title: Interventions for increasing pedestrian and cyclist visibility for the prevention of death and injuries.
abstract: BACKGROUND
  Pedestrians and cyclists account for nearly one in three of all road users killed and seriously injured in road traffic crashes. Late detection of other road users is one of the basic driver failures responsible for collisions. Aids to improve pedestrians and cyclist visibility have been used to avert potential collisions. However, the impact of these strategies on drivers' responses, and on pedestrian and cyclist safety is not known.
  
  
  OBJECTIVE
  1. To quantify the effect of visibility aids versus no visibility aids, and of different visibility aids on the occurrence of pedestrian and cyclist-motor vehicle collisions and injuries. 2. To quantify the effect of visibility aids versus no visibility aids, and of different visibility aids on drivers' detection and recognition responses.
  
  
  METHODS
  We searched the CENTRAL, the Cochrane Injuries Group specialised register, MEDLINE, TRANSPORT, National Research Register, PsycInfo and PsycLit. We searched the reference lists of included trials, contacted authors and searched the websites of relevant transport research organisations. The searches were last updated in April 2005.
  
  
  METHODS
  1. Randomised controlled trials and controlled before-and-after studies of the effect of visibility aids on the occurrence of pedestrian and cyclist-motor collisions and injuries. 2. Randomised controlled trials of the effect of visibility aids on drivers' detection and recognition responses. This included trials where the order of presentation of visibility aids was randomised or balanced using a Latin square design.
  
  
  METHODS
  Two authors independently screened records, extracted data and assessed trial quality.
  
  
  RESULTS
  We found no trials assessing the effect of visibility aids on pedestrian and cyclist-motor vehicle collisions and injuries. We identified 39 trials assessing the effect of visibility aids on drivers' responses. Fluorescent materials in yellow, red and orange colours improve detection and recognition in the daytime. For night-time visibility, lamps, flashing lights and retroreflective materials in red and yellow colours increase detection and recognition. Retroreflective materials arranged in a 'biomotion' configuration also enhance recognition. Substantial heterogeneity between and within the trials limited the possibility for meta-analysis. Summary statistics and descriptive summaries of the outcomes were presented for individual trials when appropriate.
  
  
  CONCLUSIONS
  Visibility aids have the potential to increase visibility and enable drivers to detect pedestrians and cyclists earlier. Public acceptability of these strategies would merit further development. However, the effect of visibility aids on pedestrian and cyclist safety remains unknown. Studies which collect data on simple, meaningful outcomes are required.
authors.affiliation: Royal College of Obstetricians & Gynaecologists, National Collaborating Centre For Women's and Children's Health, 27 Sussex Place, Regent's Park, London, UK. ikwan@rcog.org.uk
authors.forename: I
authors.initials: I
authors.lastname: Kwan
authors.forename: J
authors.initials: J
authors.lastname: Mapstone
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality / Q000517:prevention & control*; D001642:Bicycling / Q000293:injuries; D003020:Clothing; D003116:Color; D005453:Fluorescence; D006801:Humans; D008029:Lighting; D011482:Protective Devices; D012449:Safety; D013997:Time Factors