What is the potential of trauma registry data to be used for road traffic injury surveillance and informing road safety policy?

Introduction

Information from hospital trauma registries is increasingly being used to support injury surveillance efforts. This research examines the potential of using trauma registry data for road traffic injury surveillance for different types of road users in terms of both the information collected and how representative trauma data are compared to two population-based road traffic injury data collections.

Methods

The three data collections were assessed against recommended variables to be collected for injury surveillance purposes and the representativeness of the distribution of road traffic-related injury data from the trauma registry was compared to hospital admission and road traffic authority data collections.

Results

Data from the trauma registry was largely not representative of the distribution of age groups or activities compared to the two population-based collections, but was representative for gender for some road user groups to at least one population-based data collection.

Conclusions

Trauma data could be used to supplement information from population-based data collections to inform road safety efforts.

Impact on Industry

Road safety policy makers should be aware of the potential and the limitations of using trauma registry data for road traffic injury surveillance.     

The “Golden Hour” and field triage pattern for road trauma patients

Introduction: Although the term “golden hour” is a well-known concept among trauma system and emergency medical service providers, the relationship between time and trauma patient outcome and the process of prehospital care for road trauma patients in rural settings are poorly understood. As the underlying basis for triage decision-making, the estimated transport interval to trauma center is usually absent in the existing studies. Method: In this study, the crash data between 2013 and 2017 were obtained from the Fatality Analysis Reporting System, and the estimated intervals were calculated by using a Geographic Information System software. By comparing the estimated intervals with actual emergency medical services records, the field triage patterns for road patients were investigated at the state and county levels. Results and Conclusions: With the help of the interval prediction maps, the different triage patterns among counties were identified. Further, the average fatalities per 100,000 population by county from the National Highway Traffic Safety Administration were adopted to clarify the associated outcomes. The linear regression analysis results revealed that, for most states, all intervals except the notification interval had a significant correlation with the mortality. The estimated interval had a more significant relationship with the mortality than the actual transport interval. Practical applications: These findings indicated that adhering to the “golden hour” without regarding the destination may not be helpful for the survival of road trauma patients. The regression analyses and the interval maps can be used to identify patterns of inappropriate destination selection so that prospective decision-making can be improved.     

Estimated trends and patterns of road traffic fatalities in China, 2002–2012

Objective: This study examined the time trends and age distribution patterns of estimated road traffic fatalities (RTFs) in China over the period 2002–2012. Methods: Data on age-, sex-, and region-specific RTF rates were provided by the Chinese Ministry of Health. The crude rates were standardized and the Mann-Kendall test was used to test the significance of time trends. Annual number of RTFs was calculated. To minimize the effect of yearly variations, magnitude of changes in and age distribution patterns of the RTFs were examined using mean values of 2 years. Results: RTFs increased significantly in China during the study period. Several features were identified for the RTFs in China. First, RTF rates skyrocketed in rural areas including towns and counties. Second, a significant increase in RTFs was also observed in cities even though the change in RTF rates was not statistically significant there. Third, individuals aged 20–24, 40–49, and 55–64, especially in rural areas, were particularly at risk for RTFs in recent years. Finally, RTFs became more common among middle-aged and older adults than young Chinese, with roughly 57% of all RTFs occurring among individuals aged 45 and above during 2011–2012. Conclusions: RTFs increased dramatically in China during the past decade, especially in rural areas. Age distribution patterns of RTFs have changed there. Community-based public health education and intervention programs are warranted.     

Prevalence and characteristics of road traffic injuries among young drivers in Oman, 2009–2011

Objectives: Studies from different parts of the world have indicated that the impact of road traffic incidents disproportionally affects young adults. Few known studies have been forthcoming from Arabian Gulf countries. Within Oman, a high proportion of the population is under the age of 20. Coupled with the drastic increase in motorization in recent years, there is a need to understand the state of road safety among young people in Oman. The current research aimed to explore the prevalence and characteristics of road traffic injuries among young drivers aged 17–25 years.

Methods: Crash data from 2009 to 2011 were extracted from the Directorate General of Traffic, Royal Oman Police (ROP) database in Oman. The data were analyzed to explore the impact of road crashes on young people (17–25 years), the characteristics of young driver crashes, and how these differ from older drivers and to identify key predictors of fatalities in young driver crashes.

Results: Overall, young people were overrepresented in injuries and fatalities within the sample time period. Though it is true that many young people in crashes were driving at the time, it was also evident that young people were often victims in a crash caused by someone else. Thus, to reduce the impact of road crashes on young people, there is a need to generally address road safety within Oman. When young drivers were involved in crashes they were predominantly male. The types of crashes these drivers have can be broadly attributed to risk taking and inexperience. Speeding and nighttime driving were the key risk factors for fatalities.

Conclusion: The results highlight the need to address young driver safety in Oman. From these findings, the introduction of a graduated driver licensing system with nighttime driving restrictions could significantly improve young driver safety.     

When may road fatalities start to decrease?

Introduction

The comparative analysis of macroscopic trends in road safety has been a popular research topic. The objective of this research is to propose a simple and, at the same time, reliable multiple regime model framework for international road safety comparisons, allowing for the identification of slope changes of personal risk curves and respective breakpoints.

Method

The trends of road traffic fatalities in several EU countries have been examined through the temporal evolution of elementary socioeconomic indicators, namely motorized vehicle fleet and population, at the country level.

Results

Piece-wise linear regression models have been fitted, using a methodology that allows the simultaneous estimation of all slopes and breakpoints. The number and location of breakpoints, as well as the slope of the connecting trends, vary among countries, thus indicating different road safety evolution patterns.

Impact on industry

Macroscopic analysis of road accident trends may be proved beneficial for the identification of best examples and the implementation of appropriate programmes and measures, which will lead to important benefits for the society and the economy through the reduction of road fatalities and injuries. Best performing countries and the related programmes and measures adopted may concern several safety improvements at the processes of the road, the vehicle and the insurance industries.

Conclusions

Lessons from the analysis of the past road safety patterns of developed countries provide some insight into the underlying process that relates motorization levels with personal risk and can prove to be beneficial for predicting the road safety evolution of developing countries that may have not yet reached the same breakpoints. Furthermore, the presented framework may serve as a basis to build more elaborate models, including more reliable exposure indicators (such as vehicle-km driven).     

Strengthening road safety strategy development ‘Towards Zero’ 2008–2020 – Western Australia’s experience scientific research on road safety management SWOV workshop 16 and 17 November 2009

With a significant list of achievements in traffic safety over some 40 years, Australia’s most successful initiatives have emerged from consideration of the scientific basis for achieving effective results. Over time, the increasing use of scientific methods has matured to an extent whereby road safety strategies for entire jurisdictions are now being formed and optimised on the basis of evidence-based mathematical modelling of predicted strategy performance over periods of ten or more years ahead. This paper describes the approach used in the State of Western Australia (WA) to support the development of its new strategy, ‘Towards Zero’, addressing the 12-year period from 2008 to 2020. Also described is the early development of the modelling approach in the State of Victoria, Australia, subsequently applied, refined and adapted to Western Australia. The ‘Towards Zero’ strategy aims to ensure that road safety policies continue to evolve within a strategic framework, based on Australasia’s Safe System framework, which was derived from the best elements of the Swedish Vision Zero and the Dutch Sustainable Safety visions.The process for the development of the strategy involved a greater degree of community and stakeholder engagement than has been the case previously, based on the fundamental belief that the community should be provided with the best evidence about what works no matter how controversial, so that it can debate and consider the options available to improve safety.It is equally important to have a strategy based on the best possible evidence. The Monash University Accident Research Centre (MUARC) was appointed by the WA Office of Road Safety to identify, describe and recommend proven counter-measures within the Safe System framework and develop a series of scientifically sound directions and options.This paper outlines the modelling technique used by MUARC along with results and summarises the community consultation process.     

Beyond “best practice” road safety thinking and systems management – A case for culture change research

Forecasts of an “explosion” in the level of road trauma as many of the world’s most populous nations rapidly motorise have contributed to the urgency of documenting best practice thinking and management systems to improve road safety performance. By examining the success stories of nations with either the lowest fatailty rates per head of population or with the largest recent improvements a number of “lessons” have emerged. Data-driven problem identification and the development of evidence-driven countermeasure packages formalised in a strategy for effective implementation, with ambitious, quantitative targets and transparent lines of institutional accountability are the critical success factors. Basing this planning upon the cornerstones of the safe system conceptual model constitutes best practice thinking. This paper argues that critical elements of the safe system model are in discord with behavioural mores in the cultures of many western motorised nations and that this hampers the adoption of the most effective safety programs within key institutions and within political systems. A case is made for a systematic examination of car use and safety cultures in order to add a further dimension to best practice learnings.     

Is road rage increasing? Results of a repeated survey

PROBLEM: We report on trends in road rage victimization and perpetration based on population survey data. METHOD: Based on repeated cross-sectional telephone surveys of Ontario adults between July 2001 and December 2003, logistic regression analyses examined differences between years in road rage victimization and perpetration in the previous year controlling for demographic characteristics. RESULTS: The prevalence of any road rage victimization in the previous year decreased significantly from 47.5% in 2001 to 40.6% in 2003, while prevalence of any road rage perpetration remained stable (31.0% to 33.6%). Logistic regression analyses revealed that the odds of experiencing any road rage victimization was 33% higher in 2001 and 30% higher in 2002, than in 2003. DISCUSSION: Survey data provide a valuable perspective on road rage trends, but efforts to track road rage incidents is also needed. SUMMARY: In Ontario, the proportion of adults experiencing any road rage victimization decreased from 2001 to 2003 while the proportion reporting any road rage perpetration remained stable. IMPACT ON INDUSTRY: None.     

Is the effect of quantified road safety targets sustainable?

Recent studies have shown that the setting of road safety targets is associated with a substantial reduction in road fatalities in the short-term. Although such targets may not themselves be responsible for the reduction in fatalities, they serve as a useful measure of the intention and commitment of road authorities to formulate timely road safety measures that lead to the achievement of the target. A quantified target is regarded as one of the key components of a road safety strategy. However, few studies have examined the degree of commitment and attention of road authorities to such targets in the long-term. In this study, we revisit the effectiveness of the quantified road safety targets set by the Organisation for Economic Co-operation and Development (OECD) countries, but with a different method, time scale, and group of comparison countries. We not only evaluate the associations between quantified targets and road fatality levels, but also measure the changes in the time-series trends in road fatalities over the long-term. The results indicate that all seven treatment countries analyzed experienced desirable changes in the time-series trend in road fatalities during the period under study, which implies an increase in road safety improvement over time.     

Does the Maryland graduated driver licensing law affect both 16-year-old drivers and those who share the road with them?

PROBLEM: To assess effects of the 1999 Maryland graduated driver licensing (GDL) law on both 16-year-old drivers and other road users. METHOD: Calculation and comparison of crash involvement rates and non-fatal injury rates pre-GDL (1996-1998) and post-GDL (2001-2003) by type of road user, per population, and per licensed driver, with adjustment for trends among 30-59-year-old drivers. RESULTS: Post-GDL, prevalence of licensure decreased 24% among 16-year-olds, and rates of 16-year-old drivers involved in crashes significantly decreased per 16-year-old population (corrected rate ratio (RRc) 0.82; 95% CI (0.71, 0.96)). A significant decrease also was observed for non-fatal injuries per 16-year-old population among 16-year-old drivers involved in crashes (RRc 0.63; 95% CI (0.41, 0.98)). Similarly, decreases, albeit not statistically significant, were observed among their passengers and other vehicle occupants. Per 16-year-old licensed driver, a slight non-significant increase was observed in crash involvement rates; non-fatal injury rates per 16-year-old licensed driver suggest decreased risk (non-significant) among 16-year-old drivers, their passengers, and other vehicle occupants. SUMMARY: Maryland's GDL delayed licensure and reduced crashes and non-fatal injuries among 16-year-old drivers per population. Trends in injuries among other road users involved in crashes with 16-year-old drivers were suggestive of a benefit from GDL, although observed decreases were not significant. Per licensed driver, findings were not significant, but suggested little change in crash involvement and decreased non-fatal injuries. Because one-third fewer 16-year-olds were licensed post-GDL, these results may suggest a selection effect in licensure. IMPACT ON INDUSTRY: Because Maryland had nighttime restrictions for new drivers before 1999, this study suggests other components of GDL are beneficial for drivers and possibly for other road users. States with weak GDL laws should strongly consider revising them.     

Deprived neighborhoods and risk of road trauma (incidence and severity) among under 25year-olds in the Rhône Département (France)

Introduction

Previous research has shown that there are inequalities with regard to traffic accident risk between different social categories. This study describes the influence of the type of residential municipality (with or without deprived urban areas, “ZUS, zones urbaines sensibles”), used as an indicator of contextual deprivation, on the incidence and severity of road trauma involving people of under 25 years of age in the Rhône.

Method

Injury data were taken from The Rhône Road Trauma Registry. The study covers the 2004–2007 period, with 13,589 young casualties. The incidence of traffic injury of all severities were computed according to the type of municipality and the age, gender, and type of road user. The ratios of the incidences of deprived municipalities, compared with others were calculated. Subsequently the severity factors and incidences according to the severity level (ISS 1–8, ISS 9+) were studied.

Results

For the main types of road users except motorized two-wheeler users, the incidences were higher in the deprived municipalities: the greatest difference was for pedestrians, where the incidences were almost twice those of other municipalities. This excess risk, constituting a health inequality topic rarely considered, was even greater in municipalities with two or three ZUSs. It was essentially observed for minor injuries among motorists, cyclists, and pedestrians.

Conclusions

While the incidence increased among people less than 25 years of age, the severity of road injuries was lower in deprived neighborhoods, contrary to what is suggested by other studies. This lower severity disappeared when taking into account the crash characteristics.

Impact on industry

The incidence of injuries as a pedestrian, cyclist or motorist is higher among young people living in deprived municipalities. These areas should therefore be the targets of dedicated education programs, as well as further investigations about urban planning.     

Managers’ attitudes towards safety measures in the commercial road transport sector

Safety measures and related costs and benefits have been widely discussed and analysed in academic circles and by the authorities and industrial sectors. The study reported in this paper addresses these aspects from a cognitive based perspective. Risk management is about dealing with the conflict between production and safety. Enterprises which spend too much on safety will meet bankruptcy, and those not concerned with safety measures will meet with severe accidents and related damage. Inspired by James Reason’s theoretical framework, managers (n = 106) of commercial transport enterprises were asked about their attitudes towards safety management, what factors have contributed and their belief that further effort and investments in health, environment and safety (HES) measures will pay off. One half of the managers perceive HES work as too expensive and approximately one quarter assess mandatory HES work as compromising their competitiveness. One third of the managers do not find further safety measures than those already implemented necessary or remunerative. They claim that there are no other alternative ways of doing their activities and that there are no technical measures available that could meet outstanding safety challenges. Managers do acknowledge HES work as important for the reputation of the enterprise. The factor analysis gave five HES attitude factors: (I) concerned with formalities, (II) HES work improves health, environment and safety, (III) HES work is ineffective, (IV) HES regulation is appropriate, and (V) HES work can be improved.     

Understanding complex traffic road scenes: The case of child-pedestrians’ hazard perception

IntroductionUnderstanding the shortcomings of child-pedestrians in evaluating traffic situations may contribute to producing intervention techniques that may increase their awareness to potential hazards as well as inform and inspire designers of autonomous vehicle and infrastructure systems to deal with the complications of crossing pedestrians. Method: The present work examined pedestrians’ hazard-perception (HP) skills in complex traffic scenes. Two experiments explored how pedestrians’ HP abilities vary with age and experience. In the first, adults and youngsters (7–13-year-olds) were presented with pairs of photographs displaying traffic situations and instructed to compare between the hazard levels of the two. Findings revealed a marked trend where experienced-adults tended to rate photographs depicting field of view partially obscured by parked vehicles as more hazardous. Moreover, adults tended to rate photographs depicting vehicles closer to the crossing site as more hazardous. Lastly, adults tended to rate photographs depicting complex configurations like traffic circles, as more hazardous than T-junctions. Results: Findings suggested that youngsters may be highly influenced by cueing. Next, pedestrians’ HP was tested using a crossing decision task. Participants observed traffic scenes presented in a dynamic simulated environment of an urban road from a pedestrian’s perspective and pressed a response button whenever they assumed it was safe to cross. Compared to experienced-adults and 7–8-year-olds, 9–13-year-olds presented a less decisive performance. Compared to previous findings regarding simpler road crossing configurations, most participants, regardless of age, related more to the approaching vehicles and presence of a pedestrian crossing while refraining from addressing the road configuration. Implications for road-safety are discussed.     

“They’re lunatics on the road”: Exploring the normative influences of parents,friends, and police on young novices’ risky driving decisions

PurposeYoung novice drivers experience significantly greater risk of being injured or killed in car crashes than older more experienced drivers. This research utilised a qualitative approach guided by the framework of Akers’ social learning theory. It explored young novice drivers’ perspectives on risky driving including rewards and punishments expected from and administered by parents, friends, and police, imitation of parents’ and friends’ driving, and advantages and disadvantages of risky driving.MethodsTwenty-one young drivers (12 females, 9 males) aged 16–25 years (M = 17.71 years, SD = 2.15) with a Learner (n = 11) or Provisional (n = 10) driver licence participated in individual or small group interviews.Findings and conclusionsContent analysis supported four themes: (1) rewards and (2) punishments for risky driving, and the influence of (3) parents and (4) friends. The young novice drivers differed in their vulnerability to the negative influences of friends and parents, with some novices advising they were able to resist risky normative influences whilst others felt they could not. The authority of the police as enforcers of road rules was either accepted and respected or seen as being used to persecute young novices. These findings suggest that road safety interventions should consider the normative influence of parents and friends on the risky and safe behaviour of young novices. Police were also seen as influential upon behaviour. Future research should explore the complicated relationship between parents, friends, the police, young novices, and their risky driving behaviour.     

Can fear of going to jail reduce the number of road fatalities? The Spanish experience

The goal of this article is to evaluate the impact of the drastic Spanish Penal Code reform on the number of road deaths in Spain and the time that the effects might last. This is achieved by means of multivariate unobserved component models set up in a state space framework estimated using maximum likelihood. In short, with this reform Spain might be considered to be closing the final gap that kept it apart from other developed countries as far as the road accident rate is concerned. We have found two different types of effects on Spanish road traffic fatalities. Initially, a month before the reform was passed there was a 24.7 percent fall in Spanish road deaths. After the Bill had been passed and for the following thirteen months, the reduction stayed at a constant sixteen percent. This reform has reduced Spanish road fatalities by 534 in all between November 2007 and December 2008 and the effects will foreseeably continue during 2009.     

Road accident fatality risks for “vulnerable” versus “protected” road users in northern Ghana

Background: Road traffic injuries (RTIs) are a serious epidemic that claims more than a million lives across the globe each year. The burden of RTIs is particularly pronounced in Africa and other low- and middle-income countries. The unfavorable disparity of the burden of road trauma in the world is largely attributable to unsafe vehicles, lack of appropriate road infrastructure, and the predominance of vulnerable road users (VRUs) in developing countries. However, little research exists in northern Ghana to highlight the scale and risk of death among road users.

Objective: The objective of this research was to establish the relative risk of death among road users in northern Ghana.

Methods: Crash data from police reports between 2007 and 2011 were analyzed for the Upper Regions of Ghana. Conditional probabilities and multivariable logistic regression techniques were used to report proportions and adjusted odds ratios (AORs), respectively.

Results: Generally, crashes in northern Ghana were extremely severe; that is, 35% of all injury related collisions were fatal. The proportion of fatal casualties ranged between 21% among victims of sideswipe collisions and 41% among pedestrians and victims of rear-end collisions. Though males were 6 times more likely to die than females overall, females were more likely to die as pedestrians (90% of all female casualty deaths) and males were more likely to die as riders/drivers (78% of all male casualty deaths). Pedestrians were 3 times more likely to die (odds ratio [OR] = 3.1; 95% confidence interval [CI], 2.4 to 4.1) compared with drivers/riders. Compared with drivers, the odds of death among cyclists was about 4 times higher (AOR = 3.6; 95% CI, 2.3 to 5.6) and about 2 times higher among motorcyclists (AOR = 1.6; 95% CI, 1.2 to 2.2). Compared with casualties aged between 30 and 59 years, children under 10 years and those aged 60 years and above were independently 2 times more likely to die in traffic collisions.

Conclusion: Provision of requisite road infrastructure is vital for the safety of VRUs in northern Ghana. Cycle paths and lanes (for cyclists) as well as sidewalks (for pedestrians) in particular will separate VRUs from motorists and improve their safety. Enforcement of traffic laws particularly regarding helmet use, speeding, and alcohol use will be beneficial. Introduction of the demerit points system in the enforcement of traffic regulations may have significant deterrent effects on road users who have the penchant for violating traffic regulations. Road safety education is also required to create responsible road users.