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      Life-threatening alcohol-related traffic crashes in adverse weather: a double-matched case–control analysis from Canada

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          Abstract

          Importance

          Drunk driving is a major cause of death in North America, yet physicians rarely counsel patients on the risks of drinking and driving.

          Objective

          To test whether the risks of a life-threatening alcohol-related traffic crash were further accentuated by adverse weather.

          Design

          Double matched case–control analysis of hospitalised patients.

          Setting

          Canada’s largest trauma centre between 1 January 1995 and 1 January 2015.

          Participants

          Patients hospitalised due to a life-threatening alcohol-related traffic crash.

          Exposure

          Relative risk of a crash associated with adverse weather estimated by evaluating the weather at the place and time of the crash (cases) compared with the weather at the same place and time a week earlier and a week later (controls).

          Results

          A total of 2088 patients were included, of whom the majority were drivers injured at night. Adverse weather prevailed among 312 alcohol-related crashes and was significantly more frequent compared with control circumstances. The relative risk of a life-threatening alcohol-related traffic crash was 19% higher during adverse weather compared with normal weather (95% CI: 5 to 35, p=0.006). The absolute increase in risk amounted to 43 additional crashes, extended to diverse groups of patients, applied during night-time and daytime, contributed to about 793 additional patient-days in hospital and was distinct from the risks for drivers who were negative for alcohol.

          Conclusions

          Adverse weather was associated with an increased risk of a life-threatening alcohol-related traffic crash. An awareness of this risk might inform warnings to patients about traffic safety and counselling alternatives to drinking and driving.

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          Most cited references52

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          Distracted driving and risk of road crashes among novice and experienced drivers.

          Lucy Lee, G Simons, Eunjung Lee … (2014)
          Distracted driving attributable to the performance of secondary tasks is a major cause of motor vehicle crashes both among teenagers who are novice drivers and among adults who are experienced drivers. We conducted two studies on the relationship between the performance of secondary tasks, including cell-phone use, and the risk of crashes and near-crashes. To facilitate objective assessment, accelerometers, cameras, global positioning systems, and other sensors were installed in the vehicles of 42 newly licensed drivers (16.3 to 17.0 years of age) and 109 adults with more driving experience. During the study periods, 167 crashes and near-crashes among novice drivers and 518 crashes and near-crashes among experienced drivers were identified. The risk of a crash or near-crash among novice drivers increased significantly if they were dialing a cell phone (odds ratio, 8.32; 95% confidence interval [CI], 2.83 to 24.42), reaching for a cell phone (odds ratio, 7.05; 95% CI, 2.64 to 18.83), sending or receiving text messages (odds ratio, 3.87; 95% CI, 1.62 to 9.25), reaching for an object other than a cell phone (odds ratio, 8.00; 95% CI, 3.67 to 17.50), looking at a roadside object (odds ratio, 3.90; 95% CI, 1.72 to 8.81), or eating (odds ratio, 2.99; 95% CI, 1.30 to 6.91). Among experienced drivers, dialing a cell phone was associated with a significantly increased risk of a crash or near-crash (odds ratio, 2.49; 95% CI, 1.38 to 4.54); the risk associated with texting or accessing the Internet was not assessed in this population. The prevalence of high-risk attention to secondary tasks increased over time among novice drivers but not among experienced drivers. The risk of a crash or near-crash among novice drivers increased with the performance of many secondary tasks, including texting and dialing cell phones. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Highway Traffic Safety Administration.).
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            Effect of community-based interventions on high-risk drinking and alcohol-related injuries.

            Harold Holder (2000)
            High-risk alcohol consumption patterns, such as binge drinking and drinking before driving, and underage drinking may be linked to traffic crashes and violent assaults in community settings. To determine the effect of community-based environmental interventions in reducing the rate of high-risk drinking and alcohol-related motor vehicle injuries and assaults. A longitudinal multiple time series of 3 matched intervention communities (northern California, southern California, and South Carolina) conducted from April 1992 to December 1996. Outcomes were assessed by 120 general population telephone surveys per month of randomly selected individuals in the intervention and comparison sites, traffic data on motor vehicle crashes, and emergency department surveys in 1 intervention-comparison pair and 1 additional intervention site. Mobilize the community; encourage responsible beverage service; reduce underage drinking by limiting access to alcohol; increase local enforcement of drinking and driving laws; and limit access to alcohol by using zoning. Self-reported alcohol consumption and driving after drinking; rates of alcohol-related crashes and assault injuries observed in emergency departments and admitted to hospitals. Population surveys revealed that the self-reported amount of alcohol consumed per drinking occasion declined 6% from 1.37 to 1. 29 drinks. Self-reported rate of "having had too much to drink" declined 49% from 0.43 to 0.22 times per 6-month period. Self-reported driving when "over the legal limit" was 51% lower (0. 77 vs 0.38 times) per 6-month period in the intervention communities relative to the comparison communities. Traffic data revealed that, in the intervention vs comparison communities, nighttime injury crashes declined by 10% and crashes in which the driver had been drinking declined by 6%. Assault injuries observed in emergency departments declined by 43% in the intervention communities vs the comparison communities, and all hospitalized assault injuries declined by 2%. A coordinated, comprehensive, community-based intervention can reduce high-risk alcohol consumption and alcohol-related injuries resulting from motor vehicle crashes and assaults. JAMA. 2000;284:2341-2347.
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              Preventable deaths from hemorrhage at a level I Canadian trauma center.

              Sandro B. Rizoli, F. Brenneman, N Tremblay … (2006)
              Studies of trauma deaths have had a tremendous impact on the quality of contemporary trauma care. We studied causes of trauma death at a Level I Canadian trauma center, and tabulated preventable deaths from hemorrhage using explicit criteria. Trauma registry data were used to identify all trauma deaths at our institution from January 1, 1999 to December 31, 2003. Demographics, mechanism, and time or location of death were recorded. Registry data analysis and selective chart or autopsy review were then performed to assign causes of death. A total of 558 consecutive trauma deaths were reviewed. Mean age was 48.7 (46.7-50.6), and mean Injury Severity Score was 38.8 (37.6-40.0); 29% were females. Blunt trauma represented 87% of all cases; penetrating injuries were only 13%. Central nervous system (CNS) injuries were the most frequent cause of death (60%), followed by hemorrhage (15%), and then combination CNS and hemorrhagic injuries (11%). Multiple organ failure caused 5% of deaths and 9% of deaths were from other causes. Of hemorrhagic deaths, 48% (n = 41) were from blunt injury, and 52% (n = 45) were from a penetrating mechanism. Of these hemorrhagic deaths, 16% were judged to be preventable because of significant delays in identifying the major source of hemorrhage. Hemorrhage from blunt pelvic injury was the major cause of exsanguination in 12 of 14 of these preventable deaths. Blunt injury is the major mechanism leading to trauma deaths. Massive bleeding from blunt pelvic injury is the major cause of preventable hemorrhagic deaths in our study.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open
                Journal ID (iso-abbrev): BMJ Open
                Journal ID (hwp): bmjopen
                Journal ID (publisher-id): bmjopen
                Title: BMJ Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2044-6055
                Publication date Collection: 2019
                Publication date (Electronic): 14 March 2019
                Volume: 9
                Issue: 3
                Electronic Location Identifier: e024415
                Affiliations
                [1] departmentMedicine , Sunnybrook Health Sciences Centre , Toronto, Ontario, Canada
                Author notes
                [Correspondence to ] Dr Donald A Redelmeier; dar@ 123456ices.on.ca
                Author information
                http://orcid.org/0000-0003-4147-3544
                Article
                Publisher ID: bmjopen-2018-024415
                DOI: 10.1136/bmjopen-2018-024415
                PMC ID: 6429889
                PubMed ID: 30872544
                SO-VID: 11018010-9100-4482-9ec4-a7e85d012ae2
                Copyright © © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
                License:

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                Date received : 25 May 2018
                Date revision received : 15 November 2018
                Date accepted : 21 January 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001804, Canada Research Chairs;
                Funded by: Comprehensive Research Experience for Medical Students;
                Funded by: FundRef http://dx.doi.org/10.13039/501100000024, Canadian Institutes of Health Research;
                Categories
                Subject: Emergency Medicine
                Subject: Research
                Subject: 1506
                Subject: 1691
                Custom metadata
                special-feature unlocked

                ScienceOpen disciplines: Medicine
                Keywords: preventive medicine,primary care,substance misuse,trauma management,neurological injury
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: preventive medicine, primary care, substance misuse, trauma management, neurological injury

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