Risk of Mortality in Association with Pregnancy in Women Following Motor Vehicle Crashes: A Systematic Review and Meta-Analysis.
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ABSTRACT:
SUBMITTER: Chang YH
PROVIDER: S-EPMC8775890 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundMotor vehicle crashes are a leading cause of serious trauma during pregnancy, but little is known about their relationships with pregnancy outcomes.PurposeTo estimate the association between motor vehicle crashes and adverse pregnancy outcomes.MethodsA retrospective cohort study of 878,546 pregnant women, aged 16-46 years, who delivered a singleton infant in North Carolina from 2001 to 2008. Pregnant drivers in crashes were identified by probabilistic linkage of vital records and crash reports. Poisson regression modeled the association among crashes, vehicle safety features, and adverse pregnancy outcomes. Analyses were conducted in 2012.ResultsIn 2001-2008, 2.9% of pregnant North Carolina women were drivers in one or more crashes. After a single crash, compared to not being in a crash, pregnant drivers had slightly elevated rates of preterm birth (adjusted rate ratio [aRR]=1.23, 95% CI=1.19, 1.28); placental abruption (aRR=1.34, 95% CI=1.15, 1.56); and premature rupture of the membranes (PROM; aRR=1.32, 95% CI=1.21, 1.43). Following a second or subsequent crash, pregnant drivers had more highly elevated rates of preterm birth (aRR=1.54, 95% CI=1.24, 1.90); stillbirth (aRR=4.82, 95% CI=2.85, 8.14); placental abruption (aRR=2.97, 95% CI=1.60, 5.53); and PROM (aRR=1.95, 95% CI=1.27, 2.99). Stillbirth rates were elevated following crashes involving unbelted pregnant drivers (aRR=2.77, 95% CI=1.22, 6.28) compared to belted pregnant drivers.ConclusionsCrashes while driving during pregnancy were associated with elevated rates of adverse pregnancy outcomes, and multiple crashes were associated with even higher rates of adverse pregnancy outcomes. Crashes were especially harmful if drivers were unbelted.
| S-EPMC3859429 | biostudies-literature
Project description:ObjectivesTo systematically review and quantify the effect of motor vehicle crashes (MVCs) in pregnancy on maternal and offspring outcomes.DesignSystematic review and meta-analysis of observational data searched from inception until 1 July 2018. Searching was from June to August 2018 in Medline, Embase, Web of Science, Scopus, Latin-American and Caribbean System on Health Sciences Information, Scientific Electronic Library Online, TRANSPORT, International Road Research Documentation, European Conference of Ministers of Transportation Databases, Cochrane Database of Systematic Reviews and Cochrane Central Register.ParticipantsStudies were selected if they focused on the effects of exposure MVC during pregnancy versus non-exposure, with follow-up to verify outcomes in various settings, including secondary care, collision and emergency, and inpatient care.Data synthesisFor incidence data, we calculated a pooled estimate per 1000 women. For comparison of outcomes between women involved and those not involved in MVC, we calculated ORs with 95% CIs. Where possible, we statistically pooled the data using the random-effects model. The quality of studies used in the comparative analysis was assessed with Newcastle-Ottawa Scale.ResultsWe included 19 studies (3 222 066 women) of which the majority was carried out in high-income countries (18/19). In population-level studies of women involved in MVC, maternal death occurred in 3.6 per 1000 (95% CI 0.25-10.42; 3 studies, 12 000 women; Tau=1.77), and fetal death or stillbirth in 6.6 per 1000 (95% CI 3.81-10.12; 8 studies, 47 992 women; I2=92.6%). Pooled incidence of complications per 1000 women involved in MVC was labour induction (276.43), preterm delivery (191.90) and caesarean section (166.65). Compared with women not involved in MVC, those involved had increased odds of placental abruption (OR 1.43, 95% CI 1.27-1.63; 3 studies, 1 500 825 women) and maternal death (OR 202.27; 95% CI 110.60-369.95; 1 study, 1 094 559 women).ConclusionPregnant women involved in MVC were at higher risk of maternal death and complications than those not involved.Prospero registration numberCRD42018100788.
| S-EPMC7537450 | biostudies-literature
Project description:Anxiety-inducing life events increase the risk of motor vehicle crashes. We test the hypothesis that earthquakes, known to increase anxiety in the population, also increase the incidence of motor vehicle crashes. Our study took place in Oklahoma, USA where wastewater injection resulted in increased induced seismicity between 2010 and 2016. We identified dates of earthquakes???magnitude 4 (a level felt by most people) with data from the U.S. Geologic Survey. The Oklahoma Highway Safety Office provided county-level monthly vehicle crash counts. We defined high, medium, and low earthquake exposure counties based on the location of earthquake epicenters. Using time-series analyses, we evaluated the association between monthly counts of ?magnitude 4 earthquakes and motor vehicle crashes by exposure group. Earthquakes???magnitude 4 took place in 38 of 84 study months, and a monthly average of 5813 (SD?=?384) crashes occurred between 2010 and 2016. In high-exposure counties, we observed an additional 39.2 motor vehicle crashes per each additional???magnitude 4 earthquake in the prior month (SE?=?11.5). We found no association between the timing of ?magnitude 4 earthquakes and motor vehicle crashes in the medium or low exposure counties. With a binary earthquake exposure variable, we found a 4.6% (SE?=?1.4%) increase in motor vehicle crashes in the high exposure counties in the month following 1 or more ?magnitude 4 earthquakes. Consistent with our hypothesis, there was no association between earthquakes of magnitude???2.5 and motor vehicle crashes in the high-exposure counties. This novel evidence of an association between induced earthquakes in Oklahoma and motor vehicle crashes warrants future research given the high economic and social costs of such vehicle crashes.
| S-EPMC6214370 | biostudies-literature
Project description:BackgroundThere is growing evidence that a range of pre-injury, injury related and post-injury factors influence social and health outcomes across the injury severity spectrum. This paper documents health related outcomes for people with mild, moderate and severe injury after motor vehicle crash (MVC) injuries in New South Wales, Australia.MethodsThis inception cohort study followed 2019 people injured in MVCs, for 6 and 12 months post-injury. We categorised moderate injury as hospital length-of-stay (LOS) of 2-6 days and Injury Severity Score (ISS) of 4-11, while severe injury as LOS ≥7 days or ISS ≥ 12. We examined differences in paid work status, 12-Item Short Form Survey (SF12), EQ-5D and World Health Organisation Disability Assessment Schedule II (WHODAS) outcomes longitudinally from baseline to 12 months between levels of injury severity using linear mixed models for repeated measures. We first considered minimally sufficient adjustment factors (age, sex, crash role, perceived danger in crash, pre-injury health, pre-injury EQ-5D, recruitment source), and then more extensive adjustments including post-injury factors. The presence of mediating pathways for SF-12 Physical Component Summary (PCS) and Mental Component Summary (MCS) via post-injury factors was evaluated.ResultsBased on hospital length of stay (LOS), 25 and 10% of participants sustained moderate and severe injuries, respectively, while 43 and 4% had these injuries based on ISS. Twelve months post-injury LOS ≥7 days versus ≤1 day was associated with an estimated 9 units lower mean SF12 PCS using a minimally sufficient adjustment model, and LOS ≥ 7 days was associated with a 3 units lower mean SF12 MCS score. Mediation analyses (LOS ≥ 7 days vs ≤1 day) found for SF12 MCS outcomes, effects of injury severity were small and mostly indirect (direct effect - 0.03, indirect effect - 0.22). Whereas for SF12 PCS outcomes the effect of having a more severe injury rather than mild were both direct and indirect (direct effect - 0.50, indirect effect - 0.38).ConclusionsIndividuals with severe injuries (those with LOS ≥ 7 days and ISS 12+) had poorer recovery 12 months after the injury. In addition, post-injury mediators have an important role in influencing long-term health outcomes.Trial registrationAustralia New Zealand Clinical trial registry identification number - ACTRN12613000889752 .
| S-EPMC8005247 | biostudies-literature
Project description:Bright sunlight may create visual illusions that lead to driver error, including fallible distance judgment from aerial perspective. We tested whether the risk of a life-threatening motor vehicle crash was increased when driving in bright sunlight.This longitudinal, case-only, paired-comparison analysis evaluated patients hospitalized because of a motor vehicle crash between January 1, 1995 and December 31, 2014. The relative risk of a crash associated with bright sunlight was estimated by evaluating the prevailing weather at the time and place of the crash compared with the weather at the same hour and location on control days a week earlier and a week later.The majority of patients (n?=?6962) were injured during daylight hours and bright sunlight was the most common weather condition at the time and place of the crash. The risk of a life-threatening crash was 16% higher during bright sunlight than normal weather (95% confidence interval: 9-24, P?<?0.001). The increased risk was accentuated in the early afternoon, disappeared at night, extended to patients with different characteristics, involved crashes with diverse features, not apparent with cloudy weather, and contributed to about 5000 additional patient-days in hospital. The increased risk extended to patients with high crash severity as indicated by ambulance involvement, surgical procedures, length of hospital stay, intensive care unit admission, and patient mortality. The increased risk was not easily attributed to differences in alcohol consumption, driving distances, or anomalies of adverse weather.Bright sunlight is associated with an increased risk of a life-threatening motor vehicle crash. An awareness of this risk might inform driver education, trauma staffing, and safety warnings to prevent a life-threatening motor vehicle crash.Level of evidenceEpidemiologic Study, level III.
| S-EPMC5228668 | biostudies-literature
Project description:BACKGROUND:In 2004, a World Health Report on road safety called for enforcement of measures such as seatbelt use, effective at minimizing morbidity and mortality caused by road traffic accidents. However, injuries caused by seatbelt use have also been described. Over a decade after publication of the World Health Report on road safety, this study sought to investigate the relationship between seatbelt use and major injuries in belted compared to unbelted passengers. METHODS:Cohort studies published in English language from 2005 to 2018 were retrieved from seven databases. Critical appraisal of studies was carried out using the Scottish Intercollegiate Guidelines Network (SIGN) checklist. Pooled risk of major injuries was assessed using the random effects meta-analytic model. Heterogeneity was quantified using I-squared and Tau-squared statistics. Funnel plots and Egger's test were used to investigate publication bias. This review is registered in PROSPERO (CRD42015020309). RESULTS:Eleven studies, all carried out in developed countries were included. Overall, the risk of any major injury was significantly lower in belted passengers compared to unbelted passengers (RR 0.47; 95%CI, 0.29 to 0.80; I2 =?99.7; P?=?0.000). When analysed by crash types, belt use significantly reduced the risk of any injury (RR 0.35; 95%CI, 0.24 to 0.52). Seatbelt use reduces the risk of facial injuries (RR?=?0.56, 95% CI?=?0.37 to 0.84), abdominal injuries (RR?=?0.87; 95% CI?=?0.78 to 0.98) and, spinal injuries (RR?=?0.56, 95% CI?=?0.37 to 0.84). However, we found no statistically significant difference in risk of head injuries (RR?=?0.49; 95% CI?=?0.22 to 1.08), neck injuries (RR?=?0.69: 95%CI 0.07 to 6.44), thoracic injuries (RR 0.96, 95%CI, 0.74 to 1.24), upper limb injuries (RR?=?1.05, 95%CI 0.83 to 1.34) and lower limb injuries (RR?=?0.77, 95%CI 0.58 to 1.04) between belted and non-belted passengers. CONCLUSION:In sum, the risk of most major road traffic injuries is lower in seatbelt users. Findings were inconclusive regarding seatbelt use and susceptibility to thoracic, head and neck injuries during road traffic accidents. Awareness should be raised about the dangers of inadequate seatbelt use. Future research should aim to assess the effects of seatbelt use on major injuries by crash type.
| S-EPMC6310927 | biostudies-literature
Project description:ImportanceMotor vehicle crashes (MVCs) are a major public health problem. Research has demonstrated that individuals with attention-deficit/hyperactivity disorder (ADHD) are more likely to experience MVCs, but the effect of ADHD medication treatment on the risk of MVCs remains unclear.ObjectiveTo explore associations between ADHD medication use and risk of MVCs in a large cohort of patients with ADHD.Design, setting, and participantsFor this study, a US national cohort of patients with ADHD (n = 2 319 450) was identified from commercial health insurance claims between January 1, 2005, and December 31, 2014, and followed up for emergency department visits for MVCs. The study used within-individual analyses to compare the risk of MVCs during months in which patients received ADHD medication with the risk of MVCs during months in which they did not receive ADHD medication.ExposuresDispensed prescription of ADHD medications.Main outcomes and measuresEmergency department visits for MVCs.ResultsAmong 2 319 450 patients identified with ADHD, the mean (SD) age was 32.5 (12.8) years, and 51.7% were female. In the within-individual analyses, male patients with ADHD had a 38% (odds ratio, 0.62; 95% CI, 0.56-0.67) lower risk of MVCs in months when receiving ADHD medication compared with months when not receiving medication, and female patients had a 42% (odds ratio, 0.58; 95% CI, 0.53-0.62) lower risk of MVCs in months when receiving ADHD medication. Similar reductions were found across all age groups, across multiple sensitivity analyses, and when considering the long-term association between ADHD medication use and MVCs. Estimates of the population-attributable fraction suggested that up to 22.1% of the MVCs in patients with ADHD could have been avoided if they had received medication during the entire follow-up.Conclusions and relevanceAmong patients with ADHD, rates of MVCs were lower during periods when they received ADHD medication. Considering the high prevalence of ADHD and its association with MVCs, these findings warrant attention to this prevalent and preventable cause of mortality and morbidity.
| S-EPMC5539840 | biostudies-literature
Project description: Not available
| S-EPMC8140390 | biostudies-literature
Project description:IntroductionRoadside sobriety checkpoints are an intervention in which law enforcement officers stop passing vehicles to check whether drivers are impaired. There is clear evidence that a program of roadside sobriety checkpoints is an effective approach to reducing alcohol-involved motor vehicle crashes, likely because of general deterrent effects across the entire population of drivers. The aim of this study is to assess the duration of time over which individual roadside sobriety checkpoints are associated with alcohol-involved motor vehicle crashes, within the context of a broader checkpoint program.MethodsIn August 2018, the authors accessed incident-level data for alcohol-involved motor vehicle crashes and roadside sobriety checkpoints for the City of Los Angeles, California, 2013-2017. Counts of crashes and checkpoints were computed within three different temporal units: days (n=1,826), weeks (n=260), and months (n=60). The number of checkpoints were then calculated at different lagged periods (up to 7 days, up to 4 weeks, and up to 3 months). Autoregressive integrated moving average analyses related counts of checkpoints over these lagged periods to subsequent crashes.ResultsFewer alcohol-involved motor vehicle crashes occurred when there were more roadside sobriety checkpoints over the previous 4 days, 5 days, 6 days, 7 days, and 1 week.ConclusionsIndividual roadside sobriety checkpoints affected alcohol-involved motor vehicle crashes in Los Angeles, California for approximately 1 week. The temporal configuration of individual checkpoints is an important consideration when designing an overall roadside sobriety checkpoint program.
| S-EPMC6557160 | biostudies-literature
Project description:ObjectiveTo investigate the risk and injury severity on the regional body (head, neck, and chest) of obese children in frontal motor vehicle crashes (MVCs).MethodsNo physical surrogates (i.e., crash dummies) for obese children were available, and experiments on pediatric cadavers were generally not feasible. Therefore, computational models of obese children using medical imaging processing and state-of-the-art modeling techniques were developed. A hybrid modeling technique was used to integrate the finite element model for torso fat layer into the standard multibody model to represent various levels of obese children for 3- and 6-year-old age groups. The models were used to investigate injury severity under various crash scenarios through model simulations.ResultsThe head injury criterion and chest acceleration were observed to increase as body mass index (BMI) increased. Meanwhile, no such correlations were found between BMI and neck injury and chest deformation. Forward head and torso excursions were observed to increase as obesity increased, owing to the momentum effect of greater body mass.ConclusionsObese children appeared to have greater risks for head and chest injuries than do their non-obese counterparts in frontal MVCs, owing to higher head and chest accelerations induced by greater body excursion.
| S-EPMC4340813 | biostudies-literature