Estimating the number of serious road injuries in the Netherlands

Police and hospital data linkage for traffic injury surveillance: A systematic review

This systematic review examines studies of traffic injury that involved linkage of police crash data and hospital data and were published from 1994 to 2023 worldwide in English. Inclusion and exclusion criteria were the basis for selecting papers from PubMed, Web of Science, and Scopus, and for identifying additional relevant papers using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and supplementary snowballing (n = 60). The selected papers were reviewed in terms of research objectives, data items and sample size included, temporal and spatial coverage, linkage methods and software tools, as well as linkage rates and most significant findings. Many studies found that the number of clinically significant road injury cases was much higher according to hospital data than crash data. Under-estimation of cases in crash data differs by road user type, pedestrian cases commonly being highly under-counted. A limited number of the papers were from low- and middle-income countries. The papers reviewed lack consistency in what was reported and how, which limited comparability.

Safe System approach for cyclists in the Netherlands: Towards zero fatalities and serious injuries?

More than one third of all road deaths in the Netherlands and more than two thirds of seriously injured casualties are cyclists. In recent years these shares have increased, despite the fact that the implementation of Safe System principles has been leading in road safety policy and has been successful in reducing the total number of road deaths. However, the annual number of fatalities among cyclists failed to decline and the number of injuries among cyclists has been increasing, especially in single-bicycle crashes. This raises the question why until now Safe System implementation has failed to contribute to the reduction of the number of casualties among cyclists. This question is urgent because of the goal to reduce the number of road deaths and serious traffic injuries in the Netherlands to (virtually) ZERO by 2050. This ambition is in line with the objectives of the European Union. The causes of the unfavourable developments in road safety for cyclists in the Netherlands and which problems require a solution are examined. This raises two questions: can improved implementation of Safe System measures reverse the negative trend, and can this result in ZERO cycling casualties in the future. The discussion involves investigating three dimensions: exposure, crash risk, and injury risk. The opportunities that technological developments may offer in future decades are also considered. It is concluded that Safe System implementation will include opportunities to make cycling considerably safer in the Netherlands. However, we face too many uncertainties to allow for developing scenarios that show how close the Netherlands will be to ZERO cyclists casualties.

Are There Any Significant Differences in Terms of Age and Sex in Pedestrian and Cyclist Accidents?

This study has analyzed sex-specific differences in pedestrian and cyclist accidents involving passenger cars. The most frequently injured body regions, types of injuries, which show sex-specific differences and the general accident parameters of females and males were compared. Accident data from three different European countries (Austria, Netherlands, Sweden) were analyzed. The current analysis shows that for both, females and males, pedestrian and cyclist injuries are sustained mainly to the body regions head, thorax, upper extremities and lower extremities. The results show that the odds for sustaining skeletal injuries to the lower extremities (incl. pelvis) in females are significantly higher. It was observed in all datasets, that the odds of females being involved in a rural accident or an accident at night are lower than for males. Elderly pedestrian and cyclist (≥60YO) tend to sustain more severe injuries (AIS2+ and AIS3+) than younger pedestrian and cyclists (<60YO) in some of the datasets. The findings of this study highlight the differences in males and females in both, accident scenarios and sustained injuries. Further investigations are needed to distinguish between gender- and sex-specific differences causing the different injury patterns.

Investigation of road infrastructure and traffic density attributes at high-risk locations for motorcycle-related injuries using multiple correspondence and cluster analysis in urban Tanzania

Rapid growth in use of motorcycles combined with limited road infrastructures has increased the burden of road traffic crashes and injuries in low-and middle-income countries. The aim of this study was to assess whether high-risk locations for motorcycle-related injuries identified from police crash data registers for the period 2016 to 2017 share similar road infrastructure and traffic density attributes in Dar es Salaam city. Analysis was performed using multiple correspondence and hierarchical cluster analysis. Three distinct clusters for motorcycle injury hotspots were identified. Clusters 1 and 2 were associated with more fatal and severe injuries and were characterized by overrepresentation of trunk roads, unseparated two-way roads, mixture of road users and commercial and residential areas compared to Cluster 3. Cluster3 was associated with less severe injuries compared to clusters 1 and 2 (p < 0.001). Cluster 3 was characterized by overrepresentation of feeder/street roads, separated two-way roads and presence of traffic control measures. The clusters of hotspots differed by road infrastructure and traffic density attributes. Clusters 1 and 2 were characterized by more dangerous road environments, while cluster 3 was characterized by road environments with less severe outcomes. These findings can assist in prioritizing preventive strategies for motorcycle- related injuries.

Postmortem injury quantification for the fatally injured cyclists in the Osijek-Baranja county over a 21-year period

OBJECTIVE

The objective of this study was to quantify injuries in fatal cyclists' traffic crashes by performing injury analysis and determine injury trends as well as main epidemiological data of the cyclists' fatalities.

METHODS

The study was organized as a cross-sectional retrospective study, which included 125 cyclists' fatalities autopsied at the Clinical Department of Pathology and Forensic Medicine, Clinical Hospital Center Osijek from 1998 to 2018. We applied The Abbreviated Injury Scale (AIS©) classification for all fatally injured cyclists in traffic crashes and determined the severity of injuries by body region from the description of injuries reported in the autopsy report.

RESULTS

The majority of victims in our study (80%) were male and older than 45 (80.8%). A significant majority of cyclists (78.4%) were not wearing a helmet at the time of the fatal crash. For the rest of the cyclists (21.6%) we were not able to establish if they were wearing a helmet at the time of the crash based on the traffic police reports. Most of those who died on the spot or during transport had severe injuries to three or more ISS body regions (26/46 = 54%) and the majority of deceased cyclist had severe injuries to the head and brain, regardless of the time of death. Older cyclists died on the spot with lower injury severity scores (ISS).

CONCLUSIONS

Measures against dangerous cycling behavior such as driving under the influence of alcohol and driving without the helmet could lead to reduction of fatal, and probably, non-fatal bicycle crashes. We believe that policy change regarding mandatory helmet usage is of upmost importance. Injury analysis can provide us with valuable information regarding where the focus of treatment should be among severely injured cyclists as well as where the prevention should be targeted. Further injury analysis studies are needed, with studies including both fatal and non-fatal crashes. The Abbreviated Injury Scale represents a valuable system for describing (coding) and quantifying the severity of injuries during autopsies.

Road Safety in Low-Income Countries: State of Knowledge and Future Directions

Road safety in low-income countries (LICs) remains a major concern. Given the expected increase in traffic exposure due to the relatively rapid motorisation of transport in LICs, it is imperative to better understand the underlying mechanisms of road safety. This in turn will allow for planning cost-effective road safety improvement programs in a timely manner. With the general aim of improving road safety in LICs, this paper discusses the state of knowledge and proposes a number of future research directions developed from literature reviews and expert elicitation. Our study takes a holistic approach based on the Safe Systems framework and the framework for the UN Decade of Action for Road Safety. We focused mostly on examining the problem from traffic engineering and safety policy standpoints, but also touched upon other sectors, including public health and social sciences. We identified ten focus areas relating to (i) under-reporting; (ii) global best practices; (iii) vulnerable groups; (iv) disabilities; (v) road crash costing; (vi) vehicle safety; (vii) proactive approaches; (viii) data challenges; (ix) social/behavioural aspects; and (x) capacity building. Based on our findings, future research ought to focus on improvement of data systems, understanding the impact of and addressing non-fatal injuries, improving estimates on the economic burden, implementation research to scale up programs and transfer learnings, as well as capacity development. Our recommendations, which relate to both empirical and methodological frontiers, would lead to noteworthy improvements in the way road safety data collection and research is conducted in the context of LICs.

Road injuries, health burden, but not fatalities make 12- to 17-year olds a high risk group in the Netherlands

Background

To explore the impact of road injuries for different age groups, this study compares the health burden of road injuries in young adolescents-12 to 17 years of age-to those for older age groups. Young adolescents are underrepresented in road fatalities. However, their inexperience, developmental stage and use of bicycles may expose them to high levels of road risk, but their physical resilience may help them survive injuries which in older age groups would be fatal.

Methods

To assess the impact of injuries compared with death, this study assessed by age group the health burden expressed in disability adjusted life years; years of life lost plus years lived with disability. Its analyses make use of existing data bases on road fatalities, serious injuries (maximum abbreviated injury score 2 or more), travel, life expectancy and disability weights.

Results

For young adolescents, seriously injuries per distance travelled (injury risk) were higher than for any other age group, except for the elderly (75+). This was further amplified when health burden was taken into account, showing these young adolescents to be responsible for 15% of the total health burden associated with road crashes.

Conclusions

These results justify extra efforts to improve the understanding and prevention of injury-only crashes among young adolescents.

Crashes involving cyclists aged 50 and over in the Netherlands: An in-depth study

The number of seriously injured cyclists is increasing in the Netherlands. The majority of these seriously injured cyclists were involved in single-bicycle or bicycle-bicycle crashes. Little is known about the circumstances in which these crashes occur, as the police only registers 4% of these crashes. Therefore, an in-depth study was carried out to gain insight into the factors and circumstances that influence the occurrence and consequences of these crashes. The focus was on crashes involving cyclists aged 50 and over, as this group has a large share in the number of cyclist-only crashes. Detailed information on 41 single-bicycle and bicycle-bicycle crashes was collected and analysed. This resulted in a description of the course of events for every analysed crash, including a list of factors that had contributed to the occurrence of the crash and possible injuries. Subsequently, crashes with a similar course of events and a comparable combination of contributory factors were grouped into types of crashes. Results showed that cyclists aged 75 and over are more often involved in falls from a bicycle than younger cyclists. Contributory factors that played a role in a large number of crashes were behaviour of another road user, distraction and narrow cycling facilities or traffic lanes. However, which factors played a role in the occurrence of a crash depended on the type of crash. Eight types of crashes were identified. Based on the factors that played a role in the occurrence of these crashes, remedial measures can be developed to prevent similar crashes from occurring in the future.

Health burden of serious road injuries in the Netherlands

BACKGROUND

The consequences of injuries in terms of disabilities and health burden are relevant for policy making. This article provides an overview of the current knowledge on this topic and discusses the health burden of serious road injuries in The Netherlands.

METHODS

The overview of current knowledge on disabilities following a road crash is based on a literature review. The health burden of serious road injuries is quantified in terms of years lived with disability (YLD), by combining incidence data from the Dutch hospital discharge register with information about temporary and lifelong disability.

RESULTS

Literature shows that road traffic injuries can have a major impact on victims' physical and psychological well-being and functioning. Reported proportions of people with disability vary between 11 and 80% depending on the type of casualties, time elapsed since the crash, and the health impacts considered. Together, all casualties involving serious injuries in The Netherlands in 2009 account for about 38,000 YLD, compared to 25,000 years of life lost (YLL) of fatalities. Ninety percent of the burden of injury is due to lifelong consequences that are experienced by 20% of all those seriously injured in road accidents. Lower leg injuries and head injuries represent a high share in the total burden of injury as have cyclists that are injured in a crash without a motorized vehicle. Pedestrians and powered 2-wheeler users show the highest burden of injury per casualty.

CONCLUSION

Given their major impacts and contribution to health burden, road policy making should also be aimed at reducing the number of serious road injuries and limiting the resulting health impacts.

Record linkage for road traffic injuries in Ireland using police hospital and injury claims data

INTRODUCTION

The study of non-fatal road traffic injuries is growing in importance. Since there are rarely comprehensive injury datasets, it is necessary to combine different sources to obtain better estimates on the extent and nature of the problem. Record linkage is one such technique.

METHOD

In this study, anonymized datasets from three separate sources of injury data in Ireland: hospitals, police, and injury claims are linked using probabilistic and deterministic linkage techniques. A method is proposed that creates a 'best' set of linked records for analysis, useful when clerical review of undecided cases is not feasible.

RESULTS

The linkage of police and hospital datasets shows results that are similar to those found in other countries, with significant police understatement especially of cyclist and motorcyclist injuries. The addition of the third dataset identifies a large number of additional injuries and demonstrates the error of using only the two main sources for injury data.

PRACTICAL APPLICATION

The study also underlines the risk in relying on the Lincoln-Petersen capture-recapture estimator to provide an estimate of the total population concerned.

CONCLUSION

The data show that road traffic injuries are significantly more numerous than either police or hospital sources indicate. It is also argued that no single measure can fully capture the range of impacts that a serious injury entails.

Burden of road traffic injuries: Disability-adjusted life years in relation to hospitalization and the maximum abbreviated injury scale

BACKGROUND

The consequences of non-fatal road traffic injuries (RTI) are increasingly adopted by policy makers as an indicator of traffic safety. However, it is not agreed upon which level of severity should be used as cut-off point for assessing road safety performance. Internationally, within road safety, injury severity is assessed by means of the maximum abbreviated injury scale (MAIS). The choice for a severity cut-off point highly influences the measured disease burden of RTI. This paper assesses the burden of RTI in terms of disability adjusted life years (DALYs) by hospitalization status and MAIS cut-off point in the Netherlands.

METHODS

Hospital discharge register (HDR) and emergency department (ED) data for RTI in the Netherlands were selected for the years 2007-2009, as well as mortality data. The incidence, years lived with disability (YLD), years of life lost (YLL) owing to premature death, and DALYs were calculated. YLD for admitted patients was subdivided by MAIS severity levels.

RESULTS

RTI resulted in 48,500 YLD and 27,900 YLL respectively, amounting to 76,400 DALYs per year in the Netherlands. The largest proportion of DALYs is related to fatalities (37%), followed by admitted MAIS 2 injuries (25%), ED treated injuries (16%) and admitted MAIS 3+ injuries (18%). Admitted MAIS 1 injuries only account for a small fraction of DALYs (4%). In the Netherlands, the diseases burden of RTI is highest among cyclists with 39% of total DALYs. One half of all bicycle related DALYs are attributable to admitted MAIS 2+ injuries, but ED treated injuries also account for a large proportion of DALYs in this group (28%). Car occupants are responsible for 26% of all DALYs, primarily caused by fatalities (66%), followed by admitted MAIS 2+ injuries (25%). ED treated injuries only account for 5% of DALYs in this group.

CONCLUSIONS

When using admitted MAIS 3+ or admitted MAIS 2+ as severity cut-off point, 54% and 80% of all DALYs are captured respectively. Assessing the influence of different severity cut-off points by MAIS on the proportion and number of DALYs captured gives valuable information for guiding choices on the definition of serious RTI.

Serious road injuries in The Netherlands dissected

OBJECTIVE

This article discusses the characteristics and injury patterns of serious road injuries (Maximum Abbreviated Injury Scale [MAIS] 2+ inpatients) in The Netherlands.

METHODS

In The Netherlands, the actual number of serious injuries is estimated by linking police data to hospital data. The distribution of serious road injuries over (1) travel mode and gender and (2) crash type and age are compared for the years 2000 and 2011. Moreover, the distribution of the injuries over the body regions is illustrated using colored injury body profiles.

RESULTS

The number of serious injuries is higher for men than for women and increased from 16,500 in 2000 to 19,700 in 2011. In 2011, about half (51%) of the serious road injuries were due to a bicycle crash not involving a motor vehicle. The share of casualties aged 60 years and older is relatively high (43% in 2011) in these crashes. The injury body profiles show that head injuries (31%) and injuries to the lower extremities (37%) are most prevalent. Compared to other travel modes, pedestrians and riders of powered 2-wheelers relatively often sustain lower-leg injuries compared to other travel modes. Head injuries are most prevalent in cyclists who are injured in a crash with a motorized vehicle. Cyclists who are injured in a crash not involving a motor vehicle and casualties of 60 years and older relatively often include hip or upper-leg injuries.

CONCLUSION

The characteristics of serious road injuries differ from those of fatalities and the distribution of injuries over the body differs by travel mode, gender, and age.

GBD-2010 overestimates deaths from road injuries in OECD countries: new methods perform poorly

BACKGROUND

We assessed the quality of Global Burden of Disease-2010 (GBD-2010) estimates of road injury deaths by comparing with government statistics for Organisation for Economic Co-operation and Development (OECD) countries that report to the International Road Traffic Accident Database (IRTAD).

METHODS

We obtained tabulated data for 25 OECD countries that report to IRTAD and also report vital registration (VR) data to WHO. We collated VR deaths corresponding to the GBD-2010 road injury definition and estimated 'traffic', 'non-traffic' and 'unspecified whether traffic or non-traffic' components. We estimated national road injury deaths by redistributing partially specified causes of death, as was done by GBD until this was replaced by more complex methods in GBD-2010.

RESULTS

GBD-2010 estimates of road injury deaths exceeded IRTAD by 45% overall. IRTAD values fell below the GBD-2010 95% uncertainty interval in all but three countries. Mismatch of conceptual scope accounted for about 8% of this discrepancy, 5% was because GBD-2010 included cases other than road traffic and 3% because GBD-2010 (unlike IRTAD) includes deaths >30 days after injury. Pro rata distribution of partially specified causes in VR data gave estimates that were 18% higher than IRTAD but closer than GBD-2010 estimates for all but two countries. Cases in VR data specified as road injury gave estimates closer to IRTAD.

CONCLUSIONS

GBD-2010 road injury mortality estimates are substantially higher than the road death toll in OECD countries. The discrepancy is not explained by wider scope of the GBD road injury construct nor by undercounting by IRTAD. GBD-2010 likely attributed substantially more deaths with partially specified causes to road injuries than is appropriate.

Hypoglycemia in non-diabetic in-patients: clinical or criminal?

BACKGROUND AND AIM

We wished to establish the frequency of unexpected hypoglycemia observed in non diabetic patients outside the intensive care unit and to determine if they have a plausible clinical explanation.

METHODS

We analysed data for 2010 from three distinct sources to identify non diabetic hypoglycaemic patients: bedside and laboratory blood glucose measurements; medication records for those treatments (high-strength glucose solution and glucagon) commonly given to reverse hypoglycemia; and diagnostic codes for hypoglycemia. We excluded from the denominator admissions of patients with a diagnosis of diabetes or prescribed diabetic medication. Case notes of patients identified were reviewed. We used capture-recapture methods to establish the likely frequency of hypoglycemia in non-diabetic in-patients outside intensive care unit at different cut-off points for hypoglycemia. We also recorded co-morbidities that might have given rise to hypoglycemia.

RESULTS

Among the 37,898 admissions, the triggers identified 71 hypoglycaemic episodes at a cut-off of 3.3 mmol/l. Estimated frequency at 3.3 mmol/l was 50(CI 33-93), at 3.0 mmol/l, 36(CI 24-64), at 2.7 mmol/l, 13(CI 11-19), at 2.5 mmol/l, 11(CI 9-15) and at 2.2 mmol/l, 8(CI 7-11) per 10,000 admissions. Admissions of patients aged above 65 years were approximately 50% more likely to have an episode of hypoglycemia. Most were associated with important co-morbidities.

CONCLUSION

Significant non-diabetic hypoglycemia in hospital in-patients (at or below 2.7 mmol/l) outside critical care is rare. It is sufficiently rare for occurrences to merit case-note review and diagnostic blood tests, unless an obvious explanation is found.

The effect on road safety of a modal shift from car to bicycle

OBJECTIVE

To describe and apply a method to assess the effect on road safety of a modal shift from cars to bicycles.

METHOD

Ten percent of all car trips shorter than 7.5 km were assumed to be replaced by bicycle trips. Single-vehicle and multivehicle crashes involving cars and/or bicycles were considered. The safety of car occupants and cyclists was taken into account as well as the safety of other road users involved in such crashes. The computations were carried out by age and gender. Assuming constant risk (casualties per distance traveled), the expected number of accidents is proportional to the mobility shift. Several types of risk were considered: the risk of being injured as a car driver or cyclist and the risk of being involved as a car driver or cyclist in a crash in which another road user is injured.

RESULTS

The results indicated that the total gain of the modal shift was negative for fatalities, which means that there was a net increase in the number of fatalities. The modal shift was advantageous for young drivers and disadvantageous for elderly drivers. In addition, it was more positive for males than for females. The turning point was around the age of 35. For hospitalized casualties, due to the strong influence of the many hospitalized cyclists in nonmotorized vehicle crashes, there was a strong negative overall effect, and the modal shift resulted in a positive effect for 18- and 19-year-old males only. Overall, a small increase (up to 1%) in the number of cyclist fatalities and a greater increase of 3.5 percent in the number of inpatients was expected. The increase in casualties was mainly due to the proportion of single-vehicle bicycle crashes with serious injuries in relation to the total number of injured cyclists. The effect of the modal shift was shown to depend on age and gender, resulting in fewer casualties for younger drivers and for women.

CONCLUSIONS

It is possible to provide a first approximation of the effect on road safety of a mobility shift from cars to bicycles. This approximation indicates that, in general, road safety does not benefit from this modal shift. The effect differs for gender and age groups. Elderly drivers are safer inside a car than on a bicycle. For the number of hospitalized casualties, the modal shift increases the number of casualties for practically all ages and both genders.