The Association between High-risk Behavior and Central Nervous System Injuries: Analysis of Traffic-related Fatalities in a Large Coroner's Series

Abstract

High-risk behaviors leading to traffic fatalities are often a result of severe traumatic brain and spine injuries. The objective of the study was to analyze patterns of behavior in drivers and motorcyclists that are associated with central nervous system (CNS)-related prehospital deaths that may serve as a basis for future prevention initiatives. Our study group comprised 514 fatalities with severe CNS injuries documented at autopsy. The majority (n = 491) was the result of motor vehicle collisions (MVCs). In this group, male drivers predominated and the majority, 80 per cent, wore seatbelts. Toxicology analysis revealed 53 per cent of drivers with a mean concentration of ethanol above the legal limit. Texting while driving comprised 45 per cent of the study group. Less than 5 per cent of the fatalities were the result of road or weather conditions. In the motorcycle group (n = 23), 100 per cent of the victims were unhelmeted. We report a large autopsy series of CNS-related deaths with analysis of behavioral factors associated with the fatalities. Substance abuse and distracted driving are dominant patterns of high-risk behavior in MVCs and not wearing a motorcycle helmet is deadly for victims of motorcycle crashes.

Texting while driving: the development and validation of the distracted driving survey and risk score among young adults

“…In commercial vehicles, texting on a cell phone was associated with a much higher risk of a crash or other safety-critical event, such as near-collision or unintentional lane deviation (OR 23.2) (Olson et al 2009 ). Motor vehicle crash-related death and injury have also been strongly associated with texting (Pakula et al 2013 ; Issar et al 2013 ).…”

Road traffic injuries and fatalities among drivers distracted by mobile devices

“…Studies were published between 1998 and 2017, with sample sizes ranging from 74 to 1,080,637. Five studies were performed in the United States,[ 16 17 18 19 20 ] three in Australia,[ 21 22 23 ] one in Canada,[ 24 ] one in Qatar,[ 25 ] one in the United Arab Emirates,[ 26 ] one in Iran,[ 27 ] and one in England and Wales. [ 28 ] In addition to mobile device use, other types of behavior evaluated including smoking,[ 23 25 26 27 ] eating/drinking,[ 25 26 ] as well as various internal[ 16 18 22 23 24 25 27 28 ] and external[ 16 22 23 26 ] distractions.…”

“…[ 28 ] In addition to mobile device use, other types of behavior evaluated including smoking,[ 23 25 26 27 ] eating/drinking,[ 25 26 ] as well as various internal[ 16 18 22 23 24 25 27 28 ] and external[ 16 22 23 26 ] distractions. Studies determined the involvement of driver distraction through examination of data collected from police reports,[ 16 17 18 19 20 22 23 28 ] interviews,[ 21 22 24 25 26 27 ] phone records,[ 19 21 ] medical records,[ 21 22 26 ] coroner reports,[ 19 22 ] and investigation of the scene and vehicle. [ 22 ]…”

“…Nonfatal MVC injuries related to mobile device use was specifically reported in six studies[ 16 17 21 24 25 27 ] and ranged from 0.04% (190/443,077) to 25.4% (104/409) with a median of 9.6%. MVC fatalities attributed to mobile device use was reported in five studies,[ 16 17 19 20 28 ] ranging from 0% (0/1) to 44.7% (162/358), with a median of 0.05%. Six studies reported on both injuries and fatalities;[ 16 17 18 22 23 26 ] three of these studies combined injuries and fatalities in their reporting.…”

“…[ 18 22 23 ] Three studies only reported on fatalities due to distracted driving. [ 19 20 28 ] Injury severity was undefined in three studies. [ 18 23 27 ]…”