Harmeet Sjögren

ELDERLY IN THE TRAFFIC ENVIRONMENT: ANALYSIS OF FATAL CRASHES IN NORTHERN SWEDEN

Fatal crashes of the elderly (> or = 60 years; N = 379) in northern Sweden in the traffic environment, between 1977 and 1986, were investigated using autopsy and police reports. Males had double the death rate of females. The car occupants made up the largest category (43%) followed by pedestrians, pedalcyclists, and two-wheel-motorvehicle (TWMV) riders, but the risk of fatal injury per unit distance travelled was highest for pedestrians and pedalcyclists. Most car occupants were killed in vehicle-vehicle crashes, mostly in the daylight and at intersections or straight roads. Ice and/or snow (31%) was the major precrash factor. In two-thirds of single car crashes, roadside hazards such as trees were involved. Most elderly fatally injured car drivers were responsible for the crash, and they were commonly involved in collisions with oncoming vehicles. Only 4% of the fatally injured car drivers were driving under the influence of alcohol. Head injuries appeared to be more common in side impact than in frontal impacts. Serious chest injuries were more common than head injuries in car crashes. One-quarter of the pedestrians were injured at pedestrian crossings and about half during darkness. One in six pedestrians were under the influence of alcohol. All pedalcyclists were injured in collisions with motor vehicles and most were injured at intersections. Pedestrians, pedalcyclists, and TWMV riders had more serious head injuries than chest injuries.

Differences between older and younger drivers; characteristics of fatal car crashes and driver injuries

Car drivers (greater than or equal to 18 years; n = 514) in Northern Sweden who were fatally injured over a 13-year-period were investigated using autopsy and police reports. Fatalities per unit distance and per licenced driver were highest for the greater than = 70-year-old and = 60-year-old drivers were more often at fault than the = 60-year-old drivers were more likely to die as a consequence of less severe injuries than the less than 60-year-old ones. The belted younger drivers had fewer fatal chest injuries and more head injuries than the non-belted ones. In older drivers, fatal head injuries were more common in side impacts than in frontal impacts. Older drivers got more post-traumatic complications than the younger ones.

Role of disease in initiating the crashes of fatally injured drivers

All autopsied car drivers (n = 480) aged > or = 18 years, who were fatally injured and died within 3 days of the crash in northern Sweden over a 13-year period were studied. A grading system was developed to assess the probability of contribution of intrinsic medical factors to the crash. This system takes into account both the risk of sudden incapacitation (inability to cope), based on intrinsic medical factors revealed in the medical history and at autopsy, and extrinsic non-medical contributing factors. Almost one quarter of the drivers were found to have intrinsic medical factors. Intrinsic medical factors were more common in males than in females. Drivers with intrinsic medical factors were often at fault and usually crossed over to the wrong side of the road and crashed into an oncoming vehicle or roadside object. In 6% of the drivers, intrinsic medical factors were probably the underlying cause of the crash; in 1.3% the probability was strong. In the > or = 60-year-old group, intrinsic medical factors were the underlying cause of the crash in 19% of the cases; the probability was strong in 4%.

Violent deaths in small children in northern Sweden.

Abstract Objectives. To identify causes and trends of violent deaths among children younger than 4 years in a northern region. Study design. Retrospective analysis of medico-legal autopsy and police data. Methods. Data from all 72 deaths from “external causes” 1977–2004, in children < 4 years from the northern half of Sweden were analysed. Results. The death rate was 7.1 per 100,000 children and year during the first half of the study period, and 5.2 during the second half. Vehicle-and drowning-related deaths were halved. Fifteen were struck by motor vehicles (in 8 cases by heavy vehicles), 14 car occupants were killed in car crashes, 12 were killed by intentional violence inflicted by an adult, and 9 each were killed by (i) carbon monoxide/smoke inhalation, (ii) asphyxiation, or (iii) drowning. The boy:girl ratio was 1:1 in all groups, except in the groups “drowning” and “run over by motor vehicle”, where boys dominated. Conclusions. Medical professionals have a difficult but important task in identifying and taking action against child abuse and in promoting child safety especially in the traffic and home environments.

Comparison between blood analysis and police assessment of drug and alcohol use by injured drivers

Official statistics for alcohol/drug use by drivers can influence the introduction of intervention measures against impaired driving. Thus, the validity of official statistics is important. Since official statistics are based on police assessment of inebriation, the present study was aimed at investigating this issue by comparing blood analysis with the rate of police detection of alcohol/drug use by injured drivers. All injured motor vehicle drivers who were hospitalized (HD) (Umeå: n = 104) and all fatally-injured drivers (FD) who were autopsied (Umeå, Northern Sweden: n = 110; Gothenburg, Western Sweden: n= 133) from May 1991 through Dec 1993 were tested for alcohol and both licit and illicit drugs. The findings of the blood analyses were compared with police assessment of inebriation. In the HD, the police suspected inebriation in 13% (n= 13) whilst blood analyses showed drug and/or alcohol in 18% (n = 19) of the drivers (sensitivity 69%; specificity 97%). In the FD, the police suspected inebriation in 7% (n = 16) of the drivers whilst blood analyses showed drug and/or alcohol in 23% (n = 57) of the drivers (sensitivity 53%; specificity 100%). The blood alcohol-positive HD who the police suspected to be inebriated had significantly higher mean blood alcohol concentrations than those not suspected. To avoid biased statistics, official statistics on inebriation of injured drivers should be based on blood analysis of drug/alcohol and not on police assessment.