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Splinters & Fragments
  1. A Guard
  1. Join Together, Boston, Massachusetts, USA

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    The Cochrane Injuries Group estimates that each year more than a million people die worldwide and perhaps 10 million are permanently disabled in traffic crashes. The British Medical Journal has released a special theme issue: “War on the roads”. Relevant articles address sleepiness among drivers, seat belt use, child pedestrians, safer road design, traffic laws, and air bags. Available at or order for £5; tel +44 (0)20 7383 6270. (


    What happens after children are injured in traffic crashes? Researchers at Children’s Hospital in Philadelphia interviewed children who were hospitalized for treatment of traffic crash related injuries and their parents. More than 80% of children and parents had symptoms of acute stress disorder. More parents reported distress when their children were injured as pedestrians, and fewer reported distress when their children were injured in bicycle falls. The results are published in the electronic pages of Pediatrics. Available at (


    Sports related concussions occur regularly in popular activities such as football, soccer, and ice hockey. An international symposium held November 2001 in Vienna, Austria, has resulted in a Concussion in Sport Group paper that is available for review. The paper puts forth a revised definition of concussion, protocols for grading and evaluation, management and rehabilitation, and recommendations for prevention. Prevention recommendations include focusing on rule changes and enforcement (rather than on equipment, based on a lack of evidence) and better education of both athletes and health care providers. The paper: Concussion in Sport Group. Summary and Agreement Statement of the First International Conference on Concussion in Sport, Vienna 2001 is published at and in

    (no page numbers given).

    Another “special issue” focuses on violence at work. This edition of the African Newsletter on Occupational Health and Safety includes articles on violence against women, the global response to workplace violence, and international prevention programs now in place. Three additional articles focus on unintentional occupational themes: a Zambian chemical hazard program, the need for a better information system in Uganda, and agrochemical exposure. Full text of the newsletter is available at


    The “top end” of the Northern Territory of Australia has no speed limit in non-urban areas. It is an area with light traffic, long distances to drive, and “relatively high use of alcohol”. All of these factors add up to a high rate of single vehicle rollovers (SVROs). Researchers studied police, hospital, trauma, and coroner’s records and analyzed 441 SVROs, which accounted for 30% of all accidents and 29% of all injuries and deaths in a two year period. Alcohol consumption, speed, lack of seat belt use, and ejection from the vehicle were all associated with major injury. By analyzing police data, they also found that SVROs occurred mainly on dry, straight, unsealed roads, involving speeding vehicles that had at least one defect. (


    Trauma among the elderly is often overlooked as we focus on the fact that, in the West, injury is the leading cause of death among the young. A recent analysis examined all elderly trauma patients presenting to Illinois trauma centers over three years, to determine the incident of alcohol and drug use in association with mechanism of injury. One quarter of all trauma patients were aged 65 or older. Among the elderly, half of those who were tested for alcohol, tested positive, and almost three quarters of those were considered intoxicated. Falls were the most common mechanism of injury for elderly patients under the influence of alcohol, followed by motor vehicle, while those causes were reversed for those who tested negative. Since such a small percentage of the population was tested, the true incidence of alcohol influence is not yet known. (


    Many urban centers have “Chinatowns”: dense, crowded with people and traffic, teeming with residents and tourists. Boston’s Chinatown is surrounded by highways, including a major long term construction project. This article examines not only the injury patterns displayed in the neighborhood but also the history of events that led to traffic congestion and traffic volume data gathered for a special transportation study. Interestingly, “there were no peaks of injuries at traditionally defined commuter hours”. The authors call for changes in policies and for immediate interventions, such as reconfiguring intersections, changing signs and signals, and improved enforcement. (


    One more on traffic injuries: the Australian Transport Safety Bureau has released a report on fatal injuries to young children in driveways. As in US studies (Agran et al), these deaths primarily involve toddlers, usually at their own homes. The vehicles tended to be large four wheel drive passenger vehicles, vans or trucks, reversing at low speed. The drivers were usually men, often family members or friends. The Bureau calls for increased awareness of this danger; the use of door latches as soon as young children become mobile; improved visibility measures for large vehicles, including new sensor technology; and modifying the driveway environment. The report is available at the ATSB web site: (


    Even very brief articles can contain a wealth of interesting data. These authors used the same methods to examine drowning deaths to United Kingdom children in 1988–89 and 1998–99 and found that deaths had decreased from 149 to 104. Beyond that, they found that at least 14 British children drowned abroad (primarily while on holiday) and three boys with autism spectrum disorder drowned during 1998–99. The authors call for European Union involvement in prevention measures and for routine drowning data to be collected by government statistics agencies. (


    Have you read—or published—an interesting article recently? Please send the citation, and copy if possible, to the editor of Splinters & Fragments: Anara Guard, 44 King Street, Auburndale, MA 02466, USA (fax 1 617 437 9394; email guardwilliams{at}rcn.comoraguard{at}