Intended for healthcare professionals

Rapid response to:


Reducing the speed limit to 20 mph in urban areas

BMJ 2000; 320 doi: (Published 29 April 2000) Cite this as: BMJ 2000;320:1160

Rapid Response:

Long term sequelae of road traffic accidents

Pilkington (1) highlights the major threat to the lives of children
in the United Kingdom posed by road traffic accidents. The
devastating consequences for the survivors of road traffic accidents and
their families need further elaboration. The chronic sequelae
for survivors that create difficulties in interpersonal, educational and
social functioning are the behavioural and cognitive problems (2).
A significant proportion of children who sustain a traumatic brain injury
after the age of three present with emotional problems (3). The
implications for further education and eventual persual of employment
opportunities are obvious.

The acute medical care of individuals with a traumatic brain injury
has made significant advances over the last three decades,
resulting in an increased number of survivors. Limited rehabilitation
programmes have been developed for these patients in the United
Kingdom (4). The impact on the individual, the family and society
(including the NHS) is enormous and should not be
underestimated. The economic costs (both direct and indirect) resulting
from traumatic brain injury is immense (5). This takes on
added weight when considering that most individuals who survived a
traumatic brain injury may have a normal life expectancy.

Any measure to reduce the incidence of traumatic brain injuries
resulting from road traffic accidents should be supported. This
includes a reduction in the speed limit to 20 mph in urban areas. As
Pilkington (1) rightly points out, other issues such as driver
education and enforcement also need to be addressed. The potential for
reducing deaths and injuries as well as costs to the National
Health Service may be significant.


1. Pilkington, P. Reducing the speed limit to 20 mph in urban areas.
British Medical Journal, 2000; 320: 1160.

2. Lishman, W.A. Organic Psychiatry. The Psychological Consequences
of Cerebral Disorder. (Third Edition). Oxford: Blackwell
Science, 1998.

3. Braga, L.W. & da Paz, A.C. Neuropsychological Pediatric
Rehabilitaion. In: A. Christensen & B.P. Uzzell (Eds.) International
Handbook of Neuropsychological Rehabilitation. London: Kluver Academic,

4. Greenwood, R.J. & McMillan, T.M. Models of rehabilitation
programmes for the brain injured adult. I: Current provision, efficiency
and good practice. Clinical Rehabilitation, 1993; 7: 248-255.

5. Max, W.,: MacKenzie, E.J. & Rice, D.P. Head injuries: costs
and consequences. Journal of Head Trauma Rehabilitation, 1991; 6:

Competing interests: No competing interests

08 May 2000
Rudi Coetzer
Head of Brain Injury Service