Advanced Accident Research System Based on a Medical and Engineering Data in the Metropolitan Area of Florence

Simone Piantini; David Grassi; Marco Mangini; Marco Pierini; Giovanni Zagli; Rosario Spina; Adriano Peris


BMC Emerg Med. 2013;13(3) 

In This Article


Twenty-eight serious road accidents occurred between January through July 2011 in the metropolitan area of Florence are included in this study.

Demographics of Injured

The mean age at the time of accident was 34.6 (SD 13.9) (range 16–70 years) and the people most affected are between 26 years and 30 years. About 70% of severely injured people are younger than 45 years (Figure 15). Male subjects constituted 83% (n = 24) and female subjects 17% (n = 5).

Figure 15.

Age distribution of major trauma in In-SAFE database.

PTW riders-and-pillions-passengers are 41% (n = 12), car occupants are 31% (n = 9), pedestrians 17% (n = 5) and cyclists 10% (n = 3). Thirty-three percent of PTW occupants (n = 4) are between 26 and 30 years, 25% (n = 3) are between 16 and 20 years. Seventy-five percent (n = 6) of the car occupants are drivers with a mean age of 40.5 years (S.D. 15.8).

Accident and Vehicle Configurations

The most frequent road users involved in serious accidents are car passengers 49% (n = 25) followed by PTW users 25% (n = 13), pedestrians 10% (n = 5), cyclists 8% (n = 4), van passengers 6% (n = 3) and buses 2% (n = 1).

The main road accident configurations that have produced a serious injury are "car to PTW" crashes 25% (n = 7), "pedestrian run over" 17,9% (n = 5), "car-to-car" 17.9% (n = 5), "single vehicle PTW" 10.7% (n = 3), "single vehicle car" 7.1% (n = 2), "car-to-bicycle" 7.1% (n = 2), "van-to-PTW" 7.1% (n = 2), "car-to-van" 3.6% (n = 1), PTW-to-bicycle" 3.6% (n = 1).

In the "pedestrian run over" crashes, the vehicles most frequently involved are car 60% (n = 3). Within the PTWs (n = 12) the majority are motorcycles (67%) and the remaining are mopeds (33%).

The main vehicle-to-vehicle collision configurations are the "head-on" and "head-on side" crash 45% (n = 10), followed by "side" and "nose-to-tail" crashes 5% (n = 1). While in the "car to PTW" configuration, 57% of crashes are head-on collision.

Injury Types and Severity

In the twenty-nine major traumas analysed, the ISS ranged from 9 to 38 with a mean value of 24.2 (SD 8.7), and NISS ranged from 12 to 5 with a mean value of 33.6 (SD 10.5). The injured included in this paper spent between 3 and 44 days in the hospital (mean 10.6 days, SD 7.9) and between 1 and 34 days in the intensive care unit (mean 14, SD 13.66).

Figure 16 shows the percentage of injuries by body part according to the type of road user. Injuries to the head and to the face are prevalent in all users, while neck injuries are absent in the entire sample.

Figure 16.

Percentage of injuries by body according to the type of rod user.

Riders-and-pillion-passengers and pedestrians are the road users that reported injuries in all body regions. In the former, the most frequent injuries are to the thorax (24.3%) followed by the spine (23.1%), the head (19.1%), and the upper extremities (10.4%). In the latter, the body regions most frequently injured are the head (56.4%) and the lower extremities (12.7%) (with AIS < 3) (Figure 17).

Figure 17.

Road user injuries distribution by body part.

For cyclists, the body regions most subject to injuries are the head (78.3%), the face (17.4%), and the thorax (4.3%). Finally, the head (36.9%), and the face (23.1%) are the body regions most frequently injured in car occupants, followed by thorax, spine and extremities (9.2%) (Figure 17). Injuries to the upper extremities seem less frequent in cyclists and car occupants than in the other road users.

Figure 18.

Severity distribution of the injuries by body part according to the type of road user.

Analysing the severity distribution (percentage) of injuries by body part according to the type of road user (Figure 18), the most serious damages have an AIS score equal to five. This level of seriousness is not widespread, but is present in all road users.

Figure 19.

Frequency (%value) of the MAIS3+ for different types of road users.

PTW riders-and-pillions-passengers, cyclists, and pedestrians have more serious injuries in the head region, while in car occupants the spine is the most severely injured body region. However, in all road users the head is the body part most seriously injured with an AIS3+ in 76.4% (106 lesions). In the thorax, 51% (51 lesions) have an AIS3 + .

The main objects that have produced a high percentage of injuries in the VRUs (Table 3) are asphalt pavement (29.4%), car front bumper (15.7%), car windshield (9.8%), car windshield header rail (8.9%), curb (6%), car A pillar (5.5%) and pole/post (5.1%). The highest values of the AIS (4 and 5) are due to impact with pavement and car windshield header rail.

Analysing the source of head injuries in PTW riders-and-pillions-passengers, as seen in Table 4, the highest percentage of injuries was caused by impact against the road surface (38%) and the windshield header rail (31%). Cerebral injuries occurred from all impact sources shown in the table due to the fact that the brain is more sensitive to the inertial forces caused by sudden accelerations and decelerations than the skull base or vault. The highest number of base fracture is due to the impact with windshield head rail of the car opposite.

Similarly, the main passenger compartment areas more dangerous for car occupants are the front-door–right (26.7%), the windshield (23.3%), the dashboard (13.3%), the steering wheel (8.3%) and the head-rest and passenger (6.7%) (Table 5).

The frequency percent of the MAIS3+, for different types of road users, on the body region used for the ISS calculation, is shown in Figure 19. It shows how the body regions that report a MAIS3+ are "head or neck", the chest, the abdominal, and the extremities. The other body parts have a MAIS lower than 3. In each of these body parts, the road user categories with the higher percentages (greater than 30%) are car and PTW occupants, whereas cyclists have a MAIS 3+ only for the head-neck and chest.