Estimated potential death and disability averted with vehicle safety interventions, Association of Southeast Asian Nations.

Objective: To evaluate road safety in member countries of the Association of Southeast Asian Nations and estimate the benefits that vehicle safety interventions would have in this group of countries. Methods: We used a counterfactual analysis to assess the reduction in traffic deaths and disability-adjusted life years (DALYs) lost if eight proven vehicle safety technologies and motorcycle helmets were entirely in use in countries of the Association of Southeast Asian Nations. We modelled each technology using country-level incidence estimations of traffic injuries, and the prevalence and effectiveness of the technology to calculate the reduction in deaths and DALYs if the technology was fitted in the entire vehicle fleet. Findings: The availability of electronic stability control, including the antilock braking systems, would provide the most benefits for all road users with estimates of 23.2% (sensitivity analysis range: 9.7-27.8) fewer deaths and 21.1% (9.5-28.1) fewer DALYs. Increased use of seatbelts was estimated to prevent 11.3% (8.11-4.9) of deaths and 10.3% (8.2-14.4) of DALYs. Appropriate and correct use of motorcycle helmets could result in 8.0% (3.3-12.9) fewer deaths and 8.9% (4.2-12.5) fewer DALYs. Conclusion: Our findings show the potential of improved vehicle safety design and personal protective devices (seatbelts and helmets) to reduce traffic deaths and disabilities in the Association of Southeast Asian Nations. These improvements can be achieved by vehicle design regulations and creating consumer demand for safer vehicles and motorcycle helmets through mechanisms such as new car assessment programmes and other initiatives.

Drugs, Substance Use Disorder and Driving: Intervention of Health Professionals in the Treatment of Addictions.

Editorial of vol 27-3.

Editorial del vol 27-3.

Measuring the population burden of fatal and nonfatal injury.

The value of measuring the population burden of fatal and nonfatal injury is well established. Population health metrics are important for assessing health status and health-related quality of life after injury and for integrating mortality, disability, and quality-of-life consequences. A frequently used population health metric is the disability-adjusted life-year. This metric was launched in 1996 in the original Global Burden of Disease and Injury study and has been widely adopted by countries and health development agencies alike to identify the relative magnitude of different health problems. Apart from its obvious advantages and wide adherence, a number of challenges are encountered when the disability-adjusted life-year is applied to injuries. Validation of disability-adjusted life-year estimates for injury has been largely absent. This paper provides an overview of methods and existing knowledge regarding the population burden of injury measurement. The review of studies that measured burden of injury shows that estimates of the population burden remain uncertain because of a weak epidemiologic foundation; limited information on incidence, outcomes, and duration of disability; and a range of methodological problems, including definition and selection of incident and fatal cases, choices in selection of assessment instruments and timings of use for nonfatal injury outcomes, and the underlying concepts of valuation of disability. Recommendations are given for methodological refinements to improve the validity and comparability of future burden of injury studies.

Reduction in the exposure to being out-of-position among car occupants who used a sleeping device.

BACKGROUND: This study assesses the impact on safety of a system designed to enhance sleep in car passengers. The system holds the head posteriorly and limits its rotation in the sagittal and frontal planes, modifying the occupant's head position. This device may have an influence on the interaction between the occupant and the vehicle restraint systems. METHODS: It was a randomised, prospective, single-blind, cross-over controlled study in which 41 volunteers were exposed to using the system while riding as car passengers. Whether the device influenced the posture of the occupants and prevented them from adopting out-of-position (OOP) configurations was also analysed. Occupants were videotaped while they were using both the innovative system (cases) and their normal sleeping device (controls), if any. RESULTS: Controls were exposed to OOP situations in 825 occasions (18.4%; 95% CI 17.3% to 19.6%), while cases were exposed in 416 occasions (9.3%; 95% CI 8.4% to 10.2%). The paper also analysed how many cases and controls were exposed at least once to a particular event and how frequent a single participant incurred in an OOP situation. In both cases, the innovative device showed a reduction in exposition. When OOP situations were grouped into severe, moderate and minor events, the innovative device produced a statistically significant reduction in the occurrence of severe and moderate events. CONCLUSIONS: A device originally designed to improve comfort and rest in car passengers has been found to reduce the exposure of the occupants to being OOP while resting in the car. TRIAL REGISTRATION NUMBER: http://www.ClinicalTrials.gov, NCT01062295.

Vulnerability of female drivers involved in motor vehicle crashes: an analysis of US population at risk.

OBJECTIVES: Motor vehicle trauma has been effectively reduced over the past decades; however, it is unclear whether the benefits are equally realized by the vehicle users of either sex. With increases in the number of female drivers involved in fatal crashes and similarity in driving patterns and risk behavior, we sought to evaluate if advances in occupant safety technology provide equal injury protection for drivers of either sex involved in a serious or fatal crash. METHODS: We performed a retrospective cohort study with national crash data between 1998 and 2008 to determine the role of driver sex as a predictor of injury outcome when involved in a crash. RESULTS: The odds for a belt-restrained female driver to sustain severe injuries were 47% (95% confidence interval = 28%, 70%) higher than those for a belt-restrained male driver involved in a comparable crash. CONCLUSIONS: To address the sex-specific disparity demonstrated in this study, health policies and vehicle regulations must focus on effective safety designs specifically tailored toward the female population for equity in injury reduction.

Injury mortality indicators: recommendations from the International Collaborative Effort on Injury Statistics.

BACKGROUND: The International Collaborative Effort (ICE) on Injury Statistics called for an effort 'to reach consensus on what are the 10 most important indicators of injury incidence that offer the potential for international comparisons and for regional or global monitoring.' OBJECTIVES: To describe the process of developing the ICE indicators and to present the specifications of selected injury mortality indicators, along with comparisons between selected countries for those specified indicators. METHODS: Participants on the ICE list had been asked to send to one of the authors what they considered the most important five indicators of injury incidence. These were synthesised and presented under six themes: mortality indicators (general); mortality indicators (motor vehicle); mortality indicators (other); hospital data-based (overall); hospital data-based (traumatic brain injury (TBI)); long-term disability (overall). Following two work group discussions and after drafting and revising indicator specifications, agreement was reached on mortality indicators and specifications. Specifications for those mortality indicators are presented. Morbidity indicators are still to be agreed. RESULTS: The mortality indicators proposed were age-adjusted rates of injury death; motor vehicle traffic crash-related death; self-harm/suicide; assault/homicide; and TBI death. The empirical work highlighted difficulties in identifying TBI in countries where mortality data do not capture multiple injuries, prompting us to drop the mortality indicator related to TBI and moving us instead to introduce an indicator to monitor the use of undetermined intent in the classification of injury mortality. CONCLUSION: The ICE has reached a consensus on what injury mortality indicators should be used for comparison between countries. Specifications for each of these have been applied successfully to the mortality data of seven countries.

Longitudinal assessment of quality of life and its change in relation to motor vehicle crashes: the SUN (Seguimiento Universidad de Navarra) Cohort.

BACKGROUND: Despite the prevailing notion than injury victims are healthy subjects, there is scarce evidence on their preinjury health status, particularly for motor vehicle crash (MVC) victims, where changes between their preinjury health status (or age- and sex-adjusted standards) have seldom been compared with their postinjury status. METHODS: This longitudinal study recorded pre-event self-reported health status (as measured by Short Form-36 scores) of cohort participants who were followed up for 4 years. Differences at the beginning and the end of follow-up as well as differences in Short Form-36 scores changes over time were compared according to the occurrence of a MVC during that time. RESULTS: From 3,361 participants included for analysis, 64 had an incident MVC. At baseline, those participants who would not have subsequently a MVC had better health than those who would have it. In addition, those who reported being in a crash lost more health after the crash than their noncrash counterparts, although these differences were only seen in adjusted analyses. Adjusted analyses showed a significantly greater worsening of health in MVC victims, particularly in regards to role physical (adjusted difference in 4 years change, -7.7; 95% CI, -13.6 to -1.9), bodily pain (-5.9; 95% CI, -11.4 to -0.3), and role emotional (-6.2; 95% CI, -12.5 to -0.02). CONCLUSIONS: In this cohort, participants who eventually suffered a crash had a worse health status before their MVC than those who did not suffer a MVC. They lost even further health after the injurious event. These findings bear particular relevance when assessing the burden of disease, or when conducting effectiveness evaluation studies at the individual and population level.

Exposure to traffic and risk of hospitalization due to injuries.

Research on the risk of motor vehicle injuries and their relationship with the amount of travel has been only partially analyzed. The few individual exposure assessments are related to very specific subsets of the driving and traveling populations. This study analyzes the relationship between kilometers traveled and hospitalization due to motor vehicle injuries. Twelve thousand three hundred and sixty nine Spanish university graduates from the Seguimiento Universidad de Navarra multipurpose cohort study were evaluated. They had not been hospitalized due to motor vehicle injuries at baseline and were followed up to eight years. Biannual questionnaires allowed for self-reporting of kilometers traveled in motor vehicles, together with incidence of hospitalization. Covariates in the Cox regression models included age and gender and baseline use of safety belt while driving, driving a vehicle with driver-side airbag, driving a motorcycle, and drinking and driving. There were 49,766 participant-years with an average yearly travel of 7,828 km per person-year. Thirty-six subjects reported a first hospitalization event during this time. The adjusted hazard ratio per additional kilometer traveled was 1.00005 (95% confidence interval 1.000013 to 1.000086). Even the smallest of reductions in the amount of kilometers traveled (from an average of 3,250 km per year to 1,000) has a statistically significant protective effect on the likelihood of sustaining hospitalization due to motor vehicle injury (aHR 0.9, 95% CI 0.78 to 0.98). In light of current policies aimed to reduce motorized traffic due to environmental concerns, it may be appropriate to consider the additional health benefit related to reductions in injuries.

Real-world performance of vehicle crash test: the case of EuroNCAP.

OBJECTIVE: To investigate whether the occupants in vehicles with better safety ratings according to EuroNCAP sustain fewer fatal and severe injuries than occupants in vehicles with worse experimental safety ratings when in frontal crashes. DESIGN: Case-control study. SETTING: A representative sample of crashes in Britain from 1996 to 2008 as gathered in the Cooperative Crash Injury Study (CCIS) database under the auspices of the UK Department of Transportation and augmented with EuroNCAP experimental ratings for each crashed vehicle. SUBJECTS: Drivers and front seat passengers while occupants of vehicles for which EuroNCAP test results were available and who met inclusion criteria meant to select those in crashes similar to those in the frontal experimental setting. MAIN OUTCOME MEASURES: Fatality and severe MAIS3+ injuries to the head, thorax, pelvis and lower extremities. RESULTS: The multivariate Poisson regression models on the 1259 cases who sustained crash conditions most similar to the experimental ones showed no statistically significant effect on either mortality or MAIS3+ injury in real-world crashes when travelling in cars with better safety ratings. For example, when compared to a driver in a vehicle rated as safest for head injuries MAIS3+ in frontal crashes, drivers in vehicles rated yellow or orange presented adjusted ORs of 0.6 (0.2 to 1.7) and 0.8 (0.3 to 2.1), respectively. CONCLUSIONS: No statistically significant relationships between the EuroNCAP safety scores and real-world death or severe injury outcomes were found, suggesting the need to review biomechanical criteria chosen to set cut-off points for the rating system.

Predictive capability of the injury severity score versus the new injury severity score in the categorization of the severity of trauma patients: a cross-sectional observational study.

PURPOSE: The AIS scale is a measurement tool for single injuries. The ISS is considered the gold standard for determining the severity of injured patients, and the NISS was developed to improve the ISS with respect to loss of information, as well as to facilitate its calculation. The aim of this study was to analyse what injury severity measure, calculated according to the Abbreviated Injury Scale (AIS), 1998 and 2005 (update 2008) versions, performs better with mortality, cost and hospital length of stay healthcare indicators. METHODS: This cross-sectional observational study was carried out between February 1st 2012 and February 1st 2013. Inclusion criteria were injured patients due to external causes admitted to trauma service through the emergency department. Manual coding of all injuries was performed and ISS and NISS scores were calculated for both versions of the AIS scale. Severity was then compared to mortality (in-hospital and at 30 days), healthcare cost, and length of hospital stay. RESULTS: The index with the best predictive capability for in-hospital mortality was NISS 05 (AUC = 0.811). There was a significant increase in hospital stay and healthcare cost in the most severe patients in all indexes, except for ISS 05. CONCLUSIONS: NISS is found to be an index with higher predictive capability for in-hospital mortality and correlates better to length of hospital stay and healthcare cost.

Comparison of mortality due to severe multiple trauma in two comprehensive models of emergency care: Atlantic Pyrenees (France) and Navarra (Spain).

BACKGROUND: Injury due to external causes is an important health problem in our society today. Emergency care systems based on the concept of "comprehensive care" can prevent deaths and disabilities as well as limit the severity and pain caused by trauma. OBJECTIVE: To investigate the frequency and characteristics of different mechanisms of injury and to estimate mortality, comparing two comprehensive emergency systems: Atlantic Pyrenees (AP) in France and Navarra (NA) in Spain. MATERIAL AND METHODS: A prospective cohort study of severe multiple-injury patients attended to by the comprehensive emergency care systems of AP and NA from April 1, 2001 to March 31, 2002. Data were collected from personal patient data, the emergency coordination center "112," pre-hospital and hospital health care levels, and discharge data. Bivariate statistical analysis and multivariate logistic regression models were employed for statistical management. RESULTS: There were 614 severe multiple trauma patients recorded, 278 in AP and 336 in NA. Significant differences were observed in arrival time, pre-hospitalization care, pre-hospital Revised Trauma Score (RTS), Injury Severity Score (ISS) at the intensive care unit, and procedures used (intubation, administration of fluids, immobilization, and diagnostic methods). Logistic regression showed significant differences in patient death, age (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.03), penetrating or accidental injuries, (OR 3.85, 95% CI 1.1-13.1), RTS (OR 0.58, 95% CI 0.5-0.7), and ISS score (OR 1.05, 95% CI 1.0-1.1). CONCLUSION: Despite a more aggressive approach and employment of greater resources, the French comprehensive trauma system does not show greater survival rates among injured patients compared to Navarra, even when controlling for confounding factors like age, injury mechanism, RTS, ISS, and others.

Comparison of injury severity scores (ISS) obtained by manual coding versus "Two-step conversion" from ICD-9-CM.

BACKGROUND: The International Classification of Diseases (ICD) is the standard diagnostic tool for classifying and coding diseases and injuries. The Abbreviated Injury Scale (AIS) is the most widely used injury severity scoring system. Although manual coding is considered the gold standard, it is sometimes unavailable or impractical. There have been many prior attempts to develop programs for the automated conversion of ICD rubrics into AIS codes. OBJECTIVE: To convert ICD, Ninth Revision, Clinical Modification (ICD-9-CM) codes into AIS 2005 (update 2008) codes via a derived map using a two-step process and, subsequently, to compare Injury Severity Score (ISS) resulting from said conversion with manually coded ISS values. METHODS: A cross-sectional retrospective study was designed in which medical records at the Hospital Universitario Marqués de Valdecilla of Cantabria (HUMV) and the Complejo Hospitalario of Navarra (CHN), both in Spain, were reviewed. Coding of injuries using AIS 2005 (update 2008) version was done manually by a certified AIS specialist and ISS values were calculated. ICD-9-CM codes were automatically converted into ISS values by another certified AIS specialist in a two-step process. ISS scores obtained from manual coding were compared to those obtained through this conversion process. RESULTS: The comparison of obtained through conversion versus manual ISS resulted in 396 concordant pairs (70.2%); the analysis of values according to ISS categories (ISS<9, ISS 9-15, ISS 16-24, ISS>24) showed 493 concordant pairs (87.4%). Regarding the criterion of "major trauma" patient (i.e., ISS> 15), 538 matching pairs (95.2%) were obtained. The conversion process resulted in underestimation of ISS in 112 cases (19.9%) and conversion was not possible in 136 cases (19%) for different reasons. CONCLUSIONS: The process used in this study has proven to be a useful tool for selecting patients who meet the ISS>15 criterion for "major trauma". Further research is needed to improve the conversion process.

Reproducibility and clinical relevance of the ocular response analyzer in nonoperated eyes: corneal biomechanical and tonometric implications.

PURPOSE: To assess the reproducibility of the ocular response analyzer (ORA) in nonoperated eyes and the impact of corneal biomechanical properties on intraocular pressure (IOP) measurements in normal and glaucomatous eyes. METHODS: In the reliability study, two independent examiners obtained repeated ORA measurements in 30 eyes. In the clinical study, the examiners analyzed ORA and IOP-Goldmann values from 220 normal and 42 glaucomatous eyes. In both studies, Goldmann-correlated IOP measurement (IOP-ORAg), corneal-compensated IOP (IOP-ORAc), corneal hysteresis (CH), and corneal resistance factor (CRF) were evaluated. IOP differences of 3 mm Hg or greater between the IOP-ORAc and IOP-ORAg were considered outcome significant. RESULTS: Intraexaminer intraclass correlation coefficients and interexaminer concordance correlation coefficients ranged from 0.78 to 0.93 and from 0.81 to 0.93, respectively, for all parameters. CH reproducibility was highest, and the IOP-ORAg readings were lowest. The median IOP was 16 mm Hg with the Goldmann tonometer, 14.5 mm Hg with IOP-ORAg (P < 0.001), and 15.7 mm Hg with IOP-ORAc (P < 0.001). Outcome-significant results were found in 77 eyes (29.38%). The IOP-ORAc, CH, and CRF were correlated with age (r = 0.22, P = 0.001; r = -0.23, P = 0.001; r = -0.14, P = 0.02, respectively), but not the IOP-ORAg or IOP-Goldmann. CONCLUSIONS: The ORA provides reproducible corneal biomechanical and IOP measurements in nonoperated eyes. Considering the effect of ORA, corneal biomechanical metrics produces an outcome-significant IOP adjustment in at least one quarter of glaucomatous and normal eyes undergoing noncontact tonometry. Corneal viscoelasticity (CH) and resistance (CRF) appear to decrease minimally with increasing age in healthy adults.

The evolution of unintentional injury mortality among elderly in Europe.

OBJECTIVE: To compare cause-specific unintentional injury mortality trends among elderly (65+) in the European Union over a 10-year period. METHOD: Overall and cause-specific data for 23 out of the 29 EU and European Free Trade Association countries with population >/= 1,000,000 were retrieved from the World Health Organization (WHO), and age-standardized mortality rates for the first and last 3 available years of the study period were calculated. Proportional mortality changes were estimated through linear regression. RESULTS: Circa 1993, country-specific rates varied widely (>fourfold), but this gap is closing and a statistically significant downward trend in overall mortality is noted circa 2002, in about half of the countries. Rates from falls were reduced by 4.3%, from motor vehicle traffic by 3.1%, and from smoke, fire, and flames by 3.1%. DISCUSSION: A large proportion of EU countries enjoys steady declining trends by major unintentional injury mortality category. Success factors and barriers underlying these benchmarking patterns should be further explored to accelerate the process of injury reduction.

Injury prevention and control: reflections on the state and the direction of the field.

OBJECTIVE: To provide an assessment of the contours of the injury field today and to raise questions about our future direction. MATERIAL AND METHODS: We classified the self-reported activities of injury centers, assessed trends in injury-related publications in peer review journals, and compared data on current funding levels. RESULTS: The 47 identified centers are more likely to focus on unintentional injuries and on prevention than on intentional injuries, biomechanics, acute care or rehabilitation. Injury-related publications have doubled over the past decade, yet remained dwarfed by those on other diseases. Funding for injury prevention remains incommensurate with the burden of injury. Within the injury field itself, publications and funding are not commensurate with the burden imposed by particular injuries. CONCLUSION: Our responsibilities as injury prevention professionals will increase not only because of the projected increase in the global burden of injury but also because of our expanded conceptualization of what the scope of injury prevention should be. The lack of clarity we project about the substantive areas of our expertise and the incommensurate funding for our efforts relative to their toll on global health represent challenges to our field's coherence and ultimate effectiveness.

Classification of the severe trauma patient with the Abbreviated Injury Scale: degree of correlation between versions 98 and 2005 (2008 update). / Grado de correlación entre las versiones 98 y 2005 (actualización 2008) de la Abbreviated Injury Scale (AIS) en la categorización del paciente traumatológico grave.

OBJECTIVES: To explore differences in severity classifications according to 2 versions of the Abbreviated Injury Scale (AIS): version 2005 (the 2008 update) and the earlier version 98. To determine whether possible differences might have an impact on identifying severe trauma patients. MATERIAL AND METHODS: Descriptive study and cross-sectional analysis of a case series of patients admitted to two spanish hospitals with out-of-hospital injuries between February 2012 and February 2013. For each patient we calculated the Injury Severity Score (ISS), the New Injury Severity Score (NISS), and the AIS scores according to versions 98 and 2005. RESULTS: The sample included 699 cases. The mean Severity (SD) age of patients was 52.7 (29.2) years, and 388 (55.5%) were males. Version 98 of the AIS correlated more strongly with both the ISS (2.6%) and the NISS (2.9%). CONCLUSION: The 2008 update of the AIS (version 2005) classified fewer trauma patients than version 98 at the severity levels indicated by the ISS and NISS.

OBJETIVO: Estudiar si existen diferencias en la asignación de gravedad entre las versiones 98 y 2005 ­actualización 2008­ de la escala Abbreviated Injury Scale (AIS) y determinar si estas posibles diferencias podrían tener repercusión en la definición de paciente traumatológico grave. METODO: Estudio descriptivo de una serie de casos con análisis transversal que incluyó a pacientes ingresados por lesiones debidas a causas externas en dos hospitales españoles, llevado a cabo entre febrero de 2012 y febrero de 2013. Se calculó el Injury Severity Score (ISS) y el New Injury Severity Score (NISS) de cada uno de los casos con ambas versiones de la escala AIS. RESULTADOS: La muestra estuvo compuesta por 699 casos, con una edad media de 52,7 (DE 29,2) años, de los cuales 388 (55,5%) fueron varones. Se obtuvo una mayor clasificación de pacientes graves con la versión AIS 98, tanto para el ISS (2,6%) como el NISS (2,9%). CONCLUSIONES: La versión AIS 2005 ­actualización 2008­ clasifica un menor número de pacientes como graves en comparación con la versión AIS 98.

Self-reported drinking and driving amongst educated adults in Spain: The "Seguimiento Universidad de Navarra" (SUN) cohort findings.

BACKGROUND: The role of alcohol as a risk factor for motor vehicle crashes is long known. Yet, reports on the prevalence of drinking and driving suggest values between 20%-30% when the adult driving population is interviewed. We wondered whether these values hold true among European educated citizens and whether there are any significant differences in prevalence by age, gender, type of profession and other lifestyle indicators. METHODS: Cross-sectional analyses of baseline data from a cohort of university graduates in Spain (SUN study). Answered questionnaires contained items on current drinking and driving practices, together with data on socio-demographic characteristics and lifestyle habits. Chi square, Fisher test, and multivariate logistic regression were used to investigate the impact of several variables on drinking and driving practices. Analyses were stratified by gender. RESULTS: Almost 30% of the participants reported "sometimes" drinking and driving. This percent increased to 47% when "almost never" was also included as a positive answer to the drinking and driving practice question. These percentages varied significantly by gender, with up to 64% of men reporting "sometimes" or "almost never" vs. 36% of women doing so. Drinking and driving practices also differed by overall alcohol consumption habits, smoking, use of safety belts, and notably, type of profession. CONCLUSION: Our findings are amongst the first on the high prevalence of drinking and driving among Spanish. Particularly worrisome is the fact that health professionals reported this habit even at higher rates. Multidisciplinary interventions (e.g., legal, educational, economic) are needed to reduce this serious health risk.

[Trends in obesity, diabetes mellitus, hypertension and hypercholesterolemia in Spain (1997-2003)]. / Tendencias de la obesidad, diabetes mellitus, hipertensión e hipercolesterolemia en España (1997-2003).

BACKGROUND AND OBJECTIVE: To evaluate the trend in the prevalence in Spain of obesity, diabetes mellitus, hypertension and hypercholesterolemia. MATERIAL AND METHOD: The Spanish National Health Surveys (ENS) of 1997, 2001, 2003, which select representative samples of the Spanish general population were used. In total, 49,113 participants of both sexes were included. Self-reported data about weight and height were used to estimate the body mass index. The prevalence of diabetes, hypertension and hypercholesterolemia was estimated. Linear trend chi2 tests and multivariate logistic regression models adjusted for age, sex and educational level, were estimated. RESULTS: A significant increasing temporal trend for the prevalence of obesity, diabetes, hypertension and hypercholesterolemia was found for the studied period (1997-2003) according to the ENS. We found that the increased trend in obesity prevalence was restricted to younger participants with a significant interaction. CONCLUSIONS: The prevalence of obesity, diabetes mellitus, hypertension and hypercholesterolemia has increased in Spain between 1997 and 2003.

An evaluation of the EuroNCAP crash test safety ratings in the real world.

We investigated whether the rating obtained in the EuroNCAP test procedures correlates with injury protection to vehicle occupants in real crashes using data in the UK Cooperative Crash Injury Study (CCIS) database from 1996 to 2005. Multivariate Poisson regression models were developed, using the Abbreviated Injury Scale (AIS) score by body region as the dependent variable and the EuroNCAP score for that particular body region, seat belt use, mass ratio and Equivalent Test Speed (ETS) as independent variables. Our models identified statistically significant relationships between injury severity and safety belt use, mass ratio and ETS. We could not identify any statistically significant relationships between the EuroNCAP body region scores and real injury outcome except for the protection to pelvis-femur-knee in frontal impacts where scoring "green" is significantly better than scoring "yellow" or "red".