This study aims to examine trends in injury-related mortality among children and adolescents aged 0-19 years in a central urban district of Shanghai from 1993 to 2024, as well as its epidemiological characteristics. This study is a retrospective study. From 1993 to 2024, data were obtained from the Shanghai Cause-of-Death Surveillance System. Death records with injury as the underlying cause that were categorized under the International Statistical Classification of Diseases and Related Health Problems (ICD) codes V01-Y89 (external causes of injury and poisoning) were gathered. For children and adolescents aged from 0 to 19, the standardized injury-related mortality rate was 5.21 per 100,000, and 8.87% of all-cause mortality. The top two causes of injury-related mortality were suicide (1.15 per 100,000) and traffic injuries (1.02 per 100,000). Leading causes of injury-related mortality varied by age group: traffic injuries were the primary cause of injury-related death in the 5-9 age group; accidental poisoning and suicide were most common for the 10-14 age group, traffic injuries and suicide were the most prevalent causes in the 15-19 age group. The crude mortality rate of the 0-4 year old age group has shown a fluctuating low-level trend since 2003. The peak of accidental falls and drowning deaths in the 0-4 age group occurred in 2003. In the 5-19 years group, road traffic injuries exhibited intermittent peaks, while suicide showed a persistent upward trend. From 1993 to 2004, accidental poisoning and traffic injuries were the primary causes, while suicide and traffic injuries ranked first and second between 2005 and 2014. From 2015 to 2024, suicide surpassed traffic injuries as the primary cause of death. During the study period, the overall standardized injury-related mortality among children and adolescents aged 0-19 years in Huangpu District showed fluctuations (APC = -0.875, p = 0.420). However, significant declining trends were observed for traffic injuries, drowning, accidental falls, and accidental poisoning (p < 0.05). Different types of injuries exhibit gender and age differences, suggesting the need for targeted interventions according to the developmental trends and characteristics of children and adolescents.
Childhood injury is a major public health issue in China, yet detailed provincial-level data are limited. This study aimed to investigate the epidemiology, determinants, and burden of injuries among children aged 0-17 years in Henan Province. A population-based cross-sectional survey was conducted from June 2022 to May 2023 using a multi-stage stratified cluster random sampling design. Data were collected via face-to-face questionnaires from guardians of 9,859 children aged 0-17 years. Complex sampling weights were applied, and Rao-Scott χ 2 tests and logistic regression were used for analysis. The overall injury incidence rate was 6.88%, with a significantly higher rate in boys (8.23%) than in girls (5.32%). Multivariable logistic regression indicated that boys had higher odds of injury compared to girls (OR = 1.58, 95% CI: 1.27-1.97), and day students (returning home daily) had higher odds compared to children not enrolled in school (OR = 1.69, 95% CI: 1.16-2.46). Children under the care of their grandparents (OR = 1.33, 95%CI: 1.06-1.67) had a higher injury risk compared to those cared for by their mother. Critically, although a caregiver was present at the time of injury in 54.17% of incidents, effective supervision was lacking in 67.71% of these cases. Falls were the leading cause (53.90% of all incidents) of injury. The home was the most common injury location (41.73%), and leisure activities were the most frequent circumstance (59.30%). The most common injury type was contusion/abrasion (37.47%); the lower extremities were the most frequently injured body site (37.70%). The mean hospital stay was 18 days, with an average of 9 missed days, and the mean cost per injury was 2,713 Chinese Yuan, with road traffic injuries incurring the highest costs. This study provides key evidence for childhood injury prevention in Henan Province. Priorities include strengthening supervision (especially at home during leisure), tailored interventions for high-risk groups (boys, day students, grandparent-care children), and focusing on falls (high frequency) and road traffic injuries (high cost). Implementing these strategies is essential to reduce the burden of preventable childhood injuries.
Pressure injuries (PIs) are a serious and highly prevalent complication in individuals with spinal cord injury (SCI), negatively impacting quality of life, rehabilitation, and healthcare costs. Given their multifactorial etiology, a multidisciplinary approach that includes nutritional interventions is essential. This review provides expert consensus on the role of nutrition in PI prevention and management in SCI patients. A panel of clinicians, including experts in wound care, nutrition, urology, internal medicine, and rehabilitation, assessed current practices and proposed evidence-based dietary recommendations. A narrative literature review supported the consensus process. PI risk screening through SCI-specific tools (e.g., Braden scale) and shared decision-making were supported. Nutritional recommendations include aligning energy intake to reduced total daily energy expenditure, highly digestable protein rich in essential amino acids, omega-3 fatty acids, and micronutrients, with adequate hydration. Dietary patterns should be anti-inflammatory, rich in fiber, fruits/vegetables, legumes, fish, and fermented foods. Also, they should modulate gut microbiota and reduce advanced glycation end products through food choices and cooking methods. Practical tools, the Food Suitability Map (traffic-light guidance) and food diary, were proposed to support education, adherence, and self-management. Implementation guidance is provided for acute, chronic, community, and readmission/surgical settings. This review stresses the urgent need for standardized, SCI-specific nutritional protocols and enhanced interdisciplinary collaboration. Nutrition should be integrated into routine PI care to improve patient outcomes and reduce healthcare burden. Future research should explore nutraceuticals, refine existing protocols, assess long-term impacts of dietary strategies, and strengthen implementation in clinical practice.
Since 1979, traffic fatalities dropped 16.0% in the U.S. compared to 77.4 ± 5.9% for 14 other countries. The gap to other countries has grown and has been statistically significant since 1996. This study describes reasons for the gap in traffic fatality reductions in the U.S. NHTSA's research, programs and activities were analyzed to identify causes for the lack of traffic fatality reductions in the U.S. This includes policy decisions, selection of research projects, meaningfulness of NCAP and other tests, and errors in field accident data on serious injury and death. There were three primary and nine secondary reasons identified. NHTSA has: 1) not set targets focusing activities on fatality reductions, 2) not pursued research with measurable reductions in fatalities, 3) no meaningful engagement with industry, IIHS and others on research, NCAP, and safety priorities, 4) not conducted critical analysis of projects, programs and research, 5) inherent problems managing research, regulations, investigations, and enforcement under one leadership, 6) not verified assumptions for field accident data collection, 7) not used correct sampling frequencies or case weights in NASS-CDS and CISS, 8) not terminated testing that does not measurably reduce fatalities, 9) not followed-up on useful research, 10) not pursued crash tests with relevance to traffic fatalities and wrongheaded focus on MAIS 2 injuries, 11) not required timely engineering reports on internal and external projects, and 12) inaccessible archives of many reports and findings. Fatalities in the U.S. would have increased the past 25 years if safety technologies had not been voluntarily introduced by automotive manufacturers, including ESC (electronic stability control), AEB (automatic emergency braking) and high retention seats. NHTSA's budget has increased 459% over 25 years, a 14.4% increase each year. NHTSA has little to show for the extremely large budget, except "we could do better with more money." NHTSA must set priorities and targets for research, programs, and activities that reduce traffic deaths. They must change their leadership, because the Agency has failed its core mission to reduce traffic deaths the past 25+ years. NHTSA focuses on new car technologies in crash tests with no relevance to fatal accidents. Most fatalities are in 10+ year old vehicles, where risky driver behavior is the main cause with no seatbelt use, alcohol-drug use, and aggressive, risk-taking speeding. NHTSA must prioritize risky driver behavior and align State activities to reduce traffic fatalities.
Aboriginal and Torres Strait Islander communities experience a disproportionate burden of road traffic injuries yet little work has been done to develop a comprehensive epidemiological profile. We analysed data from the South Australian Trauma Registry for road traffic injuries in Aboriginal and Torres Strait Islander adults (≥18 years) admitted to hospital between July 2018 and June 2023. Descriptive statistics summarised demographics and hospital presentation characteristics, and an ordinal logistic regression examined the association between length of stay and injury severity scores (ISSs). Indigenous research methodologies guided study design and interpretation. A total of 127 patients were identified, all sustaining blunt trauma. Most patients identified as male (63%) and 30% were aged 25-34 years. Road traffic injuries frequently occurred on roads with speeds ≥60 km/hour (60%) and over 60% occurred in the afternoon/evening. Approximately 52% of cases reported ISS >12, and 32% of patients arrived at the hospital more than 12 hours after the time of injury. Median hospital stay was 9 days (IQR: 3.1 to 17.0) and greater ISS scores were associated with longer hospital stays (OR=1.2, 95% CI 1.08 to 1.26, p<0.001). Our findings suggest a need to focus on addressing the overrepresentation of men and individuals of working age while also targeting key risk factors like speed, with improved support and resourcing for rural and remote communities. Central to these efforts should be community-led co-design initiatives to ensure relevant and sustainable prevention strategies.
Advanced Automatic Collision Notification (AACN) systems rely on accurate prediction of serious occupant injuries to guide emergency response decisions. Current injury severity prediction (ISP) algorithms predominantly use logistic regression models that assume linear relationships in the log-odds space, potentially overlooking complex nonlinear patterns between crash characteristics and injury outcomes. This study aims to develop an improved ISP algorithm that can capture and explicitly represent these nonlinear relationships while maintaining model interpretability comparable to traditional approaches. We developed a prediction model based on trainable B-spline functions using crash data from the US National Automotive Sampling System-Crashworthiness Data System (NASS-CDS, 2010-2015) and Crash Investigation Sampling System (CISS, 2017-2023). The final complete dataset comprised 17,045 crash-involved occupants representing 9,225,347 weighted occupants nationwide. In addition to developing the predictive model using the complete dataset, we also conducted imputation and resampling experiments to demonstrate the distribution of potential model outcomes. Beyond predictors commonly employed in existing AACN algorithms, we incorporated underutilized information related to collision objects, including crash type and hit object type. Model performance was evaluated using both traditional classification metrics and triage-specific measures designed for AACN applications. The proposed model outperformed existing AACN ISP algorithms across all evaluation metrics. Analysis of the trained model revealed that continuous risk factors exhibit distinct nonlinear relationships with serious injury in the log-odds space: delta-V follows an arctangent-like relationship, principal directions of force (PDOF) exhibit a distinct bimodal pattern, and both occupant age and BMI show a Gaussian-like relationship. Among categorical predictors, crash type and hit object type were identified as influential categorical predictors. Trainable B-spline functions enable effective modeling of complex nonlinear relationships in crash injury prediction while providing explicit mathematical formulations similar to traditional logistic regression. The identification of specific functional patterns for key risk factors enhances understanding of injury mechanisms and provides a foundation for more accurate AACN systems. These findings, including the importance of previously underutilized predictors such as crash type and hit object type, provide a reference for the future development of AACN prediction systems.
To describe tetanus vaccination practices and injury characteristics in Sandun Town, Hangzhou during February 2024 to January 2025. A retrospective cross-sectional study was conducted using data from trauma and animal-injury patients who received tetanus vaccination in Sandun Town, Hangzhou from February 2024 to January 2025. Demographic characteristics, injury profiles, vaccination status, and relationships with season/temperature were analyzed. Total of 3,174 patients were initially identified, and 2,825 were included in the final analysis after applying exclusion criteria. Among them, animal-induced injuries accounted for 1,029 cases (36.4%), traffic accident injuries for 943 cases (33.4%), cutting injuries for 374 cases (13.2%), blunt force injuries for 242 cases (8.6%), and other causes for 237 cases (8.4%). Males predominated in all trauma categories except animal-induced injuries, where females were the majority (53.3%). Employees/workers were the predominant occupational group across all categories (56.4-76.4%). The upper limb was the most common injury site across all categories (56.7-74.1%). High-risk wounds were observed in 88.2-98.9% of patients. The use of passive immunizing agents was generally low (2.1-10.4%), with the highest rate in animal-induced injuries. Following the implementation of China's 2024 non-neonatal tetanus guideline, the treatment of external injuries is becoming more standardized. However, gaps persist compared with developed countries, mainly reflected in the underutilization of passive immunizing agents for high-risk wounds and inconsistent application of guidelines. Targeted education for students, migrant workers, and pet owners-particularly during warmer months-and continued training for healthcare personnel are needed.
This study aimed to analyze the epidemiological characteristics and trends of hospitalizations for unintentional injuries (UI) among children and adolescents (≤18 years) before (2015-2019) and after (2020-2024) the COVID-19 pandemic. A retrospective review was conducted on 51,591 UI-related hospital admissions from our university-affiliated children's hospital. Patients were categorized into five age groups: infants (<1 year), toddlers (1-3 years), preschool-age (4-6 years), school-age (7-12 years), and adolescents (13-18 years). Data were analyzed across the two defined periods. The total number of UI hospitalizations decreased in Post-COVID compared to pre-COVID. Marked reductions were observed particularly in 2020 and 2022, with a gradual upward trend emerging from 2023 onward-patterns consistent with the evolving impacts of the pandemic. The majority of patients were male and from rural areas throughout the study. However, an increasing yearly trend was observed in the proportion of female patients and those from urban areas after the pandemic. Toddlers consistently had the highest hospitalization rate. A shift in age distribution was noted, with a decreased proportion of cases among infants and toddlers and an increased proportion among school-age children and adolescents post-COVID. Fall/slip were the most common injury mechanism across all ages. Compared with the pre-pandemic period, the proportion of foreign body has decreased significantly in infants, whereas the rate of accidental poisoning has risen markedly among adolescents. Traffic accidents were consistently associated with the highest intensive care unit (ICU) admission rate, the highest readmission rate, and the highest medical costs, yet the lowest rate of recovered/improved. The pattern of body injuries varied with age, with head injuries decreasing and injuries to the extremities, abdomen, and pelvis becoming more common in older age groups. Clinical outcomes improved, with a lower rate of critical illness and higher rates of ICU admission, surgical intervention, and clinical recovered/improved post-COVID. This study delineates the evolving landscape of pediatric UI before and after the COVID-19 pandemic. While the fundamental causes of injury remain, their proportions and severities have shifted, influenced by changes in children's living environments and activities. These results underscore the importance of continuous epidemiological surveillance to inform and refine effective, age-specific prevention strategies and to optimize clinical resource allocation for pediatric injury care.
Road traffic injuries (RTIs) are a global contributor to injury-related mortality, with low- and middle-income countries bearing a disproportionate burden. To assess the burden and trend of RTIs in Kenya from 2014 to 2023 using the Global Burden of Disease Data. We conducted secondary analysis of RTIs using the Global Burden of Disease GBD) data. Numbers and rates per 100 000 of mortality and disability-adjusted life-years (DALYs) were reported with a 95% uncertainty interval. The average annual percentage change was calculated to assess trends in age-standardised mortality and DALY rates. From 2014 to 2023, age-standardised mortality and DALY rates for road injuries in Kenya showed an overall increasing trend, with motorcyclist-related injuries experiencing the most pronounced rise. Pedestrian injuries contributed to the highest mortality, while motor vehicle injuries accounted for the greatest DALYs. Vulnerable road users motorcyclists, cyclists and pedestrians demonstrated consistent upward trends, particularly during 2021. Road-injury rates were substantially higher in males compared with females and were greatest among adults aged 55 years and above. Road injuries in Kenya increased from 2014 to 2023, particularly among motorcyclists. In 2023, motor vehicle occupants and pedestrians bore the highest mortality and DALY burden. Males and adults aged ≥55 years had the highest mortality and DALY rates.
Teens cited for traffic violations represent a high-risk driving population, and traffic citations may function as psychologically salient teachable moments for behavior change. This study aimed to explore how parents interpreted and responded to their teen's citation and how participation in a parent-focused, technology-supported intervention influenced parental engagement in promoting safe driving amid persistent teen crash risk. We conducted 38 semi-structured virtual interviews with parents of teens who participated in the intervention arms of ProjectDRIVE, a post-citation randomized controlled trial recruiting parent-teen dyads from juvenile traffic courts. Interviews explored parents' reactions to the citation, experiences with intervention components, and recommendations for improvement and scale-up. All interviews were audio-recorded, transcribed verbatim, and analyzed thematically using an iterative coding process in ATLAS.ti. Three themes emerged. (1) Parents' reactions to the citation: Parents initially reported frustration, concern, or stress but often reframed the citation as a teachable moment to reinforce responsibility, accountability, and safer decision-making. (2) Parents' experiences with ProjectDRIVE: Objective in-vehicle driving feedback increased teens' awareness of risky behaviors and served as an external reference point, while structured parent communication strategies supported more open, less defensive conversations about driving safety. (3) Strategies for strengthening and scaling the program: Parents emphasized the importance of usability, relational support, and integration within existing systems, including juvenile courts, schools, and driver education programs, to enhance reach and sustainability. Traffic citations can serve as critical teachable moments for families of high-risk teen drivers. ProjectDRIVE supported this process by strengthening parent-teen communication, increasing accountability, and sustaining parental involvement during the early licensure period. Parent-focused interventions that integrate behavioral and technological strategies may offer a scalable, public health-oriented approach to reducing crash risk and promoting safer communities.
Adult traumatic brachial plexus injury (BPI) is a severe peripheral nerve injury that frequently results in significant upper limb disability in young individuals. The epidemiology varies with different geographical locations. This study aimed to analyze the demographic profile, mechanisms of injury, injury severity patterns, referral timelines, and reconstructive burden of adult traumatic BPI in a tertiary care institution of northern India. A retrospective observational study was conducted at the All India Institute of Medical Sciences (AIIMS), Bathinda, Punjab, India, over a two-year period. Adult patients (≥18 years) with clinically and radiologically confirmed traumatic BPI were included. Cases of obstetric and iatrogenic brachial plexus injury were excluded. Data regarding age, sex, mechanism of injury, level and severity of plexus involvement, time to presentation, associated injuries, and management modality were collected. Descriptive statistical analysis was performed. Seventy-five adult patients were included, with a mean age of 29.1 years; 69 (92%) were male. Road traffic accidents were the predominant cause, with two-wheeler accidents accounting for 78.7% of cases. Complete C5-T1 involvement was observed in 59 patients (78.7%). Forty-five patients (60%) presented more than six months after injury. At the time of analysis, 51 patients (68%) had undergone surgical intervention, including primary nerve transfer and secondary reconstructive procedures, while 24 (32%) had not undergone operative treatment. Adult traumatic BPI in this semi-urban North Indian cohort was predominantly associated with high-energy two-wheeler accidents and a high proportion of complete plexus injuries, with frequent delayed presentation. These findings highlight the substantial reconstructive demand in tertiary centers and underscore the need for improved referral pathways and trauma prevention strategies.
<b>Introduction:</b> Hand injuries are common, accounting for between 7 and 28% of all injuries. These are both closed injuries (joint dislocations and bone fractures) and open injuries (wounds and amputations). They occur in workplaces, in agriculture, during housework, sports, and during traffic accidents. <br><br><b>Aim:</b> The aim of the paper was to review the literature and present own experiences on the mechanisms of occurrence and methods of preventing severe hand injuries. <br><br><b>Material and methods:</b> Data from the literature were obtained from the Medline and PubMed databases, using keywords such as those in this paper. In addition, data from the author's institution experience are presented. <br><br><b>Results:</b> Various mechanisms of hand injuries when operating various devices, e.g., circular saws, angle grinders, mechanical presses, agricultural machinery, and fireworks, are presented. The most common causes of injury at operating these devices are discussed. Methods to prevent injuries that are specific to each device were discussed. The number of serious accidents in factories and workplaces has decreased noticeably over the last 10 years, while their incidence in households remains unchanged. <br><br><b>Conclusions:</b> Most injuries occur when operating devices with a rotating blade: circular saw, angle saw, and manual circular grinder. The cause of these injuries is most often careless handling of tools and failure to follow the operating instructions when tinkering at home. <br><br><b>Relevance of the study to the development of the field:</b> The results of this work may contribute to increasing public attention to the observance of safety when operating mechanical equipment.
This study investigates the optimization of lane-change trajectories for intelligent connected vehicles (ICVs) operating in mixed traffic environments. By integrating dynamic risk modeling with cooperative obstacle-avoidance planning, lane-change safety is enhanced while maintaining trajectory stability. A comprehensive dynamic risk-field model was developed. The relative motion states of surrounding vehicles and their geometric occupancy were mapped into a continuous spatial risk distribution. This formulation characterizes the spatial propagation and attenuation of interaction risks and describes their spatiotemporal evolution during lane-change maneuvers. On this basis, a multi-objective trajectory optimization model was established within a path-velocity decoupling framework. Risk-field functions were incorporated together with vehicle dynamic feasibility constraints. Optimal lane-change trajectories were then generated through cost minimization. The effectiveness of the proposed risk-driven optimization approach was evaluated by comparing risk levels before and after optimization. The results indicate that the composite interaction risk during lane-change maneuvers follows the order: longitudinal following phase > lane-change execution phase > lane-change preparation phase > post-change adjustment phase. The proposed risk-driven optimization method achieves a balance between risk mitigation and dynamic responsiveness. Smooth and stable lane-change trajectories are generated for ICVs. Compared with the original trajectories, the comprehensive interaction risk decreased by 0.86%, 0.55%, 3.44%, and 5.62% across the four respective phases. In addition, high-risk regions contracted, and the distribution of risk gradients became more uniform. The proposed risk-field-driven multi-objective trajectory optimization method quantitatively characterizes the evolution of interaction risk during lane changes in mixed traffic. Interaction risk levels are effectively reduced through the proposed framework. Trajectory smoothness and control stability are improved while dynamic feasibility is strictly maintained. The method thus provides theoretical support for intelligent connected vehicles to execute safe lane-change maneuvers in complex multi-vehicle interaction environments.
As China operates the world's most extensive expressway network, frequent traffic accidents undermine the sustainable development of its transportation system and negatively impact public travel safety. Variations in temporal and geographical conditions lead to differences in accident characteristics, distribution patterns, and contributing factors. This study aims to analyze the features, distribution, and influencing factors of expressway accidents in Guangdong Province from 2014 to 2023, and to propose evidence-based safety countermeasures. A total of 131 expressway accidents recorded in Guangdong Province between 2014 and 2023 were statistically analyzed. Key accident characteristics, distribution patterns, and influencing factors were examined. Significant independent variables were standardized, and five determinant factors were extracted using factor analysis. These factors were subsequently classified into four distinct accident categories through K-means clustering to further explore underlying influences. Since 2020, the number of expressway accidents in Guangdong Province increased substantially, averaging approximately 16 incidents annually. Accidents occurred more frequently in summer (29.77%) and spring (27.48%). Within a 24-h period, 34.35% of accidents took place during early morning hours, representing the highest proportion by time segment. Heavy vehicles (45.80%) and passenger cars (29.77%) were involved in the majority of accidents. Improper driving behavior was a significant contributing factor, accounting for 18.32% of incidents. Secondary accidents were found to result in considerably more severe consequences than primary accidents. A significant correlation was identified between expressway accidents and five determinant factors: environmental (F1), cause of accident (F2), vehicle-related (F3), road-related (F4), and temporal (F5). Influencing factors such as season, time period, expressway type, secondary accident occurrence, vehicle type distribution, and city were significant only within specific accident categories. In contrast, weather conditions, road surface status, visibility, and accident causes were significant across multiple categories. The findings highlight distinct temporal, vehicular, and behavioral patterns associated with expressway accidents in Guangdong Province. The analysis of determinant factors and accident categories provides a nuanced understanding of contributing influences. Based on these results, targeted safety improvement strategies are proposed to support the development of expressway traffic safety measures and inform relevant policy-making.
The rapid advancement of Battery Electric Vehicle (BEV) in automotive technology and market adoption present safety challenges due to their distinct design and operational characteristics compared to Gasoline Vehicles (GVs). A proactive approach to evaluating the safety performance of Advanced Driver Assistance Systems (ADAS) among BEVs and GVs is necessary to address these emerging risks. A total of 8,118 Florida crash reports with ADAS engaged were analyzed in this study, consisting of 6,052 from GV and 2,066 from BEV. Comparability between BEVs and GVs regarding ADAS safety evaluation across diverse traffic conditions was established using Propensity Score Matching (PSM), examining injury severity, environmental conditions, driver maneuvers, and vehicle types. And then a partially constrained Random Parameter Logit (RPL) model was employed to identify both the unique and shared factors influencing injury severity of BEVs and GVs. PSM showed that ADAS-engaged BEV crashes had lower injury severity (75.13% no-injury vs. 69.82% for GVs) but higher involvement in Vulnerable Road User (VRU) crashes (3.2% vs. 1.8%). The RPL model revealed ADAS-engaged BEV crash risk in work zones (+0.0057 severe injury probability), GV crash risk at processing straight and backing (+0.0042 minor injury probability), and shared risk at speeds above 61 mph (+0.0084 severe injury probability). This study offers an exploratory analysis of ADAS safety performance between BEVs and GVs using real-world crash data. These findings provide valuable insights for manufacturers and other stakeholders to inform decisions regarding the deployment and application of these technologies.
Unintentional childhood injuries (UCIs) are a leading cause of morbidity and mortality among children globally, imposing significant clinical and economic burdens, particularly in low- and middle-income countries. Emergency Departments (EDs) serve not only as the first point of contact for such events but also as the initial entry point for non-fatal UCIs, which represent a hidden and more substantial burden on health services. The primary objective of this study is to comprehensively analyze the clinical and socioeconomic determinants and predictors of unintentional childhood injuries (UCIs) presenting to the emergency department. Based on insights from these empirical data, the study further proposes a multidisciplinary, four-dimensional framework as a conceptual model to enhance systemic prevention and intervention strategies. This is a prospective and cross-sectional study. Data were collected using structured forms and digital medical records, covering demographic, familial, socioeconomic, and injury-related variables. Statistical analyses were performed to examine associations among risk factors, injury mechanisms, clinical outcomes, and mortality predictors. Falls were the most common cause of UCI (49.8%), followed by traffic accidents (12.4%). Injuries most frequently occurred at home(43.6%), particularly in kitchens and gardens. Male patients constituted 62.7% of the cases. Statistically significant associations were observed between low maternal education, poor economic status, and higher Injury Severity Score (ISS). Multiple trauma(MT) was more common among children aged≥12 years and those with separated parents. Elevatedserum glucose (≥153 mg/dL) and glucose/potassium ratio (≥39.48) were identified as potential clinical markers for assessing mortality risk (p<0.001). MT, abdominal and thoracic trauma, and higher ISS were associated with increased mortality. Early identification of high-risk patients using clinical predictors such as serum glucose may improve treatment outcomes. Additionally, the frequent occurrence of head, upper, and lower extremity injuries in the ED indicates that these regions should be carefully examined for potential injuries. The tendency for thoracic and abdominal injuries to co-occur, as well as the higher prevalence of MT among patients with abdominal trauma-and the predictive value of abdominal injuries for adverse clinical outcomes-underscore the need for thorough evaluation of other systems and differentiated clinical monitoring in children identified with abdominal injury. Multidisciplinary and systematic prevention and treatment strategies that address clinical, socioeconomic, and environmental factors remain essential for reducing both the incidence and severity of such injuries. The multidisciplinary, task force-oriented approach proposed in this study-emphasizing the clear definition of roles-may offer significant improvements in this regard. Kazalar, çocuklar arasında dünya genelinde morbidite ve mortalitenin önde gelen nedenlerinden biridir ve özellikle düşük ve orta gelirli ülkelerde önemli klinik ve ekonomik yükler oluşturmaktadır. Acil servisler (AS), bu tür olaylar için yalnızca ilk başvuru noktası olmakla kalmayıp, aynı zamanda sağlık hizmetlerine daha büyük ve görünmeyen bir yük oluşturan ölümcül olmayan çocukluk çağı kazalarının da ilk başvuru noktasıdır. Bu çalışmanın temel amacı, acil servise (AS) başvuran kazara çocukluk çağı yaralanmalarının klinik ve sosyoekonomik belirleyicilerini ve öngörücülerini kapsamlı bir şekilde analiz etmektir. Elde edilen bu verilerden yola çıkarak çalışma; sistemik önleme ve müdahale stratejilerini güçlendirmek adına, çok disiplinli ve dört boyutlu bir çerçeveyi kavramsal bir model önerisi olarak sunmaktadır Bu çalışma, acil servise kaza nedeniyle başvuran hastaları kapsayan prospektif, kesitsel bir çalışmadır. Veriler; demografik, ailevi, sosyoekonomik ve yaralanmayla ilgili değişkenleri içerecek şekilde yapılandırılmış formlar ve dijital tıbbi kayıtlar kullanılarak toplanmıştır. Risk faktörleri, yaralanma mekanizmaları, klinik sonuçlar ve mortalite öngörücüleri arasındaki ilişkileri incelemek için istatistiksel analizler yapılmıştır. Çocukluk çağı kazalarının en sık nedeni düşmelerdi (%49.8), bunu trafik kazaları (%12.4) izledi. Yaralanmalar en sık evde (%43,6), özellikle mutfak ve bahçelerde meydana gelmişti. Vakaların %62.7’sini erkek hastalar oluşturuyordu. Düşük anne eğitimi, kötü ekonomik durum ve yüksek Yaralanma Şiddet Skoru (ISS) arasında anlamlı ilişki saptandı. Multipl travmalar, 12 yaş ve üzeri çocuklarda ve ayrı ebeveynli olanlarda daha sık görülmekteydi. AS başvurusunda yüksek serum glukoz düzeyi (≥153 mg/dL) ve glukoz/potasyum oranı (≥39.48) mortalitenin potansiyel öngörücüleri olarak belirlendi (p<0.001). Multipl travma, abdominal ve torasik travma ile yüksek ISS artmış mortalite ile ilişkili bulundu. Serum glukozu gibi klinik öngörücüler kullanılarak yüksek riskli hastaların erken tespiti tedavi sonuçlarını iyileştirebilir. Ayrıca, acil serviste baş, üst ve alt ekstremite yaralanmalarının sık görülmesi, bu bölgelerin olası yaralanmalar açısından dikkatle incelenmesi gerektiğini göstermektedir. Abdominal yaralanmaların kötü klinik sonuçları öngörmedeki rolü dikkate alındığında, torasik ve abdominal yaralanmaların birlikte görülme eğilimi ve abdominal travmaya sahip hastalarda çoklu travma prevalansının yüksekliği, abdominal yaralanması tespit edilen çocuklarda diğer sistemlerin detaylı değerlendirilmesini ve farklı klinik izlem ve takibi gerektirdiğini göstermektedir. Çocukluk çağı kazaları, sonuçları potansiyel olarak önlenebilir olan önemli bir halk sağlığı sorunudur. Klinik, sosyoekonomik ve çevresel faktörleri ele alan çok disiplinli ve sistematik önleme stratejileri, bu tür yaralanmaların hem insidansını hem de şiddetini azaltmak açısından önemini korumaktadır. Bu çalışmada, elde edilen klinik ve sosyoekonomik bulgular ışığında önerilen görev gücü odaklı çok disiplinli yaklaşım, çocukluk çağı yaralanmalarının yönetiminde sistematik ve etkin bir iyileştirme sağlayabilir
The global burden of injury is a key indicator for assessing public health and medical needs. During the COVID-19 pandemic, this burden was impacted. This study aims to explore how the pandemic influenced the injury burden globally and regionally, and provide recommendations to relieve this burden. The burden of injury-related data is derived from the Global Burden of Disease (GBD) 2021 Study. Autoregressive integrated moving average (ARIMA) and ARIMA-Long short-Term Memory (LSTM) models were adopted for counterfactual inference to predict the scenario without the pandemic. During the COVID-19 pandemic, the observed global age-standardized incidence rate (ASIR) of injury exceeded the predicted value by 107.31 per 100,000, and the observed age-standardized prevalence rate (ASPR) was higher than the predicted value by 102.81 per 100,000. Self-harm and interpersonal violence saw the largest deviations above predicted values in Europe and parts of Asia. Specifically, Armenia's ASIR was 7,829.33 per 100,000 higher than predicted, and its ASDR exceeded projections by 5,186.32 per 100,000. Besides, traffic injuries exceeded predicted levels most significantly in Southeast Asia, with Indonesia's ASIR 25.48 per 100,000 higher than projected. And the observed ASIR of unintentional injuries in China was 379.61 per 100,000 higher than the predicted value. During the COVID-19 pandemic, the global burden of injuries surpassed the predicted levels for a scenario without the pandemic in 2020-2021, especially in Europe and Asia. In addressing an epidemic, prevention and emergency measures for high-burden injury types and key populations should be strengthened based on local socio-cultural contexts.
Motor vehicle accidents remain a leading cause of craniofacial trauma, with injury severity evolving alongside automotive safety advancements. While airbags and seatbelts have revolutionized trauma prevention, reducing worldwide mortality by over 70,000 lives in five years, their mechanics can paradoxically modify or exacerbate facial injuries due to occupant positioning, chemical factors, and collision dynamics. This study examines injury patterns, mechanisms, and trauma prevention strategies related to airbag-related maxillofacial trauma. A scoping review was conducted across PubMed, Google Scholar, and Scopus (up to October 2025). Search terms included "airbag," "maxillofacial injuries," and "occupant restraint system injuries." Inclusion criteria focused on human studies reporting airbag-related facial trauma. Two reviewers independently screened literature, resolving discrepancies via consensus. Orbital fractures (particularly blow-out fractures) and ocular trauma dominated reported injuries, attributed to blunt force distribution during a car crash with airbag deployment. Soft tissue lesions, chemical burns, and atypical fractures were also documented. Case analyses revealed that injury severity and pattern were highly variable, significantly influenced by risk factors such as pre-impact braking, seatbelt nonuse, and close occupant proximity to the steering wheel. These findings underscore that trauma prevention strategies must extend beyond the presence of safety devices to include public education on optimal occupant positioning and restraint system interactions. Furthermore, continued technological refinements aimed at mitigating deployment kinetics and chemical risks remain critical. Airbags provide indispensable protection in motor vehicle collisions, yet a balance between their lifesaving benefits and potential for injury requires multidisciplinary collaboration. Future efforts should integrate biomechanical research, clinical findings, and policy updates to improve occupant safety and optimize protective outcomes.
This study aims to analyze the spatiotemporal evolution of traffic crash risk in Manhattan and to improve one- to seven-day-ahead crash prediction through a Bagging Optimized Dynamic Mode Decomposition (BOPDMD) framework. By examining two full years of daily crash data (2019-2020), the study further investigates how latent crash patterns differ between a typical pre-pandemic year and a disruption-dominated pandemic year. Daily crash counts from 69 Manhattan neighborhoods were aggregated into zone-day matrices for 2019 and 2020, as the daily scale provides a practical compromise between short-term responsiveness and data stability for neighborhood-level crash modeling. A unified preprocessing pipeline was applied, including square-root variance stabilization and zone-wise standardization. For prediction experiments, a fixed 212-day window from April 1 to October 30 was used in each year to ensure identical sample length. Within this window, the first 160 days were used for training and the remaining 52 days were used for testing. For interpretation, BOPDMD was applied to the complete 2019 and 2020 matrices, with 365 and 366 days respectively, to extract spatial modes, temporal coefficients, and modal frequencies that characterize underlying crash dynamics. Its forecasting performance was compared with standard Dynamic Mode Decomposition (DMD) and several representative baseline models under one- to seven-day prediction horizons. BOPDMD achieved the lowest or near-lowest Mean Absolute Error (MAE) and Root Mean Squared Error (RMSE) across most prediction horizons in both years and exhibited the slowest error accumulation in multi-step forecasting. The spatiotemporal mode analysis revealed clear cross-year differences. In 2019, dominant modes captured stable high-risk corridors and regular weekly and seasonal oscillations, indicating a mobility-driven and quasi-periodic crash regime. In contrast, the 2020 modes exhibited abrupt spatial reconfiguration, rapid temporal decay, and weakened periodic structure, reflecting pandemic-induced disruptions in travel demand and risk allocation. Eigenvalue patterns confirmed that 2020 dynamics were more transient and less cyclic than those of 2019. The findings demonstrate that BOPDMD provides both accurate one- to seven-day-ahead crash forecasts and interpretable representations of underlying risk dynamics. The revealed modal structures highlight how urban crash risk shifts between stable mobility patterns and externally driven disruptions. These insights can support proactive safety management by enabling zone level risk monitoring, prioritization of high risk areas, and the design of targeted interventions for both persistent hotspots and disruption induced risk shifts in complex urban environments.
Drug-related road traffic accidents (RTAs) represent a significant public health concern, yet large-scale real-world evidence on high-risk medications remains limited. This study aimed to characterize the landscape and quantify signals of drug-associated RTAs using the U.S. FDA Adverse Event Reporting System (FAERS). A retrospective study was conducted on FAERS reports (Q1 2004-Q2 2025). Dispro-portionality analyses were performed using the Reporting Odds Ratio (ROR) and the Bayesian Confidence Propagation Neural Network (BCPNN) for the top 50 most frequently reported drugs. Gender differences and time-to-onset profiles were also analyzed. Among 22,775,812 total adverse event reports, we identified 38,760 RTA cases. The three most reported drugs were adalimumab (n = 2,278), oxycodone (n = 1,898), and etanercept (n = 1,087). Disproportionality analysis showed that 41 of the top 50 drugs (82.0%) generated positive safety signals for RTAs. Nervous system agents (36.6%) and antineoplastic/immunomodulating agents (34.1%) comprised the majority of signal-positive drugs. Zolpidem demonstrated the strongest signal (IC025 = 4.42), followed by alendronic acid (IC025 = 2.77) and buprenorphine/naloxone (IC025 = 2.64). Gender-stratified analysis of these 41 signal-positive drugs found that males had a significantly higher reporting risk for 26 drugs, whereas females had a higher risk for 6 drugs. This analysis identifies drugs most frequently associated with RTAs using real-world data, providing evidence for risk assessment and patient guidance. However, the FAERS database has inherent limitations, such as unadjusted confounders, missing data on alcohol or substance use, and incomplete accident outcomes. Thus, further clinical validation is warranted to confirm these associations.