Abstract The EU-IDB (European Injury Database) contains cross-national data on the external causes and circumstances of injuries treated in the emergency departments of hospitals. Its primary purpose is to facilitate the development and evaluation of injury prevention policies and programmes, which aim to control external risks. The information is complementary to death and hospital discharge statistics and specific surveillance systems on road and workplace accidents. Unique is the wealth of information about external circumstances of injuries as needed for evidence-based prevention actions. The IDB data are collected by dedicated national agencies and provided to the Italian National Institute of Health (ISS) which hosts the databank. As part of the EU BRIDGE-Health initiative 2017 (WP9-Injury Surveillance Platform), the EU-IDB Network was commissioned to generate comparable burden of injury estimates across Europe: “Disability Adjusted Life Year (DALY) estimates for injury utilising the European Injury Data Base (IDB)”. DALY estimates were generated for IDB countries and years where both fatal and non-fatal injury data were available. Non-fatal injury data were acquired from Emergency Department data recorded in the IDB Minimum Data Set (MDS), fatal data were obtained from the European Detailed Mortality Database (EDMD). The general approach to calculating DALYs followed that of the Global Burden of Disease (GBD) study but utilised new and different disability weights created by the the Injury-VIBES cohort and detailed injury incidence data from nineteen countries. DALY estimates were between 2-10 times larger than estimates generated by previous studies such as the GBD study, due to much higher incidence figures and larger disability weights. In the workshop, the most recent results of the EU-IDB and the respective DALY estimates will be presented and discussed.

This paper gives an overview of official monetary valuations of the prevention of road crashes, road fatalities and injuries in 31 European countries. The values have been made comparable by converting them to Euro in 2015-values, adjusted by purchasing power parities. The monetary valuation of preventing a fatality varies from 0.7 to 3.0 million Euro. The valuation of preventing a serious injury ranges from 2.5% to 34.0% of the value per fatality and the valuation of preventing a slight injury from 0.03% to 4.2% of the value of a fatality. Total costs of road crashes are equivalent to 0.4-4.1% of GDP. The method used for obtaining valuations has a major impact on values. Most countries rely on the willingness-to-pay (WTP) approach, which gives higher valuations than other methods. Additional explanations for variations in valuations are differences in the cost components included, different definitions of serious and slight injuries and different levels of underreporting. Harmonization of valuation practices is needed for making sound international comparisons of road crash costs and for cost-benefit analysis at supranational level.

Background: Information about the burden of (non-fatal) road traffic injury is very useful to further improve road safety policy. Previous studies calculated the burden of injury in individual countries. This paper estimates and compares the burden of non-fatal serious road traffic injuries in six EU countries/regions: Austria, Belgium, England, The Netherlands, the Rhone region in France and Spain. Methods: It is a cross-sectional study based on hospital discharge databases. Population: of study are patients hospitalized with MAIS3+ due to road traffic injuries. The burden of injury (expressed in years lived with disability (YLD)) is calculated applying a method that is developed within the INTEGRIS study. The method assigns estimated disability information to the casualties using the EUROCOST injury classification. Results: The average burden per MAIS3+ casualty varies between 2.4 YLD and 3.2 YLD per casualty. About 90% of the total burden of injury of MAIS3+ casualties is due to lifelong consequences that are experienced by 19% to 33% of the MAIS3+ casualties. Head injuries, spinal cord injuries and injuries to the lower extremities are responsible for more than 90% of the total burden of MAIS3+ road traffic injuries. Results per transport mode differ between the countries. Differences between countries are mainly due to differences in age distribution and in the distribution over EUROCOST injury groups of the casualties. Conclusion: The analyses presented in this paper can support further improvement of road safety policy. Countermeasures could for example be focused at reducing skull and brain injuries, spinal cord injuries and injuries to the lower extremities, as these injuries are responsible for more than 90% of the total burden of injury of MAIS3+ casualties.

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.

Because of their high number and slower reduction compared to fatalities, serious road injuries are increasingly being adopted as an additional indicator for road safety, next to fatalities. Reducing the number of serious road injuries is one of the key priorities in the EU road safety programme 2011- 2020. In 2013, the EU Member States agreed on the following definition of serious road traffic injuries: a serious road traffic injury is a road traffic casualty with a Maximum AIS level of 3 or higher (MAIS3+). One recommendation created by the EU SUSTAIN project was to conduct “A more detailed study of the causes of serious road injuries, [which] could reveal more specific keys to reduce the number of serious injuries in the EU”. This recommendation is addressed through the identification of crashrelated causation and contributory factors for selected groups of casualties with relatively many MAIS3+ casualties compared to fatalities and groups with a relatively high burden of injury of MAIS3+ casualties. This deliverable is made up of two parts brought together in order to determine the main contributory factors detailed above. This two-step approach initially identifies groups of casualties that are specifically relevant from a serious injury perspective using national level collision and hospital datasets from 6 countries. Following the determination of groups of interest a detailed analysis of the selected groups using indepth data was conducted. On the basis of in-depth data from 4 European countries the main contributory and causal factors are determined for the selected MAIS3+ casualty groups. Alongside the three proceeding deliverables that have formed the major outputs of WP7, deliverable D7.4 is aimed at addressing serious injury policy at an EU levels. As such this report is broadly aimed at policy makers although the inclusion of results from in-depth data analysis also provides information relevant to stakeholders, particularly those working in vehicle design and manufacture or road user behaviour.

Background Injury data from emergency departments (EDs) as used for the European Injury Database (IDB) can deliver most useful health indicators – beside mortality data. The current EU health information system requests EU member states to apply the IDB methodology and to deliver injury incidence rates for major domains of prevention (European Core Health Indicators ECHIs). Previous analyses (2011 – 2013) unveiled oversize variations between country estimates, which led to methodological improvements of sampling standards and national reporting requirements (metadata). Objectives To estimate EU and country rates, based on most recent data of the EU IDB (2013 – 2015) for main prevention domains (home and leisure, sport and school, road traffic, workplace, violence and self-harm); to detect shortcomings of national IDB implementations, which may affect validity and comparability of IDB-based ECHIs. Methods IDB data from 22 European countries 2013–2015 were used for the estimation of national and EU incidences. According national metadata files were analysed to identify deviations from the standard methodology. Findings: The general ED based injury rate is 7.49% of the EU population, which means about 38.07 million ED treatments annually in the EU of 28 countries. 52% of all these injuries are home, leisure and school accidents (ECHI 29), road traffic account for 8.8% and work-place for 9.4%. However, many national IDB implementation still do not fully comply with the standards, e.g. by collecting data only in insufficiently controlled samples of hospitals. Some countries still do not have EU compatible surveillance systems. Conclusions The European injury surveillance system IDB serves the intended purpose of providing meaningful health indicators for the various responsible policy sectors, but many national implementations need improvements. More attention on comparability and better central support to member states need to be provided by the future European Health Information system.

Cyclists, while relatively small in proportion with respect to motorized vehicles, have a high level of vulnerability, creating a significant need to better understand the characteristics specific to this user group. A good insight into the problem provides an opportunity to improve the road safety of this cheap, convenient and environmentally friendly mode of transport. In 2013, more than 2.000 cyclists were killed in road traffic accidents in 27 EU countries, constituting almost 8% of all road accident fatalities for that year. Although a considerable decrease by 32% in the total number of bicycle fatalities in noted within the decade 2004 – 2013, it is still smaller than the respective reduction of the overall road fatalities by 45%.The objective of this research is the analysis of basic road safety parameters related to cyclists in European countries, by the use of the EU CARE database with disaggregate data on road accidents, as well as of other international data sources (OECD/IRTAD, Eurostat, etc.). Time-series data on road accidents involving cyclists from 27 EU countries over a period of 10 years (2004-2013) are correlated with basic safety parameters, such as road type, season of the year, age and gender. Data from the EU Injury Database are used to identify injury patterns and improve the assessment of injury severity, and additional insight into accident causation for cyclists is offered through the use of in-depth accident data from the EC SafetyNet project Accident Causation System. The results of the analysis allow for an overall assessment of the cyclists safety level in Europe in comparison to other modes of transport, thus providing useful support to decision makers working for the improvement of safety in the European road network.

Measuring the true incidence of injury or medically attended injury is challenging. Population surveys, despite problems with recall and selection bias, remain the only source of information for injury incidence calculation in many countries. Emergency department (ED) registry based data provide an alternative source.

The EU research project SafetyCube pays specific attention to serious road injuries, defined as nonfatal road traffic casualties with an injury severity level of MAIS3+. By means of surveys, information was collected on current practices concerning the estimation of the number of MAIS3+ casualties and on costs related to serious road injuries in different European countries. Moreover, the effect of differences in practices on the estimated number of MAIS3+ casualties was investigated by applying different methods to the same data. Finally, by means of a literature review, analysis of additional case studies, and burden of injury calculations, health impacts of serious road injuries were investigated. This paper presents six main lessons learned from these activities. Practices concerning the estimation of the number of MAIS3+ casualties differ between countries; some countries apply correction factors to police data, other countries use hospital data, and a third group of countries uses linked police and hospital data. Practices also differ concerning the selection of MAIS3+ road traffic injuries within hospital data. Differences in methodology appear to affect the MAIS3+ estimate. Therefore, one should be careful when comparing figures from different countries. The SafetyCube guidelines can support further harmonization. It is important to reduce the number of serious road injuries because injuries can have major impacts on a casualty's life and pose a burden to society. About 75% of the MAIS3+ road traffic casualties are not fully recovered 3 years postcrash. Moreover, serious road injuries cost countries up to 2.7% of their gross domestic product.

Background The EU Injury Database IDB is designed to deliver public health indicators on various kinds of non-fatal injuries. Although IDB data should be recorded in every hospitalbased emergency department (ED), there are many countries which collect data only in samples of hospitals, which makes projections necessary. Previous analyses of estimates (2011–2013) unveiled that discharge figures are higher than the IDB based estimated numbers of admissions. It has been assumed, that these differences are caused by different case definitions in IDB samples and reference statistics (usually hospital discharge statistics). Objectives To assess the impact of varying case definitions, i.e. the inclusion/exclusion of non-residents, complications of medical interventions, sequelae of injuries, day care (zero nights) patients, follow-up (secondary) treatments, patients deceased in hospital, and the use of either ICD-10 chapter XIX (diagnoses) or XX (external causes). Methods Survey among national injury data administrators. Seven countries were able to provide the desired data on mentioned subgroups of hospitalized injury patients. Findings The average shares of complication of medical interventions and day-care patients are rather high (14% each), also follow-up treatments play a considerable role (8%). There are considerable differences between countries which indicates different coding routines: e.g. the percentage of complications ranges from 4% to26%. The number of admitted injury patients vary also considerable depending on what group of ICD-10 codes is used for defining 'injury'. Conclusions When projections of national rates are necessary, it is essential to use coherent case definitions for the IDB sample as well as for the reference statistic. For comparable national rates, the same definitions need to be applied in all EU countries. However, when this is assured, the differences between IDB based estimates for admissions and HDS figures seem to diminish, which indicates, that IDB estimates are valid.

The EU road safety policy aims to cut European road deaths by 50% by 2020 compared to 2010 and reduce non-fatal injuries accordingly. To do so, it also seeks to make vulnerable road users (VRU) safer by improving communication; and improving tools for collecting and analysing accidents. However, official data for assessing road safety seems to be considerably biased against VRU. According to police records about 1.4 million road traffic users were injured in the EU in 2014, 135 000 of which were seriously injured. In contrast, according to recent estimates of the hospital-based EU Injury Database (IDB), 3.4 million road traffic injuries occur annually, 625 000 of which must be admitted to hospital. This indicates a considerable under-reporting of road traffic injuries in police records. Under-reporting in police records is particularly high for cyclists (by a factor of 4.5), pedestrians (1.8), and powered two-wheelers (1.9). As a result, VRU account for almost 70% of road accident casualties attending hospital, as opposed to ' only’ about 50% in police records. IDB data for twelve EU countries further reveal that under-reporting is especially high for senior pedestrians (65+ years). A safe and healthy environment is a crucial factor for people to choose cycling and walking as their preferred choice of individual travel. To adequately address the safety needs of these modes of transport, the real scope and pattern of VRU accidents need to be known. In this respect, the use of hospital data in road safety management, complementary to police data, is strongly recommended.

Background Injury data from emergency departments (EDs) as used for the European Injury Database (IDB) can deliver most useful health indicators – beside mortality data. The current EU health information system requests EU member states to apply the IDB methodology and to deliver injury incidence rates for major domains of prevention (European Core Health Indicators ECHIs). Previous analyses (2011 – 2013) unveiled oversize variations between country estimates, which led to methodological improvements of sampling standards and national reporting requirements (metadata). Objectives To estimate EU and country rates, based on most recent data of the EU IDB (2013 – 2015) for main prevention domains (home and leisure, sport and school, road traffic, workplace, violence and self-harm); to detect shortcomings of national IDB implementations, which may affect validity and comparability of IDB-based ECHIs. Methods IDB data from 22 European countries 2013–2015 were used for the estimation of national and EU incidences. According national metadata files were analysed to identify deviations from the standard methodology. Findings: The general ED based injury rate is 7.49% of the EU population, which means about 38.07 million ED treatments annually in the EU of 28 countries. 52% of all these injuries are home, leisure and school accidents (ECHI 29), road traffic account for 8.8% and work-place for 9.4%. However, many national IDB implementation still do not fully comply with the standards, e.g. by collecting data only in insufficiently controlled samples of hospitals. Some countries still do not have EU compatible surveillance systems. Conclusions The European injury surveillance system IDB serves the intended purpose of providing meaningful health indicators for the various responsible policy sectors, but many national implementations need improvements. More attention on comparability and better central support to member states need to be provided by the future European Health Information system.

About 102.000 people were killed in single vehicle accidents in the 28 European Union countries between 2006 and 2015, representing almost one third of all road accident fatalities in these countries. Single vehicle collision is a type of road accident in which only one vehicle and no other road user is involved. The objective of this research is the analysis of characteristics of single vehicle accidents in European countries through the use of the EU CARE database with disaggregate data on road accidents, as well as of other European data sources (e.g. Eurostat). Timeseries data from the EU countries over a period of 10 years (2006-2015) were correlated with basic safety parameters, such as mode of transport, type of road, presence of junction, lighting and weather conditions, seasonality and person related characteristics like age and gender. The results of the analysis allow for an overall assessment of the safety level concerning single vehicle accidents in Europe in comparison to other types of accidents, thus providing useful support to decision makers working for the improvement of safety in the European road network.

Crash cost estimates for European countries, deliverable 3.2 of the H2020 project SafetyCube

SafetyCube aims to develop an innovative road safety Decision Support System (DSS) that will enable policy-makers and stakeholders to select the most appropriate strategies, measures and cost-effective approaches to reduce casualties of all road user types and all severities. Work Package 7 of SafetyCube is dedicated to serious road traffic injuries, their health impacts and their costs. This Deliverable discusses health impacts of (serious) road traffic injuries.

Interdisciplinary Care Group, a group of medical doctors and healthcare professionals who discusses the most appropriate treatment.Finally, the document specified the hierarchies between hospitals and the modalities of patient's referral from a spoke to a hub hospital. LessonsThe implementation of shared care pathways within an oncologic network has been demonstrated to be feasible.Technological improvements such as shared electronic medical records could help to increase the level of interconnection between the actors of the network. Key messages:Inter-hospitals care pathways can be implemented with a bottom-up approach, thanks to the involvement of medical doctors and health care professionals.In inter-hospital care pathways, it is important to define hierarchies between hospitals and ways of communication and referral of the patients.

In 2013, 26.090 people were killed in road accidents throughout the EU, approximately 6.200 females and 19.800 males. Females account for 51% of the total EU population, but only 24% of all road fatalities. The objective of this research is the analysis of basic road safety parameters related to road users’ gender in the EU countries, by the use of the EU CARE database with disaggregated data on road accidents and of other data sources such as Eurostat. Time-series data on road accident fatalities by gender from 28 EU countries over a period of 10 years (2004–2013) are correlated with basic safety parameters, such as age, road user type and transport mode. Data from the EU Injury Database are also used to identify injury patterns and improve the assessment of injury severity and additional insight into accident causation for road users by gender is offered through the use of in-depth accident data from the EC SafetyNet project Accident Causation System (SNACS). In all EU countries, road fatalities decreased between 2004 and 2013 for both females and males. Besides the trends of that period, the proportion of male road fatalities did not change significantly. Amongst EU countries a slight tendency for male proportions to be higher in south is noted. Additionally, the ratio between male and female fatalities increases with age, reaches a peak between the ages of 30–44 and then falls, which reflects a specific gender development in the travel behaviour of men and women in Europe. As regards the road user type, the proportion of passengers’ or pedestrians’ fatalities is higher for females than the males, while the opposite is true for drivers. The results of the analysis allow for an overall assessment of the gender-differentiated safety level in the European road network, providing thus useful support to decision makers working for the improvement of safety in the European road network.

Cyclists, while relatively small in proportion with respect to motorized vehicles, have a high level of vulnerability, creating a significant need to better understand the characteristics specific to this user group. A good insight into the problem provides an opportunity to improve the road safety of this cheap, convenient and environmentally friendly mode of transport. In 2013, more than 2.000 cyclists were killed in road traffic accidents in 27 EU countries, constituting almost 8% of all road accident fatalities for that year. Although a considerable decrease by 32% in the total number of bicycle fatalities in noted within the decade 2004–2013, it is still smaller than the respective reduction of the overall road fatalities by 45%. The objective of this research is the analysis of basic road safety parameters related to cyclists in European countries, by the use of the EU CARE database with disaggregate data on road accidents, as well as of other international data sources (OECD/IRTAD, Eurostat, etc.). Time-series data on road accidents involving cyclists from 27 EU countries over a period of 10 years (2004–2013) are correlated with basic safety parameters, such as road type, season of the year, age and gender. Data from the EU Injury Database are used to identify injury patterns and improve the assessment of injury severity, and additional insight into accident causation for cyclists is offered through the use of in-depth accident data from the EC SafetyNet project Accident Causation System. The results of the analysis allow for an overall assessment of the cyclists safety level in Europe in comparison to other modes of transport, thus providing useful support to decision makers working for the improvement of safety in the European road network.