Severity Of Road Traffic Injuries Research Articles

A Model-to-Decision Approach for the Autonomous Vehicle (AV) Ethical Dilemma: AV Collision with a Barrier/Pedestrian(s)

Abstract The introduction of autonomous vehicles (AVs) is expected to reduce the number of road traffic accidents; however, it is expected that this will not be completely incidents free. In the event of AV incidents, ethical decisions will need to be made, e.g. a decision between colliding into an immovable rigid barrier or a group of pedestrians. Selecting the collision target of such an ethical problem involves the investigation of a model-to-decision (M2D) approach. Thus using a mathematical model of the collision scenarios to make decisions based on the severity of each outcome, e.g. minor or severe and potentially fatal injuries. In this paper, a novel nonlinear (bilinear) lumped mass-spring model of an AV colliding into an immovable rigid barrier has been developed. This model is used in conjunction with a developed pragmatic ethical decision maker (EDM) approach. This research investigates the use of such an approach for AVs (containing one or two occupants) in collision scenarios involving the choice between colliding into an immovable rigid wall or into one/ten pedestrian(s). Assuming the utility of those involved in each outcome is equal, a possible solution to the ethical problem is known as the utilitarian approach; this leads to the AV steering into the collision path of least fatalities. To gain a better understanding of the public acceptance of how an AV EDM should be programmed in the case of collisions, a survey was undertaken. The results suggest that participants of the survey support the idea of AVs steering into the collision path of least overall severity, even if the number of persons at risk is greater. The results from the M2D approach highlight the effectiveness of using such an approach on-board future AVs to minimise the severity of road traffic injuries and/or the number of fatalities.

The ability of the ICD-AIS map to identify seriously injured patients in road traffic accidents—A study from Finland

Objective: In Finland, the severity of road traffic injuries is determined using the International Classification of Diseases, 10th Revision, Finnish Modification (ICD-10-FM) injury codes from Finnish Hospital Discharge data and the automatic conversion tool (ICD-AIS map) developed by the Association for the Advancement of Automotive Medicine (AAAM). The aim of this study was to evaluate the ability of the ICD-AIS map to identify seriously injured patients due to traffic accidents in Finnish injury data by comparing the severity rating generated by an expert and by the ICD-AIS map.Methods: Our data came from the North Kymi Hospital (level 2 trauma center at the time of the study). The data included 574 patients who were injured in traffic accidents during 2 years. The severity rating (Maximum Abbreviated Injury Scale [MAIS] 3+) of each patient was recorded retrospectively by an expert based on information from patient records. In addition, the rating was generated from ICD-10 injury codes by the ICD-AIS map conversion tool. These 2 ratings were compared by road user categories and the strength of agreement was described using Cohen’s kappa.Results: The proportion of seriously injured patients was 10.1% as defined by the expert and 6.6% as generated by the ICD-AIS map; exact agreement was 65.5%. The highest concordance was for pedestrians (exact agreement 100%) and the weakest for moped drivers and motorcyclists (46.7%). Furthermore, the overall strength of agreement of the severity ratings (slightly or seriously injured) between the expert and the ICD-AIS map was good (κ = 0.70). Most (65%) of the conversion problems were misclassifications caused by the simplicity of the Finnish ICD-10 injury codes compared to the injury codes used in the ICD-AIS map. In Finland, the injuries are recorded mainly with 4-digit codes and, infrequently, with 5-digit codes, whereas the ICD-AIS map defines up to 6-digit codes.Conclusions: For this sample of simplified ICD-10-FM codes, the ICD-AIS map underestimated the number of seriously injured patients. The mapping result could be improved if at least open and closed fractures of extremities and visceral contusions and ruptures had separate codes. In addition, there were a few injury codes that should be considered for inclusion in the map.

Road Traffic Injuries: A Study on Severity and Outcome among Inpatients of a Tertiary Care Level Hospital of West Bengal, India.

Background:Road traffic injuries (RTIs) are a complex phenomenon caused by nonlinear combination and interaction of man, vehicles, road, and environment.Aim:This study aims to find out the outcome and severity of RTI in a district of West Bengal, India.Settings and Design:A cross-sectional study was conducted among inpatients of Departments of Surgery and Orthopedics of Bankura Sammilani Medical College and Hospital, West Bengal, India.Materials and Methods:The study was conducted for 1 year interviewing 295 RTI selected through scheduled sampling. Information pertaining to demographic and correlates of RTI was collected by face to face and over telephone using semi-structured questionnaire. Nine-item Simplified Injury Severity Scale (SISS) was used to assess injury severity. Internal consistency of SISS scale was showed by Cronbach's alpha and association with the correlates was done by Mann–Whitney U-test.Statistical Analysis Used:With SPSS version 22.0, binary logistic regression, and Mann–Whitney U-test.Results and Conclusion:Fatal outcome in terms of death and permanent disability was 34.24% and they had higher marginally significant (P = 0.06), SISS score (45.17 ± 12.59). Participants with absence of protective devices, presence of comorbidities, drunkenness, with accidents over national highways, in-between 6 am and 6 pm, mechanized two-wheelers, and nonreceipt of first aid were found to have significantly high scores compared to their counterpart. SISS, as a proxy measure of severity assessment, could throw a light on it and awareness generation and legislative stringency might be need of the hour for the country.

Preventive effects of motorcycle helmets on intracranial injury and mortality from severe road traffic injuries

IntroductionRoad traffic injuries caused by motorcycle crashes are one of the major public health burdens leading to high mortality, functional disability, and high medical costs. The helmet is crucial protective equipment for motorcyclists. This study aimed to measure the protective effect of motorcycle helmets on clinical outcomes and to compare the effects of high- and low-speed motorcycle crashes. MethodsA cross-sectional observational study was conducted using a nationwide registry of severe trauma patients treated by emergency medical services (EMS) providers in Korea. The study population consisted of severe trauma patients injured in motorcycle crashes between January and December 2013. The primary and secondary outcomes were intracranial injury and in-hospital mortality. We calculated adjusted odds ratios (AORs) of helmet use and motorcycle speeds for study outcomes after adjusting for potential confounders. ResultsAmong 495 eligible patients, 105 (21.2%) patients were wearing helmets at the time of the crash, and 256 (51.7%) patients had intracranial injuries. The helmeted group was less likely to have an intracranial injury compared with the un-helmeted group (41.0% vs. 54.6%, AOR: 0.53 (0.33–0.84)). However, there was no significant difference in in-hospital mortality between the two groups (16.2% vs. 16.9%, AOR: 0.91 (0.49–1.69)). In the interaction analysis, there was a significant preventive effect of motorcycle helmet use on intracranial injury when the speed of the motorcycle was <30km/h (AOR: 0.50 (0.27–0.91)). ConclusionWearing helmets for severe trauma patients in motorcycle crashes reduced intracranial injuries. The preventive effect on intracranial injury was significant in low-speed motorcycle crashes.

A study to assess the factors associated with severity of road traffic injuries in the emergency medicine department in rural India

A study to assess the factors associated with severity of road traffic injuries in the emergency medicine department in rural India

Seat belt and mobile phone use among vehicle drivers in the city of Doha, Qatar: an observational study.

BackgroundIn Qatar traffic injuries and fatalities are of serious concern. Mobile phone use whilst driving has been associated with increased risk of vehicular collisions and injuries. Seat belt use has been demonstrated to save lives and reduce the severity of road traffic injuries. Whereas previously published studies may have looked at all front passengers, this study aims to obtain reliable estimates of the prevalence of seat belt and mobile phone use among vehicle drivers in the city of Doha, Qatar. Additionally, we aim to investigate the association of these behaviors with other variables namely gender, time of the day and type of vehicle.MethodsAn observational study on 2,011 vehicles was conducted in 2013. Data were collected at ten sites within Doha city over a two-week period. Two trained observers surveyed each car and recorded observations on a data collection form adapted from a form used in a 2012 Oklahoma observational study. Associations were assessed using the Chi-squared test or Fisher’s exact test. A p-value of .05 or less was considered statistically significant.ResultsOverall, 1,463 (72.7 %) drivers were found using a seat belt (95 % CI: 70.8–74.7 %) and 150 (7.5 %) their mobile phones (95 % CI: 6.3–8.6 %) during the observation period. Mobile phone use was significantly associated with not using a seat belt and driving a sport utility vehicle. Significantly lower rates of seat belt use were observed in the early morning and late afternoon. No gender differences were observed.DiscussionSeatbelt use in Doha was found to be similar to countries in the region but lower than those in western countries. Also, studies from other high-income locations, reported lower rates of mobile phone use while driving than in Doha.ConclusionsDespite road traffic crashes being one of the leading causes of death in Qatar, three out of 10 drivers in Doha, Qatar, do not use a seat belt and about one in 12 use a mobile phone while driving. More efforts, in the form of awareness campaigns and increased law enforcement, are needed to improve compliance with laws requiring seat belt use and prohibiting mobile phone use while driving.

Severe road traffic injuries in Kenya, quality of care and access.

Road traffic injuries (RTI) are on increase in developing countries. Health care facilities are poorly equipped to provide the needed services. Determine access and quality of care for RTI casualties in Kenya. Cross-sectional survey 53 large and medium size private, faith-based and public hospitals. In-patient road traffic crash casualties and health personnel in the selected hospitals were interviewed on availability of emergency care and resources. Onsite verification of status was undertaken. Out of 310 RTI casualties interviewed, 72.3%, 15.6% and 12.2% were in public, faith-based and private hospitals, respectively. Peak age of the injured was 15-49 years. First aid was availed to 16.0% of casualties. Unknown persons transported 76.5% of the injured. Police and ambulance vehicles transported 6.1% and 1.4%, respectively. 51.9% reached health facilities within 30 minutes of crash and medical care provided to 66.2% within one hour. 40.8% of recipient facilities were adequately prepared for RTI emergencies. Most RTI casualties were young and from poor backgrounds. Training of motorists and general public in first aid should be considered in RTI control initiatives. Availability of basic trauma care medical supplies in public health facilities was highly deficient.

The Role of Graduated Drivers' Licensing on Incidence and Severity of Road Traffic Injuries in Iran

The Role of Graduated Drivers' Licensing on Incidence and Severity of Road Traffic Injuries in Iran

Severe road traffic injuries and youth: a 4-year analysis for the city of Belgrade

The objective of this study is to describe severe road traffic injuries (RTIs) in the population under 18 years in Belgrade, the capital of Serbia. We analysed both severe non-fatal and fatal RTIs in children and adolescents under 18 years old in the Belgrade area, during the period 2008–2011. Data sources were the official statistics of the Public Health Institute in Belgrade and forensic-medical records from two paediatric university hospitals and five university hospitals for adults. Using descriptive statistical methods, demographic characteristics, mechanism, type and time of injuries, surgical treatment procedures, injury severity scores (ISS), length of stay and outcome were evaluated. The admission and mortality rates were calculated. Among the total of 379 injured, 256 (67.5%) were male; the average age was 13.0 ± 4.7 (range: 0–18 years). The annual hospital admission rate of RTIs for both sexes decreased in average by 12.6% (95% CI = 9.3%–15.9%). The mean percentage of annual changes of mortality rates was 2.0 %; 95% CI = 1.3%–5.3% (5.7 per 100,000 in 2008, 5.6 in 2009, 4.7 in 2010 and 5.9 in 2011). The highest admission rates and mortality rates were for pedestrians, followed by passengers and cyclists. Accidents occurred most commonly on Monday (18.7%). Among children hospitalised for traffic injuries, 57.8% had head and neck trauma, 30.6% extremity fractures, 5% abdominal injuries, 4.2% chest and 2.4% multiple injuries. The average ISS was 22.4 (SD = 20.4), ranging from 1 to 75. Alcohol in blood was confirmed in 7.4% males and 3.3% females (p > 0.05). The average time of hospital stay was 8.8 days (SD = 16.7), ranging from 1 to 14. The increased rates require implementation of a well-defined national strategy in our country.

Impact of the Penalty Points System on Severe Road Traffic Injuries in Kuwait

Objective: This study aimed to examine the effect of a penalty points system (PPS) implemented in early July 2006 on the number of severe road traffic injuries (RTIs) in Kuwait. Methods: Monthly counts of RTIs that occurred between January 2003 and December 2009 were analyzed. We used an interrupted seasonal autoregressive integrated moving average model (SARIMA) to estimate the intervention parameter along with its 95 percent confidence interval (CI) after accounting for seasonal and trend components in the data series. Based on the SARIMA model, we computed the number of RTIs that would have occurred post-PPS for 42 months after July 1, 2006, if it had not been implemented. Results: During the study period, a total of 4696 RTIs occurred. The Poisson rates of injuries (per 10 million of mean mid-year population and per 10 million of annual mean number of registered vehicles) were significantly (P < .001) lower in the post-PPS (λpost-PPS = 7 and 16, respectively) than the pre-PPS (λpre-PPS = 9 and 23, respectively) implementation period. The intervention parameter's estimate was −7.68 (95% CI: −14.77, −0.60), suggesting that 322 (95% CI: 25, 620) individuals would have had RTIs in the 42 months post-PPS enactment, had it not been implemented. This translates to a 14.6 percent (95% CI: 1.1%, 28.0%) reduction. Conclusions: These findings suggest that PPS implementation in Kuwait appears to have resulted in a significant reduction in the number of RTIs in the ensuing period. Therefore, PPS seems a feasible and effective approach in reducing RTIs in Kuwait and other countries in the region, if adequately implemented. Future studies may focus on evaluating the long-term effects of PPS implementation.

Health consequences of road accidents: insights from local health authority registries.

Road accidents are a major public health problem that affect all age groups but their impact is most striking among the young. The aim of this study is to quantify the burden of road traffic injuries, their mortality and direct in-patient economic costs and to identify the age classes at highest risk for severe road traffic injuries, through analysis of data collected by information systems of an Italian Local Health Authority. The study was conducted in a Local Health Authority of Veneto Region. Injured people were selected from Emergency Department (2006-2010). Data were linked to the Hospital Information System for hospital admissions and to the Mortality Registry to check 30-day mortality. The direct costs associated to hospitalizations were estimated through Diagnosis Related Group reimbursement rates. Multivariate analysis was performed using hospitalization and mortality as the dependent variables and gender, age, day of week when accident occurred as the independent variables. Traffic injury, hospitalization and mortality incidence rates were calculated by gender and age per 100,000 residents per year. The road traffic injuries were 9,192, decreasing from 2,112 in 2006 to 1,980 in 2010. Among injured persons 55.3% were male (68.1% among 15-19 age class); 41.7% young people aged 15-34 years (43.9% among male, 39.0% among female). Total hospitalisation rate was 5.9%. Overall mortality rate was 0.3% (0.9% among aged 65 or older). The cost of hospital admission was euro 2,742,505 (hospitalization mean cost euro 5,097). Risk of hospitalization and death was higher in male, in elderly and during week end. Young people aged 15-19 had the highest incidence of visits (2,258.4 per 100,000) and high hospitalisation weekend and mortality rates (respectively 101.5 and 8.5). Analysis at local level, using current data sources, permits to estimate the burden of injuries caused by road-traffic, to describe the characteristics of injured persons and finally to estimate costs of care. All this information could be used to make the population aware of its own risk for road accidents. Linkage of these data with police and transport data is required to focus prevention on higher risk groups and to adopt effective local road safety strategies.

Risk differences between children and adults in road traffic injuries

Our study attempted to describe the differences in circumstances, risk groups, and severity of road traffic injuries (RTIs) among injured children (1-15 years) and adults (≥16 years) coming to the tertiary-care hospital, Karachi, Pakistan. Past medical records from June 2006 to May 2007 of injured patients coming to the Emergency Department of the Aga Khan University Hospital, Karachi were reviewed. Data were recorded regarding the basic epidemiological features, hospital stay, body parts that are injured, and severity of injuries. Of 411 RTI patients, males outnumbered females by a ratio of 4 : 1 accounting for 81% (n = 333) of injured. Among pedestrians (82; 20%), females were injured more than males (38 vs. 16%; P < 0.01). When compared with adults, injured children were mostly pedestrians (18 vs. 36%; P = 0.01) and presented with severe Glasgow Coma Scale (GCS) (9 vs. 18%; P = 0.02). Among adults, most RTIs were caused by two wheelers crashing with four wheelers (16 vs. 19%; P = 0.01). Motor vehicle occupants (adjusted odds ratio: 3.04; 95% confidence interval: 1.382-6.668) were more likely to have severe GCS (GCS < 8) even after adjusting for injury severity. The study may assist local authorities in Karachi to prioritize interventions to address common injuries among those who are at a high risk for RTIs. Further quantitative and qualitative studies are needed to assess the factors leading to RTIs among pedestrians in Karachi.

Factors associated with severity of road traffic injuries, Thika, Kenya

Road traffic injuries continue to exert a huge burden on the health care system in Kenya. Few studies on the severity of road traffic injuries have been conducted in Kenya. We carried out a cross-sectional study to determine factors associated with severity of road traffic injuries in a public hospital in Thika district, Kenya. Road crash victims attending the Thika district hospital, a 265-bed public hospital, emergency room were recruited consecutively between 10th August 2009 and 15th November 2009. Epidemiologic and clinical information was collected from medical charts and through interview with the victims or surrogates using a semi-structured questionnaire. Injuries were graded as severe or non-severe based on the Injury Severity Score (ISS). Independent factors associated with injury severity were assessed using multivariate logistic regression. The mean age of participants was 32.4 years, three quarters were between 20-49 years-old and 73% (219) were male. Nineteen percent (56/300) of the victims had severe injury. Five percent (15) had head injury while 38% (115) had fractures. Vulnerable road users (pedestrians and two-wheel users) comprised 33% (99/300) of the victims. Vulnerable road users (OR=2.0, 95%CI=1.0-3.9), road crashes in rainy weather (OR=2.9, 95%CI=1.3-6.5) and night time crashes (OR=2.0, 95%CI=-1.1-3.9) were independent risk factors for sustaining severe injury. Severe injury was associated with vulnerable road users, rainy weather and night time crashes. Interventions and measures such as use of reflective jackets and helmets by two wheel users and enhanced road visibility could help reduce the severity of road traffic injuries.

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

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

Crash-related factors associated with the severity of road traffic injuries in Iran

Although the impact of traffic crashes is very high in Iran, there are few works on the association of crash-related factors with injury severity. This study was conducted on 145 drivers injured on the Qazvin-Loshan road in order to assess this association. The New Injury Severity Score (NISS), based on the conditions of the injured drivers during their first visit to regional hospitals, was used as the main outcome measure. Multiple linear regression analysis was performed by considering logarithmic scale for NISS as response variable and adjusting for the confounding effects, including the transfer to hospital variables. The results showed that high-vehicle damage (i.e. damage with repair cost more than 25% of the pre-crash value of the driver's vehicle) and being trapped inside the motor vehicle raised the NISS by 5.25 (95% confidence interval (CI) 2.51–10.71) and 2.34 (95% CI 1.20–4.67), respectively.

A hospital-initiated multisectoral road safety campaign with speed-adapted coconut drop test in Northern Laos

We investigate the efficacy of a multisectoral road safety campaign initiated at Luang Namtha Provincial Hospital (LNPH), North-Laos. Road safety days (RSD) with helmet promotion were organised prior to the Lao and International New Year 2007. Motorbike helmet protectiveness was demonstrated by dropping peeled versus unpeeled coconuts from 6-m high sticks simulating city speed-limit (40 km/h). The primary outcome was the number of road traffic injuries (RTI) needing admission (severe RTI) before and after the first RSD. Secondary outcomes were helmet usage, total RTI, hospital staff's behavioural changes and law enforcement. Neighbouring Bokeo Provincial Hospital (BPH) had no intervention. Severe RTI dropped by 34.7% within 12 months (from 449 to 293, p ≤ 0.0001, BPH +123% [from 88 to 196]). Total RTI increased by 10.8% (from 772 to 855, p = 0.0396, BPH +260.8% [from 186 to 671]). Police started the law enforcement right after the RSD. Helmet use increased from 11.2 to 42.5% (p < 0.0001). Coconut test was the main reason for safer behaviour among RSD participants seven months later (16/32). The intervention effectively prevented severe RTI. The speed-adapted coconut drop test was a simple, convincing and efficient educational tool, easily adaptable to other settings.

Association of provisional driver licensing intervention by police with changes in incidence and severity of road traffic injuries in Iran

ObjectiveThis study was conducted to evaluate the role of provisional driving license implemented by the traffic police of Iran on reducing the incidence and severity of road traffic injuries.MethodsIt was...

Road traffic injuries in one local health unit in the Lazio region: results of a surveillance system integrating police and health data

ObjectiveDifferent sources are available for the surveillance of Road Traffic injuries (RTI), but studied individually they present several limits. In this paper we present the results of a surveillance integrating healthcare data with the data gathered by the municipal police in the southeastern area of Rome (630,000 inhabitants) during the year 2003.MethodsThe Municipal police RTI reports, which list the exact location, circumstances and some risk factor of the crash, were searched in the emergency visit, hospitalization and mortality databases, to integrate them with the information on health consequences.A multivariate analysis was conducted to evaluate risk factors (crash circumstances, age ad gender of the casualty) associated with hospital admission following a RTI.Mapping of RTI locations was created. The locations with higher risk of accidents with severe health consequences and at higher risk for pedestrians were identified.ResultsAccording to police records 4571 RTI occurred in 2003, 75% of which led to emergency department admissions. Sixteen percent of these emergency visits ended in hospitalization, and 44 deaths were reported within 30 days of the event, most of which occurred in young men.The people with the highest risk of hospitalization after an RTI were the cyclists, pedestrians and followed by people on two-wheeled vehicles. The type of crash with the highest risk of hospitalization was head-on collision.Geographical analyses showed four clusters with higher severity of RTI. Specific attention was paid to pedestrian injuries. Analyzing the locations of RTIs involving pedestrians permitted us to rank the most dangerous streets. The roads at high risk for pedestrians identified problems in the bus stop constructions and in the placement of the zebra pedestrian crossings.ConclusionThis study proves the feasibility of an integrated surveillance system of RTI by using routinely collected local data. The high-risk locations identified with the geographic analyses method in this study highlighted infrastructural problems, suggesting immediate preventive interventions.

Long-term follow-up and consequences for severe road traffic injuries—treatment costs and health impairment in Sweden in the 1960s and the 1990s

The purpose of this study is to provide information from two prospective long-term follow-ups for severe road traffic injuries in Sweden. The long-term consequences, in terms of loss of health and costs of care, are presented for severe injuries in Sweden in the early 1990s and are compared with information on injury severity and health care utilisation 25 years ago. The follow-up in the 1990s show that, 1 year after the accident 38% of the non-fatal adults were suffering of some functional disability, pain and distress. Adults suffering from long-term loss of health decreased to 23% on average 3.7 years after the accident. The average health care cost was estimated to SEK46 200 (in 1995 prices), and the average in-patient care was 10 days. However, when also including subsequent expected life-long care for three severely injured patients, the average incidence-based health care cost was estimated to SEK100 300. In the 4–5 year follow-up 25 years ago, severe traffic injuries were treated on average 21 days in hospital and 38% of the adults were still suffering from long-term physical effects. Conclusions to be drawn are that treatment in hospital of severe traffic injuries has shortened by half and long-term consequences have not been worsened. Our results indicate that long-term effects do not cause as serious loss of health nowadays as they did 25 years ago.

Major Differences in Trauma Care between Hospitals in Sweden: A Preliminary Report

The quality of trauma care has been studied at five different Swedish hospitals. The results suggest that improvements in the quality of medical care for patients with severe road traffic injuries can be achieved by reorganizing the highly decentralized trauma care system in Sweden. Above all there is a need for a better structure and organization of the on-call system and of the cooperation of physicians of different specialties within the hospital. The medical care of patients with severe injuries was delayed in 30% and was inappropriate in 7% of cases. Assessment of the quality showed great variation between the hospitals. The medical care was in fact not best at the university hospital but at one well-functioning small hospital. It was an effect of an on-call system at the small hospital, which guarantees rapid participation of senior staff in both general surgery and orthopaedic surgery. The greatest problems arose in early diagnosis and treatment of bleeding in abdominal injuries. This was caused by inexperience in the first on-call team in combination with late assessment by second on-call consultants. Fractures of the femoral shaft in almost half of the cases did not get definitive surgery until several days after the accident.