Underreporting of traffic injuries involving children in Japan

Reduced road injuries while commuting due to heavy snowfall and ensuing modal shifts among junior high school students in Japan

Background

Modal shifts in transport may reduce overall road injuries. Cyclist junior high school students are at a high risk of road injuries while commuting in Japan, and injuries among junior high school students could be reduced if the cyclists switch to other transport modes.

Methods

We estimated the change in the incidence of road deaths and serious injuries while commuting in months with heavy snowfall, when cyclists are likely to switch to other transport modes. Using police data on the monthly number of road injuries while commuting among junior high school students in Japan between 2004 and 2013 and corresponding population statistics and snowfall data, we calculated the monthly injury rate (number of deaths and serious injuries divided by population) at the prefecture level. We conducted Poisson regression analysis to estimate the change in the rate in months with a snowfall of ≥100 cm, compared to months without snowfall.

Results

A total of 3,164 deaths and serious injuries occurred during 2004 to 2013. The injury rate among cyclists was almost zero in months with a snowfall of ≥100 cm. That among cyclists and pedestrians in these months was reduced by 68% (95% confidence interval, 43–82%).

Conclusion

In months with heavy snowfall, road injuries while commuting were reduced due to the near-elimination of cycling injuries among junior high school students in Japan. Switching from cycling to other transport modes would reduce overall road injuries among this population, and inducing modal shifts can be an important tool for road safety.

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

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

Determinants of Timing of Presentation of Neurotrauma Patients to a Neurosurgical Center in a Developing Country

Background:

A major goal in neurotrauma management is the prevention of secondary neuronal injuries. This goal is time bound as neurological deficits once established are usually irreversible. Late presentation is the norm in most neurotrauma patients in developing countries.

Aims:

The aim of the study was to review the timing of presentation of neurotrauma patients and the possible causes of their late presentation for neurosurgical care in our practice.

Methods:

A cross-sectional study of a 4-month prospective database of neurotrauma patients presenting to the University College Hospital, Ibadan, was done. The participants’ biodata, injury characteristics, initial-care details before referral, and information on timing and causes of delay were analyzed.

Results:

The study subjects included 111 patients, 80.2% (89/111) were males, and 52.8% aged 21–40 years. Head injury (HI), spinal cord injury (SCI), and combined HI and SCI occurred, respectively, in 80.2%, 14.4%, and 5.4%. Road accidents followed by falls were seen in 73.9% and 14.4% (16), respectively. Just 46.8% (52/111) cases presented within 12 h of injury and only 37 (33.3%) within 4 h. Majority, 83.8% (93/111) were referrals from primary care. These referrals were delayed in 81.7% (76/93) of these. The referring health facilities were located intracity with our center in 54%. Other causes of delayed presentation of these study participants included long-distance travel to our center, lack of funds, or a combination of the above factors. Eighty-nine patients (80.2%) were brought in by family members and the remaining minority by passers-by and road safety personnel.

Conclusions:

Delayed referral from primary care features prominently in timing of presentation of neurotrauma patients in Nigeria. There is a need for collaboration as well as continuing medical education between the neurotrauma specialists and primary care physicians.

Errors in accident data, its types, causes and methods of rectification-analysis of the literature

Most of the decisions taken to improve road safety are based on accident data, which makes it the back bone of any country's road safety system. Errors in this data will lead to misidentification of black spots and hazardous road segments, projection of false estimates pertinent to accidents and fatality rates, and detection of wrong parameters responsible for accident occurrence, thereby making the entire road safety exercise ineffective. Its extent varies from country to country depending upon various factors. Knowing the type of error in the accident data and the factors causing it enables the application of the correct method for its rectification. Therefore there is a need for a systematic literature review that addresses the topic at a global level. This paper fulfils the above research gap by providing a synthesis of literature for the different types of errors found in the accident data of 46 countries across the six regions of the world. The errors are classified and discussed with respect to each type and analysed with respect to income level; assessment with regard to the magnitude for each type is provided; followed by the different causes that result in their occurrence, and the various methods used to address each type of error. Among high-income countries the extent of error in reporting slight, severe, non-fatal and fatal injury accidents varied between 39-82%, 16-52%, 12-84%, and 0-31% respectively. For middle-income countries the error for the same categories varied between 93-98%, 32.5-96%, 34-99% and 0.5-89.5% respectively. The only four studies available for low-income countries showed that the error in reporting non-fatal and fatal accidents varied between 69-80% and 0-61% respectively. The logistic relation of error in accident data reporting, dichotomised at 50%, indicated that as the income level of a country increases the probability of having less error in accident data also increases. Average error in recording information related to the variables in the categories of location, victim's information, vehicle's information, and environment was 27%, 37%, 16% and 19% respectively. Among the causes identified for errors in accident data reporting, Policing System was found to be the most important. Overall 26 causes of errors in accident data were discussed out of which 12 were related to reporting and 14 were related to recording. "Capture-Recapture" was the most widely used method among the 11 different methods: that can be used for the rectification of under-reporting. There were 12 studies pertinent to the rectification of accident location and almost all of them utilised a Geographical Information System (GIS) platform coupled with a matching algorithm to estimate the correct location. It is recommended that the policing system should be reformed and public awareness should be created to help reduce errors in accident data.

Regional disparities in road traffic injury rates involving elementary and junior high school children while commuting among Japan's 47 prefectures between 2004 and 2013

OBJECTIVES

To investigate the extent and patterns of regional disparities of road traffic injury rates involving elementary and junior high school children while commuting among Japan's 47 prefectures.

METHODS

We conducted a cross-sectional ecological study using the national police data for 2004-2013 on the number of children who were killed or seriously injured (KSI) in traffic collisions stratified by prefecture, grade, mode of transport, and purpose of trip (commuting or non-commuting). We calculated stratified KSI rates by dividing the number of KSI cases by the corresponding number of children and presented these rates for the 47 prefectures. Also, for pedestrian elementary school children and cyclist junior high school children, we regressed the KSI rates while commuting by prefecture on the non-commuting KSI rates and the proportion of people who live in the urban, densely inhabited districts.

RESULTS

There were 6463 KSI cases while commuting. The ratios of the highest KSI rate to the lowest KSI rate among prefectures were 12, 30, and 58 for pedestrian elementary school children and pedestrian and cyclist junior high school children, respectively. The non-commuting KSI rates and the proportion of those living in densely inhabited districts were positively and inversely associated with the commuting KSI rates, respectively. The analysis of the residuals of the regression models did not identify prefectures with significantly higher or lower KSI rates while commuting than others.

CONCLUSIONS

There were large inter-prefecture disparities in the KSI rates while commuting, and the disparity was especially large among cyclist junior high school children.

National 10-year trend in road injuries involving school children on the way to and from school in Japan, 2003-2012

OBJECTIVES

To quantitatively describe the recent longitudinal trend in road injuries involving school children while commuting to and from school in Japan and to identify groups or situations with particularly large or small decreasing trends.

METHODS

Data on the number of children aged 6-15 years who sustained road injuries while commuting were obtained, stratified by year, demographic characteristics, mode of transport and other variables. The rates of killed or seriously injured (KSI) children were calculated from the number of KSI cases (the numerator) and the product of population and the proportion of each mode of transport estimated using the Person Trip Survey data (the denominator). We conducted descriptive analyses of the longitudinal trend in KSI rates stratified by the variables, and Poisson regression analyses were employed to quantify the annualised changes in the rates.

RESULTS

During the study period, 166 children were killed and 8484 children were seriously injured; the KSI rate decreased approximately 30%. The KSI rate was almost 10 times higher among cyclists than pedestrians. In cyclists, the decrease in the KSI rate among children aged 12-15 years was smaller in boys than in girls (estimated change -14% vs -30%). The KSI rate of male pedestrians aged 6-7 years was larger than female and older pedestrians, with a large decrease of 48%.

CONCLUSIONS

Although the overall rate of road injuries among children while commuting was decreasing, cyclists were at a much greater risk than pedestrians, and the improvements for cyclists occurred at a slower pace.

Time trend analyses of child pedestrian morbidity in Japan

OBJECTIVES

Road traffic injuries, particularly pedestrian injuries, are a major health issue among children worldwide. The present study quantitatively analyzed the time trends of child pedestrian injuries in Japan from 1975 to 2013 by age.

STUDY DESIGN

Time trend analysis of nationally aggregated data.

METHODS

We analyzed police data on pedestrian injuries requiring medical treatment among children aged 0-15 years occurring between 1975 and 2013. To quantify the time trends of pedestrian injury morbidity rates and to identify change-points in the trends, joinpoint regression analysis was applied by age group. Children were categorized into the age groups of 0-3, 4-6, 7-9, 10-12, and 13-15 years old.

RESULTS

Preschool children aged 0-6 years old showed continuous declining trends throughout the study period; these declining trends accelerated in the 2000s. School-age children aged 7-15 years old showed minimal changes from the early 1970s to the 1990s; of this age group, children aged 7-12 years old showed slight but significant declining trends in the first half and increasing trends in the latter half of this period. Children aged 7-15 years old showed declining trends in the 2000s. Despite the consistent declining trends among all age groups in the 2000s, the younger age groups showed steeper declines during this period.

CONCLUSIONS

The declining trends in all age groups in the 2000s may reflect the improved traffic environments in Japan although the environmental approaches are not yet sufficiently adopted yielding modest effects. The continuing contrast between preschool and school-age children may reflect different behaviour changes by age such as more restricted outdoor activities among young children.

Impact of mandating a driving lesson for older drivers at license renewal in Japan

In Japan, a driving lesson consisting of a lecture, a driver aptitude test, on-road driving assessment and a discussion session was added to the driving license renewal procedure for drivers aged 75 years or older in 1998 and for drivers aged 70 years or older in 2002. We investigated whether these additions contributed to a reduction in at-fault motor vehicle collisions (MVCs) by examining the trend of the at-fault MVC rates per licensed driver and the rate ratios of the older drivers relative to those aged 65-69 years for the years 1986-2011. All data were derived from nationwide traffic statistics. If the introduction of the lesson was effective in reducing at-fault MVCs of older drivers, the rate ratio should have declined, given that the lesson targeted only the older drivers. We found this was not the case, i.e., there was no declining trend in the at-fault MVC rate ratios of both drivers aged 75 years or older and drivers aged 70 years or older, relative to drivers aged 65-69 years, after the driving lesson at license renewal became mandatory for these older drivers. Therefore, the mandatory lesson for the older drivers at license renewal needs to be reconsidered.

Differential patterns, trends and hotspots of road traffic injuries on different road networks in Vellore district, southern India

OBJECTIVE

To describe spatial and temporal profiles of Road Traffic Injuries (RTIs) on different road networks in Vellore district of southern India.

METHODS

Using the information in the police maintained First Information Reports (FIRs), daily time series of RTI counts were created and temporal characteristics were analysed with respect to the vehicle, road types and time of the day for the period January 2005 to May 2007. Daily incidence and trend of RTIs were estimated using a Poisson regression analysis.

RESULTS

Of the reported 3262 RTIs, 52% had occurred on the National Highway (NH). The overall RTI rate on the NH was 8.8/100 000 vehicles per day with significantly higher pedestrian involvement. The mean numbers of RTIs were significantly higher on weekends. Thirteen percentage of all RTIs were associated with fatalities. Hotspots are major town junctions, and RTI rates differ over different stretches of the NH.

CONCLUSION

In India, FIRs form a valuable source of RTI information. Information on different vehicle profile, RTI patterns, and their spatial and temporal trends can be used by administrators to devise effective strategies for RTI prevention by concentrating on the high-risk areas, thereby optimising the use of available personnel and resources.

Effects of increasing child restraint use in reducing occupant injuries among children aged 0-5 years in Japan

OBJECTIVES

In Japan, child restraint use among preschool children started to increase before compulsory child restraint use for children aged 0-5 years was introduced by legislation in April 2000. This study determined the effects of increased child restraint use in reducing motor vehicle occupant injuries among children aged 0-5 years.

METHODS

We obtained monthly police data of child vehicle occupant injuries from 1990 to 2009. We calculated monthly ratios of morbidity rates per population of children aged 0-5 years to those of children aged 6-9 years. Time trends of the morbidity rate ratios were analyzed using a joinpoint regression model to determine whether there were trend changes in child occupant injuries and when they occurred if there were trend changes.

RESULTS

The morbidity rate ratios showed a slightly increasing trend of 0.03% per month (95% confidence interval [CI], -0.02% to 0.09%) until the change-point in December 1997 (95% CI, July 1996 to January 1999), which then changed to a decreasing trend of -0.14% per month (95% CI, -0.16 to -0.11), with an overall trend change of -0.17% (95% CI, -0.23 to -0.11). No change-point was identified in or around April 2000 when compulsory restraint use was introduced.

CONCLUSIONS

The present study used comparative indicators relative to age groups that were not covered by the legislation and showed that a decreasing trend of occupant morbidity among children aged 0-5 years started before the introduction of compulsory restraint use. This change probably reflects the prelegislative voluntary increase in child restraint use.

Basic characteristics of road traffic deaths in china

BACKGROUND

This study is to report characteristics of people killed in road traffic crashes and to describe major patterns of traffic crashes in China.

METHODS

Descriptive and inferential statistical analyses were conducted. Road traffic death national data, population denominator data and motor vehicles data of 2009 were obtained from the Bureau of Traffic Management at Ministry of Public Security and National Bureau of Statistics. The association between the fatalities from road traffic crashes and selected demographic factors, the time distribution, crash patterns, crash causes, and road user category were assessed in χ(2) analyses.

RESULTS

ROAD TRAFFIC CRASHES IN CHINA DISPROPORTIONABLY AFFECTED THE FOLLOWING POPULATIONS: males, persons 21-65 yr of age and adults aged more than 65 yr, persons living in rural areas, pedestrians, passengers, motorcyclists and bicyclists. Approximately 50% of fatalities of road traffic crash occurred in Eastern regions. The number of road traffic deaths was higher in daytime than in nighttime. Road traffic deaths in frontal crashes, side-to-side crash and crashes with an object or a person were more common than in rear-end crashes. In about 92% of road traffic deaths, auto drivers were believed to be responsible for the fatal crash. Major crash causing factors were speeding, careless driving, driving without a license, driving in the wrong lane, and driving after drinking alcohol.

CONCLUSIONS

Road traffic deaths accounted for about 70,000 premature deaths in China which should be taken into account.

Incidence and trend of road traffic injuries and related deaths in Kuwait: 2000-2009

Road traffic injuries (RTIs), disabilities and deaths are recognised as a major public health problem worldwide. This study aimed to quantify the magnitude and the trends of RTI-related fatal and non-fatal injuries in Kuwait for the period 2000-2009. Data on road traffic crashes and related events (i.e., fatal and non-fatal minor and severe injuries) were obtained from police records, and the population data were sought from Ministry of Interior, Kuwait. From 2000 to 2009, 11,591 non-fatal RTIs and 3891 RTIs-related deaths occurred in Kuwait. Non-fatal severe RTIs accounted for 28.2% of the total non-fatal RTIs. Of the 2945 RTI-related deaths that occurred from 2003 to 2009, majority were amongst males (87.3%) and in the age range of 20-59 years (70.8%). The mean (SD) annual mortality rates for the 10-year study period (2000-2009) were 14 (1) per 100,000 population and 36 (2) per 100,000 registered vehicles. From 2000 to 2009, population-based and registered vehicle-based overall RTI-related crude mortality rates decreased by 20% and 29%, respectively. However, Poisson regression analyses showed that the overall slightly decreasing trends were statistically non-significant both for population-based crude mortality rate (trend coefficient=-0.016; p(trend)=0.587) and registered vehicle-based crude mortality rate (trend coefficient=-0.024; p(trend)=0.192). Furthermore, the trend in population-based age-adjusted RTI-related mortality rate for 2003-2009 was also statistically non-significant (trend coefficient=-0.050; p(trend)=0.284). For non-fatal severe RTIs, the overall mean (SD) annual rates per 100,000 population and 100,000 registered vehicles were 44 (23) and 113 (60) with corresponding total reduction of 61% and 66% from 2000 to 2009. The overall declining trends in minor and severe RTI rates (both population based and registered vehicles based) were statistically significant (p(trend)<0.001). Despite declined minor and severe RTI rates, the RTI-related crude and age-adjusted mortality rates during the past decade continued to be high for a high-income country. Targeted interventions may help reduce the burden of minor and severe RTIs and related deaths in Kuwait and other countries in the region.

Road traffic injuries in the People's Republic of China, 1951-2008

OBJECTIVE

Road traffic injuries (RTIs) have become the leading cause of injury deaths in China. This article analyzed the trends in all crashes, nonfatal injuries, and fatalities from road traffic crashes from 1951 to 2008 and compared the crash frequency, crash severity, and crash patterns by provinces, types of road, and injured road users.

METHODS

Road traffic crash data were obtained from the Bureau of Traffic Management at the Ministry of Public Security and National Bureau of Statistics of China. Descriptive statistical analyses were conducted.

RESULTS

Over the past 5 decades, road traffic injuries have increased substantially in China. From 1951 to 2008, the total number of road traffic crashes, nonfatal injuries, and fatalities increased by 43-fold, 58-fold, and 85-fold, respectively. Linear regression suggested a significant decline of 30.1 percent (95% confidence interval [CI]: 24.8-35.3) in the mortality rate per 100,000 people during the period 2002 to 2008. From 2004 to 2008, road traffic crash mortality rate per 100,000 people varied greatly in China from the lowest of 3.0 in Henan in 2008 to the highest of 21.7 in Xizang in 2004. RTIs in China disproportionally affected the following populations: males, persons 21 to 50 years of age, pedestrians, and motorcyclists/bicyclists. Adults aged more than 65 years accounted for approximately 10 percent of total road traffic deaths. Road types and RTIs severity were closely related; highways were associated with greater mortality rates.

CONCLUSION

Road traffic injuries have become a burgeoning public health problem in China. Programs need to be developed to prevent nonfatal injuries and fatalities caused by road traffic crashes in this emerging country.

An integrated surveillance system of road traffic injuries in the Lazio region of Italy: results of a 5-year study (2001-2005)

Road traffic injuries represent a relevant public-health problem. In the Lazio region of Italy, a surveillance system was activated. The aim of this work is to describe the surveillance system and report the health information in terms of temporal trends for the 5-year period 2001-2005. We identified all emergency department (ED) visits in the emergency database and then linked them with hospital discharges and mortality registry. From the integrated database, we calculated the rates of emergency room visits, of hospital admissions, and of mortality, reporting the temporal trends. Between 2001 and 2005 the rate of ED visits was 3151 per 100,000 inhabitants. Hospitalisation rates showed a significant decreasing trend. The surveillance identified 22% more deaths in the study period than reported by the official statistics. The surveillance revealed a decreasing trend for hospital admissions and a decline in deaths in 2003 concurrent to the introduction of the driver's licence point system.

Impact of the 1994 alcohol production and sales deregulation policy on traffic crashes and fatalities in Japan

INTRODUCTION

. Many studies have demonstrated a strong relationship between alcohol availability and traffic crashes involving alcohol-impaired drivers. The present analysis focuses on the evaluation of the impact of alcohol availability on the Japanese population by comparing fatal and nonfatal motor vehicle crash rates before and after implementation of the alcohol deregulation policy in 1994. Participants and method. Poisson regression with robust standard error was used to model the before-to-after change in incidence rate ratios (IRRs) in the population. To control for potential confounders, per capita alcohol consumption, unemployment rate, and vehicle miles travelled (VMT) were also added to the model. The exponents of the fitted coefficients are equivalent to the IRRs.

RESULTS

. Implementation of the policy deregulating alcohol sales and production did not appear to increase traffic fatalities and other traffic crashes in Japan. In the overall study results, nighttime fatalities were reduced statistically significantly by 6% since the implementation of the alcohol deregulation policy in 1994. Discussion. Contrary to previous research, the findings of this study demonstrated lower rates of fatalities and higher compliance with alcohol-related driving legislation. Further well-designed, nonaligned studies on alcohol availability and traffic fatalities in other countries are urgently needed.

Clinical consequences of road traffic injuries among the elderly in Japan

Background

Road traffic injuries among the elderly have recently become a public health issue; therefore, we investigated the clinical characteristics of such injuries among the elderly in Japan.

Methods

A retrospective study was performed using data from a medium-sized hospital emergency department. Data were extracted from medical records for one year, and patients were categorized into groups ages 18-64, 65-74 and 75+. Variables included demographic characteristics, injury circumstances, and nature of injury. Univariate and bivariate descriptive statistical analyses were performed, and multivariate logistic regression was used to evaluate injury severity and hospital admission by age groups.

Results

A total of 1,656 patients were studied. Patients aged 65+ had more chest wall injury, intracranial injury, lower extremity fracture, and intrathoracic injury than patients aged 18-64.

Conclusions

Injury circumstances and nature of injuries associated with traffic incidents showed different patterns by age groups, particularly among the elderly.

Cyclist Injuries Treated in Emergency Department (ED): Consequences and Costs in South-eastern Finland in an Area of 100 000 Inhabitants

In the present study, data of bicycle crashes leading to medical attendance in acute hospital or to death which occurred between June 1(st) 2004 and May 31(st) 2006 were analyzed. The final results consisted of injury data and patient records obtained from Kuusankoski Regional Hospital and from the road accident investigation teams. The total number of cases was 216. The severity of the injuries was classified according to the Abbreviated Injury Scale (2005). The majority of the bicycle crashes considered occurred when the injured was alone, without another party. Crashes were often alcohol-related (31%). Over one third of all cyclists' injuries were head injuries. Only 13% of the injured cyclists wore a helmet. 15% of those who wore a helmet sustained a head injury and, correspondingly, 43% of those who did not. Two bicyclists died. The number of bicycle crashes in the hospital data was at least fourfold compared to the number found in the official police statistics. Systematic collection of data on bicycle crashes in hospital emergency departments should be advanced in order to gain reliable information for prevention.

Linking emergency medical department and road traffic police casualty data: a tool in assessing the burden of injuries in less resourced countries

OBJECTIVE

The study aimed to (1) assess the magnitude of road traffic injuries in a country missing a formal linkage system of police with hospital data, (2) quantify the underreporting, and (3) produce a convenient algorithm exploring its constituent components.

METHODS

Linkage of disaggregate (individual) data collected by the road traffic police (RTP) with those by the Emergency Department Injury Surveillance System (EDISS) on the Greek island of Corfu and coded with different classification systems was carried out. The applied four-step methodology, also comprising the calculation of underreporting coefficients of the variation by basic demographic variables, mode of transport, and injury outcome, led to the identification of the overall underreporting from either registry.

RESULTS

RTP data captured 96.6% (coefficient: 1.035), whereas EDISS captured only 54.4% of total fatalities (overall concordance: 51.1%). On the contrary, EDISS captured 94.6% of nonfatal injuries, whereas RTP only captured 16% (coefficient: 6.238), resulting in a low overall concordance (10.6%). Considering severity of injury assessed by EDISS, by using the ISS as the gold standard, RTP data misclassified 20.3% of severe injuries as less severe, and a statistically significant difference in the underreporting by gender was also noted.

CONCLUSION

Relatively simple methodologies can provide essential coefficients to assess the actual numbers, severity, and components of road casualties by complementing routinely collected RTP with sentinel emergency department reporting systems.

Under-reporting of road traffic injuries to the police: results from two data sources in urban India

OBJECTIVE

To report the magnitude of under-reporting of road traffic injury (RTI) to the police from population-based and hospital-based data in the urban population of Hyderabad, India.

METHODS

In a cross-sectional population-based survey, 10 459 participants aged 5-49 years (94.3% participation), selected using three-stage systematic cluster sampling, recalled the reporting of non-fatal RTIs to the police in the preceding 12 months and fatal RTIs in the preceding 3 years. In addition, 781 consecutive RTI cases presenting to the emergency department of five hospitals provided information on RTI reporting to the police.

RESULTS

In the population-based study, of those who had non-fatal RTIs and sought outpatient or inpatient services, 2.3% (95% 1.1% to 3.5%) and 17.2% (95% CI 3.5% to 30.9%), respectively, reported the RTI to the police. Of the non-fatal consecutive RTI cases presenting to emergency departments, 24.6% (95% CI 21.3% to 27.8%) reported the RTI to the police. In the population-based study, 77.8% (95% CI 65.1% to 90.5%) of the fatal RTIs were reported to the police, and of the consecutive fatal RTI cases presenting to emergency departments, 98.1% (95% CI 95.5% to 100%) were reported to the police. The major reasons cited for not reporting RTIs to the police were "not necessary to report" and "hit and run case".

CONCLUSIONS

As road safety policies are based on police data in India, these studies highlight serious limitations in estimating the true magnitude of RTIs from these data, indicating the need for better methods for such estimation.

Motor vehicle crash fatalities at 30 days in Spain

OBJECTIVES

To assess level of fulfillment and utility of the hospital discharge register (HDR) as a complementary source of information for estimating the number of deaths at 30 days due to motor vehicle crashes in Spain.

METHODS

It is a cross-sectional study were we compared the number of people injured due to motor vehicle crashes hospitalised in a public hospital (HDR), in Spain during 2001, with the number of people severely injured or killed due to motor vehicle crashes reported by the police database (Dirección General de Tráfico, DGT) for the same year. A descriptive analysis was carried out by age, sex and region (Autonomous Community), as well as an estimation of the percentage of under-reporting of deaths by the DGT based on two assumptions.

RESULTS

Police reported 27,272 severe injuries and 4,811 deaths during first 24 hours after the crash and after applying a fatality adjustment factor estimated 706 more deaths up to 30 days after the crash. The HDR reported 40,174 urgent hospitalisations. Of these, 1,099 died during the day of hospitalisation or within the following 30 days. The police only notified 68% of all cases that required hospitalisation. According to the number of deaths reported by police and contrasted with hospital register, estimations of the number of deaths at 30 days made by police could represent a level of under-reporting of between 3% and 6.6%, depending on the assumption considered.

CONCLUSIONS

This study showed that the HDR is an information source that complements police statistics and is useful to estimate the number of deaths and non-fatal injuries due to motor vehicle crashes in Spain.

Road traffic injuries: hidden epidemic in less developed countries

Road traffic injuries (RTIs) are a leading cause of morbidity, disability and mortality in less developed countries. Globally in 2002, 1.2 million deaths resulted from RTIs, and about 10 times that were injured. RTIs are often preventable, and the technology and knowledge to achieve success in this area exist. In spite of this, it is projected that given the current trend and without adequate intervention, RTIs will rank third of all major causes of morbidity and mortality globally by 2020. Although > 85% of the global deaths and injuries from road traffic crashes occur in less developed countries, traffic safety attracts little public health attention in these nations, due in part to a plethora of other equally important problems, including infectious diseases. Unfortunately, the public health and economic impact of traffic-related injuries and disabilities can be incalculable in these countries, owing to their poorly developed trauma care systems and nonexistent social welfare infrastructures to accommodate the needs of the injured and the disabled. In this paper, we highlight the problem posed to public health in less developed countries by RTIs and examine contributing factors. To engender debate and action to address the problem, we reviewed interventions that have proven effective in industrialized nations and discussed potential barriers to their replication in less developed countries.