Distribution of road traffic deaths by road user group: a global comparison

Utilizing machine learning and geographic analysis to improve Post-crash traffic injury management and emergency response systems

Traffic injuries are a major public health concern globally. This study uses machine learning (ML) and geographic analysis to analyse road traffic fatalities and improve traffic safety in Nakhon Ratchasima Province, Thailand. Data on road traffic fatalities were collected from forensic and hospital records. K-means clustering grouped death locations and identified cluster centres. The Ball Tree algorithm and Google Directions API were used to find the nearest trauma centre hospital from the injury locations. Statistical tests, including chi-square and Kruskal-Wallis, examined relationships between clusters and demographic variables. The analysis identified 181 cases, mostly males (83.43%), with a median age of 37 years. Clustering the death locations into four high-risk areas resulted in a Silhouette Score of 0.94, indicating suitable EMS locations. While no significant correlation was found with demographic variables, distinct patterns were observed in road user types. Testing the prediction performance for the nearest hospital using forty new locations yielded an accuracy, precision, recall, and F1 score of 0.90. These findings emphasize the importance of targeted interventions and resource allocation in traffic injury prevention and emergency response planning, showcasing the potential of ML and geographic analysis in enhancing traffic injury management and emergency response systems.

The safety impacts of paved shoulder width in Indian four-lane rural highways

The shoulder width, as a geometric element, plays a crucial role in enhancing highway safety. Research from high-income countries indicates that improving shoulders on highways leads to substantial safety benefits. However, the safety effectiveness of paved shoulders for low- and middle-income countries (LMICs) highway contexts has limited evidence. This study evaluated the safety effectiveness of the paved shoulder width on 61 km, four-lane, divided rural intercity highways in India. The first objective was to evaluate highway crash patterns using data from 2016 to 2019. The second objective was to evaluate the safety effectiveness of paved shoulder width using the case-control approach. The findings of this study demonstrate a consistent decline in the likelihood of crashes as the shoulder's width increases within the range of zero to 2.5 m for the 100 m segment length and zero to 1.7 m for the 500 m segment length. Nevertheless, model estimates indicate an increased crash risk for shoulders wider than 2.5 m. The results also suggested that the odds ratio for paved shoulder widths ranging from no shoulder to 2.5 m is likely to follow the crash modification factor from the highway safety manual. The findings of this study hold significant implications for the design policy of shoulder width on rural highways in LMICs.

The epidemiology and outcomes of severe road traffic injury by road user type in Korea: A nationwide retrospective observational study

OBJECTIVES

Road traffic injuries (RTIs) pose a significant public health burden, and more than half of these fatalities are attributed to vulnerable road users (VRUs). This study aimed to evaluate the epidemiology and outcomes of severe RTIs in Korea by focusing on different types of road users.

METHODS

This is nationwide retrospective observational study. Using data from the Korean Nationwide Severe Trauma Registry, this study analyzed severe RTI cases from 2016 to 2020. The study included EMS-treated severe trauma patients, defining severe RTI as cases with an injury severity score (ISS) ≥16 or out-of-hospital cardiac arrest (OHCA). The main variable of interest was the road user type, classified as motor vehicle occupants (MVOs), pedestrians, motorcyclists, and bicyclists. Trends and injury characteristics by road user type were analyzed, and multivariate logistic regression was conducted to calculate the adjusted odds ratios (AORs) and 95 % confidence intervals (CIs) of road user type for in-hospital mortality.

RESULTS

Of the 143,021 EMS-treated severe trauma cases, 24,464 were included in this study. Pedestrians represented the largest group (n = 8,782; 35.9 %). More than half of the patients died (n = 12,620, 51.6 %), and a high proportion of patients had OHCA (n = 10,048, 41.1 %). There was no significant change in the overall severe RTI numbers from 2016 to 2020, but a decrease in pedestrian cases and an increase in motorcyclist cases were noted (both p for trend<0.05). Low usage of safety devices was observed (28.2 % of motor vehicle occupants used seat belts, 35.9 % of motorcyclists used helmets, and 9.6 % of bicyclists used helmets). Head injuries were most common, particularly among bicyclists (77.0 %) and motorcyclists (69.8 %). Compared to motor vehicle occupants, pedestrians (AOR [95 % CI] 1.12 [1.04-1.20]) and others (AOR [95 % CI] 1.30 [1.02-1.65]) had higher odds of mortality, while motorcyclists (AOR [95 % CI] 0.64 [0.59-0.69]) and bicyclists (AOR [95 % CI] 0.68 [0.60-0.76]) had lower odds of mortality.

CONCLUSION

We found varying trends and injury characteristics in severe RTIs according to road user type. Adapting prevention strategies for evolving road user patterns, with particular attention to increasing safety device usage and addressing the high mortality associated with severe RTIs are warranted.

Generation of nighttime pedestrian fatal precrash scenarios at junctions in Tamil Nadu, India, using cluster correspondence analysis

OBJECTIVE

Modern transportation amenities and lifestyles have changed people's behavioral patterns while using the road, specifically at nighttime. Pedestrian and driver maneuver behaviors change based on their exposure to the environment. Pedestrians are more vulnerable to fatal injuries at junctions due to increased conflict points with vehicles. Generation of precrash scenarios allows drivers and pedestrians to understand errors on the road during driver maneuvering and pedestrian walking/crossing. This study aims to generate precrash scenarios using comprehensive nighttime fatal pedestrian crashes at junctions in Tamil Nadu, India.

METHODS

Though numerous studies were available on identifying pedestrian crash patterns, only some focused on identifying crash patterns at junctions at night. We used cluster correspondence analysis (CCA) to address this research gap to identify the patterns in nighttime pedestrian fatal crashes at junctions. Further, high-risk precrash scenarios were generated based on the positive residual means available in each cluster. This study used crash data from the Road Accident Database Management System of Tamil Nadu State in India from 2009 to 2018. Characteristics of pedestrians, drivers, vehicles, crashes, light, and roads were input to the CCA to find optimal clusters using the average silhouette width, Calinski-Harabasz measure, and objective values.

RESULTS

CCA found 4 clusters with 2 dimensions as optimal clusters, with an objective value of 3.3618 and a valence criteria ratio of 80.03%. Results from the analysis distinctly clustered the pedestrian precrash behaviors: Clusters 1 and 2 on pedestrian walking behaviors and clusters 3 and 4 on crossing behaviors. Moreover, a hidden pattern was observed in cluster 4, such as transgender drivers involved in fatal pedestrian crashes at junctions at night.

CONCLUSION

The generated precrash scenarios may be used to train drivers (novice and inexperienced for nighttime driving), test scenario creation for developing advanced driver/rider assistance systems, hypothesis creation for researchers, and planning of effective strategic interventions for engineers and policymakers to change pedestrian and driver behaviors toward sustainable safety on Indian roads.

Working towards 2030 road safety targets, the need for specific rural and remote children strategies

INTRODUCTION

Despite the importance of child road traffic death, the knowledge about rural child road traffic death in Australia is limited.

OBJECTIVE

To explore the difference of child road traffic death between urban and rural areas.

DESIGN

This study was a retrospective analysis of road traffic death in Australia among children and adolescents aged 0-19 registered between 1 January 2009 and 30 June 2019.

RESULTS

During the study period, there were 1757 child road traffic death in Australia, and the crude mortality rate was 2.96 per 100 000 population. The crude mortality rate in remote (8.83 per 100 000 population) and very remote (11.08 per 100 000 population) areas was much higher than major cities (1.83 per 100 000 population), inner regional (5.14 per 100 000 population) and outer regional (5.91 per 100 000 population).

CONCLUSIONS

Specific targets are needed to address the burden of child road traffic death in Australia around rurality, as it is a significant risk factor of child road traffic death.

Individual characteristics associated with road traffic collisions and healthcare seeking in low- and middle-income countries and territories

Incidence of road traffic collisions (RTCs), types of users involved, and healthcare requirement afterwards are essential information for efficient policy making. We analysed individual-level data from nationally representative surveys conducted in low- or middle-income countries (LMICs) between 2008-2019. We describe the weighted incidence of non-fatal RTC in the past 12 months, type of road user involved, and incidence of traffic injuries requiring medical attention. Multivariable logistic regressions were done to evaluate associated sociodemographic and economic characteristics, and alcohol use. Data were included from 90,790 individuals from 15 countries or territories. The non-fatal RTC incidence in participants aged 24-65 years was 5.2% (95% CI: 4.6-5.9), with significant differences dependent on country income status. Drivers, passengers, pedestrians and cyclists composed 37.2%, 40.3%, 11.3% and 11.2% of RTCs, respectively. The distribution of road user type varied with country income status, with divers increasing and cyclists decreasing with increasing country income status. Type of road users involved in RTCs also varied by the age and sex of the person involved, with a greater proportion of males than females involved as drivers, and a reverse pattern for pedestrians. In multivariable analysis, RTC incidence was associated with younger age, male sex, being single, and having achieved higher levels of education; there was no association with alcohol use. In a sensitivity analysis including respondents aged 18-64 years, results were similar, however, there was an association of RTC incidence with alcohol use. The incidence of injuries requiring medical attention was 1.8% (1.6-2.1). In multivariable analyses, requiring medical attention was associated with younger age, male sex, and higher wealth quintile. We found remarkable heterogeneity in RTC incidence, the type of road users involved, and the requirement for medical attention after injuries depending on country income status and socio-demographic characteristics. Targeted data-informed approaches are needed to prevent and manage RTCs.

Global burden and trends of three common road injuries from 1990 to 2019 and the implications for prevention and intervention

BACKGROUND

Analysis on the burden of specific types of road injuries (RIs) in the previous Global burden of disease (GBD) studies is lacking. The present work aimed to analyze the burden of three common RIs using the updated data of the GBD 2019, which would inform policy-making.

METHODS

Data on cyclist road injuries (CRIs), motorcyclist road injuries (MRIs), and motor vehicle road injuries (MVRIs) were extracted from the GBD 2019. Trends of age-standardized rate (ASR) were predicted using estimated annual percentage change (EAPC) from 1990 to 2019.

RESULTS

Over the past three decades, the global incident ASRs of CRIs and MRIs presented increasing trends, but that of MVRIs declined slightly. However, trends of death and disability adjusted life years (DALYs) caused by three common RIs decreased in most regions and countries. Particularly, trends in ASRs of years of life lost (YLLs) cuased by RIs decreased more pronouncedly than that of years of life lived with disability (YLDs). The burden of three common RIs showed significant social and demographic characteristics. Low-middle and middle socio-demographic index (SDI) areas had a heavy burden of RIs, particularly CRIs and MRIs. However, the high SDI area undertook a relatively low burden, and presented more pronounced downward trends in death and DALYs.

CONCLUSIONS

The burden and changing trends of three common RIs were geographically heterogeneous. The findings highlighted that increasing incident trends of RIs needed more cost-effective measures of prevention and intervention.

Uber use after alcohol consumption among car/motorcycle drivers in ten Brazilian capitals

OBJECTIVE

This study aimed to measure the proportion of Uber use instead of drinking and driving in ten Brazilian capitals, in 2019.

METHODS

A cross-sectional survey was developed in ten Brazilian capitals. Data were collected in agglomeration points (AP) and sobriety checkpoints (SC). Based on responses to a standardized questionnaire, the proportion of drivers who used Uber instead of drinking and driving was measured for total sample of each methodology and stratified by municipality, age group, gender, education level, and type of vehicle. Fisher's exact test was used to make comparisons between the strata.

RESULTS

A total of 8,864 drivers were interviewed. The most used means of transport to replace driving after drinking alcohol was the Uber system (AP: 54.6%; 95%CI: 51.2-58.0. SC: 58.6%; 95%CI: 55.2-61.9). Most of these users were aged from 18 to 29 years, women, with at least one higher education degree. According to the AP methodology, the highest magnitude of this indicator was found in Vitória (ES) (71.0%; 95%CI: 63.5-77.5), whereas the lowest was observed in Teresina (PI) (33.1%; 95%CI: 22.7-45.5). According to the SC methodology, the highest magnitude of the indicator was also found in Vitória (ES) (78.3%; 95%CI: 68.8-85.5), whereas the lowest was observed in Boa Vista (RR) (36.6%; 95%CI: 26.8-47.7).

CONCLUSION

In Brazilian capitals, the study showed higher proportions of Uber use instead of drinking and driving. This type of scientific evidence on factors associated with road traffic injuries presents the potential to guide public health interventions.

Association of Scene Time with Mortality in Major Traumatic Injuries Arrived by Emergency Medical Service

Introduction

Trauma is a major cause of death worldwide, and prehospital care is critical to improve patient outcomes. However, there is controversy surrounding the effectiveness of limiting scene time to 10 min or less in the care of major trauma patients. This study aimed to investigate the association between scene time and mortality in major trauma patients.

Methods

A retrospective cohort study was conducted on major trauma patients treated by the Thammasat University Hospital Emergency Medical Services (EMS) team from 2020 to 2022. We included traumatic adult patients who had an injury severity score (ISS) of 16 or higher. The primary outcome was 24-h mortality. Multivariable risk regression analysis was used to evaluate the independent effect of scene time on 24-h mortality.

Results

A total of 104 patients were included, of whom 11.5% died within 24 h. After adjusting for age, systolic blood pressure, Glasgow Coma Scale, and ISS, patients who had a scene time over 10 min showed a significant association with mortality (33.3% vs. 8.7%, P = 0.031). Intravenous fluid administration at the scene showed a trend toward a significant association with mortality.

Conclusions

This study provides evidence to support the importance of minimizing scene time for major trauma patients. The findings suggest that a balance between timely interventions and adequate resources should be considered to optimize patient outcomes. Further studies to investigate the impact of prehospital interventions on trauma patient outcomes are needed.

Changes in injury patterns, injury severity and hospital mortality in motorized vehicle accidents: a retrospective, cross-sectional, multicenter study with 19,225 cases derived from the TraumaRegister DGU®

PURPOSE

In the last 20 years, the number of fatalities due to road traffic accidents (RTA) in Germany has steadily decreased from 7503 to 2724 per year. Due to legal regulations, educational measures and the continuous development of safety technology the number of severe traumatic injuries and injury patterns are most likely to change. The aim of the study was to analyse severely injured motorcyclists (MC) and car occupants (CO) that were involved in RTAs in the last 15 years and investigate the development and changes of injury patterns, injury severity and hospital mortality.

METHODS

We retrospectively evaluated data from the TraumaRegister DGU® (TR-DGU) considering all RTA-related injured MCs and COs (n = 19,225) that were registered in the TR-DGU from 2006 to 2020 with a primary admission to a trauma center with continuous participation (14 of 15 years) in the TR-DGU, an Injury Severity Score (ISS) ≥ 16 and aged between 16 and 79 years. The observation period was divided into three 5-year interval subgroups for further analysis.

RESULTS

The mean age increased by 6.9 years and the ratio of severely injured MCs to COs changed from 1:1.92 to 1:1.45. COs were in 65.8% male and more often severely injured in the age groups under 30, while the majority of severely injured MCs were in the age group around 50 years and in 90.1% male. The ISS (- 3.1 points) as well as the mortality of both groups (CO: 14.4% vs. 11.8%; MC: 13.2% vs. 10.2%) steadily decreased over time. Nevertheless, the standardized mortality ratio (SMR) hardly changed and stayed < 1. Regarding the injury patterns, the greatest decline of injuries with AIS 3 + were to the head (CO: - 11.3%; MC: - 7.1%), in addition, a decrease of injuries to extremities (CO: - 1.5%; MC: - 3.3%), to the abdomen (CO: - 2.6%; MC: - 3.6%), to the pelvis in COs (- 4.7%) and to the spine (CO: + 0.1%; MC: - 2.4%) were observed. Thoracic injuries increased in both groups (CO: + 1.6%; MC: + 3.2%) and, furthermore, pelvic injuries in MCs (+ 1.7%). Another finding was the increase of the utilization of whole body CTs from 76.6 to 95.15%.

CONCLUSION

The severity of injuries and their incidence, especially head injuries, have decreased over the years and seem to contribute to a decreasing hospital mortality of polytraumatized MCs and COs injured in traffic accidents. Young drivers and an increasing number of seniors are the age groups at risk and require special attention and treatment.

Demographic characteristics of patients who underwent anterior cruciate ligament reconstruction at a tertiary care hospital in India

BACKGROUND

Anterior cruciate ligament (ACL) tears are common sports-related injuries. Their incidence is not the same either for all the sports or for the same sport across various nations. This information is maintained by many sports leagues in their registries. However, very few nationwide registries exist for such injuries. This study is carried out to know the demographic characteristics of patients who underwent ACL reconstruction at our hospital in India.

AIM

To know the demographic characteristics of patients who underwent ACL reconstruction at a tertiary care hospital in India.

METHODS

All the patients who underwent ACL reconstruction from January 2020 to December 2021 were retrospectively studied. Patients with multi-ligament injuries or a history of previous knee surgery were excluded. The patients' history was obtained from the hospital records, they were interviewed telephonically, and online questionnaires were given. Their demographic data was analyzed and compared to the existing literature.

RESULTS

A total of 124 patients were operated on for ACL reconstruction during this period. The mean age of the patients was 27.97 years. One hundred and thirteen patients (91.1%) were male and 11 (8.9%) were female. The majority of the patients (47.6%) sustained this injury by road traffic accidents (RTA) followed by sports-related injuries (39.5%). The commonest presenting complaint was giving way of the knee in 118 patients (95.2%). The mean duration from the injury to the first hospital visit among the patients was 290.1 d. The mean duration from the injury to surgery was 421.8 d.

CONCLUSION

ACL patients' demography is different in developing nations as compared to the developed world. RTA are the leading cause of ACL injuries and are followed by recreational sports as a cause. There is delayed access to healthcare leading to delayed diagnosis as well as even greater time to surgery. This, in turn, leads to poorer prognosis and longer rehabilitation. National registries for developing nations are the need of the hour due to the different demographics of ACL injuries in developing countries.

Diagnosis-specific sickness absence among injured working-aged pedestrians: a sequence analysis

BACKGROUND

The knowledge about the long-term consequences in terms of sickness absence (SA) among pedestrians injured in a traffic-related accident, including falls, is scarce. Therefore, the aim was to explore diagnosis-specific patterns of SA during a four-year period and their association with different sociodemographic and occupational factors among all individuals of working ages who were injured as a pedestrian.

METHODS

A nationwide register-based study, including all individuals aged 20-59 and living in Sweden, who in 2014-2016 had in- or specialized outpatient healthcare after a new traffic-related accident as a pedestrian. Diagnosis-specific SA (> 14 days) was assessed weekly from one year before the accident up until three years after the accident. Sequence analysis was used to identify patterns (sequences) of SA, and cluster analysis to form clusters of individuals with similar sequences. Odds ratios (ORs) with 95% confidence intervals (CIs) for association of the different factors and cluster memberships were estimated by multinomial logistic regression.

RESULTS

In total, 11,432 pedestrians received healthcare due to a traffic-related accident. Eight clusters of SA patterns were identified. The largest cluster was characterized by no SA, three clusters had different SA patterns due to injury diagnoses (immediate, episodic, and later). One cluster had SA both due to injury and other diagnoses. Two clusters had SA due to other diagnoses (short-term and long-term) and one cluster mainly consisted of individuals with disability pension (DP). Compared to the cluster "No SA", all other clusters were associated with older age, no university education, having been hospitalized, and working in health and social care. The clusters "Immediate SA", "Episodic SA" and "Both SA due to injury and other diagnoses" were also associated with higher odds of pedestrians who sustained a fracture.

CONCLUSIONS

This nationwide study of the working-aged pedestrians observed diverging patterns of SA after their accident. The largest cluster of pedestrians had no SA, and the other seven clusters had different patterns of SA in terms of diagnosis (injury and other diagnoses) and timing of SA. Differences were found between all clusters regarding sociodemographic and occupational factors. This information can contribute to the understanding of long-term consequences of road traffic accidents.

Characteristics of road traffic mortality and distribution of healthcare resources in Thailand

Road traffic mortalities (RTMs), a leading cause of death globally, mostly occur in low- and middle-income countries, and having sufficient healthcare resources could lower the number of these fatalities. Our study aimed to illustrate the incidence of RTMs per 100,000 population and to compare the distribution of healthcare resources from 2011 to 2021 with rates of RTMs in the 77 provinces of Thailand. We divided the population into adults (≥ 15 years) and children (0-14 years). Lorenz curve and Gini coefficient were used to measure the level of distribution and equality of hospital resources and in relation to RTMs across the country. The average number of deaths was 30.34 per 100,000 per year, with male predominance. The RTM rates for adults and children were 32.71 and 19.08 per 100,000 respectively, and motorcycle accidents accounted for the largest percentage of deaths across all age groups. The Gini coefficient showed that operating rooms (0.42) were the least equally distributed hospital resource, while physicians were the most equally distributed (0.34). Anomalies were identified between the distribution of RTMs and available hospital resources. We hope our study will be beneficial in reallocating these resources more fairly to reflect the different numbers of traffic accidents in each province with the aim of reducing lower traffic-related deaths.

Referral conditions for severe road traffic injuries and their influence on the occurrence of hospital deaths in Benin

Road traffic accidents are the leading cause of death by trauma. Delays in in first aid due, inter alia, to the long time to transfer traffic accident victims to hospital and the lack of pre-hospital emergency care, contribute to the increase in hospital mortality. This study aims to analyse the referral conditions for severe road traffic injuries and to assess their effect on the occurrence of hospital deaths in Benin. This is an analytical prospective cohort study conducted in road accident victims with a severe injury. Four groups of factors were studied: referral conditions, sociodemographic and victim-specific characteristics, factors related to the accident environment, and factors related to health services. A top-down binary stepwise logistic regression was the basis for the analyses. Nine point eight percent of severe trauma patients died after hospital admission (7.0-13.5). Associated factors were referral time greater than 1 hour (RR=5.7 [1.5-20.9]), transport to hospital by ambulance (RR=4.8 [1.3-17.3]) and by the police or fire department (RR=7.4 [1.8-29.7]), not wearing protective equipment (RR=4.5 [1.4-15.0]), head injuries (RR=34.8 [8.7-139.6]), and no upper extremity injuries (RR=20.1 [2.3-177.1]). To reduce the risk of hospital death in severe road traffic injuries, it is important to ensure rapid and medicalized referral of severe trauma patients in Benin.

Implementation of a model of awareness-raising for taxi motorcyclists in Benin in relation to helmet use: a quasi-experimental study

Background

This study aims to test the effectiveness of an awareness-raising model designed based on the theory of planned behaviour regarding helmet use for motorcycle taxi drivers.

Methods

This quasi-experimental study took place in the cities of Parakou (intervention group) and Porto Novo (control group). Over a three-month period, a package of awareness-raising activities, based on the theory of planned behaviour, have been implemented in the intervention area. Data relate to knowledge, attitudes and practices regarding helmet use was collected prospectively before the intervention, at the end, and 6 months later. Stata 15 was used for data analysis. Chi-square or Fisher, Student’s or Kruskal-Wallis tests was carried out. The difference-in-difference method was used to determine the specific effect of the awareness activities.

Results

After the intervention, there was an improvement in the total score in both groups compared to baseline. The total score increased by 0.2 (0.06–0.3) in the experimental group when the number of sessions attended increased by one (p = 0.005). The difference-in-difference estimator measured among subjects who attended at least one awareness session, controlling for socio-demographic variables, showed a significantly higher difference in the total score of subjects in the experimental group compared to those in the control group both at the end of the interactive sessions and 6 months later.

Conclusion

This model improves the helmet-wearing behaviour of motorbike taxi drivers in the experimental area. It could be adapted and applied to other socio-professional groups and other types of users.

Factors explaining pedestrian-involved fatality crashes on National Highways in India

Pedestrians continue to face high risk of getting involved in fatal and serious injury crashes all over the world. In many high-income countries, pedestrian involvement in fatal crashes occur mostly in urban areas. However, in many low- and middle-income countries in Asia and Africa, pedestrian involvement in fatal crashes occur on intercity highways too. This research analyses fatal pedestrian crash characteristics, and identifies probable contributory factors to pedestrian involvement in fatal crashes using logistic regression for two-, four-, and six-lane National Highways. The fatal pedestrian crash density is found to be the highest at 1.37 crashes/km/year on six-lane divided NH-1. The binary logistic regression estimation results for pedestrian involvement in the fatal crash model revealed that the predictors: "number of lanes" and "time of crash" are found to be significant at 95% level. The model results for the variable "number of lanes" highlights the need to study pedestrian crossing behaviour on highways in detail. The design standards for pedestrian crossing facilities in urban areas may not be suitable for National Highways in particular multi-lane highways. In-depth research is required to understand the suitability of various traffic calming measures and other possible interventions which can ensure pedestrian safety on highways.

Fall- and collision-related injuries among pedestrians in road traffic environment - A Swedish national register-based study

OBJECTIVE

To investigate the burden of pedestrian injuries, including pedestrian fall injuries (PFI), compared to other transport-related injuries in Sweden and document their characteristics in terms of demographics, causes, type of injuries, and severity level with a focus on long-term consequences.

METHODS

Data were retrieved from the national Swedish Traffic Accident Data Acquisition register. A total of 361,531 fatalities and injuries were reported by emergency hospitals during 2010-2019, of which 127,804 were pedestrians (35%). We assessed the magnitude of PFIs and conducted comparative analyses to assess differences compared to other types of road users regarding sex, age, severity level, injury circumstances, hospital care, causes of accidents, and type of injuries.

RESULTS

Pedestrians were the second largest group of traffic-related deaths in Sweden after car occupants and accounted for just over a quarter of all fatal accidents in the road traffic environment. Of the total number of pedestrian fatalities, three out of four have been in collision accidents and the others in fall-related accidents. In terms of injuries, pedestrians were the largest group among all road users, regardless of the type of accident. PFIs accounted for a third of all injuries in the road traffic environment and nearly half of all injuries resulting in permanent medical impairment (i.e., 2.2 times more long-term consequences among PFIs compared to injured car occupants). Females (particularly middle-aged and older) and older adults were overrepresented, and most PFIs occurred on urban and municipal roads. The causes were often related to maintenance (e.g., slippery surfaces such as ice, snow, leaves or gravel together with uneven pavements and roads are the cause three out of four of PFIs). Among collision injuries, the representation was almost equal for sex and age.

CONCLUSIONS

Injuries and fatalities among pedestrians are a considerable issue in the road traffic environment in Sweden. Contrary to other traffic groups, the incidence has not decreased over time, meaning that this issue must be met with specific measures and address the specific risk factors they are associated with.

PRACTICAL APPLICATION

Including fall accidents in the definition of traffic accidents increases the chances of getting better information about the accidents and taking preventive measures.

The neglected epidemic-Risk factors associated with road traffic injuries in Mozambique: Results of the 2016 INCOMAS study

In 2019, 93% of road traffic injury related mortality occurred in low- and middle-income countries, an estimated burden of 1.3 million deaths. This problem is growing; by 2030 road traffic injury will the seventh leading cause of death globally. This study both explores factors associated with RTIs in the central region of Mozambique, as well as pinpoints geographical "hotspots" of RTI incidence. A cross-sectional, population-level survey was carried out in two provinces (Sofala and Manica) of central Mozambique where, in addition to other variables, the number of road traffic injuries sustained by the household within the previous six months, was collected. Urbanicity, household ownership of a car or motorcycle, and socio-economic strata index were included in the analysis. We calculated the prevalence rate ratios using a generalized linear regression with a Poisson distribution, as well as the spatial prevalence rate ratio using an Integrated Nested Laplace Approximation. The survey included 3,038 households, with a mean of 6.29 (SD 0.06) individuals per household. The road traffic injury rate was 6.1% [95%CI 7.1%, 5.3%]. Urban residence was associated with a 47% decrease in rate of injury. Household motorbike ownership was associated with a 92% increase in the reported rate of road traffic injury. Higher socio-economic status households were associated with a 26% increase in the rate of road traffic injury. The rural and peri-urban areas near the "Beira corridor" (national road N6) have higher rates of road traffic injuries. In Mozambique, living in the rural areas near the "Beira corridor", higher household socio-economic strata, and motorbike ownership are risk factors for road traffic injury.

Sickness absence and disability pension among injured working-aged pedestrians - a population-based Swedish register study

Background

The knowledge is scarce about sickness absence (SA) and disability pension (DP) among pedestrians injured in a traffic-related accident, including falls. Thus, the aim was to explore the frequencies of types of accidents and injuries and their association with SA and DP among working-aged individuals.

Methods

A nationwide register-based study, including all individuals aged 16-64 and living in Sweden, who in 2010 had in- or specialized outpatient healthcare after a new traffic-related accident as a pedestrian. Information on age, sex, sociodemographics, SA, DP, type of accident, injury type, and injured body region was used. Frequencies of pedestrians with no SA or DP, with ongoing SA or full-time DP already at the time of the accident, and with a new SA spell >14 days in connection to the accident were analyzed. Crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for new SA were estimated by logistic regression.

Results

In total, 5576 pedestrians received healthcare due to a traffic-related accident (of which 75% were falls, with half of the falls related to snow and ice). At the time of the accident, 7.5% were already on SA and 10.8% on full-time DP, while 20% started a new SA spell. The most common types of injuries were fractures (45%) and external injuries (30%). The body region most frequently injured was the lower leg, ankle, foot, and other (in total 26%). Older individuals had a higher OR for new SA compared with younger (OR 1.91; 95% CI 1.44-2.53, for ages: 45-54 vs. 25-34). The injury type with the highest OR for new SA, compared with the reference group external injuries, was fractures (9.58; 7.39-12.43). The injured body region with the highest OR for new SA, compared with the reference group head, face, and neck, was lower leg, ankle, foot, and other (4.52; 2.78-7.36).

Conclusions

In this explorative nationwide study of the working-aged pedestrians injured in traffic-related accidents including falls, one fifth started a new SA spell >14 days. Fractures, internal injuries, collisions with motor vehicle, and falls related to snow and ice had the strongest associations with new SA.

State of pedestrian road safety in Uganda: a qualitative study of existing interventions

Background

Pedestrians in Uganda account for 40% of road traffic fatalities and 25% of serious injuries annually. We explored the current pedestrian road traffic injury interventions in Uganda to understand why pedestrian injuries and deaths continue despite the presence of interventions.

Methods

We conducted a qualitative study that involved a desk review of road safety policy, regulatory documents, and reports. We supplemented the document review with 14 key informant interviews and 4 focus group discussions with participants involved in road safety. Qualitative thematic content analysis was done using ATLAS. ti 7 software.

Results

Five thematic topics emerged. Specifically, Uganda had a Non-Motorized Transport Policy whose implementation revealed several gaps. The needs of pedestrians and contextual evidence were ignored in road systems. The key programmatic challenges in pedestrian road safety management included inadequate funding, lack of political support, and lack of stakeholder collaboration. There was no evidence of plans for monitoring and evaluation of the various pedestrian road safety interventions.

Conclusion

The research revealed low prioritization of pedestrian needs in the design, implementation, and evaluation of pedestrian road safety interventions. Addressing Uganda's pedestrian needs requires concerted efforts to coordinate all road safety activities, political commitment, and budgetary support at all levels.

Do detection-based warning strategies improve vehicle yielding behavior at uncontrolled midblock crosswalks?

Pedestrians being the most vulnerable road users account for a large proportion of injuries and fatalities from road traffic crashes. Pedestrians are involved in around one-third of the whole fatalities coming from the road traffic crashes in the state of Qatar. In areas with uncontrolled midblock crosswalks, it is very crucial to improve drivers' alertness and yielding behavior. The objective of this driving simulator study is to investigate the impact of pedestrian detection strategies and pavement markings on driving behavior at high-speed uncontrolled crosswalks. To this end, an untreated condition (i.e. Control) was compared with three treatment conditions. The three treated conditions included two detection strategies, i.e., advance variable message sign (VMS) and LED lights, and road markings with pedestrian encircled. Each condition was tested with a yield/stop controlled marked crosswalk for two situations, i.e. with vs. without a pedestrian present. The experiment was conducted using the driving simulator at Qatar University. In total, 67 volunteers possessing a valid Qatari driving license participated in the study. Different analyses were conducted on vehicle-pedestrian interactions, driving speed, variations in acceleration/deceleration and lateral position. The results showed that both the LED and VMS conditions were helpful in increasing yielding rates up to 98.4 % and reducing the vehicle-pedestrian conflicts significantly. Furthermore, both treatments were effective in motivating drivers to reduce vehicle speed in advance. Considering the findings of this study, we recommend LED and VMS conditions as potentially effective solutions to improve safety at yield/stop controlled crosswalks.

Pattern of orthopedic injuries among Victims of Road Traffic Accidents in Aseer region, Saudi Arabia

Background

Road Traffic Accidents (RTA) are one of the most common causes of morbidity and mortality in Saudi Arabia despite preventive measures and programs. The major factors for the increase in the incidence of mortality and morbidity are due to human factors, such as over speeding, not obeying traffic laws, fatigue, and driving before the legal age. In this study, we aim to report the pattern of orthopedic injuries (OIs) from RTA in the south-western region of Saudi Arabia and to explore the healthcare outcomes of OIs.

Method

This is a retrospective, record-based, case series study including RTA patients who were admitted to the Emergency Department (ED) at a tertiary hospital in the south-western region of Saudi Arabia. The data was collected for 531 admitted RTA patients with OIs over for five years from May 2011 to May 2016. Patients who were 15 years of age or above were included in this study. The data were analyzed using the statistical package for social science (SPSS) version 21.

Results

A total of 531 patients were included with an age range between 15 and 90 years with an average age of 29 ± 2 years. Most of the population was male constituting 91.3% of the sample while 91.9% of the sample were Saudis. About 75% of the OIs had simple fractures and complex fractures were recorded among 10.2% of the cases. About half of the cases (52%) had lower limb fractures and 32% had upper limb fractures.

Conclusions

RTA and the resultant OIs, death, and permanent disabilities cause a tremendous burden on economic resources and should be of concern for local authorities. More attention and regularities should be paid to avoid life-threatening driving behaviors.

•

Road traffic accidents are one of the most common causes of mortality.

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Many factors have a role in the incidence of road traffic accidents.

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It is crucial to understand all aspects and factors and determine the patterns accordingly.

Prevalence of Motorcycle Accidents and Its Associated Factors Among Road Traffic Accident Patients in Hawassa University Comprehensive Specialized Hospital, 2019

Background

Road traffic damages were amongst the central causes of passing away, hospitalization, disability, and low socioeconomic status. About 1.3 million lethal road traffic damages and 20–50 million nonfatal damages happened consequently of road traffic accidents every year globally. Motorcycles are a small subsection of all motor vehicles significantly over-represented in total motor vehicle accidents and lead to a great rate of deaths and disabilities.

Objective

The study aimed to assess the prevalence of motorcycle accident and associated factors among road traffic accident patients in Hawassa University Comprehensive Specialized Hospital, Hawassa city, Ethiopia in 2019.

Methods and Materials

The health institution/hospital-based retrospective cross-sectional study design was applied and a systematic random sampling technique was implemented to select the sample size of 274 patient’s cards from January 2018 to January 2019. The data were entered and analyzed on SPSS 20.

Results

From 274 patients’ medical records reviewed in the study period, 151 (55.1%) injuries were due to motorcycle accident. In a multiple logistic regression analysis, age, sex, high speed, and types of roads showed significant association with motorcycle accidents.

Conclusion

The prevalence of motorcycle accidents was the main cause of injuries among others, which was 55.1%. Motorcycle accidents occurred mainly in males and in people with the age category of 20–29 years. Age, sex, high speed, and type of road were significantly associated with a motorcycle accident.

An investigation of urban pedestrian behaviour in Bangladesh using the Perceptual Cycle Model

In Bangladesh, pedestrians remain the most neglected road user group in terms of research and safety measures, even though they are involved in nearly 50% of all fatal collisions. In the Dhaka metropolitan area, this statistic rises to around 65%. To reduce the recurrence of such collisions, it is necessary to understand the underlying thought processes of pedestrians, and how pedestrians interact with different road users, particularly when crossing the road. This study contributes to knowledge through the analysis of verbal data from 46 pedestrians, framed in terms of the Perceptual Cycle Model, where cognitive processes are described in terms of three categories: schema (mental templates), action (doing things), and world (environmental information). Concurrent verbal reports were provided by participants while they negotiated a busy area of mixed traffic in the centre of Dhaka city. The analysis revealed some of the factors that affected decision-making (for road crossing behaviour) at the different road sections. Many external factors (e.g., street sellers, rubbish blocking the path, lack of shade and poor pavement condition) prevented the pavement from being used and contributed to riskier road crossing behaviour. Some safety implications and related recommendations are presented.

Risky behaviors, psychological failures and kinematics in vehicle-to-powered two-wheeler accidents: Results from in-depth Chinese crash data

As the use of powered two-wheeler (PTW) becomes increasingly prevalent, PTW accidents are emerging as a major threat to the people's life and property in China. Understanding the risky behaviors, psychological failures and kinematics in vehicle-to-PTW accidents is an important first step in addressing this issue. Here 69 vehicle-to-PTW accidents captured on video from the Traffic Accident Investigation and Research in China (TAIRC) database are selected and reconstructed. All accidents are categorized into different crash scenarios using a harmonized method. Accident causations are identified from the perspectives of praxeology and psychology. Kinematics characteristics, such as impact speed and relative position, are also analyzed. The results show the crossing accident bundle is the most frequent followed by rear, oncoming and run-up accident bundles, with proportions of 43.48 %, 27.54 %, 11.59 % and 17.39 % respectively. Accident causations of different crash scenarios have great differences whether in accident responsibilities or in psychological failures. For instance, the PTW riders who violate the traffic regulations need to be mainly responsible for most crossing accidents, whereas most rear accidents are blamed on drivers who fail to properly check their mirrors when they turn, turn around or change lanes. From the perspective of psychology, the perception failures encountered by both drivers and riders are a typical causation in crossing accidents, while it is a contributing factor in rear accidents that a failure of prognosis from the rider combined with a failure of perception from the driver. Visual obstruction exists widely in crossing and oncoming accident bundles. The impact speeds of vehicles and PTWs are often less than 40 km/h in all accident bundles. A wider sensing area (field of view = 90°, view detection range = 35 m) should be achieved to more effectively detect the conflict PTWs. These findings about vehicle-PTW accidents provide a stronger support for the development of prevention countermeasures and advanced driver assistance system.

Effect of wearing a helmet on the occurrence of head injuries in motorcycle riders in Benin: a case-control study

Background

In Benin, motorcycles are the main means of transport for road users and are involved in more than half of crashes. This study aims to determine the effect of wearing a helmet on reducing head injuries in road crashes in Benin.

Methods

This case-control study took place in 2020 and focused on road trauma victims. The sample, consisting of 242 cases (trauma victims with head injuries) for 484 controls (without head injuries), was drawn from a database of traffic crash victims recruited from five hospitals across the country from July 2019 to January 2020. Four groups of independent variables were studied: socio-demographic and economic variables, history, behavioural variables including helmet use and road-related and environmental variables. To assess the shape of the association between the independent variables and the dependent variable, a descending step-by-step binary logistic regression model was performed using an explanatory approach.

Results

Fewer of the subjects with a head injury were wearing a helmet at the time of the crash 69.8% (95% CI = 63.6–75.6) compared to those without a head injury 90.3% (95% CI = 87.3–92.8). Adjusting for the other variables, subjects not wearing helmets were at greater risk of head injuries (OR = 3.8, 95% CI (2.5–5.7)); the head injury rating was 1.9 (95% CI = 1.2–3.3) times higher in subjects who were fatigued during the crash than among those who were not and 2.0 (95% CI = 1.2–3.3) times higher in subjects with no medical history.

Conclusion

Failure to wear a helmet exposes motorcyclists to the risk of head injuries during crashes. It is important to increase awareness and better target such initiatives at the subjects most at risk.

Patterns of injuries and injury severity among hospitalized road traffic injury (RTI) patients in Bangladesh

Background

Road traffic injuries (RTIs) are one of the key public health issues worldwide causing 1.3 million deaths every year. This study aimed to determine the patterns of injuries due to road traffic accidents (RTAs), the severity of injuries, and factors associated with injury severity.

Methodology

A cross-sectional study was conducted among RTA victims, who attended two large tertiary care hospitals located inside the Dhaka metropolitan area, through structured interview between 28 January and 22 March 2020.

Results

Among 375 RTI patients, a total of 1390 injuries were recorded among interviewed patients, yielding a mean of 3.7 injuries per patient. The most frequently injured systems were external (n = 351), lower limb (n = 235), head and neck (n = 151), and face (n = 150). The mean ISS were 20.96 ± 12.027 with a maximum of 65 and a minimum of 4. Among patients, 87 (23.20%) had a severe injury, and 37 (9.87%) patients were critically injured. A statistically significant variation in ISS was observed in ANOVA among various categories of age, education, occupation, and purpose of going outside, vehicle type and fitness, accident type, road type, times required in hospitalization, and death history (p < 0.05).

Conclusions

Our study has revealed several important findings which will help stakeholders and policymakers devise better policies to reduce RTA and RTA related injuries in Bangladesh.

An analysis on the risk of being injured and killed in road travel injuries in Namibia

Road traffic injuries (RTIs) are a major, global problem. Few studies on RTIs have been conducted in Namibia, despite having one of the highest RTI rates globally. We conducted multinomial logistic regression on national Namibian datasets on RTIs 2012-2014. Being a motorcyclist was associated with the greatest risk of being injured (adjusted Relative Risk Ratio (aRRR) 82.1 (95% CI 47.2-142.9)) or killed (aRRR 202.1 (112.7-362.7)). Risks were also elevated for cyclists (57.3 (23.6-139.5)), pedestrians (15.8 (13.2-18.9), passengers (6.1 (5.2-7.2)), relative to drivers. Among those admitted to hospital, the method of transportation to hospital had the largest association with the risk of dying. To our knowledge this study presents new information on vulnerability of different road users, which can be of use to policymakers to develop specific and targeted interventions to protect the most vulnerable road users.

Modeling Road Safety in Car-Dependent Cities: Case of Jeddah City, Saudi Arabia

Investigating the connections between pedestrian crashes and various urban variables is critical to ameliorate the prediction of pedestrian fatalities, formulate advisories for the stakeholders, and provide an evidence base for policy change to mitigate the occurrence and intensity of pedestrian fatalities. In this paper, we aim to explore the geographically varying association between the pedestrian fatalities and other associated factors of an urban environment in Jeddah city, which is a car-dependent city in Saudi Arabia. At first, Global Moran’s I and Local Indicators of Spatial Association (LISA) were applied to visualize the clustering of pedestrian fatalities in the various districts of Jeddah. Subsequently, we developed Poisson regression models based on their geographically weighted indicators. Both the global and geographically weighted regression models attempt to assess the association between the pedestrian fatalities and the geographically relevant land use and transport infrastructure factors. The results indicate that geographically weighted Poisson regression (GWPR) performed better than the global Poisson counterparts. It is also revealed that the existing transportation infrastructure in Jeddah was significantly associated with the higher pedestrian fatalities. The results have shown that the proposed model in this study can inform transport policies in Jeddah in prioritizing more safety measures for the pedestrians, including expanding pedestrians’ infrastructure, and cautious monitoring of pedestrian footpaths. It can facilitate the analysis and improvement of road safety for pedestrians in car-dependent cities.

Implementation of a model of awareness-raising for taxi motorcyclists in Benin in relation to helmet use: protocol for a quasi-experimental study

BACKGROUND

In the large cities of Benin, motorcycle taxi drivers, mainly between the ages of 20 and 40, are particularly exposed to accidents due to their profession. User awareness, along with legislative reforms and enforcement measures, would reduce the incidence of crashes and injuries. This study aims to test the effectiveness of an awareness-raising model regarding helmet use for motorcycle taxi drivers.

METHODS

This is a quasi-experimental study that will take place in the cities of Parakou (intervention group) and Porto Novo (control group). Over a three-month period, a package of awareness-raising activities will be implemented in the intervention area, targeting a group of motorcycle taxi drivers. The messages to be developed for awareness-raising will focus on the most frequently influencing factors, as identified by the baseline collection. These key messages will be disseminated through various tools and communication channels (banners, motorcycle stickers and motorcycle taxi uniforms, interactive sessions). Data will be collected prospectively via a self-reported questionnaire and observation, carried out before the intervention, at the end, and 6 months later. The data will relate to knowledge, attitudes and practices regarding helmet use. The analysis will compare the indicators between the groups, as well as between the pre- and post-intervention phase. The KoboCollect software will be used for data entry and processing, and Stata 15 will be used for data analysis. Chi-square or Fisher, Student's or Kruskal-Wallis tests will be used for the comparisons. The difference-in-difference method will be used to determine the specific effect of the awareness activities.

DISCUSSION

This study will assess the contribution of awareness messages to changing the behaviour of motorcycle taxi drivers by determining the specific effect of the intervention.

A GIS and microsimulation-based MCDA approach for evaluation of pedestrian crossings

Pedestrian crossings are sites in which vehicles and pedestrians can crash into each other, and are very important in terms of urban traffic. Drivers and pedestrians are more likely to violate traffic regulations, and thus adversely affect traffic safety and flow, in streets that have many such crossings. Careful planning of pedestrian crossing locations provides a solution to these problems. In this study, a corridor-based analysis of such sites is performed. Twenty-four criteria that are considered to affect pedestrian crossing locations and traffic flow aredetermined. Based on these criteria, the most suitable pedestrian crossing scenario is identified using Geographical Information Systems (GIS). The Analytic Hierarchy Process (AHP) and VlseKriterijuska Optimizacija I Komoromisno Resenje (VIKOR) from Multi-Criteria Decision Analysis (MCDA) methods are used to evaluate the pedestrian crossing locations, and PTV VISSIM is used to examine the impact of these sites on traffic. The proposed method is then applied to a case study of Erzurum, Turkey that involves determining the best pedestrian crossing scenario. The results show that the most suitable scenario is S.2. In terms of the evaluation criteria, this alternative scenario provides an improvement of up to 50 % over the current situation. Finally, a sensitivity analysis is performed to reveal the effect of changing the criteria weights on the evaluation process.

Vulnerable road-user deaths in Brazil: a Bayesian hierarchical model for spatial-temporal analysis

Reducing the road traffic injuries burden is relevant to many sustainable development goals (SDG), in particular SDG3 - to establish good health and well-being. To describe the spatial-temporal trends and identify hotspot regions for fatal road traffic injuries, a Bayesian hierarchical Poisson model was used to analyze data on vulnerable road users (bicyclist, motorcyclist and pedestrians) in Brazil from 1999 to 2016. During the study period, mortality rates for bicyclists remained almost unchanged (0.6 per 100,000 people) but rose dramatically for motorcyclists (from 1.0 in 1999 to 6.0 per 100,000 people in 2016) and decreased for pedestrians (from 6.3 to 3.0 per 100,000 people). Spatial analyses accounting for socio-economic factors showed that the central and northeastern microregions of Brazil are hotspot areas for fatal injuries among motorcyclists while the southern areas are for pedestrians.

Road traffic accidents in Bangladesh: Why people have poor knowledge and awareness about traffic rules?

Purpose:

The study aimed to identify the characteristics of road traffic accident (RTA) and to determine the role of different socioeconomic and demographic factors on the knowledge and awareness about traffic rules among people in Bangladesh.

Study Design:

This was a cross-sectional study.

Methods:

To conduct this study, 700 primary data were collected from respondents who were involved in RTA by interviewing in medical college hospitals and several private clinics of Dhaka, Rajshahi, and Khulna division in Bangladesh. For the achievement of the objective, the Chi-square test, Cramer's V correlation, and the logistic regression model have been applied in this study.

Results:

Traffic rules violation was identified as the second-most important reason behind RTA. Respondent's age, gender, residence, education, occupation, awareness about RTA, etc., were significantly associated with having knowledge and awareness about traffic rules. The result of multivariate analysis showed that respondent's age (<30: odds ratio [OR] = 2.019, confidence interval [CI]: 1.377–2.960); residence (rural: OR = 0.288, CI: 0.193–0.431); education (literate: OR = 5.064, CI: 3.332–7.698); and categories of victims (driver: OR = 2.731, CI: 1.676–4.450 and passenger: 1.869, CI: 1.198–2.916) were the vital predictors of having knowledge and awareness about traffic rules.

Conclusions:

By imposing strict traffic act, increasing public awareness through various types of education and awareness/outreach about traffic rules-related program, especially in rural areas, by strictly prohibiting the license giving to unskilled drivers or unfit vehicles, RTA can be minimized.

Complex relationship between household wealth, location of residence, road crash injury incidence and injury severity in Uganda

BACKGROUND

Limited evidence exists about associations between road crash injury and economic status in sub-Saharan Africa from large, population-based data sets. Existing studies generally do not incorporate fatal crashes. This study aims to understand the relationship between relative wealth and road crash injury and severity using population-representative cross-sectional data from Uganda's 2016 Demographic and Health Survey .

METHODS

One-year road crash risk was flexibly modelled as a function of wealth using fractional polynomial models, stratified by sex and rural/urban residence. Wealth was operationalised as 1/20th quantiles of the first principal component from a polychoric principal component analysis. Injury severity was coded as a three-level ordinal variable; associations with wealth were modelled with ordinal logistic regression on quintiles of relative wealth, stratified by residence.

RESULTS

Overall, injury risk peaked in the upper middle of the wealth distribution. Rural resident injury risk increased monotonically with wealth. Urban resident risk had an upside-down U shape. Risk peaked in the distribution's middle at about double the lowest levels. Only urban men had higher risk among the least wealthy than most wealthy (3.2% vs 1.7%; difference=1.5 percentage points, 95% CI 0.2 to 2.7). Among those with road crash injuries, greater relative wealth was associated with decreased likelihood of more severe injury (33.2 percentage points lower in the highest category than lowest, 95% CI 18.4 to 48.1) or death (5.9 percentage points, 95% CI -0.1 to 11.8) for urban residents but not rural residents.

CONCLUSION

Relationships between relative wealth and injury risk and severity are complex and different for urban and rural Ugandans.

Reduction of pedestrian death rates: a missed global target

Background

The UN Decade of Action for Road Safety aimed to reduce road traffic deaths by half by year 2020. We aimed to study risk factors affecting global pedestrian death rates overtime, and whether the defined target of its reduction by WHO has been achieved.

Methods

The studied variables were retrieved from the WHO Global Status Reports on Road Safety published over 2010–2018. These covered years 2007–2016 and included the estimated road traffic death rates per 100,000 population, policies to promote walking and cycling, enforcement levels of national speed limits, the gross national income per capita and the vehicle/person ratio in each country. A mixed linear model was performed to define the factors affecting the change of pedestrian death rates overtime.

Results

Global pedestrian mortality decreased by 28% over 10 years. This was significant between years 2007 and 2010 (p = 0.034), between years 2013 and 2016 (p = 0.002) but not between 2010 and 2013 (p = 0.06). Factors that reduced pedestrian death rates included time (p < 0.0001), GNI (p < 0.0001), and vehicle/person ratio (p < 0.0001). There was a significant drop overtime in both the middle-income, and high-income countries (p < 0.0001, Friedman test), but not in the low-income countries (p = 0.35, Friedman test).

Conclusions

Global pedestrian mortality has dropped by 28% over a recent decade, which is less than the 50% targeted reduction. This was mainly driven by improved GNI and using more vehicles. The economical gap between poor and rich countries has a major impact on pedestrian death rates.

What is global health? Key concepts and clarification of misperceptions: Report of the 2019 GHRP editorial meeting

The call for "Working Together to Build a Community of Shared Future for Mankind" requires us to improve people's health across the globe, while global health development entails a satisfactory answer to a fundamental question: "What is global health?" To promote research, teaching, policymaking, and practice in global health, we summarize the main points on the definition of global health from the Editorial Board Meeting of Global Health Research and Policy, convened in July 2019 in Wuhan, China. The meeting functioned as a platform for free brainstorming, in-depth discussion, and post-meeting synthesizing. Through the meeting, we have reached a consensus that global health can be considered as a general guiding principle, an organizing framework for thinking and action, a new branch of sciences and specialized discipline in the large family of public health and medicine. The word "global" in global health can be subjective or objective, depending on the context and setting. In addition to dual-, multi-country and global, a project or a study conducted at a local area can be global if it (1) is framed with a global perspective, (2) intends to address an issue with global impact, and/or (3) seeks global solutions to an issue, such as frameworks, strategies, policies, laws, and regulations. In this regard, global health is eventually an extension of "international health" by borrowing related knowledge, theories, technologies and methodologies from public health and medicine. Although global health is a concept that will continue to evolve, our conceptualization through group effort provides, to date, a comprehensive understanding. This report helps to inform individuals in the global health community to advance global health science and practice, and recommend to take advantage of the Belt and Road Initiative proposed by China.

Modeling the Complexity of Road Accidents Prevention

Simplistic representations of traffic safety disregard the dynamic interactions between the components of the road transport system (RTS). The resultant road accident (RA) preventive measures are consequently focused almost solely on individual/team failures at the sharp end of the RTS (mainly the road users). The RTS is complex and therefore cannot be easily understood by studying the system parts in isolation. The study modeled the occurrence of road accidents in Uganda using the dynamic synthesis methodology (DSM). This article presents the work done in the first three stages of the DSM. Data was collected from various stakeholders including road users, traffic police officers, road users, and road constructors. The study focused on RA prevention by considering the linear and non-linear interactions of the variables during the pre-crash phase. Qualitative models were developed and from these, key leverage points that could possibly lower the road accident incidences demonstrating the need for a shared system wide responsibility for road safety at all levels are suggested.

Estimating the burden of road traffic crashes in Uganda using police and health sector data sources

BACKGROUND

In many low-income countries, estimates of road injury burden are derived from police reports, and may not represent the complete picture of the burden in these countries. As a result, WHO and the Global Burden of Diseases, Injuries and Risk Factors Project often use complex models to generate country-specific estimates. Although such estimates inform prevention targets, they may be limited by the incompleteness of the data and the assumptions used in the models. In this cross-sectional study, we provide an alternative approach to estimating road traffic injury burden for Uganda for the year 2016 using data from multiple data sources (the police, health facilities and mortuaries).

METHODS

A digitised data collection tool was used to extract crash and injury information from files in 32 police stations, 31 health facilities and 4 mortuaries in Uganda. We estimated crash and injury burden using weights generated as inverse of the product of the probabilities of selection of police regions and stations.

RESULTS

We estimated that 25 729 crashes occurred on Ugandan roads in 2016, involving 59 077 individuals with 7558 fatalities. This is more than twice the number of fatalities reported by the police for 2016 (3502) but lower than the estimate from the 2018 Global Status Report (12 036). Pedestrians accounted for the greatest proportion of the fatalities 2455 (32.5%), followed by motorcyclists 1357 (18%).

CONCLUSIONS

Using both police and health sector data gives more robust estimates for the road traffic burden in Uganda than using either source alone.

Health Care and Productivity Costs of Non-Fatal Traffic Injuries: A Comparison of Road User Types

This study aimed to provide a detailed overview of the health care and productivity costs of non-fatal road traffic injuries by road user type. In a cohort study in the Netherlands, adult injury patients admitted to a hospital as a result of a traffic accident completed questionnaires 1 week and 1, 3, 6, 12 and 24 months after injury, including the iMTA Medical Consumption and Productivity Cost Questionnaire. In-hospital, post-hospital medical costs and productivity costs were calculated up to two years after traffic injury. In total, 1024 patients were included in this study. The mean health care costs per patient were € 8200. The mean productivity costs were € 5900. Being female, older age, with higher injury severity and having multiple comorbidities were associated with higher health care costs. Higher injury severity and being male were associated with higher productivity costs. Pedestrians aged ≥ 65 years had the highest mean health care costs (€ 18,800) and motorcyclists the highest mean productivity costs (€ 9000). Bicycle injuries occurred most often in our sample (n = 554, 54.1%) and accounted for the highest total health care and productivity costs. Considering the high proportion of total costs incurred by bicycle injuries, this is an important area for the prevention of traffic injuries.

Patient and injury characteristics associated with road traffic mortality in general hospitals in southern Thailand

Background

Road traffic injuries are a major public health burden in developing countries. Thailand has the highest fatality rate from road traffic injuries in southeast Asia so that prevention of unintentional injuries is important.

Objective

To identify patient and injury characteristics associated with road traffic mortality in the southern provinces of Thailand.

Methods

Data on a total of 78,862 road traffic injuries recorded by the general hospitals in 5 southern provinces of Thailand, during 2008–2013, were obtained from the Office of Disease Prevention and Control. Chi-squared test was used to determine the association between patient/injury characteristics and road traffic mortality, and logistic regression was used to identify the strength of associations.

Results

In this study, road traffic mortality was found to be 1.8% of all injuries. Most of the deaths occurred in males (61.7%), who were aged 25–44 years (35.8%), being drivers (68.6%), using motorcycle (78.4%), and not wearing a helmet (61.0%). Road traffic mortality was higher among males, older age people, those who were not wearing a helmet or not fastening a seat belt, pedestrians and when people crashed with or by motor car, with wound being penetrating or blunt with penetrating, and when they were having head or neck, chest, or abdominal or pelvic cavity injuries.

Conclusion

Policies and measures for reducing road traffic mortality should focus on males and older aged persons, use of safety devices, and occurrence of multiple injuries.

Predictors of fatal outcomes in pedestrian accidents in Tabriz Metropolis of Iran: Application of PLS-DA method

Objectives: Road traffic deaths in walking pedestrians are a global public health problem. Considering that in Iran pedestrians have a high proportion of deaths caused by traffic accidents, the objective of the present study was to investigate mortality rate and related factors of fatal injury in pedestrian crashes in Tabriz Metropolis of Iran as the largest and most populous city of the northwest of Iran.Methods: The design of this study is case-control based on police and Forensic Medicine Organization data. All registered fatal pedestrian crashes in Tabriz Metropolis from 2014 to 2015 (146 cases) were included in the study as the case group. Also, 292 pedestrians (the ratio of cases to controls was 1:2) with non-fatal crashes were considered as the control group. Due to high dimensional data and multicollinearity issue, Partial least squares discriminant analysis (PLS-DA) was used for data analysis. Importance of the variables was determined by the VIP (Variable Importance in the Projection) index. Performance of the model was assessed by using training and test set validation method. The area under the ROC curve (AUC) and classification error rates were calculated for the test set. R software version 3.5.1 (mixOmcs packages) was used for data analysis.Results: According to the results of PLS-DA, the most important variables related to fatal outcome in pedestrian crashes with VIP > 1 were: pedestrian age (positive effect), type of vehicle (light machinery with a negative effect), kind of vehicle plate (private plate with a negative effect), season of accident occurrence (winter season with a positive effect), type of driver's licenses (Class A with a positive effect), pedestrian gender (male with a positive effect) and Fault of Pedestrian (At-fault with a positive effect). The overall accuracy for the fitted model and AUC were 0.77 and 0.79, respectively.Conclusions: The results show that predictors of a fatal outcome in pedestrian accidents in Tabriz can be attributed to the pedestrian characteristics (which notably account for differences in vulnerability in case of an accident), the car and driver features, and weather (which may all notably influence the amount of energy involved in the collision, through the car mass, speed, and conditions delaying the braking response or reducing the braking effectiveness). Regarding the statistical method, the PLS-DA is a powerful method which can be used to analyze high dimension data with multicollinearity issue.

Investigation of pedestrian crashes using multiple correspondence analysis in India

Pedestrian safety is of growing concern with an increasing number of traffic accidents, especially in developing economies like India. In 2017, there were 20,457 pedestrian fatalities in India. Pedestrian crashes have also become a key concern in the state of Tamilnadu, India, due to the high percentage of deaths. If the available datasets are large and complex, identifying key factors is a challenging task. In this study, Multiple Correspondence Analysis (MCA), an exploratory data analysis technique was used to explore the roadway, traffic, crash, and pedestrian-related variables influencing pedestrian crashes. This study used the data from Government of Tamilnadu Road Accident Traffic Management System (RADMS) database, to analyse accident data of nine years (2009-2017) related to pedestrian crashes. The results of the study show that crashes occurring on the express highways on a multilane road are often associated with hit-and-run behaviour among drivers. Factors such as lighting conditions, location, pedestrian behaviour, crossings, and physical separation are also significantly contributing to pedestrian crashes. The key advantage of MCA is that it identifies a possible association between various contributing factors. The findings from this study will be useful for state transport authorities to improve countermeasures for mitigating pedestrian crashes and fatalities.

Educational inequalities in traffic deaths during fluctuations of the economy in four Argentinian provinces, 1999-2013

OBJECTIVES

The objective of this study is to analyse how educational differentials in traffic mortality changed during economic fluctuations in four Argentinian provinces.

STUDY DESIGN

Retrospective quantitative analysis of secondary data.

METHODS

Data on fatalities due to traffic injuries (all traffic injuries, pedestrians/cyclists, motorcyclists, car users and unspecified road users) in four Argentinian provinces between 1999 and 2013 were linked to population data and information on the educational level of the deceased to compute mortality rates by educational level. Negative binomial models were estimated using age, sex, year, province of residence, year of economic expansion or recession and educational level as explanatory variables.

RESULTS

Annual traffic mortality differentials by educational level were lower during the period of economic crisis. An absolute increase in traffic mortality was observed in individuals of low educational level during economic expansions, but here, there were no traffic mortality differences for individuals of medium to high educational level. The educational gap in motorcyclist mortality widened during the period of quick economic expansion between 2005 and 2013.

CONCLUSIONS

We found less educational inequality in traffic mortality during an economic crisis in a developing country. However, the educational inequalities for different subtypes of traffic mortality show different patterns of evolution during the cycle of economic expansion and recession. Considering deaths due to traffic injuries, economic growth seems to be riskier for individuals of lower educational level compared with those of medium-high educational level.

The relationship between impact speed and the probability of pedestrian fatality during a vehicle-pedestrian crash: A systematic review and meta-analysis

BACKGROUND

Pedestrians struck in motorised vehicle crashes constitute the largest group of traffic fatalities worldwide. Excessive speed is the primary contributory factor in such crashes. The relationship between estimated impact speed and the risk of a pedestrian fatality has generated much debate concerning what should be a safe maximum speed limit for vehicles in high pedestrian active areas.

METHODS

Four electronic databases (MEDLINE, EMBASE, COMPENDEX, and SCOPUS) were searched to identify relevant studies. Records were assessed, and data retrieved independently by two authors in adherence with the PRISMA statement. The included studies reported data on pedestrian fatalities from motorised vehicle crashes with known estimated impact speed. Summary odds ratios (OR) were obtained using meta-regression models. Time trends and publication bias were assessed.

RESULTS

Fifty-five studies were identified for a full-text assessment, 27 met inclusion criteria, and 20 were included in a meta-analysis. The analyses found that when the estimated impact speed increases by 1 km/h, the odds of a pedestrian fatality increases on average by 11% (OR = 1.11, 95% CI: 1.10-1.12). The risk of a fatality reaches 5% at an estimated impact speed of 30 km/h, 10% at 37 km/h, 50% at 59 km/h, 75% at 69 km/h and 90% at 80 km/h. Evidence of publication bias and time trend bias among included studies were found.

CONCLUSIONS

The results of the meta-analysis support setting speed limits of 30-40 km/h for high pedestrian active areas. These speed limits are commonly used by best practice countries that have the lowest road fatality rates and that practice a Safe System Approach to road safety.

Social Differences in the Prevalence of Road Traffic Injuries among Pedestrians, and Vehicle and Motorcycle Users in Iran: Results of a National Multiple Indicator Demographic and Health Survey (IrMIDHS, 2010)

Background

Traffic injuries are considered as the most important health issues for different countries in the world, especially developing countries that are experiencing rapid social changes. The purpose of this study was to investigate the prevalence of road traffic injuries (RTIs) and its socioeconomic differences among road users in Iran as it is one of the countries with high rates of accidents in the world. The study population included all people in Iran. The target sample was 3,096 clusters consisting of 2,187 urban and 909 rural households.

Methods

Source of the raw data was the Iran's Multiple Indicator Demographic and Health Survey (IrMIDHS) 2010, which is a multi-stage stratified cluster-random cross-sectional study. The logistic regression has been performed for investigating the socioeconomic determinants which influence the RTIs among pedestrian, vehicle, and motorcycle users.

Results

The prevalence of RTIs is 13.8 (95% CI: 13.1, 14.5) per 1,000 people in the year leading up to the study. The injured groups included pedestrians (14.37%), vehicles (38.36%), motorcyclists (43.37%), and 3.9% of users injured with other vehicles. A total of 78.3% of the injured people underwent outpatient treatment or were hospitalized. The mean age in these three groups was significantly increased (27.9, 32.5, 33.4, respectively), and the proportion of men decreased (89.2, 75.2, and 60.6).

Conclusions

RTIs in Iran are higher than previous estimates due to consideration of non-hospitalized cases. Considering the high contribution of human factors in developing countries, these measures should prioritize vulnerable groups.

Comparison of epidemiology and injury profile between vulnerable road users and motor vehicle occupants in road traffic fatalities

Objective: Road traffic injuries (RTIs) are a major global health issue causing a global burden of mortality and morbidity. Half of all fatalities on the world's roads are vulnerable road users (VRUs). The targeted intervention strategies based on fatality analysis focusing on VRUs can effectively contribute to reducing RTIs. This study aimed to compare VRUs and motor vehicle occupants (MVOs) in terms of epidemiology and injury profile. Methods: We utilized a nationwide, prospective database of RTI-related mortality cases for patients who visited 23 emergency departments between January 2011 and December 2015. All fatalities due to RTIs in the prehospital phase or in-hospital were eligible, excluding patients with unknown mode of transport and those admitted to general wards. The primary and secondary outcomes were fracture injuries and visceral injuries diagnosed using the International Classification of Diseases, Tenth Revision (ICD-10). We compared fracture injuries between VRUs and MVOs using Abbreviated Injury Scale (AIS) 2- and 2+ classification. Results: Among a total 3,694 road traffic fatalities (RTFs), 43.3% were pedestrians, followed by MVOs (27.0%), motorcyclists (18.9), bicyclists (6.6%), and agricultural vehicle users (4.2%). The elderly (>60 years old) accounted for 54.9% of VRU fatalities. RTFs occurred most frequently in the autumn and the VRU group and the MVO group showed significant differences in weekly and diurnal variation in RTFs. The injury severities (AIS 2+) of the head, neck, and thorax were significantly different between the 2 groups (P < 0.05). Head (32.1%) and intracranial (58.6%) injuries were the most common fracture and visceral injury sites for RTFs, followed by the thorax and intrathoracic organs (25.3 and 28.8%, respectively). Conclusions: Elderly pedestrians should be targeted for decreases in RTFs, and road traffic safety interventions for VRUs should be made based on the analysis of temporal epidemiology and injury profiles of RTFs.

Development of pedestrian crash prediction model for a developing country using artificial neural network

Urban intersections in India constitute a significant share of pedestrian fatalities. However, model-based prediction of pedestrian fatalities is still in a nascent stage in India. This study proposes an artificial neural network (ANN) technique to develop a pedestrian fatal crash frequency model at the intersection level. In this study, three activation functions are used along with four different learning algorithms to build different combinations of ANN models. In each of these combinations, the number of neurons in the hidden layer is varied by trial and error method, and the best results are considered. In this way, 12 sets of pedestrian fatal crash predictive models are developed. Out of these, Bayesian Regularization Neural Network consisting of 13 neurons in the hidden layer with 'hyperbolic tangent-sigmoid' activation function is found to be the best-fit model. Finally, based on sensitivity analysis, it is found that the 'approaching speed' of the motorized vehicle has the most significant influence on the fatal pedestrian crashes. 'Logarithm of average daily traffic' (ADT) volume is found to be the second most sensitive variable. Pedestrian-vehicular interaction concerning 'pedestrian-vehicular volume ratio' and lack of 'accessibility of pedestrian cross-walk' are found to be approximately as sensible as 'logarithm of ADT'.

Injuries following motorcycle crashes at a level-1 trauma center in Riyadh

BACKGROUND

Motor vehicle crashes are the third leading cause of death in Saudi Arabia. Motorcycle riders, in particular, are considered more vulnerable than occupants, yet there are no previous studies that have examined the epidemiology of their injuries and outcomes in the country. Better understanding is needed to inform policymakers and guide future prevention programs.

OBJECTIVE

Describe patterns of injury among conscious and unconscious patients injured in motorcycle crashes.

DESIGN

Retrospective chart review.

SETTINGS

Level 1 trauma center in Riyadh.

PATIENTS AND METHODS

This retrospective study included all patients involved in motorcycle crashes who were admitted between 2001 and 2017. Medical records were reviewed, and data about injury characteristics, outcomes and healthcare utilization were ascertained.

MAIN OUTCOME MEASURES

Injury site and mortality rate.

SAMPLE SIZE AND CHARACTERISTICS

572 patients included 488 males (85.3%) and 232 <18 years of age (40.5%), mean (SD) age 21.1 (11.6) years.

RESULTS

About 3% of patients died either before or after admission. Extremity injuries (356, 62.2%) were most common followed by head injuries (229, 40%). Fifty-six (9%) suffered amputation, mostly to a lower limb.

CONCLUSION

This study underscores the significant burden of motorcycle-related injuries on population health of Saudi Arabia. The number of amputations due to motorcycle injuries is striking. Therefore, we need to increase enforcement of safety measures during recreational use of motorcycles and to raise awareness about the dangers of motorcycle crashes to improve traffic safety and ultimately population health.

LIMITATIONS

The study was conducted at a single hospital which may affect the generalizability of the data to the Saudi population.

CONFLICT OF INTEREST

None.

Trauma demography and clinical epidemiology of motorcycle crash-related head injury in a neurosurgery practice in an African developing country

OBJECTIVE

Though motor vehicle crashes (MVCs) were the main cause of head trauma from road traffic injuries (RTIs), motorcycle crashes (MCCs) are now a major cause of RTI-related head injury (HI) in many developing countries.

METHODS

Using a prospective database of HIs from a neurosurgical practice in a sub-Saharan African developing country, a cross-sectional survey was conducted for the trauma demography and clinical epidemiology of this MCC-related HI.

RESULTS

Motorcycle crashes accounted for 57% (473/833) of all RTI-related HIs in this registry. The victims, with a mean age of 33.1 years (SD = 18.3), consisted mainly of males (83.1%), those of low socioeconomic status (>90%), and those aged between 20 and 40 years old (56%). MCCs involved only riders in 114 cases (114/473, 32.1%), of which 69% were motorcycle-motorcycle crashes. The HI was moderate-severe in 50.8%; clinical symptomatology of significant HI included loss of consciousness (92%), anisocoria (35%), Abbreviated Injury Scale head (AIS-head) score > 3 (28%), and CT-Rotterdam score > 3 (30%). Extracranial systemic injury involved the limbs most frequently, with an Injury Severity Score (ISS) >25 in 49%. The fatality rate was 24%. MCC-related HI among pedestrian victims involved more vulnerable age groups (the young and elderly) but have lower mean ISS compared to motorcycle passengers (mean ISS = 23.5 [11.6] vs. 27.4 [13.0]; 95% confidence interval [CI], 1.27-6.49; P = .004). In addition, compared to a contemporary cohort of MVC-related HIs in our registry, MCC victims were older (mean age 34.8 years [18.0] vs. 30.8 [18.4]; P = .002); had higher proportions of certain extracranial trauma like long bone fractures (71 vs. 29%; P = .02); and suffered fewer surgical brain lesions (25.5 vs. 17.2%; P = .004).

CONCLUSIONS

Motorcycle crashes are now a significant threat to the heads, limbs, and lives of vulnerable road users in developing countries.