Journal of Emergencies, Trauma, and Shock
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 Table of Contents    
ORIGINAL ARTICLE  
Year : 2013  |  Volume : 6  |  Issue : 2  |  Page : 110-112
Impact of road traffic "penalty points" on high energy pelvic trauma


Department of Trauma and Orthopaedic Surgery, AMNCH, Tallaght, Dublin 24, Ireland

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Date of Submission19-Nov-2012
Date of Acceptance20-Nov-2012
Date of Web Publication19-Apr-2013
 

   Abstract 

Background: The penalty points system (PPS) was introduced in 2002 in an attempt to reduce the increasing rate of road traffic accident (RTA) related fatalities and serious injuries. Points are awarded based on the severity of the offence and are cumulative. A total of 12 points results in the disqualification from driving. Objective: A few studies have looked at the immediate or short term impact of PPS on trauma services or specific injuries such as spine trauma in Ireland. Little data is available on the long term effect of the PPS. The aim of this study is to see if the PPS system has had an influence on the number of pelvic injuries referred to our unit for surgical intervention and if this influence is sustained in the longer term. Materials and Methods: A retrospective review of all pelvic and acetabular injuries admitted to our unit from 1999 to 2008 was undertaken. The mechanism of injury, the site and patient demographics were noted. Results: A total of 467 patients were identified over the ten year period. 454 patients were included in the study. There was a significant male preponderance of 76%. Mean age was 36.5 years (range 16 to 83). RTA's were the cause in 74% (n = 335) of the cases. The annual work load remained similar over the years. There has been a reduction in the number of RTA related pelvic injuries. There have been notable drops in the number of these cases corresponding to the introduction of the PPS and its subsequent expansion. The number of pelvic injuries due to falls continues to rise. Conslusion: The introduction of the PPS and its subsequent expansion has had a positive influence on the number of RTA related pelvic trauma. Continued surveillance and enforcement of the PPS is important for a sustained benefit from it in the long term.

Keywords: Pelvic trauma, penalty points, road safety

How to cite this article:
Ellanti P, Davarinos N, Morris S, McElwain JP. Impact of road traffic "penalty points" on high energy pelvic trauma. J Emerg Trauma Shock 2013;6:110-2

How to cite this URL:
Ellanti P, Davarinos N, Morris S, McElwain JP. Impact of road traffic "penalty points" on high energy pelvic trauma. J Emerg Trauma Shock [serial online] 2013 [cited 2018 Sep 26];6:110-2. Available from: http://www.onlinejets.org/text.asp?2013/6/2/110/110761



   Introduction Top


The introduction of the penalty points system (PPS) in October 2002 was aimed at reducing the high number of road traffic accidents (RTAs) and related fatalities in Ireland. The number of Penalty Points awarded is dependent on the severity of the offence and are cumulative up to twelve points where upon the offenders license to drive is revoked. The system was primarily composed of speed related offences but was expanded to include a range of road safety related offences. In 2006 fixed charge fines were introduced for certain offences. They provided a further financial incentive to the existing potential for losing the driving license to change dangerous driving behaviour. [1]

Pelvic fractures are relatively uncommon injuries that are challenging to manage. The high energy required to disrupt the pelvis often results in complex injury patterns with significant morbidity and mortality. RTAs are the commonest cause of major pelvic ring injuries, [2],[3],[4] followed by falls from a height.

Our unit undertakes the majority of orthopaedic trauma from a population base of approximately four hundred thousand and it is the National Referral Centre for pelvic and acetabular trauma. We noted a steady workload without the anticipated reduction in pelvic injuries that one might expect subsequent to the introduction of the PPS. The road safety authority has documented a decrease in both the number of fatalities and serious injuries in Ireland since the introduction of the PPS. [5] Other Irish studies have demonstrated similar findings with a decrease in overall RTA related admissions [6] and also specific injuries such as RTA related spine, [7] head and thoracic [8] injuries.

We undertook a retrospective study over a 10 year period to see if the PPS had any influence on the aetiology of pelvic injuries.


   Materials and Methods Top


An analysis of all the cases of pelvic and acetabular trauma that underwent surgery over a 10-year period (1999 to 2008) was carried out retrospectively. The hospital inpatient inquiry (HIPE) system, operating theatre registry and clinical notes were used to gather the data. Demographic data as well as aetiology were noted. Injuries sustained outside of Ireland as well as elective and tumour related procedures were excluded. The data was entered into a Microsoft Excel (Microsoft Corporation) database.


   Results Top


Between 1999 and 2008, a total of 467 operative procedures were undertaken for pelvic trauma. Due to incomplete or unavailable records of 13 patients a total of 454 were included in this study. The average age was 36.5yrs (16-83) with a significant male preponderance of 76% (n = 345) compared to females 24% (n = 109). The acetabulum was the most common site (69%) of injury requiring surgery. The vast majority of the injuries were due to RTAs (74%), the remainder primarily due to falls from a height [Figure 1]. The percentage of these injuries due to RTAs dropped by more than 17% in 2003 the year after the introduction of the PPS. However this number began to increase and by 2006 was similar to 2003. With the expansion of the PPS in 2006, there was a decrease in 2007 and 2008 noted. The number of these injuries due to falls was noted to be increasing over the years.
Figure 1: Number of pelvic injuries due to RTAs. Note the decrease in injuries due to RTAs subsequent to the introduction and further expansion of the PPS

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   Discussion Top


Despite road safety advances and improved motorway networks over the last decade the number of pelvis and acetabular trauma managed at our institution has remained relatively unchanged. The PPS system has had a significant impact on the number of fatalities and the number of serious and minor injuries in Ireland. It can be noted from [Figure 2] and [Figure 3] that there was a sizable drop in the immediate aftermath of the introduction of the PPS system in 2002 and on subsequent expansion of it in 2006. This relationship is also reflected in the number of pelvic injuries recorded in our unit [Figure 1]. The number of RTA related injuries for 2008 [Figure 2] seems to reflect an increase, this has been due to an increase in the number of minor injuries reported and has been attributed by the Road Safety Authority as a result of improved reporting of these minor injuries. Though the number of pelvic and acetabular injuries from RTAs managed in our unit has been overall decreasing this has not resulted in a decrease in the overall number of cases. This is primarily due the increasing number of these injuries having resulted from falls from a height. Most of these injuries are work related and in particular from construction sites. There has been enormous increase in construction activities in Ireland during the economic boom of recent years.
Figure 2: RTA related Injuries in Ireland. Note the decrease in injuries (serious and minor) after introduction of the PPS and its subsequent expansion. Data from the road safety authority

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Figure 3: RTA related fatalities in Ireland. Note the decrease in fatalities after introduction of the PPS and its subsequent expansion. Data from the road safety authority

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The year following the introduction of the PPS there was a drop in the number of fatalities and serious injuries including pelvic trauma. This early positive response has been noted in other countries such as Spain [9] and Brazil [10] on introduction of similar demerit systems. Similar to our own study, a decrease in specific injuries such as maxillofacial [11] and spine trauma [7] secondary to RTAs in Ireland has been noted in the immediate period following the introduction of the PPS. This suggests that there have been positive changes to driver behaviour.

However the effect of the initial introduction of the PPS in 2002 seems to have reversed within 2 years and by 2004 the number of fatalities and serious injuries, including pelvic trauma began to increase again [Figure 1],[Figure 2] and [Figure 3]. This trend has been noticed by other studies. [7],[12] The expansion of the PPS in 2006 saw a sustained reduction in the number of fatalities and pelvic trauma. There are many factors for this. The fixed monetary fines associated with certain offences may have had a significant impact on driver behaviour. At this time there was a more rigorous enforcement of the system and a more visible road safety campaign. Redelmeier, et al.[13] noted that after a driver is convicted of a driving offence, the risk of a fatal collision drops by 35% in the first month compared to those without a conviction. However this effect is lost by 3-4 months. They concluded that inconsistent enforcement of traffic laws may lead to road deaths. Izuierdo et al.[9] concluded that PPS in conjunction with gradual stepping up of surveillance measures and sanctions as well a publicity of road safety issues are needed for prevention of RTAs.


   Conclusion Top


We noted an almost constant workload of pelvic injuries per annum requiring surgical intervention. The introduction of the PPS and its subsequent expansion has had a positive influence on the number of RTA related pelvic trauma. Continued surveillance and enforcement of the PPS is important for a sustained benefit from it in the long term.

 
   References Top

1.Road Safety Authority. Penalty Points. Available from: http://www.rsa.ie/en/RSA/Licensed-Drivers/Penalty-points/How-it-works-why-it-matters. [Last accessed on 2012 Dec 20].  Back to cited text no. 1
    
2.Giannoudis PV, Grotz MR, Tzioupis C, Dinopoulos H, Wells GE, Bouamra O, et al. Prevalence of pelvic fractures, associated injuries, and mortality: The United Kingdom perspective. J Trauma 2007;63:875-83.  Back to cited text no. 2
    
3.Gänsslen A, Pohlemann T, Paul C, Lobenhoffer P, Tscherne H. Epidemiology of pelvic ring injuries. Injury 1996;27:S-A13-20.  Back to cited text no. 3
    
4.Laird A, Keating JF. Acetabular fractures: A 16-year prospective epidemiological study. J Bone Joint Surg Br 2005;87:969-73.  Back to cited text no. 4
    
5.Collision Fact Book: Road Safety Authority. Available from: http://www.rsa.ie/Documents/Road%20Safety/Crash%20Stats/2009_Road_Collision_Fact_Book.pdf. [Last accessed on 2010 Dec 15].  Back to cited text no. 5
    
6.Lenehan B, Street J, Barry K, Mullan G. Immediate impact of ′penalty points legislation′ on acute hospital trauma services. Injury 2005;36:912-6.  Back to cited text no. 6
    
7.Healy DG, Connolly P, Stephens MM, O′Byrne JM, McManus F, McCormack D. Speed and spinal injuries. Injury 2004;35:908-12.  Back to cited text no. 7
    
8.Donnelly M, Murray P, Cleary S. Changes in trauma service workload since the introduction of the penalty points system. Ir Med J 2005;98:53-4.  Back to cited text no. 8
    
9.Izquierdo FA, Ramírez BA, McWilliams JM, Ayuso JP. The endurance of the effects of the penalty point system in Spain three years after. Main influencing factors. Accid Anal Prev 2011;43:911-22.  Back to cited text no. 9
    
10.Poli de Figueiredo LF, Rasslan S, Bruscagin V, Cruz R, Rocha e Silva M. Increases in fines and driver licence withdrawal have effectively reduced immediate deaths from trauma on Brazilian roads: First-year report on the new traffic code. Injury 2001;32:91-4.  Back to cited text no. 10
    
11.Hussain OT, Nayyar MS, Brady FA, Beirne JC, Stassen LF. Speeding and maxillofacial injuries: Impact of the introduction of penalty points for speeding offences. Br J Oral Maxillofac Surg 2006;44:15-9.  Back to cited text no. 11
    
12.Butler JS, Burke JP, Healy DG, Stephens MM, McManus F, McCormack D, et al. Trends in RTA related spinal injuries: The post penalty points era. Ir J Med Sci 2006;175:20-3.  Back to cited text no. 12
    
13.Redelmeier DA, Tibshirani RJ, Evans L. Traffic-law enforcement and risk of death from motor-vehicle crashes: Case-crossover study. Lancet 2003;361:2177-82.  Back to cited text no. 13
    

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Correspondence Address:
Prasad Ellanti
Department of Trauma and Orthopaedic Surgery, AMNCH, Tallaght, Dublin 24
Ireland
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2700.110761

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