title: Head injury-related road crash mortality in rural Western Australia.
abstract: BACKGROUND
  The aim of the present paper was to assess the incidence of, and identify factors associated with road crash (RC)-related fatal head injuries in rural and metropolitan Western Australia.
  
  
  METHODS
  Examination of demographics, driving behaviour and RC characteristics for RC fatalities involving a head injury (Abbreviated Injury Scale (AIS) > or = 2) between 1 January 1998 and 31 December 1999 was carried out using the State Coronial Database.
  
  
  RESULTS
  There were 328 deaths. The median age was 28 years and 74.1% of cases were male. Seventy per cent died at the scene. Of scene survivors, 89% were transferred to a metropolitan hospital before dying. Sixty per cent of total RC and 65% of at-scene deaths occurred in rural areas. Single-vehicle crashes comprised 45% of total crashes, of which 72.8% occurred in rural locations. Poor driver behaviour was identified in 53% of deaths. Ethanol was implicated in 29.8% of deaths, other intoxicating drugs were implicated in 19.2%, speeding was implicated in 19.5%, and lack of safety restraints/devices was implicated in 22%. Poor driver behaviour was identified in 72% of single-vehicle deaths, compared with 38% of multivehicle crashes (P < 0.001). Rural people comprised 61% of rural crash victims. Ninety-one per cent of rural victims died in rural crashes. The incidence of RC death associated with head injury in the rural population is 13.4 deaths/100 000 per year, more than double that for the metropolitan population (6.4 deaths/100 000 per year; P < 0.001).
  
  
  CONCLUSIONS
  The rural population of Western Australia is overrepresented in head injury-related RC deaths. Single-vehicle crashes where unsafe driving behaviour is implicated comprise a large proportion of these. Strategies to reduce unsafe driving practices aimed at rural drivers are necessary.
authors.affiliation: Emergency Department, Fremantle Hospital and Forensic Pathology Department, Pathcentre, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. Julianst@barwonHealth.org.au
authors.forename: J
authors.initials: J
authors.lastname: Stella
authors.forename: P
authors.initials: P
authors.lastname: Sprivulis
authors.forename: C
authors.initials: C
authors.lastname: Cooke
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality*; D000328:Adult; D006259:Craniocerebral Trauma / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D012424:Rural Population; D014904:Western Australia / Q000453:epidemiology