Epidemiology of road traffic accidents during pleasure travelling: The evidence from the island of Crete

During the six-month period April to September 1995, all 730 road traffic injury victims who contacted any of the three hospitals of the Heraklion District in the island of Crete, directly or through the Medical Emergency Transportation Network, were recorded. A special form was completed containing information about selected characteristics of the victims, nature of the injuries and conditions of the accident. All 39 fatalities owing to road traffic accidents were also registered. In the absence of data concerning the person–time at risk only proportional analyses could be performed. On the basis of Greek hospital discharge statistics in Heraklion District during 1992, one foreigner visitor was discharged owing to injuries of any type for every 18 Greeks. The corresponding ratio for road traffic accidents is close to 1:3, underlying the importance of road traffic accidents as the major health hazard during pleasure travelling. Left-side driving country nationals were at an increased risk for traffic accident when they drove a rented rather than an owned vehicle (p = 0.02), possibly on account of maladaptation during the adjustment period in the country of visit. Moreover, road traffic victims from left-side driving countries compared with foreigners from right-side driving countries were involved 2.5 times more frequently in accidents in which overpassing or other driving manoeuvres require reflexes conditioned on reverse directionality (p = 0.02). Alcohol abuse was reported as a primary cause of accident in a significantly higher proportion of foreign nationals (p < 10^–6) reflecting the fact that the latter group was on vacation. Alcohol intoxication was more common among Eastern European victims than among victims from European Union countries (p < 10^–5). The likelihood of death following hospitalization ranged from 0% among those with a Glasgow Coma Scale (GCS) score of 8 or higher, to 90% among those with GCS less than 8. After adjustment for exact GCS score there was no difference in the probability of death or the likelihood for admission to intensive care unit between Greek and foreign nationals. Road traffic accidents are a major hazard during pleasure travelling and victims of such accidents among travellers have a distinct epidemiologic profile compared with accidents of a similar nature among locals.