Implications of estimating road traffic serious injuries from hospital data

To determine accurately the number of serious injuries at EU level and to compare serious injury rates between different countries it is essential to use a common definition. In January 2013, the High Level Group on Road Safety established the definition of serious injuries as patients with an injury level of MAIS3+(Maximum Abbreviated Injury Scale). Whatever the method used for estimating the number or serious injuries, at some point it is always necessary to use hospital records. The aim of this paper is to understand the implications for (1) in/exclusion criteria applied to case selection and (2) a methodological approach for converting ICD (International Classification of Diseases/Injuries) to MAIS codes, when estimating the number of road traffic serious injuries from hospital data. A descriptive analysis with hospital data from Spain and the Netherlands was carried out to examine the effect of certain choices concerning in- and exclusion criteria based on codes of the ICD9-CM and ICD10. The main parameters explored were: deaths before and after 30 days, readmissions, and external injury causes. Additionally, an analysis was done to explore the impact of using different conversion tools to derive MAIS3 + using data from Austria, Belgium, France, Germany, Netherlands, and Spain. Recommendations are given regarding the in/exclusion criteria and when there is incomplete data to ascertain a road injury, weighting factors could be used to correct data deviations and make more real estimations

Identification of key risk factors related to serious road injuries and their health impacts, deliverable 7.4 of the H2020 project SafetyCube

Because of their high number and slower reduction compared to fatalities, serious road injuries are increasingly being adopted as an additional indicator for road safety, next to fatalities. Reducing the number of serious road injuries is one of the key priorities in the EU road safety programme 2011- 2020. In 2013, the EU Member States agreed on the following definition of serious road traffic injuries: a serious road traffic injury is a road traffic casualty with a Maximum AIS level of 3 or higher (MAIS3+). One recommendation created by the EU SUSTAIN project was to conduct “A more detailed study of the causes of serious road injuries, [which] could reveal more specific keys to reduce the number of serious injuries in the EU”. This recommendation is addressed through the identification of crashrelated causation and contributory factors for selected groups of casualties with relatively many MAIS3+ casualties compared to fatalities and groups with a relatively high burden of injury of MAIS3+ casualties. This deliverable is made up of two parts brought together in order to determine the main contributory factors detailed above. This two-step approach initially identifies groups of casualties that are specifically relevant from a serious injury perspective using national level collision and hospital datasets from 6 countries. Following the determination of groups of interest a detailed analysis of the selected groups using indepth data was conducted. On the basis of in-depth data from 4 European countries the main contributory and causal factors are determined for the selected MAIS3+ casualty groups. Alongside the three proceeding deliverables that have formed the major outputs of WP7, deliverable D7.4 is aimed at addressing serious injury policy at an EU levels. As such this report is broadly aimed at policy makers although the inclusion of results from in-depth data analysis also provides information relevant to stakeholders, particularly those working in vehicle design and manufacture or road user behaviour

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

Physical and psychological consequences of serious road traffic injuries, deliverable 7.2 of the H2020 project SafetyCube

SafetyCube aims to develop an innovative road safety Decision Support System (DSS) that will enable policy-makers and stakeholders to select the most appropriate strategies, measures and cost-effective approaches to reduce casualties of all road user types and all severities. Work Package 7 of SafetyCube is dedicated to serious road traffic injuries, their health impacts and their costs. This Deliverable discusses health impacts of (serious) road traffic injuries

Identification of vehicle related risk factors, deliverable 6.1 of the H2020 project SafetyCube

The present Deliverable (D6.1) describes the identification and evaluation of vehicle related risk factors. It outlines the results of Task 6.1 of Work Package 6 (WP6) of SafetyCube, which aimed to identify and evaluate vehicle related risk factors and related road safety problems by (i) presenting a taxonomy of vehicle 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 reach this objective, Task 6.1 has initially exploited current knowledge (e.g. existing studies) and existing accident data (macroscopic and in-depth) in order to quantify scenarios (defined in Work Package 8) related to the vehicle element. This information will help further on in WP6 to identify countermeasures for addressing these risk factors and finally to undertake an assessment of the effects of these countermeasures (...continues)

Safety benefits of the new ECE regulation for the homologation of CRS: an estimation by the EC CASPER Project Consortium

The GRSP informal group on child restraint systems (CRS) finalised phase 1 of a new regulation for the homologation of CRS . This regulation is the subject of several discussions concerning the safety benefits and the advantages and disadvantages that certain specific points may bring. However, these discussions are sometimes not based on scientific facts and do not consider the whole package but only single items. Based on the experience of the CASPER partners in the fields of human behaviour, accident analysis, test procedures and biomechanics in the area of child safety, a consideration of the safety benefits of phase 1 of the new regulation and recommendations for phase 2 will be given

Safety benefits of the new ECE regulation for the homologation of CRS – an estimation by the CASPER consortium

The GRSP informal group on child restraint systems (CRS) is finalising phase 1 of a new regulation for the homologation of CRS. This draft regulation is already the subject of several discussions concerning the safety benefits and the advantages and disadvantages that certain specific points may bring. However, these discussions are sometimes not based on scientific facts and do not consider the whole package but only single items. Based on the experience of the CASPER partners in the fields of human behaviour, accident analysis, test procedures and biomechanics in the area of child safety a consideration of the safety benefits of the proposal for phase 1 and recommendations for phase 2 will be given

Child Advanced Safety Project for European Roads (CASPER): better knowledge and better tools to improve the real protection of children in cars

This paper is a synthesis of the results obtained in the different parts of the EC CASPER project and considers sociological approaches, technical works, and field and accident data. From parent's behaviour and wishes that show cultural differences, to human modelling works, this project widely covers the topic of child safety in cars. The CASPER project has brought a significant amount of field data that have been useful for a better understanding of the situation and used as basis for all the other tasks of the project. Consequent steps forward have been made in the development and improvement of tools usable for the approval of Child Restraint Systems (CRS) and in this aim a large collaboration with the GRSP Informal Group on CRS took place. Results have been presented and discussed in workshops with main participants and stakeholders of the child safety area

Costs related to serious injuries, deliverable 7.3 of the H2020 project SafetyCube

Costs related to serious injuries, deliverable 7.3 of the H2020 project SafetyCub

Assessment of solutions to improve the restraint conditions of children in vehicles [Deliverable 4.6 of the EC FP7 Project CASPER]

The purpose of this report was to provide applications and research results for the improvement of child protection systems. As well as considering the effect any CRS improvements would have on policies or any legislation that would need to be created or improved. The issue of cost and subsidies for child restraints is considered. Research on the effectiveness of interventions is reported and recommendations on future policies are made. Results from the sociological survey carried out as part of the CASPER project proved to be an extremely valuable resource as many of the proposed solutions are based on information gathered in the survey. As child safety is of global importance the CASPER project gathered data relevant to child safety laws and regulations from a large array of countries this data is displayed in this report. Recent statistics show that a large percentage of CRS are misused, this project aims to reduce this figure by implementing innovative designs and creating new legislation. To list some of the ways CRS are being misused: they are being incorrectly installed i.e. putting a rearward facing device in a forward facing position or incorrectly fastening the seatbelt to the device. Parents play a key role in child safety and this is researched in great depth within this project. Research was carried out in to ways of preventing these types of CRS misuse as well as researching other problems with CRS such as the issue with transporting children with disabilities. The proposed solutions are presented alongside any issues that might occur. One of the key areas of CRS improvement is Car-to-CRS communication, this ties in with integrated CRS as the idea is to make CRS fully homologated for the car. ISOFIX involves having anchors built into the car which CRS can fix onto. The next step is to develop Car-to-CRS communication so that the CRS can benefit from the cars safety features. Car manufacturers can also build CRS directly into the car creating integrated CRS which are also considered in this document. At the moment CRS are predominantly used in cars, however they could also be used in aeroplanes, trains and busses. Although they would have to be optimised for each of the different situations, for example the CRS for aeroplanes would focus more on preventing injuries caused by turbulence than crashing. During this project the CASPER consortium investigated and evaluated the systems which are currently available or currently being developed. This was done by analysing the demands and applications in terms of research, development and approval of CRS for child protection