suggesting the influence of errors may be minimized by restraint design that is more resistant to errors.
Factors predicting incorrect use of restraints by children travelling in cars: A cluster randomised observational study
Publisher: BMJ
Date: 24-11-2011
Abstract: The benefits of correctly using size-appropriate restraints for children travelling in cars are well established, and considerable research has focused on the determinants of appropriate restraint choice. There are few studies of the factors associated with incorrect use. Objective To determine predictors of incorrect restraint use by child occupants and how these differ from inappropriate use. A stratified multistage cluster s le of child occupants aged 0-10 years in New South Wales, Australia was used. Observation of restraint type and inspection of correctness of use was performed on arrival at schools, childcare centres, and child health clinics. An interview was conducted with the driver. Logistic regression was performed to estimate the effects of parental, family, and other characteristics on the likelihood of moderate or serious incorrect restraint use for restraint classes (rear/forward facing, booster, and seatbelt). Significant factors varied depending on age and restraint class. Older child restraint users (OR per year of age 0.27, 95% CI 0.07 to 0.98) and seatbelt users (OR per year of age 0.54, 95% CI 0.45 to 0.64) were less likely to be incorrectly using their restraints than younger users. Child restraint and booster users from non-English speaking families were more likely to be incorrectly using their restraints. Having more children in the car appeared to reduce incorrect use for booster (OR 0.18, 95% CI 0.06 to 0.57) and seatbelt users (OR 0.39, 95% CI 0.16 to 0.93). There is a need to reduce incorrect restraint use by both education and improved restraint design. Education aimed at reducing incorrect use may need to be targeted differently to appropriate use programmes, as the predictive factors differ.
Further Development of Motorcycle Autonomous Emergency Braking (MAEB), What Can In-Depth Studies Tell Us? A Multinational Study
Publisher: Informa UK Limited
Date: 26-09-2014
DOI: 10.1080/15389588.2014.926009
Abstract: In 2006, Motorcycle Autonomous Emergency Braking (MAEB) was developed by a European Consortium (Powered Two Wheeler Integrated Safety, PISa) as a crash severity countermeasure for riders. This system can detect an obstacle through sensors in the front of the motorcycle and brakes automatically to achieve a 0.3 g deceleration if the collision is inevitable and the rider does not react. However, if the rider does brake, full braking force is applied automatically. Previous research into the potential benefits of MAEB has shown encouraging results. However, this was based on MAEB triggering algorithms designed for motorcycle crashes involving impacts with fixed objects and rear-end crashes. To estimate the full potential benefit of MAEB, there is a need to understand the full spectrum of motorcycle crashes and further develop triggering algorithms that apply to a wider spectrum of crash scenarios. In-depth crash data from 3 different countries were used: 80 hospital admittance cases collected during 2012-2013 within a 3-h driving range of Sydney, Australia, 40 crashes with Injury Severity Score (ISS)>15 collected in the metropolitan area of Florence, Italy, during 2009-2012, and 92 fatal crashes that occurred in Sweden during 2008-2009. In the first step, the potential applicability of MAEB among the crashes was assessed using a decision tree method. To achieve this, a new triggering algorithm for MAEB was developed to address crossing scenarios as well as crashes involving stationary objects. In the second step, the potential benefit of MAEB across the applicable crashes was examined by using numerical computer simulations. Each crash was reconstructed twice-once with and once without MAEB deployed. The principal finding is that using the new triggering algorithm, MAEB is seen to apply to a broad range of multivehicle motorcycle crashes. Crash mitigation was achieved through reductions in impact speed of up to approximately 10 percent, depending on the crash scenario and the initial vehicle pre-impact speeds. This research is the first attempt to evaluate MAEB with simulations on a broad range of crash scenarios using in-depth data. The results give further insights into the feasibility of MAEB in different speed ranges. It is clear then that MAEB is a promising technology that warrants further attention by researchers, manufacturers, and regulators.
Relative benefits of population-level interventions targeting restraint-use in child car passengers
Publisher: American Academy of Pediatrics (AAP)
Date: 02-2010
Abstract: Because public health resources for injury prevention are limited, methods for comparing competing strategies are needed. We aimed to estimate potential injury reductions for 4 population-level interventions that target restraint practices for child car passengers aged 0 to 12 years. Population-attributable risk fraction (PARF) is a population-level estimate of excess risk from exposure to a risk factor. PARFs were calculated for each intervention scenario by using published age-specific mortality/injury relative-risk estimates restraint practices among injured child car passengers from police-collected data and observational data for correctness of restraint use in New South Wales, Australia. PARF reductions were estimated for population uptakes of 25%, 50%, and 75%. Assuming a 50% population uptake, (1) promoting age-appropriate restraint use could prevent additional fatalities (5.1%, infants 3.4%, 1- to 6-year-olds) and nonfatal injuries (3.2%, infants 16.2%, 1- to 6-year-olds) compared with promoting any restraint use (2) further encouraging correct age-appropriate restraint use could also prevent additional fatalities (9.1%, infants 14.3%, 1- to 6-year-olds) and nonfatal injuries (9.2%, infants 10.7%, 1- to 6-year-olds) and (3) for children aged 7 to 12 years, promoting correct use of restraints could prevent an additional 3.4% fatalities and 3.1% nonfatal injuries compared with promoting any restraint use. Interventions that target child passenger-restraint practices offer population-level benefits in terms of reduction in fatalities and injuries. These tangible benefits call for action internationally, not only to promote restraint use but correct age-appropriate restraint use for child car passengers.
Effectiveness of high back belt positioning booster seats in side impacts
Publisher: Informa UK Limited
Date: 06-2005
DOI: 10.1080/15389580590931626
Abstract: The objective of this study is to evaluate the potential of high back booster seats to provide effective protection to children in side impacts. This article presents a series of side impact sled tests at a velocity change of 30.5 km/h and a peak deceleration of 15.2 g, using the Hybrid III 6-year-old dummy in two styles of commonly used high-back booster seats: a conventional polystyrene booster seat and a convertible child restraint/booster seat. A series of tests were also performed using alternative anchorage systems in combination with the boosters. Simulated side impact tests were conducted at 90 degrees and 45 degrees. The booster seats tested were found to be too short for the 6-year-old dummy and head contact with the side door occurred in all 90 degree tests, resulting in high HIC values. The greatest potential for achieving effective protection in side impact in this test series was observed when the convertible child restraint/booster was used in combination with a rigid anchorage system. Using this system, the body of the dummy was kept farther away from the door which resulted in a softer head impact with the side door. Results from this work indicate that current booster seats offer poor torso containment and no head protection for children within the recommended age range. They also showed that the level of protection provided by belt positioning booster seats can be improved through the use of rigid anchorage systems. However, for this potential to be fully realized, belt positioning booster seats must offer better containment of the occupant during the impact.
A robust estimation of the effects of motorcycle autonomous emergency braking (MAEB) based on in-depth crashes in Australia
Publisher: Informa UK Limited
Date: 02-09-2016
DOI: 10.1080/15389588.2016.1193171
Abstract: Autonomous emergency braking (AEB) is a safety system that detects imminent forward collisions and reacts by slowing down the host vehicle without any action from the driver. AEB effectiveness in avoiding and mitigating real-world crashes has recently been demonstrated. Research suggests that a translation of AEB to powered 2-wheelers could also be beneficial. Previous studies have estimated the effects of a motorcycle AEB system (MAEB) via computer simulations. Though effects of MAEB were computed for motorcycle crashes derived from in-depth crash investigation, there may be some inaccuracies due to limitations of postcrash investigation (e.g., inaccuracies in preimpact velocity of the motorcycle). Furthermore, ideal MAEB technology was assumed, which may lead to overestimation of the benefits. This study sought to evaluate the sensitivity of the simulations to variations in reconstructed crash cases and the capacity of the MAEB system in order to provide a more robust estimation of MAEB effects. First, a comprehensive classification of accidents was used to identify scenarios in which MAEB was likely to apply, and representative crash cases from those available for this study were populated for each crash scenario. Second, 100 variant cases were generated by randomly varying a set of simulation parameters with given normal distributions around the baseline values. Variants reflected uncertainties in the original data. Third, the effects of MAEB were estimated in terms of the difference in the impact speed of the host motorcycle with and without the system via computer simulations of each variant case. Simulations were repeated assuming both an idealized and a realistic MAEB system. For each crash case, the results in the baseline case and in the variants were compared. A total of 36 crash cases representing 11 common crash scenarios were selected from 3 Australian in-depth data sets: 12 cases from New South Wales, 13 cases from Victoria, and 11 cases from South Australia. The reduction in impact speed elicited by MAEB in the baseline cases ranged from 2.8 to 10.0 km/h. The baseline cases over- or underestimated the mean impact speed reduction of the variant cases by up to 20%. Constraints imposed by simulating more realistic capabilities for an MAEB system produced a decrease in the estimated impact speed reduction of up to 14% (mean 5%) compared to an idealized system. The small difference between the baseline and variant case results demonstrates that the potential effects of MAEB computed from the cases described in in-depth crash reports are typically a good approximation, despite limitations of postcrash investigation. Furthermore, given that MAEB intervenes very close to the point of impact, limitations of the currently available technologies were not found to have a dramatic influence on the effects of the system.
Exploring Infant Fall Events Using Online Parenting Discussion Forums: Infodemiology Study
Publisher: JMIR Publications Inc.
Date: 10-05-2022
DOI: 10.2196/34413
Abstract: Falls represent the most common mechanism of injury requiring hospitalization among children under 12 months, and they commonly result in traumatic brain injury. Epidemiological studies exploring infant falls demonstrate the experienced burden, but they lack contextual information vital to the development of preventive interventions. The objective of this study was to examine contextual information for falls involving children under 12 months, using online parenting discussion forums. Online parenting forums provide an unobtrusive rich data source for collecting detailed information about fall events. Relevant discussions related to fall incidents were identified and downloaded using site-specific Google Search queries and a programming script. A qualitative descriptive approach was used to analyze the incidents and categorize contextual information into “precursor events” and “influencing factors” for infant falls. We identified 461 infant fall incidents. Common fall mechanisms included falls from furniture, falls when being carried or supported by someone, falls from baby products, and falls on the same level. Across the spectrum of fall mechanisms, common precursor events were infant rolling off, infant being alone on furniture, product misuse, caretaker falling asleep while holding the infant, and caretaker tripping/slipping while carrying the infant. Common influencing factors were infant’s rapid motor development, lapses in caretaker attention, and trip hazards. The findings define targets for interventions to prevent infant falls and suggest that the most viable intervention approach may be to target parental behavior change. Online forums can provide rich information critical for preventive interventions aimed at changing behavior.
Spinal injury in car crashes: Crash factors and the effects of occupant age
Publisher: BMJ
Date: 13-12-2011
Abstract: Motor vehicle crashes are the leading cause of serious spinal injury in most developed nations. However, since these injuries are rare, systematic analyses of the crash factors that are predictive of spinal injury have rarely been performed. This study aimed to use a population-reference crash s le to identify crash factors associated with moderate to severe spinal injury, and how these vary with occupant age. The US National Automotive S ling System Crashworthiness Data System (NASS) data for 1993-2007 were analysed using logistic regression to identify crash factors associated with Abbreviated Injury Scale (AIS)2+ spinal injury among restrained vehicle passengers. Risk of moderate or severe spinal injury (AIS2+) was associated with higher severity crashes (OR=3.5 (95% CI 2.6 to 4.6)), intrusion into an occupant's seating position (OR=2.7 (95% CI 1.9 to 3.7)), striking a fixed object rather than another car (OR=1.7 (95% CI 1.3 to 2.1)), and use of a shoulder-only belt (OR=2.7 (95% CI 1.5 to 4.8)). Older occupants (65 years or older) were at higher risk of spinal injury than younger adults in frontal, side and rollover crashes. Children under 16 were at a lower risk of spinal injury than adults in all crash types except frontal crashes. While the risk of serious spinal injury in motor vehicle crashes is low, these injuries are more common in crashes of higher severity or into fixed objects, and in the presence of intrusion. There are elevated risks of spinal injury for older occupants compared with younger adults, which may reflect changes in biomechanical tolerances with age. Children appear to be at lower risk of serious spinal injury than adults except in frontal crashes.
Pediatric spinal injury type and severity are age and mechanism dependent
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2007
Are there sex differences in crash and crash-related injury between men and women? A 13-year cohort study of young drivers in Australia
Publisher: Elsevier BV
Date: 06-2021
Effectiveness of child restraint legislation to reduce motor vehicle related serious injuries and fatalities: A national interrupted time series analysis
Publisher: Elsevier BV
Date: 07-2020
Active safety systems for powered two-wheelers: A systematic review.
Publisher: Informa UK Limited
Date: 02-01-2020
Age-specific parental knowledge of restraint transitions influences appropriateness of child occupant restraint use
Publisher: BMJ
Date: 06-2008
Abstract: To determine the factors that influence appropriate restraint usage by child occupants across the age range for which any type of child restraint may be appropriate (0-10 years). Randomized household telephone survey. Statewide survey, New South Wales, Australia. Parents or carers of children aged 0-10 years. Parental reporting of appropriateness of child restraint. Demographic information and data on age, size, restraint practices, parental knowledge of child occupant safety, and attitude to restraint use was collected using a structured interview. Data were analysed using logistic regression after cluster adjustment. Inappropriate restraint use by children was widespread, particularly in children aged 2+ years. Overall, parental knowledge of appropriate ages for restraint transitions was associated with increased likelihood of appropriate restraint use. Lower levels of formal parental education, larger families, parental restraint non-use, and parent/child negotiability of restraint use were predictors of inappropriate restraint use. For particular child age subgroups, the parental knowledge that predicted appropriate restraint use was specific to that age group. Most parents felt that they knew enough to safely restrain their child, despite widespread inappropriate restraint use. Parents are more likely to make appropriate restraint choices for their children if they possess restraint knowledge specific to their children's age and size. Educational c aigns may be most effective when they provide information for specific ages and transition points. Strategies to overcome parents' misplaced confidence that they know enough to restrain their children safely are also indicated.
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