Fact sheet

Serious road injuries in the Netherlands

Summary

This fact sheet discusses the development of the number of serious road injuries (SRI) in the Netherlands. In the Netherlands a serious road injury is defined as an inpatient with at least a MAIS2-injury severity. After an initial decrease from the 1990s onward, the number of serious road injuries has been increasing since 2006. In 2017, an estimated 20,800 people were seriously injured in traffic in the Netherlands, slightly fewer than the 21,400 serious road injuries in 2016. Given the uncertainty in the estimates, the difference between 2016 and 2017 may, however, be coincidental.

Nearly two thirds of the serious road injuries are cyclists, a majority of whom are injured in crashes not involving a motor vehicle. In proportion to the total population, relatively many serious road injuries occur among youths (15- to 19-year-olds) and among road users aged 45 and older.

The estimated number of serious road injuries is based on a combination of police registration BRON and hospital data (LBZ). Particularly crashes in which no motor vehicle is involved have a very low report rate in BRON. Since 2010 it has been difficult to monitor the developments of all crash types, also those involving a motor vehicle, as the police crash report rate has been subject to a strong decline. In later years only data of hospital admissions has been available. Since 2013 the police report rate of serious road injuries has been improving, but important characteristics are not always recorded. For example transport mode (of casualty and of crash opponent), name of the hospital, speed limit of the road on which the crash occurred, and whether the crash took place on an urban or a rural road, often suffer from missing values.  

Facts

How many serious road injuries were there in the Netherlands in 2017?

In 2017, an estimated 20,800 people were seriously injured in traffic in the Netherlands, slightly fewer than the 21,300 in 2015 and the 21,400 in 2016. Given the uncertainty in the estimated numbers, it is still too early to determine if 2017 indicated the beginning of a reversed trend or that the number of serious road injuries just happens to be slightly lower than in the previous and following years [1] .

What is the official definition of a serious road injury in the Netherlands?

A serious road injury is a road crash casualty who has been admitted to hospital and has not died within 30 days after the crash. A road crash is internationally defined as a crash on a public road, in which at least one moving vehicle is involved. The injury severity of the casualty must be 2 or higher, expressed in the Maximum Abbreviated Injury Score (MAIS) [2]. MAIS is an international standard to indicate the severity of an injury. This score can be derived from the various injuries coded for a patient. Examples of MAIS2-injuries are bone fractures and concussion with loss of consciousness.

In 2009, SWOV proposed to use this new definition for seriously injured traffic casualties. In 2010, this new definition was adopted in the Netherlands, thereby abandoning the previously used term ‘in-patients [3]. The new definition was adopted because not all police-reported in-patients (as were registered in (BRON) were indeed severely injured or even actually admitted to hospital.

In recent years, the EU has also based its definition of a serious road injury on the MAIS-score. It has however taken injury of at least MAIS3 (seriously injured) instead of MAIS2 (moderately injured) as it starting point. With this definition a large part (about 60%) of the serious road injuries according to the current definition (namely those with MAIS2) are no longer considered to be serious road injuries. In the Netherlands this definition is not yet applied. From the point of view of uniformity within the EU, and also to bring the definition more into line with what is prevalent in the medical world, it stands to reason that the Netherlands will eventually also use the EU- definition. This doesn’t imply MAIS2-victims are irrelevant; they form a large group of which a significant number of people has disabilities. Even if the casualties in this MAIS2-group are no longer considered to be serious road injuries, it remains important to monitor this group and to reduce its size [4] .

How is the number of serious road injuries determined?

SWOV annually assesses the number of road casualties based on two sources:

  • The database of police reported crashes in the Netherlands (BRON)
    In BRON the Ministry of Infrastructure and Water Management collects and publishes the police data with respect to road crashes. BRON contains information about characteristics of the crash such as road features, vehicle characteristics and the circumstances of the crash. BRON does not contain reliable information about injury severity: up to 2015 the police only distinguished between (probable) hospital inpatient admissions and A&E treatment, although that distinction was not always correct. Since 2015 this distinction is no longer made; all casualties who are taken to hospital are now reported as 'inpatients'. Furthermore, many casualties are not included at all and in recent years important information of crash characteristics has been missing, such as transport mode of casualty and of crash opponent, speed limit of the road on which the crash occurred, whether it was an urban or a rural road, and the name of the hospital the casualty has been taken to.
  • The National Basis Registration Hospital Care (LBZ)
    The national medical registration LBZ is a database managed by Dutch Hospital Data (DHD). This database contains information about the nature of the injury including body part and injury type. The register is fairly complete, although not all serious road injuries are registered as traffic casualties. Nor does LBZ contain much information about the circumstances of the crash. Furthermore, LBZ registers little information regarding the crash.

SWOV estimates the number of serious road injuries in the Netherlands by linking and analysing the data in both data sources [4] [5]. The quality of both data sources is of the utmost importance for a reliable estimate of the number of serious road injuries. A sufficiently large number of casualties must be registered in BRON as well as in LBZ. Since the year 2010, the quality of the registers is insufficient to allow making observations concerning the developments of numbers of serious road injuries stratified into subcategories such as age group or type of road user. However, based on the hospital registration it is possible to give an indication of the distribution by these characteristics, hence of the proportions of male or female casualties, travel modes, or age groups.

How has the number of serious road injuries in the Netherlands been developing since the year 2000?

Figure 1 shows the development of the number of serious road injuries in the period 2000 to 2017 [4]. Although a decline seemed to have started in 2012 and 2013, the entire period shows a rising trend. The decline did not continue in 2014 and 2015, on the contrary: in 2016 the number of serious road injuries amounted to 21,400. This was the highest number since 1993, the first year for which this estimation was made [6]. In 2017, the estimated number of serious road injuries was lower. It cannot be excluded that this was a coincidental decrease. The future will tell if a trend break started in 2017 or that it was a coincidence that the number of serious road injuries was slightly lower than in the previous and following years (as was the case in 2013).

Figure 1. Estimated number of serious road injuries in the Netherlands since 2000. Total numbers and distribution between crashes involving (M) or not involving (N) a motor vehicle. After 2009, the precise distribution between N-casualties and M-casualties cannot be determined. Sources: DHD, IenW, and SWOV.

 

The development of the number of serious road injuries is the result of the trends in various subgroups: for example, casualties in motor vehicle crashes (M-crashes) and casualties in crashes not involving a motor vehicle (N-crashes). Since 2006, we can observe a stronger rising trend in the number of serious road injuries in crashes not involving motorized vehicles, whereas the number of serious road injuries in motor vehicle crashes – after an initial decline before 2006 – seems to stabilize. It is estimated that currently more than half the serious road injuries occur in crashes not involving a motor vehicle.

 

How has the number of serious road injuries been developing for different modes of transport?

In the hospital register, cyclists (especially in crashes without a motor vehicle) constitute the largest group among the serious road injuries: more than half of the total in 2009 and a rising proportion in the following years (see Figure 2). In comparison: about one third of the road fatalities are cyclists and presently the number of fatalities among cyclists roughly equals that among car-occupants (see SWOV Fact sheet Road deaths in the Netherlands). During the last ten years, the largest increase in the proportion of serious road injuries occurred in bicycle crashes not involving a motor vehicle.

The number of serious road injuries among occupants of passenger cars and delivery vans is the only group that has shown a significant decline over the last ten years. In 2009, this group still constituted about 15% of the number of serious road injuries in the hospital register LBZ (13.6% in BRON). In 2017, more than 10% of the serious road injuries were occupants of passenger cars or delivery vehicles.

Figure 2.. Number of serious road injuries in the Netherlands since 2000, distributed by mode of transport, based on the LBZ register. The precise disaggregation is unknown as the modes of transport are not always accurately registered in the LBZ. Sources: DHD and SWOV.

 

Since the year 2010 the poor registration in BRON has made it impossible to determine the number of serious road injuries per mode of transport (see How is the number of serious road injuries determined?)). The distribution based on the LBZ is indicative, since the mode of transport that is registered by the hospital is not always the same as the mode of transport that is registered by the police. As since 2014 the mode of transport has not been recorded in BRON in more than 40% of the cases, correction of LBZ data regarding mode of transport using BRON data is often impossible. The development of serious road injuries by mode of transport based on the data in Figure 2 doesn't seem to differ very much from the development as indicated by the BRON data before 2010 (not in figure).

 

The risk of being seriously injured (serious road injuries per distance travelled) is highest for powered two-wheelers(Figure 3). This figure shows five-year averages, because risks calculated on an annual basis fluctuate due to uncertainties in mobility data and numbers of crashes. Injury data later than 2009 is not available.

Figure 3. The risks of fatal injury and serious injury (casualties per distance travelled) in the Netherlands for various modes of transport, averages over 5 year periods. Sources: CBS, IenW, DHD and SWOV .
How has the number of serious road injuries been developing for different age groups?

The distribution of the number of serious road injuries among various age groups does not correspond with the composition of the population in the Netherlands, see Figure 4. This figure shows the distribution among age groups for the five-year periods 2005-2009 (left) and 2010-2014 [i] (right) based on the hospital registration (LBZ).

In both periods just over 10% of the serious road injuries were children in the ages of 0-14 whereas they constitute circa 20% of the total population. Most of the children are injured in crashes not involving a motor vehicle: either while they are cycling or on foot.

Seniors also mainly sustain injury in crashes not involving a motor vehicle, but considering their share in the total population they are overrepresented. This overrepresentation is probably related to their greater physical vulnerability; see also SWOV Fact sheet The elderly in traffic.

Crashes involving a motor vehicle are more important among the other age groups. In fact, between 2005 and 2009, the proportion of 15 19 year old serious road injuries was even more than twice the proportion of the same group in the total population. However, in 2010-2014 this proportion has become smaller. Often the casualties are 16-17 year old moped riders and 18-19 year old car drivers. The large number of serious road injuries among this group is due to the higher crash rate during the early phases of motorized traffic participation, see also SWOV Fact sheets 18- to 24-year-olds: young drivers and Moped and light-moped riders.

The development of serious road injuries by age group is also illustrated by Figure 4. We observe a shift from the group of 25-49 year old serious road injuries to the group of elderly road users (comparing the period 2010-2014 with the period 2005-2009). The elderly form an increasing share of the road casualties, among other things due to the demographic development. In addition, the proportion of elderly road users among the serious road injuries is also growing stronger than their share in the population. The proportion of casualties in crashes not involving motor vehicles is increasing in this age group. The distinction between crashes with and without motor vehicle is somewhat uncertain in the LZB. The ages that are recorded, however, are reliable.

Figure 4. Distribution of the population by age category (green), compared with the distribution of the numbers of serious road injuries in crashes with and without motor vehicle (SRI-M and SRI-N respectively). The period 2005-2009 is shown on the left, the period 2010-2014 is shown on the right. The distribution of serious road injuries is based on the hospital register LBZ which has an accurate age registration; the involvement of a motor vehicle is recorded less accurately. Sources: DHD, SWOV (serious road injuries and; Statistics Netherlands (population).

[i] SWOV experiences more difficulty analysing data later than 2015 as these can only be consulted at Statistics Netherlands through remote access. Therefore, Figure 4 is based on data up to 2015.

What is the male-female proportion among serious road injuries?

Approximately 60% of the serious road injuries are male, and hence 40% are female. This proportion has hardly changed in recent years. However, there is a clear difference in male-female proportion for different age groups and for crashes with or without a motor vehicle (M-crashes and N-crashes), see Figure 5.

Figure 5. Shares of serious road injuries by gender and age for N and M crashes. The distribution of the serious road injuries is based on the LBZ data 2010-2014 .[ii] Sources: DHD, SWOV.

 

Overall, men are injured more frequently than women in motor vehicle crashes (dark blue vs dark orange bars in Figure 5). Men are also more frequently injured in crashes involving a motor vehicle than in crashes nót involving a motor vehicle (age group 15 to 54 years old; dark blue vs light blue bars in Figure 5). To some extent this is caused by differences in mobility between men and women. Whereas the proportions of male and female serious road injuries are almost equal among pedestrians and cyclists, the proportion of males among (light-) moped riders is about 75%. Among motorcyclists, about 90% of the serious road injuries are male.

 

If we look at the crashes without motor vehicle (N-crashes), men are overrepresented in the serious road injuries up to 60 years old. Among casualties between 60 and 85 years old in N-crashes on the other hand, the proportion of women is higher (light blue vs light orange bars in Figure 5).

The age group of 0-14 years old is responsible for about 60% of the serious road injuries in N-crashes. Above 15 years old, on the other hand, the share of motor vehicle crashes suddenly is significantly larger. At the same time we also see many male casualties in that age group. With increasing age, the share of M-crashes goes down again to reach about 40% for the over-60s. About 60% of the serious road injuries from that age onward occur in crashes without motor vehicle. Especially in this over-60s group we see more female casualties.


[ii] The years 2015 and 2016 are not shown in this graph because SWOV experiences difficulty in analysing data from 2015 onward. These can only be consulted at Statistics Netherlands through remote access.

How is the distribution of the number of serious road injuries according to different road types?

In addition to casualty characteristics, crash location characteristics are also important for road safety research and policymaking in this field. No data is available about crash location or crash type with respect to serious road injuries in crashes not involving motor vehicles; this data is derived from LBZ which does not register these characteristics.

About 60% of the serious road injuries in crashes involving a motor vehicle occur in urban areas. About one-fifth of the serious road injuries in rural areas (circa 40%), occur on roads with a speed limit of 100 km/h or higher [2]. No reliable data is available for the years later than 2009.

Which types of injury do serious road injuries sustain and what is the injury severity?

Figure 6 illustrates which body parts sustain serious injury and to what extent the consequences are acute or permanent (the burden of injury, expressed in the loss of healthy life years, called DALY. Remarkable are the large proportions of head injuries, followed by hip and leg trauma. Lasting effects are mainly the consequence of head injuries, but also of injuries to the lower leg. Casualties who suffer lasting damage mainly experience problems with their daily activities and pain. More than 20% of the casualties suffer permanent consequences. The injuries and burden of injury vary between modes of transport, between different age groups and also between males and females [7].

Figure 6. Distribution of injury and burden of injury and distribution of acute and lasting burden of injury per body part. Distributions are based on all serious road injuries in LBZ 2000-2009 [7].

 

Serious road injuries have an injury severity with a minimum MAIS score of 2. About 60% of serious road injuries have an injury severity with a MAIS score of 2 and about 10% have an injury severity with a MAIS-score of 4 or higher. Over the years, the proportion of MAIS3 casualties has been increasing slowly. Figure 7 (left) shows the distribution for the year 2017. If we distinguish between MAIS2 (the largest group of casualties with less severe injuries) and MAIS3+ (the group of casualties with more severe injuries) we can see different trends (Figure 7, right)). The number of MAIS3 + casualties appears to have been increasing steadily since 2006. The development for MAIS2 casualties is less pronounced: since 2008 this number has been more or less stable. The estimated number fluctuates between 12,000 and 13,500. The margins of the estimated numbers are relatively large (several hundreds), which makes it impossible to draw any conclusions about changes in the numbers of casualties in two consecutive years, e.g. 2016 and 2017. The right panel of Figure 7 shows the development over time of the numbers of LBZ -registered road casualties with MAIS 2 injury and those with more serious injury (MAIS 3+).

Figure 7. Proportions of serious road injuries by injury severity in 2017 (left) and development over time of numbers of serious road injuries with MAIS 2 injury and MAIS 3+ injury (right). The distribution in relation with injury severity is uncertain. Sources: DHD, IenW, SWOV.

 

The injury severity differs per age group (not shown in the figure). Among serious road injuries aged 70 + the proportion with an injury severity of MAIS 2 is about 44%, whereas among children from 0 to 14 years 78% of the serious road injuries have an injury severity with a MAIS-score of 2 (source: LBZ 2014, DHD).

Which societal costs are caused by a serious road injury?

Almost half of the total societal costs of road crashes (about 45%) can be attributed to serious road injuries, while the share of road death costs is relatively low (an estimated 13%), see Figure 8. Casualties with injury treated in the A&E department of a hospital and other casualties each have a share of about 7%, and 28% of the cost is attributable to crashes with property damage only.

The total societal costs of road crashes in 2015 are estimated at 14 billion euro (13.0 to 15.4 billion euro) [8]). This is about 2% of the gross domestic product. The costs per road death are about 2.9 million euro and about 310,000 euro per serious road injury. For more information see SWOV Fact sheet Costs of road traffic crashes.

Figure 8. Proportions of deaths, serious/slight/other injuries and property damage only crashes (PDO) of the total societal costs of road crashes (2015). Source: KiM.
 
How does the number of serious road injuries in the Netherlands compare to that in other countries?

Casualties are reported in many different ways in different countries. Definitions and report rates vary, which makes international comparison difficult. For about ten years already, the European Commission has been striving for an international definition, based on road crash casualties with MAIS 3+ injury. The Netherlands may conform to this definition. Only a few countries succeeded in collecting the necessary data (police records and hospital data) and performing the required operations.

At a European level, research has been done on MAIS3+ casualties. In 2016 the report Study on serious road traffic injuries in the EU  was published, which focuses on data and circumstances of the crashes of casualties among pedestrians, cyclists, motorcyclists and vehicle occupants. The EU-project SafetyCube investigated the differences in methods used in various countries to determine their numbers of MAIS3+ casualties, and how these methods affect the estimated numbers [9]. This EU project also studied the injury consequences of serious road injuries and the social costs of serious road injuries [10].

In the same EU-project, the burden of serious road injuries [11] and the societal costs of serious road injuries [12] were studied.

Publications and sources

Below you will find the list of references that are used in this fact sheet. All sources used can be consulted or retrieved via our knowledge portal. Here you can also find more literature on this subject.

[1]. Weijermars, W., Moore, K., Goede, M. de & Goldenbeld, C. (2018). Monitor Verkeersveiligheid 2018; Doorpakken om de verkeersveiligheid effectief te verbeteren. R-2018-16. SWOV, Den Haag.

[2]. Reurings, M.C.B. & Bos, N.M. (2011). Ernstig verkeersgewonden in de periode 1993-2009; Update van de cijfers. R-2011-5. SWOV, Leidschendam.

[3]. Reurings, M.C.B. & Bos, N.M. (2009). Ernstig gewonde verkeersslachtoffers in Nederland in 1993-2008; Het werkelijke aantal in ziekenhuizen opgenomen verkeersslachtoffers met een MAIS van ten minste 2. R-2009-12. SWOV, Leidschendam.

[4]. Bos, N.M., Bijleveld, F.D., Temürhan, M., Commandeur, J.J.F., et al. (2018). Ernstig verkeersgewonden 2017; Schatting van het aantal ernstig verkeersgewonden in 2017. R-2018-18. SWOV, Den Haag.

[5]. Reurings, M.C.B. (2010). Ernstig verkeersgewonden in Nederland in 1993-2008: in het ziekenhuis opgenomen verkeersslachtoffers met een MAIS-score van ten minste 2. Beschrijving en verantwoording van de schattingsmethode. R-2010-15. SWOV, Leidschendam.

[6]. Weijermars, W., Schagen, I. van, Moore, K., Goldenbeld, C., et al. (2017). Monitor Verkeersveiligheid 2017; Nieuwe impuls nodig voor verbetering verkeersveiligheid. R-2017-17. SWOV, Den Haag.

[7]. Weijermars, W.A.M., Bos, N.M. & Stipdonk, H.L. (2014). Lasten van verkeersletsels ontleed; Basis voor een nieuwe benadering van verkeersveiligheid. R-2014-25. SWOV, Den Haag.

[8]. KiM (2016). Mobiliteitsbeeld 2016. Kennisinstituut voor Mobiliteitsbeleid, Den Haag.

[9]. Aarts, L.T., Commandeur, J.J.F., Welsh, R., Niesen, S., et al. (2016). Study on serious road traffic injuries in the EU. European Union, Belgium.

[10]. Pérez, K., Weijermars, W., Amoros, E., Bauer, R., et al. (2016). Practical guidelines for the registration and monitoring of serious traffic injuries. D7.1 of the H2020 project SafetyCube.

[11]. Weijermars, W., Meunier, J.-C., Bos, N., Perez, C., et al. (2016). Physical and psychological consequences of serious road traffic injuries. Deliverable 7.2 of the H2020 project SafetyCube.

[12]. Schoeters, A., Wijnen , W., Carnis, L., Weijermars, W., et al. (2017). Costs related to serious injuries. D7.3 of the H2020 project SafetyCube

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Updated

06 Dec 2018