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The Impact of Musculoskeletal Injuries Sustained in Road Traffic Crashes on Work-Related Outcomes: A Systematic Review

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The Impact of Musculoskeletal Injuries Sustained in Road Traffic Crashes on Work-Related Outcomes: A Systematic Review

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The return-to-work rate post-RTA increases in the first-year post-injury, from 70% at one month to 83% at 12 months - After a year, the return-to-work rate post-RTA is 17% - this increases the financial burden on the person and their family Rehabilitation based on the biopsychosocial model improves return to work

Rehabilitation based on the biopsychosocial model improves the rate of return-to-work. The psychological component must not be ignored when it comes to rehabilitation

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The Impact of Musculoskeletal Injuries Sustained in Road Traffic Crashes on Work-Related Outcomes: A Systematic Review

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Musculoskeletal injuries occur frequently after road traffic crashes (RTCs), and the effect on work participation is not fully understood. The primary aim of this review was to determine the impact of sustaining a musculoskeletal injury during an RTC…

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WHO Global Status Report on Road Safety 2023

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WHO Global Status Report on Road Safety 2023

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Share of Global Population, Road Traffic Deaths, Paved Inter-urban Roads, and Registered Motor Vehicles, by Country Income Level 2021 (WHO)

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Number of Road Traffic Fatalities by WHO Region and Country-Income Level, 2021 (WHO)

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Road traffic fatality rate per 100,000 population by WHO region and country income level, 2021 (WHO)

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https://www.orthobullets.com/Site/Podcasts/ViewPodcast?podcastId=400

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Road traffic injuries: hidden epidemic in less developed countries.

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Road traffic injuries: hidden epidemic in less developed countries.

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In this paper they highlighted the problem posed to public health in less developed countries by road traffic incidents and examined contributing factors

# data[].attributes.attachment_link.title
Road traffic injuries: hidden epidemic in less developed countries.

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Road traffic injuries (RTIs) are a leading cause of morbidity, disability and mortality in less developed countries. Globally in 2002, 1.2 million deaths resulted from RTIs, and about 10 times that were injured. RTIs are often preventable, and the technology ...

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RTA’s also impose an enormous economic burden on society

Some estimates put the cost of RTA’s on the economy at 1.8 trillion USD

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Patient profiles of below knee-amputation following road traffic accidents in India

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Patient profiles of below knee-amputation following road traffic accidents in India

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They documented a 4% amputation rate in trauma cases the majority of which are caused by RTAs

They also raise awareness on the fact that specialised services for amputees rehabilitation is in great demand

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Abstract

Background

Primary amputation below the level of the knee joint is the most frequently performed amputation following trauma; however, data about incidence, patient profiling, and causative factors are seldom available in India.

Objective

To evaluate the profile and incidence of trauma-related amputations below the level of the knee joint at a level 1 trauma center.

Methods

An observational study over six months was conducted at a level 1 trauma center of north India. Epidemiological data such as age, sex, occupation, socioeconomic status, mechanism of injury, time of surgery, single or staged procedure, and complications were recorded from the admission files.

Observations

125/3047 (4.1%) trauma patients underwent amputation, of which 32.8% (41 of 125) had amputation below the level of the knee joint. Unilateral transtibial amputation was the most common (85.3%) involving 40/41 males with a mean age of 37.2 years of low socioeconomic status. Road traffic accidents were the most common cause (85.36% of cases). 39 of 41 cases presented within 24 h of injury and underwent surgery within 24 h of presentation. Secondary surgery was needed in 24.4% of the patients and revision amputation was done in only 2.4% (n = 1/41). No patient developed medical complications, and the average hospital stay was 8.7 days with a range from 2 to 14 days.

Conclusion

We have documented a significant amputation rate in trauma cases (4.1%) reflecting on the seriousness of patients seen at our center. Most patients are young males at the peak of their productive lives, and from low socioeconomic status. Road Safety is essential, and specialized services for the amputees may be the need of the hour.

Keywords: Below knee, Amputation, Lower limb, Road accidents, Transtibial, Trauma, Amputee clinic

1. Introduction

Amputation is often the outcome following severe open fractures, mangled extremity, and vascular injuries, especially in developing countries.1,2 With improved road safety measures and modes of transportation, the incidence of post-traumatic amputation has significantly decreased in the developed world.3 Although innovative microsurgical techniques have made limb salvage a viable option, amputations are still being done at various hospitals, with multiple confounding factors being the precipitating cause.4 Several factors contribute to the burden of amputation following road traffic accidents in developing countries; the significant vehicular load on the roads, inadequate traffic infrastructures, poor road safety sense, dearth of appropriate health infrastructure and on the spot stabilization teams, and delay in definitive treatment5, 6, 7 all contribute. Even when the patient reaches an appropriate trauma center in time, the rate of secondary complications and ensuing disability may be relatively high.8

An understanding of demographic and etiological aspects of trauma-related amputations would help in constructing appropriate and timely management protocols for these patients. Many countries have National trauma banks where such data is documented, and an understanding of the causative factors, demographic patterns, and socioeconomic impact is appropriately documented. In India, however, this data is lacking, and the published literature on this subject is scanty. In an effort to see the available literature, the authors conducted a PUBMED search in July 2020 with keywords traumatic [All Fields] AND below [All Fields] AND ("knee" [MeSH Terms] OR "knee" [All Fields] OR "knee joint" [MeSH Terms] OR ("knee" [All Fields] AND "joint" [All Fields]) OR "knee joint" [All Fields]) AND ("amputation" [MeSH Terms] OR "amputation" [All Fields] OR "amputations" [All Fields]). The data collated showed 2564 hits, 354 out of which were studies focused on India. However, we could not identify a single study documenting the epidemiology and patient profiles of the patients undergoing traumatic below-knee amputation in India. The major void in the published literature and the scarcity of relevant clinical data on this subject led us to evaluate the epidemiology of trauma-related below-knee amputations. The study was done in a level 1 trauma center in North India, to evaluate the incidence, patient profiles, and compounding factors; an attempt to improve the patient outcomes in the long term. A specialized team has been created to manage these cases via a 'Focussed Amputee Clinic'.9

2. Aims and objectives

The study aimed to evaluate the demographic profiles and the incidence of below-knee amputations in trauma patients seen in our level 1 trauma center.

3. Materials and methods

We did a prospective evaluation of retrospective cases, with an attempt to document all the patients with below-knee amputations seen in our level 1 trauma center of a tertiary care teaching hospital. In addition to the Institute Ethics clearance to evaluate amputee data (NK/3690/Study/259), The clearance specific for this project was obtained (DRB/ORTHO/2020/51).

Data of consecutive patients admitted to the Advanced Trauma Centre, PGIMER, between 1 st January 2018 and 30 th June 2018, and who underwent amputations below the level of the knee joint after trauma was prospectively collated. Any patient with an amputation done for other causes such as diabetes, malignancy, peripheral vascular disease, or congenital anomalies was excluded. Medical case records of all these included patients were retrieved, and data were recorded in a pre-structured proforma. Variables evaluated were patient age, sex, occupation, socioeconomic status, Injury mechanism, the timing of presentation to the trauma center, any delays in the surgical procedure, level of amputation, complications, and methods of early rehabilitation. The amputation decision was taken based on the MESS score (Mangled extremity Severity Score) and limb viability. Two separate consultant orthopedic surgeons were involved in deciding for amputation.

The statistical analysis was carried out using Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, version 22.0 for Windows). The mean and median were calculated for all quantitative variables. For measures of dispersion, standard deviation or interquartile range was calculated. Qualitative or categorical variables were described as frequencies and proportions. All statistical analyses were two-sided, and significance was placed at a level of 5%.

4. Observations and results

During the study period, 3047 trauma cases visited our emergency, out of which 125 patients (4.1%) ultimately required amputation. Out of these 125 amputees, 41 patients (32.8%) were of amputations below the level of the knee joint. Of these, 35 (85.36%) patients had unilateral transtibial, two (4.8%) patients underwent bilateral transtibial amputations, and four (9.7%) patients underwent foot amputations at various levels.

Evaluation of data revealed that there was significant male sex predominance; only 1 out of 41 cases was female. There was also a predominance of the young population, with the mean age being 37.2-+16.9 years (median-33) ( Table 1 ). Road traffic accidents were the most common cause of amputation, with 35/41 (85.4%) patients having sustained road traffic injuries. 18/35 patients were riding two-wheelers which got hit by four-wheelers.12.2% (5 out of 4) patients had railway accidents and 2.4% (1 out of 41) had the traumatic machine cut injury in a local wood factory. The amputation decision was taken based on the MESS score, which comes out to be 9.58, ranged from 7 to 12.

Table 1

Variables

Value (n = 41)

Mean age±SD

37.2 years + -16.9

Male gender

40 (97.5%)

Mode of Injury

Level of amputation

MESS Score

9.58 (7-12)

Associated Injuries

17 (41.5%)

Timing of surgery

Duration of hospital stay

The most common associated injury seen was a fracture in other parts of a body in 9 patients, followed by head-injury in 4 patients. Overall, 39 (95.1%) patients presented within 24 h of injury, while 2 (4.9%) cases were referred to our center>24 h post-injury. 37/39 (90.2%) patients were operated within 24 h after the presentation; Of the four patients with delayed surgery, two had associated spine and head injury, and the other two were operated after the failure of a primary vascular repair with external fixation. In the latter 2, secondary amputation was done three days after the primary procedure due to the development of ischaemic changes. The average hospital stay of patients was 8.7 days, with a range of 2-14 days.

The majority (n = 29, 70.7%) of patients were discharged after primary surgery within 5 days, while 12 patients (29.3%) required prolonged admission due to various causes (delayed stump closure in 10 patients, revision amputation in one patient, and need for multiple debridements due to uncontrolled infection and persistent discharge in one patient). All patients seen at our center belonged to the low or lower-middle socioeconomic status according to the modified Kuppuswamy scale.10

From our data, we could infer that the majority of amputees were males, at a young age and were involved in road accidents. A very high incidence (4.1%)of trauma patients presenting to our center had undergone an amputation, with 32.8% (41/125) being below-knee amputations.

5. Discussion

Traumatic limb amputations in the civilian population are a significant cause of limb loss, second only to non-traumatic conditions like peripheral vascular diseases and gangrene.11, 12, 13, 14, 15 The rising number of traumatic amputations in developing countries is of concern because of its associated significant morbidity and mortality.2 Below knee amputation is a significant disability, both in terms of function and mental disturbance, with social factors in the poor playing a significant role.

A study in 1986 documented that India has 0.62 amputees per thousand population, and every year there was an addition of around 23,500 amputees to the pool.16 We could not find any data in PubMed for the intervening 35 years; our population has multiplied manifold; our traffic has become more congested and our vehicles go faster. Potentially, the amputation rates could be higher, and we have also noted alarming rates from our data. An amputation rate of approximately 4.1% (125/3047) of patients presenting after trauma, with almost one third undergoing a below-knee amputation, is high by any standards.

The high number of amputations seen by us might be attributed to the fact that we are a tertiary care referral trauma center, where cases of high-velocity trauma, a higher proportion of open fractures, vascular injuries, and polytrauma cases are referred for treatment. Nevertheless, these numbers are alarming and indirectly reflect the compromised healthcare infrastructures, poor health policies, and deranged traffic conditions and road safety measures. Lack of public awareness and civic responsibilities has further added to this problem,7 as patient transport facilities could significantly help in minimizing trauma-related limb-threatening complications.

Worldwide too, road traffic accidents are the most common cause of vascular injuries and mangled extremities requiring amputation.17,18 The World Health Organization estimates that India has 1% of the world's vehicle population but contributes to nearly 10% of the road traffic fatalities,19 which further reflects on the poor driving in congested traffic conditions. Currently, road traffic fatalities are 2nd only to HIV/AIDS as the leading cause of ill-health and premature death in adult men aged 15-44 years.20 Aeron-Thomas et al. reported similar findings from the United Kingdom with roadside accidents as the most common mode of injury, and pedestrians, motorcyclists, and bicyclists being the most common victims.21

One significant fact of note reflected even in the published literature worldwide 22,23, is the male preponderance and young age of the amputees (mean 37.2 years). This age-group is the primary workforce for any developing economy, and amputations thus lead to a significant socioeconomic burden and communal disability, not only to the nation but to the family also. The predominance of amputees from low socioeconomic strata of life is another significant point noted in this study since social support systems are lacking in our country.

Secondary data collation related to these cases gave some insights too. The duration between the injury and definitive management is the most crucial factor which determines the morbidity and mortality 24. In our study, 90% of the patients were operated within 24 h after presentation to the hospital. Although this seems fair in the overall context of an overburdened health delivery system in our country, with poor patient transport, the delay is often a significant factor in amputation rates. This is something that needs to be addressed to reduce the current level of morbidity to the limbs.

The reoperation rate in our study was nearly 30% (n = 12/41). The primary reason for the reoperations was delayed stump closure in 83.3% (n = 10/12 reoperations). However, the revision amputation rate was significantly low in our cohort, being only 2.4% (n = 1/41). The single case of the revision amputation at a higher level was associated with persistent infection. Low et al.25 studied 2879 amputees in the USA and described a very high revision rate of 41.9%.; the majority had a revision of the amputation stump and a few were revised to a more proximal level. They had collated data retrospectively from a centralized data bank. The lower revision rate seen by us may be related to the lesser number of patients in our study and early primary amputations that were done. Also, since the amputation decisions are jointly taken by a team of faculty members, this practice may have led to a reduced rate of revision and complications ( Table 2 ).

Table 2

S. No

Authors

Number of Patients

Gender

Mean Age (years)

Hospital stay (days)

Inference

5.

Present study

41

97.5% male

37.2 years

8.7 days

No mortality. Duration of hospital stay is increased in patients with associated injuries.

Low et al.25 reported that 27.5% of amputees had experienced complications in their post-operative period like pneumonia, acute kidney injury, and DVT/thrombophlebitis being the most common ones. They also noticed that complications were common in patients with compartment syndrome, associated neurovascular injury, and patients with delayed surgery.25 None of the patients in our hospital developed any medical complications during the hospital stay, as reported in some of the other studies.15,17,25 The reason for this could be the relatively shorter hospital stays, conduction of surgeries within 24 h, and early discharge policy. The duration of hospital stay not only increases the chances of infection but also impacts the psychological well-being of the patient who is already under the trauma and stigma of limb-loss.3

An outcome of our overall data for amputation evaluation has led to the formation of 'focused amputee clinics' which help to rehabilitate these young patients of poor socioeconomic status. This consists of a core specialized team, which often starts with primary care of these amputees while in hospital.9 The availability of clinical psychologists, psychiatrists, physiotherapists, prosthetists, and plastic surgeons as required, supplements the efforts of orthopedic surgeons and provides holistic care under one roof, which continues in the rehabilitation period.

The limitations of this study covering only 6 months; nevertheless, we had a large number of serious trauma patients due fact that we are a level 1 trauma center. Another limitation was the emotional component score of patients was not recorded. Large data pools are available in the United States consisting of LEAP study (Lower Extremity Assessment Project), which was a multi-center project recording the data of patients with lower extremity trauma.26 Similar studies should be advocated in countries like India for better results and guidelines in the future.

6. Future directions

Road safety measures are the need of the hour in developing countries. The increasing vehicular movement on the roads27 and poor adherence to traffic rules puts the population at risk for severe traumatic injuries.28 In public interest, the Indian Orthopaedic Association (IOA) also filed a writ petition in 2012 in the supreme court of India against the Govt. of India asking them to recognise the huge loss of life and financial burden seen in road traffic victims; this led to the formation of an apex body that is coordinating all activities involved in road safety. The Indian Orthopaedic Association (IOA) also formed a road traffic safety committee to improve road safety awareness among public.27 At the community level, road safety measures should be included in the curriculum of all teaching programs of the younger generation and the national health program of the countries. Information, education and awareness for the prevention of this group of orthopaedic conditions can go a long way in ensuring improved safety measures on the roads.

At the institutional level, maintenance of local and nationwide registries will help to identify the burden of amputation, improve the management of cases and assess the long-term outcomes in patients. Such data will also help in formulating policies for the improvement of road traffic accident-related safety measures and development of trauma centres on the highways so that these patients receive timely care. The data can also be utilized to formulate standard operating procedures at the peripheral centres so that the patients can seek early care and do not waste precious 'limb-time' in travelling to the higher centres. For this, the peripheral centres need to be upgraded in handling trauma-related surgical emergencies and performing amputation surgeries.

7. Conclusion

Our study highlights a significant amputation rate in trauma cases (4.1%) reflecting on the seriousness of patients seen at our center and road traffic accidents are the most common cause of traumatic limb amputations, and that too during the productive years of life; one-third of these are transtibial amputations. The majority belong to a poor socioeconomic background, warranting ongoing social support and psychological rehabilitation, maybe in the form of amputee clinics. The implications of limb loss are far-reaching; at one end, our study points towards the need of implementing better road safety measures and awareness amongst the masses, and at the other end, the fact that the healthcare system needs to be strengthened for early and appropriate care.

CRediT authorship contribution statement

Uttam Chand Saini: Conceptualization, Methodology. Aman Hooda: Data curation, Writing - original draft, preparation. Sameer Aggarwal: Software, Validation, Writing - review & editing. Mandeep Singh Dhillon: Visualization, Investigation, Supervision.

Declaration of competing interest

NIL.

Acknowledgement

None.

References

2. Ghosh P., Laheri S. Prevalence and aetiology of amputation in Kolkata, India: a retrospective analysis. Hong Kong Physiother J. 2013;31:36-40. [ Google Scholar]

3. Chalya P.L., Mabula J.B., Dass R.M. Injury characteristics and outcome of road traffic crash victims at Bugando Medical Centre in Northwestern Tanzania. J Trauma Manag Outcome. 2012 Feb 9;6:1. [[ PMC free article] [ PubMed] Google Scholar]

10. Wani R.T. Socioeconomic status scales-modified Kuppuswamy and Udai Pareekh's scale updated for 2019. J Fam Med Prim Care. 2019 Jun;8(6):1846. [[ PMC free article] [ PubMed] Google Scholar]

16. Mohan D. A report on amputees in India. J Prosthet Orthot. 1986;40:16-32. [ Google Scholar]

19. WHO . 2000. Injuries in South-East Asia Region, Priorities for Policy and Action. [ Google Scholar]

20. Peden M.M., World Health Organization, editors. World Report on Road Traffic Injury Prevention. World Health Organization; Geneva: 2004. [ Google Scholar]

28. Aggarwal A., Kaur S., Dhillon M.S. Sociodemographic profile of road traffic accident victims admitted at emergency surgical OPD of a tertiary care hospital. J Postgrad Med Educ Res. 2012;46(1):15-18. [ Google Scholar]

Articles from Journal of Clinical Orthopaedics and Trauma are provided here courtesy of Elsevier

# data[].attributes.attachment_link.title
Patient profiles of below knee-amputation following road traffic accidents - An observational study from a level 1 trauma centre in India

# data[].attributes.attachment_link.description
Primary amputation below the level of the knee joint is the most frequently performed amputation following trauma; however, data about incidence, patient profiling, and causative factors are seldom available in India.To evaluate the profile and incidence ...

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https://www.orthobullets.com/Site/Podcasts/ViewPodcast?podcastId=95

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Handbook of measuring socio-economic consequences of traffic crashes

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Handbook of measuring socio-economic consequences of traffic crashes

# data[].attributes.body
This handbook shines light on the different ways we can measure the socio-economic consequences of traffic accidents and raises awareness on the consequences of these accidents occurring at an individual level

This book is aimed to be useful for developing and developed countries

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Low and middle income countries make up 92% of deaths

Low income countries have a fatality rate of 21 per 100,000 versus the high income countries fatality rate of 8 per 100,000

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Understanding Common Orthopedic Injuries Resulting from Car Accidents

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Here at Coastal Orthopedics, we realize that car accidents can be traumatic experiences that can cause severe, visible, and invisible injuries. Often, the impact can result in orthopedic injuries, which are injuries to the musculoskeletal system that includes bones, joints, muscles, tendons, and ligaments.

These injuries can cause significant pain, limit mobility and the ability to perform everyday tasks, and require a lengthy recovery process. Understanding the common orthopedic injuries resulting from car accidents can help you be aware of the potential risks and seek prompt medical attention.

Whiplash

Whiplash is a common injury that results from a car accident, particularly rear-end collisions. It occurs when the neck is jerked back and forth suddenly, causing the head to move beyond its normal range of motion. Whiplash can result in neck pain, stiffness, and limited mobility. It may also cause headaches, fatigue, and dizziness.

The severity of whiplash can vary depending on the force of the impact, the angle of the collision, and other factors. While some people may recover from whiplash within a few weeks with proper rest and pain management, others may experience chronic pain and long-term complications.

Fractures

Fractures, or broken bones, are another common orthopedic injury resulting from car accidents. Fractures can occur in any part of the body, including the arms, legs, hips, spine, and ribs. The severity of the fracture can vary from a hairline fracture to a complete break that requires surgical intervention.

Fractures can cause significant pain, swelling, and limited mobility. In severe cases, fractures can result in permanent disability or chronic pain. Immediate medical attention is essential to prevent further damage and ensure proper healing.

Dislocations

Dislocations occur when a bone is forced out of its normal position in a joint. Car accidents can cause dislocations in various parts of the body, including the shoulder, elbow, hip, and knee. Dislocations can cause significant pain, swelling, and limited mobility. In severe cases, dislocations may require surgery to correct.

Torn Ligaments

Ligaments are tough bands of tissue that connect bones to each other in joints. Car accidents can cause ligaments to tear, resulting in pain, swelling, and instability in the affected joint. Torn ligaments are most common in the knee and ankle, but they can occur in any joint. Recovery from torn ligaments can be lengthy and require physical therapy and rehabilitation.

Spinal Cord Injuries

Spinal cord injuries are a severe orthopedic injury that can result from car accidents. The spinal cord is a bundle of nerves that runs from the brain to the lower back and controls various bodily functions. Spinal cord injuries can cause partial or complete paralysis, loss of sensation, and other complications.

The severity of a spinal cord injury depends on the location and extent of the damage. Immediate medical attention is crucial to prevent further damage and ensure the best possible outcome.

Soft Tissue Injuries

Soft tissue injuries include injuries to muscles, tendons, and ligaments that are not caused by a fracture or dislocation. Car accidents can cause soft tissue injuries, including sprains and strains. Sprains occur when a ligament is stretched or torn, while strains occur when a muscle or tendon is stretched or torn.

Soft tissue injuries can cause pain, swelling, and limited mobility. While some soft tissue injuries may heal with rest and physical therapy, others may require surgical intervention.

Concussions

Concussions are a type of traumatic brain injury that can occur when the head is hit, shaken, or jerked suddenly. Car accidents can cause concussons, which can result in headaches, dizziness, nausea, and confusion. In severe cases, concussions can cause unconsciousness, seizures, and other complications.

Recovery

Recovery from a concussion can take several weeks or even months, and it is essential to seek prompt medical attention to ensure proper treatment and avoid long-term complications.

Prevention

While car accidents can happen unexpectedly, taking preventive measures can help reduce the risk of orthopedic injuries. Always wear a seatbelt and ensure that all passengers in the car do the same. Properly install and use car seats for children. Avoid driving under the influence of drugs or alcohol, and limit distractions while driving, such as using your phone or eating.

Conclusion

Car accidents can cause a range of orthopedic injuries, including whiplash, fractures, dislocations, torn ligaments, spinal cord injuries, soft tissue injuries, and concussions.

These injuries can cause significant pain, limit mobility, and require lengthy recovery periods. Understanding the common orthopedic injuries resulting from car accidents can help you be aware of the potential risks and seek prompt medical attention.

Taking preventive measures, such as wearing a seatbelt and avoiding distractions while driving, can help reduce the risk of orthopedic injuries and ensure your safety on the road.

# data[].attributes.attachment_link.title
Understanding Common Orthopedic Injuries Resulting from Car Accidents

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Here are some of the top injuries resulting from automobile accidents.

# data[].attributes.body
MSK injuries such as fractures whiplash, and soft tissue injuries causing short and long term pain, stiffness and immobility

Spinal cord injury → depending on the severity and location of the injury on the spine, it can cause partial or complete loss of sensory function or motor control of arms/legs/body (paraplegia/tetraplegia)

Traumatic brain injury (TBI) - swelling and pressure cause brain tissue damage → can cause physical, cognitive or behavioural impairments

Psychological distress and depression

(Humanity and Inclusion)

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This paper explains the impact of RTA on low income families at a micro-economic level

In India, some poor households who have

a family member injured in a road accident report that

someone has to stop working to take care

of that family member

In Ghana 73% of people injured in RTAs don't go to the hospital because of lack of money

RTAs cost about 3%of the governments GDP

They also look into solutions in reducing the risk of RTA

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Fatalities on Urban Roads versus Rural Roads

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Fatalities on Urban Roads versus Rural Roads

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Due to the quality of roads and lack of speed limit regulation, there are more deaths on rural roads in Ireland

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Analysis of Fatalities in Ireland due to RTAs

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Analysis of Fatalities in Ireland due to RTAs

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Long-term trend of fatalities caused by road traffic accidents

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Education and enforcement is required regarding the dangers of these behaviours

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Approximately 1.19 million people die each year as a result of road traffic accidents (RTA)

This equates to an incidence rate of 15 per 100,000 people

The female-to-male mortality ratio is 1:3

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Higher income countries have better laws surrounding vehicle safety standards than lower income countries

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Trauma Survivor Talks About Life After His Accident

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Despite notable progress, road safety remains urgent global issue

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The annual number of road traffic deaths fell slightly to 1.19 million per year, according to the latest WHO report. Yet with more than 2 deaths occurring per minute and over 3200 per day, road traffic crashes remain the leading killer of children and youth aged 5-29 years.

The latest WHO global status report on road safety 2023 shows that, since 2010, road traffic deaths have fallen by 5% to 1.19 million annually ¹. Yet, road crashes remain a persistent global health crisis, with pedestrians, cyclists and other vulnerable road users facing an acute and rising risk of death.

"The tragic tally of road crash deaths is heading in the right direction, downwards, but nowhere near fast enough," says WHO Director-General, Dr Tedros Adhanom Ghebreyesus. "The carnage on our roads is preventable. We call on all countries to put people rather than cars at the centre of their transport systems, and ensuring the safety of pedestrians, cyclists and other vulnerable road users."

Among UN Member States, 108 countries reported a drop in road traffic-related deaths between 2010 and 2021. Ten countries succeeded in reducing road traffic deaths by over 50%: Belarus, Brunei Darussalam, Denmark, Japan, Lithuania, Norway, Russian Federation, Trinidad and Tobago, United Arab Emirates and Venezuela. Thirty-five more countries made notable progress, reducing deaths by 30% to 50%.

Global burden and vulnerable users

The report shows that 28% of global road traffic deaths occurred in the WHO South-East Asia Region, 25% in the Western Pacific Region, 19% in the African Region, 12% in the Region of the Americas, 11% in the Eastern Mediterranean Region and 5% in the European Region.

Nine in 10 deaths occur in low- and middle-income countries, and fatalities in these countries are disproportionately higher when set against the number of vehicles and roads they have. The risk of death is 3 times higher in low-income than high-income countries, yet low-income countries have just 1% of the world's motor vehicles.

Fifty-three per cent of all road traffic fatalities are vulnerable road users including: pedestrians (23%); riders of powered two- and three-wheelers such as motorcycles (21%); cyclists (6%); and users of micro-mobility devices such as e-scooters (3%). Deaths among car and other 4-wheeled light vehicle occupants fell slightly to 30% of global fatalities.

"Our mission at Bloomberg Philanthropies is to save and improve as many lives as possible, and one of the best ways to do that is to make more of the world's roads safe for all," said Michael R. Bloomberg, founder of Bloomberg LP and Bloomberg Philanthropies and WHO Global Ambassador for Noncommunicable Diseases and Injuries, who also wrote a foreword for the report. "For more than a decade now, we've made encouraging progress together with the World Health Organization and our partners. Still, as this new report makes clear, road safety demands stronger commitments from governments worldwide - and we'll continue to urge more leaders to take lifesaving action."

Pedestrian deaths rose 3% to 274 000 between 2010 and 2021, accounting for 23% of global fatalities. Deaths among cyclists rose by nearly 20% to 71 000, accounting for 6% of global deaths. Meanwhile, research indicates that 80% of the world's roads fail to meet pedestrian safety standards and just 0.2% have cycle lanes, leaving these road users dangerously exposed. And while 9 in 10 people surveyed identify as pedestrians, just a quarter of countries have policies to promote walking, cycling and public transport.

Call for better standards and policies

The report reveals an alarming lack of progress in advancing laws and safety standards. Just six countries have laws that meet WHO best practice for all risk factors (speeding, drink-driving, and use of motorcycle helmets, seatbelts and child restraints) while 140 countries (two-thirds of UN Member States) have such laws for at least one of these risk factors. Of note, 23 of these countries modified their laws to meet WHO best practice since the Global status report on road safety 2018.

The global motor-vehicle fleet is set to double by 2030. Yet just 35 countries - less than a fifth of UN Member States - legislate on all key vehicle safety features (e.g. advanced braking systems, front- and side-impact protection, etc). The report also reveals major gaps in ensuring safe road infrastructure, with just 51 countries - a quarter of UN Member States - having laws that require safety inspections that cover all road users.

Note to editors

The WHO Global status report on road Safety 2023 is the fifth in a series measuring progress in reducing road traffic deaths. This report covers progress between 2010 and 2021 and sets a baseline for efforts to meet the United Nations Decade of Action 2021-2030 target to halve road traffic deaths by 2030.

This report was produced with support from Bloomberg Philanthropies. Since 2007, Bloomberg Philanthropies has committed $500 million to support road safety interventions in low- and middle-income countries and cities across the world.

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Despite notable progress, road safety remains urgent global issue

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The annual number of road traffic deaths fell slightly to 1.19 million per year, according to the latest WHO report. Yet with more than 2 deaths occurring per minute and over 3200 per day, road traffic crashes remain the leading killer of children and youth aged 5-29 years.

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Trauma Survivor Shares Story of His Accident and Recovery

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World Bank and WHO: Half the world lacks access to essential health services, 100 million still pushed into extreme poverty because of health expenses

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At least half of the world's population cannot obtain essential health services, according to a new report from the World Bank and WHO. And each year, large numbers of households are being pushed into poverty because they must pay for health care out of their own pockets.

Currently, 800 million people spend at least 10 percent of their household budgets on health expenses for themselves, a sick child or other family member. For almost 100 million people these expenses are high enough to push them into extreme poverty, forcing them to survive on just $1.90 or less a day. The findings, released today in Tracking Universal Health Coverage: 2017 Global Monitoring Report, have been simultaneously published in Lancet Global Health.

"It is completely unacceptable that half the world still lacks coverage for the most essential health services," said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. "And it is unnecessary. A solution exists: universal health coverage (UHC) allows everyone to obtain the health services they need, when and where they need them, without facing financial hardship."

"The report makes clear that if we are serious - not just about better health outcomes, but also about ending poverty - we must urgently scale up our efforts on universal health coverage," said World Bank Group President Dr. Jim Yong Kim. "Investments in health, and more generally investments in people, are critical to build human capital and enable sustainable and inclusive economic growth. But the system is broken: we need a fundamental shift in the way we mobilize resources for health and human capital, especially at the country level. We are working on many fronts to help countries spend more and more effectively on people, and increase their progress towards universal health coverage."

There is some good news: The report shows that the 21st century has seen an increase in the number of people able to obtain some key health services, such as immunization and family planning, as well as antiretroviral treatment for HIV and insecticide-treated bed nets to prevent malaria. In addition, fewer people are now being tipped into extreme poverty than at the turn of the century.

Progress, however, is very uneven.

There are wide gaps in the availability of services in Sub-Saharan Africa and Southern Asia. In other regions, basic health care services such as family planning and infant immunization are becoming more available, but lack of financial protection means increasing financial distress for families as they pay for these services out of their own pockets. This is even a challenge in more affluent regions such as Eastern Asia, Latin America and Europe, where a growing number of people are spending at least 10 percent of their household budgets on out-of-pocket health expenses. Inequalities in health services are seen not just between, but also within countries: national averages can mask low levels of health service coverage in disadvantaged population groups. For example, only 17 percent of mothers and children in the poorest fifth of households in low- and lower-middle income countries received at least six of seven basic maternal and child health interventions, compared to 74 percent for the wealthiest fifth of households.

The report is a key point of discussion at the global Universal Health Coverage Forum 2017, currently taking place in Tokyo, Japan. Convened by the Government of Japan, a leading supporter of UHC domestically and globally, the Forum is cosponsored by the Japan International Cooperation Agency (JICA), UHC2030, the leading global movement advocating for UHC, UNICEF, the World Bank, and WHO. Japanese Prime Minister Shinzo Abe, UN Secretary-General Antonio Guterres, World Bank President Kim, WHO Director-General Tedros and UNICEF Executive Director Anthony Lake will all be in attendance, in addition to heads of state and ministers from over 30 countries.

"Past experiences taught us that designing a robust health financing mechanism that protects each individual vulnerable person from financial hardship, as well as developing health care facilities and a workforce including doctors to provide necessary health services wherever people live, are critically important in achieving 'Health for All,'" said Mr. Katsunobu Kato, Minister of Health, Labour and Welfare, Japan. "I firmly believe that these early-stage investments for UHC by the whole government were an important enabling factor in Japan's rapid economic development later on."

The Forum is the culmination of events in over 100 countries, which began on Dec. 12-Universal Health Coverage Day-to highlight the growing global momentum on UHC. It seeks to showcase the strong high-level political commitment to UHC at global and country levels, highlight the experiences of countries that have been pathfinders on UHC progress, and add to the knowledge base on how to strengthen health systems and effectively promote UHC.

The main high-level sessions of the Forum take place tomorrow, Dec. 14, and will also feature an all-day "innovation showcase," highlighting innovations driving progress in health systems around the world, and a celebratory public event in the evening. A commitment to action, called the Tokyo Declaration on Universal Health Coverage, will be released during the Forum's closing ceremony.

"Without health care, how can children reach their full potential? And without a healthy, productive population, how can societies realize their aspirations?" said UNICEF Executive Director Anthony Lake. "Universal health coverage can help level the playing field for children today, in turn helping them break intergenerational cycles of poverty and poor health tomorrow."

Building on the G7 Ise-Shima Summit and the TICAD VI in 2016, both of which stress the need for UHC, the Forum in Tokyo is seen as a milestone for accelerating progress towards the target of UHC by 2030, a key part of the Sustainable Development Goals. Countries will then gear up for the next global moment: a high-level meeting of the UN General Assembly on UHC in 2019.

Note to editors

The World Bank/WHO UHC Global Monitoring Report, issued regularly, measures the proportion of a population that can access essential quality health services, and the proportion of the population that spends a large amount of household income on health. It also evaluates the overall level and the extent to which UHC is equitable - offering service coverage and financial protection to all people within a population, such as the poor or those living in remote rural areas. The report uses 16 essential health services as indicators of the level and equity of coverage in countries.

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World Bank and WHO: Half the world lacks access to essential health services, 100 million still pushed into extreme poverty because of health expenses

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World Bank and WHO: Half the world lacks access to essential health services, 100 million still pushed into extreme poverty because of health expenses

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Comparison of common causes of death in different age groups

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Comparison of common causes of death in different age groups

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RTAs are the most common cause of death in 5-29 year olds and are the twelfth most common in the "all ages" group

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In general, higher income countries receive better quality education and therefore, better quality of rehab post-RTA

The 'Rehabilitation 2030' initiative aims to make high quality rehabilitation available globally

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Background

The Rehabilitation 2030 initiative draws attention to the profound unmet need for rehabilitation worldwide, and highlights the importance of strengthening health systems to provide rehabilitation. The initiative marks a new strategic approach for the global rehabilitation community by emphasizing that:

Rehabilitation should be available for all the population and through all stages of the life course.

Efforts to strengthen rehabilitation should be directed towards supporting the health system as a whole and integrating rehabilitation into all levels of health care.

Rehabilitation is an essential health service and crucial for achieving universal health coverage.

With ageing populations, and an increase in the number of people living with chronic disease, rehabilitation is a priority health strategy for the 21st century that uniquely contributes to optimising the functioning of the population.

The Rehabilitation 2030 initiative was launched in February 2017 and introduced a 'call for action', rallying stakeholder towards concerted and coordinated global action to scale up rehabilitation. In order to achieve this, 10 priority areas for action were identified:

Why do we have the Rehabilitation 2030 initiative?

Globally, one in three people are living with a health condition that benefits from rehabilitation. These needs are spread across the lifespan, from children with congenital and intellectual impairment, to young adults with physical limitation resulting from unintentional and war-related injuries, to older people experiencing chronic disease or difficulties associated with ageing. These rehabilitation needs will only grow in the coming years as populations continue to age, and the number of people living with chronic disease continues to increase throughout the world.

Many countries are not equipped to respond to existing rehabilitation needs, let alone the forecasted increase that is arising from health and demographic trends. Rehabilitation is often not prioritized in countries and continues to be under-resourced. As a result, countless individuals do not have access to rehabilitation services, leading to an exacerbation of their condition, further complications and lifelong consequences. In some low- and middle-income countries, more than 50% of people do not receive the rehabilitation services they require.

In 2017, in recognition of the growing global rehabilitation needs, under-developed rehabilitation services and significant potential for unmet rehabilitation needs to increase in future, the WHO, Member States, development partners and civil society came together to launch the Rehabilitation 2030 initiative.

Rehabilitation 2030 activities

Since the initial call for action, WHO has undertaken a series of activities to accelerate action and support progress in countries towards achieving the goals of the Rehabilitation 2030 initiative.
Technical support to countries
WHO has supported over 20 countries across all world regions to strengthen their health systems to better provide rehabilitation services. The number of countries requesting technical support from WHO is ever increasing. For more information on WHO's country support, read here.

Relevant WHO resources

Rehabilitation in health systems provides recommendations for Member States and other relevant stakeholders to strengthen and expand the availability of...

Rehabilitation in health systems provides key recommendations for countries and relevant stakeholders to strengthen and expand the availability of quality rehabilitation services.

There is great variation across countries regarding the rehabilitation needs of the population, characteristics of the health system and the challenges...

Rehabilitation in health systems: guide for action is a practical tool that supports countries to identify priorities, develop a comprehensive strategic plan, and establish monitoring and evaluation mechanisms for rehabilitation.

In many countries, the rehabilitation workforce is underequipped to meet population needs due to large scale shortages across professions and specializations,...

Rehabilitation Competency Framework is a tool that supports competency-based approaches to strengthening the rehabilitation workforce so that it is prepared to meet the needs of populations.

Additional WHO resources will soon be available, that will help countries to: strengthen rehabilitation service planning and integration; address workforce challenges and improve workforce planning, strengthen rehabilitation data collection and integration into health information systems; guide rehabilitation research; and integrate rehabilitation into emergency preparedness and response efforts.

Global meetings and events

Multimedia library

Related health topic

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Background The Rehabilitation 2030 initiative draws attention to the profound unmet need for rehabilitation worldwide, and highlights the importance of strengthening health systems to provide rehabilitation. The initiative marks a new strategic approach for the global rehabilitation community by emphasizing that: Rehabilitation should be available for all the population and through all stages of the life course.

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Road Traffic Injuries Rehabilitation Factsheet

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WHO fact sheet on road traffic injuries providing key facts and information on who is at risk, drink driving, motor cycle helmets, seat belts and child restraints, and WHO response.