Fact sheet

Serious road injuries in the Netherlands

Summary

This fact sheet discusses the development of the number of serious road injuries in the Netherlands. In the Netherlands, serious road injuries are defined as persons admitted to hospital for the treatment of injuries sustained in a road crash, whose injuries have a severity of 2 or more on the medical injury scale AIS (MAIS2+), and who have not died within thirty days. Internationally, a similar definition is used, but with an injury severity of 3 or more (MAIS3+). It stands to reason that the Netherlands will also start to use this definition.

Estimates of the number of serious road injuries are based on a combination of police crash registration (BRON) en de registratie van patiënten door ziekenhuizen (LBZ).

After an initial decline from the nineties onwards, the number of serious road injuries (according to the Dutch definition) has risen since 2006. In 2019, an estimated 21,400 road users were seriously injured in Dutch traffic. Because of the uncertainty margin of the determination method, the number is similar to that in 2018, when 21,700 serious road injuries occurred. For years, the number of serious road injuries in the international definition increased and amounted to 6,900 in 2019. Also this number is more or less similar to the 2018 number, which amounted to 6,800 with an injury severity of 3 or more.

Almost two thirds of the number of serious road injuries consist of cyclists. By far the largest part of them are injured in a crash without involvement of a motor vehicle. Over two in five serious injuries are aged 60 or over, one in ten is aged 80 or over.

Facts

How many people were seriously injured in a road crash in the Netherlands in 2019?

In 2019, an estimated number of 21,400 road users were seriously injured in Dutch traffic (with an injury severity of MAIS2+, of whom 6,900 with an injury severity of MAIS3+). Because of the uncertainty margin of the determination method, the numbers are similar to the number of serious road injuries in 2018 [1] .

What is the official definition of a serious road injury?

In the Netherlands, a serious road injury is defined as a road crash casualty that has been admitted to hospital with moderate to severe injury 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 registered in BRON) proved to have been hospitalised or seriously injured.

Since a number of 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 to seriously injured) as its starting point. With this definition, the group of MAIS2 injuries are no longer counted as serious injuries. This group accounts for a significant share – currently two thirds – of the serious road injuries in the current Dutch definition – and includes a large number of casualties that continue to struggle with impairments [4]. In the Netherlands, the EU definition of a serious road injury has not yet been adopted. With respect to uniformity within the EU, and in order to bring the definiton into line with what is customary in the medical world, it stands to reason that the Netherlands will eventually adopt the EU definition as well. In this fact sheet, we will therefore also mention the number of road injuries with injury severity MAIS3+.

How is the number of serious road injuries determined in the Netherlands?

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

  • The database of (mainly) police reported road crashes in the Netherlands (BRON).
    IIn BRON, the Ministry of Infrastructure and Water Management collects and publishes road crash data based on police registration, notifications by road inspectors of the Dutch national road authority and information from media reports. This database contains crash characteristics such as road and vehicle characteristics and crash circumstances. BRON does not contain good-quality information about injury severity, and a lot of casualties are missing, particularly those resulting from crashes not involving a motor vehicle.
  • The national hospital registration (LBZ).
    LBZ is a database maintained by Dutch Hospital Data (DHD). It contains injury data of patients discharged after hospitalisation. Examples of data that are registered are injured body parts and injury types. We assume that LBZ contains all road casualties admitted to hospital. Yet, in the database, not all casualties are identifiable as road casualties. Moreover, LBZ does not contain much information about the crash. For instance, information about crash location is entirely missing.

SWOV estimates the number of serious road injuries in the Netherlands by linking and analysing the data from both data sources [5]. 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, most notably, BRON has been insufficient to allow making observations concerning the developments of numbers of serious road injuries stratified into subcategories (such as type of road user, age group etc). The last few years, BRON has not contained important characteristics, such as crash circumstances, data of the hospital the casualty was transported to, and whether hospitalisation occurred. This makes linking BRON data to LBZ data less reliable. However, based on the hospital registration, it is possible to give an indication of the proportions of male or female casualties, travel modes, or age groups.

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

Figure 1 shows the development of the number of serious road injuries from 2000 up to 2020 using the Dutch and the international definition [5] [6]. Using the Dutch definition, there was an upward trend in serious road injuries (with MAIS2+ injuries) for this period, even though a slight decline occurred several times. This last happened in 2017, but in 2018 the number of serious road injuries once more increased and remained stable in 2019. Using the international definition, there was a continuously upward trend of serious road injuries (with MAIS3+ injuries, which makes it a subset of the group of casualties with MAIS2+ injuries) from 2007 onwards. The 2018 deviation can be attributed to a change in the determination method. The 2019 number of MAIS3+ injuries is practically similar to that in 2018.

Figure 1. The number of serious road injuries in the Netherlands since the year 2000, using the Dutch (MAIS2+) and the international definition (MAIS3+). From 2018 onwards, a new determination method has been used. Sources: DHD, IenW and SWOV.

 

 

How are serious road injuries distributed by transport mode?

In the hospital registration, cyclists are the largest group among serious road injuries (see Figure 2). In 2019, 66% 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). In the hospital registration, the number of cyclists among serious road injuries increased over time, while in 2000 it was still 40%. Conversely, the number of serious road injuries with other transport modes decreased, and most strongly decreased for cars/delivery vans: in 2000, this was 24% of the serious road injuries according to the hospital registration, while in 2019 the share of these traffic modes decreased to 9%. In 2019, 55% of the serious road injuries in the hospital registration were injured in a road crash not involving a motor vehicle. Among cyclists this was 82%.

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

 

Since the year 2010, the poor registration in BRON has made it difficult to determine the number of serious road injuries per transport mode (see How is the number of serious road injuries determined? ). The distribution based on LBZ appears to be a reasonable alternative.

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 risk of serious injury (serious injuries per distance travelled) in the Netherlands for various transport modes , averages over five-year periods. Sources: Statistics Netherlands, IenW, DHD and SWOV .
How are serious road injuries distributed by age and gender?

Older road users make up a growing share of serious road injuries, see Figure 4. This figure shows the age distribution for serious road injuries based on the hospital registration (LBZ). In 2019, about 45% of the serious road injuries were aged 60 or over, while in 2010 this age group comprised only 31%. This growing share partly relates to demographic developments, but the share of older people among serious road injuries grows more strongly than their share of the population. Older people have an increased physical vulnerability, see SWOV fact sheet The elderly in traffic.

In 2019, children made up around 5% of serious road injuries; in 2010 this was still 9%. Also see SWOV fact sheet Children aged 0 to 14. Most children are injured while cycling or walking. The share of seriously injured young people aged 15 to 20 decreased from 10% in 2010 to 6% in 2019. They were probably mostly (light) moped riders aged 16 or 17 and car drivers aged 18 or 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 en Moped and light-moped riders.

Figure 4. Distribution of the number of serious road injuries by age group from 2010 onwards, based on LBZ. Sources: DHD, SWOV .

 

In 2019, 58% of the serious road injuries were male and 42% female. In general, women are more often than men injured in crashes not involving a motor vehicle. This partly relates to mobility differences between men and women: men drive more, women more often walk or use public transport [7].

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 policy making 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 almost all derived from the hospital register LBZ which does not register these characteristics.

Of the serious road injuries in crashes that do involve motor vehicles, more information is available, because the quality of their registration in BRON is higher. Therefore, we know that up to 2010 about 60% of these serious road injuries occurred in urban areas. Of the serious road injuries involving a motor vehicle in rural areas (about 40%), about one fifth occurred 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 5 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 impairment mainly experience pain and problems with their daily activities. More than 20% of the casualties suffer permanent consequences. The injuries and burden of injury vary between traffic modes, between different age groups and also between males and females [8].

 
Figure 5. 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].
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 6. 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 (€16 tot €19 billion [9]). This is more than 2% of the gross domestic product. The costs per road death are about €2.8 million and about €300,000 per serious road injury. For more information see SWOV fact sheet Road crash costs.

Figure 6. Proportions of deaths, serious/slight/other injuries and property damage only crashes (PDO) of the total societal costs of road crashes (2018) [9].
What is the target for the number of road casualties?

For 2020, the national road safety targets were a maximum of 500 road deaths and 10,600 serious injuries [10]. For the new period up to 2030, no targets have been determined (yet). The minister aspires to 0 road casualties in 2050 [11]. Currently, the annual number of serious road injuries amounts to more than 21,000. At an average annual reduction of about 14%, we will arrive at 200 serious road injuries in 2050 [12]. As yet, the number of serious road injuries does not show a downward trend.

The United Nations and the European Union have also formulated targets for a maximum number of road injuries. Mid 2020, the United Nations prolonged their previous targets formulated in 2010: to halve the number of road injuries in the next ten years. For this 2030 target, the year 2021 will be taken as baseline year [13].The European Union has also formulated targets for road injuries [14]: half the 2020 number of serious road injuries (with MAIS3+ severity) by 2030. Another objective was to have as many member states as possible know their number of MAIS3+ injuries in 2018. This process has not been concluded however.

If we were to apply the EU target to the Netherlands, and were to assume a 2020 number of serious road injuries equal to the 2018 and 2019 numbers, this would imply a maximum of 3,500 serious road injuries (MAIS3+) in 2030.

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 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. When determining the number of serious road injuries, SWOV has also reported the MAIS3+ injuries for a number of years now. Yet, not many other countries, have succeeded in collecting the necessary data (police records and hospital data) and performing the required data editing. In 2014, the European Commission did give a first-time estimate of the number of MAIS3+ injuries in Europe: 135,000 [15].

At a European level, research has been done on MAIS3+ casualties. In 2016 the report Study on serious road traffic injuries in the EU [16], 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 [17]. This EU project also studied the injury consequences of serious road injuries [18] en naar de maatschappelijke kosten van ernstig verkeersgewonden [19].

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 Library portal. Here you can also find more literature on this subject.

[1]. Aarts, L.T., Schepers, J.P., Goldenbeld, C., Decae, R.J., et al. (2020). De Staat van de Verkeersveiligheid 2020. Doelstellingen 2020 worden niet gehaald. R-2020-27. SWOV, Den Haag.

[2]. Reurings, M.C.B. & Bos, N.M. (2011). Ernstig verkeersgewonden in de periode 1993-2009; Update van de cijfers [Serious road injuries in the period 1993-2009. Data update]. R-2011-5. [Summary in English]. 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 [Seriously injured road crash casualties in the Netherlands in the period 1993-2008. The real number of in-patients with a minimum MAIS of 2]. R-2009-12. [Summary in English]. 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., Bijleveld, F.D., Decae, R.J. & Aarts, L.T. (2020). Ernstig verkeersgewonden 2019; Schatting van het aantal ernstig verkeersgewonden in 2019. R-2020-28. SWOV, Den Haag.

[6]. Reurings, M.C.B. & Bos, N. (2012). Ernstig verkeersgewonden in de jaren 2009 en 2010: Update van de cijfers [Serious road injuries in the years 2009 and 2010. Update of the data]. R-2012-7. [Summary in English]. SWOV, Leidschendam.

[7]. CBS (2020). Hoeveel reist de Nederlander en hoe?. CBS. Accessed on 18-11-2020 at www.cbs.nl/nl-nl/visualisaties/verkeer-en-vervoer/personen/mobiliteit

[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]. Ministerie van Verkeer en Waterstaat (2008). Strategisch Plan Verkeersveiligheid 2008-2020; Van, voor en door iedereen. Ministerie van Verkeer en Waterstaat, ’s-Gravenhage

[11]. Ministerie van IenW, Ministerie van JenV, IPO, VNG, et al. (2018). Veilig van deur tot deur. Het Strategisch Plan Verkeersveiligheid 2030: Een gezamenlijke visie op aanpak verkeersveiligheidsbeleid. Ministerie van Infrastructuur en Waterstaat, Ministerie van Justitie en Veiligheid, Interprovinciaal Overleg (IPO), Vereniging van Nederlandse Gemeenten (VNG) , Vervoersregio Amsterdam en Metropoolregio Rotterdam Den Haag (MRDH), Den Haag.

[12]. Weijermars, W., Schagen, I. van & Aarts, L. (2018). Verkeersveiligheidsverkenning 2030. Slachtofferprognoses en beschouwing SPV. R-2018-17. SWOV, Den Haag.

[13] United Nations (2020). Improving global road safety. A/74/L.86. United Nations, New York.

[14]. Council of the European Union (2017). Council conclusions on road safety: endorsing the Valletta Declaration of March 2017. Outcome of Proceedings from the General Secretariat of the Council. 9994/17 / TRANS 252 / 8666/1/17 REV 1 TRANS 158. Council of the European Union, Brussels.

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

[16]. 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.

[17]. 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.

[18]. 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.

[19]. 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

08 Dec 2020