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Elihu D. Richter, MD, MPH, Paul Barach, MD, MPH, Lee Friedman, BA, Samuel Krikler, MS and Abraham Israeli, MD, MBA

Elihu D. Richter and Lee Friedman are with Hebrew University-Hadassah School of Community Medicine and Public Health, Unit of Occupational and Environmental Medicine and Injury Prevention Center, Jerusalem, Israel. Paul Barach was with the Center for Patient Safety, Department of Anesthesia and Critical Care, Pritzker School of Medicine, University of Chicago, Ill. Samuel Krikler is with the Department of Statistics and Abraham Israeli was with the Department of Medical Ecology and Health Services, Hebrew University-Hadassah, Jerusalem.

Correspondence: Requests for reprints should be sent to Elihu D Richter MD, MPH, Unit of Occupational and Environmental Medicine, Hebrew University-Hadassah Medical School, Jerusalem 91120, Israel (elir{at}cc.huji.ac.il).

Objectives. We assessed the 5-year, nationwide impact on road deaths of the raise in the speed limit (November 1, 1993) on 3 major interurban highways in Israel from 90 to 100 kph.

Methods. We compared before–after trends in deaths as well as case fatality—an outcome independent of exposure (defined as vehicle-kilometers traveled).

Results. After the raise, speeds rose by 4.5%–9.1%. Over 5 years, there was a sustained increase in deaths (15%) and case fatality rates (38%) on all interurban roads. Corresponding increases in deaths (13%) and case fatality (24%) on urban roads indicated "speed spillover."

Conclusions. Immediate increases in case fatality predicted and tracked the sustained increase in deaths from increased speeds of impact. Newtonian fourth power models predicted the effects of "small" increases in speed on large rises in case fatality rates. Countermeasures and congestion reduced the impact on deaths and case-fatality rates by more than half.