Corinne Peek

FATAL INJURIES IN MOTORCYCLE RIDERS ACCORDING TO HELMET USE

OBJECTIVE: Helmets have been shown to be effective in preventing head injuries in motorcyclists, but some studies have suggested that helmets may cause injury to parts of the head or neck because they add mass to the head. DESIGN: This study examined patterns of fatal injuries in helmeted and unhelmeted motorcyclists. MATERIALS AND METHODS: Coroner reports, hospital records, and police reports for motorcyclists fatally injured in crashes from July 1, 1988 through October 31, 1989 were examined. All injury diagnoses were abstracted and coded to the 1990 version of The Abbreviated Injury Scale and the International Classification of Diseases, 9th revision. MAIN RESULTS: Cerebral injury, intracranial hemorrhage, face, skull vault, and cervical spine injuries were more likely to be found in fatally injured unhelmeted motorcyclists than in helmeted motorcyclists. CONCLUSIONS: These results expand earlier reports showing that helmets provide protection for all types and locations of head injuries, and show that they are not associated with increased neck injury occurrence.

Compliance with the 1992 California motorcycle helmet use law

To evaluate helmet use in California before and after the introduction of an unrestricted helmet use law on January 1, 1992, observations of motorcycles and their riders were made at 60 locations in seven California counties, twice before and four times after the law was introduced. Helmet use increased from about 50% in 1991 to more than 99% throughout 1992. Compliance was achieved despite variations in helmet use by motorcycle design and road type. Seven percent of riders used nonstandard helmets after the law. With adequate enforcement, unrestricted helmet use laws can achieve almost 100% compliance and reduce the number of people riding motorcycles.

LOWER EXTREMITY INJURIES FROM MOTORCYCLE CRASHES: A COMMON CAUSE OF PREVENTABLE INJURY

Lower extremity injuries are among the most common injuries sustained by motorcycle riders in crashes and often lead to extended and costly medical treatment and permanent disability. This study characterizes lower extremity injuries in a group of 700 motorcycle riders in crashes in Los Angeles County from July 1, 1988, through October 31, 1989. Motorcycle crash fatalities (n = 163) were identified through the Los Angeles County Coroners office, and nonfatally injured riders (n = 537) were identified at four of the ten level I and level II trauma centers in the county. Lower extremity injuries were diagnosed in 301 (56%) of nonfatally injured and in 75 (46%) of fatally injured riders. Fractures were the most common lower extremity injury and were diagnosed in 52% and 42% of riders with nonfatal and fatal injuries, respectively. Over a third of all fractures were to the tibia or fibula. Drivers and passengers did not differ in their risk for lower extremity injuries. Multiple-vehicle collisions resulted in a higher risk of lower extremity injuries than did single-vehicle collisions. The highest risk for lower extremity fractures was observed among riders in broadside collisions in which another vehicle struck the motorcycle (risk ratio = 2.7). Modifications in vehicle design and rider apparel may prevent some lower extremity injuries in motorcycle crashes.

Failure of the Mandatory Domestic Violence Reporting Law to Increase Medical Facility Referral to Police

STUDY OBJECTIVE To assess the effect of Californias 1994 mandatory domestic violence reporting law on Los Angeles Sheriffs Department dispatches to medical facilities for domestic violence incidents. METHODS This ecological time-trend study analyzed data from the Los Angeles Sheriffs Department for the period January 1, 1993, to December 31, 1995. All 26,051 dispatches for domestic violence offenses during the study period were analyzed. The outcome measures were changes in biweekly department dispatches for domestic violence offenses resulting from the implementation of the mandatory domestic violence reporting law adjusted for seasonal variation and the Simpson/Goldman murders. RESULTS The percentage of biweekly dispatches to medical facilities for domestic violence offenses did not increase in response to the law (beta = -.0072, P = .095). Total domestic violence dispatches increased significantly after the Simpson/Goldman murders but not after passage of the law (beta = 82.7, P < .0001 versus beta = -10.1, P = .2205). CONCLUSION The mandatory domestic violence reporting law in California did not increase medical personnel reporting of domestic violence situations to the Sheriffs Department during the 2 years after its implementation.

Need for law enforcement in cases of intimate partner violence in a university ED

The purpose of this study was to quantify the proportion of men and women seen in a university emergency department (ED) for treatment of injuries resulting from intimate partner violence (IPV) that require reports to law enforcement authorities. A total of 1,516 adult ED patients were asked to complete a written survey instrument; 1,003 patients (66.2%) completed the survey. Two percent of patients reported they presented to the ED for treatment of injuries resulting from IPV. Three percent reported IPV within the last year, and 10% reported that they had ever been physically abused by a partner. Six percent of respondents reported that they had ever been threatened with a gun or knife by a partner, 2% within the past year. Only the lifetime prevalence of IPV was significantly greater among female patients, 15% versus 6% (P < .001). Approximately 2% of our ED patients require law enforcement intervention for IPV.

Effect of immediate resuscitation on children with submersion injury

STUDY OBJECTIVE To determine the effect of immediate resuscitative efforts on the neurological outcome of children with submersion injury. DESIGN A case-control study was designed to determine if immediate resuscitation by rescuers or bystanders reduces the frequency of severe neurological damage or death in children with a documented submersion event. Logistic regression was used calculate an adjusted odds ratio. PARTICIPANTS The study group consisted of 166 children, aged zero to 14 years, having a submersion event during May 1984 through August 1992, and admitted through various emergency departments to Huntington Memorial Hospital in Pasadena, California. MEASUREMENTS AND MAIN RESULTS All study subjects had an observed and documented episode of apnea at the time of submersion. Outcomes were evaluated on the basis of neurological impairment or death. Exposure was verified from historical accounts of postsubmersion events provided by family, friends, and/or paramedical personnel. The study factors included age and gender, duration of submersion, hypothermia, presence of apnea, resuscitative efforts, and clinical outcome. Children with a good outcome were 4.75 (adjusted odds ratio (OR)) times more likely to have a history of immediate resuscitation than children with poor outcome (95% confidence interval: 3.44 < OR < 6.06, P = .0001). Various types of resuscitative efforts and potential confounding factors were also evaluated. CPR and mouth-to-mouth resuscitation were the most effective types for the prevention of death or severe anoxic encephalopathy. CONCLUSION Immediate resuscitation before the arrival of paramedical personnel is associated with a significantly better neurological outcome in children with submersion injury.