Social and hospital costs of patients admitted to a university hospital in Brazil due to motorcycle crashes

Driver's license, head protection devices and severity of motorcyclists' injuries in traffic accidents

OBJECTIVES

to describe traffic accidents involving motorcyclists and analyze the association between possession of a motorcycle driver's license and use of helmets according to the severity of injuries.

METHODS

a cross-sectional study was conducted among all patients hospitalized in the traumatology and orthopedics sector of a public reference hospital in northeastern Brazil.

RESULTS

170 patients were surveyed, the majority were male (95.9%). Their ages ranged from 18 to 67 years. Most were black or brown (52.3%), had completed elementary school (58.9%) and had monthly income smaller than two minimum wages (56.5%). An association was found between being licensed to drive a motorcycle and wearing a helmet. Among those who suffered moderate injuries, this association was OR=5.66(1.85-17.23) and among those who suffered severe injuries it was OR=13.57(2.82-65.14).

CONCLUSIONS

people who were licensed to drive motorcycles used a helmet as protective equipment more often and, in accidents, suffered fewer injuries.

Costs and 30-day readmission after lower limb fractures from motorcycle crashes in Queensland, Australia: A linked data analysis

BACKGROUND

Lower limb trauma is the most common injury sustained in motorcycle crashes. There are limited data describing this cohort in Australia and limited international data establishing costs due to lower limb trauma following motorcycle crashes.

METHODS

This retrospective cohort study utilised administrative hospitalisation data from Queensland, Australia from 2011-2017. Eligible participants included those admitted with a principal diagnosis coded as lower extremity or pelvic fracture following a motorcycle crash (defined as the index admission). Multiply injured motorcyclists where the lower limb injury was not coded as the primary diagnosis (i.e. principal diagnosis was rather coded as head injury, internal organ injures etc.) were not included in the study. Hospitalisation data were also linked to clinical costing data. Logistic regression was used to determine risk factors for 30-day readmission. Costing data were compared between those readmitted and those who weren't, using bootstrapped t-tests and ANVOA.

RESULTS

A total of 3342 patients met eligibility, with the most common lower limb fracture being tibia/fibula fractures (40.8%). 212 participants (6.3%) were readmitted within 30-days of discharge. The following were found to predict readmission: male sex (OR 1.84, 95% CI 1.01-1.94); chronic anaemia (OR 2.19, 95% CI 1.41-3.39); current/ex-smoker (OR 1.60, 95% CI 1.21-2.12); emergency admission (OR 2.77, 95% CI 1.35-5.70) and tibia/fibula fracture type (OR 1.46, 95% CI 1.10-1.94). The most common reasons for readmission were related to ongoing fracture care, infection or post-operative complications. The average hospitalisation cost for the index admission was AU$29,044 (95% CI $27,235-$30,853) with significant differences seen between fracture types. The total hospitalisation cost of readmissions was almost AU$2 million over the study period, with an average cost of $10,977 (95% CI $9,131- $13,059).

CONCLUSIONS

Unplanned readmissions occur in 6.3% of lower limb fractures sustained in motorcycle crashes. Independent predictors of readmission within 30 days of discharge included male sex, chronic anaemia, smoking status, fracture type and emergency admission. Index admission and readmission hospitalisation costs are substantial and should prompt health services to invest in ways to reduce readmission.

Reconstrução microcirúrgica em um hospital ortopédico: Indicações e desfechos em adultos

Objective  Advances in reconstructive microsurgery in orthopedic surgery provided better functional and aesthetic results and avoided many indications for amputation. In high-volume trauma and orthopedic hospitals, microsurgical reconstruction is essential to reduce costs and complications for these complex orthopedic defects. We describe a microsurgical approach to traumatic wounds, tumor resection, bone defects, and free muscle transfer, performed by an orthopedic microsurgery unit. The objective of the present study was to evaluate predictor factors for outcomes of microsurgical flaps for limb reconstruction, and to provide a descriptive analysis of microsurgical flaps for orthopedic indications.

Methods  Cross-sectional prospective study that included all consecutive cases of microsurgical flaps for orthopedic indications from 2014 to 2020. Data were collected from personal medical history, intraoperative microsurgical procedure, and laboratory blood tests. Complications and free-flap outcomes were studied in a descriptive and statistical analysis.

Results  We evaluated 171 flaps in 168 patients; the indications were traumatic in 66% of the patients. Type III complications of the Clavien-Dindo Classification were observed in 51 flaps. The overall success rate of the microsurgical flaps was 88.3%. In the multivariate analysis, the risk factors for complications were ischemia time ≥ 2 hours ( p  = 0.032) and obesity ( p  = 0.007). Partial flap loss was more common in patients with thrombocytosis in the preoperative platelet count ( p  = 0.001).

Conclusion  The independent risk factors for complications of microsurgical flaps for limb reconstruction are obesity and flap ischemia time ≥ 2 hours, and presence of thrombocytosis is a risk factor for partial flap loss.

[Time trend in hospitalizations from motor vehicle accidents in the city of São Paulo, Brazil, 2000-2019]

This study assessed the hospitalization rates from motor vehicle accidents in the Brazilian Unified National Health System (SUS) in residents of the city of São Paulo, Brazil, from 2000 to 2019, according to sex, age bracket, and means of transportation (pedestrians, cyclists, motorcyclists, and motor vehicle occupants). A segmented regression model with negative binomial response was adjusted with inflection points to accommodate possible changes in trends. 189,765 hospitalizations were recorded during the study period, mostly males (80.5%) and from 20 to 49 years of age (71.2%). The most frequent type of accident involved motorcyclists (42.8%), followed by run-over pedestrians (33.7%). In general, the period from 2000 to 2007 was marked by increasing hospitalization rates from motor vehicle accidents involving all means of transportation, in both sexes, and in most age brackets. The year when the rates stopped increasing (or in some cases began to drop) differed according to the means of transportation. For vehicle occupants and cyclists, the trend in most age brackets turned downward in 2008, but the same did not happen with pedestrians and motorcyclists until 2012. Starting in 2015, the decline stopped in pedestrians, and the rates in cyclists turned upward again in most age brackets. For motorcyclists, the rates turned upward again in men 20 to 59 years of age (7.2% per year, exceeding 140 per 100,000 inhabitants in 2019) and in women 15 to 39 years of age (4.9% per year). The benefits of traffic safety measures implemented thus far in Brazil may have reached their limit, so that the current control and prevention measures need to be revised.

Do Type of Helmet and Alcohol Use Increase Facial Trauma Severity?

PURPOSE

Facial trauma caused by motorcycle accidents has become a major issue because of its high prevalence and morbidity, causing death and esthetic and functional sequelae in many individuals. This work evaluated helmet and alcohol use and severity of facial fractures in motorcyclists treated at public hospitals in Pernambuco, Brazil.

PATIENTS AND METHODS

This prospective study was conducted from December 2016 to December 2018 and submitted to statistical and descriptive analysis. Variables such as gender, age, helmet use and type, previous accidents, and duration of hospitalization were collected. The Facial Injury Severity Scale was used to classify the facial fractures. The Alcohol Use Disorders Identification Test was used to verify alcohol dependence.

RESULTS

The sample was composed of 455 patients. Most were male patients (90.8%) and were aged 18 to 29 years (54.5%). Of the patients, 36.5% reported no helmet use and 31.6% reported wearing an open helmet. Alcohol use was reported in 38.7% of the group. In 79.8% of the sample, alcohol use was classified as low risk. There was a greater likelihood of having severe facial trauma if patients were aged between 30 and 39 years and had harmful or at-risk alcohol use. These patients also tended to remain hospitalized for more than 10 days. No statistically significant relationship was found with the type of helmet.

CONCLUSIONS

The individuals most affected by facial trauma were young male patients (aged 18 to 29 years). Patients aged 30 to 39 years with high-risk use and dependence on alcohol were more likely to have more complex facial trauma. The type of helmet used was not effective in reducing the severity of facial fractures.

Predictors of hospitalization and surgical intervention among patients with motorcycle injuries

Background

To describe the distribution of injuries, hospitalization rates by body areas injured, and surgery-requiring admissions, and to identify independent predictors of admission to a regional hospital in Jamaica.

Methods

A cross-sectional study was conducted among persons presenting to the St Ann’s Bay Regional Hospital in Jamaica (2016–2018) with injuries sustained from motorcycle crashes. A census was done of patients admitted to the surgery ward from the emergency room, as well as those referred to the Orthopaedic Outpatient Department. Trained members of the orthopedic team administered a pretested questionnaire within 24 hours of presenting to the orthopedic service to elicit data on sociodemographic characteristics, motor vehicle collision circumstance and motor bike specifications, physical injuries sustained and medical management, as well as compliance with legal requirements for riding a motorcycle. Associations between variables were examined using χ² tests and logistic regression.

Results

There were 155 participants in the study, and 75.3% of motorcyclists with injuries required admission. The average length of stay was approximately 10 days. Surgery was required for 71.6% of those admitted. Lower limb injuries constituted 55% of all injuries. The independent predictors for admission were alcohol use and total body areas involved. Motorcycle crash victims who used alcohol close to the time of crash were three times more likely to be admitted to hospital than those who did not consume alcohol. As the total body areas involved increased by one, there was a threefold increase in the likelihood of being admitted. Additionally, the greater the number of body areas involved, the greater was the likelihood of admission.

Discussion

Lower limb injuries are the most commonly reported injuries among victims of motorcycle crashes. Alcohol and total body areas involved are independent predictors of admission to hospital. In the planning of trauma delivery services, this information should be taken into account.

Level of Evidence

Level IV.

Microbiological profile and susceptibility pattern of surgical site infections related to orthopaedic trauma

BACKGROUND

Understanding the epidemiology of microorganisms associated with surgical site infections related to orthopaedic trauma (SSI-ROT) is important in establishing treatment protocols. The aim of this study was to evaluate the etiology and susceptibility pattern of SSIs related to orthopaedic trauma in a Brazilian reference hospital for trauma.

METHODS

Patients with SSI-ROT in a Brazilian reference hospital for trauma were retrospectively analyzed. All patients with orthopaedic trauma who underwent a surgical procedure and developed SSI within one year were included. All patients had culture samples from the surgical site obtained from biopsy of bone or soft tissue. Clinical and epidemiological data of the patients were collected.

RESULTS

A total of 147 patients with trauma-related infection were included in the analysis. The mean time to infection was 55.5 days, and the mean duration of hospitalization was 20.0 days. The in-hospital mortality rate after infection was 5.4%. Cultures were obtained from all patients, with 104 samples obtained from soft tissues and 43 samples from bone. The positivity rate was 93.2%. Among the isolates, 56.5% (77 patients) were gram-negative bacteria and 43.8% (60 patients) were gram-positive bacteria. Staphylococcus aureus was identified in 34%, Enterobacter spp. in 14.9%, and Pseudomonas aeruginosa in 11.6%. Staphylococcus aureus presented a higher positivity in bone samples (odds ratio, 1.29; 95% CI, 1.01-1.70; p = 0.04). Few microorganisms were multi-resistant.

CONCLUSION

SSI in orthopaedic trauma can be associated with gram-negative bacilli, the susceptibility profile of which suggested that most infections occur after discharge. Staphylococcus aureus infections were commonly caused by methicillin-susceptible isolates, and this susceptibility to oral antibiotic options helps in the dehospitalization of patients.