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It has been another week of tragedy on Irish roads. A small rural community in Co Galway is this weekend mourning the loss of Una Bowden (47) and her daughters Ciara (14) and Saoirse (nine) who were killed in a collision involving a lorry and a car on the N17 Galway-Sligo road outside Claremorris in Co Mayo on Tuesday evening. On Wednesday a man in his 20s died after another collision between a car and a lorry in Co Roscommon on the N61 Athlone road at Newtown.
The latest road fatalities come as motorists take to the country’s roads in greater numbers with the large movement of people over the Easter Bank Holiday weekend, one of the busiest of the year.
As of Thursday morning 55 people had been killed on Irish roads, an increase of 13 on the same period last year. The fatalities comprise 24 drivers, 17 passengers, 10 pedestrians, three motorcyclists and one cyclist.
While road deaths – all personal tragedies for individual families – make the headlines, serious injuries sustained in road traffic incidents remain a grey area when it comes to hard statistics.
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The Road Safety Authority (RSA) has sought to investigate this further and conducted a nine-year data trawl to determine the true levels of road crash injuries from 2014 to 2022 as reflected in medical records.
One alarming finding that emerges from this new data centres around serious injuries to cyclists on roads. The number of injured child cyclists recorded in Irish hospital data is more than six times higher than in records kept by An Garda Síochána, the traditional source of official crash statistics.
The report, focused on cycling – and due to be released by the RSA on Saturday – is the first of several to be published examining rates among various road user categories such as pedestrians and vehicle occupants. It is part of a research project in conjunction with the HSE and Trinity College Dublin examining medical data, as opposed to relying on Garda records alone, and gives the first overall picture of the extent to which cyclists have been injured on Irish roads.
In headline terms the study found there were 4,790 cyclists hospitalised, or about 532 per year, a figure 2½ times the rate of Garda Siochana data, which recorded 1,932 serious injury cases in the same time frame.
According to the RSA, various reasons for the discrepancy include the potential for some collisions not being reported to gardaí, and a broad Garda definition of what amounts to serious injury compared to more precise medical indicators. Gardaí regard all inpatient casualties as serious.
When road crash analyst Dr Stefanía Castelló began sifting through hospital data two years ago she came upon an alarming statistic – the amount of children injured while riding their bikes was about six times greater than officially recorded by gardaí.
“We know from the international evidence that there is a discrepancy between police and hospital records overall so we were expecting to see underreporting in the Garda numbers,” she said of the RSA project aimed at recalibrating how we measure road injuries. “[But] we were, I think, surprised by the magnitude of this discrepancy in particular.”
Such stark findings raise complicated questions. What other aspects of road collision injuries have been historically misunderstood; and now that we are adjusting the data what might it mean for policy?
The revised approach does not amount to a criticism of gardaí – they can only report what is reported to them, and their categorisation of injuries is broad, without the benefit of medical expertise.
A deeper analysis of the data reveals important findings.
The number of injured cyclists in the zero-to-14 age category was 6.1 times higher in hospital records than in Garda records showing serious injury and some 3.6 times higher for those aged 65 and over.
Hospitalised cyclists were more often men in Co Dublin between the age of 35 and 54 years. Seriously injured cyclists documented by gardaí were similar in profile but were more frequently aged between 25 and 44.
Almost two-thirds (64 per cent) of hospitalised cyclists were injured in single-vehicle collisions, in this case meaning the bicycles themselves. However Garda records show 78 per cent of seriously injured cyclists were injured in multivehicle collisions.
According to gardaí, frequent causes of bike-only crashes included road surface, loss of control, a collision with a kerb or footpath, or avoiding another vehicle. In both hospital and Garda data single-vehicle bike crashes peaked between 2020 and 2021.
As well as giving a more accurate injury rate the RSA data gives the first comprehensive insight into the extent and nature of serious, often life-changing, injuries. Half of head injuries were to the brain followed by 34 per cent open wounds, 22 per cent fractures, and 18 per cent superficial injuries. Upper-limb injuries included fractures in 86 per cent of cases, as well as open and superficial wounds, while in lower-limb injuries fractures accounted for 67 per cent.
Although most injured cyclists would spend a day or less in hospital care, one in five spent five days or more.
Using the European MAIS (Maximum Abbreviated Injury Scale) injury ranking system the hospital data showed the majority (83 per cent) of hospitalised cyclists sustain minor to moderate severity, with the remainder – 827, or about 92 per year – seriously injured. All levels of injury peaked between 2020 and 2021, with 143, or 12 a month, admitted in 2021.
The most common admission time to hospitals following road traffic incidents involving cyclists was between 8pm and 12am, on a Sunday, and more often in June or July.
The takeaway from the new data is clear: Garda numbers focusing on serious injuries in particular, across all road-user types, give an unreliable picture of crash injuries generally. Medical records are more nuanced.
This new RSA method – the longevity of which will depend on future funding – aims to deliver a better understanding of crashes and their effects on people, an outcome that can help shape responses and focus public attention.
When gardaí attend the scene of a collision the resulting paperwork includes relatively rudimentary information primarily designed to serve investigations: time and place, vehicle types, road conditions. An injury assessment is made but, as noted by the RSA team, gardaí are not medics.
Ireland is not unique in such limitations. Recognising the blind spots of such an approach elsewhere, the European Commission set about improving standards.
In 2013 it introduced a new common definition of serious road injury. Four years later the Valletta declaration on road safety included a commitment by transport ministers to, among other things, pursue reliable and comparable data based on the so-called MAIS scale. By last year about 19 countries, including Ireland, had provided this data to the European Commission. The approaches have varied but, according to the RSA’s head of research Velma Burns, Ireland has gone beyond what is demanded by EC standards.
Emerging discrepancies in crash data – initially demonstrated with preliminary findings at the RSA’s annual conference last year – is informed by a more comprehensive approach under the guidance of the HSE and the department of public health and primary care at Trinity College Dublin.
Now instead of Garda reports alone discharge information from the Hospital In-patient Enquiry (Hipe) system is analysed. This allows researchers to see demographics and clinical data that can help with assessments of injury severity using specifics of the Abbreviated Injury Scale (AIS).
Its data sets run from 2014 to 2022 and allow researchers accurately determine those who were seriously injured, clinically, and those with a higher potential for life-changing consequences. Injuries scored with an AIS score of three or more are deemed seriously injured and are designated as MAIS3+, while those who suffer only minor to moderate injuries are recorded as MAIS2-.
Put more simply it all means a more accurate classification and understanding of the nature and volume of injuries.
The difference in data sets has prompted some criticism. The road safety advocacy group Parc believes the RSA has previously highlighted statistical drops in serious injury rates despite knowing it was doing so on the basis of outmoded, understated records.
“The statistics resulting from serious RTCs and published by the RSA every year are vastly underestimated and highly unreliable,” it said, pushing for the inclusion of information drawn from medical records. “We would expect the Road Safety Authority to be extra vigilant to ensure that policymakers have up to date and accurate data in a timely matter.”
Parc has called for the publication of improved serious injury data as soon as possible.
The RSA is currently working to that end; later reports will cover injuries among other road-users. Pedestrians are likely next, although discrepancies in those cases are expected to be less severe, probably because of an increased likelihood of reports to gardaí compared to single-cyclist collisions.
“It benefits us firstly and most importantly by giving us a more accurate read on the true prevalence of serious injuries,” Ms Burns said of the project work. “That is the fundamental point. If we didn’t look at the hospital data for cyclists we would not know that in fact it’s almost [two to three times the number] hospitalised compared to what we are seeing in the Garda official figures.”
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