Incidence and risk factors of severe traumatic brain injury resulting from road accidents: a population-based study

A population-based study was carried out in 1996-2001 to provide the incidence and to identify the risk factors of severe traumatic brain injury (TBI) resulting from a road accident. The severe TBI was defined as an injury to the brain or the skull, excluding scalp injuries, with an abbreviated injury scale (AIS) severity score greater than 2. The severe TBI of 1238 patients were described. The annual incidence and mortality of severe TBI were, respectively, 13.7 per 100,000 and 5.3 per 100,000. The fatality rate increased from 20% in childhood to 71% over 75-year-old. Compared to restrained car occupants, the odds ratio for having a severe TBI was 18.1 (95% confidence interval, CI=12.8-25.5) for un-helmeted motorcyclists, 9.2 (95% CI=7.5-11.3) for pedestrians, 6.4 (95% CI=4.7-8.8) for un-helmeted cyclists, 3.9 (95% CI=3.1-4.8) for unrestrained car occupants and 2.8 (95% CI=2.2-3.5) for helmeted motorcyclists. Even after adjustment for several severity factors, male gender and age above 55 were both risk factors. Prevention programs aiming at improving the head protection should be promoted. The circumstances of the accident should be taken into account to predict a severe TBI.     

Mobile phone use among motorcyclists and electric bike riders: A case study of Hanoi,Vietnam

Motorcyclist injuries and fatalities are a major concern of many developing countries. In Vietnam, motorcycles are involved in more than 70% of all road traffic crashes. This paper aims to explore the prevalence and factors associated with mobile phone use among motorcyclists and electric bike riders, using a case study of Hanoi, Vietnam. A cross-sectional observation survey was undertaken at 12 sites, in which each site was surveyed during a two-hour peak period from 16:30 to 18:30 for two weekdays and one weekend day. A total of 26,360 riders were observed, consisting of 24,759 motorcyclists and 1601 electric bike riders. The overall prevalence of mobile phone use while riding was 8.4% (95% CI: 8.06–8.74%) with calling having higher prevalence than screen operation: 4.64% (95% CI: 4.39–4.90%) vs. 3.76% (95% CI: 3.52–3.99%) respectively. Moreover, the prevalence of mobile phone use was higher among motorcyclists than electric bike riders: 8.66% (95%CI: 8.30–9.01%) vs. 4.43% (95% CI: 3.40–5.47%) respectively. Logistic regression analyses revealed that mobile phone use while riding was associated with vehicle type, age, gender, riding alone, weather, day of week, proximity to city centre, number of lanes, separate car lanes, red traffic light duration, and police presence. Combining greater enforcement of existing legislations with extensive education and publicity programs is recommended to reduce potential deaths and injuries related to the use of mobile phones while riding.     

A behavioral comparison between motorcyclists and a matched group of non-motorcycling car drivers: factors influencing accident risk

Motorcyclists and a matched group of non-motorcycling car drivers were assessed on behavioral measures known to relate to accident involvement. Using a range of laboratory measures, we found that motorcyclists chose faster speeds than the car drivers, overtook more, and pulled into smaller gaps in traffic, though they did not travel any closer to the vehicle in front. The speed and following distance findings were replicated by two further studies involving unobtrusive roadside observation. We suggest that the increased risk-taking behavior of motorcyclists was only likely to account for a small proportion of the difference in accident risk between motorcyclists and car drivers. A second group of motorcyclists was asked to complete the simulator tests as if driving a car. They did not differ from the non-motorcycling car drivers on the risk-taking measures but were better at hazard perception. There were also no differences for sensation seeking, mild social deviance, and attitudes to riding/driving, indicating that the risk-taking tendencies of motorcyclists did not transfer beyond motorcycling, while their hazard perception skill did.     

Disabilities caused by road traffic accidents and their relation to severity scores

The disabilities incurred by 2502 road accident patients admitted in three separate years to an Accident Hospital have been analysed. There were about equal numbers of disabled among pedestrians, motorcyclists and vehicle occupants. This corresponds to the high relative frequency and severity of injuries among motorcyclists. Most of the serious disabilities were caused by head or lower limb injuries. Different severities of disability were not closely correlated with Abbreviated Injury Scale (AIS), (ISS) or (PI) scores or with treatment periods but useful threshold values are described which separate groups with high and low rates of disability. For given severities of injury, disabilities were less severe among young casualties. Comparisons with other studies show rather wide variations in estimates of the incidence of slight disabilities. There is fair agreement with the present findings that serious disabilities occur in about 3% of inpatient hospital cases or in about 1% of total casualties.     

Determinants of traffic injuries in drivers and motorcyclists involved in an accident

Basic information on the risk factors of road traffic injuries in Iran is scarce. This case-control study was conducted to determine the association of potential risk factors with the incidence of injury among motor vehicle drivers and motorcyclists on Qazvin-Loshan Road. The cases were 175 drivers and motorcyclists who had a road traffic accident (RTA) and sustained an injury. The controls were 175 motorists who had a RTA, on the same road and over the same time period, without suffering any injury. The analyses were separately performed by comparing the controls with mildly and severely injured cases, using New Injury Severity Score (NISS) 15 as a threshold. The results showed that fire following collision was significant in the crude analysis of all 175 cases and controls. The severity of collision, vehicle type (motorcycle versus other vehicle crashes), and gender were significant in the multivariable analyses of both mildly and severely injured cases. Safety equipment use is only significant (adjusted odds ratio, AOR=0.44, 95% confidence interval, 95%CI=0.23-0.84) among mild cases. The number of collisions (AOR=3.87, 95%CI=1.64-9.10) and weather conditions (AOR=4.32, 95%CI=1.13-16.5) only associate significantly with the occurrence of road traffic injury in severe cases, in comparison with the controls.     

Cognitive compatibility of motorcyclists and car drivers

Incompatibility between different types of road user is a problem that previous research has shown to be resistant to a range of interventions. Cars and motorcycles are particularly prone to this. Insight is provided in this paper by a naturalistic method using concurrent verbal protocols and an automatic, highly reliable semantic network creation tool. The method shows how the same road situation is interpreted differently by car drivers and motorcyclists in ways congruent with wider accident rates. Analysis of the structure and content of the semantic networks reveals a greater degree of cognitive compatibility on faster roads such as motorways, but evidence of more critical incompatibilities on country roads and junctions. Both of these road types are implicated in helping to activate cognitive schema which in turn generate stereotypical behaviors unfavourable to the anticipation of motorcyclists by car drivers. The results are discussed in terms of practical measures such as road signs which warn of events behind as well as in front, cross-mode training and the concept of route driveability.     

The real number of road traffic accident casualties in The Netherlands: a year-long survey

Between August 1986 and July 1987 more than 24,000 households, containing nearly 67,000 persons, were surveyed by telephone about traffic injuries during the past three months. Expressed on an annual basis, approximately 430,000 people, or about 1 in 34 of the Dutch population, had suffered some sort of injury in a road accident. The road traffic morbidity was, therefore, 2,942 per 100,000 inhabitants. Of these, about 135,000 had to be treated in hospital (20,000 as inpatients). More than 100,000 did not need treatment. Cyclists formed by far the largest category of road user, but mopedists had the highest injury rate per kilometer travelled. 210,000 of these casualties fell within the definition for recording by the police. The police recorded only 49,748 traffic casualties, or about 25%, during the same period. The police data were not representative; the completeness declined according to severity of the injuries: inpatients, about 70%; outpatients 26%; extramural about 11%. Cyclists (11%), children (9%), and single vehicle accidents (5%) were very much underrepresented. The largest category of road user is cyclists, not car occupants as indicated by the police data. A number of recommendations are made for supplementing the police data and the existing hospital inpatient data. These include extending the Home Accident Recording System of outpatients and the General Practitioner Panel to include road accident victims. Together a representative sample of 95% of all those receiving medical treatment would thus be obtained.     

Differences in rural and urban driver-injury severities in accidents involving large-trucks: an exploratory analysis

This study explores the differences between urban and rural driver injuries (both passenger-vehicle and large-truck driver injuries) in accidents that involve large trucks (in excess of 10,000 pounds). Using 4 years of California accident data, and considering four driver-injury severity categories (no injury, complaint of pain, visible injury, and severe/fatal injury), a multinomial logit analysis of the data was conducted. Significant differences with respect to various risk factors including driver, vehicle, environmental, road geometry and traffic characteristics were found to exist between urban and rural models. For example, in rural accidents involving tractor-trailer combinations, the probability of drivers' injuries being severe/fatal increased about 26% relative to accidents involving single-unit trucks. In urban areas, this same probability increased nearly 700%. In accidents where alcohol or drug use was identified as being the primary cause of the accident, the probability of severe/fatal injury increased roughly 250% percent in rural areas and nearly 800% in urban areas. While many of the same variables were found to be significant in both rural and urban models (although often with quite different impact), there were 13 variables that significantly influenced driver-injury severity in rural but not urban areas, and 17 variables that significantly influenced driver-injury severity in urban but not rural areas. We speculate that the significant differences between rural and urban injury severities may be at least partially attributable to the different perceptual, cognitive and response demands placed on drivers in rural versus urban areas.     

Factors contributing to young moped rider accidents in Denmark

Young road users still constitute a high-risk group with regard to road traffic accidents. The crash rate of a moped is four times greater than that of a motorcycle, and the likelihood of being injured in a road traffic accident is 10–20 times higher among moped riders compared to car drivers. Nevertheless, research on the behaviour and accident involvement of young moped riders remains sparse.Based on analysis of 128 accident protocols, the purpose of this study was to increase knowledge about moped accidents. The study was performed in Denmark involving riders aged 16 or 17. A distinction was made between accident factors related to (1) the road and its surroundings, (2) the vehicle, and (3) the reported behaviour and condition of the road user. Thirteen accident factors were identified with the majority concerning the reported behaviour and condition of the road user. The average number of accident factors assigned per accident was 2.7. Riding speed was assigned in 45% of the accidents which made it the most frequently assigned factor on the part of the moped rider followed by attention errors (42%), a tuned up moped (29%) and position on the road (14%). For the other parties involved, attention error (52%) was the most frequently assigned accident factor. The majority (78%) of the accidents involved road rule breaching on the part of the moped rider.The results indicate that preventive measures should aim to eliminate violations and increase anticipatory skills among moped riders and awareness of mopeds among other road users. Due to their young age the effect of such measures could be enhanced by infrastructural measures facilitating safe interaction between mopeds and other road users.     

Safety riding program and motorcycle-related injuries in Thailand

A retrospective cohort study was conducted in Thailand from 2007 to 2009 to evaluate the efficacy of a safety riding program in preventing motorcycle-related injuries. A training group of motorcyclists were certified by the Asia-Pacific Honda Safety Riding Program in either 30-h instruction (teaching skills, riding demonstration) or 15-h license (knowledge, skills, and hazard perception) courses. The control group consisted of untrained motorcyclists matched on an approximately 1:1 ratio with the training group by region and date of licensure. In total, there were 3250 subjects in the training group and 2963 in the control group. Demographic data and factors associated with motorcycle-related injuries were collected. Motorcycle-related injuries were identified using the Road Injuries Victims Protection for injuries claims and inpatient diagnosis-related group datasets from the National Health Security Office. The capture–recapture technique was used to estimate the prevalence of injuries. Multivariate analysis was used to identify factors related to motorcycle-related injuries. The prevalence of motorcycle-related injuries was estimated to be 586 out of 6213 riders (9.4%) with a 95% confidence interval (CI): 460–790. The license course and the instruction course were significantly associated with a 30% and 29% reduction of motorcycle-related injuries, respectively (relative risk 0.70, 95% CI: 0.53–0.92 and 0.71, 95% CI: 0.42–1.18, respectively). Other factors associated with the injuries were male gender and young age. Safety riding training was effective in reducing injuries. These training programs differ from those in other developed countries but display comparable effects. Hazard perception skills might be a key for success. This strategy should be expanded to a national scale.     

Injuries to the elderly in the traffic environment

Two hundred ninety-seven persons, all aged 60 or over (180 women, 117 men), injured in the traffic environment, and treated at the Regional Hospital in Ume?, over a one-year period, were analysed. Injuries were grouped into three main categories: falls (52%), vehicle-associated events (44%), and "other" injury events (4%). In women, falls were a more common cause of injury than vehicle events, whilst in men there was a tendency for a converse relationship. Two-thirds of the falls involved slipping on ice and snow. Ice- and snow- related injuries (all categories) accounted for 37% of the total cost of all injuries in the elderly in the traffic environment. The main groups in the vehicle-associated injury category were cyclists (48%), car occupants (34%), other occupants (14%), and pedestrians (4%). Vehicle-associated injuries became more common with advancing age, resulted in the most severe and critical [Maximum Abbreviated Injury Scale (MAIS) greater than or equal to 4] injuries and the most fatalities, and cost (total and mean) more than falls. In conclusion, from the injury cost point of view, it is most important to prevent vehicle-associated injuries. However, when total frequencies are considered, falls deserve to be given just as much priority in injury prevention programs as vehicle-associated injuries, to make the traffic environment safer for this growing population.     

Using speeding detections and numbers of fatalities to estimate relative risk of a fatality for motorcyclists and car drivers

Precise estimation of the relative risk of motorcyclists being involved in a fatal accident compared to car drivers is difficult. Simple estimates based on the proportions of licenced drivers or riders that are killed in a fatal accident are biased as they do not take into account the exposure to risk. However, exposure is difficult to quantify. Here we adapt the ideas behind the well known induced exposure methods and use available summary data on speeding detections and fatalities for motorcycle riders and car drivers to estimate the relative risk of a fatality for motorcyclists compared to car drivers under mild assumptions. The method is applied to data on motorcycle riders and car drivers in Victoria, Australia in 2010 and a small simulation study is conducted.     

Health status recovery at one year in children injured in a road accident: A cohort study

Despite the frequency of traumatic injuries due to road accidents and potential importance of identifying children at risk of impaired recovery one year after a road accident, there is a lack of data on long-term recovery of health status, except in children with severe traumatic brain injury. The aim of the present study was to evaluate predictive factors of recovery in children one year after road traffic injuries. The prospective cohort study was composed of children aged <16 years, admitted to public or private sector hospitals in the Rhône administrative area of France following a road accident. Recovery of health status one year after the accident and information concerning quality of life and the consequences of the accident for the child or family 1 year after the accident were collected by questionnaire, usually completed by the parents. Victims were in majority male (64.6%) and had mild or moderate injuries (81.9% with Maximum Abbreviated Injury Scale (M-AIS) <3). One year after the accident, 75.0% of the mild-to-moderate and 34.8% of the severe cases estimated health status as fully recovered. After adjustment, severity score (M-AIS ≥ 3) and lower limb injury (AIS > 1) were associated with incomplete recovery of health status: weighted odds ratio (OR_w), 4.3 [95% confidence interval (95% CI), 1.3–14.6] and OR_w, 6.5 [95% CI, 1.9–21.7], respectively. Recovery status correlated significantly with quality of life physical scores (r = 0.46), especially body pain (r = 0.48) and role/social–physical (r = 0.50) and, to a lesser extent, quality of life psychosocial scores (r = 0.21). In a cohort of children injured in a road accident, those with high injury severity score and those with lower limb injuries are less likely to recover full health status by 1 year. Impaired health status was associated with a lower physical quality of life score at 1 year.     

Applying the motorcyclist's perspective to improve car drivers' attitudes towards motorcyclists

This study sought to provide a first crucial step in the direction of developing an intervention program aimed at improving safe attitudes and skills among car drivers towards motorcycles. We intended to improve drivers’ attitudes towards motorcyclists by exposing them to demands that motorcyclists face on the road. Car drivers were exposed to hazard perception clips taken from a motorcyclist's perspective, and interactive hazards in a motorcycle simulator. Car hazard perception clips and a car simulator were used as control conditions. A questionnaire assessed participant knowledge and attitudes towards motorcyclists before and after the intervention. After the intervention participants had more empathic- and fewer negative-attitudes, as well as safer attitudes towards motorcyclists. Self-reported attitude-change suggested that the use of motorcycle hazard perception clips was more effective than the simulator, and the intervention was most effective for those car drivers who reported the most negative attitudes prior viewing the clips or riding the simulator. Providing car drivers with a perspective of the motorcyclist may prove to be a useful tool for promoting safer attitudes towards motorcyclists.     

Are car daytime running lights detrimental to motorcycle conspicuity?

For a long time, motorcycles were the only vehicles with daytime running lights (DRLs), but this conspicuity advantage has been questioned due to the rapidly increasing introduction of DRLs on cars as well. The present experiment was designed to assess effects of car DRLs on motorcycle perception in a situation that specifically brought attentional conspicuity to bear. Photographs representing complex urban traffic scenes were displayed briefly (250 ms) to 24 participants who had to detect vulnerable road users (motorcyclists, cyclists, pedestrians) appearing at different locations and distances. Car DRLs hampered motorcycle perception compared to conditions where car lights were not on, especially when the motorcycle was at a greater distance from the observer and when it was located in the central part of the visual scene. Car DRLs also hampered the perception of cyclists and pedestrians. Although the globally positive safety effect of car DRLs is generally acknowledged, our study suggests that more attention should be paid to motorcyclists and other vulnerable road users when introducing car DRLs. Several means of improving motorcycle conspicuity in car DRL environments are discussed.     

Car drivers' attitudes towards motorcyclists: a survey

Motorcyclists are over-represented in UK traffic accident statistics. Many car–motorcycle accidents are however due to the inappropriate actions of car drivers. It is predicted that car drivers at risk of collision with motorcycles have divergent attitudes and beliefs about motorcyclists compared to safer drivers, which may lead to a deficient mental model guiding their interactions with motorcyclists. To assess car drivers’ attitudes towards motorcyclists, a survey was undertaken. Respondents filled in 26 general and motorcycle-related items and the 24 items of the reduced Driver Behaviour Questionnaire. Compared to an experienced dual driver group (who both drive cars and ride motorcycles), all other drivers showed divergent beliefs and attitudes. Four factors were extracted from the motorcycle items: negative attitudes, empathic attitudes, awareness of perceptual problems, and spatial understanding. Car drivers with a moderate amount of experience (between 2 and 10 years driving) held the most negative views and reported the most violations. The results have lead to several suggestions for interventions aimed at decreasing the divergence between drivers’ perceptions of motorcyclists, and the perceptions of experienced dual drivers.     

Bicycle injury events among older adults in Northern Sweden: A 10-year population based study

Bicycles are a common mode of transportation and injured bicyclists cause a substantial burden on the medical sector. In Sweden, about half of fatally injured bicyclists are 65 years or older. This study analyzes the injury mechanisms, injuries, and consequences among bicyclists 65 years or older and compare with younger bicyclists (≤64) and older adults as passenger car drivers, to give a basis for an injury preventive discussion for this age group. Umeå University Hospital's primary catchments area had 142,000 inhabitants in 2006. Nearly all injured road users in the well-defined geographic area are treated at this hospital and a 10-year data set (N = 456) of injured bicyclists aged 65+ from the hospital's continuous injury registration (1997-2006) was analyzed. The results show that the annual injury incidence was 2.4 and 2.2 per 1000 men and women, respectively, aged 65 or older. For men the incidence rate was constant in the three age groups 65-74, 75-84 and 85+, while it decreased strongly for women. The incidence rate for old adults as passenger car drivers and younger bicyclists was 1.0 and 4.6, respectively. Most frequent injury mechanisms were falls when getting on or off a bicycle (20%) and by potholes or irregularities on the ground, edge of a sidewalk, or similar (13%). Only 6% were hit by cars, trucks, or buses. Half of the injured suffered fractures or dislocations, and 10% suffered concussion or more serious intracranial injuries. Getting on or off the bicycle caused most fractures (especially a high fraction of the hip and femur fractures) and resulted in 27% of all inpatient days in hospital. Three individuals died. One-third of the injured were treated as inpatients for a total of 1413 days (on average 9 days), with 69% of the days being caused by fractures. The cost for out- and inpatient acute treatment was approximately USD 4700 (SEK 33,000) per injured. The results merit an interest for this target group; bicycle injuries among older adults are costly both for the individual and the medical sector. Injury mitigation strategies focused on the needs of this group are probably as well motivated as those focused on older car drivers.     

Impact of safety belt use on road accident injury and injury type in Kuwait

The enactment of Kuwait's seat belt law in January 1994 provided an opportunity to examine the impact of seat belt use on road accident fatalities and injury types in this affluent Persian Gulf nation. Via a structured data form, the results of injurious/fatal road accidents for more than 1200 accident victims were gathered from the files of the six major government hospitals which treat most traffic accident victims. Statistical analysis of the data showed that seat belt use has had a positive effect in reducing both road traffic fatalities and multiple injuries in Kuwait. The use of seat belts has also affected the nature of the injuries resulting from road traffic accidents. Non-users of belts experienced higher frequencies of head, face, abdominal and limb injuries. Users of belts, on the other hand, suffered higher frequencies of neck and chest injuries. The interrelationship between the victim, his age, and the type of injuries resulting from road traffic accidents is also investigated.     

Red-light running rates at five intersections by road user in Changsha,China: An observational study

The red-light running rate by type of road users has not been reported in China so far. We conducted an observation study to report the violation rate in Changsha, China. Portable digital devices were used to record red-light running violations at five selected intersections. The observation was performed for three days (weekday, weekend and holiday), four time periods per day and an hour per time period (peak and off-peak hours in the morning and in the afternoon). Violation rate was calculated as number of violations divided by total number of vehicles/pedestrians × 100%. We used adjusted violation rate ratio (VRR) to quantify the effects of type of day and time period based on Poisson model. Totally, 162,124 vehicles (including motor vehicles, motorcycles and bicycles) and 31,649 pedestrians were recorded. The red-light running rate was 0.14% for motor vehicle drivers, far lowering than those for motorcyclists (18.64%), bicyclists (18.74%) and pedestrians (18.54%). The rate on holiday was 1.89 times that on weekday for drivers. The rate for motorcyclists was high in off-peak hours (adjusted VRR: 1.11), but low on weekend and on holiday (adjusted VRRs: 0.80 and 0.65). The rate for bicyclists was 32% lower on weekend than on weekday. For pedestrians, the rates were high on weekend and holiday and in off-peak hours (adjusted VRR: 1.09, 1.67 and 1.30). The red-light running rate of motor vehicle drivers is far lower than those for motorcyclists, bicyclists and pedestrians. The effects of type of day and time period on violation rate vary with road users, indicating the type of day and time period should be considered when developing and implementing interventions to reduce red-light running of different road users.