Road trauma among young Australians: Implementing policy to reduce road deaths and serious injury

Effectiveness of road safety interventions: An evidence and gap map

Background

Road Traffic injuries (RTI) are among the top ten leading causes of death in the world resulting in 1.35 million deaths every year, about 93% of which occur in low- and middle-income countries (LMICs). Despite several global resolutions to reduce traffic injuries, they have continued to grow in many countries. Many high-income countries have successfully reduced RTI by using a public health approach and implementing evidence-based interventions. As many LMICs develop their highway infrastructure, adopting a similar scientific approach towards road safety is crucial. The evidence also needs to be evaluated to assess external validity because measures that have worked in high-income countries may not translate equally well to other contexts. An evidence gap map for RTI is the first step towards understanding what evidence is available, from where, and the key gaps in knowledge.

Objectives

The objective of this evidence gap map (EGM) is to identify existing evidence from all effectiveness studies and systematic reviews related to road safety interventions. In addition, the EGM identifies gaps in evidence where new primary studies and systematic reviews could add value. This will help direct future research and discussions based on systematic evidence towards the approaches and interventions which are most effective in the road safety sector. This could enable the generation of evidence for informing policy at global, regional or national levels.

Search Methods

The EGM includes systematic reviews and impact evaluations assessing the effect of interventions for RTI reported in academic databases, organization websites, and grey literature sources. The studies were searched up to December 2019.

Selection Criteria

The interventions were divided into five broad categories: (a) human factors (e.g., enforcement or road user education), (b) road design, infrastructure and traffic control, (c) legal and institutional framework, (d) post-crash pre-hospital care, and (e) vehicle factors (except car design for occupant protection) and protective devices. Included studies reported two primary outcomes: fatal crashes and non-fatal injury crashes; and four intermediate outcomes: change in use of seat belts, change in use of helmets, change in speed, and change in alcohol/drug use. Studies were excluded if they did not report injury or fatality as one of the outcomes.

Data Collection and Analysis

The EGM is presented in the form of a matrix with two primary dimensions: interventions (rows) and outcomes (columns). Additional dimensions are country income groups, region, quality level for systematic reviews, type of study design used (e.g., case-control), type of road user studied (e.g., pedestrian, cyclists), age groups, and road type. The EGM is available online where the matrix of interventions and outcomes can be filtered by one or more dimensions. The webpage includes a bibliography of the selected studies and titles and abstracts available for preview. Quality appraisal for systematic reviews was conducted using a critical appraisal tool for systematic reviews, AMSTAR 2.

Main Results

The EGM identified 1859 studies of which 322 were systematic reviews, 7 were protocol studies and 1530 were impact evaluations. Some studies included more than one intervention, outcome, study method, or study region. The studies were distributed among intervention categories as: human factors (n = 771), road design, infrastructure and traffic control (n = 661), legal and institutional framework (n = 424), post-crash pre-hospital care (n = 118) and vehicle factors and protective devices (n = 111). Fatal crashes as outcomes were reported in 1414 records and non-fatal injury crashes in 1252 records. Among the four intermediate outcomes, speed was most commonly reported (n = 298) followed by alcohol (n = 206), use of seatbelts (n = 167), and use of helmets (n = 66). Ninety-six percent of the studies were reported from high-income countries (HIC), 4.5% from upper-middle-income countries, and only 1.4% from lower-middle and low-income countries. There were 25 systematic reviews of high quality, 4 of moderate quality, and 293 of low quality.

Authors' Conclusions

The EGM shows that the distribution of available road safety evidence is skewed across the world. A vast majority of the literature is from HICs. In contrast, only a small fraction of the literature reports on the many LMICs that are fast expanding their road infrastructure, experiencing rapid changes in traffic patterns, and witnessing growth in road injuries. This bias in literature explains why many interventions that are of high importance in the context of LMICs remain poorly studied. Besides, many interventions that have been tested only in HICs may not work equally effectively in LMICs. Another important finding was that a large majority of systematic reviews are of low quality. The scarcity of evidence on many important interventions and lack of good quality evidence-synthesis have significant implications for future road safety research and practice in LMICs. The EGM presented here will help identify priority areas for researchers, while directing practitioners and policy makers towards proven interventions.

Unveiling the relevance of traffic enforcement cameras on the severity of vehicle-pedestrian collisions in an urban environment with machine learning models

PURPOSE

One of the leading causes of violent fatalities around the world is road traffic collisions, and pedestrians are among the most vulnerable road users with respect to such incidents. Since walking is highly promoted in urban areas to alleviate motor-vehicle externalities, it is paramount to understand the causes associated with vehicle-pedestrian collisions and their severity to provide safe environments. Although traffic enforcement cameras can address vehicle-vehicle collisions, little is known about their effectiveness with respect to vehicle-pedestrian incidents.

METHODOLOGY

In this study, we trained a set of machine learning models to forecast if a vehicle-pedestrian collision will turn into an injury or fatality, and the most suitable model was used to investigate the contributing features associated with such events with emphasis on the impact of traffic enforcement cameras. In addition to traffic enforcement camera proximity, features associated with the collision, weather, vehicle, victim, and infrastructure are included in the model to reduce unobserved heterogeneity.

RESULTS

Results show that a Linear Discriminant Analysis model surpasses other machine learning models considering the evaluation metrics. Results reveal that the age and gender of the victim, the involvement of larger vehicles in the collision, and the quality of the illumination are the causes associated with pedestrian fatalities. On the other hand, involvement of motorcycles and collisions that occurred in densely populated locations are the causes associated with pedestrian injuries.

CONCLUSIONS

This investigation demonstrates how to articulate machine learning into a vehicle-pedestrian crash analysis to understand the direction and magnitude of covariates in the corresponding severity outcome. Furthermore, it highlights the remarkable effect that traffic enforcement cameras and other features have on vehicle-pedestrian crash severity. These results provide actionable guidance for educational campaigns, enhanced traffic engineering, and infrastructure improvements that could be implemented in the analyzed region to provide safer transportation.

Road traffic injury mortality and morbidity by country development status, 2011-2017

PURPOSE

This research examined road traffic injury mortality and morbidity disparities across of country development status, and discussed the possibility of reducing country disparities by various actions to accelerate the pace of achieving Sustainable Development Goals target 3.6 - to halve the number of global deaths and injuries from road traffic accidents by 2020.

METHODS

Data for road traffic mortality, morbidity, and socio-demographic index (SDI) were extracted by country from the estimates of the Global Burden of Disease study, and the implementation of the three types of national actions (legislation, prioritized vehicle safety standards, and trauma-related post-crash care service) were extracted from the Global Status Report on Road Safety by World Health Organization. We fitted joinpoint regression analysis to identify and quantify the significant rate changes from 2011 to 2017.

RESULTS

Age-adjusted road traffic mortality decreased substantially for all the five SDI categories from 2011 to 2017 (by 7.52%-16.08%). Age-adjusted road traffic mortality decreased significantly as SDI increased in the study time period, while age-adjusted morbidity generally increased as SDI increased. Subgroup analysis by road user yielded similar results, but with two major differences during the study period of 2011 to 2017: (1) pedestrians in the high SDI countries experienced the lowest mortality (1.68-1.90 per 100,000 population) and morbidity (110.45-112.72 per 100,000 population for incidence and 487.48-491.24 per 100,000 population for prevalence), and (2) motor vehicle occupants in the high SDI countries had the lowest mortality (4.07-4.50 per 100,000 population) but the highest morbidity (428.74-467.78 per 100,000 population for incidence and 1025.70-1116.60 per 100,000 population for prevalence). Implementation of the three types of national actions remained nearly unchanged in all five SDI categories from 2011 to 2017 and was consistently stronger in the higher SDI countries than in the lower SDI countries. Lower income nations comprise the heaviest burden of global road traffic injuries and deaths.

CONCLUSION

Global road traffic deaths would decrease substantially if the large mortality disparities across country development status were reduced through full implementation of proven national actions including legislation and law enforcement, prioritized vehicle safety standards and trauma-related post-crash care services.

At what stages of licensing do graduated driver licensing systems reduce crashes? Example from Queensland, Australia

Evaluations of new graduated licensing systems (GLS) commonly examine pre-post young driver crash rates relative to another driver group. This comparison approach is important to account for other influences on crashes over time, but has limited ability to determine which GLS components are most effective and at what stage during the licensing process. We previously identified declines in young driver crashes in Queensland, Australia, following introduction of a new GLS in 2007. The objective of the current research was to conduct complementary modelling to identify at what points through the licensing process had particular GLS policies contributed to reductions. Crash trends were explored for learner and provisional drivers under the new GLS versus previous system for three time periods relative to the month of acquiring a provisional licence: the preceding learner period, the first month of provisional licensure (when crashes typically peak), and the overall provisional period. Interrupted time series analyses were conducted for the log ratio of crashes per 10,000 licensed (learner and provisional) drivers with the total number of licensed drivers as an offset. The greatest declines were found in the first month of licensure, with indications that a longer learner period, higher supervised driving hours, and a new provisional night-passenger restriction were key contributors to provisional crash reductions. There was also some indication that a restriction on all phone use reduced crashes during the learner period. We conclude that time series analysis focusing on licensing stage, rather than calendar time only, offers a complementary approach to analysing GLS effectiveness by better identifying where and how changes impact crashes.

Road Traffic Injuries and Related Safety Measures: A Multicentre Analysis at Military Hospitals in Tabuk, Saudi Arabia

Background

Road traffic injuries are one of the major public safety issues around the world, as they put a great burden on countries' economies. Saudi Arabia has a good road transportation system, but still, road-related fatalities are higher in this country. The main purpose of this study was to determine the association between the severity of injuries caused by road traffic collision and safety measures taken by the drivers admitted to the emergency departments at two military hospitals in Tabuk, a city in Saudi Arabia.

Methods

A total of 342 male drivers who had injuries due to road traffic collision took part in this multicentre, cross-sectional study. The research sites were King Salman Armed Forces Hospital and King Khalid Armed Forces Hospital in Tabuk, Saudi Arabia. The data were collected using a common protocol and a self-reported questionnaire with the help of convenience sampling approach. Descriptive statistics and logistic regression analysis were done using IBM SPSS version 23.

Results

Nearly 62.0% of the male drivers were aged less than 36 years. About 90% of the drivers were from low- and middle-income groups. Logistic regression analysis indicated that drivers who had road traffic collision and used mobile phones while driving were four times more likely to have severe injuries (OR = 3.89; 95% CI (2.53, 5.95)), those who drove the vehicle at an excessive speed limit were three times more likely to have severe injuries (OR = 2.71; 95% CI (1.01, 4.97)), and those who attempted to overtake another vehicle were two times more likely to have severe injuries (OR = 1.85; 95% CI (1.24, 3.77)).

Conclusion

Based on the results of the present study, the most important safety measures which contributed the most to road traffic collision were use of mobile phones while driving the vehicle, driving at an excessive speed limit, irregularity in maintaining the vehicle, attempt to pass other vehicles, and not following the traffic rules. All the safety measures are protective, but if care is not taken, they will risk the life. There is an urgent need to spread traffic safety awareness in this region.

Impacts of graduated driver licensing regulations

We evaluate the impact of the Graduated Driver Licensing (GDL) system introduced in Victoria, Australia as they influence both injury and fatality rates. Since 1990, the Victorian GDL scheme has undergone several modifications including the introduction of new requirements and the stricter enforcement of existing regulations. Our evaluation of the GDL is based on monthly mortality and morbidity data for drivers 18-25 for the period January 2000 to June 2017. We estimate the immediate and long-term impacts of each policy change to the GDL system. Our results indicate that several initiatives in the GDL system have had impacts on both fatalities and injuries requiring hospitalisation when differentiated by gender. In a number of cases we observe that reactions to these measures are common to both genders. These include: the signalling of the proposed GDL changes in the media, the introduction of an extra probationary year for those under 21, the total alcohol ban for the entire probationary period, and limits on peer passengers for the first year. Stricter mobile phone restrictions appear to have had no impact on injuries for either males or females although they were associated with lower fatality rates for both. In addition, we found an indication that in the period prior to the introduction of the mandatory requirement of 120 h supervised driving, there was a rise in male driver injuries possibly caused by a rush of more inexperienced learners to obtain their probationary licence.