The Decrease in Traumatic Brain Injury Epidemics Deriving from Road Traffic Collision Following Strengthened Legislative Measures in France

Lieutaud, Thomas; Gadegbeku, Blandine; Ndiaye, Amina; Chiron, Mireille; Viallon, Vivian · 2016 · Crossref

DOI: 10.1371/journal.pone.0167082

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Summary

This study evaluates the impact of strengthened road traffic legislation in France, implemented in 2002, on the incidence, severity, and mortality of Traumatic Brain Injury (TBI) resulting from Road Traffic Collisions (RTC). Motivated by the observation that RTCs accounted for half of severe TBIs in France during the 1990s, the researchers aimed to determine if legal changes altered user behavior and injury outcomes. The study compares two six-year periods: before the legislative changes (1996–2001) and after (2003–2008). The researchers utilized data from the Rhône Registry, which records all RTC casualties in the Rhône Department of France. Injuries were coded using the Abbreviated Injury Scale (AIS), with TBI defined as any head lesion with an AIS score ≥ 2. The analysis included demographic variables, road user types (car occupants, powered two-wheelers, cyclists, pedestrians, and others), and safety device usage. Statistical comparisons were performed using SAS software, including logistic regression to assess the risk of death after adjusting for age, sex, road user type, and injury severity. The results demonstrated a significant decrease in RTC-related TBI incidence by 42% in the post-2002 period, a reduction more pronounced than the 25% decrease in overall RTC casualty incidence. TBI mortality rates dropped by 56%, and lethality among TBI casualties decreased by 23%. These improvements were most marked among car occupants, who saw a 52% reduction in TBI cases. Conversely, the number of casualties involving powered two-wheelers (PTW) increased, and there was a significant rise in severe TBI cases among PTW users and cyclists. The study also found that non-use of seatbelts and helmets was strongly associated with TBI and fatality; for instance, helmet use was significantly lower among deceased PTW users compared to national averages. Additionally, while TBI incidence decreased across all age groups under 60, the reduction was less pronounced in older age classes, identifying individuals over 60 and two-wheel users as the primary at-risk groups in the later period. The authors conclude that the substantial reductions in TBI incidence and mortality are largely attributable to changes in road user behavior induced by law enforcement, rather than solely improvements in vehicle safety or care standards. The disproportionate benefit for car occupants suggests effective compliance with seatbelt laws, while the persistent risk for two-wheel users highlights the need for targeted interventions. The findings imply that legislative measures can significantly alter trauma epidemiology, but specific vulnerable populations remain at high risk despite overall improvements.

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• fatality injury trends
• incidence prevalence

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• Empirical Findings: crash risk outcomes