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.

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

OBJECTIVE: 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.

The European New Car Assessment Programme: A historical review.

Established in 1997, the European New Car Assessment Programme (Euro NCAP) provides consumers with a safety performance assessment for the majority of the most popular cars in Europe. Thanks to its rigorous crash tests, Euro NCAP has rapidly become an important driver safety improvement to new cars. After ten years of rating vehicles, Euro NCAP felt that a change was necessary to stay in tune with rapidly emerging driver assistance and crash avoidance systems and to respond to shifting priorities in road safety. A new overall rating system was introduced that combines the most important aspects of vehicle safety under a single star rating. The overall rating system has allowed Euro NCAP to continue to push for better fitment and higher performance for vehicles sold on the European market. In the coming years, the safety rating is expected to play an important role in the support of the roll-out of highly automated vehicles.

Commentary: Status of road safety in Asia.

OBJECTIVES: The objective of this article is to assess the status of road safety in Asia and present accident and injury prevention strategies based on global road safety improvement experiences and discuss the way forward by indicating opportunities and countermeasures that could be implemented to achieve a new level of safety in Asia. METHODS: This study provides a review and analyses of data in the literature, including from the World Health Organization (WHO) and World Bank, and a review of lessons learned from best practices in high-income countries. In addition, an estimation of costs due to road transport injuries in Asia and review of future trends in road transport is provided. RESULTS: Data on the global and Asian road safety problem and status of prevention strategies in Asia as well as recommendations for future actions are discussed. The total number of deaths due to road accidents in the 24 Asian countries, encompassing 56% of the total world population, is 750,000 per year (statistics 2010). The total number of injuries is more than 50 million, of which 12% are hospital admissions. The loss to the economy in the 24 Asian countries is estimated to around US$800 billion or 3.6% of the gross domestic product (GDP). CONCLUSIONS: This article clearly shows that road safety is causing large problems and high costs in Asia, with an enormous impact on the well-being of people, economy, and productivity. In many Asian low- and middle-income countries, the yearly number of fatalities and injuries is increasing. Vulnerable road users (pedestrians, cyclists, and motorcyclists combined) are particularly at risk. Road safety in Asia should be given rightful attention, including taking powerful, effective actions. This review stresses the need for reliable accident data, because there is considerable underreporting in the official statistics. Reliable accident data are imperative to determine evidence-based intervention strategies and monitor the success of these interventions and analyses. On the other hand, lack of good high-quality accident data should not be an excuse to postpone interventions. There are many opportunities for evidence-based transport safety improvements, including measures concerning the 5 key risk factors: speed, drunk driving, not wearing motorcycle helmets, not wearing seat belts, and not using child restraints in cars, as specified in the Decade of Action for Road Safety 2011-2020. In this commentary, a number of additional measures are proposed that are not covered in the Decade of Action Plan. These new measures include separate roads or lanes for pedestrians and cyclists; helmet wearing for e-bike riders; special attention to elderly persons in public transportation; introduction of emerging collision avoidance technologies, in particular automatic emergency braking (AEB) and alcohol locks; improved truck safety focusing on the other road user (including blind spot detection technology; underride protection at the front, rear, and side; and energy-absorbing fronts); and improvements in motorcycle safety concerning protective clothing, requirements for advanced braking systems, improved visibility of motorcycles by using daytime running lights, and better guardrails.

Correlation Between Euro NCAP Pedestrian Test Results and Injury Severity in Injury Crashes with Pedestrians and Bicyclists in Sweden.

Pedestrians and bicyclists account for a significant share of deaths and serious injuries in the road transport system. The protection of pedestrians in car-to-pedestrian crashes has therefore been addressed by friendlier car fronts and since 1997, the European New Car Assessment Program (Euro NCAP) has assessed the level of protection for most car models available in Europe. In the current study, Euro NCAP pedestrian scoring was compared with real-life injury outcomes in car-to-pedestrian and car-tobicyclist crashes occurring in Sweden. Approximately 1200 injured pedestrians and 2000 injured bicyclists were included in the study. Groups of cars with low, medium and high pedestrian scores were compared with respect to pedestrian injury severity on the Maximum Abbreviated Injury Scale (MAIS)-level and risk of permanent medical impairment (RPMI). Significant injury reductions to both pedestrians and bicyclists were found between low and high performing cars. For pedestrians, the reduction of MAIS2+, MAIS3+, RPMI1+ and RPMI10+ ranged from 20-56% and was significant on all levels except for MAIS3+ injuries. Pedestrian head injuries had the highest reduction, 80-90% depending on level of medical impairment. For bicyclist, an injury reduction was only observed between medium and high performing cars. Significant injury reductions were found for all body regions. It was also found that cars fitted with autonomous emergency braking including pedestrian detection might have a 60-70% lower crash involvement than expected. Based on these results, it was recommended that pedestrian protection are implemented on a global scale to provide protection for vulnerable road users worldwide.

Nonconformities in real-world fatal crashes--electronic stability control and seat belt reminders.

OBJECTIVE: Many new safety systems are entering the market. Vision Zero is a safety strategy aiming at the elimination of fatalities and impairing injuries by the use of a holistic model for safe traffic to develop a safe system. The aim of this article is to analyze fatalities in modern cars with respect to the Vision Zero model with special respect to electronic stability control (ESC) systems and modern seat belt reminders (SBRs). The model is used to identify and understand cases where cars with ESC systems lost control and where occupants were unbelted in a seat with seat belt reminders under normal driving conditions. METHODS: The model for safe traffic was used to analyze in-depth studies of fatal crashes with respect to seat belt use and loss of control. Vehicles from 2003 and later in crashes from January 2004 to mid-2010 were analyzed. The data were analyzed case by case. Cars that were equipped with ESC systems and lost control and occupants not using the seat belt in a seat with a seat belt reminder were considered as nonconformities. A total of 138 fatal crashes involving 152 fatally injured occupants were analyzed. RESULTS: Cars with ESC systems had fewer loss-of-control-relevant cases than cars without ESC systems. Thirteen percent of the ESC-equipped vehicles had loss-of-control-relevant crashes and 36 percent of the cars without ESC systems had loss-of-control-relevant crashes. The analysis indicates that only one car of the 9 equipped with ESC that lost control did it on a road surface with relevant friction when driving within the speed restriction of the road. In seats with seat belt reminders that are in accordance with the European New Car Assessment Programme's (Euro NCAP) protocol, 93 percent of the occupants were using a seat belt. In seats without reminders this number was 74 percent. CONCLUSIONS: This study shows that ESC systems result in a very significant reduction in fatal crashes, especially under normal driving conditions. Under extreme driving conditions such as speeding or extremely low friction (snow or on the side of the road), ESC systems can fail in keeping the car under control. Seat belt reminders result in higher seat belt use rates but the level of unbelted occupants is higher than roadside studies have indicated. The holistic Vision Zero approach helped in the analysis by identifying nonconformities and putting these into the safe systems perspective.

The effects of studded tires on fatal crashes with passenger cars and the benefits of electronic stability control (ESC) in Swedish winter driving.

This study set out to examine the effects of studded tires on fatal crashes on roads covered with ice or snow in Sweden and also to investigate the extra benefits of electronic stability control (ESC) during the winter months. Two different studies are presented in this paper. Both studies used an induced exposure approach. In the main study, 369 in-depth studies of fatal crashes with passenger cars were analyzed to determine whether loss-of-control (LOC) had been a major component or not. Only crashes involving cars without ESC and equipped with approved studded or non-studded winter tires were analyzed. The additional study used police-reported crashes that occurred during the winter seasons 2003-2010, involving passenger cars with and without ESC. While police records in Sweden do not include any tire information, it was assumed that most cars involved in crashes during the winter period would be equipped with studded tires. Findings in the main study showed that in 64% of the fatal crashes on roads covered with ice or snow LOC had been a major component. Furthermore, in 82% of LOC crashes, the passenger car over-steered prior to collision. Studded tires were found to have a statistically significant effect of 42% in terms of fatal crash reduction on roads covered with ice or snow, compared to non-studded winter tires. The effect on dry or wet roads in the winter was negative, although statistically non-significant. In the additional study, it was found that ESC further reduced crashes with injuries by 29%. The benefits on severe and fatal crashes were slightly greater (32%), although the lower 95% confidence limit was lower. Although studded tires were shown to reduce the risk of fatal crash involvement, compared to non-studded winter tires, the proportion of LOC and over-steering among cars with studded tires was large (59% and 49%, respectively). It was therefore concluded that studded tires do not prevent all LOC crashes, while ESC has benefits in those crashes since this technology mostly addresses over-steering. This is also supported by the fact that the share of LOC fatal crashes is considerably lower for ESC-equipped cars. This study recommends that non-ESC cars should be fitted with studded tires if they are to be driven on roads covered by ice or snow. If the proportion of studded tires is to be decreased on Swedish roads to reduce the about of hazardous particulates especially in built up areas, from a road safety point of view it is recommended that this should be done in phase with the implementation of ESC on all passenger cars.

The correlation between pedestrian injury severity in real-life crashes and Euro NCAP pedestrian test results.

OBJECTIVE: The aim of the present study was to estimate the correlation between Euro NCAP pedestrian rating scores and injury outcome in real-life car-to-pedestrian crashes, with special focus on long-term disability. Another aim was to determine whether brake assist (BA) systems affect the injury outcome in real-life car-to-pedestrian crashes and to estimate the combined effects in injury reduction of a high Euro NCAP ranking score and BA. METHODS: In the current study, the Euro NCAP pedestrian scoring was compared with the real-life outcome in pedestrian crashes that occurred in Sweden during 2003 to 2010. The real-life crash data were obtained from the data acquisition system Swedish Traffic Accident Data Acquisition (STRADA), which combines police records and hospital admission data. The medical data consisted of International Classification of Diseases (ICD) diagnoses and Abbreviated Injury Scale (AIS) scoring. In all, approximately 500 pedestrians submitted to hospital were included in the study. Each car model was coded according to Euro NCAP pedestrian scores. In addition, the presence or absence of BA was coded for each car involved. Cars were grouped according to their scoring. Injury outcomes were analyzed with AIS and, at the victim level, with permanent medical impairment. This was done by translating the injury scores for each individual to the risk of serious consequences (RSC) at 1, 5, and 10 percent risk of disability level. This indicates the total risk of a medical disability for each victim, given the severity and location of injuries. The mean RSC (mRSC) was then calculated for each car group and t-tests were conducted to falsify the null hypothesis at p ≤ .05 that the mRSC within the groups was equal. RESULTS: The results showed a significant reduction of injury severity for cars with better pedestrian scoring, although cars with a high score could not be studied due to lack of cases. The reduction in RSC for medium-performing cars in comparison with low-performing cars was 17, 26, and 38 percent for 1, 5, and 10 percent of medical impairment, respectively. These results applied to urban areas with speed limits up to 50 km/h, although no significant reduction was found in higher speed zones. Regarding cars with BA, the null hypothesis could not be rejected at p = .05; hence, no significant results of injury reduction were found. CONCLUSIONS: A significant correlation between Euro NCAP pedestrian score and injury outcome in real-life car-to-pedestrian crashes was found. Injury reduction was found to be higher with increasing severity and level of permanent medical impairment. The difference between 1- and 2-star cars is 17 percent in mean risk of permanent medical impairment (mRSC) 1%+, 26 percent in mRSC 5%+, and 38 percent in mRSC 10%+ for crashes in speed zones up to 50 km/h. Brake assist was not found to provide a statistically significant injury reduction.

Census study of fatal car-to-car intersection crashes in Sweden involving modern vehicles.

OBJECTIVE: Intersections are challenging for many road users. According to US, European, and global statistics, intersection-related crashes with fatal outcome represent approximately 20 percent of all traffic fatalities. The aim of this study was to use Swedish data to investigate and characterize fatal car-to-car intersection crashes for modern cars equipped with frontal and side air bags. METHOD: The Swedish Transport Administration (STA) national database on fatal crashes was searched to find vehicle-to-vehicle intersection crashes involving modern cars that occurred between 2003 and 2009 that resulted in fatal injuries for at least one of the involved passengers. From all intersection crashes, the car-to-car crashes from the sample were analyzed at an occupant level. Occupant location in the target vehicle with respect to impact direction as well as AIS3+ injuries to body regions was examined for the total car-to-car sample. Crashes involving a target vehicle equipped with front and side air bags were then selected for an in-depth study. RESULTS: In the STA database, 39 vehicle-to-vehicle crashes matched the search criteria. Of 39 crashes, 17 involved a heavy goods vehicle (HGV) as the striking vehicle, and 17 were car-to-car crashes. All car-to-car crashes were side impacts, occurring at rural intersections, involving 20 (12 female and 8 male) fatally injured occupants, 15 of whom were 61 years or older and classified as senior occupants. A majority of fatally injured occupants sustained combined AIS3+ injuries to more than one body region. CONCLUSIONS: All modern car-to-car crashes with a fatal outcome occurring at Swedish intersections from 2003 to 2009 were side impacts. The crashes were characterized by a senior front seat driver, traveling with a front seat passenger, hit on the left side at approximately 70 km/h. In this study all fatal crashes occurred at severities beyond those currently evaluated in side impact rating procedures but were within survivable limits for a non-senior occupant in a majority of cases.

Comparison between Euro NCAP test results and real-world crash data.

OBJECTIVE: The objective of this study was 2-fold: first, to compare Euro NCAP safety ratings of cars with those published by the Folksam real-world injury ratings; and second, to compare injury risk measures between Euro NCAP 2 and 5 Star cars with real-world injury and disability outcomes using police and insurance injury data. METHODS: Car models were grouped according to the Euro NCAP star rating scores. Folksam risk of injury ratings come from statistical analysis of real-world crashes using police and insurance databases. The paired comparison method using 2-car crashes was used to control for crash speed and the mass differences between cars of different weights were normalized. RESULTS: For all comparisons, 5-star rated Euro NCAP cars were found to have a lower risk of injury compared to 2-star rated cars (5-star cars were 10% ± 2.5% lower risk than 2-star cars). For fatal and serious injuries, the difference was 23 ± 8 percent, and for fatal injuries alone the difference was 68 ± 32 percent. By comparison, the Folksam 5-star rated cars had a relative risk of 0.020 ± 0.0024, whereas 2-star rated car risk was 0.028 ± 0.0016, corresponding to a 27 percent difference in risk between 5- and 2-star cars. CONCLUSIONS: Good correlation was found between Euro NCAP test results and real-world injury outcomes. The largest difference in injury risk between 2- and 5-star rated cars in Euro NCAP was found for risk of fatality, confirming that car manufacturers have focused their safety performance on serious crash outcomes. In addition, Euro NCAP crash tests were shown to be highly correlated with serious crash performance, confirming their relevance for evaluating real-world crash performance. Good concordance was found between Euro NCAP and Folksam real-world crash and injury ratings.

Intelligent seat belt reminders-do they change driver seat belt use in Europe?

OBJECTIVE: Many modern cars have seat belt reminders (SBRs) using loud and clear sound and light signals. These systems have developed over the last few years. This study investigates how these modern systems influence the seat belt use in real-life traffic in built-up areas in some European cities. METHODS: The data were collected by field observations in major cities in six European countries and in five cities around Sweden. A selection of car models having seat belt reminders (SBR) were compared to a fleet of similar car models without such reminders. RESULTS: A significant difference in seat belt wearing rate was found in the cars with seat belt reminders. For all observations, the total seat belt wearing rate was 97.5% +/- 0.5% in cars with SBR, while it was 85.8% +/- 0.8% in cars without. There were differences in seat belt use in the different observation locations. The lowest seat belt use was found in Brussels/Belgium with a use rate of 92.6 +/- 2.2% in cars with seat belt reminders and 69.6 +/- 3.1% in cars not fitted with reminders. The highest seat belt use was found in Paris/France where 99.8 +/- 0.4% of the drivers used the seat belt in cars with reminders and 96.9 +/-1.1% were belted in cars without reminders. CONCLUSION: Seat belt reminders fulfilling Euro NCAP's seat belt reminder protocol are increasing the seat belt use in daily traffic significantly. Around 80% (82.2% +/- 8.6%) of the drivers not putting the belt on without a seat belt reminder do so in cars equipped with an SBR that has a light signal and an associated loud and clear sound signal.

The use of seat belts in cars with smart seat belt reminders--results of an observational study.

UNLABELLED: Recently, smart seat belt reminders (SBR) have been introduced in cars. By increasingly reminding drivers and passengers if they are not using the seat belt, the intention is to increase the belt use to almost 100%. OBJECTIVE: The objective was to study if there were differences in driver's seat belt use between cars with and without SBR. METHODS: Drivers of cars with and without SBR were observed concerning seat belt use. The case (cars with SBR) and the control group (cars without SBR) were similar in all major aspects except SBR. In all, more than 3,000 drivers were observed in five cities in Sweden. RESULTS: In cars without SBR, 82.3 percent of the drivers used the seat belt, while in cars with SBR, the seat belt use was 98.9 percent. The difference was significant. In cars with mild reminders, the use was 93.0 percent. CONCLUSION: It is concluded, that if the results can be generalised to the whole car population this would have a dramatic impact on the number of fatally and seriously injured car occupants.

The effectiveness of electronic stability control (ESC) in reducing real life crashes and injuries.

UNLABELLED: Electronic Stability Control (ESC) was introduced on the mass market in 1998. Since then, several studies showing the positive effects of ESC have been presented. OBJECTIVE: In this study, data from crashes occurring in Sweden during 1998 to 2004 were used to evaluate the effectiveness of ESC on real life crashes. The effectiveness was analyzed for different road conditions, and some accident types and injury levels. METHODS: The study used statistical analysis. To control for exposure, induced exposure methods were used, where ESC-sensitive to ESC-insensitive crashes and road conditions were matched in relation to cars equipped with and without ESC. Cars of similar or, in some cases, identical make and model were used to isolate the role of ESC. RESULTS: The study shows a positive and consistent effect of ESC overall and in circumstances where the road has low friction. The overall effectiveness on all injury crash types, except rear end crashes, was 16.7 +/- 9.3%, while for serious and fatal crashes; the effectiveness was 21.6 +/- 12.8%. The corresponding estimates for crashes with injured car occupants were 23.0 +/- 9.2% and 26.9 +/- 13.9%. For serious and fatal loss-of-control type crashes on wet roads the effectiveness was 56.2 +/- 23.5% and for roads covered with ice or snow the effectiveness was 49.2 +/- 30.2%. It was estimated that for Sweden, with a total of 500 vehicle related deaths annually, that 80-100 fatalities could be saved annually if all cars had ESC. CONCLUSIONS: ESC was found to reduce crashes with personal injuries, especially serious and fatal injuries. The effectiveness ranged from at least 13% for car occupants in all types of crashes with serious or fatal outcome to a minimum of 35% effectiveness for single/oncoming/overtaking serious and fatal crashes on wet or icy road surface. No difference in deformation pattern was found for cars with or without ESC.

The effectiveness of ESP (Electronic Stability Program) in reducing real life accidents.

ESP (Electronic Stability Program) has recently been introduced onto the market in an effort to reduce the number and severity of loss-of-control automobile accidents. This reduction is expected to be particularly evident for accidents on roads with low friction (e.g., wet or icy conditions). This study aimed to evaluate the statistical effectiveness of ESP using data from accidents that occurred in Sweden during 2000 to 2002. To control for exposure, induced exposure methods were used, where ESP-sensitive to ESP-insensitive accidents and road conditions were matched in relation to cars equipped with and without ESP. Cars of similar, or in some cases identical, make and model were used to isolate the role of ESP. As predicted, the study showed a positive effect of ESP in circumstances where road surfaces have low friction. The overall effectiveness was 22.1 (+/-21) percent, while for accidents on wet roads, the effectiveness increased to 31.5 (+/-23.4) percent. On roads covered with ice and snow, the corresponding effectiveness was 38.2 (+/-26.1) percent. In addition, ESP was found to be effective for three different types of cars: small front-wheel drive; large front-wheel drive; and large rear-wheel drive.

The risk of whiplash injury in the rear seat compared to the front seat in rear impacts.

One hundred ninety-five rear impacts with both front- and rear-seat occupants in the struck car, where at least one occupant sustained permanent disability, were selected for study. There was a significantly higher disability risk for the female rear-seat occupant compared with the male driver. Furthermore, a higher risk was found for female rear-seat occupants compared with female front-seat passengers. The disability risk for occupants of the driver's seat was three times higher for females than for males, and four times higher for females in the rear seat. In the future, test methods should consider the risk of whiplash injury in both the front and the rear seat.