Traffic Injury Severity Research Articles

The quality of the injury severity classification by the police: An important step for a reliable assessment

This study aims to assess the under-reporting and misclassification of the traffic injury severity reported by the police for the first time in Portugal. The non-fatality traffic injuries classified by the police are compared with the information recorded by the hospitals using linked data. The underreporting in the police data was found to be of 29%. Therefore, a significant number of road traffic casualties admitted in the hospitals were not known by the police. Taking advantage of the linked information on accident injuries, the misclassification in the police reports is assessed considering two criteria: the length of hospital stay (LS) and the maximum abbreviated injury scale (MAIS). The latter criterion corresponds to the common definition recently established by the European Commission, which has the advantage of representing the medical conditions of the casualty. The comparison between police classification and LS indicates that a discrepancy between the police reports and the established police definition exists. On the other hand, the police classification shows a tendency to overclassify the injury severity regarding the MAIS. A remarkable proportion of severe injuries reported by the police are, in fact, slight injuries. Additionally, using univariate and multivariate analyses, factors contributing to the misclassification of casualties by the police are identified. Finally, similarly to the fatality adjustment coefficient used in Portugal and in other countries in the past, non-fatality adjustment coefficients were computed to estimate the total casualties taking into account the under-reporting and misclassification phenomena. These adjustment factors are compared with other countries.

Factors affecting injury severity of vehicle occupants following road traffic collisions

AimWe aimed to define factors affecting injury severity of vehicle occupants following road traffic collisions (RTC). Patients and methods422 vehicle occupants (343 males, 81.3%) with RTC-related injuries were prospectively studied over 18 months. General linear model was used to test the effect of age, gender, alcohol and drug use, time of injury, mechanism of injury, size and speed of the vehicle, position in the vehicle, seatbelt usage, and air bag deployment on the Injury Severity Score (ISS) of the vehicle occupants. ResultsThe mean (range) age of patients was 28.2 (1–78) years and the mean (range) ISS was 7.9 (1–50). Front impact was the most common mechanism of injury (32.9%) followed by rollover (25.6%) and side impact (22.3%). 18.2% used seatbelts. The general linear model was highly significant and showed that mechanism of injury (p<0.0001), speed of the vehicle (p=0.02), and age of the vehicle occupant (p=0.03) significantly affected the Injury Severity Score. ConclusionsThe mechanism of the RTC, the vehicle speed, and age of the vehicle occupant are the most important factors affecting the severity of road traffic collision injuries. A detailed history of the mechanism of injury is important for alerting clinicians to severity of injury, the need for admission, and workup of the patients. Furthermore, strict speed limit enforcement is an injury prevention priority in our community.

A multinomial logit analysis of risk factors influencing road traffic injury severities in the Erzurum and Kars Provinces of Turkey

A retrospective cross-sectional study is conducted analysing 11,771 traffic accidents reported by the police between January 2008 and December 2013 which are classified into three injury severity categories: fatal, injury, and no injury. Based on this classification, a multinomial logit analysis is performed to determine the risk factors affecting the severity of traffic injuries. The estimation results reveal that the following factors increase the probability of fatal injuries: drivers over the age of 65; primary-educated drivers; single-vehicle accidents; accidents occurring on state routes, highways or provincial roads; and the presence of pedestrian crosswalks. The results also indicate that accidents involving cars or private vehicles or those occurring during the evening peak, under clear weather conditions, on local city streets or in the presence of traffic lights decrease the probability of fatal injuries. This study comprises the most comprehensive database ever created for a Turkish sample. This study is also the first attempt to use an unordered response model to determine risk factors influencing the severity of traffic injuries in Turkey.

Examining driver injury severity in two vehicle crashes – A copula based approach

A most commonly identified exogenous factor that significantly affects traffic crash injury severity sustained is the collision type variable. Most studies consider collision type only as an explanatory variable in modeling injury. However, it is possible that each collision type has a fundamentally distinct effect on injury severity sustained in the crash. In this paper, we examine the hypothesis that collision type fundamentally alters the injury severity pattern under consideration. Toward this end, we propose a joint modeling framework to study collision type and injury severity sustained as two dimensions of the severity process. We employ a copula based joint framework that ties the collision type (represented as a multinomial logit model) and injury severity (represented as an ordered logit model) through a closed form flexible dependency structure to study the injury severity process. The proposed approach also accommodates the potential heterogeneity (across drivers) in the dependency structure. Further, the study incorporates collision type as a vehicle-level, as opposed to a crash-level variable as hitherto assumed in earlier research, while also examining the impact of a comprehensive set of exogenous factors on driver injury severity. The proposed modeling system is estimated using collision data from the province of Victoria, Australia for the years 2006 through 2010.

Comparison of Road Traffic Injury Characteristics between Local versus Floating Migrant Patients in a Tertiary Hospital between 2007 and 2010

BackgroundThe aim of this study is to give a description of the road traffic injuries (RTIs) characteristics of floating migrant population by comparing with those of local residents in a harbor city of China.MethodsA population-based descriptive study was carried out between 2007 and 2010 with RTI patient records from the Fifth Center Hospital of Tianjin. Inpatient diagnoses of RTI patients were defined using the International Classification of Diseases, Tenth Revision (ICD-10) codes. We analyzed the demographics and general characteristics of RTI patients that were in the hospital during the four years. In order to compare the group differences between local resident patients and floating migrant patients, the distribution of their ages, diagnoses, severity of injuries, duration of inpatient stays, hospitalization cost were analyzed.ResultsPeople between the ages of 16 and 55 were the most likely to suffer RTIs. The floating migrant patients between the ages of 16 and 45 had a higher incidence of accidents, while local resident patients between 46 and 55 had a higher incidence of accidents. Compared to local resident patients, floating migrant patients were more vulnerable to open injuries and severe traffic injuries. With the severity of injuries ranked from mild to severe, floating migrant patients had lower duration of inpatient stay, but higher hospitalization costs compared to local resident patients.ConclusionsFloating migrant patients had a different age distribution, severity of injuries, diseases, inpatient duration and hospitalization cost compared with local resident patients. Compared to local resident patients, floating migrants had a higher risk to RTIs and were more vulnerable to severer traffic accidents at lower ages.

Analysis of Traffic Injury Severity in Dhaka, Bangladesh

This research identifies roadway, traffic, and environmental factors that influence the injury severity of road traffic crashes in Dhaka, Bangladesh. Dhaka provides a rather unusual driving-risk environment to study because virtually anyone in Dhaka can obtain a driver's license, traffic enforcement is lax, and few fines are given when drivers violate traffic rules. To examine this city with presumed heightened crash severity risk, the authors collected police-reported crash data from 2007 to 2011 containing about 2,714 road traffic crashes. The injury severity of traffic crashes—recorded as fatal injury, serious injury, or property damage only—was modeled with an ordered probit model. Significant factors increasing the probability of fatal injuries included crashes along highways (65%), absence of a road divider (80%), crashes during night time (54%), and vehicle–pedestrian collisions (367%); two-way traffic configuration (21%) and traffic police–controlled schemes (41%) decreased the probability of fatalities. Both similarities and differences of the findings between crash risk in Dhaka and that in developed countries are discussed in policy-relevant terms.

Definición de alta hospitalaria, lesión grave y muerte por lesiones por tráfico

Road traffic injury surveillance involves methodological difficulties due, among other reasons, to the lack of consensus criteria for case definition. Police records have usually been the main source of information for monitoring traffic injuries, while health system data has hardly been used. Police records usually include comprehensive information on the characteristics of the crash, but often underreport injury cases and do not collect reliable information on the severity of injuries. However, statistics on severe traffic injuries have been based almost exclusively on police data. The aim of this paper is to propose criteria based on medical records to define: a) “Hospital discharge for traffic injuries”, b) “Person with severe traffic injury”, and c) “Death from traffic injuries” in order to homogenize the use of these sources.

Costs of traffic injuries

ObjectiveThe aim of this study was to analyse the socioeconomic costs of traffic injuries in Denmark, notably the healthcare costs and the productivity costs related to traffic injuries, in a...

Injury severity models for motor vehicle accidents: a review

Modelling of traffic accidents injury severity is a complex task. In the last few years the number and variety of studies that analyse injury severity of traffic accidents have increased considerably. In this paper 19 modelling techniques used to model injury severity of traffic accidents where at least a four-wheeled vehicle is involved have been analysed. The analysis and the comparison between models was performed based on seven criteria (modelling technique, number of records, number of variables, area type, features, injury level and model fit). In general, it is not possible to recommend a method that could be identified as the best one. Each modelling technique has its own limitations and characteristics, awareness of which will help analysts to decide the best method to be used in each particular modelling problem. However, some general conclusions can be established: in most cases the results of models' fits are found to be satisfactory, though not excellent; in the case of data mining models, accuracy improves with balanced datasets; and no correlation was found to exist between the number of accident records and the number of analysed variables.

Nonfatal Road Traffic Injuries: Can Road Safety Campaigns Prevent Hazardous Behavior? An Italian Experience

Objectives: Road traffic injuries are a widespread problem and are very difficult to prevent. The purpose of this study was to verify whether intensive versus basic road safety education programs are associated with different incidence and severity of nonfatal road injuries. Method: The study had an ecological design and involved Local Health Authority One (LHA1) in Salerno, Italy, which includes 20 municipalities. Data on nonfatal road injuries occurring in the periods June to August 2003 and June to August 2008 were obtained from trained operators through the information system of the emergency department. All 20 municipalities received a basic community road safety education program (publicity campaign using bill-posting, brochures, mass media communication with press conferences, articles in local papers, radio and television interviews, and a dedicated LHA1 web site), and 12 municipalities also received an intensive education campaign (in secondary schools, community conferences, and activities organized by police and firefighters). The incidence and severity of nonfatal road traffic injuries were compared between June to August 2003 (before the campaign) and June to August 2008. Results: The total number of injuries in all 20 municipalities in 2003 and 2008 was 907 and 755, respectively. The incidence of injuries decreased in the study period both in the 8 municipalities where only the basic campaign was run (difference in incidence = −0.4; P = .053) and in the 12 municipalities where the intensive campaign was implemented (difference in incidence = −0.5; P < .001); focusing on severity, the incidence of severe injuries decreased or remained the same in the study period in the 2 studied group. Discussion: The results are coherent with other European studies and show that an overall downward trend exists but is presumably not a direct consequence of road safety education. This does not mean that such campaigns are useless (they are important to raise awareness) but that they should be supplemented with complementary activities in order to be really effective.

Blunt Liver Injury with Intact Ribs under Impacts on the Abdomen: A Biomechanical Investigation

Abdominal trauma accounts for nearly 20% of all severe traffic injuries and can often result from intentional physical violence, from which blunt liver injury is regarded as the most common result and is associated with a high mortality rate. Liver injury may be caused by a direct impact with a certain velocity and energy on the abdomen, which may result in a lacerated liver by penetration of fractured ribs. However, liver ruptures without rib cage fractures were found in autopsies in a series of cases. All the victims sustained punches on the abdomen by fist. Many studies have been dedicated to determining the mechanism underlying hepatic injury following abdominal trauma, but most have been empirical. The actual process and biomechanism of liver injury induced by blunt impact on the abdomen, especially with intact ribs remained, are still inexhaustive. In order to investigate this, finite element methods and numerical simulation technology were used. A finite element human torso model was developed from high resolution CT data. The model consists of geometrically-detailed liver and rib cage models and simplified models of soft tissues, thoracic and abdominal organs. Then, the torso model was used in simulations in which the right hypochondrium was punched by a fist from the frontal, lateral, and rear directions, and in each direction with several impact velocities. Overall, the results showed that liver rupture was primarily caused by a direct strike of the ribs induced by blunt impact to the abdomen. Among three impact directions, a lateral impact was most likely to cause liver injury with a minimum punch speed of 5 m/s (the momentum was about 2.447 kg.m/s). Liver injuries could occur in isolation and were not accompanied by rib fractures due to different material characteristics and injury tolerance.

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.

Pattern of Road Traffic Injuries in Lublin County, Poland

Road traffic injury patients admitted to 35 hospitals in Lublin region. To describe the pattern of road traffic injuries in Lublin county, Poland. Review of medical records for the period from January 2004 to December 2005. Pedestrians accounted for the largest share of the Road traffic crash (RTC) injury cases (35.8%) and 46.4% of deaths. The highest mortality was observed in motorcycle occupants (7.1%) and victims with abdominal injuries (9.8%). Vulnerable road users represented 71.4% of all RTC deaths, with mortality 5.8%. Early transfers accounted for 82.5% of cases. Mortality in early transfers is 4 times higher than in late transfers. Poland ranks as one of the worst European countries in terms of severity and fatal outcomes of road traffic injuries. Groups of road users in Poland at the highest risk are pedestrians, cyclists, children and young male drivers. The highest mortality rate occurs among road users affected by multiple trauma and head/vertebral column injuries. Alleviation of consequences of road traffic injuries in Poland may be achieved by coordinated efforts and collective responsibility of government, central level agencies, rescue team members and community groups.

Epidemiological study of road traffic injuries in Beijing: a report of 990 cases

Objective To investigate the epidemiological features and risk factors of road traffic injury in Beijing. Methods Data of road traffic injuries of Beijing Changping Hospital in 2010 was collected for statistical analysis of the epidemiological features. Results A total of 990 cases of road traffic injuries were treated in Beijing Changping Hospital in 2010,with a male/female ratio of 2.57:1 and at average age of 45 yeats.There were 21 cases aged ＜ 18 years,703 cases aged 18-55 years and 266 cases aged ≥56 years.Self-employed individuals and fanning production staffs were the risky population that were easily subjected to road traffic injuries.Summer and autumn were the accident-prone seasons.The most common injury site was the lower limbs,next with the neck and head.The hospital stay was mainly in a range of 5-10 days (12.8 days on average). Conclusions Male self-employed individuals and agricultural producers are the high-risk groups of road traffie accidents in the area,where shows a high occurrence of road traffic accidents in the summer and autumn.Thereby,traffic safety education and prevention-control measures based on these characteristics should be carried out to effectively reduce the number and severity of the local traffic injuries. Key words: Accidents,traffic; Epidemiology; Beijing

A Data Mining Approach to Identify Key Factors of Traffic Injury Severity

Seventy percent of the traffic crash fatalities of Iran happen on rural roads, and a significant proportion of the rural roads network of this country is constituted of the main two-lane, two-way roads. The purpose of this study is to identify the most important factors which affect injury severity of drivers involved in traffic crashes on these roads, so that by eliminating or controlling such factors an overall safety improvement can be accomplished. Using the Classification and Regression Tree (CART), one of the powerful data mining tools, the crash data pertaining to the last three years (2006-2008) were analyzed. The variable selection procedure was carried out on the basis of Variable Importance Measure (VIM) which is one of the CART method outputs. The results revealed that not using the seat belt, improper overtaking and speeding are the most important factors associated with injury severity. KEYWORDS: injury severity; traffic safety; data mining; Classification and Regression Trees (CART); Variable Importance Measure (VIM)

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.

Injury epidemiology and publishing injury research

In the Dictionary of Epidemiology, Professor Last offers the following definition: “Epidemiology is the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems”.1 I similarly try to define injury epidemiology as the study of the distribution and determinants of injuries and safety related states-events in specified populations, and the application of this study to prevent injuries and promote safety. The published research on injuries falls into this category only if it is produced based on the general perspectives of epidemiology and meets the necessary methodological standards. Injury epidemiology needs to be redirected from the largely descriptive studies, towards applying rigorous analytical methods for defining the underlying casual patterns of injury, determinants of the injury incidence, severity, and outcomes; and designing, implementing and rigorously evaluating interventions.2Although many journals try to be quite rigorous in assessing the methodological soundness of published articles, it is not uncommon for many of them, including some of the more well-known journals, to publish articles with various degrees of methodological flaws. I have provided examples of such flaws in published burn injury research.3 JIVR gives a high priority to publishing research reports that are in line with the needs mentioned above and which use various epidemiological study designs to address injury and violence problems. JIVR has published many articles with sufficient variability in study populations, objectives and methodologies. This can be seen in our recent issue, Vol 4: No 1. Of the seven original articles published, one used a qualitative methodology.4The second article used secondary data analysis on data from the World Health Organization and the United Nations data banks.5A retrospective cohort study design was used in the third article to examine the effect on fetal development of high doses of drugs taken as a suicide attempt during pregnancy.6In this issue we also published an interventional study from Sweden.7Ecologic study design, although of limited value in assessing the causal relationships , is a useful cost-effective study design in epidemiology. The fifth article used this methodology to investigate the association between the use of the Mental Health Act and general population suicide rates in England and Wales.8The last two original articles we published in Vol 4: No 1 issue of JIVR analyzed determinants of victimization from bullying,9and determinants of traffic injury severity.10

A method for simplifying the analysis of traffic accidents injury severity on two-lane highways using Bayesian networks

Introduction This study describes a method for reducing the number of variables frequently considered in modeling the severity of traffic accidents. The method's efficiency is assessed by constructing Bayesian networks (BN). Method It is based on a two stage selection process. Several variable selection algorithms, commonly used in data mining, are applied in order to select subsets of variables. BNs are built using the selected subsets and their performance is compared with the original BN (with all the variables) using five indicators. The BNs that improve the indicators’ values are further analyzed for identifying the most significant variables (accident type, age, atmospheric factors, gender, lighting, number of injured, and occupant involved). A new BN is built using these variables, where the results of the indicators indicate, in most of the cases, a statistically significant improvement with respect to the original BN. Conclusions It is possible to reduce the number of variables used to model traffic accidents injury severity through BNs without reducing the performance of the model. Impact on Industry The study provides the safety analysts a methodology that could be used to minimize the number of variables used in order to determine efficiently the injury severity of traffic accidents without reducing the performance of the model.

Analysis of the traffic injury severity on two-lane, two-way rural roads based on classification tree models

Two-lane, two-way roads constitute a major portion of the rural roads in most countries of the world. This study identifies the factors influencing crash injury severity on these roads in Iran. Classification and regression trees (CART), which is one of the most common methods of data mining, was employed to analyze the traffic crash data of the main two-lane, two-way rural roads of Iran over a 3-year period (2006–2008). In the analysis procedure, the problem of three-class prediction was decomposed into a set of binary prediction models, which resulted in a higher overall accuracy of the predictions of the model. In addition, the prediction accuracy of the fatality class, which was nearly 0% in some of the previous studies, increased significantly. The results indicated that improper overtaking and not using a seatbelt are the most important factors affecting the severity of injuries.

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.