论文标题：Seatbelt use and risk of major injuries sustained by vehicle occupants during motor-vehicle crashes: a systematic review and meta-analysis of cohort studies

期刊：

作者：Nicole Fouda Mbarga, Abdul-Razak Abubakari, Leopold Ndemnge Aminde and Antony R. Morgan

发表时间：2018/12/29

数字识别码：10.1186/s12889-018-6280-1

原文链接：

微信链接：

不少研究数据都显示，正确使用安全带可以有效地降低交通事故的死亡率。近期，Nicole Fouda Mbarga等人在BMC Public Health上发表的一篇综述详细介绍了安全带的正确使用同交通事故带来的重大伤害之间的关联性。

在全球范围内，遭遇创伤后所需承担的负担都是一个主要的公共卫生问题。其中，道路交通伤害（Road Traffic Injury，RTI）更是位列全球第九大致死事故。因为交通事故，每年全球的平均死亡人数可达到124万人次。RTI每年还能造成2千万到5千万的非致命伤或者残疾。在全球范围内，大多数道路交通死亡事故中，汽车乘客占比31％，其次是机动的两/三轮车（23％）以及行人（22％）。RTIs给全球各国带来巨大的经济负担，尤其是发展明升中国家，其中道路交通事故的成本每年占国民生产总值的1％至2％。因此，在全球范围内减少交通事故的发生是十分迫切的。

世界卫生组织（WHO）早在2004年便发布了一份能有效解决和预防道路交通事故带来损失的手机版，其中包括众多的干预措施。其中，最为突出的便是安全带的正确使用。并且，自20世纪60年代以来，正确使用安全带已经被证实可以有效地降低死亡率。在WHO的手机版颁布10余年后，Nicole Fouda Mbarga等人在BMC Public Health上发表的一篇综述详细介绍了安全带的正确使用同交通事故带来的重大伤害之间的关联性。

Nicole Fouda Mbarga团队的研究者从7个数据库中检索了2005年至2018年以英语发表的队列研究，主要关注道路交通伤害与头部受伤，颈部损伤，面部损伤，脊髓损伤，胸部损伤，腹部损伤和肢体损伤的相关性。

图2. 检索流程图

他们使用苏格兰校际指南网络（Scottish Intercollegiate Guidelines Network，SIGN）检查表进行了严格的评估，利用随机效应Meta分析模型评估重大伤害的汇总风险，以及使用I平方和Tau平方对异质性进行了量化，并且用漏斗图和Egger测试检查了偏倚情况。

研究人员使用meta分析对11项研究进行了比对，他们发现其中6项研究的结果表明使用安全带与受重伤的风险存在很低的相关性。虽然因佩戴安全带而降低的受伤风险在不同的研究中存在显著的差异（如图2所示），但是总的来说，与非佩戴者相比，安全带佩戴者发生任何重大伤害的风险是显著降低的（图2所示的Overall相对风险：RR:0.47，95%置信区间：0.28至0.80；Tau2=0.669；I2=99.9；P<8201; 0.0001）。

图3. 面临交通风险的对比

除此之外，如下图3所示，在大多数情况下：包括多次翻车、侧翻或侧翻，使用安全带的乘客与未系安全带的乘客相比，在按碰撞类型进行分析时，受伤风险也显著降低（RR=0.35；95%CI，0.24至0.52；I2=99.9%；P=0.000）。

图4.碰撞类型造成伤害的对比

作者接下来分别分析了系安全带对头部受伤，颈部损伤，面部损伤，脊髓损伤，胸部损伤，腹部损伤和肢体损伤所带来的风险。他们发现，系安全带与不系安全带相比，其对降低乘车人颅脑损伤、胸部损伤、颈部损伤的影响无显著的统计学差异；与之形成对比的是：对于乘车人腹部受伤、面部受伤、脊椎受伤风险的降低，安全带的作用功不可没。而对于肢体受伤的风险而言，由于研究的样本数量较少，无法获取异质性分析结果。

作者最后指出，基于种种的汇总研究和分析，使用安全带可以降低道路交通事故中某些特定类型伤害的风险。然而，安全带使用所提供的保护程度是在特定环境下的，所以建议有关部门及时更新道路交通事故的公共卫生指南，从而能帮助大家更正确地了解在发生交通事故期间安全带使用所赋予保护的有效性，才能避免在交通事故中的过多的人员伤亡。

摘要：

Background

In 2004, a World Health Report on road safety called for enforcement of measures such as seatbelt use, effective at minimizing morbidity and mortality caused by road traffic accidents. However, injuries caused by seatbelt use have also been described. Over a decade after publication of the World Health Report on road safety, this study sought to investigate the relationship between seatbelt use and major injuries in belted compared to unbelted passengers.

Methods

Cohort studies published in English language from 2005 to 2018 were retrieved from seven databases. Critical appraisal of studies was carried out using the Scottish Intercollegiate Guidelines Network (SIGN) checklist. Pooled risk of major injuries was assessed using the random effects meta-analytic model. Heterogeneity was quantified using I-squared and Tau-squared statistics. Funnel plots and Egger’s test were used to investigate publication bias. This review is registered in PROSPERO (CRD42015020309).

Results

Eleven studies, all carried out in developed countries were included. Overall, the risk of any major injury was significantly lower in belted passengers compared to unbelted passengers (RR 0.47; 95%CI, 0.29 to 0.80; I2 = 99.7; P = 0.000). When analysed by crash types, belt use significantly reduced the risk of any injury (RR 0.35; 95%CI, 0.24 to 0.52). Seatbelt use reduces the risk of facial injuries (RR = 0.56, 95% CI = 0.37 to 0.84), abdominal injuries (RR = 0.87; 95% CI = 0.78 to 0.98) and, spinal injuries (RR = 0.56, 95% CI = 0.37 to 0.84). However, we found no statistically significant difference in risk of head injuries (RR = 0.49; 95% CI = 0.22 to 1.08), neck injuries (RR = 0.69: 95%CI 0.07 to 6.44), thoracic injuries (RR 0.96, 95%CI, 0.74 to 1.24), upper limb injuries (RR = 1.05, 95%CI 0.83 to 1.34) and lower limb injuries (RR = 0.77, 95%CI 0.58 to 1.04) between belted and non-belted passengers.

Conclusion

In sum, the risk of most major road traffic injuries is lower in seatbelt users. Findings were inconclusive regarding seatbelt use and susceptibility to thoracic, head and neck injuries during road traffic accidents. Awareness should be raised about the dangers of inadequate seatbelt use. Future research should aim to assess the effects of seatbelt use on major injuries by crash type.

阅读论文全文请访问：

期刊介绍:

BMC Public Health(, 2.420 - ,3.039 - ) is an open access, peer-reviewed journal that considers articles on the epidemiology of disease and the understanding of all aspects of public health. The journal has a special focus on the social determinants of health, the environmental, behavioral, and occupational correlates of health and disease, and the impact of health policies, practices and interventions on the community.

（来源：明升手机版(明升中国)）