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Bicyclists are minimally or unprotected road users. Their vulnerability results in a high injury risk despite their relatively low own speed. However, the actual injury situation of bicyclists has not been investigated very well so far. The purpose of this study was to analyze the actual injury situation of bicyclists in Germany to create a basis for effective preventive measures. Technical and medical data were prospectively collected shortly after the accident at the accident scenes and medical institutions providing care for the injured. Data of injured bicyclists from 1985 to 2003 were analyzed for the following parameters: collision opponent, collision type, collision speed (km/h), Abbreviated Injury Scale (AIS), Maximum AIS (MAIS), incidence of polytrauma (Injury Severity Score >16), incidence of death (death before end of first hospital stay). 4,264 injured bicyclists were included. 55% were male and 45% female. The age was grouped to preschool age in 0.9%, 6 to 12 years in 10.8%, 13 to 17 years in 10.4%, 18 to 64 years in 64.7%, and over 64 years in 13.2%. The MAIS was 1 in 78.8%, 2 in 17.0%, 3 in 3.0%, 4 in 0.6%, 5 in 0.4%, and 6 in 0.2%. The incidence of polytrauma was 0.9%, and the incidence of death was 0.5%. The incidence of injuries to different body regions was as follows: head, 47.8%; neck, 5.2%, thorax, 21%; upper extremities, 46.3%; abdomen, 5.8%; pelvis, 11.5%, lower extremities, 62.1%. The accident location was urban in 95.2%, and rural in 4.8%. The accidents happened during daylight in 82.4%, during night in 12.2%, and during dawn/dusk in 5.3%. The road situation was as follows: straight, 27.3%; bend, 3.0%; junction, 32.0%; crossing, 26.4%; gate, 5.9%; others, 5.4%. The collision opponents were cars in 65.8%, trucks in 7.2%, bicycles in 7.4%, standing objects in 8.8%, multiple objects in 4.3%, and others in 6.5%. The collision speed was grouped <31 in 77.9%, 31-50 in 4.9%, 51-70 in 3.7%, and >70 in 1.5%. The helmet use rate was 1.5%. 68% of the registered head injuries were located in the effective helmet protection area. In bicyclists, head and extremities are at high risk for injuries. The helmet use rate is unsatisfactorily low. Remarkably, two thirds of the head injuries could have been prevented by helmets. Accidents are concentrated to crossings, junctions and gates. A significant lower mean injury severity was observed in victims using separate bicycle lanes. These results do strongly support the extension or addition of bicycle lanes and their consequent use. However, the lanes are frequently interrupted at crossings and junctions. This emphasizes also the important endangering of bicyclists coming from crossings, junctions and gates, i.e. all situations in which contact of bicyclists to motorized vehicles is possible. Redesigning junctions and bicycle traffic lanes to minimize the possibility of this dangerous contact would be preventive measures. A more consequent helmet use and use and an extension of bicycle paths for a better separation of bicyclists and motorized vehicle would be simple but very effective preventive measures.
The "Seven Steps Method" is an analysis and classification system, which describes the human participation factors and their causes in the temporal sequence (from the perceptibility to concrete action errors) taking into consideration the logical sequence of individual basic functions. By means of the "seven steps" it is possible to describe the relevant human causes of accidents from persons involved in the accident in an economic way with a sufficient degree of exactitude, because the causes can be further differentiated in their value (e.g. diversion as external diversion with regard to impact due to surroundings) and their sub values (e.g. external diversion with regard to impact due to surroundings in the shape of a "capture" of the perception by a prominent object of the traffic environment). Theoretically it is possible that one or more causing moments can be assigned to a person involved in an accident in each of the "seven steps"; however it is also possible to sufficiently clarify the cause in only one level (examples for this are described). In the practice of accident investigation at the site of the accident, the sequence chart is also relevant. With its assistance the questioning of the people involved in an accident can be accomplished in a structured way by assigning a set of questions to each step.
The incidence and treatment of sternal fractures among traffic accidents are of increasing importance to ensure best possible outcomes. Analysis of technical indicators of the collision, preclinical and clinical data of patients with sterna fractures from 1985-2004 among 42,055 injured patients were assessed by an Accident Research Unit. Two time groups were categorized: 1985-1994 (A) vs. 1995-2004 (B). 267/42,055 patients (0.64%) suffered a sterna fracture. Regarding the vehicle type, the majority occurred after car accidents in 0.81% (251/31,183 pts), followed by 0.19% (5/2,633pts) driving motorbike, and 0.11% (4/3,258pts) driving a truck. 91% wore a safety belt. Only 13% of all passengers suffering a sternal fracture had an airbag on board (33/255 car/trucks), with an airbag malfunction in 18%. The steering column was deformed in 39%, the steering wheel in 36%. Cars in the recent years were significantly older (7.67-±5 years (B) vs. 5.88-±5 years (A), p=0.003). Cervical spine injuries are frequent (23% vs. 22%), followed by multiple rib fractures (14% vs. 12%) and lung injuries (12% vs. 11%). We found 9/146 (6%) and 3/121 patients (3%) with heart contusion among the 267 sternal fractures. MAIS was 2.56-±1.3 vs. 2.62-±1.3 (A vs. B, p=0.349). 18% of patients were polytraumatized, with 11.2% dying at the scene, 2.3% in the hospital. Sternal fractures occur most often in old cars to seat-belted drivers often without any airbag. Severe multiple rib fractures and lung contusion are concomitant injuries in more than 10% each indicating the severity of the crash. Over a twentyyear period, the injury severity encountered was not different with 18% polytrauma patients suffering sternal fractures.
Annually within the European Union, there are over 50,000 road accident fatalities and 2 million other casualties, of which the majority are either the occupants of cars or other road users in collision with a car. The European Commission now has competency for vehicle-based injury countermeasures through the Whole Vehicle Type Approval system. As a result, the Commission has recognised that casualty reduction strategies must be based on a full understanding of the real-world need under European conditions and that the effectiveness of vehicle countermeasures must be properly evaluated. The PENDANT study commenced in January 2003 in order to explore the possibility of developing a co-ordinated set of targeted, in-depth crash data resources to support European Union vehicle and road safety policy. Three main work activity areas (Work Packages) commenced to provide these resources. This paper describes some of the outcomes of Work Package 2 (WP2, In-depth Crash Investigations and Data Analysis). In WP2, some 1,100 investigations of crashes involving injured car occupants were conducted in eight EU countries to a common protocol based on that developed in the STAIRS programme. This paper describes the purposes, methodology and results of WP2. It is expected that the results will be used as a co-ordinated system to inform European vehicle safety policy in a systematic, integrated manner. Furthermore, the results of the data analyses will be exploited further to provide new directions to develop injury countermeasures and regulations.
This study aimed to identify the occurrence, type and mechanisms of the traumatic injuries of the vulnerable road users in vehicle collisions, and to determine the effects of human, engineering, and environment factors on traffic accidents and injuries. The pedestrian accident cases were collected in the years 2000 to 2005 from Changsha Wujing hospital China and Accident Research Unit at Medical University Hannover in Germany. A statistic analysis was carried out using the collected accident data. The results from analysis of Changsha data were compared with results from analysis of GIDAS data Hannover. The injury severities were determined using AIS code and ISS values. The results were presented in terms of cause of injuries, injury distributions, injury patterns, injury severity. The factors influenced the injury outcomes were proposed and discussed for the vehicle transport environment and road users. The results were discussed with regard to accident data collection, accident sampling and injury distributions etc. In the urban area of Changsha, motorcycles and passenger cars are most frequently involved in vehicle pedestrian accidents. Head and lower extremities injuries are the predominant types of pedestrian injuries. The pedestrian accidents were identified as vital issue in urban traffic safety and therefore a high priority should be given to this road user group in research of safe urban transportation. In Hannover area, cars are most frequently involved in traffic accidents, injured pedestrians are involved in road traffic of Germany in 13% of all causalities only in 2005 and have nearly the same number as motorcyclists, but the half of bicyclists.
In the context of this study, different data sources for accident research were examined regarding their possible data access and evaluated concerning the individual quality and extent of the data. Analyses of accidents require detailed and comprehensive information in particular concerning vehicle damages, injury patterns and descriptions of the accident sequence. The police documentation supplies the basic accident statistics and is amended in the context of the forensic treatment by further information, e.g. by medical and technical appraisals and witness questionings. As a new approach to the data acquisition for the analysis of fatal traffic accidents, the information was made usable which was collected by the police and by the investigations of the public prosecutor. The best strategy for obtaining reliable, extensive and complete data consists of combining the information from these two sources: the very complete, but elementary statistic data of the Niedersächsisches Landesamt für Statistik (Lower Saxony State Authority of Statistics), based on the police documentation as well as the very extensive accident information resulting from the investigation documentation of the public prosecutor after conclusion of the procedure, the so-called Court Records. Of all 715 fatal traffic accidents, which happened in the year 2003 in the German State of Lower Saxony, 238 cases were selected by means of a statistically coincidental selective procedure based on a statistically representative manner (every third accident). These cases cover the investigation documents of the 11 responsible public prosecutor- offices, which were requested and evaluated while preserving the data security. Of the 238 cases 202 cases were available, which were individually coded and stored in a data base using 160 variables. Thus a data base of a sample of representative data for fatal accidents in Lower Saxony was set up. The data base contains extensive information concerning general accident data (35 variables), concerning road and road surface data (30 variables), concerning vehicle-specific data (68 variables) as well as concerning personal and injury data (27 variables).
Description of road traffic related knee injuries in published investigations is very heterogeneous. The purpose of this study was to estimate the risk of knee injuries in real world car impacts in Germany focusing vulnerable road users (pedestrians, bicyclists and motorcyclists) and restrained car drivers. The accident research unit analyses technical and medical data collected shortly after the accident at scene. Two different periods (years 1985-1993 and 1995-2003) were compared focusing on knee injuries (Abbreviated Injury Scale (AISKnee) 2/3). In order to determine the influences type of collision, direction and speed as well as the injury pattern and different injury scores (AIS, MAIS, ISS) were examined. 1.794 pedestrians, 742 motorcyclists, 2.728 bicyclists and 1.116 car drivers were extracted. 2% had serious ligamentous or bony injuries in relation to all injured. The risk of injury is higher for twowheelers than for pedestrians, but knee injury severity is higher for the latter group. Overall the current knee injury risk is low and significant reduced comparing both time periods (27%, p<0,0001). Severe injuries (AISKnee 2/3) were below 1%). Improved aerodynamic design of car fronts reduced the risk for severe knee injuries significantly (p=0,0015). Highest risk of injury is for motorcycle followed by pedestrians, respectively. Knee protectors could prevent injuries by reducing local forces. The classically described dashboard injury was rarely identified. The overall injury risk for knee injuries in road traffic is lower than estimated and reduced comparing both periods. The aerodynamic shape of current cars compared to older types reduced the incidence and severity of knee injuries. Further modification and optimization of the interior and exterior design could be a proper measurement. Classic described injury mechanisms were rarely identified. It seems that the AIS is still underestimating extremity injuries and their long term results.