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.
Although ATV accidents account for numerous deaths in the US and Australia, the role in traffic accidents and hospital admissions in Germany is unknown. At a level I trauma centre, hospital and crash charts were analysed for medical and technical parameters of ATV accidents. ATV drivers were 0.1% of emergency trauma patients. The mean total hospital stayrnwas 15 days; there were 1.5 stays per patients with 2.0 surgical procedures needed. One patient died, only two recovered fully. 14 cases of ATV accidents out of 18990 (0.1%) were documented within 10 years. The mean impact velocity was 35 km/h. Car collisions were predominant. The upper extremity was the predominant injured region (AIS 0.7), Mean maximum AIS was 1.4. ATV accidents in Germany are rare but pose high risk for severe injuries. Possible reasons are low active and passive security, limited experience and risky driving behaviour. Preventive measures are discussed.rn
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 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.
The National Highways Development Project in India is aimed at upgrading over 12,000 km of national highways from 2-lane undivided roads to 4-lane divided roads. With nearly 40% of fatal crashes being reported on national highways, the effect of this project on road safety needs to be assessed. Researchers carried out on-site crash investigations and in-depth crash data collection for a period of 45 to 60 days on four 2-lane undivided highways and a 4-lane divided highway. Based on 76 crashes examined, researchers found a shift of crash pattern from head-on collisions on undivided 2- lane highways to front-rear collisions on divided 4-lane highways. This paper presents the methodology, analysis of crashes examined, and the critical safety problems identified for greater consideration in future highway development projects. This paper also highlights the need and significance of in-depth crash investigations to understand local traffic conditions and problems in India.
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.
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.
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.
The NHTSA-sponsored Crash Injury Research and Engineering Network (CIREN) has collected and analyzed crash, vehicle damage, and detailed injury data from over 4000 case occupants who were patients admitted to Level-I trauma centers following involvement in motor vehicle crashes. Since 2005, CIREN has used a methodology known as "BioTab" to analyze and document the causes of injuries resulting from passenger vehicle crashes. BioTab was developed to provide a complete evidenced-based method to describe and document injury causation from in-depth crash investigations with confidence levels assigned to the causes of injury based on the available evidence. This paper describes how the BioTab method is being used in CIREN to leverage the data collected from in-depth crash investigations, and particularly the detailed injury data available in CIREN, to develop evidence-based assessments of injury causation. CIREN case examples are provided to demonstrate the ability of the BioTab method to improve real-world crash/injury data assessment.