Serious road injuries in the Netherlands

Updated

This fact sheet discusses the development of the number of serious road injuries in the Netherlands. Internationally, serious road injuries are defined as persons having sustained injuries in a road crash, whose injuries have a maximum severity of 3 on the medical injury scale AIS (MAIS3+). In the Netherlands, the definition is slightly different: serious road injuries are persons admitted to hospital for injuries with a maximum severity of 2 or more (MAIS2+) and that have not died within 30 days after the crash. Information about these serious road injuries is to be found in the Dutch version of this fact sheet (Ernstig verkeersgewonden in Nederland). It stands to reason that the Netherlands will also start to use the international definition based on MAIS3+ injuries. This fact sheet uses the international definition of casualties, but on the basis of hospital registration. The registered number is estimated to be a few percent lower than the total number of MAIS3+ casualties.

The estimate of the number of serious road injuries in the Netherlands is based on a combination of police crash registration (BRON) and hospital patient registration (LBZ).

Overall, after an initial decrease from the nineties onwards, the number of serious road injuries increased between 2006 and 2019. In 2020, 6,500 road users were seriously injured in the Netherlands. This number is lower than the 2019 number, when 6,900 road users were seriously injured, and it is lower than expected on account of the upward trend. Particularly in the months with social distancing measures to curb the COVID-19 pandemic, and probably related to these measures, casualty numbers were lower than in previous years. This does not imply that lower numbers of serious road injuries are to be expected in the future.

Over two thirds of the seriously injured road users are cyclists. A large majority of them was injured in a crash that did not involve a motor vehicle. More than three out of five seriously injured road users were aged 60 or over, while 15% of them were aged 80 or over.

How many road users were seriously injured in the Netherlands in 2020?

In 2020, an estimated number of 6,500 road users were seriously injured in the Netherlands (with an injury severity of MAIS3+). This number is lower than in 2019 and also lower than the number expected on the basis of the (upward) trends [1] [2].

What is the official definition of a serious road injury?

Internationally, a serious road injury is defined as a road crash casualty that has sustained severe injuries . 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 3 or higher, expressed in the Maximum Abbreviated Injury Score (MAIS) which extends from 1 (slight injury) to 6 (maximum injury) [3]. 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 MAIS3 injuries are skull base fractures, hip or femur shaft fractures, or wrist or ankle amputations.

Until 2010, the term ‘in-patients’ was used in the Netherlands [4]. This term was abandoned as not all of them proved to have been hospitalised or seriously injured.

In the Netherlands, an injury severity of MAIS2+ is currently used for serious road injuries, for which casualties have been admitted to hospital and have not died within 30 days after the crash. Thus classified, the number of serious road injuries is about three times higher than in the international definition. Information about the MAIS2+ injuries can be found in the Dutch version of this fact sheet (Ernstig verkeersgewonden in Nederland). In the Netherlands, the international definition of a serious road injury has not yet been adopted. With respect to international uniformity – at least within the EU- , and in order to bring the definition into line with what is customary in the medical world, it stands to reason that the Netherlands will eventually adopt the international definition as well.

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

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

  • Database of registered road crashes in the Netherlands (BRON).
    In BRON, the Ministry of Infrastructure and Water Management collects and publishes road crash databased on police registration, notifications by road inspectors of the Dutch national road authority and information from media reports. This database contains information on crash characteristics such as road and vehicle characteristics and crash circumstances. BRON does not contain reliable information about injury severity, and a lot of casualties are missing, particularly those resulting from crashes not involving a motor vehicle.
  • The national hospital discharge register (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 and also estimates how many serious road injuries are missing in both databases or are not recognised as such [1]. The quality of both data sources is crucial for a reliable estimate of the number of serious road injuries. A sufficiently large number of casualties 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 reliable observations concerning the developments in serious road injuries with certain characteristics (such as type of road user, age group etc) [1]). About 10% of serious road injuries in crashes without motorised traffic (for example cyclists crashing with a post or with another non-motorised road user) are to be found in BRON; and about 60% of serious road injuries in crashes with motor vehicles are thus registered. This implies that BRON registers the different types and numbers of serious road injuries (rather) incompletely and therefore presents an incomplete picture of actual road safety problems. Hospital registration (LBZ) does provide a more reliable indication of the most common characteristics of serious road injuries. About 95% of serious road injuries are registered there. The hospital registration does, however, not register the location of the crash. It is hoped that, in the future, ambulance data will add more information about crash location.

How did the number of serious road injuries in the Netherlands develop between 2000 and 2020?

Figure 1 shows the development of the number of serious road injuries between 2000 and 2020 according to the international definition [1] [5] [6]. The development shows a continuously upward trend since 2007. But in 2020, the number of serious injuries decreased, probably also caused by the social distancing measures in the context of the COVID-19 pandemic. The decrease in the number of MAIS3+ casualties between 2017 and 2018 can be attributed to a change in the determination method [7].

Figure 1. The number of road injuries found in the Netherlands since 2000, according to 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 by far the largest group among serious road injuries (see Figure 2). In 2020, 70% (about 4,300) of the serious road injuries in the hospital registration were cyclists. In comparison: about one third of the road deaths are cyclists and the number of road deaths 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 seriously injured road users increased over time (not in figure), and amounted to 66% (about 3,700) in 2014-2016. The number of serious road injuries among riders of motorised two-wheelers slightly decreased: while in 2014 this had amounted to 17% (about 900) of the hospital-registered serious road injuries, the number decreased to 15% (about 900 as well) in 2019 and 2020.

In 2020, 57% (about 1,000) of the hospital-registered seriously injured road users were injured in a crash not involving a motorised vehicle.

Figure 2. Distribution of serious road injuries in the Netherlands in 2020, by transport mode, based on the hospital discharge LBZ Sources: DHD and SWOV, see also [1].

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 in the Netherlands determined?). The casualty characteristics based on LBZ appear to be a reasonable alternative.

The risk of being seriously injured (serious road injuries per distance travelled) is highest for (light) mopeds (Figure 3). Figure 3 shows the average risk of the last known four-year period (2014-2017). A multiannual period is presented because risks calculated on an annual basis fluctuate too much due to uncertainties in mobility data and casualty numbers. For more recent years, only the hospital discharge register (LBZ) is reliable enough to determine serious injury data. Currently, information about risk does not extend beyond 2017 on account of the lack of reliable mobility data over the following period.

Figure 3. The risk of serious injury (serious injuries per distance travelled) in the Netherlands for various transport modes, averaged over 2014-2017, determined on the basis of the hospital discharge register LBZ. *For motorised two-wheelers, the 2015-2017 averages are used, since these transport modes could not be properly disaggregated. Sources: Statistics Netherlands, DHD and SWOV .

How are serious road injuries distributed by age and gender?

Figure 4 shows the 2020 age distribution for serious road injuries, based on the hospital discharge register LBZ. An ever growing share of serious injuries are sustained among older road users. In 2020, 58% (about 3,600) of the hospital-registered seriously injured road users were aged 60 or over, while in 2014 this had amounted to 51% (ca. 2,800). The growing share is related to demographic developments, but the share of older road users sustaining serious injuries grows faster than their share of the population. Older people are physically more vulnerable, see also SWOV fact sheet Older road users. Among older seriously injured road users, the share of cyclists exceeds that of other age groups.

In 2020, children made up around 4% (about 200) of the hospital-registered serious road injuries; in 2014 this was about 6% (about 300). Also see SWOV fact sheet Children aged 0 to 14. Most children are injured while cycling or walking. Between 2014 and 2020, the share of hospital-registered seriously injured young people aged 15 to 19 remained unchanged at 5% (about 300). Because they have just started participating in motorised traffic, crash risk for this age group is higher; see also SWOV fact sheets Young drivers and Moped and light-moped riders.

Figure 4. Distribution of serious road injuries in the Netherlands by age group in 2020, based on hospital discharge register LBZ. Sources: DHD, SWOV .

In 2020, 62% (about 3,800) of the serious road injuries were male and 38% (about 2,400) were female. In general, women are more often injured in crashes not involving a motor vehicle than men are. This partly relates to mobility differences between men and women: men drive more, women more often walk or use public transport [8].

What is the distribution of the number of serious road injuries across different road types?

In addition to casualty characteristics, crash location characteristics (type, location) are also important for road safety research and policy making in this field. Currently, hardly any data are available about crash location of serious road injuries, because crash location is only available in BRON, which only includes part of the serious road injuries (see the question How is the number of serious road injuries determined in the Netherlands?). Particularly for serious road injuries sustained in crashes without involvement of a motor vehicle, hardly any crash location information is available. The reason for this lack is that the data of these crashes are almost all derived from the hospital discharge register LBZ which does not register location characteristics.

Of the serious road injuries in crashes that do involve motor vehicles, more crash information is available. Up to 2010, the quality of their registration in BRON was higher, although still not complete. 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 [9]. 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 permanent (the burden of injury, expressed in the number of years lived with disability (YLD)). Remarkable are the large proportions of head injuries, followed by hip and leg trauma. Lasting effects mainly result from head injuries, but also from injuries to the torso. Casualties who suffer lasting impairment mainly experience pain and problems with their daily activities. More than 33% of the casualties experience lingering effects. The injuries and burden of injury vary between traffic modes, between different age groups and also between males and females [10].

Figure 5.  Distribution of injury and burden of injury per body part. Distributions are based on all serious road injuries in LBZ 2014 [10].

Which societal costs are caused by a serious road injury?

Currently, the societal costs of serious road injuries in the Netherlands are only available using the Dutch definition based on an injury severity of MAIS2+. More than one third of the total societal costs of road crashes (about 37%) can be attributed to serious road injuries (part of which is accounted for by MAIS3+ 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 to €19 billion [11]). 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 (MAIS2+). 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); severe injury is defined according to the Dutch definition based on MAIS2+) [11] .

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 using the Dutch definition based on an injury severity of MAIS2+ [11] . Neither for the number of road deaths, nor for serious road injuries were the targets met. For the years to come, 0 road casualties by 2050 are aspired to [12] . The United Nations and the European Union have set targets for the maximum number of serious road injuries. Mid-2020, the United Nations extended the previous 2010 target, which implies a 50% reduction of road injuries by 2030 compared to 2021 [13]. The European Union has now also set targets for the number of road injuries [14] : a 50% reduction of the number of serious road injuries (with MAIS3+ severity) by 2030 compared to 2020. In addition, the objective was that in 2018 as many Member States as possible would know how many MAIS3+ injuries they had. However, the process of gathering information about MAIS3+ injuries in all Member States has not been finalised yet.

If we were to apply the EU target to the Netherlands, this would imply a maximum of 3,000 to 3,500 serious road injuries (with MAIS3+ severity) by 2030. Mid-2021 a motion to adopt the 50% reduction target was passed [15].

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 a harmonised definition, based on road crash casualties with MAIS3+ injuries. It stands to reason that the Netherlands will 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, quite a number of countries encounter problems in collecting the necessary 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 [16].

At a European level, research has been done on MAIS3+ casualties. In 2016, the report Study on serious road traffic injuries in the EU [17] was published, which focuses on data and circumstances of the crashes of MAIS3+ casualties among pedestrians, cyclists, motorcyclists and car occupants. The EU-project SafetyCube investigated the differences in methods used in countries to determine their numbers of MAIS3+ casualties, and how these methods affect the estimated numbers [18]. This EU project also studied the consequences [10] and the societal costs of serious road injuries [19].

Publications and sources

Below you will find the list of references that are used in this fact sheet; all sources can be consulted or retrieved. Via Publications you can find more literature on the subject of road safety.

[1]. Bos, N.M., Bijleveld, F.D., Decae, R.J. & Aarts, L.T. (2021). Ernstig verkeersgewonden 2020. Schatting van het aantal ernstig verkeersgewonden in 2020 [Serious road injuries 2020. Estimate of the number of serious road injuries in 2020]. R-2021-22 [Summary in English]. SWOV, Den Haag.

[2]. Aarts, L., Wijlhuizen, G.J., Gebhard, S., Goldenbeld, C., et al. (2021). De Staat van de Verkeersveiligheid 2021. Doelstellingen voor 2020 definitief niet gehaald – hoe nu verder? R-2021-21. SWOV, Den Haag.

[3]. EC (2013). Towards a strategy on serious road traffic injuries. Memo, 19 March 2013. European Comission, Brussels.

[4]. 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.

[5]. Reurings, M.C.B. & Bos, N.M. (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.

[6]. Bos, N.M., Stipdonk, H.L. & Commandeur, J.J.F. (2017). Ernstig verkeersgewonden 2016. Schatting van het aantal ernstig verkeersgewonden in 2016 [Serious road injuries 2016. Estimate of the number of serious road injuries in 2016]. R-2017-18 [Summary in English]. SWOV, Den Haag.

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

[8]. 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.

[9]. 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.

[10]. 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.

[11]. Ministerie van IenM (2012). Structuurvisie infrastructuur en ruimte. Nederland concurrerend, bereikbaar, leefbaar en veilig. Ministerie van Infrastructuur en Milieu, Den Haag.

[12]. 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.

[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]. Tweede Kamer (2021). Motie van het lid Geurts over een halvering van het aantal verkeersslachtoffers in 2030. Maatregelen verkeersveiligheid 29 398, nr. 946. Tweede Kamer der Staten-Generaal, Den Haag.

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

[17]. 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.

[18]. 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.

[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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