Per-Olof Bylund

Sick leave and disability pension among passenger car occupants injured in urban traffic

Study Design. A follow‐up cohort study of passenger car occupants injured in car crashes in an urban area in Sweden. Objectives. To analyze the injuries, injury events, and long‐term consequences of injuries in car crashes. Summary of Background Data. The consequences of car crashes usually are described in terms of the number of people injured, the severity of injuries, or the number of inpatient days. Certain types of crash injuries can results in long‐term sick leave and granting of disability pension. The increased socioeconomic significance of these outcomes is not always indicated by analysis of commonly used variables. Methods. Two hundred fifty‐five passenger car occupants aged 16‐64 years who were injured in car crashes in urban traffic were analyzed in terms of length of sick leave and receipt of disability pension. Results. Strain of the cervical spine was the most common type of injury (55%; 141 injuries), and these injuries accounted for 82% of all sick leave taken within 2.5 years after the injury event. Injury to the cervical spine in 16 of 18 cases resulted in long‐term sick leave or dependence on disability pension. The most common injury mechanism was rear‐end collisions (39%). This type of crash resulted in 64% of all sick‐leave days within 2.5 years after the injury event. Twelve out of 18 injured people on long‐term sick leave or receiving disability pension had been in cars struck from behind. Conclusions. It is important to include long‐term consequences in the form of sick leave and disability pension when describing the consequences of different types of car crashes and injuries.

Bicycle injury events among older adults in Northern Sweden: a 10-year population based study.

Bicycles are a common mode of transportation and injured bicyclists cause a substantial burden on the medical sector. In Sweden, about half of fatally injured bicyclists are 65 years or older. This study analyzes the injury mechanisms, injuries, and consequences among bicyclists 65 years or older and compare with younger bicyclists (< or =64) and older adults as passenger car drivers, to give a basis for an injury preventive discussion for this age group. Umeå University Hospitals primary catchments area had 142,000 inhabitants in 2006. Nearly all injured road users in the well-defined geographic area are treated at this hospital and a 10-year data set (N=456) of injured bicyclists aged 65+ from the hospitals continuous injury registration (1997-2006) was analyzed. The results show that the annual injury incidence was 2.4 and 2.2 per 1000 men and women, respectively, aged 65 or older. For men the incidence rate was constant in the three age groups 65-74, 75-84 and 85+, while it decreased strongly for women. The incidence rate for old adults as passenger car drivers and younger bicyclists was 1.0 and 4.6, respectively. Most frequent injury mechanisms were falls when getting on or off a bicycle (20%) and by potholes or irregularities on the ground, edge of a sidewalk, or similar (13%). Only 6% were hit by cars, trucks, or buses. Half of the injured suffered fractures or dislocations, and 10% suffered concussion or more serious intracranial injuries. Getting on or off the bicycle caused most fractures (especially a high fraction of the hip and femur fractures) and resulted in 27% of all inpatient days in hospital. Three individuals died. One-third of the injured were treated as inpatients for a total of 1413 days (on average 9 days), with 69% of the days being caused by fractures. The cost for out- and inpatient acute treatment was approximately USD 4700 (SEK 33,000) per injured. The results merit an interest for this target group; bicycle injuries among older adults are costly both for the individual and the medical sector. Injury mitigation strategies focused on the needs of this group are probably as well motivated as those focused on older car drivers.

A 10-Year Incidence of Acute Whiplash Injuries After Road Traffic Crashes in a Defined Population in Northern Sweden

To examine the annual incidence of acute whiplash injuries after road traffic crashes in a geographic catchment area in Northern Sweden during the period 2000‐2009.

Occupational road trauma and permanent medical impairment

Abstract Medically impairing occupational injuries sustained in traffic in Sweden were analysed. More than half of the cases with a permanent medical impairment were caused by minor injuries. Soft tissue injuries to the neck (whiplash injuries) made up nearly half of all permanently impairing injuries, and half of these were caused by rear-end collisions. As a final result, just over one third (37%) of the total group had a permanent decreased work capacity, or needed to change jobs because of residual problems from their injuries. Professional drivers had the highest injury incidence per employed and they accounted for 28% of the total number of permanent impairment cases, and for 43% of the fatalities. Professional drivers also had a higher percentage of serious injuries and severe permanent impairments than other occupational groups. This might be associated with the low use of safety belts (16%) compared to other occupational groups, where usage was 4–5 times higher. This occupational injury problem ought to be handled in the same way as other occupational safety problems, i.e. protective equipment in a vehicle should be used and the use of safe vehicles should be encouraged.

INJURY EVENTS AMONG BUS AND COACH OCCUPANTS: Non-crash Injuries as Important as Crash Injuries

Injury events among bus and coach occupants : non-crash injuries as important as crash injuries

SEX DIFFERENCES IN SYMPTOMS, DISABILITY AND LIFE SATISFACTION THREE YEARS AFTER MILD TRAUMATIC BRAIN INJURY: A POPULATION- BASED COHORT STUDY

OBJECTIVE To investigate sex differences in symptoms, structure of symptoms, disability and life satisfaction 3 years after mild traumatic brain injury. Secondary aims were to find risk factors for adverse outcome. DESIGN Population-based cohort study. PATIENTS The cohort comprised 137,000 inhabitants at risk in a defined population served by a single hospital in northern Sweden. Patients attending the emergency department following a mild traumatic brain injury in 2001 were included. METHODS Of 214 patients aged 18-64 years, 163 answered a questionnaire on symptoms, disability, and life-satisfaction 3 years post-injury. The instruments were analysed with descriptive statistics. A principal component analysis of the Rivermead Post-Concussion Symptoms Questionnaire was conducted. Risk factors were identified using logistic regression. RESULTS Post-concussion syndrome was found in 50% of the women and 30% of the men. Disability was found in 52% of the women and 37% of the men, and 57% of the women and 56% of the men were satisfied with their lives. For both genders, high frequency of symptoms was a risk factor for disability and low life satisfaction. Back pain was a risk factor for disability. Living alone was a risk factor for low levels of life satisfaction. The principal component analysis revealed differences between the sexes. CONCLUSION There are sex differences in outcome 3 years after mild traumatic brain injury. Women and men should be analysed separately.

Collisions with passenger cars and moose, Sweden.

The number of collisions between motor vehicles and moose is increasing in many countries. Collisions with large, high animals such as moose cause typical rear- and downward deformation of the windshield pillars and front roof, most pronounced for small passenger cars; the injury risk increases with the deformation of the car. A strengthening of the windshield pillars and front roof and the use of antilacerative windshields would reduce the injury risk to car occupants.

Accidental deaths caused by electricity in Sweden, 1975-2000.

ABSTRACT: This study analyzes accidental fatalities caused by electricity—at work and during leisure time—to evaluate risk factors, the role of alcohol, and to identify possible preventive strategies. In Sweden, data on fatalities by electrocution from 1975 through 2000 were collected from the National Cause‐of‐Death Register. Additional cases were found in the archives of The Swedish National Electrical Safety Board. Suicides and deaths by lightning were excluded. Two hundred and eighty‐five deaths were found, including occupational (n=132), leisure time (n=151), and unknown (n=2). Most deaths were caused by aerial power lines, and the most common place for an electrical injury was a railway area or residential property. Postmortem blood from 20% (n=47) of the tested cases was found positive for alcohol, and these persons were killed mainly during leisure time. During the study period, the overall incidence of electricity‐related fatalities has decreased, in spite of increased use of electricity. This indicates that safety improvements have been successful.

Impairing injuries among medical personnel.

Medically impairing injuries among medical personnel (n = 209) were analyzed based on data obtained from the Work-Related No-Fault Liability Insurance’s (TFA) injury registration system. Almost half (98; 47%) were injured during patient care, of which 29 were injured as a result of physical trauma inflicted by the patient. When moving themselves between the homes of the patients and between different wards, 94 (45%) were injured (18 in vehicle crashes). The injuries most often resulting in medical impairment were sprains and/or strains (101; 48%) and fractures (67; 32%). The injuries primarily affected the upper extremities (48%). Fifteen percent had a medical impairment of 10% or more, and in about half of the cases, the impairment was 1% to 4%. Every injured person was on sick leave for 7 months, on average, during the 2-year follow-up period. In 12% of the cases, the injury led to a disability pension.

Injuries in special transportation services for elderly and disabled - A multi-methodology approach to estimate incidence and societal costs

Objective. Previous research has shown that elderly and disabled travelers using Special Transportation Services (STS) are injured without being involved in a vehicle crash. In order to estimate the true costs for these vehicle-related injuries, the focus needs to be adjusted towards an incident/traveler-oriented perspective. The aim of the project was thus to utilize such a perspective, in order to make a best estimation of the true costs for injury incidents, related to STS in Sweden. Methods. In order to address the chosen perspective, a mixed-method approach was used, involving quantitative as well as qualitative research methods applied on four different sets of data, the hospital-based material (n = 32), two sets of STS material (n = 127), and interview-based material (n = 1,000). Results. The results showed that the injury incidence rate in STS is considerable, i.e., 3.2 per 100,000 trips (ranging from 1.5–1.9 in STS taxis and 3.6–5.6 in STS special vehicles). However, this high incidence rate is not due to road traffic crashes, but to non-collision injury incidents involving elderly and frail passengers, easily sustaining injuries from minor to moderate external violence. Typically, this violence is affecting an older female STS user, while entering and exiting the vehicle. The true costs were estimated to be