Road traffic injuries and data systems in Egypt: addressing the challenges

Computed tomography benefits and cost in hemodynamically stable patients with blunt abdominal trauma at an Egyptian University Hospital

Background

Trauma is a significant cause of mortality, especially among individuals aged between 15 and 44 years, with a substantial burden falling on economically active populations. Low- and middle-income countries (LMICs) bear the burden of trauma-related deaths, accounting for over 90 % globally. In Egypt, trauma rates are increasing, primarily due to road traffic crashes (RTC), affecting males disproportionately. Blunt abdominal trauma, often caused by RTC, can lead to missed intra-abdominal injuries (IAIs) due to atypical symptoms. Computed Tomography (CT) offers high sensitivity and specificity in detecting IAIs, but concerns about cost and radiation exposure exist.

Methodology

This study investigates the roles of Focused Assessment with Sonography for Trauma (FAST) and CT in managing blunt abdominal trauma. A retrospective cohort study was conducted on hemodynamically stable patients. Data included patient demographics, trauma details, healthcare decisions, costs, and outcomes.

Results

Computed tomography significantly reduced unnecessary laparotomies (12.3% vs. 24.8 %, p = 0.001), shortened hospital stays (4.83±0.71 days vs. 6.15±1.28 days, p = 0.005), and reduced ICU admissions (8 vs. 32, p = 0.023) compared to FAST alone. Overall costs were lower in the CT & FAST Group ($2055.95 vs. $3488.7, p = 0.0001), with no significant difference in missed IAIs.

Conclusion

This study highlights the limitations of relying solely on FAST for IAIs and underscores the value of CT in guiding healthcare decisions. Incorporating CT led to reduced negative laparotomies, shorter hospital stays, and fewer ICU admissions. While CT incurs initial costs, its long-term benefits outweigh expenditures, particularly in LMICs. This study provides insights into optimizing diagnostic approaches for blunt abdominal trauma in low-resource settings.

Factors influencing the road accidents in low and middle-income countries: a systematic literature review

This paper studies the main factors affecting road traffic accidents (RTAs) using a systematic review. The primary focus is on factors related to road characteristics and driver behaviours. This review also addresses the socioeconomic and demographic factors to provide a clear overview of which groups suffer the most from RTAs. Several factors were found to affect RTAs, notably road characteristics: highways, high-speed roads, unplanned intersections and two-way roads without dividers; driver behaviours: reckless/aggressive driving and riding, excessive speeding, unawareness of traffic laws, and not using safety equipment; and vehicle types: four and two-wheeled. This review found that male and economically productive people with less education were mostly associated with RTAs. In addition, for most of the low and middle-income countries analyzed, there is a lack of quality data relating to RTAs. Nevertheless, this review provides researchers and policy makers with a better understanding of road accidents for improving road safety.

Emergency department-based injury surveillance information system: a conceptual model

BACKGROUND

Injury data play a pivotal role in monitoring public health issues and Injury Surveillance Information Systems (ISIS) are useful for continuous data collection and analysis purposes. Since emergency department (ED) is usually the first place of referral for the injured people, the aim of this study was to develop a conceptual model for an ED-based ISIS.

METHODS

This study was completed in 2020 and the Delphi technique (three rounds) was used to determine the main components of an ED-based ISIS. The participants were selected using the purposive sampling method. A 5-point Likert scale questionnaire was used for data collection and data were analyzed using descriptive statistics.

RESULTS

In the first, second, and third rounds of the Delphi study, 60, 44, and 28 experts participated, respectively. In the first and second rounds, most of the items including the personal data, clinical data, data sources, and system functions were found important. In the third round of the Delphi study, 13 items which did not reach a consensus in the previous rounds were questioned again and five items were removed from the final model.

CONCLUSION

According to the findings, various data elements and functions could be considered for designing an ED-based ISIS and a number of data sources should be taken into count to be integrated with this system. Although the conceptual model presented in the present study can facilitate designing the actual system, the final system needs to be implemented and used in practice to determine how it can meet users' requirements.

Challenges to the development of the trauma system in Egypt

Trauma is a hidden disease in Egypt, and its significance on public health has been underestimated for decades. Road traffic accidents are the leading cause of injuries presented to hospitals in Egypt. Trauma systems in developed countries effectively reduced the morbidity and mortality associated with injuries in crowded cities. Developing a trauma system in Egypt is mandatory with the exploding population growth, increasing incidence of injuries, and the vast expansion of the infrastructures in the road network. However, the implementation of the trauma system in Egypt will not be devoid of challenges, including a lack of mandatory healthcare infrastructures such as adequate pre-hospital care, poor quality of data, and a shortage of adequately trained emergency physicians across the country.

Current and Future Trends in Driver Behaviour and Traffic Safety Scholarship: An African Research Agenda

Road traffic accidents are strongly associated with driver behaviour. Africa, as a region, has the highest road accident fatality rate, but there is very little research dealing with this critical issue on the continent. This paper, therefore, sought to establish the state of driver behaviour and road safety scholarship in Africa to determine current research trends as well as potential future research directions. To this end, two bibliometric analyses were conducted, one which considered the issue from an African perspective and the other which considered the broader body of work. The analysis revealed a critical shortage of research related to driver behaviour in Africa. The existing body of research primarily focused on the identification of issues and tended to focus on narrow research problems within limited geographical areas. A need was identified for the collection of broader macro-level data and statistical analyses thereof to indicate regional traffic crash patterns; causes and effects; country-level studies, particularly countries with high traffic fatality rates and low levels of research; cross-country comparisons; and modelling. Future research directions should also include the link between driver behaviour, traffic safety and the sustainable developments goals, as well as policy-related research to determine current and potential future country-level policies.

Neurotrauma Surveillance in National Registries of Low- and Middle-Income Countries: A Scoping Review and Comparative Analysis of Data Dictionaries

BACKGROUND

Injury is a major global health problem, causing >5 800 000 deaths annually and widespread disability largely attributable to neurotrauma. 89% of trauma deaths occur in low- and middle-income countries (LMICs), however data on neurotrauma epidemiology in LMICs is lacking. In order to support neurotrauma surveillance efforts, we present a review and analysis of data dictionaries from national registries in LMICs.

METHODS

We performed a scoping review to identify existing national trauma registries for all LMICs. Inclusion/ exclusion criteria included articles published since 1991 describing national registry neurotrauma data capture methods in LMICs. Data sources included PubMed and Google Scholar using the terms "trauma/neurotrauma registry" and country name. Resulting registries were analyzed for neurotrauma-specific data dictionaries. These findings were augmented by data from direct contact of neurotrauma organizations, health ministries, and key informants from a convenience sample. These data were then compared to the World Health Organization (WHO) minimum dataset for injury (MDI) from the international registry for trauma and emergency care (IRTEC).

RESULTS

We identified 15 LMICs with 16 total national trauma registries tracking neurotrauma-specific data elements. Among these, Cameroon had the highest concordance with the MDI, followed by Colombia, Iran, Myanmar and Thailand. The MDI elements least often found in the data dictionaries included helmet use, and alcohol level. Data dictionaries differed significantly among LMICs. Common elements included Glasgow Coma Score, mechanism of injury, anatomical site of injury and injury severity scores. Limitations included low response rate in direct contact methods.

CONCLUSION

Significant heterogeneity was observed between the neurotrauma data dictionaries, as well as a spectrum of concordance or discordance with the MDI. Findings offer a contextually relevant menu of possible neurotrauma data elements that LMICs can consider tracking nationally to enhance neurotrauma surveillance and care systems. Standardization of nationwide neurotrauma data collection can facilitate international comparisons and bidirectional learning among healthcare governments.

[Assessment of road safety intervention implementation in Benin in 2019]

OBJECTIVE

The study aims to assess the level of implementation of road safety interventions in Benin.

METHOD

The research is based on an evaluative study of road safety aimed to analyze the implementation and logic of road safety interventions, conducted in Benin in 2019. It combined a review of the gray literature and a qualitative component. The data were collected through documents and interviews in structures involved in road safety management.

RESULTS

Road safety was a national priority with one lead institution and several structures involved. There was a lack of consensus among stakeholders, insufficient framework documents, resources, legislative texts, and study data. Few roads were in good condition and very few allowed the separation of two-wheeled vehicles. The vehicle fleet was outdated. Various activities were carried out to raise awareness, to educate the population and to enforce the texts but they were insufficient and poorly coordinated. Reference hospitals had the minimum service to deal with trauma cases. The interventions had not yet resulted in a reduction in the number of injuries and fatalities by accidents, which was increasing.

CONCLUSION

Benin has made great efforts in the area of road safety. However, there are still some shortcomings to take into account.

Lives Saved in Low- and Middle-Income Countries by Road Safety Initiatives Funded by Bloomberg Philanthropies and Implemented by Their Partners between 2007-2018

Over the past 12 years, Bloomberg Philanthropies (BP) and its partner organisations have implemented a global road safety program in low- and middle-income countries. The program was implemented to address the historically increasing number of road fatalities and the inadequate funding to reduce them. This study evaluates the performance of the program by estimating lives saved from road safety interventions implemented during the program period (2007–2018) through to 2030. We estimated that 311,758 lives will have been saved by 2030, with 97,148 lives saved up until 2018 when the evaluation was conducted and a further 214,608 lives projected to be saved if these changes are sustained until 2030. Legislative changes alone accounted for 75% of lives saved. Concurrent activities related to reducing drink driving, implementing legislative changes, and social marketing campaigns run in conjunction with police enforcement and other road safety activities accounted for 57% of the total estimated lives saved. Saving 311,758 lives with funding of USD $259 million indicates a cost-effectiveness ratio of USD $831 per life saved. The potential health gains achieved through the number of lives saved from the road safety initiatives funded by Bloomberg Philanthropies represent a considerable return on investment. This study demonstrates the extent to which successful, cost-effective road safety initiatives can reduce road fatalities in low- and middle-income countries.

Developing a systematic approach for Population-based Injury Severity Assessment (PISA): a million-person survey in rural Bangladesh

INTRODUCTION

There is currently no defined method for assessing injury severity using population-based data, which limits our understanding of the burden of non-fatal injuries and community-based approaches for primary prevention of injuries. This study describes a systematic approach, Population-based Injury Severity Assessment (PISA) index, for assessing injury severity at the population level.

METHODS

Based on the WHO International Classification of Functionality conceptual model on health and disability, eight indicators for assessing injury severity were defined. The eight indicators assessed anatomical, physiological, postinjury immobility, hospitalisation, surgical treatment, disability, duration of assisted living and days lost from work or school. Using a large population-based survey conducted in 2013 including 1.16 million individuals from seven subdistricts of rural Bangladesh, information on the eight indicators were derived for all non-fatal injury events, and these were summarised into a single injury severity index using a principal component analysis (PCA). Principal component loadings derived from the PCA were used to predict the severity (low, moderate, high) of non-fatal injuries, and were applied to the fatal injury data to assess the criterion validity of the index. The determinants of non-fatal injury severity were determined using ordered logistic regression.

RESULTS

There were 119 703 non-fatal injuries and 14% were classified as high severity based on the PISA index. The PISA index accurately predicted 82% of all fatal injuries as highly severe. Non-fatal injuries of high severity were frequent with unintentional poisoning (57%) and violence (35%). Injuries of high severity were commoner among males (OR 1.16, 95% CI 1.12 to 1.21), adults 65 years and older (OR 1.30, 95% CI 1.23 to 1.36), lower socioeconomic status and intentional injuries. Education was associated with reduced odds of high severe injuries.

CONCLUSION

The PISA index provides a valid and systematic approach for assessing injury severity at the population level, and is relevant for improving the characterisation of the burden and epidemiology of injuries in non-health facility-based settings. Additional testing of the PISA index is needed to further establish its validity and reliability.

Non-operative management of blunt abdominal solid organ trauma in adult patients

INTRODUCTION

Despite agreement in the literature that "stable" blunt trauma patients may be managed conservatively, in Egypt many such patients receive operative management. This paper presents the results of a pragmatic, prospective, observational study to evaluate outcomes of non-operative (NOP) versus operative (OP) management of blunt abdominal solid organ trauma in hemodynamically stable adults admitted to Tanta University Emergency Hospital (TUH) in Egypt.

METHODS

A prospective observational study enrolled adult blunt abdominal trauma patients with solid organ injury at TUH over a 3-year period (June 2014-June 2017). Inclusion criteria were age ≥18 yr, mean arterial pressure >65 mm Hg, heart rate <110 bpm, hematocrit ≥7 mg/dl, and abdominal organ injury diagnosed by ultrasound or computed tomography (CT). Excluded patients were those with pelvis and femur fractures; patients with penetrating abdominal trauma; predominate burn injuries, children and pregnant women. All patients were assigned to non-operative or operative management based on clinician preference. Outcomes of interest were 30-day mortality, blood transfusion volume, and length of stay. Descriptive statistics and χ2 were used to compare outcomes.

RESULTS

During the study period, 4254 trauma patients presented to TUH. Of these, 790 had blunt abdominal trauma and 111 (14.1%) met inclusion criteria. Injury severity scores for each group were comparable (24 ± 10 - NOP vs. 28 ± 11 - OP, p = 0.126). NOP received less transfused blood (213.41 ± 360.3 ml [NOP] vs.1155.17 ± 380.4 ml [OP] (p < 0.0001)) but had a longer length of stay (8.29 ± 2.8 [NOP] vs. 6.45 ± 1.97 days [OP] (p = 0.012)). There was no difference in mortality between groups (p = 0.091).

CONCLUSION

Our study demonstrated that non-operative management in Egypt of blunt abdominal trauma was safe and resulted in fewer procedures, fewer units of blood transfused, and no increase in mortality. Longer length of stay for non-operative patients might reflect treating physician caution in their management.

Child and adolescent injury burden in the eastern mediterranean region: Findings from the Global Burden of Disease 1990-2017

BACKGROUND

Child and adolescent injury is one of the leading causes of child death globally with a large proportion occurring in Low- and Middle-Income Countries (LMICs). Similarly, the Eastern Mediterranean Region (EMR) countries borne a heavy burden that largely impact child and adolescent safety and health in the region. We aim to assess child and adolescent injury morbidity and mortality and estimate its burden in the Eastern Mediterranean Region based on findings from the Global Burden of Disease (GBD), Injuries and Risk Factors study 2017.

METHODS

Data from the Global Burden of Disease GBD 2017 were used to estimate injury mortality for children aged 0-19, Years of Life Lost (YLLs), Years lived with Disability (YLDs) and Disability Adjusted Life Years (DALYs) by age and sex from 1990 to 2017.

RESULTS

In 2017, an estimated 133,117 (95% UI 122,587-143,361) children died in EMR compared to 707,755 (95% UI 674401.6-738,166.6) globally. The highest rate of injury deaths was reported in Syria at 183.7 (95% UI 181.8-185.7) per 100,000 population. The leading cause of injury deaths was self-harm and interpersonal violence followed by transport injury. The primary cause of injury DALYs in EMR in 2017 was self-harm and interpersonal violence with a rate of 1272.95 (95% UI 1228.9 - 1319.2) almost 3-times the global rate.

CONCLUSION

Almost 19% of global child injury related deaths occur in the EMR. Concerted efforts should be integrated to inform policies and adopt injury preventive strategies to reduce injury burden and promote child and adolescent health and well-being in EMR countries.

Driving behavior and road traffic crashes among professional and nonprofessional drivers in South Egypt

Egypt has one of the highest traffic crash rates in the world. This study aims to investigate the correlates with driving behaviors and road traffic crashes (RTCs) among professional and nonprofessional drivers in South Egypt. A total of 518 drivers (203 professional and 315 nonprofessional) were interviewed and their sociodemographic characteristics, driving habits, and RTC involvement during the preceding 2 years were documented. The Arabic version of the Driver Behavior Questionnaire (DBQ) was used to assess drivers' lapses, errors, and violations. The results showed that professional drivers had more lapses (OR 3.03, 95% CI 1.54-5.96), errors (OR 2.88, 95% CI 1.44-5.76), and violations (OR 2.04, 95% CI 1.05-3.97) compared to nonprofessional drivers and female drivers were more likely to lapse than males (OR 3.18, 95% CI 1.79-5.66). RTC involvement was associated with female sex (OR 3.27, 95% CI 1.56-6.86), age < 30 years (OR 2.31, 95% CI 1.20-4.44), illiteracy (OR 1.51, 95% CI 1.02-2.23), eating while driving (OR 2.41, 95% CI 1.43-4.06), and not using seatbelt (OR 1.89, 95% CI 1.06-3.37). Driving lapses, errors, and violations did not significantly increase the risk of RTCs.

The association between sensation seeking and driving outcomes: A systematic review and meta-analysis

The purpose of this study was to evaluate the association between sensation seeking (SS) and driving outcomes (including four aberrant driving behaviors, accident involvement and tickets received) through a systematic review and meta-analysis. Forty-four eligible studies, representing 48 individual trials, were identified from a systematic literature search of four electronic databases, and included in the meta-analysis. Overall, the meta-analysis results showed that SS yielded significant positive correlations with risky driving (pooled r = 0.24, p < 0.001), aggressive driving (pooled r = 0.23, p = 0.019), and errors (pooled r = 0.22, p = 0.016). SS was also positively correlated with accident involvement (pooled r = 0.08, p < 0.001) and tickets received (pooled r = 0.19, p < 0.001), though at weaker levels. The correlations could also be moderated by a number of study and sample characteristics, such as country of origin, publication year, age, gender, driving experience and type of SS measure. The findings help facilitate our understanding of the role of SS in aberrant driving behaviors and accident risk, and provide new insight into the design of evidence-based driving education and accident prevention interventions.

Pattern of road traffic injuries in Yemen: a hospital-based study

Introduction

Road traffic injuries (RTIs) are the eighth leading cause of death globally and the leading cause of death for young people. This study aimed to present time-limited trial surveillance in two referral hospitals to describe the pattern of RTIs in Sana'a, Yemen and determine road traffic crashes (RTCs) associated factors.

Methods

All RTIs presented to Emergency Departments (ED) of the two Sanaa city hospitals between August and October, 2015 were studied and described. Data were collected everyday by trained data collectors. A pretested questionnaire modified from WHO injury surveillance form was used for data collection.

Results

A total of 156 casualties from 128 RTCs had attended the two study hospitals during the study period. About 73% of victims were less than 30 years old. Only 13% of casualties were transported by ambulance. None of the victims wore the seat belt in case of 4-wheeled vehicles' users nor the helmet in case of 2-wheeled vehicles' users. Poor driving skills were involved in 133 (85%) casualties. Factors related to the vehicles contributed to 12% of RTCs. Of the 156 casualties, 17% had severe injuries and needed ICU admission. After 48 hours of the accident, 38% of patients ended with disability due to fractured limbs, 29% were not improving and their conditions were deteriorating, 18% had recovered and 5% died.

Conclusion

Several personal, behavioral, environmental and vehicles related factors had contributed to RTIs in Yemen. The burden of RTIs in Yemen in terms of disability and mortality is high.

Ecological study of road traffic injuries in the eastern Mediterranean region: country economic level, road user category and gender perspectives

BACKGROUND

The Eastern Mediterranean region has the second highest number of road traffic injury mortality rates after the African region based on 2013 data, with road traffic injuries accounting for 27% of the total injury mortality in the region. Globally the number of road traffic deaths has plateaued despite an increase in motorization, but it is uncertain whether this applies to the Region. This study investigated the regional trends in both road traffic injury mortality and morbidity and examined country-based differences considering on income level, categories of road users, and gender distribution.

METHODS

Register-based ecological study linking data from Global Burden of Disease Study with the United Nations Statistics Division for population and World Bank definition for country income level. Road traffic injury mortality rates and disability-adjusted life years were compiled for all ages at country level in 1995, 2005, 2015 and combined for a regional average (n = 22) and a global average (n = 122). The data were stratified by country economic level, road user category and gender.

RESULTS

Road traffic injury mortality rates in the Region were higher than the global average for all three reference years but suggest a downward trend. In 2015 mortality rates were more than twice as high in low and high income countries compared to global income averages and motor vehicle occupants had a 3-fold greater mortality than the global average. Severe injuries decreased by more than half for high/middle income countries but remained high for low income countries; three times higher for males than females.

CONCLUSION

Despite a potential downward trend, inequalities in road traffic injury mortality and morbidity burden remain high in the Eastern Mediterranean region. Action needs to be intensified and targeted to implement and enforce safety measures that prevent and mitigate severe motor vehicle crashes in high income countries especially and invest in efforts to promote public, active transport for vulnerable road users in the resource poor countries of the Region.

Global road fatality trends' estimations based on country-wise micro level data

The global road crash deaths during the past 35 years are estimated and analysed considering micro-level data for 215 countries. The data were gathered from Governmental records, international databases, and personal contacts. The data are adjusted for underreporting, death definition differences and missing data. The study models both reported and adjusted death to forecast future crash trends for each continent. The developed models employed curve fitting regression technique. It took over five years to build-up the database. The global sum of crash deaths showed firm increasing trends between 1980 and 2008. Subsequently, the global deaths tend to slow down. The adjusted death during 2014 ranged between 792,000 and 905,000. The high range showed 40% lesser death than World Health Organization (WHO) estimate. The developed models presented a plateauing transition stage of global road deaths before descending. This is contradicting WHO and The World Bank (TWB) forecasts. The global adjusted death for 2020 and 2030, differed substantially from WHO and TWB forecasts. The results showed inconsistencies in road deaths between various WHO sectors. The trend of crash fatalities in Asia followed closely with that for global trend, and that in Africa it showed fluctuated trend with steep increasing tendency after 1999. In South America, it showed continuous ascending trends, and that in Europe and Oceanic countries showed clear descending patterns. The trend in North and Central America did not change much during the period between 1980 and 2007. While the developed models indicated drops of 33% in North and Central America, 18% in Oceania and 13% in Asia by 2025 compared with 2014, they increase by over 44% in Africa and 32% in South America. The poor safety records in several continents, require careful reading, proper interpretation of the results and extensive research.

Registry Data Coordinator (RDC): a Proper Accessible Strategy for Improving Road Traffic Injury (RTI) Hospital Based Trauma Registry Systems in Developing Countries and Low Income Countries

INTRODUCTION

Evidence suggested that a significant level of trauma mortality can be prevented using registry system.

AIM

This study aimed to improve Kashan Hospital Based Trauma Registry System (KHBTRS) for Road Traffic Injury (RTI).

MATERIAL AND METHODS

After conducting focus group discussion absence of minimum data set (MDS) and poor data collection process (DCP) were identified as main problems for KHBTRS- RTI. Proposed MDS were surveyed by 20 experts of trauma research center of throughout the Iran. Then approved MDS applied for trauma registry system data base in form of SQL. DCP were reform from prospective data collection (review of medical record) to concurrent (through the interview) approach.

RESULTS

Most of participants for MDS approval belonged to clinical group 13(65%). 146 MDS in eighteen main categories were proposed for RTI. The maximum score for each MDS main categories were attributed to body parts injured 220 (100%) and patient vital signs 139 (99.29%) respectively. Pilot testing of KHBTRS- RTI database of 50 (50%) riders indicated fully completeness 50 (100%) for concurrent approach. It was concluded that based on experts' viewpoints MDS relating to injury nature and place of occurrence have more priority in comparisons to MDS relating to causes of injury. It may attribute to health care providers focus on clinical care and treatment.

CONCLUSION

It was concluded that based on experts' viewpoints MDS relating to injury nature and place of occurrence have more priority in comparisons to MDS relating to RTI prevention; it may attribute to health care providers focus on clinical care and treatment. To develop injury interventions based on given data, recruitment of professionals as registry data coordinator with specific job description to collect and advocacy of injury external causes data seems imperative.

Admission delays' magnitude of traumatized patients in the emergency department of a hospital in Egypt: a cross-sectional study

BACKGROUND

Injury is an escalating public health problem, representing about 9% of global mortality, which disproportionately impacts lower- and middle-income countries. There are approximately 12,000 annual fatalities from road traffic injuries in Egypt, but a little information about delays in seeking emergent care is available.

OBJECTIVES

To measure the time interval between sustaining an injury and presentation to the emergency department of Ain Shams University Surgery Hospital and to identify possible causes of these delays.

METHODS

We conducted a cross-sectional, facilitated survey of a convenience sample of trauma patients presenting to the emergency department of Ain Shams University Surgery Hospital from 1 February to 31 May 2014. Data obtained included: demographic information, trauma incident details, and injury assessment.

RESULTS

The average reported transport time for patients from injury to hospital arrival was 3.8 h, while the mean ambulance response time was 45 min. Referral from other hospitals was revealed to be a significant cause of delay (P = 0.004), while ignorance of the local ambulance phone number could not be confirmed as a cause (P = 0.2).

CONCLUSION

This study demonstrated that trauma patients at our hospital experience more than 3 h of delay until they reach the ED. It also identified the possible causes accounting for that delay. However, additional nationwide research is needed to establish the clear causation or association of these causes with the delay intervals.

Causes and outcome predictors of traumatic brain injury among emergency admitted pediatric patients at Cairo University Hospitals

BACKGROUND

Traumatic brain injury (TBI) is a major global public health problem with significant morbidity and mortality, especially among the pediatric age group. Researchers are eager to find new diagnostic tools that might be useful for outcome prediction of pediatric TBI.

OBJECTIVE

This study aims to determine the causes of TBI in pediatric patients admitted to the Emergency Hospital at Cairo University, and monitor and evaluate some clinical and laboratory markers for outcome prediction.

PATIENTS AND METHODS

A hospital-based prospective study was carried out; all pediatric patients with TBI admitted to the New Emergency Hospital during 6 months (November 2014-April 2015) were enrolled in the study. A total of 67 pediatric patients with TBI were examined and investigated upon admission and followed prospectively till discharge or death. Probing questions were used to collect data on child abuse and neglect. The Glasgow Coma Scale (GCS) was used for clinical assessment, followed by cerebral tomography (computed tomography scan). Routine laboratory investigations, arterial blood gases (pH, PCO2, and HCO3), and coagulopathy tests (prothrombin time, prothrombin concentration, international normalized ratio, and D-dimer) were performed on days 1 and 7.

RESULTS

Fall from height, traffic accidents, and direct head trauma represented 38.8, 34.3, and 21% of head trauma etiologies, respectively. Child neglect and abuse was detected in 62.7 and 18% of patients, respectively. Values of GCS at days 1 and 7 were significantly higher among survivors (P<0.001). D-dimer levels on days 1 and 7 were significantly higher among nonsurvivors (P<0.001). Receiver operating characteristics curve analysis showed the discriminative ability of D-dimer level on day 1 in predicting mortality with 89.3% sensitivity and 76.9% specificity.

CONCLUSION AND RECOMMENDATIONS

Falls, traffic accidents, and direct head trauma were the most frequent etiologies for TBI in emergency admitted pediatric patients. Child neglect and abuse were the most prominent predisposing factors. GCS and D-dimer were the most important clinical and laboratory markers predicting mortality. Further large-scale studies are needed to determine the prevalence of TBIs and to prove the prognostic role of the D-dimer.

Developing a Minimum Data Set for an Information Management System to Study Traffic Accidents in Iran

Background:

Each year, around 1.2 million people die in the road traffic incidents. Reducing traffic accidents requires an exact understanding of the risk factors associated with traffic patterns and behaviors. Properly analyzing these factors calls for a comprehensive system for collecting and processing accident data.

Objectives:

The aim of this study was to develop a minimum data set (MDS) for an information management system to study traffic accidents in Iran.

Materials and Methods:

This descriptive, cross-sectional study was performed in 2014. Data were collected from the traffic police, trauma centers, medical emergency centers, and via the internet. The investigated resources for this study were forms, databases, and documents retrieved from the internet. Forms and databases were identical, and one sample of each was evaluated. The related internet-sourced data were evaluated in their entirety. Data were collected using three checklists. In order to arrive at a consensus about the data elements, the decision Delphi technique was applied using questionnaires. The content validity and reliability of the questionnaires were assessed by experts’ opinions and the test-retest method, respectively.

Results:

An (MDS) of a traffic accident information management system was assigned to three sections: a minimum data set for traffic police with six classes, including 118 data elements; a trauma center with five data classes, including 57 data elements; and a medical emergency center, with 11 classes, including 64 data elements.

Conclusions:

Planning for the prevention of traffic accidents requires standardized data. As the foundation for crash prevention efforts, existing standard data infrastructures present policymakers and government officials with a great opportunity to strengthen and integrate existing accident information systems to better track road traffic injuries and fatalities.

Developing sustainable trauma care education in Egypt: sequential trauma education program, steps to success

INTRODUCTION

As one of the leading causes of death and disability in the world, human trauma and injury disproportionately affects individuals in developing countries. To meet the need for improved trauma care in Egypt, the Sequential Trauma Emergency/Education ProgramS (STEPS) course was created through the collaborative effort of U.S. and Egyptian physicians. The objective of course development was to create a high-quality, modular, adaptable, and sustainable trauma care course that could be readily adopted by a lower- or middle-income country.

METHODS

We describe the development, transition, and host nation sustainability of a trauma care training course between a high-income Western nation and a lower-middle-income Middle Eastern/Northern African country, including the number of physicians trained and the challenges to program development and sustainability.

RESULTS

STEPS was developed at the University of Maryland, based in part on World Health Organization's Emergency and Trauma Care materials, and introduced to the Egyptian Ministry of Health and Population and Ain Shams University in May 2006. To date, 639 physicians from multiple specialties have taken the 4-day course through the Ministry of Health and Population or public/governmental universities. In 2008, the course transitioned completely to the leadership of Egyptian academic physicians. Multiple Egyptian medical schools and the Egyptian Emergency Medicine Board now require STEPS or its equivalent for physicians in training.

CONCLUSIONS

Success of this collaborative educational program is demonstrated by the numbers of physicians trained, the adoption of STEPS by the Egyptian Emergency Medicine Board, and program continuance after transitioning to in-country leadership and trainers.

Motorcycle crashes: attitudes of the motorcyclists regarding riders' experience and safety measures

Motorcycle injuries constitute a major but neglected emerging public health problem in developing countries and contribute significantly to the overall road traffic injuries. The aims of this work were to study the attitudes and practices of the motorcyclists regarding training and safety measures, and to determine some underlying factors of motorcycle crashes. This cross sectional hospital based study was conducted on all injured conscious motorcyclists who were admitted to the emergency department at Benha University Hospital, Benha City, Qalubia governorate, Egypt from December 2012 up to December 2013. The data were collected using a standard interview questionnaire which included four main sections; personal data, data about the rider's experience and training, safety issues and data about the crash the motorcyclist involved in. The questionnaire was completed by 246 motorcyclists. Of these, 67.5% did not have a motor cycle license and friends/family were the source of training for 56.9% of them. There were highly significant associations between the source of training and age, education, occupation and marital status (P < 0.001 for all). Correctly positioning the motorcycle according to road conditions, making one visible to other road users and the proper maintenance of the motorcycle were the most commonly reported safety measures. Inattentive mode, suffering stress on the day of the accident, not paying attention to distances or to the regulations, not being familiar with the road of the accident and not using the protection system were some of the underlying factors of motorcycle accidents.

Evidence gaps in the global decade of road traffic safety

Road traffic accidents are a leading cause of global mortality. In March 2010, the United Nations General Assembly and the World Health Organization (WHO) officially proclaimed 2011-2020 as the "Decade of Action for Road Safety." Researchers must focus on vulnerable road users and low- and middle-income countries (LMICs) and should give preference to simple high-impact interventions likely to be inexpensive and widely applicable. Collaborative investigative networks should include LMICs, and economic evaluations should demonstrate the value of novel interventions in LMIC settings. Reliable data systems are essential to understand needs and outcomes, and knowledge translation studies should support effective implementation.

Seatbelt use and speeding on three major roads in Egypt: a brief report

OBJECTIVE

Road traffic injuries pose a significant threat to the Egyptian population. Recent estimates revealed that Egypt experiences 42 road traffic deaths per 100,000 population (1.8% of all deaths in the country), which is the highest death rate in the region. More than half of the road traffic crashes that resulted in injuries occurred on the country's highways. Despite the significance of this public health problem, very little risk factor information currently exists. The overall goal of this paper is to understand the burden of speeding and the level of seatbelt and child restraint use on a highway (Cairo Ring Road) and two urban roads crossing Alexandria city (Kornish and Gamal Abd-Elnaser roads).

METHODS

Two rounds of seatbelt and child restraint observational studies and one round of speed observational study were carried out between 2011 and 2012.

RESULTS

Findings revealed that seatbelt use among drivers and front seat passengers were low for all three sites (range: 11.1% to 19.8% for drivers; 2.9% to 4.0% for front seat passengers). Similarly, child restraint use in cars with children was very low ranging from 1.1% to 3.9% on all three roads. All three roads experienced a high percentage of vehicles driving above the speed limit (39.4% on Kornish Road, 22.6% on Cairo Ring Road, 11.8% on Gamal Abd-Elnaser Road), with the majority of these vehicles driving 1 to 10 kilometer above the speed limit.

CONCLUSION

Future interventions need to focus on enhancing enforcement of speed and seatbelt wearing, closing gaps in legislation, and standardizing existing data systems to help inform good road safety policies.

Socioeconomic and disability consequences of injuries in the Sudan: a community-based survey in Khartoum State

BACKGROUND

Fatal and non-fatal injuries are of increasing public health concern globally, particularly in low and middle-income countries. Injuries sustained by individuals also impact society, creating a loss of productivity with serious economic consequences. In Sudan, there is no documentation of the burden of injuries on individuals and society.

METHODS

A community-based survey was performed in Khartoum State, using a stratified two-stage cluster sampling technique. Households were selected in each cluster by systematic random sampling. Face-to-face interviews during October and November 2010 were conducted. Fatal injuries occurring during 5 years preceding the survey and non-fatal injuries occurring during 12 months preceding interviews were included.

RESULTS

The total number of individuals included was 5661, residing in 973 households. There were 28 deaths due to injuries out of a total of 129 reported deaths over 5 years. A total of 441 cases of non-fatal injuries occurred during the 12 months preceding the survey. The number of disability days differed significantly between mechanisms of injury. Road traffic crashes and falls caused the longest duration of disability. Men had a higher probability than women of losing a job due to an injury.

CONCLUSIONS

This study demonstrates the importance of prioritising prevention of road traffic crashes and falls. The loss of productivity in lower socioeconomic strata highlights the need for social security policies. Further research is needed for estimating the economic cost of injuries in Sudan.