Patterns of injuries and injury severity among hospitalized road traffic injury (RTI) patients in Bangladesh

Factors associated with road traffic injury in a high-risk zone of Bangladesh: a mixed-method study

INTRODUCTION

Road traffic injuries are a significant public health issue in low-income and middle-income countries. This study was designed to explore the pattern and factors associated with road traffic injury in a high-risk zone of Bangladesh.

METHOD

This mixed-method study included a total of 363 road traffic injury victims for the quantitative component, and 10 traffic-related officials and 10 drivers for the qualitative element. Data were collected using a pretested questionnaire, key informant interviews and a focus group discussion using a focus group discussion guide. Quantitative and qualitative analyses were done using Stata V.17 and NVivo V.12, respectively.

RESULTS

Most participants were male, illiterate and young (<30 years) with age averaging 31.50±9.16 years. Of all road traffic injury victims, most had mild (45.18%) injuries, and the least had severe (5.79%) injuries, with head being the most common site (34.44%). The highest proportion of injuries were sustained by motor vehicle drivers (57.58%), followed by cyclists/rickshaw pullers (22.59%) and passengers (19.83%). Most vehicles were new (75.21%), and the rest were old (24.79%). Nearly one-third of the participants did not know about driving rules. The presence of knowledge was associated with less severe injury (p=0.031) compared with the absence of knowledge. The qualitative component of the study identified several factors related to road traffic injury, including driver factors (lack of sleep, bad driving habits and lack of helmets), driving activity factors (ignoring rules, overtaking, crossing speed limits and using bright headlights), road-related factors (broken roads, unplanned curves and angles, the need for spacious streets and the lack of appraisal of previous crash records) and traffic control factors (stringent traffic rules, effective implementation and training on using speed guns).

CONCLUSION

The factors related to road traffic injury identified in this study could be used to plan targeted interventions for road safety improvement.

Seat belt use and cardiac arrest immediately after motor vehicle collision: Nationwide observational study

Objective

Motor vehicle collisions (MVCs) are known to cause traumatic cardiac arrest; it is unclear whether seat belts prevent this. This study aimed to evaluate the association between seat belt use and immediate cardiac arrest in cases of MVCs.

Method

This cross-sectional observational study used data from a nationwide EMS-based severe trauma registry in South Korea. The sample comprised adult patients with EMS-assessed severe trauma due to MVCs between 2018 and 2019. The primary, secondary, and tertiary outcomes were immediate cardiac arrest, in-hospital mortality, and death or severe disability, respectively. We calculated the adjusted odds ratios (AORs) of immediate cardiac arrest with seat belt use after adjusting for potential confounders.

Results

Among the 8178 eligible patients, 6314 (77.2 %) and 1864 (29.5 %) were wearing and not wearing seat belts, respectively. Immediate cardiac arrest, mortality, and death/severe disability rates were higher in the "no seat belt use" group than in the "seat belt use" group (9.4 % vs. 4.0 %, 12.4 % vs. 6.2 %, 17.7 % vs. 9.9 %, respectively; p < 0.001). The former group was more likely to experience immediate cardiac arrest (AOR [95 %CI]: 3.29 [2.65-4.08]), in-hospital mortality (AOR [95 %CI]: 2.72 [2.26-3.27]), and death or severe disability (AOR [95 %CI]: 2.40 [2.05-2.80]).

Conclusion

There was an association between wearing seat belts during MVCs and a reduced risk of immediate cardiac arrest.

On-Arrival Lumbar Epidural Analgesia for Lower Limb Trauma Pain in Emergency Care: A Superiority Randomized Controlled Trial

BACKGROUND

Lower limb trauma in emergency settings often leads to pain management challenges. Traditional methods, primarily non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, have limitations. This study explores the efficacy of epidural analgesia in emergency for lower limb trauma patients (ELETRA) as an alternative for managing pain in lower limb trauma patients upon arrival in emergency care.

OBJECTIVES

 This study primarily focuses on determining ELETRA's effectiveness in reducing pain for patients with lower limb trauma upon arrival. It also aims to evaluate ELETRA's influence on decreasing stress and shortening hospital stays compared to traditional pain management approaches.

METHODS

This study was executed as a prospective, parallel-design, randomized controlled trial in the emergency department of a tertiary care teaching hospital. The interventions were performed in a dedicated induction room adjacent to the emergency operating theater. The trial was registered in the Clinical Trial Registry of India with registration number CTRI/2022/08/044699 dated 16/08/2022. Participants were 18- to 50-year-old patients with lower limb injuries, classified under American Society of Anesthesiologists (ASA) class 1 or 2. Participants were randomized into two groups: one receiving ELETRA and the other standard pain control treatment. The effectiveness of pain relief was measured through a visual analog scale (VAS), and hemodynamic parameters, adverse effects, levels of acute phase reactants, and stress hormones were also measured along with patient satisfaction.

RESULTS

The study enrolled 356 participants with lower limb injuries. After excluding participants lost following the intervention, data from 157 individuals in Group A and 160 in Group B were analyzed. Group A's success rate for analgesia (VAS < 2) was 92.35% (n = 145), significantly higher than Group B's 75.62% (n = 121) (p < 0.001). The commonest side effect was hypotension (5.73%) in Group A and nausea in Group B (7.5%). C-reactive protein (CRP) levels rose to 104.71 ± 8.99 mg/dL in Group A and 192.58 ± 9.23 mg/dL in Group B; the difference was statistically significant. Serum cortisol levels were also higher in Group B (67.18 ± 9.21) compared to Group A (44.72 ± 6.14) at one week. Group B had a longer hospital stay, averaging 12.24 ± 4.81 days, against Group A's 10.19 ± 4.91 days.

CONCLUSION

ELETRA is a safe and effective alternative for pain management in lower limb trauma patients in emergency settings. It reduces pain, improves patient satisfaction, and has a favorable impact on stress responses.

Factors affecting citizen safety of urban transportation service in Bangladesh: The case of Pabna municipality

Background

With the rapid growth of cities, the extent of road accidents has increased, posing a threat to the safety of citizens. In Bangladesh, like many other countries, urban areas face a high incidence of road accidents, leading to loss of life, injuries, and economic costs. This research aims to investigate the factors affecting citizen safety of urban transportation service in Bangladesh.

Methods

This study utilized verbal interviews maintained by questionnaires to gather data on citizen perception regarding factors impacting transportation safety. The questionnaire consisted of two sections, collecting non-parametric data on travel behavior and socioeconomic factors, and parametric data on factors related to transportation safety. The dataset was subsequently analyzed using statistical devices such as descriptive statistics, Principal Component Analysis (PCA), Pearson's Correlation Matrix (PCM), and Cluster Analysis (CA).

Results and conclusion

The findings of the study indicate strong significant correlations among several pairs of variables. Notably, traffic rules and enforcement, and driver travel behavior demonstrate a strong positive correlation of 0.784. Similarly, vehicle condition and safety features, and traffic rules and enforcement display a robust positive association of 0.764. PCA demonstrate 23% of the total variance, with a significant positive loading affecting citizen safety, which is influenced by traffic rules enforcement and drivers' travel behavior. The research findings emphasize the implication of traffic rule enforcement and responsible driver behavior in ensuring citizen safety. In Bangladesh, inadequate transportation regulation enforcement has led to high rates of reckless driving and traffic accidents, especially among pedestrians, cyclists, and motorcyclists.

A qualitative exploration of the facility-based trauma care for Road Traffic Crash patients in Bangladesh: When only numbers do not tell the whole story

OBJECTIVE

Bangladesh is currently undergoing an epidemic of road traffic crashes (RTCs). In addition to morbidity and mortality, the economic loss from RTC as per cent of gross domestic product is comparatively higher than in countries with similar socioeconomic conditions. However, trauma care remained poorly developed as a specialty and service delivery mechanism. This study aimed to examine the current situation of in-hospital trauma care after RTCs to inform the design of a comprehensive service for Bangladesh.

DESIGN, SETTING AND PARTICIPANTS

This qualitative study attempted to elicit stakeholders' perceptions and experiences of managing RTCs through in-depth interviews and focus group discussions. Three districts and Dhaka city were selected based on the frequency of occurrence of RTCs. Fifteen in-depth interviews and 5 focus group discussions were conducted with 38 RTC patients, their relatives and community members in the catchment areas of 11 facilities managing trauma patients. Key informant interviews were conducted with 21 service providers and 17 key stakeholders/policy-makers.

RESULTS

Hospital-based trauma care was generally poor in primary and secondary-level facilities. There was no triage area or triage protocol in the emergency rooms, no trained staff for trauma care, no dedicated RTC patient register and scarce life-saving equipment. Only in Dhaka-based tertiary hospitals was trauma care prioritised. These hospitals follow Advanced Trauma Life Support guidelines and maintain an RTC logbook. Emergency diagnostic services were not always available in the hospitals. Most RTC patients were males; the female participants were additionally vulnerable to physical and mental trauma. Affected people avoided taking legal action considering it a lengthy, complicated and ultimately ineffective process.

CONCLUSION

The trauma care services currently available in the studied health facilities are very rudimentary and without the necessary human and financial resources. This needs urgent attention from policymakers, programmers and practitioners to reduce morbidity and mortality from the current epidemic of RTCs in Bangladesh.

Trauma Care Scenarios Following Road Traffic Crashes in Bangladesh: A Scoping Review

INTRODUCTION

We conducted a scoping review of the trauma care situation following road traffic crashes (RTCs) in Bangladesh to inform the design of a comprehensive program for mitigating associated morbidity and mortality.

METHODS

We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis approach to select relevant articles, documents, and reports following a set of inclusion and exclusion criteria. In total, 52 articles and 8 reports and program documents were included in the analysis. We adopted a mixed studies review method for synthesizing evidence and organized information by key themes using a data extraction matrix.

RESULTS

Findings revealed RTC mortality to be 15.3 per 100,000 population in 2019. Pedestrians, cyclists, and motorcyclists were the most vulnerable groups succumbing to moderate to grave injuries. We found that 81% of motorcycle victims did not use any safety device, an estimated 1,844 people per day suffered different degrees of injury, and 29 people per day became permanently disabled. The ambulance-based prehospital care operated in a disjointed and disorganized manner without standard operating procedures and dispatch structure. This disorganization and a lack of a universal communication system led to treatment delay, resulting in chronic disability for the victims. Injury-related patients occupied about 33% of hospital beds, 19% of which were RTC victims. The cost of care for these victims involved substantial out-of-pocket spending, which sometimes reached catastrophic levels. Since 2009, the management of RTCs has deteriorated with a concomitant increase in morbidity and mortality, resulting in a drain on people's lives and livelihoods.

CONCLUSION

The current situation regarding post-crash care in the country, especially when RTCs are on the rise, is not compatible with reaching the SDG targets 3.6 and 11.2 or the government's stated goal of achieving universal health coverage by 2030.

A knowledge elicitation approach to traffic accident analysis in open data: comparing periods before and after the Covid-19 outbreak

Extracting knowledge from open data of traffic accidents has been attracting increasing attention to policymakers responsible for road safety. This article presents a knowledge elicitation approach to exploring the determinants of traffic accidents from open government data of an urban area in Taiwan. The collected open dataset contains 34 decisional attributes and one predictive attribute (i.e., type of injury, including head, breast, leg), and 47,974 cases. Prediction models using a classification-oriented mechanism and generated rules that considered datasets from before (B-dataset; 30,116 cases) and after (A-dataset; 17,868 cases) beginning to combat the Covid-19 pandemic in an urban area of Taiwan were compared. The findings showed that prediction accuracy was acceptable but not high, at 70.73% for B-dataset and 74.77% for A-dataset. Determinants in the human and vehicle categories revealed higher classification ranks than those in the temporal and environment categories. Traffic accidents involving motorcycles were 5.13% higher in A-dataset, whereas those involving cars were 4.11% lower. Injury on leg or foot was 3.46% higher in A-dataset, whereas other types of injury were up to 1.00% lower. The average support for rules in the A-dataset rule base and the simplicity of the A-dataset decision tree were higher than those of B-dataset. The research demonstrates the value of open government data in prediction model development and knowledge elicitation to support policymaking in the traffic safety domain.

Association of Air Pollution and Weather Factors with Traffic Injury Severity: A Study in Taiwan

Exposure to air pollutants may elevate the injury severity scores (ISSs) for road traffic injuries (RTIs). This multicenter cross-sectional study aimed to investigate the associations between air pollution, weather conditions, and RTI severity. This retrospective study was performed in Taiwan in 2018. The location of each road traffic accident (RTA) was used to determine the nearest air quality monitoring and weather station, and the time of each RTA was matched to the corresponding hourly air pollutant concentration and weather factors. Five multiple logistic regression models were used to compute the risk of sustaining severe injury (ISS ≥ 9). Of the 14,973 patients with RTIs, 2853 sustained severe injury. Moderate or unhealthy air quality index, higher exposure to particulate matter ≤2.5 μm in diameter, bicyclists or pedestrians, greater road width, nighttime, and higher temperature and relative humidity were significant risk factors for severe injury. Exposure to nitrogen oxide and ozone did not increase the risk. Auto occupants and scene-to-hospital time were the protective factors. Sensitivity analyses showed consistent results between air pollutants and the risk of severe injury. Poor air quality and hot and humid weather conditions were associated with severe RTIs. Active commuters were at higher risk of sustaining severe RTI.