Behavioral pathways in bicycle-motor vehicle crashes: From contributing factors,pre-crash actions,to injury severities

Introduction: This study performed a path analysis to uncover the behavioral pathways (from contributing factors, pre-crash actions to injury severities) in bicycle-motor vehicle crashes. Method: The analysis investigated more than 7,000 bicycle-motor vehicle crashes in North Carolina between 2007 and 2014. Pre-crash actions discussed in this study are actions of cyclists and motorists prior to the event of a crash, including “bicyclist failed to yield,” “motorist failed to yield,” “bicyclist overtaking motorist,” and “motorist overtaking bicyclist.” Results: Model results show significant correlates of pre-crash actions and bicyclist injury severity. For example, young bicyclists (18 years old or younger) are 23.5% more likely to fail to yield to motor traffic prior to the event of a crash than elder bicyclists. The “bicyclist failed to yield” action is associated with increased bicyclist injury severity than other actions, as this behavior is associated with an increase of 5.88 percentage points in probability of a bicyclist being at least evidently injured. The path analysis can highlight contributing factors related to risky pre-crash actions that lead to severe injuries. For example, bicyclists traveling on regular vehicle travel lanes are found to be more likely to involve the “bicyclist failed to yield” action, which resulted in a total 44.38% (7.04% direct effect + 37.34% indirect effect) higher likelihood of evident or severe injuries. The path analysis can also identify factors (e.g., intersection) that are not directly but indirectly correlated with injury severity through pre-crash actions. Practical Applications: This study offers a methodological framework to quantify the behavioral pathways in bicycle-motor vehicle crashes. The findings are useful for cycling safety improvements from the perspective of bicyclist behavior, such as the educational program for cyclists.     

Case-control study of risk factors for fatal and non-fatal injury in crashes of rotary-wing aircraft

INTRODUCTION: There have been few studies of the risk factors for fatal injury in air crashes of rotary-wing aircraft, and none of risk factors for all serious injury (fatal and non-fatal) in these aircraft. The aim of the study was to identify the potentially modifiable risk factors for injury in civil rotary-wing aircraft crashes in New Zealand. METHOD: We analyzed records from all reported civil rotary-wing aircraft crashes in New Zealand between 1988 and 1994. Air crash data from the official databases were merged with nationwide injury records and information obtained from Coroner's files. Crashes where the pilot-in-command was fatally injured were compared with crashes where the pilot-in-command was not fatally injured on 50 variables, covering pilot, aircraft, environmental, and operational characteristics. A second analysis compared crashes where the pilot-in-command was seriously injured (either fatally or non-fatally) with crashes where the pilot-in-command was not hospitalized with an injury. A series of multivariate logistic regression analyses were conducted to estimate the odds associated with each of the factors identified by the univariate analyses. RESULTS: The most significant risk factors for all serious injury were: (a) not obtaining a weather briefing, (b) off-airport location of the crash site, (c) flights carried out for air transport purposes, and (d) non-solo flights. Other risk factors, significant for fatal injury only, included post-crash fire and the nature of the crash terrain. Factors within the control of the pilot, environmental, and flight characteristics are the key determinants of the injury outcome of civil rotary-wing aircraft crashes.     

Reconstruction of crashes involving injured child occupants: the risk of serious injuries associated with sub-optimal restraint use may be reduced by better controlling occupant kinematics

OBJECTIVE: To determine whether injuries to sub-optimally restrained child occupants in real-world crashes were likely to be preventable by alternative restraint usage practices and to assess the usefulness of crash reconstruction for exploring injury mechanisms in child occupants. METHODS: Real-world crashes in which child occupants sustained significant injuries were reconstructed on a laboratory crash sled using the Hybrid III family of child dummies. Alternative restraint scenarios and cases in which children were not seriously injured were also simulated to compare dummy kinematics and dynamic responses in optimal restraint configurations. RESULTS: Restraint misuse was associated with greater motion of the dummy torso and head during crashes, often allowing contact between the child and the vehicle interior, resulting in injury. Poor pre-crash posture for a child inappropriately restrained in an adult belt appeared to worsen the geometry of the sash (shoulder) belt, resulting in a cervical injury due to direct interaction with the belt. Dynamic dummy data did not appear to discriminate between injury and non-injury cases. CONCLUSIONS: Dummy kinematics suggest that injuries in which inappropriate use and misuse were a factor were less likely if the most appropriate restraint was used correctly. Adequately controlling the head and upper body of the child occupant was seen to prevent undesirable interactions with the vehicle interior and restraint system, which were associated with injury in the real world. Neck forces and moments and injury criteria calculated from these did not predict injury reliably.     

Before the crash: A systematic analysis of police narratives to determine the prevalence of pre-crash factors in fatality road transport crashes

Abstract

Objectives: The objectives of this study were to identify the prevalence of pre-crash factors that were present in fatal road transport crashes for the deceased and counterpart road user.

Methods: The study is a retrospective population-based case series study of transport-related deaths reported to coroners in Australia from 2013 to 2016. Data was extracted from the National Coronial Information System.

Results: In total, 6,137 fatality crashes occurred during the study period. Police reports were available for 5,523 crashes (89.9%). The most frequently reported pre-crash factors reported behaviour specifically drivers (e.g., driving without a license or while license was disqualified). Presence of intoxicating substances were also reported in the deceased and counterparts. Analyses of toxicology reports are continuing to determine if rates are comparable to level of use in community.

Conclusions: Coronial report provide detailed information that may be pertinent to understanding and potentially preventing crashes. Also emerging from the data is the extent of pre-crash factors that relate to illegal or deviant behavior and whether these are contextual or contributory factors.     

Health-related quality of life 24 months after sustaining a minor musculoskeletal injury in a road traffic crash: A prospective cohort study

Objectives: A better understanding of the long-term factors that independently predict poorer quality of life following mild to moderate musculoskeletal injuries is needed. We aimed to establish the predictors of quality of life (including sociodemographic, health, psychosocial, and pre-injury factors) 24 months after a noncatastrophic road traffic injury.

Methods: In a prospective cohort study of 252 participants with mild/moderate injury sustained in a road traffic crash, quality of life was measured 24 months following the baseline survey. A telephone-administered questionnaire obtained information on various potential explanatory variables. Health-related quality of life was measured using the European Quality of Life–5 Dimensions (EQ-5D) and Medical Outcomes Survey Short Form–12 (SF-12). Multivariable linear regression analyses determined the associations between explanatory variables and quality of life measures.

Results: Mean SF-12 physical component summary (PCS) and mental component summary (MCS) scores increased by 7.3 and 2.5 units, respectively, from baseline to 24-month follow-up. Each 10-year increase in baseline age was independently associated with 3.1-unit (P < .001) and 1.5-unit (P = .001) decrease in EQ Visual Analogue Scale (VAS) and SF-12 PCS scores at follow-up, respectively. Poor/fair compared to excellent pre-injury health was associated with a 0.16-, 21.3-, and 11.5-unit decrease in EQ-5D summary (P = .03), VAS scores (P = .001), and SF-12 PCS scores (P < .001), respectively. Baseline pain severity ratings and pain catastrophizing scores were inversely associated with 24-month EQ VAS scores (both P < .001). Each unit increase in baseline pain score (P = .001) and pain catastrophizing score (P = .02) was associated with a 1.0- and 4.6-unit decrease in SF-12 MCS scores at 24 months, respectively. Other observed predictors of quality of life measures (EQ-5D summary and/or VAS scores and/ or SF-12 MCS) included marital status, smoking, hospital admission, pre-injury health (anxiety/depression and chronic illness), and whiplash injury.

Conclusion: Sociodemographic indicators, pre-injury health, and biopsychosocial correlates were independently associated with health-related quality of life 24 months following a noncatastrophic road traffic crash injury.     

Collisions involving senior drivers: high-risk conditions and locations

OBJECTIVES: To better understand the characteristics of crashes involving senior drivers 65 and older, studies of these crashes were reviewed. METHODS: The review focused primarily on North American studies published since 1990. Studies point to important differences between the crashes of senior drivers and those of younger drivers. RESULTS. Numerous studies have found that senior drivers' crashes are much more likely than crashes of younger drivers to occur at intersections. Senior drivers have particularly high rates of involvement in intersection crashes when they are turning, and even more so when they are turning left. Senior drivers are more likely than younger drivers to have been at fault in these situations, typically because they failed to yield the right-of-way, disregarded the traffic signal, or committed some other traffic violation. Studies also suggest that the extent of overinvolvement of senior drivers in certain types of crashes generally increases with advancing age. CONCLUSIONS. The extent to which the distinctive characteristics of senior drivers' crashes may be due to changing travel patterns associated with aging, or physical or cognitive impairments related to the aging process, is unclear. Further research is needed to understand the pre-crash circumstances of older drivers' intersection crashes.     

Functional outcomes of motor vehicle crash thoracic injuries in pediatric and adult occupants

Objective: Characterization of the severity of injury should account for both mortality and disability. The objective of this study was to develop a disability metric for thoracic injuries in motor vehicle crashes (MVCs) and compare the functional outcomes between the pediatric and adult populations.

Methods: Disability risk (DR) was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank for the most frequently occurring Abbreviated Injury Scale (AIS) 2–5 thoracic injuries. Occupants with thoracic injury were classified as disabled or not disabled based on the FIM scale, and comparisons were made between the following age groups: pediatric, adult, middle-aged, and older occupants (ages 7–18, 19–45, 46–65, and 66+, respectively). For each age group, DR was calculated by dividing the number of patients who were disabled and sustained a given injury by the number of patients who sustained a given injury. To account for the effect of higher severity co-injuries, a maximum AIS adjusted DR (DR_MAIS) was also calculated for each injury. DR and DR_MAIS could range from 0 to 100% disability risk.

Results: The mean DR_MAIS for MVC thoracic injuries was 20% for pediatric occupants, 22% for adults, 29% for middle-aged adults, and 43% for older adults. Older adults possessed higher DR_MAIS values for diaphragm laceration/rupture, heart laceration, hemo/pneumothorax, lung contusion/laceration, and rib and sternum fracture compared to the other age groups. The pediatric population possessed a higher DR_MAIS value for flail chest compared to the other age groups.

Conclusion: Older adults had significantly greater overall disability than each of the other age groups for thoracic injuries. The developed disability metrics are important in quantifying the significant burden of injuries and loss of quality life years. Such metrics can be used to better characterize severity of injury and further the understanding of age-related differences in injury outcomes, which can influence future age-specific modifications to AIS.     

Effect of electronic stability control on automobile crash risk

Per vehicle crash involvement rates were compared for otherwise identical vehicle models with and without electronic stability control (ESC) systems. ESC was found to affect single-vehicle crashes to a greater extent than multiple-vehicle crashes, and crashes with fatal injuries to a greater extent than less severe crashes. Based on all police-reported crashes in 7 states over 2 years, ESC reduced single-vehicle crash involvement risk by approximately 41 percent (95 percent confidence limits 3348) and single-vehicle injury crash involvement risk by 41 percent (2752). This translates to an estimated 7 percent reduction in overall crash involvement risk (310) and a 9 percent reduction in overall injury crash involvement risk (314). Based on all fatal crashes in the United States over 3 years, ESC was found to have reduced single-vehicle fatal crash involvement risk by 56 percent (3968). This translates to an estimated 34 percent reduction in overall fatal crash involvement risk (2145).     

Disability among adults injured in motor-vehicle crashes in the United States

INTRODUCTION: Little population-based information exists about the long-term effects of motor-vehicle crash-related injuries. METHOD: We analyzed data from the 1995 National Health Interview Survey Disability (NHIS-D) Supplement to estimate the prevalence of crash-related disability among noninstitutionalized U.S. adults aged 18 years and older. RESULTS: More than 1.2 million adults were living in their homes with the disabling effects of motor-vehicle crash-related injuries in 1995. The prevalence of crash-related disability was highest for persons in their mid-life years, ages 35-64. Half of the respondents had sustained the injuries more than 5 years before the interview. Forty-one percent of working-aged individuals reported being unable to work because of their disability. CONCLUSIONS: Because crash-related disability is most prevalent during the mid-life years, quality of life and productivity may be affected for decades. These findings highlight the personal and societal burden associated with motor-vehicle crash-related disability in the United States.     

Effects of red light running camera systems installation and then deactivation on intersection safety

IntroductionThe primary objective of this paper is to evaluate the safety impacts of red-light running camera (RLC) system installation and then deactivation at 48 intersections in Houston, Texas. The second objective is to evaluate the spillover effect at nearby non-treated intersections in Houston after the deactivation.MethodsTo accomplish study objectives, an Empirical Bayes (EB) before-after analysis was used.ResultsThe results indicate statistically significant collision reductions on all red-light running (RLR) crash types (37 percent) as well as right-angle RLR crashes (47 percent) at the treated intersections after RLC activation. By way of comparison, the RLC deactivation analysis indicated that crashes increased by 20 percent for all RLR crash types and by 23 percent in right-angle RLR crashes at the formerly treated intersections. After deactivation, all severity RLR crashes increased more than expected at nearby non-treated intersections, which indicates the possibility of an adverse spillover effect. However, fatal/injury crashes associated with rear-end decreased after deactivation at both formerly treated and non-treated intersections, although those rear-end crashes account for smaller proportions when compared to all crash types/right-angle crashes.Practical applicationsOverall, removing RLC treatments results in a negative reaction to the safety benefits that the treatment provides when it is in place and actively working and to the nearby intersections where the treatment has not been implemented. This study helps define the effects that RLCs have on safety at signalized intersections after installation and deactivation.     

Mortality in rural locations after severe injuries from motor vehicle crashes

BackgroundMortality from traffic crashes is often higher in rural regions, and this may be attributable to decreased survival probability after severe injury.MethodsData were obtained from the National Automotive Sampling System – General Estimates System (NASS-GES) for 2002–2008. Using weighted survey logistic regression, three injury outcomes were analyzed: (a) Death overall, (b) Severe injury (incapacitating or fatal), and (c) Death, after severe injury. Models controlled for (pre-crash) person, event, and county level factors.ResultsThe sample included 883,473 motorists. Applying weights, this represented a population of 98,411,993. Only 2% of the weighted sample sustained a severe injury, and 9% of these severely injured motorists died. The probability of death overall and the probability of severe injury increased with older age, safety belt nonuse, vehicle damage, high speed, and early morning crashes . Males were less likely to be severely injured, but more likely to die if severely injured. Motorists in southern states were more likely to have severe injuries, but not more likely to die if severely injured. Motorists who crashed in very rural counties were significantly more likely to die overall, and were more likely to die if severely injured.ConclusionsMotorists with severe injury are more likely to die in rural areas, after controlling for person- and event-specific factors.     

Investigation of crashes at pedestrian hybrid beacons: Results of a large-scale study in Arizona

Introduction: The pedestrian hybrid beacon (PHB) is a traffic control device used at pedestrian crossings. A recent Arizona Department of Transportation research effort investigated changes in crashes for different severity levels and crash types (e.g., rear-end crashes) due to the PHB presence, as well as for crashes involving pedestrians and bicycles. Method: Two types of methodologies were used to evaluate the safety of PHBs: (a) an Empirical Bayes (EB) before-after study, and (b) a long-term cross-sectional observational study. For the EB before-after evaluation, the research team considered three reference groups: unsignalized intersections, signalized intersections, and both unsignalized and signalized intersections combined. Results: For the signalized and combined unsignalized and signalized intersection groups, all crash types considered showed statistically significant reductions in crashes (e.g., total crashes, fatal and injury crashes, rear-end crashes, fatal and injury rear-end crashes, angle crashes, fatal and injury angle crashes, pedestrian-related crashes, and fatal and injury pedestrian-related crashes). A cross-sectional study was conducted with a larger number of PHBs (186) to identify relationships between roadway characteristics and crashes at PHBs, especially with respect to the distance to an adjacent traffic control signal. The distance to an adjacent traffic signal was found to be significant only at the α = 0.1 level, and only for rear-end and fatal and injury rear-end crashes. Conclusions: This analysis represents the largest known study to date on the safety impacts of PHBs, along with a focus on how crossing and geometric characteristics affect crash patterns. The study showed the safety benefits of PHBs for both pedestrians and vehicles. Practical Applications: The findings from this study clearly support the installation of PHBs at midblock or intersection crossings, as well as at crossings on higher-speed roads.     

Adolescent driving: Characteristics associated with single-vehicle and injury crashes

The high motor-vehicle crash rate of young drivers may be attributed to both driving inexperience and a greater tendency to engage in risk-taking behavior. This study examines risk-taking behavior, as indicated by single-vehicle crashes and injury crashes, and factors associated with these behaviors, based on measures of demographic, psychosocial, and substance use obtained from high school senior questionnaires. Because previous work indicated different predictors for young men and young women, separate logistic regression analyses were conducted. For young women, propensity toward cigarette use was associated with higher rates of single-vehicle crashes; while race, alcohol misuse, and friends' involvement with alcohol and marijuana were associated with injury crashes. For young men, availability of substances, driving frequency, alcohol misuse, and propensity toward marijuana use were associated with higher rates of single-vehicle crashes. Young men's living situation, availability of substances, and marijuana use were related to injury crashes.     

Ordered logistic models of influencing factors on crash injury severity of single and multiple-vehicle downgrade crashes: A case study in Wyoming

Introduction: The state of Wyoming, like other western United States, is characterized by mountainous terrain. Such terrain is well noted for its severe downgrades and difficult geometry. Given the specific challenges of driving in such difficult terrain, crashes with severe injuries are bound to occur. The literature is replete with research about factors that influence crash injury severity under different conditions. Differences in geometric characteristics of downgrades and mechanics of vehicle operations on such sections mean different factors may be at play in impacting crash severity in contrast to straight, level roadway sections. However, the impact of downgrades on injury severity has not been fully explored in the literature. This study is thus an attempt to fill this research gap. In this paper, an investigation was carried out to determine the influencing factors of crash injury severities of downgrade crashes. Method: Due to the ordered nature of the response variable, the ordered logit model was chosen to investigate the influencing factors of crash injury severities of downgrade crashes. The model was calibrated separately for single and multiple-vehicle crashes to ensure the different factors influencing both types of crashes were captured. Results: The parameter estimates were as expected and mostly had signs consistent with engineering intuition. The results of the ordered model for single-vehicle crashes indicated that alcohol, gender, road condition, vehicle type, point of impact, vehicle maneuver, safety equipment use, driver action, and annual average daily traffic (AADT) per lane all impacted the injury severity of downgrade crashes. Safety equipment use, lighting conditions, posted speed limit, and lane width were also found to be significant factors influencing multiple-vehicle downgrade crashes. Injury severity probability plots were included as part of the study to provide a pictorial representation of how some of the variables change in response to each level of crash injury severity. Conclusion: Overall, this study provides insights into contributory factors of downgrade crashes. The literature review indicated that there are substantial differences between single- and multiple vehicle crashes. This was confirmed by the analysis which showed that mostly, separate factors impacted the crash injury severity of the two crash types. Practical applications: The results of this study could be used by policy makers, in other locations, to reduce downgrade crashes in mountainous areas.     

In-depth approach for identifying crash causation patterns and its implications for pedestrian crash prevention

IntroductionA pedestrian crash occurs due to a series of contributing factors taking effect in an antecedent-consequent order. One specific type of antecedent-consequent order is called a crash causation pattern. Understanding crash causation patterns is important for clarifying the complicated growth of a pedestrian crash, which ultimately helps recommend corresponding countermeasures. However, previous studies lack an in-depth investigation of pedestrian crash cases, and are insufficient to propose a representative picture of causation patterns. Method: In this study, pedestrian crash causation patterns were discerned by using the Driving Reliability and Error Analysis Method (DREAM). One hundred and forty-two pedestrian crashes were investigated, and five pedestrian pre-crash scenarios were extracted. Then, the crash causation patterns in each pre-crash scenario were analyzed; and finally, six distinct patterns were identified. Accordingly, 17 typical situations corresponding to these causation patterns were specified as well. Results: Among these patterns, the pattern related to distracted driving and the pattern related to an unexpected change of pedestrian trajectory contributed to a large portion of the total crashes (i.e., 27% and 24%, respectively). Other patterns also played an important role in inducing a pedestrian crash; these patterns include the pattern related to an obstructed line of sight caused by outside objects (9%), the pattern that involves reduced visibility (13%), and the pattern related to an improper estimation of the gap distance between the vehicle and the pedestrian (10%). The results further demonstrated the inter-heterogeneity of a crash causation pattern, as well as the intra-heterogeneity of pattern features between different pedestrian pre-crash scenarios. Conclusions and practical applications: Essentially, a crash causation pattern might involve different contributing factors by nature or dependent on specific scenarios. Finally, this study proposed suggestions for roadway facility design, roadway safety education and pedestrian crash prevention system development.     

Attitudes toward a primary seat belt law among adults in a rural state with a secondary seat belt law

Problem

Enforced primary seatbelt laws can reduce morbidity and mortality associated with motor-vehicle crashes. Constituent support is an important factor associated with legislator voting behavior toward injury prevention laws. Little is known about attitudes toward a primary seat belt law among adults in rural states without a primary seat belt law.

Methods

Data from the Behavioral Risk Factor Surveillance System (BRFSS) survey, a telephone survey of a representative sample of adults in Montana, were used to assess attitudes toward a primary seat belt law.

Results

Sixty-one percent of respondents supported a primary seat belt law. Using multiple logistic regression analyses, women (AOR 1.87; 95% CI 1.49-2.36), persons aged 65 years and older (1.45; 1.06-1.96), American Indians (2.71; 1.55-4.75), those with health insurance (1.51; 1.07-2.14), and those who reported always wearing their seat belt (4.05; 3.14-5.21) were more likely to support a primary seat belt law than respondents without these characteristics.

Conclusions

The majority of adults in a rural state support a primary seat belt law.     

Implications of Functional Capacity Loss and Fatality for Vehicle Safety Prioritization

Objective: We investigate the use of the Functional Capacity Index (FCI) as a tool for establishing vehicle safety priorities by comparing the life year burden of injuries to the burden of fatality in frontal and side automotive crashes. We demonstrate FCI’s utility by investigating in detail the resulting disabling injuries and their life year costs.

Methods: We selected occupants in the 2000–2013 NASS-CDS database involved in frontal and side crashes, merged their injuries with FCI, and then used the merged data to estimate each occupant’s overall functional loss. Lifetime functional loss was assessed by combining this measure of impairment with the occupants’ expected future life spans, estimated from the Social Security Administration’s Actuarial Life Table.

Results: Frontal crashes produce a large number of disabling injuries, particularly to the lower extremities. In our population, these crashes are estimated to account for approximately 400,000 life years lost to disability in comparison with 500,000 life years lost to fatality. Victims of side crashes experienced a higher rate of fatality but a significantly lower rate of disabling injury (0.3 vs. 1.0%), resulting in approximately 370,000 life years lost to fatality versus 50,000 life years lost to disability.

Conclusions: The burden of disabling injuries to car crash survivors should be considered when setting vehicle safety design priorities. In frontal crashes this burden in life years is similar to the burden attributable to fatality.     

A multinomial logit model of motorcycle crash severity at Australian intersections

Introduction: Motorcyclists are exposed to more fatalities and severe injuries per mile of travel as compared to other vehicle drivers. Moreover, crashes that take place at intersections are more likely to result in serious or fatal injuries as compared to those that occur at non-intersections. Therefore, the purpose of this study is to evaluate the contributing factors to motorcycle crash severity at intersections. Method: A data set of 7,714 motorcycle crashes at intersections in the State of Victoria, Australia was analyzed over the period of 2006–2018. The multinomial logit model was used for evaluating the motorcycle crashes. The severity of motorcycle crashes was divided into three categories: minor injury, serious injury and fatal injury. The risk factors consisted of four major categories: motorcyclist characteristics, environmental characteristics, intersection characteristics and crash characteristics. Results: The results of the model demonstrated that certain factors increased the probability of fatal injuries. These factors were: motorcyclists aged over 59 years, weekend crashes, midnight/early morning crashes, morning rush hours crashes, multiple vehicles involved in the crash, t-intersections, crashes in towns, crashes in rural areas, stop or give-way intersections, roundabouts, and uncontrolled intersections. By contrast, factors such as female motorcyclists, snowy or stormy or foggy weather, rainy weather, evening rush hours crashes, and unpaved roads reduced the probability of fatal injuries. Practical Applications: The results from our study demonstrated that certain treatment measures for t-intersections may reduce the probability of fatal injuries. An effective way for improving the safety of stop or give-way intersections and uncontrolled intersections could be to convert them to all-way stop controls. Further, it is recommended to educate the older riders that with ageing, there are physiological changes that occur within the body which can increase both crash likelihood and injury severity.     

Analysis of bicycle crashes in Sweden involving injuries with high risk of health loss

Objective: The objectives of the present article were to (a) describe the main characteristics of bicycle crashes with regard to the road environment, crash opponent, cyclist, and crash dynamics; (b) compare individuals who describe their health after the crash as declined with those who describe their health as not affected; and (c) compare the number of injured cyclists who describe their health as declined after the crash with the predicted number of permanent medical impairments within the same population.

Methods: A sample of individuals with specific injury diagnoses was drawn from the Swedish Traffic Accident Data Acquisition (STRADA) database (n?=?2,678). A survey form was used to collect additional information about the crash and the health-related outcomes. The predicted number of impaired individuals was calculated by accumulating the risk for all individuals to sustain at least a 1% permanent medical impairment, based on the injured body region and injury severity.

Results: Nine hundred forty-seven individuals (36%) responded, of whom 44% reported declined health after the crash. The majority (68%) were injured in single bicycle crashes, 17% in collisions with motor vehicles, and 11% in collisions with another cyclist or pedestrian. Most single bicycle crashes related to loss of control (46%), mainly due to skidding on winter surface conditions (14%), followed by loss of control during braking (6%). There was no significant difference in crash distribution comparing all crashes with crashes among people with declined health. The predicted number of impaired individuals (n?=?427) corresponded well with the number of individuals self-reporting declined health (n?=?421).

Conclusions: The types of crashes leading to health loss do not substantially differ from those that do not result in health loss. Two thirds of injuries leading to health loss occur in single bicycle crashes. In addition to separating cyclists from motorized traffic, other preventive strategies are needed.