The aim of the present study was to estimate the correlation between Euro NCAP pedestrian rating scores and injury outcome in real-life car to pedestrian crashes, with special focus on long-term disability. The study also surveyed most frequently injured body regions and risk differences for specific elements of pedestrians hit by cars. Another aim was to determine whether Brake Assist systems affect the injury outcome in real-life car to pedestrian crashes and to estimate the effect in injury reduction of a high Euro NCAP ranking score combined with Brake Assist. In the current study, the Euro NCAP pedestrian scoring was compared with the real-life outcome in pedestrian crashes that occurred in Sweden 2003-2010. The real-life crash data was obtained from the data acquisition system STRADA, which combines police records and hospital admission data. The medical data consisted of International Statistical Classification of Diseases and Related Health Problems (ICD) diagnoses and Abbreviated Injury Scale (AIS) scoring. In all approximately 500 pedestrians submitted to hospital were included in the study. Each car model was coded according to Euro NCAP pedestrian scores. In addition, the presence or absence of Brake Assist (BA) was coded for each car involved. Pedestrians were grouped according to associated car scoring. Injury outcomes were analyzed with AIS and, at victim level, with permanent medical impairment. This was done by translating the injury scores for each individual to Risk of Serious Consequences (RSC) at 1, 5 and 10% level of medical disability or more. This indicates the total risk of a medical disability for each victim, given the severity and location of injuries. The mean RSC (mrsc) was then calculated for each pedestrian group and t-tests were conducted to ensure statistically significant differences in mrsc between groups. The results showed a significant reduction of injury severity for pedestrians hit by cars with better pedestrian scoring, although pedestrians hit by cars with a high score (three or four stars) could not be studied, due to lack of cases. The reduction of RSC for pedestrians hit by medium performing (two-star) cars in comparison with pedestrians hit by low performing (one-star) cars was 12, 19 and 28% for 1 ,5 and 10% of medical impairment or more, respectively. These results applied to speed limits up to 90 km/h. In urban areas with speed limits up to 50 km/h the reduction of RSC was 17, 26 and 38% for 1, 5 and 10% of medical impairment or more, respectively. Car to pedestrian crashes was most common at speed limits up to 50 km/h and leg, arm and head were the most frequently injured body regions. RSC for pedestrians hit by cars with Brake Assist was not statistically significant lower than for pedestrians hit by cars without Brake Assist. RSC for pedestrians hit by two-star cars with Brake Assist was 19, 31 and 46% lower for 1, 5 and 10% of medical impairment or more, respectively, compared to pedestrians hit by one-star cars without Brake Assist. A significant correlation between Euro NCAP pedestrian score and injury outcome in real-life car to pedestrian crashes was found. The injury reduction was found to be larger for higher severity and level of permanent medical impairment. Car to pedestrian crashes was most common at lower speed zones. Leg, arm and head were the most frequently injured body regions. Brake Assist had no statistically significant effect measured in RSC on car to pedestrian crashes in this material. A high Euro NCAP scoring combined with Brake Assist was shown to give a high effect in reduction of RSC for pedestrians. / Syftet med denna studie var att uppskatta korrelationen mellan Euro NCAPs testresultat för fotgängarskydd och skadeutfall i verkliga olyckor med fotgängare och personbilar, med särskilt fokus på skador som ger medicinsk invaliditet. I studien kartlades även de mest frekvent skadade kroppsregionerna och riskskillnader för särskilda faktorer för fotgängare påkörda av personbilar. Studien syftar dessutom till att undersöka bromsassistanssystems påverkan av skadeutfallet för fotgängare i verkliga olyckor med personbil och att uppskatta den skadereducerande effekten av en hög Euro NCAP-poäng kombinerat med en bromsassistansutrustning. I denna studie var Euro NCAPs fotgängarskyddspoäng jämförd mot skadeutfallet i verkliga olyckor som skett i Sverige 2003-2010. Data från verkliga olyckor inhämtades från databasen STRADA (Swedish Traffic Accident Data Acquisition) som kombinerar polis- och sjukvårdsrapporterad data. De medicinska data innehåller diagnoser av typen ICD (International Statistical Classification of Diseases and Related Health Problems) och värden för AIS (Abbreviated Injury Scale). I helhet var omkring 500 fotgängare inkluderade i studien. Varje enskild personbilmodell kodades enligt Euro NCAPs fotgängarskyddspoäng. Dessutom kodades förekomst eller avsaknad av bromsassistansutrustning för varje enskild personbil inkluderad i studien. Fotgängarna grupperades enligt påkörande personbils fotgängarskyddspoäng. Skadeutfallet analyserades med AIS, på individnivå och med medicinsk invaliditet. Detta gjordes genom översättning av skadeutfall för varje fotgängare till risk för allvarliga konsekvenser (RSC, Risk of Serious Consequences) på 1, 5 och 10 % medicinsk invaliditet eller mer. Detta påvisar den totala risken för medicinsk invaliditet med hänsyn till skadegrad och -lokalisering. Medelvärdet av RSC (mrsc) beräknades sedan för varje fotgängargrupp och t-test utfördes för att säkerställa statistiskt signifikanta skillnader mellan gruppernas mrsc. Resultaten visade en signifikant skadereduktion för fotgängare påkörda av personbilar med en högre fotgängarskyddspoäng, trots att fotgängarolyckor med personbilar som har hög poäng (stjärnbetyg tre och fyra) inte kunde studeras på grund av fåtaligt antal olycksfall. Reduktionen av RCS för fotgängare påkörda av medelpresterande (stjärnbetyg två) personbilar i jämförelse med fotgängare påkörda av lågpresterande (stjärnbetyg ett) personbilar var 12, 19 och 28 % för 1, 5 respektive 10 % medicinsk invaliditet eller mer. Dessa resultat gäller olyckor på vägar med hastighetsgräns upp till 90 km/h. I stadsmiljö med hastighetsgräns upp till 50 km/h var reduktionen av RSC 17, 26 och 38 % för 1, 5 respektive 10 % medicinsk invaliditet eller mer. Fotgängarolyckor med personbil var vanligast på vägar med hastighetsgräns upp till 50 km/h och ben, arm och huvud var de mest frekvent skadade kroppsregionerna. RSC för fotgängare påkörda av personbilar utrustade med bromsassistans var inte statistiskt signifikant lägre än för fotgängare påkörda av personbilar utan bromsassistansutrustning. RSC för fotgängare påkörda av tvåstjärniga personbilar utrustade med bromsassistans var 19, 31 och 46 % lägre för 1, 5 respektive 10 % medicinsk invaliditet eller mer jämfört med fotgängare påkörda av enstjärniga personbilar utan bromsassistansutrustning. En signifikant korrelation mellan Euro NCAPs fotgängarpoäng och skadeutfall i verkliga fotgängarolyckor med personbil påträffades. Skadereduktionen visade sig vara högre för högre skadegrad och nivå av medicinsk invaliditet. Det var vanligare att personbilar kör på fotgängare på vägar med lägre hastighetsgräns. Ben, arm och huvud var de mest frekvent skadade kroppsregionerna. Bromsassistans hade inte en statistiskt signifikant effekt mätt i RSC för fotgängarolyckor i detta material. En hög Euro NCAP poäng kombinerat med bromsassistansutrustning visade sig ge en hög effekt av att reducera fotgängares RSC.

Physical activity is an essential component of a healthy life, e.g. to prevent obesity, cardiovascular disease and premature death, of which sports can be an important part. Unfortunately, sports activities increase the risk of both overuse and acute injuries. Severe acute injuries may also lead to a permanent medical impairment (PMI), which may influence the ability to be physically active throughout life. However, sports injuries may be prevented, but a profound understanding of the injuries and how to prevent them is needed. This doctoral thesis examine acute sports injuries reported by licensed athletes of all ages and level of sports nationwide in Sweden, by using national insurance data. Approximately 80% of all the Sports Federations (SF) had their mandatory accident insurance in the insurance company Folksam, and since there is no national sports injury surveillance system in Sweden, this is a unique database, able to be used in epidemiological studies on acute injuries occurring in organized sports in Sweden. The main aim of this thesis was to identify high-risk sports for acute injuries, the most common and the most severe injuries, especially in large sports with numerous licensed athletes, many injuries and injuries resulting in PMI. Based on the results, there will be recommendations regarding sports and body locations where injury prevention efforts should be focused to gain the greatest prevention effect at a national level in Sweden. Another aim was to evaluate the effectiveness of a neuromuscular knee control training program (KCP) that has been implemented nationwide to reduce knee and cruciate ligament injuries, among football players in Sweden. After evaluating the validity and reliability of the information within the database based on international guidelines, acute injury data were examined and the results presented in four papers. These results showed that there is a need of injury prevention especially in motorcycle sports, team ball sports, and ice hockey. Particularly, knee injuries need to be prevented since they were both the most common injuries and leading to PMI. The severe head- and upper limb injuries also need attention. Sixty-nine percent of the PMI injured athletes, were younger than 25 years. The injury prevention training program, KCP can be considered partially implemented nationwide, since 21 out of 24 district SFs provided KCP educations. The incidence of knee and cruciate ligament injuries has decreased among football players in Sweden. A concerning aspect is that there is no national official policy regarding sports injury and injury prevention in Sweden, nor an official authority that has the explicit responsibility for these issues.