Lower Leg Injury Reference Values and Risk Curves from Survival Analysis for Male and Female Dummies: Meta-analysis of Postmortem Human Subject Tests

Objective: Derive lower leg injury risk functions using survival analysis and determine injury reference values (IRV) applicable to human mid-size male and small-size female anthropometries by conducting a meta-analysis of experimental data from different studies under axial impact loading to the foot–ankle–leg complex.

Methods: Specimen-specific dynamic peak force, age, total body mass, and injury data were obtained from tests conducted by applying the external load to the dorsal surface of the foot of postmortem human subject (PMHS) foot–ankle–leg preparations. Calcaneus and/or tibia injuries, alone or in combination and with/without involvement of adjacent articular complexes, were included in the injury group. Injury and noninjury tests were included. Maximum axial loads recorded by a load cell attached to the proximal end of the preparation were used. Data were analyzed by treating force as the primary variable. Age was considered as the covariate. Data were censored based on the number of tests conducted on each specimen and whether it remained intact or sustained injury; that is, right, left, and interval censoring. The best fits from different distributions were based on the Akaike information criterion; mean and plus and minus 95% confidence intervals were obtained; and normalized confidence interval sizes (quality indices) were determined at 5, 10, 25, and 50% risk levels. The normalization was based on the mean curve. Using human-equivalent age as 45 years, data were normalized and risk curves were developed for the 50th and 5th percentile human size of the dummies.

Results: Out of the available 114 tests (76 fracture and 38 no injury) from 5 groups of experiments, survival analysis was carried out using 3 groups consisting of 62 tests (35 fracture and 27 no injury). Peak forces associated with 4 specific risk levels at 25, 45, and 65 years of age are given along with probability curves (mean and plus and minus 95% confidence intervals) for PMHS and normalized data applicable to male and female dummies. Quality indices increased (less tightness-of-fit) with decreasing age and risk level for all age groups and these data are given for all chosen risk levels.

Conclusions: These PMHS-based probability distributions at different ages using information from different groups of researchers constituting the largest body of data can be used as human tolerances to lower leg injury from axial loading. Decreasing quality indices (increasing index value) at lower probabilities suggest the need for additional tests. The anthropometry-specific mid-size male and small-size female mean human risk curves along with plus and minus 95% confidence intervals from survival analysis and associated IRV data can be used as a first step in studies aimed at advancing occupant safety in automotive and other environments.     

The Relationships Between Biomechanical and Postural Stresses,Musculoskeletal Injury Rates,and Perceived Body Discomfort Experienced by Industrial Workers: A Field Study

A combination of archival, subjective, and observational field data collection methods were used to investigate the relationship between biomechanical and postural stresses, and the resulting physical strain experienced by industrial workers of a packaging plant. Assessment of physical strain was based on the number and incidence rate of Occupational Safety and Health Administration (OSHA)-reportable injuries that were recorded over a period of 27 months, and based on the self-reported ratings of perceived body discomfort. Both the biomechanical and postural stresses correlated with the musculoskeletal injury rate. The results illustrate the usefulness of postural and biomechanical analyses for assessing the risk of injury in industry.     

基于事故数据分析推导的全国及化工行业可接受风险标准基准值研究

为了探索行业风险可接受现状,印证已颁布的可接受风险标准中标准基准值选取的可行性,基于可接受风险标准理论,通过搜集、分析及估算全国及化工行业最近10 a的基础事故数据,采用平均个人风险值法（AIR）和事故累计概率-死亡人数曲线（FN曲线）法的运算思想,确定了全国及化工行业的死亡、受伤及职业病风险个人/社会可接受标准基准值,并通过数据范围的选择将其分为宽松型、通用型及严格型3种不同“严格”程度的基准值以备不同条件下选用。研究结果表明:死亡标准基准值通过与已颁布的标准基准值进行对比后发现2者均处于同一量级（10-4）,印证了彼此的可行性,受伤及职业病标准基准值可为后期该领域的研究提供参考。     

Quantitative risk assessment of the Italian gas distribution network

European Critical Infrastructures include physical resources, services, information technology facilities, networks and infrastructure assets, which, if disrupted or destroyed would have a serious impact on the health, safety, security, economic or social well-being of the Member States.The gas distribution network is a critical infrastructure and its failure can cause damage to structures and injury to people.The aim of this paper is to analyze and then assess the risk of the Italian high pressure natural gas distribution network.The paper describes an application of a methodology for quantitative risk assessment.Failure frequencies considered in risk calculation were found in the European Gas pipeline Incident data Group (EGIG) database, whereas consequences were computed as a function of pipe diameter and operating pressure for each section of the network. The results of this quantitative risk assessment is the determination of local and social risks for the Italian North East Area.     

Integrated model of simulated occupant injury risk and real medical costs

Introduction

The purpose of this study was to develop an integrated methodology that links occupant injury risk functions, estimated in the laboratory, with real world medical treatment costs by using the abbreviated injury score (AIS). Using our model, the expected medical treatment costs for crash injuries to various body regions and of different severities can be investigated.

Methods

First, the simulation results are compared with NHTSA crash data. We used a modified kinematics simulation model that incorporates an F = E^b function as a supplement to the previous Steffan's model to obtain a more accurate acceleration history a(t). Second, head injury criteria HIC₃₆ can be calculated from a(t), and we use the injury probability P as a function of HIC_36, as proposed by Kuppa, to obtain the injury risk function for various AIS values. Third, medical treatment cost models for various AIS values can be calculated by using a regression cost model with real world data. Finally, the injury risk function and medical treatment cost models are linked through AIS values. We establish an integrated methodology and predict medical costs and car safety data using real world police reports, medical treatment costs, and laboratory simulation results.

Results

Using head injuries in frontal crashes as an example, we focus on simulation parameters for different vehicle models, with and without airbags. We specifically examine impact closing speed, Delta-V, and impact directions.

Conclusion

Simulation results can be used to supplement insufficient real crash data, in particular ΔV, and injury risk results from police crash reports.

Impact on industry

The proposed integrated methodology may provide the vehicle industry with a new safety assessment method. Real crash data coupling provides consumers with more realistic and applicable information.     

毒气泄漏扩散风险的参数不确定性分析

有毒气体泄漏扩散受很多不确定性因素的影响,为了分析和评估影响毒气泄漏扩散的风速和泄漏速率的变化和不确定性,采用蒙特卡罗模拟和基于Wilks公式容许限的非参数统计法,通过抽样计算得到“95/95准则”下的毒气泄漏扩散地面浓度分布,计算了有毒气体泄漏扩散的不同风险等级的影响范围和风险概率曲线。以氨气泄漏事故为例进行实例分析,结果表明,相对于以确定性参数得出的氨气泄漏扩散浓度分布,引入参数的不确定性评估,更能贴合泄漏现场存在不确定性因素的实际情况,更有利于人员的安全和应急疏散管理。     

Analysis of precipitation-related motor vehicle collision and injury risk using insurance and police record information for Winnipeg, Canada

Introduction

Police records are the most common source of data used to estimate motor-vehicle collision risks, understand causal or contributing factors, and evaluate the efficacy of interventions. The literature notes concerns about this information citing discrepancies between police reports and other sources of injury occurrence and severity data. The primary objective of the analysis was to assess the adequacy of police reports for an examination of weather-related injury collision risk.

Method

Analyses of relative risk were carried out using both police records and comprehensive insurance claim data for Winnipeg, Canada over the period 1999-2001.

Results and conclusions

Both data sets yielded very similar results—precipitation substantially increases the risk of injury collision (police records: RR 1.76, CI 1.55-2.00; insurance: RR 1.80, CI 1.62-1.99) and risk of injury (police records, RR 1.74, CI 1.55-1.96; insurance, RR 1.69, CI 1.55-1.85) relative to corresponding dry weather control periods. Both rainfall and snowfall were associated with large increases in collisions and injuries.

Impact on Industry

While relative risks are almost identical, over 64% more injury collisions and 74% more injuries were identified using the insurance data, which is an important difference for evaluating absolute risk and exposure.     

Pedestrian fatality and impact speed squared: Cloglog modeling from French national data

Objective: The present study estimates pedestrians' risk of death according to impact speed when hit by a passenger car in a frontal collision.

Methods: Data were coded for all fatal crashes in France in 2011 and for a random sample of 1/20th of all road injuries for the same year and weighted to take into account police underreporting of mild injury. A cloglog model was used to optimize risk adjustment for high collision speeds. The fit of the model on the data was also improved by using the square of the impact speed, which best matches the energy dissipated in the collision.

Results: Modeling clearly demonstrated that the risk of death was very close to 1 when impact speeds exceeded 80 km/h. For speeds less than 40 km/h, because data representative of all crashes resulting in injury were used, the estimated risk of death was fairly low. However, although the curve seemed deceptively flat below 50 km/h, the risk of death in fact rose 2-fold between 30 and 40 km/h and 6-fold between 30 and 50 km/h. For any given speed, the risk of death was much higher for more elderly subjects, especially those over 75 years of age. These results concern frontal crashes involving a passenger car. Collisions involving trucks are far less frequent, but half result in the pedestrian being run over, incurring greater mortality.

Conclusions: For impact speeds below 60 km/h, the shape of the curve relating probability of death to impact speed was very similar to those reported in recent rigorous studies. For higher impact speeds, the present model allows the curve to rise ever more steeply, giving a much better fit to observed data. The present results confirm that, when a pedestrian is struck by a car, impact speed is a major risk factor, thus providing a supplementary argument for strict speed limits in areas where pedestrians are highly exposed.     

Review: The Dynamics of Near Vertex Head Impact and its Role in Injury Prevention and the Complex Clinical Presentation of Basicranial and Cervical Spine Injury

The clinical presentation of cervical and basilar skull fractures following bead impact is often complex, particularly when multiple noncontiguous fractures are present. Based on the results of 22 human cadaver head-neck impact experiments, a biomechanical framework of spinal injury is developed in which these complex cases may be better understood. This includes the significance of head rebound, head and neck decoupling, cervical spine buckling, cervical injury mechanisms, basilar skull fractures, and cervical spine tolerance. These data also demonstrate that compliant pads significantly increase the risk for spinal injury though they also significantly reduce peak head force and the head injury criteria (p < 0.04). On the basis of these observations, we hypothesize that impact injury should be modeled as the dynamic response of two large masses, coupled by a segmented curved beam-column composed of seven small masses with interposed nonlinear viscoelastic flexibility elements.     

Effects of vehicle impact velocity, vehicle front-end shapes on pedestrian injury risk

Objective: This study aimed at investigating the effects of vehicle impact velocity, vehicle front-end shape, and pedestrian size on injury risk to pedestrians in collisions with passenger vehicles with various frontal shapes. Method: A series of parametric studies was carried out using 2 total human model for safety (THUMS) pedestrian models (177 and 165?cm) and 4 vehicle finite element (FE) models with different front-end shapes (medium-size sedan, minicar, one-box vehicle, and sport utility vehicle [SUV]). The effects of the impact velocity on pedestrian injury risk were analyzed at velocities of 20, 30, 40, and 50?km/h. The dynamic response of the pedestrian was investigated, and the injury risk to the head, chest, pelvis, and lower extremities was compared in terms of the injury parameters head injury criteria (HIC), chest deflection, and von Mises stress distribution of the rib cage, pelvis force, and bending moment diagram of the lower extremities. Result: Vehicle impact velocity has the most significant influence on injury severity for adult pedestrians. All injury parameters can be reduced in severity by decreasing vehicle impact velocities. The head and lower extremities are at greater risk of injury in medium-size sedan and SUV collisions. The chest injury risk was particularly high in one-box vehicle impacts. The fracture risk of the pelvis was also high in one-box vehicle and SUV collisions. In minicar collisions, the injury risk was the smallest if the head did not make contact with the A-pillar. Conclusion: The vehicle impact velocity and vehicle front-end shape are 2 dominant factors that influence the pedestrian kinematics and injury severity. A significant reduction of all injuries can be achieved for all vehicle types when the vehicle impact velocity is less than 30?km/h. Vehicle designs consisting of a short front-end and a wide windshield area can protect pedestrians from fatalities. The results also could be valuable in the design of a pedestrian-friendly vehicle front-end shape. [Supplementary materials are available for this article. Go to the publisher's online edition of Traffic Injury Prevention for the following free supplemental resource: Head impact conditions and injury parameters in four-type vehicle collisions and validation result of the finite element model of one-box vehicle and minicar. ].     

Development of injury risk models to guide CT evaluation in the emergency department after motor vehicle collisions

Abstract

Objective: The clinical evaluation of motor vehicle collision (MVC) victims is challenging and commonly relies on computed tomography (CT) to detect internal injuries. CT scans are financially expensive and each scan exposes the patient to additional ionizing radiation with an associated, albeit low, risk of cancer. Injury risk prediction based on regression modeling has been to be shown to be successful in estimating Injury Severity Scores (ISSs). The objective of this study was to (1) create risk models for internal injuries of occupants involved in MVCs based on CT body regions (head, neck, chest, abdomen/pelvis, cervical spine, thoracic spine, and lumbar spine) and (2) evaluate the performance of these risk prediction models to predict internal injury.

Methods: All Abbreviated Injury Scale (AIS) 2008 injury codes were classified based on which CT body region would be necessary to scan in order to make the diagnosis. Cases were identified from the NASS-CDS. The NASS-CDS data set was queried for cases of adult occupants who sought medical care and for which key crash characteristics were all present. Forward stepwise logistic regression was performed on data from 2010–2014 to create models predicting risk of internal injury for each CT body region. Injury risk for each region was grouped into 5 levels: very low (<2%), low (2–5%), medium (5–10%), high (10–20%), and very high (20%). The models were then tested using weighted data from 2015 in order to determine whether injury rates fell within the predicted risk level.

Results: The inclusion and exclusion criteria identified 5,477 cases in the NASS-CDS database. Cases from 2010–2014 were used for risk modeling (n?=?4,826). Seven internal injury risk models were created based on the CT body regions using data from 2010–2014. These models were tested against data from 2015 (n?=?651). In all CT body regions, the majority of occupants fell in the very low or low predicted injury rate groups, except for the head. On average, 57% of patients were classified as very low risk and 15% as low risk for each body region. In most cases the actual rate of injury was within the predicted injury risk range. The 95% confidence interval overlapped with predicting injury risk range in all cases.

Conclusion: This study successfully demonstrated the ability for internal injury risk models to accurately identify occupants at low risk for internal injury in individual body regions. This represents a step towards incorporating telemetry data into a clinical tool to guide physicians in the use of CT for the evaluation of MVC victims.     

Detection of the toughest: Pedestrian injury risk as a smooth function of age

Objective: Though it is common to refer to age-specific groups (e.g., children, adults, elderly), smooth trends conditional on age are mainly ignored in the literature. The present study examines the pedestrian injury risk in full-frontal pedestrian-to–passenger car accidents and incorporates age—in addition to collision speed and injury severity—as a plug-in parameter.

Methods: Recent work introduced a model for pedestrian injury risk functions using explicit formulae with easily interpretable model parameters. This model is expanded by pedestrian age as another model parameter. Using the German In-Depth Accident Study (GIDAS) to obtain age-specific risk proportions, the model parameters are fitted to the raw data and then smoothed by broken-line regression.

Results: The approach supplies explicit probabilities for pedestrian injury risk conditional on pedestrian age, collision speed, and injury severity under investigation. All results yield consistency to each other in the sense that risks for more severe injuries are less probable than those for less severe injuries. As a side product, the approach indicates specific ages at which the risk behavior fundamentally changes. These threshold values can be interpreted as the most robust ages for pedestrians.

Conclusions: The obtained age-wise risk functions can be aggregated and adapted to any population. The presented approach is formulated in such general terms that in can be directly used for other data sets or additional parameters; for example, the pedestrian's sex. Thus far, no other study using age as a plug-in parameter can be found.     

Age- and Sex-Specific Thorax Finite Element Model Development and Simulation

Objective: The shape, size, bone density, and cortical thickness of the thoracic skeleton vary significantly with age and sex, which can affect the injury tolerance, especially in at-risk populations such as the elderly. Computational modeling has emerged as a powerful and versatile tool to assess injury risk. However, current computational models only represent certain ages and sexes in the population. The purpose of this study was to morph an existing finite element (FE) model of the thorax to depict thorax morphology for males and females of ages 30 and 70 years old (YO) and to investigate the effect on injury risk.

Methods: Age- and sex-specific FE models were developed using thin-plate spline interpolation. In order to execute the thin-plate spline interpolation, homologous landmarks on the reference, target, and FE model are required. An image segmentation and registration algorithm was used to collect homologous rib and sternum landmark data from males and females aged 0–100 years. The Generalized Procrustes Analysis was applied to the homologous landmark data to quantify age- and sex-specific isolated shape changes in the thorax. The Global Human Body Models Consortium (GHBMC) 50th percentile male occupant model was morphed to create age- and sex-specific thoracic shape change models (scaled to a 50th percentile male size). To evaluate the thoracic response, 2 loading cases (frontal hub impact and lateral impact) were simulated to assess the importance of geometric and material property changes with age and sex.

Results: Due to the geometric and material property changes with age and sex, there were observed differences in the response of the thorax in both the frontal and lateral impacts. Material property changes alone had little to no effect on the maximum thoracic force or the maximum percent compression. With age, the thorax becomes stiffer due to superior rotation of the ribs, which can result in increased bone strain that can increase the risk of fracture. For the 70-YO models, the simulations predicted a higher number of rib fractures in comparison to the 30-YO models. The male models experienced more superior rotation of the ribs in comparison to the female models, which resulted in a higher number of rib fractures for the males.

Conclusion: In this study, age- and sex-specific thoracic models were developed and the biomechanical response was studied using frontal and lateral impact simulations. The development of these age- and sex-specific FE models of the thorax will lead to an improved understanding of the complex relationship between thoracic geometry, age, sex, and injury risk.     

Factors associated with higher levels of injury severity in occupants of motor vehicles that were severely damaged in traffic crashes in Kentucky, 2000-2001

OBJECTIVES: The majority of motor vehicle occupants who were killed or hospitalized in crashes in Kentucky in 2000-2001 occupied vehicles that were severely damaged in the crash. Even so, overall only a small percentage of all severely damaged vehicle occupants were killed or hospitalized. The purpose was to identify occupant, vehicle, crash, and roadway/environmental factors that were associated with increased risk of severe injury in crashes where the occupant's vehicle was severely damaged. METHODS: This study probabilistically linked Kentucky's statewide motor vehicle crash and inpatient hospital discharge data files for 2000 and 2001, and selected cases representing occupants of vehicles that were reported by police as having either "severe" or "very severe" damage. For occupants who were identified through data linkage as having been hospitalized, the Injury Severity Score (ISS) was calculated using ICDMAP-90 software, and the scores were stratified into the following categories: critical (>24), severe (15-24), moderate (9-14), and mild (<9). We then created an outcome variable, injury severity level, with five levels: killed; hospitalized with at least moderate injuries (ISS = critical, severe, or moderate); hospitalized with mild injuries (ISS = mild); injured according to the police report but not hospitalized; and no apparent injury according to the police report. We performed a stepwise, ordinal logistic regression of injury severity, using independent variables identified from the existing crash literature. RESULTS: Occupant risk factors for higher levels of injury severity selected by the regression were age (risk increased with age, other factors being equal), female gender, restraint non-use, ejection from the vehicle, and driver impairment (by alcohol and/or drugs). Crash risk factors included head-on collision, collision with a fixed object, vehicle rollover, and vehicle fire. Roadway/environmental factors were federal- or state-maintained roadway and posted speed limit 89 kph (55 mph) or greater. CONCLUSIONS: Many of the identified risk factors are explicitly or implicitly mentioned in the strategic plans of key organizations involved in highway safety and injury prevention in Kentucky. Our analysis provides additional evidence of their importance, and confirms that their mitigation will reduce injury severity in crashes involving severe vehicle damage. Additionally, older occupants and female occupants showed increased risks of serious injury, but to our knowledge these factors are not currently addressed in any state plans. An opportunity exists to clarify the nature of these risks through further studies, which might lead to the identification of countermeasures specific to these populations.     

系统安全风险描述研究

从安全风险研究角度系统描述部件状态、部件状态向量、系统状态、风险和风险矩阵、风险分类、系统状态风险、风险状态集、风险状态概率、风险转移概率、临界状态、关键部件和风险重要度,对系统安全风险有了更加全面深刻而准确的呈现,得到基于部件状态向量的系统安全风险描述,给出系统处于低中高风险的概率、风险转移临界集和安全风险重要度的计算方法。     

Socio-demographic and experience factors affecting drivers’ runoff risk along horizontal curves of two-lane rural highway

Introduction: An improper driving strategy is one of the causative factors for a high probability of runoff and overturning crashes along the horizontal curves of two-lane highways. The socio-demographic and driving experience factors of a driver do influence driving strategy. Hence, this paper explored the effect of these factors on the driver’s runoff risk along the horizontal curves. Method: The driving performance data of 48 drivers along 52 horizontal curves was recorded in a fixed-base driving simulator. The driving performance index was estimated from the weighted lateral acceleration profile of each driver along a horizontal curve. It was clustered and compared with the actual runoff events observed during the experiment. It yielded high, moderate, and low-risk clusters. Using cross-tabulation, each risk cluster was compared with the socio-demographic and experience factors. Further, generalized mixed logistic regression models were developed to predict the high-risk and high to moderate risk events. Results: The age and experience of drivers are the influencing factors for runoff crash. The high-risk event percentage for mid-age drivers decreases with an increase in driving experience. For younger drivers, it increases initially but decreases afterwards. The generalized mixed logistic regression models identified young drivers with mid and high experience and mid-age drivers with low-experience as the high-risk groups. Conclusions: The proposed index parameter is effective in identifying the risk associated with horizontal curves. Driver training program focusing on the horizontal curve negotiation skills and graduated driver licensing could help the high-risk groups. Practical applications: The proposed index parameter can evaluate driving behavior at the horizontal curves. Driving behavior of high-risk groups could be considered in highway geometric design. Motor-vehicle agencies, advanced driver assistance systems manufacturers, and insurance agencies can use proposed index parameter to identify the high-risk drivers for their perusal.     

The relationship between employees' perceptions of safety and organizational culture

PROBLEM: With limited resources to help reduce occupational injuries, companies struggle with how to best focus these resources to achieve the greatest reduction in injuries for the optimal cost. Safety culture has been identified as a critical factor that sets the tone for importance of safety within an organization. METHOD: An employee safety perception survey was conducted, and injury data were collected over a 45-month period from a large ready-mix concrete producer located in the southwest region of the United States. RESULTS: The results of this preliminary study suggest that the reductions in injuries experienced at the company locations was strongly impacted by the positive employee perceptions on several key factors. Management's commitment to safety was the factor with the greatest positive perception by employees taking the survey. DISCUSSION: This study was set up as a pilot project and did not unitize an experimental design. That weakness reduces the strength of these findings but adds to the importance of expanding the pilot project with an appropriate experimental design. SUMMARY: Management leadership has been identified, along with several other factors, to influence employee perceptions of the safety management system. Those perceptions, in turn, appear to influence employee decisions that relate to at-risk behaviors and decisions on the job. IMPACT ON INDUSTRY: The results suggest that employee perceptions of the safety system are related to management's commitment to safety, which, in turn, appear to be related to injury rates. Management should focus on how to best leverage these key factors to more positively impact injury rates within their companies.     

基于粗神经网络的管制员工作差错风险预警模型

针对空中交通管制员工作差错风险类型,指出指标体系建构过程的动态性特征,从个人、团队、设备、环境及管理几个方面,建构预警指标体系,运用粗糙集在数据挖掘方面的优势,通过基于属性重要度的启发式约简算法,提取关键指标,剔除冗余指标,可以实现在不丢失关键预警监控对象的情况下,结合BP人工神经网络构建实时预警模型,既有利于加快运算速度,又有利于进行重点监控.经过实例仿真,粗糙集与BP网络结合建构的预警模型,能有效针对管制员工作差错风险进行实时预警监控.     

Risk factors affecting injury severity determined by the MAIS score

Objective: Traffic crashes result in a loss of life but also impact the quality of life and productivity of crash survivors. Given the importance of traffic crash outcomes, the issue has received attention from researchers and practitioners as well as government institutions, such as the European Commission (EC). Thus, to obtain detailed information on the injury type and severity of crash victims, hospital data have been proposed for use alongside police crash records. A new injury severity classification based on hospital data, called the maximum abbreviated injury scale (MAIS), was developed and recently adopted by the EC. This study provides an in-depth analysis of the factors that affect injury severity as classified by the MAIS score.

Method: In this study, the MAIS score was derived from the International Classification of Diseases. The European Union adopted an MAIS score equal to or greater than 3 as the definition for a serious traffic crash injury. Gains are expected from using both police and hospital data because the injury severities of the victims are detailed by medical staff and the characteristics of the crash and the site of its occurrence are also provided. The data were obtained by linking police and hospital data sets from the Porto metropolitan area of Portugal over a 6-year period (2006–2011). A mixed logit model was used to understand the factors that contribute to the injury severity of traffic victims and to explore the impact of these factors on injury severity. A random parameter approach offers methodological flexibility to capture individual-specific heterogeneity. Additionally, to understand the importance of using a reliable injury severity scale, we compared MAIS with length of hospital stay (LHS), a classification used by several countries, including Portugal, to officially report injury severity. To do so, the same statistical technique was applied using the same variables to analyze their impact on the injury severity classified according to LHS.

Results: This study showed the impact of variables, such as the presence of blood alcohol, the use of protection devices, the type of crash, and the site characteristics, on the injury severity classified according to the MAIS score. Additionally, the sex and age of the victims were analyzed as risk factors, showing that elderly and male road users are highly associated with MAIS 3+ injuries. The comparison between the marginal effects of the variables estimated by the MAIS and LHS models showed significant differences. In addition to the differences in the magnitude of impact of each variable, we found that the impact of the road environment variable was dependent on the injury severity classification.

Conclusions: The differences in the effects of risk factors between the classifications highlight the importance of using a reliable classification of injury severity. Additionally, the relationship between LHS and MAIS levels is quite different among countries, supporting the previous conclusion that bias is expected in the assessment of risk factors if an injury severity classification other than MAIS is used.