News, Comment, and Short Research Notes

He underwent closed reduction of his extremity fractures in the ICU as well as irrigation and closure of the facial lacerations. On the eighth hospital day, he had reduction of the Le Forte fracture and ORIF of the left femur. Three weeks postoperatively he was transferred to a rehabilitation facility. He never regained full mobility, and he was discharged to an extended care facility six weeks after the accident. DISCUSSION

Although they sustained a similar degree of impact in a frontal collision with a stationary object, the conditions of these two passengers were dramatically different. The driver had fewer injuries and a much lower ISS, shorter recuperative time, and lower hospital expenditures than did the passenger, who never recovered fully from the accident. Other reports have confirmed the effectiveness of airbags in relation to injury severity (Evans 1990; Jagger 1987; Purse1 1978; Viano 1988). Further investigation of ideal restraint systems should consider the protective benefits of passenger- as well as driver-side airbags. REFERENCES Evans, L. Fatality risk reduction from safety belt use. J Trauma 27:746-749; 1987. Evans, L. Restraint effectiveness, occupant ejection from cars, and fatality reductions. Accid Anal Prev 22:167175; 1990. Huelke, D. F.; Sherman, H. W. Seat belt effectiveness: Case examples from real-world investigations. J Trauma 27:750-753; 1987. Jagger, J.; Vernberg, K.; Jane, J. A. Airbags: Reducing the toll of brain trauma. Neurosurgery 20:815-817; 1987. Lestina, D. C.; Williams, A. E; Lund, A. K.; Zador, P.; et al. Motor vehicle crash injury patterns and the Virginia seat belt law. JAMA 265:1409-1413; 1991. Orsay, E. M.; Turnbull, T. L.; Dunne, M.; et al. Prospective study of the effect of safety belts on morbidity and health care costs in motor-vehicle accidents. JAMA 260: 3598-3603; 1988. Pursel, H. D.; Bryant, R. W.; Scheel, J. W.; et al. Matched case methodology for measuring restraint effectiveness. SAE paper 780415; In: SAE Transaction for 1978, 196551994; Warrendale. PA: Society of Automotive Engineers; 1979. States, J. D.; Huelke, D. F.; Dance, M.; et al. Fatal injuries caused by underarm use of shoulder belts. J Trauma 27: 740-744; 1987. Viano, D. C. Limits and challenges of crash protection. Accid Anal Prev 20: 421-429; 1988.

David A. Kulber Jonathan R. Hiatt Cedars-Sinai Medical Center UCLA School of Medicine 8700 Beverly Blvd., Los Angeles,

CA 90048,


SEAT BELT LAWS AND CASUALTIES I refer to the paper “Change in injuries associated with safety belt laws” by Campbell et al. in the February 1991 issue. In their opening remarks the authors said their analysis was done from the standpoint of changes in injury associated with the introduction of a seat belt use law and that it did not analyse changes in fatalities. That many such analyses of fatalities have been reported and for information on fatality reduction in Australia see Andreassend (1972); Foldvary and Lane (1974). While I am flattered to be quoted, I wish to take issue with being categorised as having done an analysis of fatalities. There are some justifiable criticisms of studies of seat belt use that have looked at the change in the total number of fatalities among all road user types taken together, and ignored the specifics of the effect being applicable to only a small part of the total road population at risk (in many countries). That is the number of deaths to drivers and MP


News, Comment,


and Short



front passengers of cars may have been a small fraction of the total number of road deaths and the effect of a change to them could easily be swamped by changes in the deaths to other road users. My 1972 paper specifically analysed the effect of the seat belt law on the sum of the number of persons killed or injured, or on the sum of the number of persons killed or admitted to hospital and who, in both cases, were drivers and front seat passengers of cars, wagons, or utilities. These were the same sort of groupings used by Campbell, Stewart, and Reinfurt (1991). Of historical interest now, my paper of interim results showed that for the first six months of 1971 compared to the same period in 1970, the driver and front passenger casualties in cars, wagons, and utilities decreased by 18.2% while casualties among all other road users decreased by 5.7%. The two decreases were significantly different (p < ,001). It should be noted that this analysis applied to all accident-involved cars and ignored whether a car had a belt fitted or not. At that time about 70% of the observed cars were fitted with seat belts. What I also illustrated in my paper was the change in the distribution of casually classes of victims when three-point seat belts were worn, based on 1969 data.

Fatal and hospital admission Worn Not worn Apparent


Injured medical treatment

6.1 11.1

Il.8 13.4



Injured not requiring treatment 4.1 3.9

Not injured 78.0 71.6



loo’% 2252 100% 3139


With the hindsight of twenty years, I believe the second form of analysis, that is, the shift in the distribution by casualty class, is the more appropriate way to evaluate severity-modifying devices such as seat belts, rather than just the decline in the number of persons injured. The latter does not allow for any change that may occur in vehicle occupancy. Campbell et al. referred to a second model fit to pre-law data used to derive expected frequencies. I could not see the results of this model reported in the paper nor what the level of fit was between the expected and observed results. Perhaps the authors may wish to clarify this point. REFERENCES Andreassend, D. C. The effects of compulsory seat belt wearing legislation in Victoria. Proc. National Road Safety Symposium Dept of Shipping and Transport, Canberra, 1972. Campbell, B. J.: Stewart, J. R.; Reinfurt, D. W. Changes in injuries associated with safety belt laws. Accid. Anal. Prev. 23:87-93; 1991. Foldvary. L. A.; Lane, J. C. The effectiveness of compulsory wearing of scat belts in casualty reduction. Accid. Anal. Prev. 6:59-82; 1974.

David Andreassen A. R. R. B., P. 0. Box 15h Nunawading, Vie. 31.31 Australia





An International Congress on Traffic Safety was held in New Delhi 27-30 January 1991 included on the theme “The Vulnerable Road User.” The sponsors of the conference the World Health Organization, the Association for the Advancement of Automotive Medicine, The Indian Institute of Technology, The International Association for Ac-

Seat belt laws and casualties.

101 News, Comment, and Short Research Notes He underwent closed reduction of his extremity fractures in the ICU as well as irrigation and closure of...
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