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 2018, an estimated 21,700 people were seriously injured in traffic in the Netherlands, approximately 1,000 more than in 2017. Even taking into account uncertainties in the estimates, we may conclude that the number of serious road injuries once again increased in 2018.  

Nearly two thirds of the serious road injuries are cyclists, a majority of whom are injured in crashes not involving a motor vehicle. Two in every five serious road injuries are 60 years old or older, almost one in every ten is 80 years old or older.

The estimated number of serious road injuries is based on a combination of police registration BRON and the national hospital registration LBZ (maintained by Dutch Hospital Data). 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. Recently the report rate in BRON has improved again, but important characteristics are not always recorded. For example, transport mode (of casualty and of crash opponent), 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. The registration of serious road injuries in the national hospital registration LBZ is much more complete than in BRON. We had therefore better use the LBZ files to get an impression of the characteristics of serious road injuries. In these files, however, fewer crash characteristics are recorded than in BRON. The location of crashes, for example, is not recorded in the LBZ files.

Facts

How many serious road injuries were there in the Netherlands in 2018?

In 2018, an estimated 21,700 people were seriously injured in traffic in the Netherlands, approximately 1,000 more than in 2017. In spite of the uncertainties in the estimated numbers, we may still conclude that the number of serious road injuries once again increased in 2018 [1].

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

In the Netherlands, a serious road injury has been defined as a road crash casualty that 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. Until 2010, the term ‘in-patients’ was used in the Netherlands [3]. This term was abandoned as not all in-patients (as were registered in (BRON) proved to have been hospitalized or seriously injured.

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 its 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. Obviously, this does not imply MAIS2 victims are irrelevant; they form a large group of which a significant number of people has disabilities [4]. 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 [5].

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 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 – in particular casualties injured in crashes involving a motor vehicle - 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 was taken to.
  • The National hospital registration (LBZ)
    The national hospital registration LBZ is a database managed by Dutch Hospital Data (DHD). This database contains information about the nature of the injury including the injured body part and the injury type. We assume that the database contains all serious road injuries resulting in hospitalization, although the database does not identify all serious injuries as serious road injuries. Furthermore, LBZ registers little information regarding the crash. Information about crash location is entirely missing for instance.

SWOV estimates the number of serious road injuries in the Netherlands by linking and analysing the data in both data sources [5] [6]. The quality of both data sources is crucial for a reliable estimate of the number of serious road injuries. A sufficiently large number of serious road injuries 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.

In 2018, the number of serious road injuries has been determined using a slightly different method, which causes a method deviation with regard to the time series established up to 2018. For the purpose of comparison, the numbers of serious road injuries in 2014-2017 have therefore been recalculated using the new method. This tells us that, between 2017 and 2018, the number of serious road injuries increased by about 1,000 [5]. The time series of both the old and the new method are presented in Figure 7 in the paragraph discussing the question Which types of injury do road casualties sustain and what is the injury severity?. For the purpose of consistency, the new series starting in 2014 has also been used in a number of detailed analyses in this fact sheet and in the Road Safety Monitor 2019 [1].

 

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

Figure 1 shows the development of the number of serious road injuries from 2000 up to and including 2018 [5]. For this period there is a rising trend, although, occasionally a cautious decline appeared to materialize. In 2017 this occurred for the last time, but in 2018 the number of serious road injuries increased again.

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. From 2018 onwards, a new method in determining the number of serious road injuries has been used. This makes the numbers up to 2018 difficult to compare to the numbers from 2018 onwards. 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 have, above all, been able to observe a rising trend in the number of serious road injuries in crashes not involving motor 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 developed for different modes of transport?

In the hospital register, cyclists (especially in crashes not involving a motor vehicle) constitute the largest group among the serious road injuries: more than half of the total number in 2009 and a rising proportion in the following years (see Figure 2). In 2018, 64% of the serious road injuries in the hospital registration were cyclists. In comparison: about one third of the road fatalities are cyclists and 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 (N crashes involving cyclists).

In hospital registration LBZ, the number of serious road injuries (SRI) 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 LBZ (13.6% in BRON). In 2018, more than 9% 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 LBZ. Sources: DHD and SWOV.

 

Since the year 2010 the poor registration in police register BRON has made it difficult 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 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 no longer possible. The development of serious road injuries by mode of transport based on the LBZ data in Figure 2 does not, however, 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 are 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: Statistics Netherlands, IenW, DHD and SWOV .
How has the number of serious road injuries developed 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 2014-2018 (right) based on the hospital registration (LBZ).

In the period 2005-2009, just over 10% of the serious road injuries were children aged 0-14 whereas they constituted 18% of the total population. In the period 2014-2018, approximately 5% were children, while they constituted 16% of the total population. Most of the children are injured in crashes not involving a motor vehicle (N crashes): either while they are cycling or on foot.

Seniors also mainly sustain injuries in crashes not involving a motor vehicle (N crashes), but considering their share in the total population they are overrepresented in comparison to children: in the period 2005-2009, about 22% of the serious road injuries were sustained by the over-65s, while they constituted 15% of the population; in the period 2014-2018, this group constituted 32% of the serious road injuries and 18% of the population. This overrepresentation is probably related to their greater physical vulnerability; see also SWOV fact sheet The elderly in traffic.

The age group of people aged 15 to 55 more often gets seriously injured in motor vehicle crashes (M crashes) than in crashes not involving a motor vehicle. Between 2005 and 2009, the youngest, aged 15-19, were more than four times more often seriously injured in crashes involving a motor vehicle than in crashes not involving a motor vehicle. Furthermore, this age group constitutes more than twice the proportion of the serious road injuries among the entire population. The casualties are expected to be mostly moped riders aged 16-17 and car drivers aged 18-19, 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. While the largest age groups as shares of the population shifted from the 35-49-year-olds in 2005-2009 to the 45-59-year-olds in 2014-2018, the highest peaks in the shares of serious road injuries shifted from the 15-24-year-olds to the 50-74-year-olds. The elderly form an increasing share of serious road injuries, 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 hospital registration LZB. The ages that are recorded, however, are reliable.

Figure 4. Distribution of the population by age category (green), compared to the distribution of the numbers of serious road injuries by age category (orange) in crashes with and without motor vehicle (SRI-M and SRI-N (light and dark orange) respectively). The period 2005-2009 is shown on the left, the period 2014-2018 is shown on the right. The distribution of serious road injuries is based on the hospital register LBZ (according to a new calculation method for 2014-2018): 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).
What is the male-female distribution among serious road injuries?

Approximately 60% of the serious road injuries are male, and hence 40% are female. These proportions have hardly changed in recent years. There is also a clear difference in male-female distribution for different age groups and for crashes with or without a motor vehicle (M-crashes and N-crashes). In general, women are more often than men injured in crashes without a motor vehicle (58% of the seriously injured women compared to 46% of the seriously injured men). The age groups with the largest numbers of serious road injuries are the 30-39-year-olds involved in a motor vehicle crash in the male group and the 60-79-year-olds involved in crashes without a motor vehicle in the female group.

In general, two in five serious road injuries are sustained by people aged 60 or over; almost one in ten is aged 80 or over. Looking at the distribution by age group (see Figure 5), the share of male casualties aged 15-49 in motor vehicle crashes is particularly notable, in addition to the share of female casualties aged 60 or over in crashes without a motor vehicle. This is partly related to mobility differences between men and women: men more often drive, while women more often walk or travel by public transport [7]. Nevertheless, men are also overrepresented among the serious road injuries up to 60 years old in crashes without a motor vehicle (light blue versus dark blue bars in 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 LBZ data 2014-2018. Gender in this registration is accurate, while motor vehicle involvement is uncertain. Sources: DHD, SWOV.

 

In the age group 0-14, 53% of the serious road injuries is the result of crashes without motor vehicles. From age 15 onwards, on the other hand, the share of motor vehicle crashes is suddenly significantly larger, with more than half to three quarters of the serious road injuries involving a motor vehicle (see Figure 5). With increasing age, the share of M-crashes goes down again to reach slightly more than one third for the over-60s. From that age onwards, serious road injuries mainly occur in crashes without a motor vehicle.

What 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 are available about crash location or crash type with respect to serious road injuries in crashes not involving motor vehicles; the data of these crashes are derived from the hospital register LBZ which does not register these characteristics.

Up to 2010, about 60% of the serious road injuries in crashes involving a motor vehicle occured in urban areas. About one fifth of the serious road injuries in rural areas (about 40%), occured on roads with a speed limit of 100 km/h or higher [2]. No reliable data are available for the years following 2009.

Which types of injury do road casualties 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 [8].

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 [8].

 

Serious road injuries in the Netherlands have an injury severity with a minimum MAIS score of 2. In 2018, about 69% of serious road injuries had an injury severity with a MAIS score of 2 and about 2% had an injury severity with a MAIS-score of 4 or higher (see Figure 7, left). Over the years, the proportion of MAIS3 casualties has slowly increased (see Figure 7, right). On account of having used a different method to determine the number of serious road injuries, the share of severe injuries (MAIS3+) has decreased. This decrease is mainly caused by a more refined and recent method of assessing injury severity [5]. The right side of Figure 7 concerning the development of the injury severity distribution, therefore, shows a second series relating to the period 2014-2017: the orange symbols are the serious road injuries determined using the new method, just as was done for the year 2018. 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. The number of MAIS3+ casualties appears to have steadily increased since 2006: both using the old or the new method. 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, using the old method, and around 14.000 using the new method (2014-2018).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. 2017 and 2018.

Figure 7. Proportions of serious road injuries by injury severity in 2018 (left) and development over time of numbers of serious road injuries with MAIS2 injury and MAIS3+ injury (right). The blue series up to 2018 have been determined using the old method; the orange series of 2014-2018 using the new method [5]. The distribution in relation to 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 MAIS3+ is higher than among children aged 0 to 14 (sources: LBZ 2014, DHD).

Which societal costs are caused by a serious road injury?

More than one third of the total societal costs of road crashes (about 37%) can be attributed to serious road injuries, while the share of road death costs is relatively low (an estimated 11%), see Figure 8. Casualties with slight injuries (treated in a hospital emergency room) have a share of about 22% and other casualties a share of about 6% in societal costs. About a quarter (24%) of the costs is attributable to crashes with property damage only.

The total societal costs of road crashes in 2018 are estimated at 17 billion euro (16.0 to 19 billion euro) [9]). This is more than 2% of the gross domestic product. The costs per road death are about 2.8 million euro and about 300,000 euro per serious road injury.

Figure 8. Proportions of deaths, serious/slight/other injuries and property damage only crashes (PDO) of the total societal costs of road crashes (2018) [9].
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, the European Commission has been striving for an international definition, based on road crash casualties with MAIS3+ injuries. It stands to reason that the Netherlands will eventually conform to this definition. Only a few countries have succeeded in collecting the necessary data (police records and hospital data) and performing the required operations. In 2014, however, the European Commission gave a first-time estimate of the number of MAIS3+ injuries in Europe: 135,000 [10].

At a European level, research has been done on MAIS3+ casualties. In 2016 the report Study on serious road traffic injuries in the EU [11] was published, which focuses on data and circumstances of the crashes of MAIS3+ 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 [12]. This EU project also studied the injury consequences of serious road injuries [13] and the societal costs of serious road injuries [14].

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. (2019). Monitor Verkeersveiligheid 2019; Effectieve maatregelen nodig om het tij te keren. R-2019-22. 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] Polinder, S., Haagsma, J., Bos, N., Panneman, M., et al. (2015). Burden of road traffic injuries: Disability-adjusted life years in relation to hospitalization and the maximum abbreviated injury scale. In: Accident Analysis & Prevention, vol. 80, p. 193-200.

[5]. Bos, N.M., Decae, R.J., Bijleveld, F.D., Hermens, F., et al. (2019). Ernstig verkeersgewonden 2018; Schatting van het aantal ernstig verkeersgewonden in 2018. R-2019-23. SWOV, Den Haag. .

[6]. 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.

[7]. CBS (2019). Personenmobiliteit naar vervoerswijze. CBS. Geraadpleegd 03-12-2019 op https://www.cbs.nl/nl-nl/maatschappij/verkeer-en-vervoer/transport-en-mobiliteit/mobiliteit/personenmobiliteit/categorie-personenmobiliteit/personenmobiliteit-naar-vervoerswijze.

[8] 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.

[9]. KiM (2019). Mobiliteitsbeeld 2019. Kennisinstituut voor Mobiliteitsbeleid (KiM), Den Haag.  

[10]. European Commission (2016). Road Safety: new statistics call for fresh efforts to save lives on EU roads. Geraadpleegd 21-11-2019 op https://ec.europa.eu/transport/media/news/2016-03-31-road-safety_en.

[11]. 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.

[12]. 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.

[13]. 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.

[14]. 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

16 Dec 2019