Graciela Bauzá, MD Wayne W. LaMorte, MD, PhD, MPH Peter A. Burke, MD, FACS

1. High Mortality in Elderly Drivers is Associated with Distinct Injury Patterns:Analysis of 187,869 Injured Drivers Graciela Bauzá, MD Wayne W. LaMorte, MD, PhD, MPH Peter A. Burke, MD, FACS Erwin F. Hirsch, MD, FACS Boston University Medical Center Boston, MA

2. Background • 6 million motor vehicle collisions (MVCs) in 2004 • 40,000 fatalities (22/100,000 drivers) in 2004 • 85% National Restraint Use Rate (<50% in MA) • $230 billion cost • 1 death / 12 minutes • Leading cause of death ages 3-33 (2002 data) • >50% deaths are unrestrained occupants NHTSA/FARS 2004 • Elderly (70+) ~ 9% of total U.S. resident population (~20 million licensed) • Growth rate higher than total population • 12% of all traffic fatalities NHTSA/FARS 2004

4. Objective:To determine whether elderly drivers involved in motor vehicle collisions differ in severity or pattern of injury from other age groups. Methods: • Retrospective review of National Trauma Data Bank (NTDB) • NTDB 1994-2004 • Subjects: 187,869 drivers 15,755 elderly drivers (70+) • Main measurements: Injury Severity Score, Abbreviated Injury Score, Length of Stay, Mortality, Disposition, Restraint usage • Statistical Analysis: chi-squared tests and ANOVA

5. Injury Severity Score (ISS) * 58,970 52,283 41,083 19,788 15,755 * ISS for 70+ injured drivers is significantly higher than for other age groups (p=0.0001).

6. Abbreviated Injury Score (AIS) p=0.0001 p=0.0001 p=0.0001 p>0.05 p>0.05 p=0.0001 p=0.0001 p=0.0001

7. Injury Frequency(per 10,000 Injured Drivers)

8. * * *Length of Stay and Mortality for 70+ was significantly higher than for other age groups (p<0.0001).

9. Disposition

10. Safety Measure Use * National Safety Belt Use Rate for 2005 was 85%. (NHTSA)

11. * * * * * * * * * *ISS and Mortality were significantly higher in unrestrained elderly drivers (p<0.05).

12. AISAirbag +/- Seatbelt None

13. Concussions

14. Intracranial Hemorrhage

15. Conclusion • Elderly drivers in MVCs have: • Greater injury severity, especially head & chest • Greater mortality • Safety measures are particularly vital in reducing injury severity and mortality in elderly drivers.

16. If he can walk out of this… we can do better!!!

17. Acknowledgments Peter A. Burke, MD, FACS Erwin F. Hirsch, MD, FACS Wayne W. LaMorte, MD, PhD, MPH Heidi Wing Marie Yacubovich

18. References 1. http://www.trauma.org/scores/index.html. 2. Administration, N.H.T.S., Traffic Safety Facts-2003. 2005: Washington DC. 3. Austin, R.A. and B.M. Faigin, Effect of vehicle and crash factors on older occupants. J Safety Res, 2003. 34(4): p. 441-52. 4. Azad, N., MD, FRCPC; Byszewski, A, MD, FRCPC; Amos, S, PhD; Molnar, FJ, MSC, MDCM, FRCPC, A Survey of the Impact of Driving Cessation on Older Drivers. Geriatrics Today, 2002. 5: p. 170-4. 5. Braver, E.R. and R.E. Trempel, Are older drivers actually at higher risk of involvement in collisions resulting in deaths or non-fatal injuries among their passengers and other road users? Inj Prev, 2004. 10(1): p. 27-32. 6. Carr, D.B., The older adult driver. Am Fam Physician, 2000. 61(1): p. 141-6, 148. 7. Coley, A., et al., The effect of seatbelt use on injury patterns, disposition, and hospital charges for elders. Acad Emerg Med, 2002. 9(12): p. 1411-6. 8. Cook, L.J., et al., Motor vehicle crash characteristics and medical outcomes among older drivers in Utah, 1992-1995. Ann Emerg Med, 2000. 35(6): p. 585-91. 9. Dellinger, A.M., et al., Driving cessation: what older former drivers tell us. J Am Geriatr Soc, 2001. 49(4): p. 431-5. 10. Dr. Stewart C. Wang, D.J.S., Dr. Patricia Dissinger, et al. The Interactive Effects of Age And Sex on Injury Patterns and Outcomes in Elderly Motor Vehicle Crash Occupants. in Third Annual CIREN Conference. 1999. 11. Fang, M.C., et al., Advanced age, anticoagulation intensity, and risk for intracranial hemorrhage among patients taking warfarin for atrial fibrillation. Ann Intern Med, 2004. 141(10): p. 745-52. 12. Glassbrenner, D., Seat Belt Use in 2002 - Demographic Characteristics, N.H.T.S.A. U.S Department of Transportation, Editor. 2003.

19. References 13. Glassbrenner, D., J.S. Carra, and J. Nichols, Recent estimates of safety belt use. J Safety Res, 2004. 35(2): p. 237-44. 14. Grabowski, D.C., C.M. Campbell, and M.A. Morrisey, Elderly licensure laws and motor vehicle fatalities. Jama, 2004. 291(23): p. 2840-6. 15. Kahane, C. Fatality Reduction by Air Bags: Analyses of Accident Data Through Early 1996. 1998 [cited. 16. Lyman, J.M., G. McGwin, Jr., and R.V. Sims, Factors related to driving difficulty and habits in older drivers. Accid Anal Prev, 2001. 33(3): p. 413-21. 17. Lyman, S., et al., Older driver involvements in police reported crashes and fatal crashes: trends and projections. Inj Prev, 2002. 8(2): p. 116-20. 18. Marottoli, R.A., The physician's role in the assessment of older drivers. Am Fam Physician, 2000. 61(1): p. 39, 42. 19. Moran, S.G., et al., The applicability of a computer model for predicting head injury incurred during actual motor vehicle collisions. J Trauma, 2004. 57(1): p. 99-103. 20. NHTSA, U.S.D.o.T., Third Report to Congress: Effectiveness of Occupant Protection Systems and Their Use. 1996: Washington, D.C. 21. Nirula, R., et al., Correlation of head injury to vehicle contact points using crash injury research and engineering network data. Accid Anal Prev, 2003. 35(2): p. 201-10. 22. Stewart, T.C., et al., Effect of airbag deployment on head injuries in severe passenger motor vehicle crashes in Ontario, Canada. J Trauma, 2003. 54(2): p. 266-72. 23. Team, M.C. Characteristics and Outcomes of Traumatic Brain Injury among Motor Vehicle Occupants. in Eighth Quarterly CIREN meeting. 2002. 24. Wang, S.C.e.a. The Interactive Effects of Age and Sex on Injury Patterns and Outcomes in Elderly Motor Vehicle Crash Occupants. in CIREN Conference.