81 Unfallstatistik
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Abschätzung der Gesamtzahl Schwerstverletzter in Folge von Straßenverkehrsunfällen in Deutschland
(2010)
Die Zahlen der im Straßenverkehr Getöteten, Schwer- und Leichtverletzten werden in Deutschland seit Jahren in amtlichen Statistiken geführt. Über die Gruppe der besonders schwer betroffenen Patienten liegen jedoch nur vage Schätzungen vor. Auch werden unterschiedliche Kriterien zur Definition dieser so genannten Schwerstverletzten verwendet, die zumeist auf einer Beschreibung der Art und der Schwere der Verletzungen beruhen. In der vorliegenden Arbeit sollen mit Daten aus dem Trauma-Register der DGU sowohl die unterschiedlichen Definitionen dargestellt werden, als auch über verschiedene Methoden die Gesamtzahl dieser Personen in Deutschland geschätzt werden. Das TraumaRegister DGU (TR-DGU) ist eine freiwillige Dokumentation von Unfallopfern, die lebend eine Klinik erreichen, dort behandelt werden und intensivmedizinisch betreut werden müssen. Das Register besteht seit 1993 und erfasst derzeit etwa 6.000 Fälle pro Jahr aus über 100 Kliniken. Pro Patient werden ca. 100 Angaben einschließlich der Codierung seiner Verletzungen gemäß Abbreviated Injury Scale (AIS) erfasst. Dieser Codierung erlaubt die Berechnung des Injury Severity Score (ISS) und des New ISS (NISS). Zum Vergleich werden folgende Definitionen eines Schwerstverletzten betrachtet: Maximum AIS ≥ 3; Maximum AIS ≥ 4; ISS ≥ 9; ISS ≥ 16; NISS ≥ 16, Polytrauma sowie die Notwendigkeit der Intensivtherapie. Am Beispiel des Kriteriums "ISS ≥ 16" werden schließlich auf drei verschiedene Arten die Gesamtzahl Schwerstverletzter Verkehrsunfallopfer geschätzt: 1.) in fünf ausgewählten Regionen werden die Schwerstverletzten aus dem TR-DGU mit der Anzahl Schwerverletzter aus der amtlichen Statistik verglichen, um den Anteil der besonders schwer betroffenen Patienten zu bestimmen. 2.) Aus dem TR-DGU wird je nach Versorgungsstufe des Krankenhauses (lokales, regionales oder überregionales Zentrum) die durchschnittliche Anzahl Schwerstverletzter ermittelt und dann über die Anzahl solcher Kliniken in Deutschland hochgerechnet. 3.) Die Zahl der Schwerstverletzten wird aus der Zahl der Getöteten Verkehrsunfallopfer geschätzt. Dazu nutzt man das Verhältnis von in der Klinik verstorbenen zu überlebenden Schwerstverletzten aus dem TR-DGU. Mit Literaturangaben zum Anteil von präklinisch Verstorbenen wird dann auf der Basis der Anzahl der Getöteten aus der amtlichen Statistik die Gesamtzahl Schwerstverletzter geschätzt. Je nach Definition eines Schwerstverletzten konnten zwischen 9.213 und 17.425 Fälle aus dem TR-DGU der letzten 10 Jahre berücksichtigt werden. Von diesen Patienten sind zwischen 12,7% und 20,2% im Krankenhaus verstorben. Die Krankenhaus Liegedauer der Überlebenden liegt zwischen 30 und 35 Tagen. Nimmt man die Definition "ISS -³ 16" als Basis (n=13.467), so reduziert sich die Zahl Schwerstverletzter um 37%, wenn man stattdessen den Begriff des Polytraumas wählt; betrachtet man hingegen die Intensivpflichtigkeit als Kriterium so erhöht sich die Zahl um 22%. Der erste Schätzansatz kommt zum Ergebnis, dass etwa 8-10% der Schwerverletzten zu den besonders schwer Verletzten zählen. Für ganz Deutschland erhält man damit Schätzwerte zwischen 6.300 und 7.900 Fälle pro Jahr. Die zweite Methode ergab, dass die Krankenhäuser der drei unterschiedlichen Versorgungsstufen jeweils 30,2, 11,5 oder 3,3 Fälle pro Jahr behandeln. Bezogen auf die 874 deutschen Kliniken ergeben sich geschätzte Gesamtzahlen von 6.800 bis 10.400 Fälle. Die dritte Methode zeigt, dass pro Patient, der im Krankenhaus verstirbt, 6,3 Schwerstverletzte überleben. Im Krankenhaus versterben jedoch etwa nur 25% bis 40% der insgesamt Getöteten; der Großteil der Getöteten verstirbt unmittelbar an der Unfallstelle. Damit müssen noch 1,5 bis 3 Todesfälle hinzugerechnet werden, was schließlich zu einem Verhältnis von 6,3 Schwerstverletzten zu 2,5 bis 4 Todesfällen führt. Bei einer Gesamtzahl von 5.595 Getöteten (Mittelwert 2002-2008) ergeben sich so Gesamtzahlen von 8.800 bis 14.000 Schwerstverletzte pro Jahr. Die Ergebnisse der angewendeten Schätzmethoden variieren stark und lassen auf eine Gesamtzahl von etwa 10.000 schwerstverletzten Verkehrsunfallopfern pro Jahr in Deutschland schließen. Bei Anwendung der Definition Intensivtherapie ergeben sich sogar etwa 12.500 Fälle. Alle Schätzmethoden sind gewissen Unsicherheiten ausgesetzt, die wenn möglich in Variationsrechnungen berücksichtigt wurden. Eine deutlich verbesserte Schätzung dieser Zahl ist jedoch erst möglich, wenn in wenigen Jahren vollzählige Erfassungen aus den derzeit entstehenden regionalen TraumaNetzwerken der DGU im TraumaRegister vorliegen.
Accidents with vulnerable road users require special attention within the road safety work because these accidents are often accompanied with severe injuries. Thus In 2006 at least 6200 Powered Two Wheeler (PTW) riders were killed in road crashes in the EU 25 representing 16% of the total number of road deaths while accounting for only 2% of the total kilometers driven. For the prevention of accidents with VRU above all the knowledge of the causes of the accidents is of special importance. This study is based on the methodology of the German In-Depth Accident Study GIDAS. Within GIDAS extensive data on various fields of accidentology are collected on-scene from road traffic accidents with injuries in the Hannover and Dresden area. Using a well defined sample plan the collected data is highly representative to the whole German situation (Brühning et al, Otte et al). The need of in-depth accident causation data in accident research led to the development of a special tool for the collection of such data called ACASS (Accident Causation Analysis with Seven Steps), which was implemented in the GIDAS methodology in 2008 and described by Otte in 2009.
This study that was funded by the Research Association for Automotive Technology (FAT) develops a method for the evaluation of the placement of tanks or batteries by using the deformation frequencies in real-world accidents. Therefore, the deformations of more than 20.000 passenger cars in the GIDAS database are analysed. For each vehicle a contour of deformation is calculated and the deformed areas of the vehicles are transferred in a rangy matrix of deformation. Thereby, the vehicle is divided into more than 190.000 cells. Afterwards, all single matrices of deformation are summarized for each cell which allows representative analyses of the deformation frequencies of accidents with passenger cars in Germany. On the basis of these deformation frequencies it is possible to determine least deformed areas of all passenger cars. Furthermore, intended placements of tanks or batteries can be estimated in an early stage of development. Therefore, all vehicles with deformations in the intended tank areas can be analysed individually. Considering numerous parameters out of the GIDAS database (e.g. collision speed, kind of accident, overlap, collision partner etc.) the occurring forces can be calculated or the deformation frequency can be estimated. Furthermore, it is possible to consider the influence of primary and secondary safety systems on the deformation behaviour. The analysis of "worst case accident events" is an additional application of the calculated matrix of deformation frequency.
A national initiative from the vehicle manufacturers, safety system suppliers, the road administration and universities in Sweden took off in 2007. The aim was to develop a national investigation network and a methodology focusing on all phases of a crash (pre-crash, in-crash and post-crash) as well as all parts of the road transport system (road user, vehicle and road environment). The initiative is formally run as a project with the acronym INTACT (Investigation Network and Accident Collection Techniques). It was a three year pilot with the aim to develop methodologies for an extended national crash investigation activity. During the first year the INTACT partners agreed on the aim for the investigation and methods for retrieving the data were developed. During the second and third year the methodology was tested in real-world investigations and further refinement was made. The paper describes the methodology developed to obtain high qualitative in-depth road crash data.
The overall purpose of the ASSESS project is to develop a relevant and standardised set of test and assessment methods and associated tools for integrated vehicle safety systems, primarily focussing on currently available pre-crash sensing systems. The first stage of the project was to define casualty relevant accident scenarios so that the test scenarios will be developed based on accident scenarios which currently result in the greatest injury outcome, measured by a combination of casualty severity and casualty frequency. The first analysis stage was completed using data from a range of accident databases, including those which were nationally representative (STATS19, UK and STRADA, SE) and in-depth sources which provided more detailed parameters to characterise the accident scenarios (GIDAS, DE and OTS, UK). A common analysis method was developed in order to compare the data from these different sources, and while the data sets were not completely compatible, the majority of the data was aligned in such a way that allowed a useful comparison to be made. As the ASSESS project focuses on pre-crash sensing systems fitted to passenger cars, the data selected for the analysis was "injury accidents which involved at least one passenger car". The accident data analysis yielded the following ranked list of most relevant accident scenarios: Rank Accident scenario 1 Driving accident - single vehicle loss of control 2 Accidents in longitudinal traffic (same and opposite directions) 3 Accidents with turning vehicle(s) or crossing paths in junctions 4 Accidents involving pedestrians The ranked list highlights the relatively large role played by "accidents in longitudinal traffic", and "accidents with turning vehicle(s) or crossing paths in junctions" (the second and third most prevalent accident scenarios, respectively). The pre-crash systems addressed in ASSESS propose to yield beneficial safety outcomes with specific regard to these accident scenarios. This indicates that the ASSESS project is highly relevant to the current casualty crash problem. In the second stage of the analysis a selection of these accident scenarios were analysed further to define the accident parameters at a more detailed level .This paper describes the analysis approach and results from the first analysis stage.
Accidents involving two wheels vehicles represent one of the more important types of accidents in Europe. These accidents are usually not easy to reconstruct specially for the analysis of the injuries and its correlation with accident dynamics and evidences. Different methodologies are applied in this work for the reconstruction of two wheeler accidents, especially accident involving motorcycles. From the typologies of road evidences like skid marks, to the use of Pc-Crash and the use of Madymo models, different reconstruction of real accidents are presented. One of the questions that sometimes arise for legal purposes when some type of head injuries arise is if the occupant was wearing or not a helmet. The correlation of head injuries with the use of the helmet is a very important issue, therefore an important legal aspect. One of the key questions for the reconstructions that is difficult to analyze, is if the vehicle occupant, was or not, wearing the helmet. Based on the previously collected information, a generic model of a helmet was developed on CAD 3D, followed by its conversion into finite elements, all in order to perform impact tests using the Madymo software that would help improve the helmet- safety, but that also can be used as a tool in accident reconstruction.
Estimation of the benefits for the UK for potential options to modify UNECE Regulation No. 95
(2010)
The side impact problem in Europe remains substantial. UK data shows that between 22% and 26% of car occupant casualties are involved in a side impact, but this rises to between 29% and 38% for those who are fatally injured. This indicates the more injurious nature of side impacts compared with frontal impacts. The European Enhanced Vehicle safety Committee (EEVC) has performed work to address the side impact issue since 1979. As part of its continuing work, it has recently investigated potential options for regulatory changes to improve side impact protection in cars further. To support this work the UK undertook an analysis to estimate the benefit for potential options to modify UNECE Regulation 95. The analysis used the UK national STATS19 and detailed Co-operative Crash Injury Study (CCIS) accident databases. Of the potential options reviewed, it was found that the addition of a pole test offered the greatest benefit.
Pedestrian and cyclist are the most vulnerable road users in traffic crashes. One important aspect of this study was the comparable analysis of the exact impact configuration and the resulting injury patterns of pedestrians and cyclists in view of epidemiology. The secondary aim was assessment of head injury risks and kinematics of adult pedestrian and cyclists in primary and secondary impacts and to correlate the injuries related to physical parameters like HIC value, 3ms linear acceleration, and discuss the technical parameter with injuries observed in real-world accidents based documented real accidents of GIDAS and explains the head injuries by simulated load and impact conditions based on PC-Crash and MADYMO. A subsample of n=402 pedestrians and n=940 bicyclists from GIDAS database, Germany was used for preselection, from which 22 pedestrian and 18 cyclist accidents were selected for reconstruction by initially using PC-Crash to calculate impact conditions, such as vehicle impact velocity, vehicle kinematic sequence and throw out distance. The impact conditions then were employed to identify the initial conditions in simulation of MADYMO reconstruction. The results show that cyclists always suffer lower injury outcomes for the same accident severity. Differences in HIC, head relative impact velocity, 3ms linear contiguous acceleration, maximum angular velocity and acceleration, contact force, throwing distance and head contact timing are shown. The differences of landing conditions in secondary impacts of pedestrians and cyclists are also identified. Injury risk curves were generated by logistic regression model for each predicting physical parameters.
The purpose of this study was to analyse the actual injury situation of bicyclists regarding accidents involving more than one bicyclist. Bicyclists were included in a medical and technical analysis to create a basis for preventive measures and discovered repeating accident patterns and circumstances such as daytime, environment, helmet use rate. Technical and medical data were collected at the scene, shortly after accident. The population was compared focusing on bicycle versus bicycle accidents. Technical analysis included speed at crash, type of collision, impact angle, environment, used lane and relative velocity. Medical analysis included injury pattern and severity (AIS, ISS). Included were 578 injured bicyclists in 289 accidents from years 1999 to 2008, 61 percent were male (n=350) and 39 percent female (n=228). Sixty-seven percent ranged between 18 to 64 years of age, twelve percent each between 13 to 17 years of age and older than 65 years, eight percent between 6 to 12 years and one percent between 2 to 5 years.. Crashes took place in urban areas in 92 percent, in rural areas in 8 percent. Weather conditions were dry lanes in 97 percent and wet conditions in 3 percent. Eighty-three percent of all accidents happened during daytime, ten percent during night, and seven percent during dawn. The helmet use rate was only 7,5 percent in all involved bicyclists. The mean Maximum Abbreviated injury scale, Injury severity score was 1,31. Bicyclists are still minimally- or unprotected road users. The helmet use rate is unsatisfactorily low. The incidence of bicycle to bicycle crashes is high. Most of these accidents take place in urban areas. The level and pattern of injuries is moderate. Most of the more severe injuries occur to the head and could have been avoided by frequent helmet use.
Tree impacts are still one of the most important focal points of road deaths in Germany. For the year 2008, the latest figures in the national statistics show a share of 28% of road users killed in crashes with trees alongside a road amongst all crashes on rural roads (except the Autobahn). The official German statistics show the attribute "impact on a tree" since 1995. For this first reported year, the share of road users killed in such crashes was 30%. During the last 14 years, fatal accidents with road users killed on rural roads (except the Autobahn) after impacts on a tree declined by 60% from 1,737 (year 1995) to 696 (year 2008). But this is more or less in line with the general evolution of vehicle and traffic safety in Germany. For Germany as a whole the accident statistics do not show a reduction for "treer crashes" which is clearly more than the average for all accidents. But, as shown with the paper, there are different evolutions in the several German States. In public awareness the topic "tree impacts" is mostly associated with the situation in Germany after the reunification. At that time a lot of road users were killed on the avenues in the so called "new countries". The fact that "tree impacts" are still a big share within the figure of killed road users seems to be little-known. Using updated information coming from the official statistics and in-depth-studies, accident researchers can identify a big potential for further improvements of traffic safety on the associated district roads, state roads and federal highways. There is still a need to analyse more details of the accident occurrence with impacts on trees to generate new and updated findings on the current limits and potentials of measures to improve vehicle and traffic safety. To make further efforts in reducing the figures of victims of "tree impacts" the intensification of well-known conventional solutions " for example implementation of guard rails and reduction of speed - is an option. Measures related to vehicle safety technology especially in the field of primary (active) safety will have additional benefit within the physically imposed limits. With this background it can be seen that the subject "tree impacts" should be analysed with a holistic approach taking into account the entire system of driver, vehicle, road, the environment and a social consensus as well.