Sonstige
Who doesn't wear seat belts?
(2009)
Using real world accident data, seat belts were estimated to be 61% effective at preventing fatalities, and 32% effective at preventing serious injuries. They were most effective for drivers with an airbag. Seat belts were estimated as having prevented 57,000 fatalities and 213,000 seriously injured casualties in the UK since 1983. Seat belt legislation was estimated to have prevented 31,000 fatalities and 118,000 seriously injured casualties. A future increase in effective seat belt wearing rate (which takes into account seating position) in the UK from 92.5% to 93% may prevent casualties valued at a societal cost of over -£18 million per year. To target a seat belt campaign, the question "who doesn"t wear seat belts?" must be answered. Seat belt wearing rates and the number of unbelted casualties were analysed. It was primarily young adult males who didn"t wear seat belts, and they made up the majority of unbelted fatalities and seriously injured casualties.
One of the major problems of road safety in Europe is the powered two wheelers accidents. One of the European countries with one of the highest rates is Portugal where in 2006, mopeds and motorcycles fatalities represented 27% of all road users deaths. In this work, a deep analysis and overview of the current state of mopeds and motorcycles accidents for the 2004-2006 period is presented. Within this period 830 PTW occupants die, 2958 have been severely injured and 25000 suffer slight injuries. A detailed analysis of the conditions of these accidents has been carried out, using the data of the national accident database. This analysis provides global information, about geographic environmental conditions, driver- characteristics among others. From this data detailed information is obtained allowing to know when, where and who. In order to answer the question why more a widely collection of data has been collect for 70 accidents. The data has been collected using OECD methodology. For these accidents a detailed reconstruction has been carried out, what is especially important for fatal accidents where for instance speed in an important factor. From these collection and analysis of data a wider overview of facts and measures are extracted. Among them, some are emphasized such as that the quality and non-use of helmets plays an important role in severe and fatal accidents especially for accidents involving moped vehicles, or speed is the most important factor in fatal accidents involving motorcycles. Concerning motorcycle accident reconstruction, different tools can be used depending of the accident scenario and complexity. For simple cases, with specific characteristics, analytical formulation based in vehicle crash dynamics can be use in order to determine the impact speed of the vehicles impact, analysing the skid marks, deformations, victims rest position and considering parameters (EES, vehicle deceleration, etc). Aspects such as the energy absorption capability of motorcycles are also discussed. In the general cases the accident reconstruction software Pc-Crash has been used for the reconstruction of the accident. In very complex cases, has for instance the impact between motorcyclist and barriers, Madymo software is used especially to determine speed from injuries. An example of the impact of a motorcyclist and a motorcyclist-friendly barrier is present to illustrate the benefits and limitations of such systems.
A lack of representative European accident data to aid the development of safety policy, regulation and technological advancement is a major obstacle in the European Union. Data are needed to assess the performance of road and vehicle safety and is also needed to support the development of further actions by stakeholders. This short-paper describes the process of developing a data collection and analysis system designed to partly fill these gaps. A project team with members from 7 countries was set up to devise appropriate variable lists to collect fatal crash data under the following topic levels: accident, road environment, vehicle, and road user, using retrospective detailed police reports (n=1,300). The typical level of detail recorded was a minimum of 150 variables for each accident. The project will enable multidisciplinary information on the circumstances of fatal crashes to be interpreted to provide information on a range of causal factors and events surrounding the collisions.
The Powered Two Wheelers (PTWs) accidents constitute one of the road safety targets in Europe. PTWs users' fatalities represent 15% of EU road fatalities, having increased the last few years, which is quite opposite than other road users casualties. To reduce PTW accidents is necessary to know which the accident causations are from different points of view (human factor, vehicle characteristics, environment, type of accident, situation, etc.). In TRACE project ("Traffic Accident Causation in Europe", under the European Commission 6th Framework Program, 2006-2008,) a specific task was focused on PTW users point of view, analyzing extensive databases to locate the main accident configurations (type of accident, severity, frequency), and an in-depth database to obtain the causation factors, the risk factors for each configuration founded in the extensive databases analysis and the variables associated to each causation factor in the PTW configurations.
It is well known that motorcycle riding is fascinating but quite more dangerous than for example car driving. In 2006, 5,091 persons were killed as victims of crashes occurring on public roads in Germany. 52% (2,683) were car occupants, 16% (793) motorcycle riders, 14% (711) pedestrians, 10% (486) bicycle riders, 5% (235) commercial vehicle occupants, 2% (107) riders of smaller powered two-wheelers, called "Mofa, Moped and Mokick". This shows that motorcycle riders recently are the second largest group of killed traffic participants in Germany. Latest information coming from the Federal Statistics predict for the year 2007 the figure of 4,958 killed road victims in total. This would be again a successful reduction (-133 killed persons or "2.6% compared to the year 2006). But the news coming from the Federal Statistics during the year 2007 and at the begin of 2008 did not always tell the same positive story. It is questioned whether the positive trend of substantially reduced figures of killed road user year by year will longer continue for Germany. That means it could be impossible to reach the ambitious target, set by the European Commission, to cut in half the figure of killed road users until the year 2010 " compared to the figure for the year 2001. It was reported that the group of 45 to 49 years old traffic participants (all traffic modes) is conspicuous with an increase of 30% up to 297 killed road users in total from January to August 2007. This increase can be ascribed in particular by an increase of killed motorcycle riders within this age group. Due to mild weather conditions in Germany in 2007 the season for motorcycle riding began relatively early and this may be a main reason for the increase of the figure of killed motorcycle riders by 16% from January to August 2007. With this background the accident occurrence of motorcycles became more and more essential. As part of the actual discussion about historical trends, recent emphases, causes and relevant structures of the events of motorcycle crashes it is evident, to have latest and carefully updated figures coming from both the Federal Statistics and In-depth studies. The paper will give a contribution to this using the German Federal Statistics and in-depth studies, for example GIDAS. Additional data coming from the DEKRA Motorcycle Accident Database as well as from literature are considered, too. The paper will help to describe the current situation of the accident involvement of motorcycles in Germany.
In the course of the EUROPEAN PROJECT TRACE all fatally injured pedestrians autopsied at the Institute for Legal Medicine in Munich in 2004 had been analysed by using the "Human Functional Failure (HFF) analysis" method. It was possible to apply this method although some restrictions have to be taken into account. The results derived from this analysis comprise first the failures the pedestrians (most often "impairment of sensorimotor and cognitive abilities") and the opponents (most often " Non-detection in visibility constraints conditions") faced in the accident, second the conflicts and tasks (pedestrian crossing the street conflicting with a vehicle from the side (which was going ahead on a straight road), the degree of accident involvement (pedestrians often the primary active part), and further the contributing factors to the accident (pedestrians most often "alcohol (> 0.05% BAC)", opponents most often "visibility constraints").
Pedestrian accidents are one of the major concerns related with road accidents around the world. Portugal has one of the highest rates of pedestrian fatalities in Europe. In this paper an overview conditions were the pedestrian accidents occurred in Portugal is presented. In the last years, a project related with the pedestrian accidents has run in Portugal for the period 2004-2006 where 603 people died, 2097 have been severely injured and about 17000 slightly injured. Within this project all the pedestrian accidents in this period have been analysed providing global information about a wide range of aspects, since location, driver and pedestrian characteristics, weather and road conditions, among others. In addition, 50 in-depth accidents have been investigated and the data collected according the Pendant methodology. For this in-depth methodology detailed information about the accident has been collected, including injuries, vehicle damage, road conditions and road user- behaviour and actions. An accident reconstruction has been carried for each case including the determination of the speeds and driver actions, and the analysis of the contributing factors for the accident. Depending of the accident complexity, different methodologies have been used to analyse these accident, from the classical analytical equations such as Simms and Woods, to the use of detailed computational pedestrian models as those included in the commercial software- PC-Crash-® or Madymo-®. Also one of the goals of our investigation is the development of multibody models and methodologies for the reconstruction of pedestrian accidents. Some of these tools integrated in the commercial software Cosmos Motion-® are presented. The advantages of the different approaches are compared and discussed for some of the accidents investigated. With these tools the impact speed can be determined from the projection distance with analytical tools or PC-Crash-®, but more complex tools should be used to determine speed from the injuries, what is especially important for fatal accidents. The influence of the vehicle geometry and stiffness characteristics is another aspect analysed, where the influence of the vehicle stiffness has been determined using a combined multibody-finite elements approach within the software Madymo-®.
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.
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.
In recent years special attention has been paid to reducing the number of fatalities resulting from road traffic accidents. The ambitious target to cut in half the number of road users who are killed each year by 2010 compared with the 2001 figures, as set out in the European White Paper "European Transport Policy for 2010: Time to Decide" implies a general approach covering all kinds of road users. Much has been achieved, e.g. in relation to the safety of car passengers and pedestrians but PTW accidents still represent a significant proportion of fatal road accidents. More than 6,000 motorcyclists die annually on European roads which amounts to 16% of the EU-15 road fatalities. The European Commission therefore launched in 2004 a Sub- Project dealing with motorcycle accidents within an Integrated Project called APROSYS (Advanced PROtection SYStems) forming part of the 6th Framework Programme. In a first step, the combined national statistical data collections of Germany, Italy, the Netherlands and Spain were analysed. Amongst other things parameters like accident location, road conditions, road alignment and injury severity have been explored. The main focus of the analysis was on serious and fatal motorcycle accidents and the results showed similar trends in all four countries. From these results 7 accident scenarios were selected for further investigation via such in-depth databases as the DEKRA database, the GIDAS 2002 database, the COST 327 database and the Dutch element of the MAIDS database. Three tasks, namely the study of PTW collisions with passenger cars, PTW accidents involving road infrastructure features, and motorcyclist protective devices have been assessed and these will concentrate inter alia on accident causes, rider kinematics and injury patterns. A detailed literature review together with the findings of the in-depths database analysis is presented in the paper. Conclusions are drawn and the further stages of the project are highlighted.
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.
While the number of fatal accidents is diminishing every year, there is still a need of improvement and action to prevent these deaths. Basis for this purpose has to be an analysis about the factors influencing the car crash mortality. There are various studies describing the univariate influence of several factors, but crash scenarios are too complex to be described by a single variable. The multivariate analysis respects the interference of the variables and gets so to more detailed and representative results. This multivariate analysis is based on about 2,600 cases (the data have been collected by the accident research units Hannover and Dresden (during the years 1999-2003). This paper presents a multivariate model (containing ten different variables) which detects 93% of these cases properly. This means it detects the cases as truly survived and truly death.
Traffic accidents were ranked the third among the major causes of death in Thailand. About 13,438 deaths and the death rate from traffic accident was 21.5 per 100,000 of population in 2002. The deaths and death rate varied upon the economic situation. After the economic crisis, traffic accidents were increased as well as the period of the bubble economy. In the Central region of Thailand numbers of road traffic crashes were lower than Bangkok Metropolis, but the highest in the number of deaths, death rate and serious injuries in 2002. Men aged 15"29 years old had higher numbers of deaths than men in other age groups and higher than women. Deaths and injuries from road traffic crashes were the highest in April and January, because there was a long weekend in those months. About 80 percent of road traffic crashes were caused by private car and motorcycle. In 2000 about 51 percent of traffic accidents took place on the straight way, followed by the junction and curves. In 2002, about 97 percent of road traffic crashes were caused by human factors including improper passing, speeding and disregarding to traffic signal, however, the identification of causes of traffic accident needed to improve. Drunk driving, disregarding on safety equipment usage, inefficiency of law enforcement and discontinuing of road safety programs were the deepest causes of traffic accidents. Research based information, a broad coalition of stakeholder and urban planning policy were needed to incorporate for a comprehensive road safety policy formulation and actions.
Portugal has the highest rate of road fatalities in Europe (2002 and for Eur-15 - CARE database). For this highest rate, the accidents involving pedestrians and motorcycle occupants have a higher contribution than the European average. In the last years, especially accidents involving motorcycles have been investigated and currently two different projects are being carried out, one related with motorcycles accidents and the other with pedestrian accidents. In these projects, countermeasures among others to reduce the fatalities between these two types of road users are being studied. These accidents are investigated with the commercial accident reconstruction software PCCRASH but also new methodologies based on multibody dynamics are in development in order to more accurately study these two types of accidents. In this paper, the methodologies in use for accident reconstruction and new methodologies in development are presented. Speeding his found to be one of the major causes of road fatalities for pedestrians and motorcycle occupants. In the case of motorcycle accidents, these involve mainly young drivers. Aspects as social behavior are also important to understand the causes of some of these accidents. Some examples of accidents occurring in Portugal, involving especially motorcycles and pedestrians are presented and discussed.
The European Union has set a target to reduce all road fatalities (over 40,000) with 50% in 2010. This target percentage remained unchanged with the introduction of the ten new member states within the EU as by May 1st, 2004. According to Eurostat, 34% of all fatalities in 1998 in the, then, fifteen states of the European Union were the result of single vehicle collisions. This represents over 14,000 lives lost each year of which many can likely be saved through better roadside infrastructure design. The challenge for road safety professionals is to find methods and design strategies that help to reduce these casualties. Procedures for full-scale vehicle crash testing of guard rails were first published in the US in 1962. Present European regulation is mainly based on these procedures and later developments. Since then the vehicle fleet has changed considerably. Due to the complexity of the actual safety problem the numerical simulation approach offers a good opportunity to evaluate the different parameters involved in road safety, such as infrastructure properties, vehicle type, vehicle occupants and injuries. The ideal situation would be that simulation tools are coupled or integrated and all involved effects would be related. At the moment this is not the case yet, but initiatives are taken and a new virtual era has started. This paper offers a method looking at two components that encompass the driving environment: the car and the guardrail. As part of the EC-funded project, RISER (Roadside Infrastructure for Safer European Roads) a multi body simulation program study is carried out to determine sensitivities of some parameters in car to guardrail collisions and gives insides in performance of the car with passive safety equipment, the guardrail and the interaction of these objects with each other. By offering a set of methods that includes these two aspects and their intertwining relations, more confidence can be gained in actually reducing fatalities due to single vehicle collisions with, or due to, roadside furniture. Reducing the number of fatalities of single vehicle crashes would contribute greatly to the stated goal of reducing casualties altogether.
Due to recent years accident avoidance and crashworthiness on Austrian roads were mostly developed on national statistics and on-scene investigation respectively. Identification and elimination of black spots were main targets. In fact many fatal accidents do not occur on such black spots and black-spot investigation has reached a limit. New methods are required and therefore the Austrian Road Safety Programme was introduced by the Austrian Ministry of Transport, Innovation and Technology. The primary objective is the reduction of fatalities and severe injuries. Graz University of Technology initiated the project ZEDATU (Zentrale Datenbank tödlicher Unfälle) with the goal to identify similarities in different accident configurations. A matrix was established which categorizes risk and key factors of participating parties. Based on this information countermeasures were worked out.
NASS: the glass is half full
(2007)
The National Accident Sampling System (NASS) was born in the late 1970s. It was based on a substantial amount of experience and analysis of what was needed in the United States to understand the safety challenges of our highways. This work also showed how to collect high quality and useful crash data efficiently. Unfortunately, when Ronald Reagan - a President who believed in limited government - was elected, any hope of full funding for NASS was lost. The concept of 75 teams investigating about 18,000 serious crashes in detail annually was never realized. The system got up to 50 teams, then was cut to 36, and finally to 24 teams investigating fewer than a quarter of the originally anticipated number of crashes per year. Despite this, the NASS investigations provide a rich source of data, collected according to a sophisticated statistical sampling system to facilitate detailed national estimates of road casualties on our nation- highways and their causes. In addition, changes have been made in recent years to increase the number of more serious crashes of recent model vehicles to make the results more relevant to improving vehicle safety. A recent, detailed examination of hundreds of rollovers has provided considerable insight into rollover casualties and into what can be done to reduce them. Some of these results will be presented that show the value of the NASS system. Our experience with NASS and the Fatal Accident Reporting System (FARS) suggests a number of improvements that could be made in the United States" crash data systems. It also provides justification for a doubling or tripling of our national expenditures on crash data collection.
The increase in light duty trucks (LDT) on the road in the US is a safety concern because of their aggressivity, or risk they present to occupants of cars, especially in side impacts. We use FARS data to look at fatality trends in frontal and side impacts between cars and LDT. FARS data is also used to determine risk, or fatalities per registered vehicle, imposed on car drivers from other vehicle types. We use NASS CDS data to investigate sources of serious injuries in vehicles with side impact. These sources of injury are categorized into three major groups: 1) contact without intrusion, 2) contact with intrusion, and 3) restraints. We find a greater fraction of intrusion related injuries in cars struck on their side by SUV or pick-up trucks than when they are struck by other cars.
In Finland all fatal motor vehicle accidents are studied in-depth on-the-spot by multidisciplinary (police, road and vehicle engineers, physician and behavioural scientist) road accident investigation teams (legislation 2001, work started 1968), which operate in every province. The purpose of the teams is to uncover risk factors that turned an ordinary driving situation into a serious accident and give safety recommendations for improving road safety. The investigation teams do not take a stand on guilt or insurance compensation. When analysing accidents the teams use the concepts of key event, immediate, background and injury risk factors. Compiled investigation folders of each case contain investigation forms from each member, preinvestigation protocol, photographs, sketches etc. About 500 items of information are collected from each accident party. The collected information is also coded into a computer database. Both the database and the investigation folders are widely utilized by researchers and authorities conducting safety work.
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).
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.
The significant demographic changes are predicted for the European future. The age group over 65 years is permanently increasing and over next 30 years every fourth person will belong to this group. This development will continue so far that by 2050 in many countries will double the percentage of the population aged 65 and more. Many studies analyze the new phenomena of the ageing (graying) society during the last decade. Mobility is integrated part of the life of every citizen, even more it means for the elderly people. The adequate mobility is the precondition for their active life and for their social communication that contribute to their health and functional capacity and their autonomy and independency. The active seniors demand less public support. The mobility of the older citizens is closely linked with health and societal problems and creates an important public challenge. On the other side the participation of seniors in transport due to their limited physical and mental possibilities means for them an increased risk to be injured or killed. The main mobility spaces are roads that can be used not only as a traveler in a vehicle (driver or passenger) but also as a pedestrian or cyclist or even as a motorcyclist. The road traffic is then an opportunity and danger in the same time. The accident analyzes show specific risk features of seniors that are different compared with other age groups. First of all the older road users (65 and more) are facing to the higher risk (number of killed divided by the population size) to be killed in a road accident compared with the group of younger road users (0 - 64). More significant difference can be observed when comparing the road user groups. The fatality percentage of the older pedestrians is 2,5 times higher compared with the group 25 " 64. Similar frequency show the cyclist fatalities. On the other side the vehicle passengers in the younger group have more or less two time higher percentage compared to seniors and in the group of motorcyclists even achieved in 2008 almost five times higher compared with the older group. The share of the old road users fatalities (around 19%) didn"t practically change during the last 10 years in the European average. But comparing the gender involvement (2006) there is an interesting difference " female fatalities make 30, 2%, male fatalities 15, 3% of all fatalities in their groups. The risk of the senior users is more connected with their physical and mental limits than with their risk behavior. According to the Czech statistics (2007) the vehicle drivers over 65 years cause only 3, 6% of all accidents. The solution of the problem is to minimize the risk and to create a safe environment for the elderly people using the roads. In order to achieve this goal a deep knowledge of risk and of accident circumstances, full understanding of the behavior of the seniors and their limitations and accommodating approach of the whole society is necessary. Road risk of the ageing society has to be considered as a part of the health and social policy. These can build a creditable basis for the implementation of the measures that secure safe moving of seniors on the roads.
Sowohl die Zahl der im Straßenverkehr Getöteten wie auch die der Schwerverletzten sind nach Angaben der amtlichen Statistiken in Deutschland seit Jahren rückläufig. Die Gruppe der Schwerverletzten ist allerdings sehr heterogen und umfasst alle Unfallopfer, die für mindestens 24 Stunden in einem Krankenhaus behandelt wurden. Die vorliegende Untersuchung versucht, mit Hilfe von Daten des Traumaregisters der Deutschen Gesellschaft für Unfallchirurgie (DGU) die Frage zu beantworten, ob auch bei den besonders schwer verletzten Verkehrsunfallopfern ein Rückgang der Zahlen zu beobachten ist. Dazu wurden "schwerstverletzte" Patienten definiert als solche, die im Injury Severity Score (ISS) mindestens 9 Punkte erreicht haben und zudem intensivmedizinisch behandelt werden mussten. Der Zeitraum der Untersuchung umfasst zehn Jahre von 1997 bis 2006, der für einige Fragestellungen zusätzlich in zwei je 5-jährige Phasen unterteilt wurde. Ab 2002 (Phase 2) ist auch eine separate Auswertung für Fahrrad- und Motorradfahrer möglich. Die erste Fragestellung richtete sich auf die Veränderung der Anzahl schwerstverletzter Verkehrsunfallopfer über die Zeit. Dafür wurden die Daten von über 11.000 Patienten aus 67 verschiedenen Kliniken betrachtet. Pro Klinik wurde ein Durchschnittswert für die Anzahl von Verkehrsunfallopfern bestimmt, der dann mit der tatsächlich beobachteten Zahl verglichen wurde. Im Ergebnis zeigte sich, dass die relativen Abweichungen vom Durchschnitt insgesamt nur etwa -±10% betragen und dass kein deutlicher Trend einer Abnahme oder Zunahme der Schwerstverletztenzahlen in den vergangenen 10 Jahren erkennbar ist. In der zweiten Fragestellung wurde untersucht, ob und wie stark ein Rückgang der Letalität zu einem Anstieg der Schwerstverletztenzahlen geführt haben könnte. Es konnte gezeigt werden, dass in den letzten beiden Jahren deutlich weniger Patienten im Krankenhaus verstorben sind, als dies nach ihrer Prognose zu erwarten gewesen wäre. Dieser Rückgang der Letalitätsrate von absolut bis zu 5 (in 2006: Prognose 18% versus beobachtet 13%) trägt damit auch zu einer Zunahme bei der Zahl der Schwerstverletzten bei. Zur Abschätzung der Prognose wurde ein im Traumaregister entwickeltes und validiertes Scoresystem (RISC) eingesetzt. In der letzten Fragestellung sollte geklärt werden, ob sich das Verletzungsmuster bei den Schwerstverletzten in den vergangenen zehn Jahren und abhängig von der Art der Verkehrsteilnahme verändert hat. Insgesamt konnte gezeigt werden, dass der relative Anteil der Autofahrer rückläufig war, von 60% auf 50%. Bei den verletzten Körperregionen zeigt das Schädel-Hirn-Trauma den deutlichsten Rückgang von 69 % auf 60% insgesamt. Dieser Trend ist bei allen Verkehrsbeteiligten erkennbar. Lediglich Verletzungen der Wirbelsäule werden häufiger gesehen, was aber auch ein Effekt der verbesserten CT-Diagnostik sein kann, zum Beispiel beim Ganzkörper-CT. Je nach Art der Verkehrsbeteiligung zeigen sich sehr unterschiedliche Verletzungsmuster. Verletzungen des Kopfes sind bei Radfahrern und Fußgängern dominierend (über 70%), während Motorradfahrer hier die günstigsten Raten zeigen (45%). Motorrad- und Autofahrer haben die höchsten Raten für Verletzungen des Brustkorbs und im Bauchraum, bedingt durch die im Mittel höheren einwirkenden Kräfte auf den Körper. Insgesamt lassen sich die Daten des DGU-Traumaregisters gut nutzen, um typische Verletzungsmuster zu beschreiben und um relative Veränderungen bei der Zahl der Schwerstverletzten über die Zeit nachzuweisen. Beobachtungszeiträume von zehn Jahren und mehr, wie im vorliegenden Fall, ermöglichen auch aktuelle Trendaussagen. Epidemiologische Aussagen wie in den amtlichen Statistiken sind aber nur sehr eingeschränkt möglich, da das Traumaregister bisher nur auf freiwilliger Basis Daten sammelt.