Sonstige
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.
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.
The paper aims to study the injury risk and kinematics of pedestrians involved in different passenger vehicle collisions. Furthermore, the difference of pedestrian kinematics in the accidents involved minivan and sedan was analyzed. The 18 sample cases of passenger car to pedestrian collisions were selected from the database of In-depth Investigation of Vehicle Accident in Changsha of China (IVAC),of which the 12 pedestrian accidents involved in a minivan impact for each case, and the 6 accidents in a sedan impact for each. The selected cases were reconstructed by using mathematical models of pedestrians and accident vehicles in a multi-body dynamic code MADYMO environment. The logistic regression models of the risks for pedestrian AIS 3+ injuries and fatalities were developed in terms of vehicle impact speed by analyzing the minivan-pedestrian and sedan-pedestrian accidents. The difference of pedestrian kinematics was identified by comparing the results from reconstructed pedestrian accidents between the minivans and sedans collisions. The result shows that there is a significant correlation among the impact speed and the severity of pedestrian injuries. The minivan poses greater risk to pedestrian than sedan at the same impact speed. The kinematics of pedestrian was greatly influenced by vehicle front shape.
The declining trend since 1991 in the number of killed people was broken in 2011 when overall 4 009 people died in traffic accidents in Germany. The question arises if there is a stagnating trend of fatalities in Germany in future? By breaking down the accidents with casualties towards a monthly view one can see a decreasing trend of fatalities in the warmer months especially since 2009. When comparing against winter months higher deviations are observed. In December 2011 an increase of 191 traffic deaths were registered (181 in 2010 compared to 372 in 2011). Further analyses of different accident influences were evaluated and their possibility of drastic change from one year to the other was determined. As seen weather- and environmental conditions are one of the major contributing factors and are one of the causes for the increased number of fatalities. To support the underlying assumption a model had been created to calculate the number of traffic deaths on a daily basis approach. As an input, road conditions projected through weather parameters and also different driving behaviors on weekdays or holidays were used. As a result, estimates of daily fatality with up to 75% precision can be achieved out of the 2009, 2010 and 2011 data. Further on it shows that weather and street conditions have a high influence on the overall resulting number of traffic accidents with casualties, and especially to the number of fatalities. Hence it is estimated that approximately 3 300 people were killed in traffic accidents in Germany in 2013 which would be again a reduction of another 13% compared to 2012. Therefore an answer to the question will be that the decreasing trend in traffic fatalities in Germany somehow is not broken when environmental conditions are included in national statistics. Their effects will become more visible in future accident statistics and it is estimated variances of 5% to 8% of the annual number of traffic fatalities in Germany will be seen.
Analysis of the accident scenario of powered two-wheelers on the basis of real-world accidents
(2013)
For the first time since 20 years the German national statistics of traffic accidents revealed an increasing number of fatalities and seriously injured persons in 2011. This negative development was especially caused by increasing numbers in all groups of vulnerable road users (VRU). Furthermore, the comparison of fatality reduction rates between several categories of road users shows that persons on motorcycles show the worst performance over years. Although every second fatality in German traffic accidents is still a car occupant, users of PTW make up more than 20% in the meantime. Assuming further improvements in the field of occupant protection this trend will continue. For that reason, a study on the basis of real-world accidents was conducted to describe the accident scenario involving motorcycles and to identify the reasons of the above-described fact. Approximately 1.800 motorcycle accidents out of GIDAS database were used for the analyses. The first part of the study deals with the question how representative the GIDAS database is for the German motorcycle accident scenario. Afterwards, detailed descriptive statistics on motorcycle accidents were presented considering numerous parameters about the accident scene, environmental influences, vehicle information, individual characteristics, interview data, injury severity and injury causation. One important point is the identification of the most frequent critical situations that are typical for motorcycle accidents. Furthermore, a special focus was on accident causation. Finally, conspicuous facts out of the analysis are emphasized. All in all, the study gives a comprehensive overview about the German motorcycle accident scenario. One the one hand, the use of weighted GIDAS data allows representative and robust statements on the basis of large case numbers; on the other hand highly detailed conclusions can be drawn. The results of the study help to understand the particularities of motorcycle accidents and provide approaches for further improvements in the field of PTW safety.
Causation patterns and data collection blind spots for fatal intersection accidents in Norway
(2010)
Norwegian fatal intersection accidents from the years 2005-2007 were analysed to identify any causation patterns among their underlying contributing factors, and also to evaluate whether the data collection and documentation procedures used by the Norwegian in-depth investigation teams produces the information necessary to perform causation pattern analysis. A total of 28 fatal accidents were analysed. Details on crash contributing factors for each driver in each crash were first coded using the Driving Reliability and Error Analysis Method (DREAM), and then aggregated based on whether the driver was going straight or turning. Analysis results indicate that turning drivers to a large extent are faced with perception difficulties and unexpected behaviour from the primary conflict vehicle, while at the same time trying to negotiate a demanding traffic situation. Drivers going straight on the other hand have less perception difficulties. Instead, their main problem is that they largely expect turning drivers to yield. When this assumption is violated, they are either slow to react or do not react at all. Contributing factors often pointed to in literature, e.g. high speed, drugs and/or alcohol and inadequate driver training, played a role in 12 of 28 accidents. While this confirms their prevalence, it also indicates that most drivers end up in these situations due to combinations of less auspicious contributing factors. In terms of data collection and documentation, information on blunt end factors (those more distant in time/space, yet important for the development of events) was more limited than information on sharp end factors (those close in time/space to the crash). A possible explanation is that analysts may view some blunt end factors as event circumstances rather than contributing factors in themselves, and therefore do not report them. There was also an asymmetry in terms of reported obstructions to view due to signposts and vegetation. While frequently reported as contributing for turning drivers, they were rarely reported as contributing for their counterparts in the same accidents. This probably reflects an involuntary focus of the analyst on identifying contributing factors for the driver legally held liable, while less attention is paid to the driver judged not at fault. Since who to blame often is irrelevant from a countermeasure development point of view, this underlying investigator mindset needs addressing to avoid future bias in crash investigation reports.
A total survey of road traffic accidents involving most severely injured, defined as sustaining a polytrauma or severe monotrauma (ISS > 15) or being killed, was conducted over 14 months in a large study region in Germany. Data on injuries, pre-clinical and clinical care, crash circumstances and vehicle damage were obtained both prospectively and retrospectively from trauma centers, dispatch centers, police and fire departments. 149 patients with a polytrauma and eight with a severe monotrauma were recorded altogether. 22 patients died in hospital. Another 76 victims had deceased at the accident scene. In 2008, 49 % of patients treated with life-threatening injuries were car or van occupants, 21 % motorcyclists, 18 % cyclists and 10 % pedestrians. Among fatalities at the scene, vehicle occupants constituted an even larger portion. The number of road users with life-threatening trauma in the region was extrapolated to the German situation. It suggests that 10 % among the "seriously injured" as defined in national accident statistics are surviving accident victims with a polytrauma or severe monotrauma.
While many medical studies have dealt with the incidence, nature and treatment of polytrauma the injury-causing accident mechanisms are rarely discussed in detail, mostly due to the lack of documentation of the technical aspects. The present prospective study was started in late 2007 and collects data from traffic accidents with most severely injured in six south- German counties and two larger cities for the duration of one year. It is aimed at identifying and documenting all polytrauma cases (ISS ≥ 16) caused by traffic accidents and their crash circumstances. The data collection is based on an interdisciplinary concept to include both the police, emergency dispatch centers, hospitals and fire departments in the region and is completely anonymous. Potentially relevant cases where an emergency physician was called to the scene of a traffic accident are provided by the dispatch center. All three hospitals in the region suited for the treatment of polytraumatised patients record injuries, major diagnostic and surgery data. Data and images from the accident scene are provided by the police and by fire departments. The latter provide information which is usually not available from the police, like deployed airbags, vehicle extrication measures and detailed views of car interiors. The main objective of the study is to determine the structure of road users who sustain a polytrauma, their crash opponents and the injury patterns found in relation to the collision configuration and the protection by seat belts, air bags and other devices. With detailed documentation of vehicle damage and extrication measures the study is also intended to support the development of injury predictors for pre-hospital treatment and provide field data regarding further improvement of technical rescue.
Motorcycle riders are one of the most vulnerable road users. Annually, on estimate 6000 people are killed in motorcycle accidents in the former 15 EU countries. The objective of this research was to investigate and analyze the main aspects and causes of this vulnerability and the accidents in general. For this aim around 70 accidents in The Netherlands were investigated in the framework of an international research program (MAIDS). Also a control group of motorcycles with riders was investigated so that exposure could be taken into account. An important result is that human failure is in 82% of the cases the main cause of the accident, in 52% this is due the other vehicle driver. Perception and decision failures are the most common failures. The most injuries are caused by the environment but they are typically only less severe (AIS1). Injuries caused by the car (front and side) are typically severe injuries (AIS4+). Previous convictions of the MC rider seem to be related to the chance to get involved in an accident. It was shown that the Dutch and the total MAIDS accident sample are comparable.
Die Bundesanstalt für Straßenwesen (BASt) bringt zum Ende jeden Jahres eine Prognose der Unfall- und Verunglücktenzahlen des noch laufenden Jahres heraus, um so über die Entwicklung der Verkehrssicherheit in Deutschland Bilanz ziehen zu können. Dabei wird das Unfallgeschehen nach dem Schweregrad der Konsequenzen, der Ortslage sowie Alter und Art der Verkehrsbeteiligung der Verunglückten in 27 Zeitreihen unterteilt. Zu diesem Zeitpunkt sind die Daten lediglich für die ersten acht oder neun Monate erhältlich. Um Bilanz zu ziehen, werden die Anzahlen der letzten drei oder vier Monate prognostiziert. Gesamtziel des hier beschriebenen Forschungsvorhabens ist die Optimierung der jährlichen Unfallprognosen durch Anwendung von strukturellen Zeitreihenmodellen, bei denen die Vorhersagen aus dem Trend der vorliegenden Monate, und der Dynamik der vorhergehenden Jahre abgeleitet werden. Um dem Einfluss der Witterungsverhältnisse Rechnung zu tragen, werden dabei meteorologische Variablen in das Vorhersagemodell aufgenommen. Um die Modelle zu testen, werden die endgültigen Daten der letzten 15 Jahre jeweils aus den vorläufigen Daten der ersten Monate vorhergesagt und mit den tatsächlich beobachteten endgültigen Unfall- und Verunglücktenzahlen verglichen. Die Resultate zeigen, dass im Vergleich zu den bisherigen Vorhersagen mithilfe der hier vorgestellten Modelle die Vorhersagen für 25 der 27 Reihen präziser werden. Lediglich zwei Reihen zeigen einen leichten Anstieg des Vorhersagefehlers. Beim Vergleich von Modellen mit und ohne meteorologischen Variablen zeigt sich, dass 23 der 27 Reihen besser vorhergesagt werden können, wenn man das Wetter berücksichtigt. Neben der verbesserten Vorhersage ermöglicht die Aufnahme der Wettervariablen auch eine Einschätzung, wie groß der Einfluss der Witterungsgegebenheiten auf das Unfallgeschehen ist. Es zeigt sich also, dass die Anwendung von strukturellen Zeitreihenmodellen und die Berücksichtigung von meteorologischen Variablen zu einer deutlichen Verbesserung der Vorhersagegenauigkeit führen. Die Verbesserung der Vorhersagen durch die Aufnahme von Wettervariablen bestätigt nochmals den Einfluss der Witterungsumstände auf das Unfallgeschehen.