INJURY PREVENTION
INJURY PREVENTION |
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| Team Leader: Dr. Ronan Lyons | Date of Completion: 2.4.98 |
This document is a supplement to, not a substitute for, professional skills and experience. Users are advised to consult the supporting evidence for a consideration of all the implications of a recommendation |
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| The Statements | The Evidence |
3.1 Drink Driving |
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| 3.1a. Avoiding
alcohol before driving prevents road traffic accidents. Excess alcohol is involved
in 20% of all traffic related deaths in Britaini,ii. (Health Gain Notation - 1 "beneficial") |
i. Wagenaar AC. Methods used in
studies of drink-drive control efforts: a meta-analysis of the literature from 1960-1991. Accident
Analysis and Prevention 1995; 27(3): 307-316. (Type IV evidence - observational studies) ii. Gloag D. British road traffic deaths fall but casualties rise. British Medical Journal 1995; 311: 281. http://www.bmj.com/cgi/content/full/311/7000/281/a (Type IV evidence - observational studies) |
| 3.1b. The use of remediation
therapy for drink driving offenders will reduce the number that reoffend. Remediation
therapy results in a 7-9% reduction in drinking/driving recidivism and alcohol-related
crashesi. (Health Gain Notation - 1 "beneficial") |
i. Wells-Parker E,
Bangert-Drowns R, Williams M. Final results from a meta-analysis of remedial interventions
with drink/drive offenders. Addiction 1995; 90: 907-926. (Type I evidence - systematic review) |
| 3.1c. A reduction in
the permitted Blood Alcohol Concentration to 50 mg/100 ml is likely to lead to a
reduction in injuries. The Australian Capital Territory reduced the legal limit from 80 to
50 mg which led to a 41% reduction on incidence of driving with a blood alcohol
concentration > 150 mg, and there were a third less injured drivers with a blood
alcohol concentration > 80 mgi. (Health Gain Notation - 1 " beneficial") |
i. BMA Board of Science and
Education. Driving impairment through alcohol and other drugs. London: British Medical
Association, 1996. (Type IV evidence - observational studies)
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| 3.1d. A far more
extensive use of random breath testing, accompanied by a high level of publicity
will lead to a reduction in injuries. To be most effective breath testing should be
intensive and applied to everybody at a checkpoint and not depend on "due
cause". New South Wales' adoption of this policy resulted in a sustained
20% reduction in fatalitiesi. (Health Gain Notation - 1 "beneficial") |
i. Peacock C. International
policies on alcohol-impaired driving: A review. The International Journal of Addictions
1992; 27(2): 187-208. (Type IV evidence - observational studies) |
| 3.2 Car Restraint | |
| 3.2a. Strategies that
increase the use of seat belts or child restraints will result in fewer
injuries. A Transport Research Laboratory survey in April 1996 showed only 43% of
teenagers and adult rear passengers wearing seat belts. Over 25% of 5-13 year olds were
unrestrained. An unrestrained child travelling in a car is approximately 3 times more
likely to sustain head injury than a restrained child i,ii,iii. (Health Gain Notation - 1 "beneficial") |
i. Preventing unintentional
injuries in children and young adolescents. Effective Health Care Bulletin Vol. 2 No. 5.
University of York: NHS Centre for Reviews and Dissemination, 1996. (Type IV evidence - observational studies) ii.Transport Research Laboratory. Restraint use by car occupants, 1994-96. Crowthorne: Transport Research Laboratory, 1996; LF2074. (Type IV evidence - observational studies) iii.Ruta D, Beattie T, Narayan V. A prospective study of non-fatal childhood road traffic accidents: what can seat restraint achieve? Journal of Public Health Medicine 1993; 15(1): 88-92. (Type IV evidence - observational studies) |
| 3.3 Speed Control | |
| 3.3a. Stricter
enforcement of speed limits will result in fewer injuries. The overall contribution
of speed to accidents is not known but is widely quoted to be one third of all fatalities.
Introduction of speed cameras in West London over a 6 year period led to a threefold
reduction in deaths, from 68 to 20 and a reduction in serious injuries by over a quarter
from 813 to 596 i . (Health Gain Notation - 1 "beneficial.") |
i. Highways Agency. West London
speed camera project: analysis of accident data 36 months before and 36 months after
implimentation. London: London Research Centre,1997. (Type IV evidence - observational studies) |
| 3.4 Road Design | |
| 3.4a. Safer design of
roads and roadside environments will result in fewer injuries. Many improvements in the
past have concentrated on built up areas. As deaths on rural roads become relatively more
important (54% of all deaths in the United Kingdom in 1993) a matching shift in prevention
effort, to rural roads is needed i . (Health Gain Notation-1 "beneficial") |
i. Preventing unintentional
injuries in children and young adolescents. Effective Health Care Bulletin. Vol. 2 No. 5.
University of York: NHS Centre for Reviews and Dissemination, 1996. (Type III evidence - well designed non randomised trials) |
| 3.4b. Roadside guardrails (crash
barriers) and crash cushions will reduce injury severity. Roadside guardrails reduce
the chance of sustaining a personal injury by about 50% and the chance of sustaining a
fatal injury by about 45%i . (Health Gain Notation - 1 "beneficial") |
i. Elvik R. The safety value of guardrails
and crash cushions: a meta-analysis of evidence from evaluation studies. Accident
Analysis and Prevention 1995; 27(4): 523-549. (Type IV evidence - meta-analysis of observational studies) |
| 3.4c. Area wide traffic management
schemes should be targeted at areas with high injury rates and will reduce pedestrian
injury rates. The provision of crossing patrollers, measures to redistribute traffic, and
the design of roads to reduce speeds are effective in reducing pedestrian injuries i
. (Health Gain Notation -1 "beneficial") |
i. Preventing unintentional injuries in
children and young adolescents. Effective Health Care Bulletin. Vol. 2 No. 5. University
of York: NHS Centre for Reviews and Dissemination, 1996. (Type III evidence - well designed non randomised trials) |
| 3.5 Vehicle Design | |
| 3.5a. A European
Directive on Pedestrian Protection should be introduced to ensure all new cars are
fitted with pedestrian protection features. Meanwhile, national legislation should
prohibit the fitting of "bull bars" i,ii . (Health Gain Notation - 1 "beneficial") Fitting all vehicles with pedestrian protection features would lead to an estimated 7% reduction in pedestrian deaths, 21% reduction in serious injuries and 3.5% of cyclist deaths. Bull bars cause an estimated 2-3 deaths and 40 serious casualties each year. |
i. Parliamentary Advisory
Council for Transport Safety. Bull-bars. London: Parliamentary Advisory Council for
Transport Safety, March 1997 (Type IV evidence - observational studies) ii. Hardy BJ. A study of accidents involving bull bar equipped vehicles. Study No. 243 Crowthorne, Berkshire: Transport Research Laboratory, 1996. (Type IV evidence - observational study) |
| 3.5b. Permanently switched
on lights on cars can reduce daytime road traffic accidents. A meta-analysis of 17
observational studies of the effect of daytime running lights found that there were 10-15%
less multi party daytime crashes in cars with the lights switched oni. As they
are observational studies there is a risk of uncontrolled confounding. For similar reasons
daytime running lights are mandatory in motorcyles. (Health Gain Notation - 2 "likely to be beneficial") |
i. Elvik R. A meta-analysis
of studies concerning the safety effect of daytime running lights on cars. Accident
Analysis and Prevention 1996; 28(6): 685-694 (Type IV evidence - meta-analysis of observational studies) |
| 3.6 Road Safety Education | |
| 3.6a. Road safety
education for children will lead to a reduction in injuries. There is some evidence of
benefit in education ie. safe places to cross and "Traffic Clubs" i,ii
. (Health Gain Notation -2 " likely to be beneficial") |
i. Preventing unintentional
injuries in children and young adolescents. Effective Health Care Bulletin. Vol. 2 No. 5.
University of York: NHS Centre for Reviews and Dissemination, 1996. (Type III evidence - well designed non randomised trials) ii. Ozanne-Smith J, Sherrard J, Brumen IA, Shire of Bulla: Safe living programme. Victoria, Australia: Monash University Accident Research Centre, 1994. (Type III evidence - well designed non randomised trials) |
| 3.6b. Strategies to
increase the wearing of cycle helmets will reduce the incidence of head injury.
Compulsory wearing of cycle helmets is controversial. In Australia (Victoria) injury rate
was lowered by legislation (70% reduction in head injury admissions or deaths over a
2-year period) but cycling use also decreased, thus losing some of the benefits of
exercise. Community wide programmes seem to be more effective than isolated programmes
through single organisations i,ii. (Health Gain Notation - 2 " likely to be beneficial) |
i. Preventing unintentional injuries in young
people. Effective Health Care Bulletin. Vol. 2 No. 5. University of York: NHS Centre for
Reviews and Dissemination, 1996. (Type IV evidence - observational studies) ii. Bergman AB, Rivera FP, Richards DD.The Seattle children's bicycle helmet campaign. American Journal of Diseases in Childhood 1990; 144: 727-731. (Type IV evidence - observational studies) |
Health Evidence Bulletins: Wales, Duthie Library, UWCM, Cardiff CF14 4XN. e-mail: weightmanal@cardiff.ac.uk