Limitations of data compiled from police reports on pediatric pedestrian and bicycle motor vehicle events

Police reports were compared to the information provided by a hospital monitoring system for children under 15 years old injured as pedestrians and bicyclists by moving motor vehicles in Orange County, California. The analysis was limited to identifying caveats in the police report database. Underreporting by police was conservatively estimated at 20% for pedestrians and 10% for bicyclists. Comparison of the pedestrian databases suggested underreporting by police of incidents involving 0-4-year-olds, nontraffic incidents, incidents in which the vehicle was backing up, and cases not involving a child crossing a street. Comparison of the bicyclist databases indicated an underreporting by police of nontraffic cases. These caveats, in part, are related to police agency reporting requirements. The police injury severity scale was found to correlate poorly with a scale based on medical diagnoses, and substantial underreporting by police of serious injuries was demonstrated. We suggest that utilization of police injury severity scales be limited to categories of fatal, injured, and not injured (when available).     

Road environment, crash type and hospitalisation of bicyclists and motorcyclists presented to emergency departments in Western Australia

Emergency presentations by bicyclists and motorcyclists are often the result from a fall or non-motor vehicle collision that occurred in off-road locations. Consequently, they are unlikely to be captured by police records. If the injury is not severe enough to warrant hospitalisation, they will also not be captured by the hospital admission system. To ascertain the nature and type of these crash events, a 6-month prospective study was undertaken of bicyclists and motorcyclists who presented to emergency departments in Perth, Western Australia, due to involvement in a crash or non-motor vehicle collision. Of the 330 eligible presentations, 151 bicyclists and 104 motorcyclists agreed to participate in a structured interview, representing a response rate of 77.3%. Among them, 120 (79%) bicyclists and 71 (68%) motorcyclists had a fall or non-motor vehicle collision, and many of the crashes (88 (58%) and 47 (45%), respectively) occurred off-road. Moreover, 26.5% of bicyclist and 62.5% of motorcyclist presentations led to hospital admissions. Multivariate logistic regression analysis further showed that the crash location and road type affected hospitalisation for both groups. Although, crashes occurring in rural areas contributed 14% of the events overall, their adjusted risk of hospitalisation increased five times when compared to metropolitan locations. Crash preventive measures targeting rural areas should be considered to further improve the safety of bicyclists and motorcyclists.     

Motor vehicle and roadway factors in pedestrian and bicyclist injuries: an examination based on emergency department data.

Information on 2558 persons treated for injuries incurred while bicycling or walking was collected from eight hospital emergency departments over approximately a one-year time period. The emergency departments represented a mix of urban and suburban/rural sites in three states--California, New York, and North Carolina. The data were collected on special survey forms and included detailed information about the location of the injury event. Results show that, overall, 70% of the reported bicycle injury events and 64% of the reported pedestrian injury events did not involve a motor vehicle. In addition, 31% of the bicyclists and 53% of the pedestrians were injured in non-roadway locations such as sidewalks, parking lots, or off-road trails. Although pedestrians and bicyclists struck by motor vehicles in the roadway were generally the most seriously injured, they represented less than a third of the reported cases. Increased knowledge of non-roadway and non-motor vehicle pedestrian and bicyclist injury events can contribute to more effective program and countermeasure development to improve pedestrian and bicyclist safety.     

Trends in head injuries associated with mandatory bicycle helmet legislation targeting children and adolescents

Background

Bicycling related head injuries (HIs) can be severe. Helmet use reduces head injury risk; however, there are few controlled studies of the effect of helmet legislation. We conducted this study to investigate changes in HIs after bicycle helmet legislation targeting those <18 in Alberta, Canada in 2002.

Methods

Bicyclist and pedestrian (control) HI rates and HIs as a proportion of all injuries were compared for the three years (1999–2001) before and four years (2003–2006) after bicycle helmet legislation in three age groups (children: <13, adolescents: 13–17, and adults: 18+).

Results

There were 41,270 ED visits and 2782 hospitalizations for bicyclists and 9836 ED visits and 2029 hospitalizations for pedestrians (excluding the legislation year 2002). The rate of ED HIs declined for child bicyclists and child pedestrians, while the rate of non-HIs declined in adult bicyclists and child pedestrians. The rate of hospitalized HIs declined in child bicyclists and all ages of pedestrians while non-HI rates declined for child and adult pedestrians. Non-HI rates for adolescent and adult bicyclists increased. After adjusting for sex and location, the proportion of ED bicycle HIs declined by 9% (APR = 0.91; 95% CI: 0.86, 0.95) in children, was unchanged among adolescents and increased in adults (APR = 1.08; 95% CI: 1.01, 1.15). The proportion of bicycle HI related hospitalizations decreased by 30% (APR = 0.70; 95% CI: 0.55, 0.90) in children, 36% (APR = 0.64; 95% CI: 0.49, 0.84) in adolescents and 24% (APR = 0.76; 95% CI: 0.63, 0.91) in adults. There were no observed changes in the proportion of pedestrian HIs resulting in ED visits or hospitalizations.

Interpretation

Our data indicate significant declines in the proportion of child bicyclist ED HIs and child, adolescent and adult bicyclist HI hospitalizations. This is in contrast to no significant trends in the proportion of ED or hospitalized HIs among pedestrians and the unexpected increases in the proportion of ED HIs for adult bicyclists. Comparing bicyclist and pedestrian trends in the proportion of child and adolescent HIs suggests a bicycle helmet legislation effect.     

A study of bicyclist kinematics and injuries based on reconstruction of passenger car–bicycle accident in China

Like pedestrians, bicyclists are vulnerable road users, representing a population with a high risk of fatal and severe injuries in traffic accidents as they are unprotected during vehicle collisions. The objective of this study is to investigate the kinematics response of bicyclists and the correlation of the injury severity with vehicle impact speed. Twenty-four car–bicyclist cases with detailed information were selected for accident reconstruction using mathematical models, which was implemented in the MADYMO program. The dynamic response of bicyclists in the typical impact configuration and the correlation of head impact conditions were analyzed and discussed with respect to the head impact speed, time of head impact and impact angle of bicyclists to vehicle impact speed. Furthermore, the injury distribution of bicyclists and the risk of head injuries and fractures of lower limbs were investigated in terms of vehicle impact speed. The results indicate that wrap-around distance (WAD), head impact speed, time of head impact, head impact angle, and throw-out distance (TOD) of the bicyclists have a strong relationship with vehicle impact speed. The vehicle impact speed corresponding to a 50% probability of head AIS 2+ injuries, head AIS 3+ injuries, and lower limb fracture risk for bicyclists is 53.8 km/h, 58.9 km/h, and 41.2 km/h, respectively. A higher vehicle impact speed produces a higher injury risk to bicyclist. The results could provide background knowledge for the establishment or modification of pedestrian regulations considering bicyclist protection as well as being helpful for developing safety measures and protection devices for bicyclists.     

Measuring transport injuries in a developing country: an application of the capture-recapture method

The purposes of this study are to provide an estimation of the incidence of transport injuries in a defined local community in Nicaragua by using the capture-recapture method, and to compare results using this method when data at different levels of severity are utilized.Two sources of injury data were used to monitor injuries: hospital data (inpatient and outpatient) and traffic police records. Characteristics available for matching included name, age, sex, and date of occurrence. The methodology of capture-recapture was used to estimate the ascertainment degree of both sources of data and the estimate mortality and incidence rates. Estimates were calculated both when all hospital data were taken into account (inpatient and outpatient combined) and when only inpatient records were matched against police records.First, including police records and all hospital data, the mortality and morbidity estimates were 35.5/100000 and 43.7/1000 per year, respectively. Second, when outpatients were excluded from the analysis, the corresponding estimates were 28.6/100000 and 7.5/1000, respectively. In non-fatal cases, the ascertainment-corrected coverage through police records was 2.6% and through hospital surveillance 19.0% when both inpatients and outpatients were included. In fatal cases, the corresponding rates were 56.1 and 22.8%, respectively. The combined data set pointed out pedestrians and cyclists as the main risk groups. Most fatalities were due to head injuries.Our results show that neither police records nor hospital records nor the aggregate database provided acceptable coverage of transport-related injuries. Combining police and hospital data by means of capture-recapture analysis produces more valid estimates, but caution must be given to the issue of severity heterogeneity between the two sources.     

The role of alcohol in nonfatal bicycle injuries

To assess the risk of nonfatal bicycle injury related to blood alcohol concentration (BAC) an unmatched case-control study was conducted in Helsinki in 1986. Eligible cases were the 140 adults injured either in motor vehicle or other bicycle accidents occurring between 3 P.M. and 10 P.M., who arrived at hospital within six hours of injury. Seven hundred bicyclists from the street were randomly selected as controls. BAC was measured with a breathalyzer. A major difference in alcohol involvement was found between cases (24.1%) and controls (4.0%). The injury risk estimate (odds ratio) of an inebriated bicyclist was at least ten-fold at BACs above 100 mg/dl compared to a sober bicyclist. Alcohol increased the bicyclist's risk of injury from falling more than from collision. As an unprotected road user, an inebriated bicyclist greatly increases his own risk of injury but seldom causes danger to other road users.     

Moped injuries among adolescents: a significant forgotten problem?

OBJECTIVES: The study's objective is to investigate the size of the problem of moped injuries among children and young adults. DESIGN: A comprehensive prospective injury registration has been carried out at the Central Hospital and Emergency Clinic in Rogaland county in Norway. Out of this system we selected cases of traffic injuries occurring from 1990 to 1996 among a defined population aged 0-24 years and analyzed incidence of traffic injury by the type of transport of the victim. RESULTS: Moped injuries represented 9% (85 per 100,000 person-years) of all (hospitalized and non-hospitalized) traffic related injuries among people under 25 years and 44% of all cases among persons aged 16 and 17 years. Moped injuries represented 13% of hospitalized cases altogether and 50% of hospitalized traffic injuries among persons aged 16 and 17 years. The overall male:female moped injury incidence rate ratio was 2.7 (95% CI 2.0-3.7). Police records captured only 40% of the moped injuries overall. 43% of moped injuries were lone accidents and 40% occurred in a moped-car collision. CONCLUSION: Moped injuries represent a major source of serious traffic injury among older children. This risk seems to be partially overlooked. Significantly higher attention seems to be warranted to reduce the risk of moped injury in populations where the moped is a popular means of transport among older children.     

The relationship between visibility aid use and motor vehicle related injuries among bicyclists presenting to emergency departments

Background

Little is known about the effectiveness of visibility aids (VAs; e.g., reflectors, lights, fluorescent clothing) in reducing the risk of a bicyclist–motor-vehicle (MV) collision.

Purpose

To determine if VAs reduce the risk of a bicyclist–MV collision.

Methods

Cases were bicyclists struck by a MV and assessed at Calgary and Edmonton, Alberta, Canada, emergency departments (EDs) from May 2008 to October 2010. Controls were bicyclists with non-MV injuries. Participants were interviewed about their personal and injury characteristics, including use of VAs. Injury information was collected from charts. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for VAs during daylight and dark conditions, and adjusted for confounders using logistic regression. Missing values were imputed using chained equations and adjusted OR estimates from the imputed data were calculated.

Results

There were 2403 injured bicyclists including 278 cases. After adjusting for age, sex, type of bicycling (commuting vs. recreational) and bicyclist speed, white compared with black (OR 0.52; 95% CI 0.28, 0.95), and bicyclist self-reported light compared with dark coloured (OR 0.67; 95% CI 0.49, 0.92) upper body clothing reduced the odds of a MV collision during daylight. After imputing missing values, white compared with black (OR 0.57; 95% CI: 0.32, 0.99) and bicyclist self-reported light compared with dark coloured (OR 0.71; 95% CI 0.52, 0.97) upper body clothing remained protective against MV collision in daylight conditions. During dark conditions, crude estimates indicated that reflective clothing or other items, red/orange/yellow front upper body clothing compared with black, fluorescent clothing, headlights and tail lights were estimated to increase the odds of a MV collision. An imputed adjusted analysis revealed that red/orange/yellow front upper body clothing colour (OR 4.11; 95% CI 1.06, 15.99) and tail lights (OR 2.54; 95% CI: 1.06, 6.07) remained the only significant risk factors for MV collisions. One or more visibility aids reduced the odds of a bicyclist MV collision resulting in hospitalization.

Conclusions

Bicyclist clothing choice may be important in reducing the risk of MV collision. The protective effect of visibility aids varies based on light conditions, and non-bicyclist risk factors also need to be considered.     

Estimating non-fatal road casualties in a large French county, using the capture-recapture method

INTRODUCTION: Non-fatal road casualties are under-reported, with official figures coming from the police. In the French Rh?ne county, a road trauma registry constitutes a second source of reporting but its completeness needs to be assessed. We also wish to estimate an incidence rate of non-fatal road casualties that is corrected for under-count. METHODS: Having two sources of reporting available, we can apply the capture-recapture method under certain conditions. To take into account different reporting probabilities among casualties, the capture-recapture analysis is stratified according to injury severity (New Injury Severity Score=NISS), road user type and human third party. To evaluate the sensitivity of the capture-recapture estimate on the number of matched casualties between the police file and the registry, three scenarios of record-linkage are considered. RESULTS: For serious (NISS 9+) non-fatal road casualties, the police ascertainment rate is at most 57%, the registry ascertainment rate is at most 87%, and the aggregate ascertainment rate is at most 95%. The ascertainment-corrected incidence rate for serious (NISS 9+) non-fatal road casualties is at least 65 per 100,000. CONCLUSION: The degree of completeness of the registry for serious casualties is rather high, though not satisfactory.     

Bicyclist injury severities in bicycle-motor vehicle accidents

This research explores the factors contributing to the injury severity of bicyclists in bicycle-motor vehicle accidents using a multinomial logit model. The model predicts the probability of four injury severity outcomes: fatal, incapacitating, non-incapacitating, and possible or no injury. The analysis is based on police-reported accident data between 1997 and 2002 from North Carolina, USA. The results show several factors which more than double the probability of a bicyclist suffering a fatal injury in an accident, all other things being kept constant. Notably, inclement weather, darkness with no streetlights, a.m. peak (06:00 a.m. to 09:59 a.m.), head-on collision, speeding-involved, vehicle speeds above 48.3 km/h (30 mph), truck involved, intoxicated driver, bicyclist age 55 or over, and intoxicated bicyclist. The largest effect is caused when estimated vehicle speed prior to impact is greater than 80.5 km/h (50 mph), where the probability of fatal injury increases more than 16-fold. Speed also shows a threshold effect at 32.2 km/h (20 mph), which supports the commonly used 30km/h speed limit in residential neighborhoods. The results also imply that bicyclist fault is more closely correlated with greater bicyclist injury severity than driver fault.     

Using reflective clothing to enhance the conspicuity of bicyclists at night

Bicycling at night is more dangerous than in the daytime and poor conspicuity is likely to be a contributing factor. The use of reflective markings on a pedestrian's major joints to facilitate the perception of biological motion has been shown to greatly enhance pedestrian conspicuity at night, but few corresponding data exist for bicyclists. Twelve younger and twelve older participants drove around a closed-road circuit at night and indicated when they first recognized a bicyclist who wore black clothing either alone, or together with a reflective bicycling vest, or a vest plus ankle and knee reflectors. The bicyclist pedalled in place on a bicycle that had either a static or flashing light, or no light on the handlebars. Bicyclist clothing significantly affected conspicuity; drivers responded to bicyclists wearing the vest plus ankle and knee reflectors at significantly longer distances than when the bicyclist wore the vest alone or black clothing without a vest. Older drivers responded to bicyclists less often and at shorter distances than younger drivers. The presence of a bicycle light, whether static or flashing, did not enhance the conspicuity of the bicyclist; this may result in bicyclists who use a bicycle light being overconfident of their own conspicuity at night. The implications of our findings are that ankle and knee markings are a simple and very effective approach for enhancing bicyclist conspicuity at night.     

Motor vehicle-bicycle crashes in Beijing: irregular maneuvers, crash patterns, and injury severity

This research presents a comprehensive analysis of motor vehicle–bicycle crashes using 4 years of reported crash data (2004–2007) in Beijing. The interrelationship of irregular maneuvers, crash patterns and bicyclist injury severity are investigated by controlling for a variety of risk factors related to bicyclist demographics, roadway geometric design, road environment, etc.Results show that different irregular maneuvers are correlated with a number of risk factors at different roadway locations such as the bicyclist age and gender, weather and traffic condition. Furthermore, angle collisions are the leading pattern of motor vehicle–bicycle crashes, and different irregular maneuvers may lead to some specific crash patterns such as head-on or rear-end crashes. Orthokinetic scrape is more likely to result in running over bicyclists, which may lead to more severe injury. Moreover, bicyclist injury severity level could be elevated by specific crash patterns and risk factors including head-on and angle collisions, occurrence of running over bicyclists, night without streetlight, roads without median/division, higher speed limit, heavy vehicle involvement and older bicyclists.This study suggests installation of median, division between roadway and bikeway, and improvement of illumination on road segments. Reduced speed limit is also recommended at roadway locations with high bicycle traffic volume. Furthermore, it may be necessary to develop safety campaigns aimed at male, teenage and older bicyclists.     

San Francisco pedestrian injury surveillance: mapping, under-reporting, and injury severity in police and hospital records

GOALS: Police reports of severely injured pedestrians help identify hazardous traffic areas in San Francisco, but they under-report non-fatal collisions. We set out to: identify injured pedestrians who were missing from police collision reports, see what biases exist in injury reporting and assess the utility of broad categories of police severe injury (including fatal) for mapping and analysis. METHODS: We linked data on injured pedestrians from police collision reports listed in the Statewide Integrated Traffic Reporting System (SWITRS, n = 1991) with records of pedestrians treated at San Francisco General Hospital (SFGH, n = 1323) for 2000 and 2001. Data were analyzed using bivariate statistics, logistic regression and mapping. RESULTS: : We found that police collision reports underestimated the number of injured pedestrians by 21% (531/2442). Pedestrians treated at SFGH who were African-American were less likely then whites (odds ratio = 0.55, p-value < or= 0.01), and females were more likely than males (odds ratio = 1.5, p-value < or = 0.01) to have a police collision report. Over 70% of pedestrians deemed by the police to have a severe injury received treatment at SFGH, regardless of the collision's distance from SFGH. The sensitivity of a police-designated severe injury (including fatal) was 69% and the specificity was 89% when compared with a known SFGH assessment. But, sensitivity declined when we included pedestrians without a SFGH record. CONCLUSION: Though collision reports have demonstrated limitations, broad categories of police severity may be sensitive enough to map locations where numerous severe injuries occur, for timely countermeasure selection.     

Comparative analysis of vehicle-bicyclist and vehicle-pedestrian accidents in Japan

Bicyclist and pedestrian injuries in collisions with vehicles in Japan were investigated based on national and in-depth accident data analyses and mathematical simulations. In an impact with a bonnet-type vehicle, a bicyclist slides over the bonnet of the vehicle, behavior that is not observed for pedestrians. As a result, the bicyclist’s head tends to strike a bonnet-type vehicle at a more rearward location in comparison with pedestrians. The first contact position of a bicycle with a vehicle, the vehicle front-end geometry and the bicycle velocity affect whether the bicyclist’s head strikes the vehicle or not. Due to the bent-knee posture of a bicyclist’s legs, the types of leg injuries sustained by bicyclists and their causes differ from those seen for pedestrians. Component test procedures have been proposed for evaluating pedestrian safety, but some modifications of the head impact area and angle are necessary when applying these methods to bicyclists.     

Complementing police road-crash records with trauma registry data--an initial evaluation

This paper examines the consistency of hospital and police reporting of outcomes of road traffic crashes using a database of linked police crash reports and trauma registry records. Criteria for inclusion into the trauma registry include trauma-related causes with subsequent stay of more than 24 h or death due to injuries. During the 1997 calendar year there were 497 cases of road-related injuries within the combined trauma registry of Sir Charles Gairdner and Fremantle Hospitals, of which only 82% had matching police records. Linkage rates were associated with gender, injury severity and the number of vehicles involved. Within the road user category, pedestrians were least likely to link. Of the linked records, police classification of injury severity was correct in 78% of cases. Male casualties were more likely to be correctly classified than females, after adjustment for related variables including injury severity. Correct classification of injury by police was also closely related to severity of injury. Identification and targeting of these groups of casualties is vital in refining the road-crash reporting system. Increased crash reporting and availability of data from these two sources will provide road authorities with more reliable measures of injury outcome.     

Misclassification of injury severity among road casualties in police reports

This study aims to evaluate the discordance between police reports of injury severity among road casualties and the length of hospital stay and the Injury Severity Scale (ISS) by linking information from the crash records of the Hong Kong Police with the trauma records of a regional hospital. Sensitivity and specificity analyses suggest that police injury grading diverges noticeably from the definition of a 12-h hospital stay. Police reports overestimate injury severity remarkably. The results of logistic regression indicate that age, the ISS, and the position of the victim significantly determine the likelihood of police injury misclassification. Furthermore, an optimal demarcation point of the length of hospital stay for serious injury is estimated.     

Injury to recreational and professional cricket players: Circumstances,type and potential for intervention

This paper describes injury (circumstances and type) experienced by sub-populations at all levels of cricket and, where possible, the type of protective equipment used. The sample differs to that generally examined in the literature in that it is not restricted to evaluation of elite and professional players only. Over a 6-year period (2000–2005), 498 cases were identified. The average age of injury was 27 years and 86% of those injured were male. The population incidence rate was 2.3 per 100,000 per year, and participation incidence rate 39 per 100,000 per year. Over all age groups upper limb (36%) and lower limb (31%) were most commonly injured. Fracture was the main type of injury. Differences among age groups were identified. Children (<10 years) most commonly suffered head injury (contact with the bat); 10–19 year olds, head, upper and lower limb injury (in similar proportions) generally from contact with bat/ball; those over 20 years mainly had upper and lower limb injuries. Contact with the bat/ball was the dominant mechanism of injury for those under 50 years of age while overexertion, strenuous or repetitive movements, slips and falls were the mechanisms for those over 50. The large number of head injuries to children is of concern and both these, and the substantial number of injuries to the hand/phalanges (63% of all upper limb injuries), are important targets for injury prevention. The difference in injury patterns between children and adults is indicative of a need to develop, and use, different types of PPE at different skill/age levels.     

Effects of graduated driver licensing on licensure and traffic injury rates in Upstate New York

Objective

In 2003, New York State implemented an enhanced graduated driving licensing (GDL) program that requires extended supervised driving and a passenger restriction. This study examines its safety benefit in 55 Upstate New York counties.

Methods

We analyzed fatal/incapacitating traffic injury data among 16-, 17- and 21-24-year olds for the years 2001 and 2005 using the negative binomial model. To adjust for trends in the traffic injury rate, the relative rate ratio (rRR) of 16- and 17-year olds relative to 21-24-year olds was estimated.

Results

GDL implementation was associated with a 31% reduction in the driver injury rate (rRR 0.69, 95% confidence interval (CI) 0.49-0.96), but not with any statistically significant change in the passenger injury rate (rRR 1.19, 95% CI 0.77-1.84), or pedestrian and bicyclist injury rate (rRR 1.53, 95% CI 0.89-2.62) among 16-year olds. Sixteen-year olds experienced a 21% decline in licensure rates between 2001 and 2005. GDL implementation had no appreciable impact on driver injury and licensure rates for 17- and 21-24-year olds.

Conclusions

GDL implementation is associated with a significant reduction in licensure and driver injury rate among 16-year olds. GDL implementation does not have a statistically significant impact on passenger, pedestrian, and bicyclist injury rates for 16-year olds.