Swedish Traffic Accident Data Acquisition Research Articles

Reversing accidents involving pedestrians: an epidemiological investigation and cluster analysis using a novel database derived from Swedish National Register data

Objectives In contemporary urban environments, the intersection between Vulnerable Road Users, specifically unprotected pedestrians, and motor vehicles poses a persistent challenge to road safety. Reversing accidents, characterized by vehicles moving backward, often result in severe consequences for pedestrians due to limited visibility and inherent blind spots for the driver. This paper aims to provide a thorough examination of reversing accidents involving pedestrians in Sweden between 2000–2021; shedding light on the magnitude of the problem, contributing factors, consequences, and potential mitigation strategies. Method Using a national database, reversing accidents were compiled by classifying free text descriptions of traffic accidents reported to the Swedish Traffic Accident Data Acquisition. The database was then used to describe reversing accidents and their consequences for struck pedestrians using descriptive epidemiology and cluster analysis. Results The results show that reversing accidents accounted for 12% of all pedestrians injured in a collision with a motor vehicle in Sweden during the studied period. In terms of personal characteristics, the struck pedestrians were more often female and of old or young age, whilst the drivers of the reversing vehicles were more often between 18–54 years and men. Most accidents were non-fatal, with only roughly 2% resulting in fatalities. Through a cluster analysis, four distinct accident types were identified. Two of these were identified as particularly important to prioritize in future preventative work: accidents that are characterized by occur during daylight hours in the urban environment (often low speeds) and often result in fatality or serious injury. Conclusions Due to the low speeds, reversing accidents are rarely fatal. However, they account for a large proportion of accidents with pedestrians and can be grouped into clearly distinguishable accident types that can function as templates in road safety development in Sweden.

Rollator related pedestrian single accidents and collision events in Sweden

Rollators (four-wheel walkers in USA; zimmer frames in UK) are commonly used as mobility aids for the elderly and people with a variety of disabilities. Pedestrian rollator users are a sub-group of Vulnerable Road Users (VRUs), although this group is rarely recognised in traffic safety contexts. The aim of this study is to extract and analyse rollator related pedestrian accident and injury data in Sweden. The results will provide valuable insight into the risks and obstacles rollator users are exposed to in the traffic environment and may in the long term contribute to improving the mobility of this group. The current study is based on data from 2,020 accidents involving 2,305 persons extracted from the Swedish Traffic Accident Data Acquisition (STRADA) database. For consistency reasons, a subset of data (N = 745) was analysed in order to investigate the development of accidents over a period of 10 years. Thereafter, each accident in the whole data set was registered as either single or collision. The results show that the number of rollator accidents in Sweden increased by approximately 80% during 2007–2016. Females dominate the injury statistics of single accidents, collisions, as well as fatal outcome, which may be due to exposure and/or differences in physical characteristics. Single accidents are much more common than collisions (n=1,668 and n=352, respectively) and the injury consequences are at least as serious. Data from the present study have revealed that the frequency of minor injuries (ISS 1–3) is 4.3 times, moderate (ISS 4–8) 6.0 times and serious injuries (ISS 9–15) 8.9 times higher in single accidents than in collisions. Fatal injuries are, however, more common in collision events (33 in comparison to 8). The vast majority of single accidents (99%) was due to falls. Many of the single accidents (29%) were caused by ground level differences (typically a curb) or due to surface conditions (19%). Collisions involved cars, trucks or buses in 91% of cases, occurring predominantly in car parks (31%) and on (zebra) crossings (30%). In 54% of cases the vehicles reversed into the rollator. Abbreviated Injury Scale (AIS) 3+ injuries were dominated by head (36%) and torso (33%) injuries in collision events, and hip fractures (71%) in single accidents. The present study shows that further research into rollator user related accidents, both single accidents and collision events, is required. In order to introduce appropriate measures, future work should follow up on accident and injury developments and further improve the quality of mobility aid related accident data in general. Improved stability and design, proper training programmes, effective maintenance services, development of a supporting infrastructure would contribute to increased safety for rollator users.

Effects on crash risk of automatic emergency braking systems for pedestrians and bicyclists

Objective The first automatic emergency braking (AEB) system was presented in 2003 and aimed to mitigate or reduce rear-end crashes. Since then, several AEB systems aimed to reduce other collision types have been introduced and studies have shown that they reduce crash risks. The aim with this study was to evaluate crash reductions of cars fitted with AEB systems with pedestrian detection and those with bicyclist detection. Methods The study is based on the Swedish Traffic Accident Data Acquisition that includes road traffic accidents reported by the police and by emergency hospitals. Crashes occurring between 2015 and 2020 and with cars from model years 2015 to 2020 were included. The statistical analysis used odds ratio calculations with an induced exposure approach where the outcomes of sensitive and nonsensitive crashes were studied. The sensitive crashes were hit pedestrians and bicyclists, respectively. The nonsensitive crash type in both comparisons was struck vehicles in rear-end crashes. Evaluations were also made for different light and weather conditions and for high and low speed roads. Results Seven hundred and twelve hit pedestrians and 1,105 hit bicyclists were included, and the nonsensitive crashes consisted of 1,978 vehicles. The overall reduction on crash risk for AEB with pedestrian detection was 8% (±15%; ns) and for AEB with bicyclist detection it was 21% (±17%). When separating for light conditions, no reduction in crash risk for AEB with pedestrian detection nor for AEB with bicyclist detection could be seen in darkness. However, in daylight and twilight conditions, AEB with pedestrian detection reduced pedestrian crash risk by 18% (±19%; ns) and AEB with bicyclist detection reduced bicyclist crash risk by 23% (±19%). No significant reductions could be seen when separating for weather conditions except for a 53% (±31%) reduction for bicyclists in rain, fog, and snowfall. A larger reduction on high-speed roads (50–120 km/h) compared with low-speed roads (10–40 km/h) was also found. Conclusions AEB systems with bicyclist detection were found to reduce the numbers of hit bicyclists, especially in daylight and twilight conditions. In darkness, no reduction for hit pedestrians or bicyclists was found.

Electric scooter accidents leading to emergency department visits: influence of alcohol and outcomes in Stockholm, Sweden

Electric scooters are a popular form of transportation, but accidents have increased with increased usage over the last years with rising health care costs as a consequence. This study aims to quantify accidents associated with the use of alcohol and to compare injuries at the emergency department (ED) among patients who have been involved in an accident involving an electric scooter. We used data from a multi-center retrospective registry-based cohort in the Swedish Traffic Accident Data Acquisition. We included all patients that had been involved in an electric scooter accident needing a visit to all EDs in Stockholm, Sweden during 2019–2020. Data on alcohol intake was manually drawn from medical files. Out of all of the 369 patients, the majority were men (n = 223, 60%) and aged below 30 years (n = 181, 49%). In all, 102 (28%) of the patients had a positive history of alcohol intake prior to the accident. Patients with alcohol intake more often arrived nighttime than those without alcohol, via ambulance (40% and 24%, respectively, p-value < 0.01). Those with alcohol intake needed to be admitted to hospital from the ED instead of being discharged more often than those withour alcohol (17% and 9%, respectively, p-value < 0.05) even if the majority still had minor injuries. Every 33,000 trips on electric scooters are statistically accompanied by an accident leading to an ED visit. We conclude that accidents with electric scooters are often associated with alcohol intake. They often demand more resources, such as an ambulance transfer and admission to hospital, and involve multiple injuries, compared to those without alcohol intake.

Car accidents in drivers with Parkinson's disease or multiple sclerosis: A Swedish nationwide study.

Parkinson's disease (PD) and multiple sclerosis (MS) can impair driving. However, we lack evidence on car accidents associated with these diseases. The aims of this study were to examine what types of car accident were associated with drivers with PD and MS, compared to individuals with ulcerative colitis (UC; the comparison group), and to evaluate the occurrence of car accidents in relation to years since diagnosis. This retrospective nationwide, registry-based study included drivers involved in car accidents between 2010 and 2019, based on the Swedish Traffic Accident Data Acquisition database. Data on pre-existing diagnoses were retrieved retrospectively from the National Patient Registry. Data analyses included group comparisons, time-to-event analysis, and binary logistic regression. In total, 1491 drivers, including 199 with PD, 385 with MS, and 907 with UC, were registered to have been involved in a car accident. The mean time from diagnosis to the car accident was 5.6 years for PD, 8.0 years for MS, and 9.4 years for UC. Time to car accident since diagnosis differed significantly (p < 0.001) among groups (adjusted for age). Drivers with PD had more than twice the odds of a single-car accident than drivers with MS or UC, but no differences were observed between MS and UC. Drivers with PD were older and experienced the car accident within a shorter timeframe after disease diagnosis. Although several factors may cause a car accident, fitness to drive could be more thoroughly evaluated for patients with PD by physicians, even early after the diagnosis.

Fall- and collision-related injuries among pedestrians in road traffic environment – A Swedish national register-based study

Objective: To investigate the burden of pedestrian injuries, including pedestrian fall injuries (PFI), compared to other transport-related injuries in Sweden and document their characteristics in terms of demographics, causes, type of injuries, and severity level with a focus on long-term consequences. Methods: Data were retrieved from the national Swedish Traffic Accident Data Acquisition register. A total of 361,531 fatalities and injuries were reported by emergency hospitals during 2010–2019, of which 127,804 were pedestrians (35%). We assessed the magnitude of PFIs and conducted comparative analyses to assess differences compared to other types of road users regarding sex, age, severity level, injury circumstances, hospital care, causes of accidents, and type of injuries. Results: Pedestrians were the second largest group of traffic-related deaths in Sweden after car occupants and accounted for just over a quarter of all fatal accidents in the road traffic environment. Of the total number of pedestrian fatalities, three out of four have been in collision accidents and the others in fall-related accidents. In terms of injuries, pedestrians were the largest group among all road users, regardless of the type of accident. PFIs accounted for a third of all injuries in the road traffic environment and nearly half of all injuries resulting in permanent medical impairment (i.e., 2.2 times more long-term consequences among PFIs compared to injured car occupants). Females (particularly middle-aged and older) and older adults were overrepresented, and most PFIs occurred on urban and municipal roads. The causes were often related to maintenance (e.g., slippery surfaces such as ice, snow, leaves or gravel together with uneven pavements and roads are the cause three out of four of PFIs). Among collision injuries, the representation was almost equal for sex and age. Conclusions: Injuries and fatalities among pedestrians are a considerable issue in the road traffic environment in Sweden. Contrary to other traffic groups, the incidence has not decreased over time, meaning that this issue must be met with specific measures and address the specific risk factors they are associated with. Practical Application: Including fall accidents in the definition of traffic accidents increases the chances of getting better information about the accidents and taking preventive measures.

Identifying individual-based injury patterns in multi-trauma road users by using an association rule mining method

In many road crashes the human body is exposed to high forces, commonly resulting in multiple injuries. This study of linked road crash data aimed to identify co-occurring injuries in multiple injured road users by using a novel application of a data mining technique commonly used in Market Basket Analysis. We expected that some injuries are statistically associated with each other and form Individual-Based Injury Patterns (IBIPs) and further that specific road users are associated with certain IBIPs. First, a new injury taxonomy was developed through a four-step process to allow the use of injury data recorded from either of the two major dictionaries used to document anatomical injury. Then data from the Swedish Traffic Accident Data Acquisition, which includes crash circumstances from the police and injury information from hospitals, was analysed for the years 2011 to 2017. The injury data was analysed using the Apriori algorithm to identify statistical association between injuries (IBIP). Each IBIP were then used as the outcome variable in logistic regression modelling to identify associations between specific road user types and IBIPs. A total of 48,544 individuals were included in the analysis of which 36,480 (75.1%) had a single injury category recorded and 12,064 (24.9%) were considered multiply injured. The data mining analysis identified 77 IBIPs in the multiply injured sample and 16 of these were associated with only one road user type. IBIPs and their relation to road user type are one step on the journey towards developing a tool to better understand and quantify injury severity and thereby improve the evidence-base supporting prioritisation of road safety countermeasures.

Electric scooters accidents: Analyses of two Swedish accident data sets

Since august 2018 electric scooters (e-scooters) are available in selected cities in Sweden, operated by several different operators. There is a growing concern regarding their safety as they grow in popularity. The aim with this study was to investigate injuries associated with e-scooters in Sweden and to identify accident characteristics. In addition, the aim was to observe how different data collection procedures and samples may influence the results. Two complementary data sets were used; insurance data including all reported injuries to Folksam Insurance Group during the period January 2019 to May 2020 and the Swedish Traffic Accident Data Acquisition database (STRADA), the national system for road traffic injury data collection, was used to study accident related to e-scooter use in the Stockholm city area between May and the end of August 2019. Most of the injuries associated with e-scooters occurred in single crashes, but in 13% of the accidents another road user was injured, either due to interactions with e-scooters or due to a parked e-scooter being a hazard. In both data sets more than half of the accidents occurred during weekends. In total 46% of all who had visited an emergency department the accident occurred during night-time (10 pm to 6 am). The overall large proportion of injuries to the head and face indicates the need for actions aimed to increase helmet use among e-scooter riders. Local authorities should take a wider responsibility since one third of all accidents primarily occurred due to lack of maintenance or that the rider hit a curb stone. In comparison to hospital data, insurance claims include riders with all types of injuries irrespectively what type of healthcare the rider was seeking. Hence, to better understand the consequences and to make the right decisions regarding countermeasures aimed to improve the safety of e-scooter riding, data from different data source are needed.

Quality of life following road traffic injury: the impact of age and gender

PurposeThe impact of road traffic crashes on health is well developed, in terms of deaths and direct consequences, but it is less so in terms of long-term life consequences. Few studies have compared the general impact on Health Related Quality of Life (HRQoL) following road traffic injury (RTI) by using a variety of different injured body parts and severity levels of the injury and compared them with a sample of non-injured referent individuals. Consequently, the aim of the current study is to assess how injury severity is associated with HRQoL, and if it differs between men, women, over age and injured body parts.MethodsThis cross-sectional study identified people with a RTI in the Swedish Traffic Accident Data Acquisition System (STRADA). A frequency matched reference group was also included. Data include both register data and self-reported HRQoL data.ResultsA total of 1788 out of 4761 persons with an RTI (37.6%) and 2186 out of 4761 reference persons (45.9%) returned the questionnaire, giving a total response rate of 41.9% (n = 3974). The findings show different patterns of HRQoL loss, depending on sex, age, injured body part, and levels of injury severity.ConclusionThe results show that even relatively minor road traffic injuries can lead to a significantly lower of HRQoL, especially for women, compared to the non-injured reference group. Moreover, when the inherent reduction of HRQoL over age was considered, the results indicated that younger individuals have a larger difference from the reference group in HRQoL, independent of the injury severity, compared to the older individuals; hence, an improved understanding of age and gender differences in HRQoL following an RTI is needed to better understand the long-term consequences of injuries from a public health perspective.

What types of injuries did seriously injured pedestrians and cyclists receive in a Swedish urban region in the time period 2003–2017 when Vision Zero was implemented?

ObjectivesThe aim of the study is to examine what types of injuries that seriously injured pedestrians and cyclists received in urban road spaces from 2003 to 2017 in the Swedish region of Västmanland, when the road safety policy Vision Zero was implemented. Study designThis is a cross-sectional data annually collected over a period of fifteen years. MethodsData from health care for 403 seriously injured pedestrians and cyclists were retrieved from the registry STRADA (Swedish Traffic Accident Data Acquisition) and cross-referenced with the National Road Database to see if any Vision Zero measures had previously been implemented at the crash location. The study includes injuries from both single and multiple crashes on roads, pavements, and tracks for walking and cycling (road space). Statistical analysis was performed by descriptive statistics, chi-square tests, and multiple logistic regression analyses. ResultsPedestrians were seriously injured in lower extremities more than cyclists, whereas more cyclists were seriously injured in the head. During the period, pedestriansꞌ head injuries decreased significantly, but injuries in lower extremities increased significantly. In addition, for cyclists, there was a shift from decreased probability of head injuries to increased probability of injuries in lower extremities related to increased age. For pedestrians, pavements/tracks were associated with a decreased probability of a majority of injury outcomes but for cyclists only for severe injury outcomes. ConclusionsFrom 2003 to 2017, there was a shift among seriously injured pedestrians, with head injuries decreasing and injuries in lower extremities increasing. This shift was probably related to an ageing population in the region, given that increased age among both pedestrians and cyclists was associated with a decreased probability of head injuries but increased probability of injuries in lower extremities. On Vision Zero roads, there was a decreased probability of pedestrians receiving serious injury to more than one bodily region. An increased number of older people combined with policies for more active mobility such as walking and cycling are a challenge for road authorities in urban areas.

The Impact of Traffic Calming Measures on Cyclists’ and E-Cyclists’ Safety

Cycling is a sustainable transport mode, especially in urban areas for short distances. Electric bikes and electric scooters are increasingly emerging into traffic network in cities in Sweden due to advantages related to accessibility, environment, etc. However, they bring questions in terms of traffic risk and accidents. The road infrastructure must be adapted to accommodate the increasing share of these new types of bikes in traffic. The study will assess both bikes and e-bikes safety according to exposure, risk and consequences. The study will review relevant literature on Traffic Calming Measures (TCMs). It will develop a conceptual framework to determine the impact of different TCMs (horizontal and vertical) on traffic safety for both traditional and e-bikes safety. Accident data from the Swedish Traffic Accident Data Acquisition (STRADA) will be collected and analysed in order to identify roundabouts (as a chosen type of TCMs) with high accidents rates for cyclists in Norrkoping city in Sweden.

Incidence of seriously injured road users in a Swedish region, 2003\u20132014, from the perspective of a national road safety policy

BackgroundSince 1997 Sweden has a policy for road safety called Vision Zero. Given that Vision Zero is mainly used to reduce fatalities among car occupants, the question has been raised by the research community whether a Vision Zero approach promotes health for all road traffic users. The objective is to measure target fulfilment of the national road safety policy for a Swedish region by examining incidence of serious injury during 2003–2014 in rural and urban road spaces with or without implemented measures.MethodsData on seriously injured road users, defined as ISS > 8 (Injury Severity Score), were retrieved from STRADA (Swedish Traffic Accident Data Acquisition) together with data from NVDB (National Road Database). These data are used to describe where road users are seriously injured in relation to implemented national policy and using a conceptual model of a road space comprising roads, pavements and tracks for walking and cycling. Seriously injured road users in single and multiple crashes with and without vehicles are included. The development of the incidence is analysed for different road users and places in the road space.ResultsDespite implemented road safety measures in the region, the incidence of seriously injured road users per 100,000 inhabitants in rural areas increased from 7.8 in 2003 to 9.3 in 2014 but doubled in urban areas from 8.0 in to 16.3 respectively. In areas not transformed by Vision Zero, only 36% were injured in rural areas while 64% were injured in urban areas. In contrast, in transformed areas 61% of injuries occurred in rural areas, whereas 39% occurred in urban areas. While the incidence decreased for car occupants on transformed national roads in rural areas, the incidence of serious injuries increased among unprotected road users in urban areas, in particular on pavements and tracks for cycling and walking than on the roads where Vision Zero had been implemented.ConclusionThe reduction in the incidence for car occupants in the region may not be adequate to contribute to fulfilling the national target. More needs to be done, especially in the urban areas, where more active mobility is desired.

The effectiveness of centerline rumble strips (CLRS) on two-lane carriageways in Sweden on injury accident risk for cars equipped with electronic stability control (ESC) and cars without ESC

Objective: Electronic Stability Control (ESC) and Lane Departure Warning (LDW) are in-vehicle safety systems that complement each other. While the implementation of on-board lane support systems in traffic is still limited and the majority of the traffic volume is made up by ESC-equipped cars, the effectiveness of centerline rumble strips (CLRS) for ESC-equipped cars need to be quantified. The aim of the present study is to estimate the effectiveness of CLRS on two-lane carriageways in Sweden, on injury accident risk for cars equipped with ESC and cars without ESC.Methods: Police reported injury crashes during 2011‒2016 were extracted from the Swedish Traffic Accident Data Acquisition (STRADA) database and merged with the National Road Database (NVDB) containing information regarding road design and road use parameters. The analysis includes crashes on two-lane carriageways in Sweden with a width of at least seven meters in dry and wet road conditions, that is, road surface not covered by ice or snow. The crashes involved a total of 7,490 cars with injured drivers, where 39% of the cars were equipped with ESC.The effectiveness estimates were calculated for injured drivers in ESC-equipped cars in crashes involving drift out of lane to the left, and posted speed limits of 80 and 90 km/h. The analysis was carried out by applying the induced exposure approach in which rates of cars involved in crashes sensitive and non-sensitive to CLRS were compared at sites with and without CLRS. In order to substantiate the evidence for causality, case and control rates of car model year and Seat Belt Reminder (SBR) fitment, driver age, driver gender, traffic volume, road width, speed limit and road surface condition were compared.Results: For ESC-equipped cars, the analysis showed a reduction in CLRS-sensitive crashes by 40% (19‒56%, confidence interval [CI] 95%) where CLRS had been implemented, and a reduction by 29% (11‒44%, CI 95%) for cars without ESC-equipment.Conclusions: Contemporary effectiveness estimates may have important implications for the short and medium-term national road safety management. CLRS remains an important countermeasure to consider for reducing the number of real-world injury crashes. From a systematic safety perspective, it is important to accentuate that CLRS and ESC essentially address different crash scenarios. Still, both CLRS and ESC have the potential to avoid crashes involving unintentional lane drifting resulting in loss of control. When the CLRS alerts a driver of unintentional lane drifting, the ESC can be essential in supporting the driver to safely veer back into the lane without loss of control. However, further analysis on the combined safety benefit of ESC and CLRS is required.

Trajectories of sickness absence after road traffic injury: a Swedish register-based cohort study

ObjectivesDespite much focus on the health impact of road traffic injury (RTI) on life, there is a lack of knowledge of the dynamic process of return to work following RTI...

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

Objective: The objectives of the present article were to (a) describe the main characteristics of bicycle crashes with regard to the road environment, crash opponent, cyclist, and crash dynamics; (b) compare individuals who describe their health after the crash as declined with those who describe their health as not affected; and (c) compare the number of injured cyclists who describe their health as declined after the crash with the predicted number of permanent medical impairments within the same population.Methods: A sample of individuals with specific injury diagnoses was drawn from the Swedish Traffic Accident Data Acquisition (STRADA) database (n = 2,678). A survey form was used to collect additional information about the crash and the health-related outcomes. The predicted number of impaired individuals was calculated by accumulating the risk for all individuals to sustain at least a 1% permanent medical impairment, based on the injured body region and injury severity.Results: Nine hundred forty-seven individuals (36%) responded, of whom 44% reported declined health after the crash. The majority (68%) were injured in single bicycle crashes, 17% in collisions with motor vehicles, and 11% in collisions with another cyclist or pedestrian. Most single bicycle crashes related to loss of control (46%), mainly due to skidding on winter surface conditions (14%), followed by loss of control during braking (6%). There was no significant difference in crash distribution comparing all crashes with crashes among people with declined health. The predicted number of impaired individuals (n = 427) corresponded well with the number of individuals self-reporting declined health (n = 421).Conclusions: The types of crashes leading to health loss do not substantially differ from those that do not result in health loss. Two thirds of injuries leading to health loss occur in single bicycle crashes. In addition to separating cyclists from motorized traffic, other preventive strategies are needed.

Factors related to the increasing number of seriously injured cyclists and pedestrians in a Swedish urban region 2003-17.

BackgroundThe number of seriously injured unprotected road users has increased during implementation of a road safety policy Vision Zero. The aim of the study is to identify factors associated with the increase in serious injuries among cyclists and pedestrians (even single pedestrian accidents) that occurred in an urban road space in a Swedish region 2003–17. The urban road space includes roads, pavements and tracks for walking and cycling.MethodsData were retrieved from STRADA (Swedish Traffic Accident Data Acquisition) and NVDB (National Road Database). Descriptive statistics and logistic regression with odds ratios for sex, age and part of road space were assessed.ResultsThe number of seriously injured cyclists and pedestrians more than doubled from 2003 to 2017, with the greatest increase for pedestrians. Older age increased the probability of serious injury since 2012 for the group ≥ 80 years and since 2015 for the group 65–79 years. No significant effect of sex. Most injuries occur in areas not transformed by Vision Zero.ConclusionsAn increasing number of elderly persons in the generation born in the 1940s and increased life expectancy are important factors. There is a need to increase road safety measures that also promote active mobility.

Acute injuries resulting from accidents involving powered mobility devices (PMDs)—Development and outcomes of PMD-related accidents in Sweden

Objective: Powered mobility devices (PMDs) are commonly used as aids for older people and people with disabilities, subgroups of vulnarable road users (VRUs) who are rarely noted in traffic safety contexts. However, the problem of accidents involving PMD drivers has been reported in many countries where these vehicles have become increasingly popular.The aim of this study is to extract and analyze national PMD-related accident and injury data reported to the Swedish Traffic Accident Data Acquisition (STRADA) database. The results will provide valuable insight into the risks and obstacles that PMD drivers are exposed to in the traffic environment and may contribute to improving the mobility of this group in the long term.Methods: The current study is based on data from 743 accidents and 998 persons. An analysis was performed on a subset of data (N = 301) in order to investigate the development of accidents over a period of 10 years. Thereafter, each accident in the whole data set was registered as either single (N = 427) or collision (N = 315).Results: The results show that there was a 3-fold increase in the number of PMD-related accidents reported to STRADA during the period 2007–2016.With regard to single accidents, collisions, as well as fatalities, the injury statistics were dominated by males. Single accidents were more common than collisions (N = 427 and N = 316, respectively) and the level of injury sustained in each type of accident is on par. The vast majority of single accidents resulted in the PMD driver impacting the ground (87%), due to either PMD turnover (71%) or the driver falling out of the PMD (16%). The reason for many of the single accidents was a difference in ground level (34%, typically a curb).Cars, trucks, or buses were involved in 67% of collision events; these occured predominantly at junctions or intersections (70%).Abbreviated Injury Scale (AIS) 3+ injuries were dominated by hip and head injuries in both single accidents and collision events.Conclusions: The present study shows that further research on PMD accidents is required, with regard to both single accidents and collision events. To ensure that appropriate decisions are made, future work should follow up on injury trends and further improve the quality of PDM-related accident data. Improved vehicle stability and design, increased usage of safety equipment, proper training programs, effective maintenance services, and development of a supporting infrastructure would contribute to increased safety for PMD drivers.

Does injury pattern among major road trauma patients influence prehospital transport decisions regardless of the distance to the nearest trauma centre? \u2013 a retrospective study

BackgroundPrehospital undertriage occurs when the required level of care for a major trauma patient is underestimated and the patient is transported to a lower-level emergency care facility. One possible reason is that the pattern of injuries exceeding a certain severity threshold is not easily recognizable in the field. The present study aims to examine whether the injury patterns of major road trauma patients are associated with trauma centre transport decisions in Sweden, controlling for the distance from the crash to the nearest trauma centre and other patient characteristics.MethodsThe Swedish Traffic Accident Data Acquisition (STRADA) database was queried from April 2011 to March 2017. Teaching hospitals with neurosurgery capabilities were classified as trauma centres (TC), all other hospitals were classified as other emergency departments (ED). Injury Severity Score ≥ 13 was used as the threshold for major trauma. Ten common injury patterns were derived from the STRADA data; six patterns included serious neuro trauma to the head or spine. The remaining four patterns were: other severe injuries, moderate to serious abdomen injuries, serious thorax injuries and all other remaining injury patterns. Logistic regression was used to analyse the effect of injury patterns, age, sex and distance from crash to nearest TC on transport decision (TC or ED).ResultsOf the 2542 patients, 38.0% were transported to a TC, equating to a prehospital undertriage of 62%. Over half (59.4%) of the patients had four or more Abbreviated Injury Scale (AIS) 2+ injuries. After controlling for age, sex and distance to nearest TC, only patients sustaining serious head injuries together with other severe injuries had significantly higher odds of being transported to a TC (OR = 4.18, 95% CI: 2.03, 8.73). The odds of being transported to a TC decreased by 5% with every kilometre further away the crash location was to the nearest TC.ConclusionThese results highlight that there is considerable prehospital undertriage in Sweden and suggest that distance to nearest TC is more influential in transport decisions than injury pattern. These results can be used to further develop prehospital transportation guidelines and designation of trauma centres.

The effectiveness of lane departure warning systems—A reduction in real-world passenger car injury crashes

ABSTRACTObjective: The objective of this study was to estimate the safety benefits of in vehicle lane departure warning (LDW) and lane keeping aid (LKA) systems in reducing relevant real-world passenger car injury crashes.Methods: The study used an induced exposure method, where LDW/LKA-sensitive and nonsensitive crashes were compared for Volvo passenger cars equipped with and without LDW/LKA systems. These crashes were matched by car make, model, model year, and technical equipment; that is, low-speed autonomous emergency braking (AEB) called City Safety (CS). The data were extracted from the Swedish Traffic Accident Data Acquisition database (STRADA) and consisted of 1,853 driver injury crashes that involved 146 LDW-equipped cars, 11 LKA-equipped cars, and 1,696 cars without LDW/LKA systems.Results: The analysis showed a positive effect of the LDW/LKA systems in reducing lane departure crashes. The LDW/LKA systems were estimated to reduce head-on and single-vehicle injury crashes on Swedish roads with speed limits between 70 and 120 km/h and with dry or wet road surfaces (i.e., not covered by ice or snow) by 53% with a lower limit of 11% (95% confidence interval [CI]). This reduction corresponded to a reduction of 30% with a lower limit of 6% (95% CI) for all head-on and single-vehicle driver injury crashes (including all speed limits and all road surface conditions).Conclusions: LDW/LKA systems were estimated to lower the driver injury risk in crash types that the systems are designed to prevent; that is, head-on and single-vehicle crashes. Though these are important findings, they were based on a small data set. Therefore, further research is desirable to evaluate the effectiveness of LDW/LKA systems under real-world conditions and to differentiate the effectiveness between technical solutions (i.e., LDW and LKA) proposed by different manufacturers.

Prehospital transportation decisions for patients sustaining major trauma in road traffic crashes in Sweden

ABSTRACTObjective: The objective of this study was to evaluate the proportion and characteristics of patients sustaining major trauma in road traffic crashes (RTCs) who could benefit from direct transportation to a trauma center (TC).Methods: Currently, there is no national classification of TC in Sweden. In this study, 7 university hospitals (UHs) in Sweden were selected to represent a TC level I or level II. These UHs have similar capabilities as the definition for level I and level II TC in the United States. Major trauma was defined as Injury Severity Score (ISS) > 15. A total of 117,730 patients who were transported by road or air ambulance were selected from the Swedish TRaffic Accident Data Acquisition (STRADA) database between 2007 to 2014. An analysis of the patient characteristics sustaining major trauma in comparison with patients sustaining minor trauma (ISS < 15) was conducted. Major trauma patients transported to a TC versus non-TC were further analysed with respect to injured body region and road user type.Results: Approximately 3% (n = 3, 411) of patients sustained major trauma. Thirty-eight percent of major trauma patients were transported to a TC, and 62% were transported to a non-TC. This results in large proportions of patients with Abbreviated Injury Scale (AIS) 3+ injuries being transported to a non-TC. The number of AIS 3+ head injuries for major trauma patients transported to a TC versus non-TC were similar, whereas a larger number of AIS 3+ thorax injuries were present in the non-TC group. The non-TC major trauma patients had a higher probability of traveling in a car, truck, or bus and to be involved in a crash in a rural location.Conclusions: Our results show that the majority of RTC major trauma patients are transported to a non-TC. This may cause unnecessary morbidity and mortality. These findings can guide the development of improved prehospital treatment guidelines, protocols and decision support systems.