Burden of injury of serious road injuries in six EU countries

BACKGROUND: Information about the burden of (non-fatal) road traffic injury is very useful to further improve road safety policy. Previous studies calculated the burden of injury in individual countries. This paper estimates and compares the burden of non-fatal serious road traffic injuries in six EU countries/regions: Austria, Belgium, England, The Netherlands, the Rhône region in France and Spain. METHODS: It is a cross-sectional study based on hospital discharge databases. POPULATION: of study are patients hospitalized with MAIS3+ due to road traffic injuries. The burden of injury (expressed in years lived with disability (YLD)) is calculated applying a method that is developed within the INTEGRIS study. The method assigns estimated disability information to the casualties using the EUROCOST injury classification. RESULTS: The average burden per MAIS3+ casualty varies between 2.4 YLD and 3.2 YLD per casualty. About 90% of the total burden of injury of MAIS3+ casualties is due to lifelong consequences that are experienced by 19% to 33% of the MAIS3+ casualties. Head injuries, spinal cord injuries and injuries to the lower extremities are responsible for more than 90% of the total burden of MAIS3+ road traffic injuries. Results per transport mode differ between the countries. Differences between countries are mainly due to differences in age distribution and in the distribution over EUROCOST injury groups of the casualties. CONCLUSION: The analyses presented in this paper can support further improvement of road safety policy. Countermeasures could for example be focused at reducing skull and brain injuries, spinal cord injuries and injuries to the lower extremities, as these injuries are responsible for more than 90% of the total burden of injury of MAIS3+ casualties

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

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

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

Risk factors for motorcycle loss-of-control crashes

<p><b>Objective:</b> The present article identifies and assesses the effect of critical factors on the risk of motorcycle loss-of-control (LOC) crashes.</p> <p><b>Method:</b> Data come from a French project on road crashes, which include all fatal road crashes and a random sample of 1/20th of nonfatal crashes in France in 2011, based on police reports. A case–control study was carried out on a sample of 903 crashes for 444 LOC motorcycle riders (case) and 470 non-LOC and nonresponsible motorcycle riders (control). The sample was weighted due to the randomization of nonfatal crashes. Missing values were imputed using multiple imputation.</p> <p><b>Results:</b> Road alignment and surface conditions, human factors, and motorcycle type played important roles in motorcycle LOC crashes. Riding in a curve was associated with a 3-fold greater risk of losing control of motorcycle than riding in a straight line. Poor road adhesion significantly increased the risk of losing control; the risk increased more than 20-fold when deteriorated road adhesion was encountered unexpectedly, due to loose gravel, ice, oil, bumps, road marking, metal plates, etc. For motorcyclists, riding with a positive blood alcohol concentration (over or equal to the legal limit of 0.5 g/L) was very dangerous, often resulting in losing control. The risk of LOC crash varied for different types of motorcycle: Riders of roadsters and sports bikes were more likely to have an LOC crash greater than that of riders of basic or touring motorcycles. In addition, LOC risk increased with speed; a model using the square of the traveling speed showed better fit than one using speed itself.</p> <p><b>Conclusion:</b> The LOC crash factors related to riders, vehicles, and road infrastructure identified here were expected but were rarely identified and taken simultaneously into account in previous studies. They could be targeted by countermeasures to improve motorcyclist safety.</p

Number and prevalence for isolated or combined influences for responsible and non-responsible drivers (n = 4,047^*, data source Voiesur 2011).

<p>Number and prevalence for isolated or combined influences for responsible and non-responsible drivers (n = 4,047^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0187320#t006fn001" target="_blank">*</a>}, data source Voiesur 2011).</p

Cannabis, alcohol and fatal road accidents

<div><p>Introduction</p><p>This research aims to estimate the relative risks of responsibility for a fatal accident linked to driving under the influence of cannabis or alcohol, the prevalence of these influences among drivers and the corresponding attributable risk ratios. A secondary goal is to estimate the same items for three other groups of illicit drugs (amphetamines, cocaine and opiates), and to compare the results to a similar study carried out in France between 2001 and 2003.</p><p>Methodology</p><p>Police procedures for fatal accidents in Metropolitan France during 2011 were analyzed and 300 characteristics encoded to provide a database of 4,059 drivers. Information on alcohol and four groups of illicit drugs derived from tests for positivity and potential confirmation through blood analysis. The study compares drivers responsible for causing the accident, that is to say having directly contributed to its occurrence, to drivers involved in an accident for which they were not responsible, and who can be assimilated to drivers in general.</p><p>Results</p><p>The proportion of persons driving under the influence of alcohol is estimated at 2.1% (95% CI: 1.4–2.8) and under the influence of cannabis at 3.4% (2.9%-3.9%). Drivers under the influence of alcohol are 17.8 times (12.1–26.1) more likely to be responsible for a fatal accident, and the proportion of fatal accidents which would be prevented if no drivers ever exceeded the legal limit for alcohol is estimated at 27.7% (26.0%-29.4%). Drivers under the influence of cannabis multiply their risk of being responsible for causing a fatal accident by 1.65 (1.16–2.34), and the proportion of fatal accidents which would be prevented if no drivers ever drove under the influence of cannabis is estimated at 4.2% (3.7%-4.8%). An increased risk linked to opiate use has also been found to be significant, but with low prevalence, requiring caution in interpreting this finding. Other groups of narcotics have even lower prevalence, and the associated extra risks cannot be assessed.</p><p>Conclusion</p><p>Almost a decade separates the present study from a similar one previously conducted in France, and there have been numerous developments in the intervening years. Even so, the prevalence of drivers responsible for causing fatal accidents under the influence of alcohol or narcotics has stayed remarkably stable, as have the proportion of fatal accidents which could in theory be prevented if no drivers ever exceeded the legal limits. The overall number of deaths from traffic accidents has dropped sharply during this period, and the number of victims attributable to alcohol and/or cannabis declined proportionally. Alcohol remains the main problem in France. It is just as important to note that one in two drivers considered to be under the influence of cannabis was also under the influence of alcohol. With risks cumulating between the two, it is particularly important to point out the danger of consuming them together.</p></div

Prevalence and crude OR of responsibility linked to driving under the influence (n = 4,059 drivers involved in a fatal accident, source Voiesur 2011 data) <i>(ORs in brackets are non-significant)</i>.

<p>Prevalence and crude OR of responsibility linked to driving under the influence (n = 4,059 drivers involved in a fatal accident, source Voiesur 2011 data) <i>(ORs in brackets are non-significant)</i>.</p

Adjusted ORs^* for driver responsibility linked to driving under the influence (n = 4,047^**, data source Voiesur 2011, fatal accidents).

<p>Adjusted ORs^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0187320#t004fn001" target="_blank">*</a>} for driver responsibility linked to driving under the influence (n = 4,047^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0187320#t004fn002" target="_blank">**</a>}, data source Voiesur 2011, fatal accidents).</p

Screening and drug concentration measure process for drivers killed within 30 days after the crash or not.

<p>Numbers of drivers assessed positive, negative or with unknown status for alcohol and THC. * Dose assessment was not performed because the result of screening was negative. † Dose assessment was made in case of positive results of screening or when screening was not performed.</p