Search

Background In France, like in most developed countries, the number of road accident fatalities is estimated from police data. These estimates are considered to be good-quality, unlike estimates of road injuries admitted to hospital, and especially serious injuries. Methods The present study aimed to supply such data from French hospital medical information data-bases (PMSI). In the PMSI data-bases, road accident victims are identified by external causes of morbidity and mortality, which should be systematically recorded in case of injury, but are often missing. We therefore modeled presence/absence of external cause from the relevant subset of the medicine-surgery-obstetrics PMSI data-base using a logistic regression, and then weighting the results by inverse estimated probability. As ICD-10 coding does not include injury severity, we used the AAAM10 conversion instrument developed by the American Association for Automotive Medicine, originators of the Abbreviated Injury Scale, so as to conform to the European Commission’s definition of serious injury. Results The number of road-accident related hospital admissions is estimated to be about 100000 per year; serious injuries increased from about 18000 in 2010 to almost 20000 in 2017, with almost 17000 in 2012 and 2013, with a mean of one fatality per 5 serious injury admissions. Conclusions These serious injury estimates are close to those obtained by our team from other data and with a different estimation method. The present method has the advantage of using ICD codes for injured people admitted to hospital. This classification and data source (hospital discharge registry) are also used by most european countries reporting serious injury estimates to the Commission. It allows cost estimation of hospital care, and could be applied to other types of accidental injury.

Context and objective Among the different products and protective gear used by riders of two-wheeled motorized vehicles, back protectors that are designed to prevent damage to the spinal column are widely used today compared other protections. However, few studies measure their effectiveness. Can their effectiveness be measured? How do they help decrease or change the nature of thoracolumbar traumas that occur? To address these questions and remedy the lack of objective data regarding these products, an epidemiological, clinical, and biomechanical analysis of motorcycle riders who were admitted to a French trauma center after an accident was performed. So, this study investigates the effectiveness of back protectors, including their ability to prevent specific mechanisms of thoracic and lumbar spinal injuries related to TWMV accidents. Method A questionnaire was administered to victims of accidents involving two-wheeled motorized vehicles who were admitted to the trauma room at the Marseille trauma center over the course of 2016. Collect data are related to the victim, the accident scenario, and a detailed description of the observed injuries using AIS (Abbreviated Injury Scale) coding and Magerl classification. Univariate analyses and Fisher tests were performed for victims who were or were not wearing back protectors. Results This study collected data from 124 victims. Almost half of the victims were wearing a back protector at the time of the accident (53 victims, thus 43% of riders). Collectively, twenty-nine victims who were wearing back protectors had 57 thoracolumbar injuries, and twenty eight victims who were not wearing back protectors had 75 thoracolumbar lesions. The results from this study show that there is no significant difference in the nature and mechanism of thoracolumbar injuries as a function of back protection. The majority of the thoracolumbar injuries were not severe. They were primarily bone injuries, essentially compression fractures, regardless of whether a back protector was worn. Conclusion This study shows that the use of back protection does not decrease the number, type, or mechanism of thoracolumbar injuries associated with accidents involving two-wheeled motorized vehicles. However, it suggests that lumbar vertebral injuries are deflected towards the thoracic vertebrae when back protectors are worn. Finally, it suggests that the design of back protectors should be reconsidered to better protect riders from what are referred to as compression fractures (craniocaudal force), which remain the primary form of fracture regardless of the rider’s characteristics, based on the data analyzed.

To determine accurately the number of serious injuries at EU level and to compare serious injury rates between different countries it is essential to use a common definition. In January 2013, the High Level Group on Road Safety established the definition of serious injuries as patients with an injury level of MAIS3+(Maximum Abbreviated Injury Scale). Whatever the method used for estimating the number or serious injuries, at some point it is always necessary to use hospital records. The aim of this paper is to understand the implications for (1) in/exclusion criteria applied to case selection and (2) a methodological approach for converting ICD (International Classification of Diseases/Injuries) to MAIS codes, when estimating the number of road traffic serious injuries from hospital data. A descriptive analysis with hospital data from Spain and the Netherlands was carried out to examine the effect of certain choices concerning in- and exclusion criteria based on codes of the ICD9-CM and ICD10. The main parameters explored were: deaths before and after 30 days, readmissions, and external injury causes. Additionally, an analysis was done to explore the impact of using different conversion tools to derive MAIS3 + using data from Austria, Belgium, France, Germany, Netherlands, and Spain. Recommendations are given regarding the in/exclusion criteria and when there is incomplete data to ascertain a road injury, weighting factors could be used to correct data deviations and make more real estimations.

The objective of this study was to assess the influence of longitudinal barriers located on the median strips and hard shoulders of toll motorways on crash severity in vehicles running off the roadway. The study was based on crashes involving injury and property damage only, recorded from 1996 to 2010 on a French toll motorway network of about 2000 km. In run-off from the roadway onto the hard shoulder, injury risk was halved by a longitudinal barrier. A specific one-sided W-beam guardrail (“GS4”) appeared to be the best solution for cars, and even for LUVs and trucks. This does not affect the advisability of specific guardrails for bridges or of concrete barriers, when narrow working widths are required. In run-off onto median strips, a specific guardrail (“GS2”) appeared to be the most efficient, followed by the three other metal guardrails currently installed. Concrete barriers, however, are much more effective in preventing complete crossing of the median, which is uncommon and mainly involves trucks, but often with very serious consequences. Longitudinal barriers make an important contribution to highway-user safety, providing a “forgiving” infrastructure in the event of a vehicle going off the road, provided that there are very few motorized two-wheel vehicles using the roadway.

Rapport annuel d'activité du Registre du Rhône

L'essentiel de ce rapport étudie les facteurs liés à la survenue et à la gravité des accidents impliquant un Îhicule et un piéton. Sont ainsi analysés la répartition des configurations accidentelles, les manoeuvres d'urgence effectuées par les conducteurs, la répartition des "responsabilités" entre les deux impliqués et des défaillances identifiées en termes d'erreur de détection, de décision, de diagnostic, ou de pronostic. Le risque d'être tué pour le piéton est montré comme dépendant du carré de la vitesse au choc, ainsi que de son âge et, dans une moindre mesure, de la localisation de l'impact. Si certains résultats sont limités par la précision des informations "PV", surtout corporels, ils sont néanmoins en faveur de certaines contre-mesures envisagées ou en cours de déploiement pour les Îhicules (aide à la détection, dispositif limitant les franchissements PL), l'infrastructure (amélioration de la détection, aménagement zones "communes", régulation de vitesse) ainsi que pour les conducteurs et les piétons (éducation à l'autre).

Objective: The aim of the present study was to describe the consequences of a road accident in adults, taking account of the type of road user, and to determine predictive factors for consequences at two years. Design: Prospective follow-up study. Methods: The cohort was composed of 1,168 victims of road traffic accidents, aged ≥16 years. Two years after the accident, 912 victims completed a self-administered questionnaire. Weighted logistic regression models were implemented to compare casualties still reporting impact related to the accident versus those reporting no residual impact. Five outcomes were analysed: unrecovered health status, impact on occupation or studies, on familial or affective life, on leisure or sport activities and but also the financial difficulties related to the accident. Results: 46.1% of respondents were motorised four-wheel users, 29.6% motorised two-wheel (including quad) users, 13.3% pedestrians (including inline skate and push scooter users) and 11.1% cyclists. 53.3% reported unrecovered health status, 32.0% persisting impact on occupation or studies, 25.2% on familial or affective life, 46.9% on leisure or sport activities and 20.2% still had accident-related financial difficulties. Type of user, adjusted on age and gender, was linked to unrecovered health status and to impact on leisure or sport activities. When global severity (as measured by NISS) was integrated in the previous model, type of user was also associated with impact on occupation or studies. Type of user was further associated with impact on occupation or studies and on leisure or sport activities when global severity and the sociodemographic data obtained at inclusion were taken into account. It was not, however, related to any of the outcomes studied here, when the models focused on the injured body region. Finally, type of road user did not seem, on the various predictive models, to be related to financial difficulties due to the accident or to impact on familial or affective life. Conclusions: Overall, victims were affected by their accident even two years after it occurred. The severity of lesions induced by the accident was the main predictive factor. However, considering lesion as intermediary factors between the accident and the recovery status at two year post-accident, impact on health status was lower for cyclists than M4W users or M2W users.

In car-pedestrian accidents, lateral bending and shearing kinematics have been identified as principal injury mechanisms causing permanent disabilities and impairments to the knee joint. Regarding the combined lateral bending and shearing contributions of knee joint kinematics, developing a coupled knee injury criterion is necessary for improving vehicle countermeasures to mitigate pedestrian knee injuries.The advantages of both experimental tests and finite element (FE) simulations were combined to determine the reliable injury tolerances of the knee joint. First, 7 isolated lower limb tests from postmortem human subjects (PMHS) were reported, with dynamic loading at a velocity of 20 km/h. With the intention of replicating relevant injury mechanisms of vehicle-pedestrian impacts, the experimental tests were categorized into 3 groups by the impact locations on the tibia: the distal end to prioritize pure bending, the middle diaphysis to have combined bending and shearing effects, and the proximal end to acquire pure shearing. Then, the corresponding FE model was employed to provide an additional way to determine exact injury occurrences and develop a robust knee injury criterion by the variation in both the lateral bending and shearing contributions through a sensitivity analysis of impact locations.Considering the experimental test results and the subsequent sensitivity analysis of FE simulations, both the tolerances and patterns of knee joint injuries were determined to be influenced by impact locations due to various combined contributions of lateral bending and shearing. Both medial collateral ligament and cruciate ligament failures were noted as the onsets of knee injuries, namely, initial injuries. Finally, a new injury criterion categorized by initial injury patterns of knee joint was proposed by coupling lateral bending and shearing levels.The developed injury criterion correlated the combined joint kinematics to initial knee injuries based on subsegment tests and FE simulations conducted with a biofidelic lower limb model. This provides a valuable way of predicting the risk of knee injury associated with vehicle-pedestrian crashes and thereby represents a further step to promote the design of vehicle countermeasures for pedestrian safety.

In addition to the immediate physical injuries they suffer, road accident victims may also be subject to ongoing deterioration of their state of health in terms of permanent physical and mental problems, disabilities, etc. These various health shocks entail recourse to care and treatment, the upshot being increases in health expenses. In France little is known about the financial impact of accidents on victims. This paper uses data from a sample of 777 individuals suffering from road accident-induced physical impairment. Information about these individuals includes details of their personal and socioprofessional characteristics, together with data provided by their health insurance offices regarding their use of treatment and their medical expenses. The analysis of these data reveals that the costs incurred by road accident victims are significantly associated with such factors as age, seriousness of impairment, and marital status. Interaction effects are also noted between these explanatory factors: for example, the effect of the seriousness of impairment on the costs involved differs according to the age of the victim., Les blessés de la route sont victimes de préjudices physiques immédiats occasionnés lors de la collision routière. D'autres conséquences résident en la détérioration durable de leur état de santé, en la permanence de séquelles physiques et mentales, et d’ handicaps, etc. L’ensemble de ces altérations de l’état de santé a pour effet d’accroître le recours aux soins, et par conséquent, augmente les dépenses de santé engagées par les accidentés de la route. L’impact financier de l’accident sur les victimes blessées reste mal connu pour la France. Cette contribution utilise des données relatives à un échantillon de 777 individus souffrant d’une déficience physique causée par un accident de la route. Pour ces individus, nous disposons d’informations détaillées sur leurs caractéristiques individuelles, socioprofessionnelles, ainsi que des données fournies par les caisses d’assurance maladie (CAM) renseignant leurs recours aux soins et leurs dépenses médicales. Les résultats de notre analyse montrent que les frais de soins des accidentés de la route sont associés de manière significative à des facteurs tels que l’âge, la gravité du préjudice corporel, le statut matrimonial. Des effets d’interaction existent aussi entre les facteurs explicatifs eux-mêmes. Ainsi, l’effet de la gravité des lésions corporelles sur le montant des dépenses de soin est différent selon l’âge de la victime.

The percentage of trauma during pregnancy related to road accident is between 50% and 75%. This type of trauma can result in premature birth or even foetal loss. To analyse and understand the injury mechanisms in pregnant women involved in a car accident, several studies proposed computational or physical tools to simulate accidents. Specific dummy and numerical models have been proposed and validated using experimental data from post-mortem human surrogate (PMHS) scaled with the equal-stress, equal-velocity scaling method to a pregnant woman. This study proposes to evaluate the reliability of this assumption and its scope.

The use of the bicycle on a large scale encouraged in the context to develop an eco friendly environment is facing today on a range of barriers. One of these barriers identified by researchers and governments is observed to include ‘road safety’. Hence, it is necessary to set up a protection system for bicyclists especially for the cephalic segment. Currently only few studies are available concerning the head impact loading in case of real accidents. Therefore, the objective of this work is to identify the initial condition of head impact in case of real accident. Head impact velocity and head impact area are extracted and implemented in the last generation of head injury prediction tool to simulate the head trauma by impacting directly the Strasbourg University Finite Element Head Model (SUFEHM) on the vehicle structures. The present study can be divided into three activities i.e. obtain real bicyclist accidents data issued from in depth accident investigation databases, cyclist body kinematic reconstruction to obtain the initial conditions of the head just before the impact and head impact simulation to evaluate the head loading during impact and the injury risk. A total of 26 bicyclists’ accident cases with head injuries have been collected from both a French and a German accident database. For each accident case, body kinematic has been simulated using Madymo® software. Two methodologies and human multibody models were used: 10 accident cases have been reconstructed by IFSTTAR using its owned developed human model and 16 accident cases have been reconstructed by Unistra using the human pedestrian TNO model. The results show that the head is impacted more often on top parietal zone, and the mean impact velocity is 6.8 ± 2.7 m/s with 5.5 ± 3.0 m/s and 3.4 ± 2.1 m/s for normal and tangential components respectively. Among these real accidents, 19 cases have been selected to be simulated by finite element computations by coupling the human head model and a windscreen model whose properties were extracted from literature. All reconstructed head impact gave results in accordance with the damage actually incurred to the victims. The objective of this study is to demonstrate the feasibility of numerical reconstruction as an understanding tool of the head impact conditions in bicyclist's accident cases, and hence providing knowledge for helmet optimization using biomechanical criteria.

Thoracic and abdominal organs are typically severely injured during crash situations leading to severe traumas with high morbidity. To prevent this, the definition of efficient safety devices should be based on a detailed knowledge of injury mechanisms and related injury criteria. To this end, finite element (FE) simulation coupled to experiment could be a valuable tool to provide a better understanding of internal organ behaviour. This preliminary study aims to improve FE modelling focusing on the mechanical behaviour of the liver. It concerns the identification of structure mechanical properties up to the evaluation of damage occurrence. This work furthers the building of a methodology to implement liver behaviour in a FE model that is robust enough to encompass the biological, intrinsic and experimental variabilities. It is based on an ongoing experimental characterization of the liver under quasistatic compression. A first set of model parameters relevant to the subinjury level has been obtained. Subsequent damage evaluation was performed through von Mises level analysis by comparison to the experimental tests including necropsies and histological structure analysis. Results revealed that damage was centred in the middle part of the right lobe. This work moves us closer to a complete understanding of injury mechanisms incorporating clinical data concerning liver traumas. Abdominal organs, damage evaluation, FE simulation, inverse analysis

BACKGROUND: The trunk of a car occupant can be injured by a frontal or lateral impact. Lesions can be either intrusion injuries or due to the effects of deceleration alone. The aim of this study conducted with human cadavers was to explore the effects of deceleration on the liver during frontal or lateral deceleration. METHODS: Trunks previously instrumented with accelerometers in three sites, the left and right lobes of the liver and the retrohepatic inferior vena cava, were subjected to substantial deceleration in three orientations: frontal, left, and right lateral. The anatomic consequences and deceleration data were measured. A deceleration ratio was defined as a peak deceleration measured in the liver divided by peak deceleration imposed on the trunk. RESULTS: Peak deceleration imposed on the trunks was up to 60 g, which caused peak deceleration up to 26 g in the liver. No anatomic injury was observed. For each orientation, deceleration ratios were not significantly different among the three sites (p = 0.64) or between left and right lateral decelerations (p = 0.12). Deceleration ratios were significantly different (p = 0.001) between frontal (3 sites combined) and lateral (3 sites of left and right lateral orientations combined) decelerations: 39.4% (+/-6) versus 48.4% (+/-11). CONCLUSIONS: In conclusion, at tested decelerations, under the hepatic injury threshold, cadaveric liver seemed to be subjected to higher deceleration when the trunk was decelerated in lateral than in frontal direction, without terminal impact. Language: en

Deuxièmes journées d'études nationales de l'AFTIM, AVIGNON, FRANCE, 25-/03/1987 - 27/03/1987; Les traits sociologiques de la population des conducteurs de poids-lourds, les mécanismes sociaux de sa constitution, les caractéristiques de ses conditions d'emploi et de travail ont été analysés à partir d'échantillons représentatifs de l'ensemble des conducteurs réalisant le véhiculage des marchandises. Au regard de nombreuses caractéristiques sociologiques, ils ressemblent aux autres ouvriers. Mais, l'analyse de l'évolution de leurs carrières, indique l'existence de processus sociaux opérant des formes de sélection entre les conducteurs, quittant ou gardant ce type d'emploi. Ces derniers, cherchent à améliorer leurs situations, en allant vers les entreprises offrant de meilleurs salaires et/ou des conditions de travail moins difficiles. Comme les durées et les rythmes de travail habituels sont connus, il est possible de calculer une exposition au risque d'implication dans les accidents de la route (selon le moment de la journée où les conducteurs sont au volant et en fonction de la quantité de travail déjà effectuée) et ensuite de la comparer, à partir d'un échantillon représentatif des conducteurs impliqués, aux caractéristiques temporelles de l'activité des conducteurs avant les accidents. Cela permet de montrer que le risque d'implication dans un accident croit avec le nombre d'heures de travail effectuées d'une part, en fonction des moments de la journée où les conducteurs sont au volant d'autre part (à la fin de la journée normale de travail et la nuit). Mais les relations entre les durées ou les moments de travail et le risque d'accident ne sont pas identiques pour les différentes catégories de conducteurs. Les jeunes et les conducteurs de la branche transport connaissent un niveau global de risque plus élevé mais semblent trouver des ressources diverses pour lutter contre la fatigue aux seuils de temps les plus dangereux. Aussi il convient de s'interroger sur les relations existantes entre le Risque d'accident et les conditions d'emploi propres aux différentes Branches d'activités économiques, d'une part ; entre le risque d'accident et les conditions d'acquisition des compétences mises en oeuvre dans la conduite des véhicules lourds, d'autre part.

This paper describes the modelling approach using MADYMO 2D at INRETS (The French National Institute for Transport and Safety Research). A mathematical dynamic model of the pedestrian leg in lateral impact was developed (M.MATYJEWSKI) to test car fronts in order to estimate the severity of the knee joint lesions and to predict the risk of leg injuries in car/pedestrian accidents. Results of this model were compared with those obtained with an instrumented mechanical leg used in the bumper impact test. A train passenger behaviour during a crash at low speed was developed (J.BLOCH and F.MINNE) to improve the function of the fusible area at each carriage extremities. Results of this model were compared with those obtained during a real scale crash test. The kinematic of a 3 -year old child in a childseat on a passenger car seat is analysed (R.BIARD and J.L.CHANIAC) during a frontal impact. Experimental results from sled tests serve as a basis for the validation of the model.