India State-Level Disease Burden Initiative Road Injury Collaborators. Mortality due to road injuries in the states of India: the Global Burden of Disease Study 1990-2017

Fabrication of Quercetin-Functionalized Morpholine and Pyridine Motifs-Laden Silk Fibroin Nanofibers for Effective Wound Healing in Preclinical Study

Choosing suitable wound dressings is crucial for effective wound healing. Spun scaffolds with bioactive molecule functionalization are gaining attention as a promising approach to expedite tissue repair and regeneration. Here, we present the synthesis of novel multifunctional quercetin with morpholine and pyridine functional motifs (QFM) embedded in silk fibroin (SF)-spun fibers (SF-QFM) for preclinical skin repair therapies. The verification of the novel QFM structural arrangement was characterized using ATR-FTIR, NMR, and ESI-MS spectroscopy analysis. Extensive characterization of the spun SF-QFM fibrous mats revealed their excellent antibacterial and antioxidant properties, biocompatibility, biodegradability, and remarkable mechanical and controlled drug release capabilities. SF-QFM mats were studied for drug release in pH 7.4 PBS over 72 h. The QFM-controlled release is mainly driven by diffusion and follows Fickian's law. Significant QFM release (40%) occurred within the first 6 h, with a total release of 79% at the end of 72 h, which is considered beneficial in effectively reducing bacterial load and helping expedite the healing process. Interestingly, the SF-QFM-spun mat demonstrated significantly improved NIH 3T3 cell proliferation and migration compared to the pure SF mat, as evidenced by the complete migration of NIH 3T3 cells within 24 h in the scratch assay. Furthermore, the in vivo outcome of SF-QFM was demonstrated by the regeneration of fresh fibroblasts and the realignment of collagen fibers deposition at 9 days post-operation in a preclinical rat full-thickness skin defect model. Our findings collectively indicate that the SF-QFM electrospun nanofiber scaffolds hold significant capability as a cost-effective and efficient bioactive spun architecture for use in wound healing applications.

Examining factors influencing the severity of motorized two-wheeler crashes in Delhi

Failure to meet road safety targets has necessitated urgent actions from stakeholders worldwide, especially in developing countries like India. Road safety of motorized two-wheelers (MTWs), one of India's most preferred travel modes for urban commutes, is in danger and witnessing threatening figures of fatalities and injuries. Most of the studies in the domain of MTW safety were conducted in developed countries, with very limited research in countries having a significant proportion of MTWs. The present work investigates police-reported crash data to identify the contributory factors of motorized two-wheeler crash severity. Data from MTW crash-prone areas were selected from Delhi, which is leading in road traffic fatalities among the million-plus urban cities in India. A binary logistic regression model was developed using the data for 2016-2018 period. The model results show that the odds of fatal motorized two-wheeler crashes increase when the following circumstances apply: crash occurs on underpasses; involves bus, truck, heavy motor vehicle (lorry, crane) as the striking vehicle; when hit-and-run type of crash occurs and when older age-group (> = 55) riders are involved. Finally, based on the findings, countermeasures were suggested to facilitate policymakers and traffic enforcement agencies, in improving the road safety situation of MTW users.

Review of the India Adolescent Health Strategy in the context of disease burden among adolescents

Background

A nuanced understanding of the health needs of adolescents in the context of the India Adolescent Health Strategy (IAHS) is needed to inform policy interventions for improving the health and well-being of adolescents in India.

Methods

Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, we identified the top ten causes of years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) disaggregated by sex and age group (10-14 and 15-19 years) for India and its states in 2019. To inform the IAHS of refinement or expansion in focus needed to improve adolescent health in India, we reviewed the extent to which the top 10 causes of disease burden are addressed in the IAHS, and the availability of and age- and sex-disaggregation in the service utilisation data for adolescents captured in the Adolescent Friendly Health Clinic monitoring information system (AFHC MIS) and Health Management Information System (HMIS). We also reviewed the availability of and age-and sex-disaggregation in the data capture at the population level for the IAHS outcome indicators in the data sources identified in the IAHS operational framework.

Findings

Females in the 10-14 and 15-19 years age groups suffered 6.75 million and 9.25 million DALYs, respectively, 39.1% and 44.2% of which were YLLs; the corresponding DALYs for males were 6.71 million and 9.65 million (42.3% and 41.1% YLLs), respectively. Within the 6 thematic areas of the IAHS, most strategies and indicators identified are for sexual and reproductive health followed by nutrition, and broadly these conditions accounted for YLDs and not YLLs in adolescents. Significant gaps in the IAHS in comparison to the disease burden for fatal diseases and conditions were seen across injuries, communicable diseases, and non-communicable diseases. Injuries accounted for 65.9% and 45.3% of YLLs in males and females aged 15-19 years, and 40.8% in males aged 10-14 years. Specifically, road injuries (15.3%, 95% UI 11.0-18.0) and self-harm (11.3%, 95% UI 8.7-14.2) accounted for most of the injury deaths in 15-19 years whereas drowning (7.7% 95% UI 5.8-9.6) and road injuries (6.9%, 95% UI 4.7-8.6) accounted for the most injury deaths in 10-14 years males. However, only self-harm and gender-based violence are specifically addressed in the IAHS with non-specific interventions for other injuries. Diarrhoea, lower respiratory infections, malaria, encephalitis, tuberculosis, typhoid, cirrhosis, and hepatitis are the other disease conditions accounting for YLLs and DALYs in adolescents but these are neither addressed in the IAHS nor in service provision under the AFHC MIS. There is no age- or sex-disaggregation in the cause of death data captured in the HMIS to allow an understanding of mortality in adolescents. For the IAHS outcome indicators at the population level, data capture for the 10-14 years irrespective of sex was largely missing from the population surveys and none of the surveys captured data for either females or males aged 15-19 years for physical inactivity and mental health indicators.

Interpretation

The considerable differences seen in the IAHS thematic focus as compared with the leading causes of fatal and non-fatal disease burden in adolescents in India, and in the availability of population-level data to monitor the outcome indicators of the IAHS can pose substantial limitations for improving adolescent health in India. The findings in this paper can be utilized by decision makers to refine action aimed at improving adolescent health and well-being.

Funding

Bill & Melinda Gates Foundation.

Global burden and trends of three common road injuries from 1990 to 2019 and the implications for prevention and intervention

BACKGROUND

Analysis on the burden of specific types of road injuries (RIs) in the previous Global burden of disease (GBD) studies is lacking. The present work aimed to analyze the burden of three common RIs using the updated data of the GBD 2019, which would inform policy-making.

METHODS

Data on cyclist road injuries (CRIs), motorcyclist road injuries (MRIs), and motor vehicle road injuries (MVRIs) were extracted from the GBD 2019. Trends of age-standardized rate (ASR) were predicted using estimated annual percentage change (EAPC) from 1990 to 2019.

RESULTS

Over the past three decades, the global incident ASRs of CRIs and MRIs presented increasing trends, but that of MVRIs declined slightly. However, trends of death and disability adjusted life years (DALYs) caused by three common RIs decreased in most regions and countries. Particularly, trends in ASRs of years of life lost (YLLs) cuased by RIs decreased more pronouncedly than that of years of life lived with disability (YLDs). The burden of three common RIs showed significant social and demographic characteristics. Low-middle and middle socio-demographic index (SDI) areas had a heavy burden of RIs, particularly CRIs and MRIs. However, the high SDI area undertook a relatively low burden, and presented more pronounced downward trends in death and DALYs.

CONCLUSIONS

The burden and changing trends of three common RIs were geographically heterogeneous. The findings highlighted that increasing incident trends of RIs needed more cost-effective measures of prevention and intervention.

The temporal trend of road traffic mortality in China from 2004 to 2020

Background

Road traffic accidents are one of the critical disasters that cause massive negative influences to the social economy and people's property, health and life safety. The purpose of this study is to analyze the temporal trend of road traffic mortality in China from 2004 to 2020, and further analyze the key factors that the influencing changes in China's road traffic mortality and provides information for the development of targeted interventions to reduce the number of preventable deaths.

Methods

The data were retrieved from the Chinese Death Cause Monitoring Data Set from 2004 to 2020. The road traffic mortality rates were standardized by the Sixth National Population Census (6th NPC) data. Joinpoint regression method was manipulated to analyze temporal trends of standardized road traffic mortality. The study used annual percentage change (APC) and average annual percentage change (AAPC) calculated by the Joinpoint regression model to describe trends in road traffic mortality rates.

Results

The overall age-adjusted road traffic mortality in China showed a declining trend from 2004 to 2020 (AAPC2004-2020 = - 4.2%), from 20.9 to 12.92 per 100,000. Rural road traffic mortality rates were generally higher than the one in urban areas, and males were generally higher than females. There was an overall downward trend of the standardized road traffic mortality in the East and Central regions between 2004 and 2020. It was worth noting that the road traffic mortality rates in the Western region showed an upward trend from 2006 to 2011 (APC2006-2011 = 3.3%) and continued to decline after 2011 (APC2011-2020 = - 6.7%). The road traffic mortality rates of aged 65 years and older was highest, which required focused attention.

Conclusions

From 2004 to 2020, the road traffic mortality rates in China generally declined. At the same time, there was a slow reduction or even an upward trend in road traffic mortality rates among the elderly and in western regions. Rural males are a priority group for road traffic injury prevention.

The incidence of brain trauma caused by road injuries: Results from the Global Burden of Disease Study 2019

BACKGROUND

Road collisions are a significant source of traumatic brain injury (TBI). We aimed to determine the pattern of road injury related TBI (RI-TBI) incidence, as well as its temporal trends.

METHODS

We collected detailed information on RI-TBI between 1990 and 2019, derived from the Global Burden of Disease Study 2019. Estimated annual percentage changes (EAPCs) of RI-TBI age standardized incidence rate (ASIR), by sex, region, and cause of road injuries, were assessed to quantify the temporal trends of RI-TBI burden.

RESULTS

Globally, incident cases of RI-TBI increased 68.1% from 6,900,000 in 1990 to 11,600,000 in 2019. The overall ASIR increased by an average of 0.43% (95% CI 0.30%-0.56%) per year during this period. The ASIR of RI-TBI due to cyclist, motorcyclist and other road injuries increased between 1990 and 2019; the corresponding EAPCs were 0.56 (95% CI 0.37-0.75), 1.60 (95% CI 1.35-1.86), and 0.75 (95% CI 0.59-0.91), respectively. In contrast, the ASIR of RI-TBI due to motor vehicle and pedestrian decreased with an EAPC of -0.12 and -0.14 respectively. The changing pattern for RI-TBI was heterogeneous across countries and regions. The most pronounced increases were observed in Mexico (EAPC = 3.74), followed by China (EAPC = 2.45) and Lesotho (EAPC = 1.91).

CONCLUSIONS

RI-TBI remains a major public health concern worldwide, although road safety legislations have contributed to the decreasing incidence in some countries. We found an unfavorable trend in several countries with a relatively low socio-demographic index, suggesting that much more targeted and specific approaches should be adopted in these areas to forestall the increase in RI-TBI.

Symmetry of computerised tomography of the brain in traumatic brain injury: a quality improvement audit

BACKGROUND

Non-contrast Computerised Tomography (NCCT) of brain is the gold standard investigation for diagnosis and management of Traumatic brain injury (TBI). Asymmetrical CT brain images as a result of improper head positioning in the CT gantry will compromise the diagnostic value. Therefore, this audit aimed to assess the degree of asymmetry in CT brain studies carried out in TBI patients.

METHODS

This audit was carried out at a level one trauma centre and included CT scans of TBI patients with a Glasgow come scale (GCS) score ≤ 13, admitted to the Neurological intensive care unit (NICU). The first cycle involved a period of three months. The data collected included demographic data and variables such as GCS at the time of the scan and whether the patient was intubated or not. The visualisation of bilateral internal auditory meatuses was used as landmark to determine scan symmetry. If the internal auditory meatus on both sides were visible on the same slice of CT scan, it was considered symmetric. The degree of asymmetry was gauged based on the axial slice difference between bilateral meatuses. The data collected was tabulated and presented to Neurosurgery residents and a checklist was formulated which had to be followed while positioning the patient on CT table prior to imaging.

RESULTS

The first cycle of the audit showed that 83.8% of scans were asymmetric and among them 44.1% revealed gross asymmetry affecting interpretation of the scan. Following, implementation of the checklist the percentage of gross asymmetry dropped to 21.86% in the second and to 22.22% in the third audit.

CONCLUSION

The use of checklist prior to CT brain studies showed sustainable improvement in reducing gross asymmetry and in acquisition of symmetrical CT brain images.

A comprehensive examination of the economic impact of out-of-pocket health expenditures in India

More than 50% of health expenditure is financed through out-of-pocket payments in India, imposing a colossal financial burden on households. Amidst the rising incidence of non-communicable diseases, injuries, and an unfinished agenda of infectious diseases, this study examines comprehensively the economic impact of out-of-pocket health expenditure (OOPE) across 17 disease categories in India. Data from the latest round of the National Sample Survey (2017-18), titled 'Household Social Consumption: Health', were employed. Outcomes, namely, catastrophic health expenditure (CHE), poverty headcount ratio, distressed financing, foregone care, and loss of household earnings, were estimated. Results showed that 49% of households that sought hospitalization and/or outpatient care experienced CHE and 15% of households fell below the poverty line due to OOPE. Notably, outpatient care was more burdensome (CHE: 47.8% and impoverishment: 15.0%) than hospitalization (CHE: 43.1% and impoverishment: 10.7%). Nearly 16% of households used distressed sources to finance hospitalization-related OOPE. Cancer, genitourinary disorders, psychiatric and neurological disorders, obstetric conditions, and injuries imposed a substantial economic burden on households. OOPE and associated financial burden were higher among households where members sought care in private healthcare facilities compared with those treated in public facilities across most disease categories. The high burden of OOPE necessitates the need to increase health insurance uptake and consider outpatient services under the purview of health insurance. Concerted efforts to strengthen the public health sector, improved regulation of private healthcare providers, and prioritizing health promotion and disease prevention strategies are crucial to augment financial risk protection.

Mortality Rate and Years of Life Lost Due to Road Traffic Accidents in Fars Province, 2004-2019

Background

Traffic accidents are one of the most critical health problems and the ninth leading cause of death globally. We aimed to determine the Mortality rate and the number of Years of Life Lost (YLL) due to road traffic accidents.

Methods

In this retrospective cohort study, mortality rate and YLL due to road traffic accidents were examined in Fars province, central Iran during the years 2004-2019. Mortality statistics were collected through death registration of ministry of health and medical education for Fars Province. Age Standardized mortality Rate (ASR) was calculated and join point regression analysis carried out to examine the trend of YLL rate. Data were analyzed using Excel spreadsheet version 2016 and Join point Regression Program 4.9.0.0.

Results

During the 16-year study period, 25,858 deaths due to road traffic accidents occurred in the province. 79.2% (20483 cases) were in men, and 33.7% (8703 cases) were aged 15-29 years. Total YLL during the 16-year study period were 458,975 (14.6 per 1000 people) in men, 117,999 (3.8 per 1000 people) in women. According to the join point regression, the 16- year trend of YLL rate due to premature mortality was decreasing: AAPC was -4.9% (95% CI: -8.8 to -0.9; P=0.018) for male, and -3.5% (95% CI: -6.3 to-0.5; P=0.011) for female.

Conclusion

Considering that the number of deaths, mortality rate and YLL has decreased in Fars province during the 16 years under study. Therefore, because the mortality rate due to road traffic accidents in Iran is higher than the global average, the need for training programs for drivers, compliance with standards and retrofitting of vehicles, road safety, driving supervision and the use of seat belts are essential.

Pattern of Road Traffic Injuries and Their Pre-hospitalization Factors Reported at a Public Tertiary Healthcare Facility and Rural Private Healthcare Facility in Rajasthan, India

OBJECTIVE

We aimed to report the pattern of road traffic injuries (RTIs) and pre-hospitalization factors of road traffic injuries among the accident victims reported at an urban and a rural healthcare facility in the Jaipur district, Rajasthan.

METHODS

This cross-sectional study was conducted in a tertiary-level, urban public healthcare facility in Jaipur city and a secondary-level, rural private facility in nearby Chomu town. The study participants were all those who encountered road traffic injury and visited any of these healthcare facilities to seek care. The study tool included information on demographics, type of road user, vehicles, accidents, roads, environment, and other pre-hospitalization factors. Data collectors were nurses trained to collect data using the tablet-based application. Data were analyzed using proportions/percentages. Bivariate analysis was done to assess the significance of differences between categories of factors and between rural and urban facilities.

RESULTS

Among 4,642 cases, 93.8% were enrolled in the urban facility, and the remaining were enrolled in the rural facility. Predominantly, males (83.9%) and young adults 18-34 years (58.9%) were reported in both study facilities. Among the accident victims reported at the urban facility, major groups were educated up to the primary level (25.1%) or graduate level (21.9%). About 60% of them were drivers. Most of these injuries occurred on urban roads (50.2%) or two-lane roads (42%). About three-fourths of the injured were using two-wheeler geared vehicles, and 46.7% were overtaking or turning the vehicle when the accident happened. The majority of cases (61.6%) did not require hospitalization. Among the rural facility participants, 27.2% were graduates, and 24.7% were below primary education. Most of these injuries happened on the national highway (35.8%) or rural roads (33.3%). Most of them used two-wheeler geared (80.1%) at the time of the accident. Most were injured while doing normal straight driving (80.5%). Most participants (80.1%) in the rural facility did not follow the traffic rules, and 43.9% required hospitalization.

CONCLUSION

Young males were the most affected age group by road traffic injuries. Differential patterns of road traffic injuries and pre-hospital factors were observed in urban and rural areas.

Burden of road traffic injuries in Iran: a national and subnational perspective, 1990-2019

OBJECTIVES

Reliable and valid information on burden of road traffic injuries (RTIs) is essential for short-term and long-term planning. We designed the present study to describe the levels and trends of burden of RTIs in Iran from 1990 to 2019.

METHODS

This is an observational epidemiological study. We used the Global Burden of Disease (GBD) 2019 estimates to report RTIs incidence, prevalence, mortality and disability-adjusted life-years (DALYs) by sex, age group and road user category in Iran and each of the 31 provinces from 1990 to 2019.

RESULTS

Age-standardised incidence, prevalence, death and DALY rates of RTIs decreased by 31.7% (95% uncertainty interval (UI): 29.4 to 33.9), 34.9% (33.8 to 36.0), 57.7% (48.1 to 62.3) and 60.1% (51.7 to 65.2), respectively between 1990 and 2019. The 2019 age-standardised DALY rates varied from smallest value in Tehran 303.8 (216.9 to 667.2) per 100 000 to largest value in Sistan-Baluchistan 2286.8 (1978.1 to 2627.9) per 100 000. The burden of RTIs was mainly related to injuries sustained by drivers or passengers of motorised vehicles with three or more wheels and pedestrians' injuries, mostly affected males aged 15-29 years and individuals aged ≥70 years.

CONCLUSION

The reducing trend in the burden of RTIs in Iran possibly reflects the effectiveness of the intervention programmes. However, with regard to the Sustainable Development Goals the burden is still at an alarming level. Further reductions are necessary for specific road user groups such as adolescent and adult male drivers or passengers of motorised vehicles, also pedestrians aged ≥70 years.

Investigating the role of beliefs in influencing the hand-held and hands-free mobile phone use among pedestrians in India

Mobile phone distraction is a significant contributor to pedestrian injuries. However, mobile phone engagement among pedestrians has been scarcely explored in a developing country like India. The present study utilized the beliefs-based theory of planned behaviour to examine the association between pedestrian beliefs towards distracted walking (behavioural, normative, and control) and their mobile phone use frequencies. Based on a survey of 560 pedestrians (64.6% males), it was found that the major use of mobile phones was for listening to music (30.7%), followed by receiving a call (25%), making a call (18.9%), texting (9.8%), navigation (8.5%) and internet browsing (7.1%). A series of multivariate ANOVAs and logistic regression models were developed to investigate the relationships between the beliefs and frequencies of mobile phone use in hands-free and hand-held conditions. Significant multivariate differences were found for behavioural and normative beliefs in hands-free conditions and all three types of beliefs in hand-held conditions. The frequency of mobile phone use was significantly predicted by normative beliefs (p < 0.001) in the hands-free condition, and by behavioural (p = 0.041) and normative beliefs (p = 0.004) in the hand-held condition. The findings may assist the road safety countermeasures in addressing the issue of pedestrian distraction.

Characteristics of road traffic accident types and casualties in Guangzhou, China, from 2007 to 2020: A retrospective cohort study based on the general population

Introduction

This study aimed to explore the trend and main influencing factors of road traffic accidents in Guangzhou, China, from 2007 to 2020 and to provide a reference and guidance for government decision-making.

Methods

A retrospective cohort study was used to describe road traffic accidents in Guangzhou. According to the population types, all people with road traffic accidents were divided into migrant workers and the control population. We divided road users, administrative districts, motorcycle types and injury levels into subgroups to investigate the characteristics of road traffic accidents in Guangzhou. The road traffic accident data were derived from the Guangzhou Public Security Traffic Management Integrated System.

Results

The incidence rate of road traffic accidents per 10,000 vehicles in Guangzhou decreased from 36.55 in 2007 to 10.07 in 2012, remained relatively stable at 9.47 in 2017, and finally rose to 11.12 in 2020. The injury rate showed the same trend as the incidence rate, while the mortality rate gradually decreased from 14.21 in 2007 to 5.19 in 2020. Vulnerable road users such as motorized two-to-three-wheeler drivers and migrant workers were casualties in more than 80% of the cases. The proportion of casualties involving mopeds and electric bicycles increased rapidly after 2018. Motor vehicle drivers frequently caused road traffic accidents and were most often uninjured.

Conclusion

Road safety in Guangzhou has shown a clear trend of improvement, but casualties are uneven across administrative districts. More attention should be given to motorized two-to-three-wheelers, migrant workers, and road traffic violations by uninjured individuals.

Global, Regional, and National Burden of Road Injuries from 1990 to 2019

(1) Background: Understanding occurrence can help formulate effective preventative laws and regulations. However, the most recent global burden and road injuries (RIs) trends have not been reported. This study reports the burden of RIs globally from 1990 to 2019. (2) Methods: RIs data were downloaded from the Global Burden of Disease 2019. Incidence, deaths, and disability-adjusted life years (DALYs) described the trend and burden of RIs. We calculated age-standardized rates (ASRs) and estimated annual percentage change (EAPC) for the above indexes to evaluate the temporal trend of RIs. We evaluated the social-demographic index (SDI) with epidemiological RI parameters and reported proportions of age-standardized rates due to RI. (3) Results: In 2019, the global incidence of RIs reached 103.2 million. The EAPC of RI incidence increased, whereas deaths and DALYs decreased. Age-standardized incident rate (ASIR) was highest in low-middle SDI regions, age-standardized death rate (ASDR) was high in middle SDI regions, and age-standardized DALYs increased in low SDI regions. The highest accident rates were found in those aged 20-24 years old. Cyclist injuries were the leading RIs (34%), though pedestrian and motor vehicle accidents were the leading cause of death (37.4%, 37.6%) and DALYs (35.7%, 32.3%), respectively. (4) Conclusions: Over the past 30 years, RIs incidence increased annually, though death and DALY rates decreased. RIs places a considerable burden on public health in low SDI countries. Data should be used to develop and implement effective measures to reduce the burden of RIs.

No role of antibiotics in patients with chest trauma requiring inter-costal drain: a pilot randomized controlled trial

PURPOSE

To study the role of prolonged prophylactic antibiotic therapy (PAT) in the prevention of Inter-costal drain (ICD) related infectious complications in patients with Blunt Trauma Chest (BTC).

METHODS

Patients of age 15 years and above with BTC requiring ICD were included. Patients with penetrating chest injuries, associated injuries/illnesses requiring antibiotic administration, need for mechanical ventilation, known pulmonary disease or immuno-compromised status and need for open thoracotomy were excluded. 120 patients were randomized equally to two groups; no prolonged PAT group (Group A) and prolonged PAT group (group B). Both group patients received one shot of injectable antibiotic prior to ICD insertion. Primary outcome measure was comparison of ICD related infectious complications (pneumonia, empyema and SSI) and secondary outcome measures included the duration of ICD, Length of Hospital stay (LOS) and in-hospital mortality in both the groups.

RESULTS

Infectious complications (pneumonia, empyema and SSI) were seen in only one patient in antibiotic group, and none in no antibiotic group (p value = 0.500). Other complications such as post ICD pain scores, respiratory failure requiring ventilatory support, retained hemothorax or recurrent pneumothorax, did not show any statistical difference between both groups. Also, no significant difference was seen in both the groups in terms of mean duration of ICD (p value = 0.600) and LOS (p value = 0.259).m CONCLUSION: Overall prevalence of ICD related infectious complications are low in BTC patients. Definitive role of prolonged prophylactic antibiotics in reducing infectious complications and other associated co morbidities in BTC patients with ICDs could not be established.

TRIAL REGISTRY DETAILS

Clinical Trial Registry, India (Trial registered at ctri.nic.in/clinical trials/login.php, number REF/2019/021704 dated 18/10/2019).

'Coming home does not mean that the injury has gone'-exploring the lived experience of socioeconomic and quality of life outcomes in post-discharge trauma patients in urban India

Trauma results in long-term socioeconomic outcomes that affect quality of life (QOL) after discharge. However, there is limited research on the lived experience of these outcomes and QOL from low - and middle-income countries. The aim of this study was to explore the different socioeconomic and QOL outcomes that trauma patients have experienced during their recovery. We conducted semi-structured qualitative interviews of 21 adult trauma patients between three to eight months after discharge from two tertiary-care public hospitals in Mumbai, India. We performed thematic analysis to identify emerging themes within the range of different experiences of the participants across gender, age, and mechanism of injury. Three themes emerged in the analysis. Recovery is incomplete-even up to eight months post discharge, participants had needs unmet by the healthcare system. Recovery is expensive-participants struggled with a range of direct and indirect costs and had to adopt coping strategies. Recovery is intersocial-post-discharge socioeconomic and QOL outcomes of the participants were shaped by the nature of social support available and their sociodemographic characteristics. Provisioning affordable and accessible rehabilitation services, and linkages with support groups may improve these outcomes. Future research should look at the effect of age and gender on these outcomes.

Impact of electrically assisted bicycles on physical activity and traffic accident risk: a prospective observational study

Background

Electrically assisted bicycles (e-bikes) have become increasingly popular and may facilitate active commuting and recreational cycling.

Objective

To evaluate the physical activity levels and usage characteristics of e-bikers and conventional cyclists under real-world conditions.

Methods

We conducted a prospective observational study in Germany to examine the effects of e-biking compared with conventional cycling on reaching the World Health Organization (WHO) target for physical activity-at least 150 min of moderate-to-vigorous physical activity (MVPA) per week. Study participants (1250 e-bikers and 629 conventional bike users) were equipped with activity trackers to assess the time, distance and heart rate during cycling over four consecutive weeks. Questionnaires were used to assess any traffic accidents incurred over 12 months.

Results

The proportion of participants reaching 150 min of MVPA per week was higher for conventional bike users than for e-bike users (35.0% vs 22.4%, p<0.001). In a multiple regression model, the odds of reaching the physical activity target were lower for e-biking than for conventional biking (OR=0.56; 95% CI 0.43 to 0.72) with age, sex, comorbidities and bike usage patterns as confounding factors. No significant differences were observed between bike groups for traffic accidents, yet when controlled for cycling time and frequency of cycling e-bikers had a higher risk of a traffic accident (OR=1.63; 95% CI 1.02 to 2.58).

Conclusion

E-bikes are associated with a lower probability of reaching WHO targets for MVPA due to reduced duration and a reduced cardiovascular effort during riding. However, e-bikes might facilitate active transportation, particularly in older individuals or those with pre-existing conditions.

The burden of transport injury and risk factors in India from 1990 to 2019: evidence from the global burden of disease study

Background

India is one of the fastest-growing developing economies associated with many socio-demographic challenges that include a high density of population, growing urbanization, and poor road infrastructure. These challenges might lead to the cause of injury, especially transport related. Therefore, we aim to analyze the burden of Transport Injury (TI) and associated risk factors in India using the required data from 1990 to 2019.

Methods

This study has used the latest Global Burden of Disease Study (GBD) 2019 data set and estimated TI-related incidence rate, mortality (death) rate, and Disability-Adjusted Life Years (DALYs) lost for India over the period from 1990 to 2019. The latest round of GBD survey-2019 provides information about 369 diseases and injuries and 87 risk factors across age groups and gender.

Results

Around 25% of the death rate of all ages was caused due to TI in 2019, significantly higher than in 1990 (20%). However, between 1990 and 2019, the DALYs rate per 100,000 people due to TI decreased slightly by 1.6% for all ages and both gender while more reduction has been observed in under 5- and 5–14-years age groups. On the contrary, the incidence rate and DALYs rate had increased substantially in the age group above 50 years which could be a serious issue for the safety of aging people. By analyzing the sub-cause of TI, we found that motorcyclist road injuries and pedestrian road injuries have been major causes of deaths in India during the last three decades. Further, we have found four risk factors associated with environmental change, occupational hazard, behavioral risk, and metabolic risk that cause TI injuries.

Conclusions

TI-related disease burden has not been reduced over the years in India despite improvements in road infrastructure and digital technology. Improvement in transport policies; awareness about traffic rules and laws among citizens, and improvement in governance in the road & transport sector could change the behavioral risk factors of TI and reduce population unwanted death and suffering.

Adherence to Head-of-Bed Elevation in Traumatic Brain Injury: An Audit

Background An important factor affecting the outcome of traumatic brain injury (TBI) is the early management of raised intracranial pressure (ICP). Head-of-bed elevation (HBE) is a simple and effective method to reduce ICP and prevent aspiration in head injury.

Methods This audit was carried out in a level one trauma center. All adult TBI patients were included in the study except patients who had relative contraindication to HBE, managed in prone or Trendelenburg position or who were able to be seated themselves. Patients were observed twice daily, to check adherence to HBE. Adequate HBE angle was referred as an angle of 20 to 30 degrees. A digital protractor was used to measure the head-end angle. Following the first audit cycle, after discussion with nursing staff, a bedside checklist was formulated and two postintervention audit cycles were carried out.

Results The first cycle showed that 40.35% of patients had inadequate HBE. Following implementation of the checklist, this percentage dropped to 11.27 and 7.5% in the second and third cycles, respectively. Agitation (p-value = 0.038) and Glasgow coma scale at admission (p-value = 0.028) were found to be confounders for adherence to HBE.

Conclusion Agitation among mild and moderate TBI patients contributed to noncompliance for HBE. There was an increasing trend in adherence to maintaining adequate HBE following the use of a bedside checklist. Sustainability of improvement was confirmed with third audit cycle.

Estimates of road traffic deaths in Tanzania

INTRODUCTION

There is considerable uncertainty in estimates of traffic deaths in many sub-Saharan African countries, with the Global Burden of Disease (GBD) and the Global Status Report on Road Safety (GSRRS) reporting widely differing estimates. As a case study, we reviewed and compared estimates for Tanzania.

METHODS

We estimated the incidence of traffic deaths and vehicle ownership in Tanzania from nationally representative surveys. We compared findings with GBD and GSRRS estimates.

RESULTS

Traffic death estimates based on the 2012 census (9382 deaths; 95% CI: 7565 to 11 199) and the 2011-2014 Sample Vital Registration with Verbal Autopsy (8778; 95% CI: 7631 to 9925) were consistent with each other and were about halfway between GBD (5 608; 95% UI: 4506 to 7014) and WHO (16 252; 95% CI: 13 130 to 19 374) estimates and more than twice official statistics (3885 deaths in 2013). Surveys and vehicle registrations data show that motorcycles have increased rapidly since 2007 and now comprise 66% of vehicles. However, these trends are not reflected in GBD estimates of motorcycles in the country, likely resulting in an underestimation of motorcyclist deaths.

CONCLUSION

Reducing discrepancies between GBD and GSRRS estimates and demonstrating consistency with local epidemiological data will increase the legitimacy of such estimates among national stakeholders. GBD, which is the only project that models the road-user distribution of traffic deaths in all countries, likely severely underestimates motorcycle deaths in countries where there has been a recent increase in motorcycles. Addressing police under-reporting and strengthening surveillance capacity in Tanzania will allow a better understanding of the road safety problem and better targeting of interventions.

Administrative data deficiencies plague understanding of the magnitude of rape-related crimes in Indian women and girls

Background

This paper investigates trends in rape-related crimes against women and girls reported in the Indian administrative data from 2001 to 2018 to assess the burden of crime, describe sub-national variations, and highlight data gaps to address sexual violence effectively in India.

Methods

Data on five rape-related crimes were extracted from the annual reports of National Crimes Record Bureau (NCRB), and included assault with the intent to outrage modesty of woman, rape, insult to the modesty of women, attempt to commit rape, and murder with rape/gang-rape. Rates for all categories combined, and for each crime were estimated for women and girls for India and its states. Trends for type of offender for rape, mean number of people arrested, and legal status of the cases was also assessed.

Results

The rate of all rape-related crime increased from 11.6 in 2001 to 19.8 in 2018 per 100,000 women and girls. Most of the 70.7% increase in rate between 2001 and 2018 was post 2012 following a gang-rape and murder case in India’s capital. The largest proportion of crimes was recorded as assault with the intent to outrage modesty of the woman, followed by rape. The cited offender in rape cases was for the majority a close known person (44·3%) or other known person (43·1%). By the end of 2018, only 9·6% of the cases had completed trials, with acquittals in 73% cases.

Conclusions

The wide variations in the yearly crime rates at state-level highlighted significant issues in data quality including under-reporting, non-comparability, possible bias in data reporting in NCRB, definition of rape-related crime in India, and access in reporting of crimes. Addressing barriers to reporting, improving quality and scope of administrative data recorded on sexual violence is urgently needed for India to meet SDG targets of eliminating all forms of violence against women and girls.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13182-0.

Demographics of road injuries and micromobility injuries among China, India, Japan, and the United States population: evidence from an age-period-cohort analysis

BACKGROUND

Micromobility sharing platforms have involved skyrocketing numbers of users in multiple countries since 2010. However, few studies have examined the overall impact of the growing micromobility market on road injuries.

METHOD

We use road injury data from the Global Burden of Disease Study database to examine the effect of age, period, and cohort on micromobility injury-related deaths and incidence. We compared four countries that vary in demographic background and road infrastructure. By comparing the countries, we analyzed the relationship between the trends in road injuries and these factors.

RESULTS

We found an overall upward trend in micromobility injuries. A higher risk of micromobility-related injuries was witnessed in China and the US in 2015-2019, and people older than 45 showed a growing micromobility-related mortality and incidence rate in China, India, and the US. Cohorts after 1960 showed higher micromobility injury incidence risks in China and India, but the population born after 1990 in India showed a slightly lower risk compared to those before it.

CONCLUSIONS

The boosted usage of micromobility devices explains these increasing trends. Road infrastructure and separated traffic ease the collisions from micromobility devices. The overall situation calls for improvement in legislation as well as road infrastructure.

Clinical Features, Management, and Outcomes of Chest Trauma at a Tertiary-Care Centre in India: A Retrospective Observational Study

Introduction

Chest is one of the main sites of injuries in trauma being a part of the torso. Many important organs lie in rib cage. However, data on chest injuries are scarce.

Methods

A retrospective study was carried out for chest trauma patients including polytrauma (n = 184) from hospital records for five years (2016–2020). Various parameters including demographic profile, mode of injury, management, and outcomes were studied.

Results

Mean age of patients was 37 ± 16 years with a male to female ratio of 2.4 : 1. Road traffic injuries remained the most common cause of trauma followed by assaults. Most of the patients were managed conservatively (55.43%). Mortality was seen in only 1.63% patients.

Conclusion

Young male patients are usually affected by trauma. Road traffic injuries are the commonest cause. However, most patients can be managed by conservative treatment and mortality is seen only in polytrauma patients in the present study.

Road injury burden in Mexico 1990 to 2019: Secondary data analysis from the Global Burden of Disease Study

Road injuries have been a major cause of premature mortality and disability in Mexico. The objective of this paper is to report the findings from the Global Burden of Disease study (GBD-2019) on road injuries in Mexico at a national and subnational scale from 1990 to 2019, and to assess the association between road injury burden and the socio-demographic index. Following the 2019 Global Burden of Disease study road injury mortality, premature mortality, the years lived with disability and disability-adjusted life-years (DALYs) are reported. While the number of deaths from road injuries increased between 1990 and 2019, the age-standardized mortality rates declined. Pedestrian road injuries and motor vehicle road injuries accounted for 8 of every 10 deaths from road injury in 2019. Road injury mortality and DALY rates decreased nationally, but stagnated since 2011. The road injury burden was higher for men in all age groups. Pedestrian and motor vehicle road injuries caused the highest DALY rate in both males and females. There was no significant association between the SDI and the road injury age-standardized DALY rates. This study presents a comprehensive report of road injury burden of disease in Mexico. Mexico continues to have an incomplete, fragmented and poorly enforced legislative framework, with a large diversity between its 32 states. Thus, an integrated legislative and juridical effort is needed to continue reducing the road injury disease burden, which is tailored for specific age groups, vulnerable road users and high-burden areas.

Advanced Trauma Care for Nurses (ATCN): A Single-Center Analysis of Trauma Nurses Knowledge Gaps

BACKGROUND

Trauma is a global cause of death and disability, and trauma systems are not well developed in low- and middle-income countries. Training of nurses in trauma care is of utmost importance to improve the organization and delivery of trauma care.

OBJECTIVE

This study aimed to identify common knowledge gaps and develop study aids to improve nurses' performance taking the Advanced Trauma Care for Nurses (ATCN) course.

METHODS

This is a descriptive, single-center study of the multiple-choice final examinations of the ATCN course conducted over 1 year in the All India Institute of Medical Sciences, Rishikesh, Level I trauma center. The questions missed by candidates were compiled, and the wrong options were tabulated. The most commonly missed questions were identified, and the most commonly marked wrong option was analyzed vis-a-vis the correct answer. Each error was classified into either a theoretical error or a practice-based error.

RESULTS

Ninety-six nurses attended 6 courses from June 2019 to June 2020. Of the theoretical-based questions, the top 3 categories of most missed questions were geriatric trauma (n = 13; 81.2%), massive transfusion (n = 35; 72.9%), and traumatic brain injury (n = 35; 72.9%). Of the practice-based questions, the top 3 categories of most missed questions were dislocated extremity management (n = 54; 79.4%), basic airway (n = 31; 64.5%), and shock management (n = 30; 62.5%).

CONCLUSIONS

Periodic identification and categorization of the ATCN course examination's most frequent knowledge gaps allow instructors to develop teaching aids to enhance instructor teaching and improve trauma nurses' knowledge.

Impact of COVID-19 Pandemic during the Lockdown on the Traumatic Brain Injury—An Institutional Experience

Background Traumatic brain injuries (TBIs) contribute to a significant socioeconomic impact, primarily affecting the lower-income sections of the society. The COVID-19 pandemic has resulted in a marked reduction in in-patient attendance. We are highlighting the impact of lockdown in neurotrauma cases in our institution compared to the prelockdown period.

Methods We have done the retrospective review of the patients admitted due to TBI in prelockdown (January 14–March 21, 2020) and lockdown period (March 25–May 31, 2020) for the same duration of the 68 days at our tertiary institution. We have included demographic characteristics (age, sex), mode of injury, the severity of TBI, radiological diagnosis (computed tomography scan), and treatment obtained in our study. We compared the data for percentage (%) reduction of TBI cases and factors responsible for it during the lockdown period.

Result A total of 166 patients were included in both groups. TBI’s most common mechanism was road traffic accident, but we observed an increase in self-fall (16.9% vs. 38.1%) and assault (11.2% vs. 19%) during the lockdown period. We have noted that moderate TBI increased during the lockdown period by 17%. Overall, there is a reduction of 67% in TBI cases during the lockdown period.

Conclusion The COVID pandemic has limited road traffic activity, and strict implementation of lockdown has restricted the infection and has reduced the neurotrauma emergencies. Simultaneously, moderate TBI cases have increased because of the lack of transportation facility and delay in the management of mild TBI cases.

An exploratory qualitative study of the prevention of road traffic collisions and neurotrauma in India: perspectives from key informants in an Indian industrial city (Visakhapatnam)

BACKGROUND

Despite current preventative strategies, road traffic collisions (RTCs) and resultant neurotrauma remain a major problem in India. This study seeks to explore local perspectives in the context within which RTCs take place and identify potential suggestions for improving the current status.

METHODS

Ten semi-structured interviews were carried out with purposively selected key informants from the city of Visakhapatnam, Andhra Pradesh. Participants were from one of the following categories: commissioning stakeholders; service providers; community or local patient group/advocacy group representatives. Transcripts from these interviews were analysed qualitatively using the Framework Method.

RESULTS

Participants felt RTCs are a serious problem in India and a leading cause of neurotrauma. Major risk factors identified related to user behaviour such as speeding and not using personal safety equipment, and the user state, namely drink driving and underage driving. Other reported risk factors included poor infrastructure, moving obstacles on the road such as other vehicles, pedestrians and animals, overloaded vehicles and substandard safety equipment. Participants discussed how RTCs affect not only the health of the casualty, but are also a burden to the healthcare system, families, and the national economy. Although there are ongoing preventative strategies being carried out by both the government and the community, challenges to successful prevention emerged from the interviews which included resource deficiencies, inconsistent implementation, lack of appropriate action, poor governance, lack of knowledge and the mindset of the community and entities involved in prevention. Recommendations were given on how prevention of RTCs and neurotrauma might be improved, addressing the areas of education and awareness, research, the pre-hospital and trauma systems, enforcement and legislation, and road engineering, in addition to building collaborations and changing mindsets.

CONCLUSIONS

RTCs remain a major problem in India and a significant cause of neurotrauma. Addressing the identified gaps and shortfalls in current approaches and reinforcing collective responsibility towards road safety would be the way forward in improving prevention and reducing the burden.

Injury and its associated factors among residents of an urban slum during the festival month in South India: A community-based survey

Introduction

Injury morbidity and mortality have been steadily increasing in both developed and developing countries including India. The current study tried to assess the incidence of injury and identify the risk factors associated with injuries during the festival month in a selected urban area in Puducherry.

Methods

It is a community-based cross-sectional survey conducted among the residents in the urban field practice area of a medical college in Puducherry. Participants were interviewed using a pretested questionnaire. Information on the incidence of injury and its associated factors were collected. Data were entered in EpiData and analyzed using Stata. Generalized linear models with Poisson distribution were used to identify the risk factors associated with the injuries.

Results

Overall, 1380 participants from two selected clusters were interviewed. The incidence rate of injuries was 5.2% (95% CI: 4.0-6.4). In adjusted analysis male (RR 1.96, 95% CI: 1.15-3.37) and student (RR 2.91, 95% CI: 1.13-7.54) were independently associated with having an injury. Most of the injuries were unintentional and accidental.

Conclusion

The reported incidence of at least one injury was 52 per 1000 population per month and the majority were accidental in nature. It was higher during the festival week. Public health strategies at the primary healthcare level targeting adult males and school children will be effective in the reduction and prevention of injury.

The burden of injuries in Mexico: Secondary data analysis from the Global Burden of Disease Study, 1990 to 2019

IMPORTANCE

Injuries have been a major cause of premature mortality and short-term and long-term disability in Mexico.

OBJECTIVE

To report the findings from the Global Burden of Disease 2019 study on injuries in Mexico at a national and subnational scale from 1990 to 2019.

METHODS

Following the 2019 Global Burden of Disease study we examined injury mortality, premature mortality, years lived with disability and disability-adjusted life-years according to 14 subcategories. We calculated the Pearson correlation coefficient between the injury burden and the socio-demographic index.

RESULTS

While the number of deaths from injuries increased significantly, the changes in the age-standardized mortality rates trended towards declines. Interpersonal violence, road injuries, falls and self-harm accounted for 8 of every 10 deaths from injury in 2019. Injury mortality and the disability-adjusted life-years rates decreased nationally and in most states in the period as a whole, but have increased since 2007. The injury burden was higher for men in all age groups. Interpersonal violence caused the highest disability-adjusted life-years rate in males and road injuries in females. The socio-demographic index increased in all states, while the injury age-standardized disability-adjusted life-years rates between 1990 and 2019 decreased, but there was no statistical association between both indicators.

DISCUSSION AND CONCLUSIONS

This study represents a comprehensive review of injury burden of disease in Mexico. The injury burden decreased, but improved heterogeneously among states. To further reduce the injury burden of disease, it's necessary for federal, state and local governments to prioritize safety promotion and injury prevention programs, infrastructure improvements, legislation, and enforcement at a national and subnational level. Mexico's injury prevention efforts should also be tailored for specific age groups, such as males aged 20-49 years or females in the younger and older age groups, and high-burden areas.

Road Use Pattern and Street Crossing Habits of Schoolchildren in India

Road traffic accidents (RTAs) contribute significant DALYs in the global burden of diseases. Vulnerable groups particularly pedestrians and children are at an increased risk. Road use pattern, street crossing habits, and road safety awareness are important determinants of RTAs. The present study was carried out to assess the road use pattern and street crossing habits of schoolchildren. This cross-sectional study included 497 schoolchildren of 12–15 years. The interview technique was used as a tool for data collection on a predesigned questionnaire. A total of 40.4% of schoolchildren did not like to go to school alone and wanted somebody from the family to drop them to school. About one quarter of the students were afraid of traffic and expressed their inability to deal with traffic on the road. A total of 10.7% reported crossing the street in groups, and 1.4% reported running while crossing the street. Only 80.9% of students received some form of road safety training, and the parents and schools were the major source of information for such safety training. Age <14 years and a lower level of mother's education were found to be significant contributors for poor road crossing habit in univariate as well as multivariate analysis. The study suggests that the knowledge regarding safe road use and street crossing was lacking among study participants albeit in a small proportion only. Safety aspects can be partly strengthened by imparting practical knowledge about road use pattern, street crossing habits, and road safety procedures.

Early hospital discharge following non-operative management of blunt liver and splenic trauma: A pilot randomized controlled trial

BACKGROUND

Despite the acceptance of non-operative management (NOM), there is no consensus on the optimal length of hospital stay in patients with blunt liver and splenic injury (BLSI). Recent studies on pediatric patients have demonstrated the safety of early discharge following NOM for BLSI. We aimed at evaluating the feasibility and safety of early discharge in adult patients with BLSI following NOM in a randomized controlled trial.

MATERIALS AND METHODS

After initial assessment and management, patients aged 18-60 years with BLSI planned for NOM were randomized into 2 groups: Group A (test group; discharge day 3), and Group B (control group; discharge day 5). Standard NOM protocol was followed. These patients were discharged on the proposed day if they met the pre-defined discharge criteria. All patients were followed at days 7, 15, and 30 of discharge.

RESULTS

Sixty patients were recruited, 30 randomized to each arm. Most patients were males and aged less than 30 years. Road traffic injury was the most common mode of injury. Both groups were comparable in demography and injury-related parameters. 27 patients (90%) from group A and 28 patients (93%) from group B were discharged on the proposed day. Three patients had unplanned hospital visits for reasons unrelated to BLSI. All patients were asymptomatic and had a normal examination during their scheduled follow-up visits.

CONCLUSION

Adult patients undergoing NOM for BLSI can be safely discharged after 48 h of in-hospital observation, provided other injuries precluding discharge do not exist.

Participants' perception of the AIIMS Trauma Assessment and Management (ATAM) course for management of polytrauma: A multi-institutional experience from India

BACKGROUND

In India, the mortality due to polytrauma after road traffic injuries is high and there is a need to train medical and paramedical personnel. The AIIMS Trauma Assessment and Management (ATAM) course was developed at the Apex Trauma Centre of All India Institute of Medical Sciences, New Delhi to sensitize medical personnel with initial assessment and management of polytrauma victims. The aim of this study was to evaluate the impact on knowledge and skills and also evaluate the feedback and the perception of the participants of the ATAM course.

METHODS

The course was conducted for doctors, nurses and other paramedical/allied professionals in five tertiary level centres associated to medical colleges from geographically diverse locations (Anand, Bengaluru, Delhi, Lucknow and Thrissur). Cognitive knowledge was assessed using pre-training and post-training multiple choice question (MCQ) tests. The participants also self-rated their level of knowledge, skill, confidence and capability (Numerical rating scale of 1-10). Post-training feedback was obtained from the participants using a five-point Likert scale response.

RESULTS

26 ATAM courses were conducted by 68 course instructors and attended by 780 participants. These participants include 40.4% doctors, 44.2% nurses, 4.7% paramedical technicians, 4.2% medical students and 6.4% paramedical and allied health professionals. There was significant improvement (p < 0.0001) in the cognitive knowledge, skill, confidence and capability of the participants. 85%-86% of the participants strongly agreed or agreed that the course content was effective and 85% of participants perceived that the course was excellent or very good.

CONCLUSION

The ATAM course had a positive impact on the knowledge, skills, confidence and capability of health caregivers attending the course. The ATAM course is an effective, practical and favourable option that is tailored to the polytrauma training needs of India. We recommend widespread dissemination of this course.

An Analysis of 30-Day in-Hospital Trauma Mortality in Four Urban University Hospitals Using the Australia India Trauma Registry

Background

India has one-sixth (16%) of the world’s population but more than one-fifth (21%) of the world’s injury mortality. A trauma registry established by the Australia India Trauma Systems Collaboration (AITSC) Project was utilized to study 30-day in-hospital trauma mortality at high-volume Indian hospitals.

Methods

The AITSC Project collected data prospectively between April 2016 and March 2018 at four Indian university hospitals in New Delhi, Mumbai, and Ahmedabad. Patients admitted with an injury mechanism of road or rail-related injury, fall, assault, or burns were included. The associations between demographic, physiological on-admission vitals, and process-of-care parameters with early (0–24 h), delayed (1–7 days), and late (8–30 days) in-hospital trauma mortality were analyzed.

Results

Of 9354 patients in the AITSC registry, 8606 were subjected to analysis. The 30-day mortality was 12.4% among all trauma victims. Early (24-h) mortality was 1.9%, delayed (1–7 days) mortality was 7.3%, and late (8–30 days) mortality was 3.2%. Abnormal physiological parameters such as a low SBP, SpO2, and GCS and high HR and RR were observed among non-survivors. Early initiation of trauma assessment and monitoring on arrival was an important process of care indicator for predicting 30-day survival.

Conclusions

One in ten admitted trauma patients (12.4%) died in urban trauma centers in India. More than half of the trauma deaths were delayed, beyond 24 h but within one week following injury. On-admission physiological vital signs remain a valid predictor of early 24-h trauma mortality.

WITHDRAWN: Participants' perception of the AIIMS Trauma Assessment and Management (ATAM) course for management of polytrauma due to road traffic injuries: A multi-institutional experience from India

OBJECTIVE

In India, the mortality due to polytrauma after road traffic injuries is high and there is a need to train medical and paramedical personnel. The AIIMS Trauma Assessment and Management (ATAM) course was developed at the Apex Trauma Centre of All India Institute of Medical Sciences, New Delhi to sensitize medical personnel with initial assessment and management of polytrauma victims. The aim of this study was to evaluate the impact on knowledge and skills and also evaluate the feedback and the perception of the participants of the ATAM course.

METHODS

The course was conducted for doctors, nurses and other paramedical/allied professionals in five tertiary level centres associated to medical colleges from geographically diverse locations (Anand, Bengaluru, Delhi, Lucknow and Thrissur). Cognitive knowledge was assessed using pre-training and post-training multiple choice question (MCQ) tests. The participants also self-rated their level of knowledge, skill, confidence and capability (Numerical rating scale of 1-10). Post-training feedback was obtained from the participants using a five-point Likert scale response.

RESULTS

26 ATAM courses were conducted by 68 course instructors and attended by 780 participants. These participants include 40.4% doctors, 44.2% nurses, 4.7% paramedical technicians, 4.2% medical students and 6.4% paramedical and allied health professionals. There was significant improvement (p < 0.0001) in the cognitive knowledge, skill, confidence and capability of the participants. 85%-86% of the participants strongly agreed or agreed that the course content was effective and 85% of participants perceived that the course was excellent or very good.

CONCLUSION

The ATAM course had a positive impact on the knowledge, skills, confidence and capability of health caregivers attending the course. The ATAM course is an effective, practical and favourable option that is tailored to the polytrauma training needs of India. We recommend widespread dissemination of this course.

Fatal injuries and economic development in the population sample of Central and Eastern European Countries: the perspective of adolescents

Objectives

Researches consider the young generation (adolescents) to be the population group whose mortality from injury has the lowest effect on economic growth. The objective was to evaluate the relations between economic indicators and preventable injury mortality in Central and Eastern European Countries (CEECs), with a primary focus on adolescents.

Methods

The analyses included health indicators of preventable injury mortality and economic indicators that represent human development and economic growth in the CEECs from 1990 to 2016. The analytical process involved a population group divided by age (0–14 years: children, 15–24 years: adolescents, 25–74 years: adults) and gender. Descriptive analysis, cluster analysis and primarily panel regression analysis were used.

Results

Significant effects of economic indicators on drowning were found in all analysed relations. In the group of adolescents, significant effects of fatal falls were found. Overall, it can be concluded that the effects of fatal injuries are not homogenous between age and gender groups.

Conclusions

The effects of years and individual countries should be taken into account in the cross-sectional analyses. In terms of economic growth, public policies should focus on drowning in children, on falls in adolescents and on transport accidents, fire injuries and poisoning in adults.

Hospital-Based Case Series Analysis of Road Traffic Trauma Patients in Sri Lanka

Road traffic accidents claim many lives each year worldwide and cause significant disability among survivors. Resulting socioeconomic burden is severe in low- and middle-income countries. Global emphasis currently focuses on trauma education and prevention in addition to improving post-injury care. Sri Lankan government recently made compulsory legislation to improve the safety standards of imported motor vehicles. Such regulations would not directly protect vulnerable road users (VRUs) who form the main bulk of Sri Lankan and South Asian automobile trauma casualties. With the objective of reviewing the management outcome of automobile trauma in order to correlate the potential impact of new legislation on injury prevention, data of all admitted road traffic injury victims were audited for 2 months. Out of 473 eligible cases (332 (70.2%)—males; mean age 37.2 years), there were 14 (3%) fatalities. Of 459 (97%) survivors, 77 (16%) suffered major injuries. Twelve out of 14 (85.7%) fatalities, 64 of 77 (83.1%) survivors with major injuries and 263 of 382 (68.8%) cases of lesser injuries were VRUs (p value = 0.02: chi-square). VRUs had a significantly higher mean Injury Severity Score (ISS) of 10.96 ± 8.43 SD than non-VRUs who had a mean ISS of 8.14 ± 6.04 SD (p = 0.003: t test). Among all survivors, 33/39 (84.6%) with permanent disability, 95/110 (86.4%) with temporary disability and 199/310 (64.2%) with no residual disability were VRUs (p value < 0.0001: chi-square). Of 222 drivers/riders, 45 (20.3%) had consumed alcohol prior to the incident and 20 (9%) were driving without a valid licence. Thirty-four out of 162 (21%) motor bike travellers were not wearing a protecting helmet. Results denote that VRUs suffer significant majority of the fatalities and major injuries after road traffic trauma and to have higher residual temporary/permanent disability among survivors. Recent compulsory motor vehicle safety measures are unlikely to directly protect majority of automobile trauma victims in Sri Lanka. To obtain a higher impact on road traffic injury prevention, main emphasis has to be given to improve the safety standards of VRUs in developing countries.

Biocompatible implant mimicking cartilage: A new horizon for reconstructive facial field

Cartilage is avascular with limited to no regenerative capacity, so its loss could be a challenge for reconstructive surgery. Current treatment options for damaged cartilage are also limited. In this aspect there is a tremendous need to develop an ideal cartilage-mimicking biomaterial that could repair maxillofacial defects. Considering this fact in this study we have prepared twelve silicone-based materials (using Silicone 40, 60, and 80) reinforced with hydroxyapatite, tri-calcium phosphate, and titanium dioxide which itself has proven their efficacy in several studies and able to complement the shortcomings of using silicones. Among the mechanical properties (Young's modulus, tensile strength, percent elongation, and hardness), hardness of Silicone-40 showed similarities with goat ear (P > .05). Silicone peaks have been detected in FTIR. Both AFM morphology and SEM images of the samples confirmed more roughed surfaces. All the materials were nonhemolytic in hemocompatibility tests, but among the twelve materials S2, S3, S5, and S6 showed the least hemolysis. For all tested bacterial strains, adherence was lower on each material than that grown on the plain industrial silicone material which was used as a positive control. S2, S3, S5, and S6 samples were selected as the best based on mechanical characterizations, surface characterizations, in vitro hemocompatibility tests and bacterial adherence activity. So, outcomes of this present study would be promising when developing ideal cartilage-mimicking biocomposites and their emerging applications to treat maxillofacial defects due to cartilage damage.