Injury typology of fatal motorcycle collisions with roadside barriers in Australia and New Zealand

Motorcycle injuries: a systematic review for forensic evaluation

The intricate interplay of exposure and speed leave motorcyclists vulnerable, leading to high mortality rates. During the collision, the driver and the passenger are usually projected away from the motorcycle, with variable trajectories or final positions. Injuries resulting from the crash can exhibit distinct and specific characteristics depending on the circumstances of the occurrence.The aim of this study is to provide a systematic review of the literature on injuries sustained by motorcyclists involved in road accidents describing and analyzing elements that are useful for forensic assessment.The literature search was performed using PubMed, Scopus and Web of Science from January 1970 to June 2023. Eligible studies have investigated issues of interest to forensic medicine about during traffic accidents involving motorcycle. A total of 142 studies met the inclusion criteria and were classified and analyzed based on the anatomical regions of the body affected (head, neck, thoraco-abdominal, pelvis, and limb injuries). Moreover, also the strategies for preventing lesions and assessing injuries in the reconstruction of motorcycle accidents were examined and discussed.This review highlights that, beyond injuries commonly associated with motorcycle accidents, such as head injuries, there are also unique lesions linked to the specific dynamics of accidents. These include factors like the seating position of the passenger or impact with the helmet or motorbike components. The forensic assessment of injury distribution could serve as support in reconstructing the sequence of events leading to the crash and defining the cause of death in trauma fatalities.

Severe traffic injuries in the Helsinki Trauma Registry between 2009-2018

OBJECTIVE

The European Union (EU) has adopted the Vision Zero and Safe System approach to eliminate deaths and serious traffic injuries on European roads by 2050. Detailed information on serious injuries, injury mechanisms and consequences are needed. The aim of this study was to describe and compare by injury mechanism the demographics, injuries, injury severity, and treatment of seriously injured road traffic trauma patients.

MATERIAL AND METHODS

We analysed data on severe traffic injury trauma patients aged ≥16 years of the Helsinki Trauma Registry (HTR) covering the years 2009-2018. The variables analysed were basic patient demographics, injury mechanism, Abbreviated Injury Scale (AIS) codes, injured body regions, patient Injury Severity Score (ISS) and New Injury Severity Score (NISS) values, NISS groups (NISS 16-24 and NISS ≥25), AIS 3+ injuries, trauma bay and 30-day mortality, length of stay (LOS) at ICU and in hospital, surgeries performed, pre-injury classification, and intention of injury.

RESULTS

A total of 1 063 traffic injury patients were analysed; 38.6% were motor vehicle occupants, 28.5% motorcyclists or moped drivers, 17.2% bicyclists, and 15.7% pedestrians. The mean age of patients was 44.3 years (SD 20.2). Median ISS score was 22 and median NISS score was 27. Both scores were highest in pedestrians. Among all patients, total hospital LOS was 12 517 days (median 9) and total ICU LOS was 6 311 days (median 5). The most common AIS 3+ injuries according to ISS body regions were chest injuries (60%) and head or neck injuries (43.7%). Chest injuries occurred more frequently in motorcyclists and motor vehicle occupants, whereas head or neck injuries were most common among bicyclists and pedestrians.

CONCLUSIONS

Severely injured pedestrians and bicyclists were older and they had higher mortality than motorcyclists and motor vehicle occupants. According to NISS, the overall severity was highest among pedestrians followed by bicyclists. However, the both median ICU LOS and hospital LOS were highest for pedestrians but lowest for bicyclists. The most common AIS 3+ injuries were chest and head or neck injuries. To specify effective injury prevention measures, hospital data should be complemented with information on the circumstances of the accident.

Physical, psychological and economic burden of two-wheel users after a road traffic injury: Evidence from intensive care units of three EU countries

INTRODUCTION

This study aimed to assess the physical, psychological, and economic burden shouldered by severely injured two-wheel users in three European countries as well as the cost resulting from their hospitalization.

METHODS

A total of seven public hospitals were involved in three countries: Greece, Italy, and Germany. Participants enrolled during a 12-month period starting in April 2013. Eligibility criteria included an injury sustained at Road Traffic Crashes (RTC) irrespective of the type of vehicle, hospitalization 1 day in the Intensive Care Unit (ICU) or sub-ICU, and age 18 years or over. Patients were interviewed at 1, 6, and 12 months upon admission. The study used widely recommended classifications for injury severity (Abbreviated Injury Severity [AIS]; Maximum Abbreviated Injury Severity [MAIS]) and standardized measures such as the Disability Assessment Schedule II (WHODAS 2.0), "Impact of Event Scale" (IES-R), Center for Epidemiological Studies Depression Scale (CES-D Scale). Health Care Expenditure was assessed through the Monash University Accident Research Centre (MUARC's) framework, which included measures of 'Direct' and 'Indirect' costs. Diagnosis-related groups (DRGs) were used to estimate hospitalization costs.

RESULTS

A total of 54 two-wheel users enrolled in the study in all the countries and 32 completed all follow-up questionnaires. Physical disability increased over 12 months following the injury. Post Traumatic Stress Disorder (PTSD) symptoms of avoidance remained at high levels over the study period. PTSD symptoms of intrusion improved significantly during the second half of the year under investigation. The total annual cost of injury for the two-wheel users who were hospitalized in the selected ICU of all the partner countries for severe injury in 2013/2014, was estimated at €714,491 made up of €123,457 direct and €591,034 indirect costs. Men, aged 50-64 years and those who sustained slight injuries primarily at the lower extremities presented higher indirect costs per person. A total of €1032.092 was spent on hospitalization payments. Women, aged 65+ and those who sustained severe injuries at the central body region presented higher direct costs per person. Women, aged 50-64 years, those with severe injuries and a major injury at the central body and the upper body region presented the highest hospitalization costs per person.

CONCLUSIONS

There is a need for effective strategies to early detect and treat groups at risk of being confronted with prolonged psychosocial and economic consequences.

PRACTICAL IMPLICATIONS

A holistic understanding of the impact of injury on individuals is important in order to achieve effective treatment of psychological co-morbidities in a timely manner.

Understanding fatal older road user crash circumstances and risk factors

OBJECTIVE

This study used medicolegal data to investigate fatal older road user (ORU) crash circumstances and risk factors relating to four key components of the Safe System approach (e.g., roads and roadsides, vehicles, road users, and speeds) to identify areas of priority for targeted prevention activity.

METHODS

The Coroners Court of Victoria's Surveillance Database was searched to identify coronial records with at least one deceased ORU in the state of Victoria, Australia, for 2013-2014. Information relating to the ORU, crash characteristics and circumstances, and risk factors was extracted and analyzed.

RESULTS

The average rate of fatal ORU crashes per 100,000 population was 8.1 (95% confidence interval [CI] 6.0-10.2), which was more than double the average rate of fatal middle-aged road user crashes (3.6, 95% CI 2.5-4.6). There was a significant relationship between age group and deceased road user type (χ²(15, N = 226) = 3.56, p < 0.001). The proportion of deceased drivers decreased with age, whereas the proportion of deceased pedestrians increased with age. The majority of fatal ORU crashes involved a counterpart (another vehicle: 59.4%; fixed/stationary object: 25.4%), and occurred "on road" (87.0%), on roads that were paved (94.2%), dry (74.2%), and had light traffic volume (38.3%). Road user error was identified by the police and/or coroner for the majority of fatal ORU crashes (57.9%), with a significant proportion of deceased ORU deemed to have "misjudged" (40.9%) or "failed to yield" (37.9%).

CONCLUSIONS

Road user error was the most significant risk factor identified in fatal ORU crashes, which suggests that there is a limited capacity of the Victorian road system to fully accommodate road user errors. Initiatives related to safer roads and roadsides, vehicles, and speed zones, as well as behavioral approaches, are key areas of priority for targeted activity to prevent fatal older road user crashes in the future.

Using medico-legal data to investigate fatal older road user crash circumstances and risk factors

OBJECTIVE

This study used medico-legal data to investigate fatal older road user (ORU, aged 65 years and older) crash circumstances and risk factors relating to 4 key components of the Safe System approach (e.g., roads and roadsides, vehicles, road users, and speeds) to identify areas of priority for targeted prevention activity.

METHOD

The Coroners' Court of Victoria's (CCOV) Surveillance Database was searched to identify and describe the frequency and rate per 100,000 population of fatal ORU crashes in the Australian state of Victoria for 2013-2014. Information relating to the deceased ORU, crash characteristics and circumstances, and risk factors was extracted and analyzed.

RESULTS

One hundred and thirty-eight unintentional fatal ORU crashes were identified in the CCOV Surveillance Database. Of these fatal ORU crashes, most involved older drivers (44%), followed by older pedestrians (32%), older passengers (17%), older pedal cyclists (4%), older motorcyclists (1%), and older mobility scooter users (1%). The average annual rate of fatal ORU crashes per 100,000 population was 8.1 (95% confidence interval [CI], 6.0-10.2). In terms of the crash characteristics and circumstances, most fatal ORU crashes involved a counterpart (98%), of which the majority were passenger cars (50%) or fixed/stationary objects (25%), including trees (46%) or embankments (23%). In addition, most fatal ORU crashes occurred close to home (73%), on-road (87%), on roads that were paved (94%), on roads with light traffic volume (37%), and during low-risk conditions: between 12 p.m. and 6 p.m. (44%), on weekdays (80%), during daylight (75%), and under dry/clear conditions (81%). Road user (RU) error was identified by the police and/or the coroner for the majority of fatal crashes (55%), with a significant proportion of deceased ORUs deemed to have failed to yield (54%) or misjudged (41%).

CONCLUSIONS

RU error was the most significant factor identified in fatal ORU crashes, which suggests that there is a limited capacity of the road system to fully accommodate RU errors. Initiatives related to safer roads and roadsides, vehicles, speed zones, as well as behavioral approaches are key areas of priority for targeted activity to prevent fatal ORU crashes in the future.

Relationship between Driving-Violation Behaviours and Risk Perception in Motorcycle Accidents

Objective/Background

Riding motorcycles is a popular means of community mobility in many Asian and developing countries. However, the potential harm associated with accidents is greater for motorcyclists and their passengers than for other vehicle users. The primary aims of this study were to explore the relationship between driving-violation behaviours and perceptions of the risk associated with potential accident causes, and to assess the contribution of these factors to active involvement in accidents among Chinese motorcyclists.

Methods

A total of 621 Chinese motorcyclists were recruited. All were asked to fill in a specially developed questionnaire to assess their driving-violation behaviours and perceptions of potential causes of motorcycle accidents.

Results

A relationship was identified between driving-violation behaviours and risk perceptions. Furthermore, both were significant predictors of involvement in motorcycle accidents. The motorcyclists involved in accidents demonstrated more aggressive and ordinary driving-violation behaviours. In addition, these motorcyclists exhibited lower perceptions of risk from both driving and environmental factors. Instead, these motorcyclists were more likely to identify risk in terms of belief-related causes.

Conclusion

This study could assist occupational-therapy practitioners involved in driving rehabilitation and training to identify strategies to deal with drivers’ violation behaviours and risk perception. It could also provide evidence-based recommendations for drivers’ education, driving-safety campaigns, or even licensing policies.

Influence of horizontally curved roadway section characteristics on motorcycle-to-barrier crash frequency

The purpose of this study was to investigate motorcycle-to-barrier crash frequency on horizontally curved roadway sections in Washington State using police-reported crash data linked with roadway data and augmented with barrier presence information. Data included 4915 horizontal curved roadway sections with 252 of these sections experiencing 329 motorcycle-to-barrier crashes between 2002 and 2011. Negative binomial regression was used to predict motorcycle-to-barrier crash frequency using horizontal curvature and other roadway characteristics. Based on the model results, the strongest predictor of crash frequency was found to be curve radius. This supports a motorcycle-to-barrier crash countermeasure placement criterion based, at the very least, on horizontal curve radius. With respect to the existing horizontal curve criterion of 820 feet or less, curves meeting this criterion were found to increase motorcycle-to-barrier crash frequency rate by a factor of 10 compared to curves not meeting this criterion. Other statistically significant predictors were curve length, traffic volume and the location of adjacent curves. Assuming curves of identical radius, the model results suggest that longer curves, those with higher traffic volume, and those that have no adjacent curved sections within 300 feet of either curve end would likely be better candidates for a motorcycle-to-barrier crash countermeasure.

Single-vehicle and Multi-vehicle Accidents Involving Motorcycles in a Small City in China: Characteristics and Injury Patterns

Introduction

There is a gap that involves examining differences between patients in single-vehicle (SV) versus multi-vehicle (MV) accidents involving motorcycles in Shantou, China, regarding the injury patterns and mortality the patients sustained. This study aims to address this gap and provide a basis and reference for motorcycle injury prevention.

Method

Medical record data was collected between October 2002 and June 2012 on all motorcycle injury patients admitted to a hospital in the city of Shantou of the east Guangdong province in China. Comparative analysis was conducted between patients in SV accidents and patients in MV accidents regarding demographic and clinic characteristics, mortality, and injury patterns.

Results

Approximately 48% (n = 1977) of patients were involved in SV accidents and 52% (n = 2119) were involved in MV accidents. The average age was 34 years. Collision of a motorcycle with a heavy vehicle/bus (4%) was associated with a 34 times greater risk of death (RR: 34.32; 95% CI: 17.43-67.57). Compared to patients involved in MV accidents, those involved in SV accidents were more likely to sustain a skull fracture (RR: 1.47; 95% CI: 1.22-1.77), an open head wound (RR: 1.46; 95% CI: 1.23-1.74), an intracranial injury (RR: 1.39; 95% CI: 1.26-1.53), a superficial head injury (RR: 1.37; 95% CI: 1.01-1.86), an injury to an organ (RR: 2.01; 95% CI: 1.24-3.26), and a crushing injury (RR: 1.98; 95% CI: 1.06-3.70) to the thorax or abdomen. However, they were less likely to sustain a spinal fracture (RR: 0.58; 95% CI: 0.39-0.85), a pelvic fracture (RR: 0.22; 95% CI: 0.11-0.46), an upper extremity fracture (RR: 0.75; 95% CI: 0.59-0.96), or injuries to their lower extremities, except for a dislocation, sprain, or injury to a joint or ligament (RR: 0.82; 95% CI: 0.49-1.36).

Conclusion

The relative risk of death is higher for patients involved in multi-vehicle accidents than patients in single-vehicle accidents, especially when a collision involves mass vehicle(s). Injury to the head dominated motorcycle injuries. Single-vehicle accidents have a higher correlation with head injury or internal injuries to the thorax or abdomen. Multi-vehicle accidents are more correlated with extremity injuries, especially to the lower extremities or external trauma to the thorax or abdomen.

Head and spine injuries sustained by motorcyclists in head-leading collisions with fixed roadside objects

OBJECTIVE

Motorcyclist collisions with fixed objects account for a substantial proportion of fatalities in many countries. Biomechanically valid crash test protocols are required to assess the injury potential of different fixed objects to motorcyclists and/or to develop safety devices that ameliorate this injury risk. The aim of the present article is to provide field-observed injury data pertaining to motorcyclist head-leading collisions with fixed objects to assist in the development of crash test protocols.

METHOD

The Australian National Coronial Information System was used to identify fatal motorcyclist head-leading collisions with fixed objects. Head and spine injuries were identified from the autopsy reports for these individuals. The head impact locations and injuries were used to infer impact orientations and corresponding injury mechanisms.

RESULTS

A sample of 44 motorcyclists estimated to have impacted fixed objects in the head-leading orientation was identified. The analysis of autopsy reports indicated a predominance of basilar skull fractures, intracranial injuries to the frontal cerebrum and inferior aspects of the brain (brainstem and cerebellum), and upper cervical spine injuries. Analysis of head impact locations identified a predominance of impacts to the frontal and/or lateral aspects and when considered in combination with the injury mechanisms, a typical impact orientation of sliding in the prone position with head extension was inferred.

CONCLUSIONS

The study results were used to suggest possible crash test protocols for motorcyclists sliding into fixed objects and/or safety devices designed to reduce the injury risk of fixed objects. The predominant orientation of lying prone with head extension led the authors to suggest a crash test using the motorcycle anthropomorphic test device (MATD) sliding prone. However, the occurrence of the supine orientation, albeit less frequent, indicates the utility of a crash test with an anthropomorphic test device (ATD) sliding supine. The 2 options are discussed, particularly with regard to appropriate injury assessment reference values.

The rising burden of serious thoracic trauma sustained by motorcyclists in road traffic crashes

In many countries increased on-road motorcycling participation has contributed to increased motorcyclist morbidity and mortality over recent decades. Improved helmet technologies and increased helmet wearing rates have contributed to reductions in serious head injuries, to the point where in many regions thoracic injury is now the most frequently occurring serious injury. However, few advances have been made in reducing the severity of motorcyclist thoracic injury. The aim of the present study is to provide needed information regarding serious motorcyclist thoracic trauma, to assist motorcycling groups, road safety advocates and road authorities develop and prioritise counter-measures and ultimately reduce the rising trauma burden. For this purpose, a data collection of linked police-reported and hospital data was established, and considerable attention was given to establishing a weighting procedure to estimate hospital cases not reported to police and fatal cases not admitted to hospital. The resulting data collection of an estimated 19,979 hospitalised motorcyclists is used to provide detailed information on the nature, incidence and risk factors for thoracic trauma. Over the last decade the incidence of motorcyclist serious thoracic injury has more than doubled in the population considered, and by 2011 while motorcycles comprised 3.2% of the registered vehicle fleet, one quarter of road traffic-related serious thoracic trauma cases treated in hospitals were motorcyclists. Motor-vehicle collisions, fixed object collisions and non-collision crashes were fairly evenly represented amongst these cases, while older motorcyclists were over-represented. Several prevention strategies are identified and discussed.

The protective effect of roadside barriers for motorcyclists

OBJECTIVE

Roadside barriers are often deployed between road users and fixed hazards to protect users from injury. However, the United States and Australian Roadside Design Guides do not consider motorcyclists in the risk-based decision process for the deployment of a barrier, because the severity indices for barriers and fixed hazards were developed for passenger vehicles. The aim of the present article is to quantify the protective effect of barriers with regards to motorcyclist injury and to thereby inform the Roadside Design Guides as to the relative severity of roadside hazards and infrastructure for motorcyclists.

METHOD

A retrospective case series study, using linked police-reported road crash and hospital admission data in New South Wales, Australia, from 2001 to 2009 was performed. Crude and adjusted relative risks of motorcyclist serious injury were determined for various fixed objects compared to barriers, using serious injury rates and multiple variable logistic regression. Calculated relative risks compared with guardrail for motorcyclists were compared with those determined from the United States and Australian Roadside Design Guides for passenger vehicle occupants.

RESULTS

The study identified 1364 motorcyclists injured as a result of single-vehicle collisions with roadside barriers, trees, utility poles, and other fixed roadside infrastructure. Trees, posts, and utility poles were shown to provide significantly higher risks of serious injury to motorcyclists compared to barriers. This was also found to be true for serious injuries to particular body regions, such as the head, spine, and torso. The results for motorcyclists were in reasonable agreement with those derived from severity indices in the United States and Australian Roadside Design Guides for passenger vehicle occupants.

CONCLUSIONS

Roadside barriers provide a significant reduction in the risk of serious injury to motorcyclists compared to various roadside hazards. The provisions in the United States and Australian Roadside Design Guides for passenger vehicle occupants are generally applicable to motorcyclists and support the prior and ongoing use of such guides for designing roadsides that reduce the risk of injury to motorcyclists. However, a more realistic estimation might be derived by increasing the severity indices for barriers by around 25 percent for motorcyclists.