Practical guidelines for the registration and monitoring of serious traffic injuries, D7.1 of the H2020 project SafetyCube

BACKGROUND AND OBJECTIVES Crashes also cause numerous serious traffic injuries, resulting in considerable economic and human costs. Given the burden of injury produced by traffic, using only fatalities as an indicator to monitor road safety gives a very small picture of the health impact of traffic crashes, just the tip of the iceberg. Moreover, in several countries during the last years the number of serious traffic injuries has not been decreasing as fast as the number of fatalities. In other countries the number of serious traffic injuries has even been increasing (Berecki-Gisolf et al., 2013; IRTAD Working Group on Serious Road Traffic Casualties, 2010; Weijermars et al., 2015).Therefore, serious traffic injuries are more commonly being adopted by policy makers as an additional indicator of road safety. Reducing the number of serious traffic injuries is one of the key priorities in the road safety programme 2011-2020 of the European Commission (EC, 2010). To be able to compare performance and monitor developments in serious traffic injuries across Europe, a common definition of a serious road injury was necessary. In January 2013, the High Level Group on Road Safety, representing all EU Member States, established the definition of serious traffic injuries as road casualties with an injury level of MAIS ≥ 3. The Maximum AIS represents the most severe injury obtained by a casualty according to the Abbreviated Injury Scale (AIS). Traditionally the main source of information on traffic accidents and injuries has been the police registration. This provides the official data for statistics at national and European level (CARE Database). Data reported by police usually is very detailed about the circumstances of the crash particularly if there are people injured or killed. But on the other hand police cannot assess the severity of injuries in a reliable way, due, obviously to their training. Therefore, police based data use to classify people involved in a crash as fatality, severe injured if hospitalised more than 24 hours and slight injured if not hospitalised. Moreover, it is known that even a so clear definition as a fatality is not always well reported and produces underreporting. This is due to several factors such as lack of coverage of police at the scene or people dying at hospital not followed by police (Amoros et al., 2006; Broughton et al., 2007; Pérez et al., 2006). Hospital records of patients with road traffic injuries usually include very little information on circumstances of the crash but it does contain data about the person, the hospitalisation (date of hospitalisation and discharge, medical diagnosis, mechanism or external cause of injury, and interventions). Hospital inpatient Discharge Register (HDR) offers an opportunity to complement police data on road traffic injuries. Medical diagnoses can be used to derive information about severity of injuries. Among others, one of the possible scales to measure injury severity is the Abbreviated Injury Scale (AIS). The High Level group identified three main ways Member States can collect data on serious traffic injuries (MAIS ≥ 3): 1) by applying a correction on police data, 2) by using hospital data and 3) by using linked police and hospital data. Once one of these three ways is selected, several additional choices need to be made. In order to be able to compare injury data across different countries, it is important to understand the effects of methodological choices on the estimated numbers of serious traffic injuries. A number of questions arise: How to determine the correction factors that are to be applied to police data? How to select road traffic casualties in the hospital data and how to derive MAIS ≥ 3 casualties? How should police and hospital data be linked and how can the number of MAIS ≥ 3 casualties be determined on the basis of the linked data sources? Currently, EU member states use different procedures to determine the number of MAIS ≥ 3 traffic injuries, dependent on the available data. Given the major differences in the procedures being applied, the quality of the data differs considerably and the numbers are not yet fully comparable between countries. In order to be able to compare injury data across different countries, it is important to understand the effects of methodological choices on the estimated numbers of serious traffic injuries. Work Package 7 of SafetyCube project is dedicated to serious traffic injuries, their health impacts and their costs. One of the aims of work package 7 is to assess and improve the estimation of the number of serious traffic injuries. The aim of this deliverable (D7.1) is to report practices in Europe concerning the reporting of serious traffic injuries and to provide guidelines and recommendations applied to each of the three main ways to estimate the number of road traffic serious injuries. Specific objectives for this deliverable are to: Describe the current state of collection of data on serious traffic injuries across Europe Provide practical guidelines for the estimation of the number of serious traffic injuries for each of the three ways identified by the High Level Group Examine how the estimated number of serious traffic injuries is affected by differences in methodology

Identification of infrastructure related risk factors, Deliverable 5.1 of the H2020 project SafetyCube

The present Deliverable (D5.1) describes the identification and evaluation of infrastructure related risk factors. It outlines the results of Task 5.1 of WP5 of SafetyCube, which aimed to identify and evaluate infrastructure related risk factors and related road safety problems by (i) presenting a taxonomy of infrastructure related risks, (ii) identifying “hot topics” of concern for relevant stakeholders and (iii) evaluating the relative importance for road safety outcomes (crash risk, crash frequency and severity etc.) within the scientific literature for each identified risk factor. To help achieve this, Task 5.1 has initially exploited current knowledge (e.g. existing studies) and, where possible, existing accident data (macroscopic and in-depth) in order to identify and rank risk factors related to the road infrastructure. This information will help further on in WP5 to identify countermeasures for addressing these risk factors and finally to undertake an assessment of the effects of these countermeasures. In order to develop a comprehensive taxonomy of road infrastructure-related risks, an overview of infrastructure safety across Europe was undertaken to identify the main types of road infrastructure-related risks, using key resources and publications such as the European Road Safety Observatory (ERSO), The Handbook of Road Safety Measures (Elvik et al., 2009), the iRAP toolkit and the SWOV factsheets, to name a few. The taxonomy developed contained 59 specific risk factors within 16 general risk factors, all within 10 infrastructure elements. In addition to this, stakeholder consultations in the form of a series of workshops were undertaken to prioritise risk factors (‘hot topics’) based on the feedback from the stakeholders on which risk factors they considered to be the most important or most relevant in terms of road infrastructure safety. The stakeholders who attended the workshops had a wide range of backgrounds (e.g. government, industry, research, relevant consumer organisations etc.) and a wide range of interests and knowledge. The identified ‘hot topics’ were ranked in terms of importance (i.e. which would have the greatest effect on road safety). SafetyCube analysis will put the greatest emphasis on these topics (e.g. pedestrian/cyclist safety, crossings, visibility, removing obstacles). To evaluate the scientific literature, a methodology was developed in Work Package 3 of the SafetyCube project. WP5 has applied this methodology to road infrastructure risk factors. This uniformed approach facilitated systematic searching of the scientific literature and consistent evaluation of the evidence for each risk factor. The method included a literature search strategy, a ‘coding template’ to record key data and metadata from individual studies, and guidelines for summarising the findings (Martensen et al, 2016b). The main databases used in the WP5 literature search were Scopus and TRID, with some risk factors utilising additional database searches (e.g. Google Scholar, Science Direct). Studies using crash data were considered highest priority. Where a high number of studies were found, further selection criteria were applied to ensure the best quality studies were included in the analysis (e.g. key meta-analyses, recent studies, country origin, importance). Once the most relevant studies were identified for a risk factor, each study was coded within a template developed in WP3. Information coded for each study included road system element, basic study information, road user group information, study design, measures of exposure, measures of outcomes and types of effects. The information in the coded templates will be included in the relational database developed to serve as the main source (‘back end’) of the Decision Support System (DSS) being developed for SafetyCube. Each risk factor was assigned a secondary coding partner who would carry out the control procedure and would discuss with the primary coding partner any coding issues they had found. Once all studies were coded for a risk factor, a synopsis was created, synthesising the coded studies and outlining the main findings in the form of meta-analyses (where possible) or another type of comprehensive synthesis (e.g. vote-count analysis). Each synopsis consists of three sections: a 2 page summary (including abstract, overview of effects and analysis methods); a scientific overview (short literature synthesis, overview of studies, analysis methods and analysis of the effects) and finally supporting documents (e.g. details of literature search and comparison of available studies in detail, if relevant). To enrich the background information in the synopses, in-depth accident investigation data from a number of sources across Europe (i.e. GIDAS, CARE/CADaS) was sourced. Not all risk factors could be enhanced with this data, but where it was possible, the aim was to provide further information on the type of crash scenarios typically found in collisions where specific infrastructure-related risk factors are present. If present, this data was included in the synopsis for the specific risk factor. After undertaking the literature search and coding of the studies, it was found that for some risk factors, not enough detailed studies could be found to allow a synopsis to be written. Therefore, the revised number of specific risk factors that did have a synopsis written was 37, within 7 infrastructure elements. Nevertheless, the coded studies on the remaining risk factors will be included in the database to be accessible by the interested DSS users. At the start of each synopsis, the risk factor is assigned a colour code, which indicates how important this risk factor is in terms of the amount of evidence demonstrating its impact on road safety in terms of increasing crash risk or severity. The code can either be Red (very clear increased risk), Yellow (probably risky), Grey (unclear results) or Green (probably not risky). In total, eight risk factors were given a Red code (e.g. traffic volume, traffic composition, road surface deficiencies, shoulder deficiencies, workzone length, low curve radius), twenty were given a Yellow code (e.g. secondary crashes, risks associated with road type, narrow lane or median, roadside deficiencies, type of junction, design and visibility at junctions) seven were given a Grey code (e.g. congestion, frost and snow, densely spaced junctions etc.). The specific risk factors given the red code were found to be distributed across a range of infrastructure elements, demonstrating that the greatest risk is spread across several aspects of infrastructure design and traffic control. However, four ‘hot topics’ were rated as being risky, which were ‘small work-zone length’, ‘low curve radius’, ‘absence of shoulder’ and ‘narrow shoulder’. Some limitations were identified. Firstly, because of the method used to attribute colour code, it is in theory possible for a risk factor with a Yellow colour code to have a greater overall magnitude of impact on road safety than a risk factor coded Red. This would occur if studies reported a large impact of a risk factor but without sufficient consistency to allocate a red colour code. Road safety benefits should be expected from implementing measures to mitigate Yellow as well as Red coded infrastructure risks. Secondly, findings may have been limited by both the implemented literature search strategy and the quality of the studies identified, but this was to ensure the studies included were of sufficiently high quality to inform understanding of the risk factor. Finally, due to difficulties of finding relevant studies, it was not possible to evaluate the effects on road safety of all topics listed in the taxonomy. The next task of WP5 is to begin identifying measures that will counter the identified risk factors. Priority will be placed on investigating measures aimed to mitigate the risk factors identified as Red. The priority of risk factors in the Yellow category will depend on why they were assigned to this category and whether or not they are a hot topic

Identification of road user related risk factors, deliverable 4.1 of the H2020 project SafetyCube.

Safety CaUsation, Benefits and Efficiency (SafetyCube) is a European Commission supported Horizon 2020 project with the objective of developing an innovative road safety Decision Support System (DSS). The DSS will enable policy-makers and stakeholders to select and implement the most appropriate strategies, measures, and cost-effective approaches to reduce casualties of all road user types and all severities. This document is the first deliverable (4.1) of work package 4 which is dedicated to identifying and assessing human related risk factors and corresponding countermeasures as well as their effect on road safety. The focus of deliverable 4.1 is on identification and assessment of risk factors and describes the corresponding operational procedure and corresponding outcomes. The following steps have been carried out: Identification of human related risk factors – creation of a taxonomy Consultation of relevant stakeholders and policy papers for identification of topic with high priority (‘hot topics’) Systematic literature search and selection of relevant studies on identified risk factors •Coding of studies •Analysis of risk factors on basis of coded studies •Synopses of risk factors, including accident scenarios The core output of this task are synopses of risk factors which will be available through the DSS. Within the synopses, each risk factor was analysed systematically on basis of scientific studies and is further assigned to one of four levels of risk (marked with a colour code). Essential information of the more than 180 included studies were coded and will also be available in the database of the DSS. Furthermore, the synopses contain theoretical background on the risk factor and are prepared in different sections with different levels of detail for an academic as well as a non-academic audience. These sections are readable independently. It is important to note that the relationship between road safety and road user related risk factors is a difficult task. For some risk factors the available studies focused more on conditions of the behaviour (in which situations the behaviour is shown or which groups are more likely to show this behaviour) rather than the risk factor itself. Therefore, it cannot be concluded that those risk factors that have not often been studied or have to rely more indirect and arguably weaker methodologies, e.g. self-reports , do not increase the chance of a crash occurring. The following analysed risk factors were assessed as ‘risky’, ‘probably risky’ or ‘unclear’. No risk factors were identified as ‘probably not risky’. Risky Probably risky Unclear • Influenced driving – alcohol • Influenced Driving – drugs (legal & illegal) • Speeding and inappropriate speed • Traffic rule violations – red light running • Distraction – cell phone use (hand held) • Distraction – cell phone use (hands free) • Distraction – cell phone use (texting) • Fatigue – sleep disorders – sleep apnea • Risk taking – overtaking • Risk taking – close following behaviour • Insufficient knowledge and skills • Functional impairment – cognitive impairment • Functional impairment – vision loss • Diseases and disorders – diabetes • Personal factors – sensation seeking • Personal factors – ADHD • Emotions – anger, aggression • Fatigue – Not enough sleep/driving while tired • Distraction – conversation with passengers • Distraction – outside of vehicle • Distraction – cognitive overload and inattention • Functional impairment – hearing loss (few studies) • Observation errors (few studies) • Distraction – music – entertainment systems (many studies, mixed results) • Distraction – operating devices (many studies, mixed results) The next step in SafetyCube’s WP4 is to identify and assess the effectiveness of measures and to establish a link to the identified risk factors. The work of this first task indicates a set of risk factors that should be centre of attention when identifying corresponding road safety measures (category ‘risky’)

Inventory of assessed infrastructure risk factors and measures, Deliverable 5.4 of the H2020 project SafetyCube

Inventory of assessed infrastructure risk factors and measures, Deliverable 5.4 of the H2020 project SafetyCub