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


The analysis of the state-of-the-art shows that deeper analysis and reconstruction of real-world accidents are an important means for VRUs and automotive safety research.

The correlation of the injuries with their causes and technical parameters allow a better comprehension of injury mechanisms and injury tolerance levels. These studies also give the opportunity to relate the real accident configurations and their consequences to the crash tests results. Structures causing injuries can be recognized at an early stage, and the vehicle's dynamic response can be identified by the reconstruction. Feedback regarding the road traffic engineering can also be obtained.

In 2011, the successful linkage rate between ICU patients and police information was about 80–85% of the total patients admitted to the ICU for a road accident major trauma. This is mainly due to the retrospective study of the accidents collected and, sometimes, due to the impossibility of knowing which police force has been involved in the road accident detection. In the first case, this working method can lead to insufficiency of significant data for a deeper correlation analysis between dynamics and injuries that lead to exclusion of the case study, The second is due to the fact that several types of police forces in Italy are involved in road accident detection, and many different and unlinked methods are used.

In the urban and metropolitan areas, the range of 16–30 years is the age most subject to serious injury (52%) due to the high percentage of car-to-PTW accident configurations (25%), and given that the PTWs are the vehicles mainly used by this group of people. However, the youngest severely injured are car occupants, with a mean age of 32 years, also if less common.

This can be explained with a more frequent use of dangerous or aggressive behaviour driving/riding compared to elderly people.

Sixty-eight percent of those involved in serious accidents are VRUs. The previous analysis shows that the head is the body region most seriously injured, mainly in pedestrians and cyclists, and the windshield area (centre or upper edge) causes a large percentage (18.7%) of the total injuries incurred. The high incidence of injuries due to ground impact (Table 3) underlines that the second impact is the cause of the greatest number of lesions. This is due to the high quantity of energy that the striking vehicle transmits to the VRU. The five percent of the total injuries sustained by the VRUs are due to the A-pillar impact where, in a total of the 13 lesions, 30% are localized in the head region.

This advises improvement of the vehicle design, e.g. with an wide use of some energy absorbing devices, such as airbags that can be reduce injury risk caused by these structures, without reducing safety performance of the vehicle, by avoiding softening the structures. Alternatively, working on the pre-crash phase with an active system for the collision mitigation based, e.g., on radar and camera acquisition systems. The ground impact suggests the development of new shape of hoods which absorb a greater quantity of energy and release the VRU with a minor speed, so as to reduce the consequences of the second impact with the asphalt.

For the PTW rider-and-pillion, the thorax and the spine are the body regions most frequent injured, while the head is the region with most severe injuries. This latest aspect of the sample analysed is mainly due to the presence of several demi-jet helmets, and of two cases where the helmet became detached after the first impact. This leads to the belief that the use of thoracic protection leads to the reduction of these lesions. Furthermore, the use of full-face helmets reduces the face injury risk, and correct fastening reduces the risk detaching.

The patients spent a mean of 10.6 days in the hospital ward and a mean of 14 days in the ICU. The average daily cost for normal care is calculated at €700, while for intensive care it is €2,000. The average total cost for each patient subject to major trauma (a mean of 24.6 days in the hospital) is equal to €35,400, excluding the cost of physician-staffed ambulance, paramedics or helicopter and ER. Our cost is comparable to what is indicated by Westhoff et al.[52] for Germany (€10,000 - 250,000). Excluding the costs of any period of rehabilitation of the people injured and the intervention of the police forces, the average social expense for the health care of the 29 people was €1,026,600. The social spending is another important facet that it highlights the usefulness of to invest resources for studies and development actions on the mitigation of injuries from road trauma.

Limitations of the present work must be mentioned. Confidence in the results of this study is limited by its low number of road accidents collected so far. Moreover they are heterogeneous in term of accident configurations. Consequently any further and deeper analysis on the data collected is not possible. Further analysis will be conducted as soon as the analysis of all cases acquired during 2011 is concluded. Finally, a multivariate analysis to study the presence of more contributory factors is actually not feasible due to the limited sample size, but the model is still under evolution in this direction.