Patterns of injuries and motor-vehicle traffic accidents in Athens

Extremity Injuries in Pillion Riders of Fatal 2-Wheeler Road Traffic Accidents: An Autopsy-Based Study

ABSTRACT

The extremities are the important anatomical regions that are disproportionately injured during road traffic accidents in poor and medium-income countries. The data regarding extremity injuries, particularly in pillion passengers, are minimal globally. We analyzed the pattern of extremity injuries and their association with various parameters such as collision type, seating position, road type, and type of vehicle. This was a hospital-based cross-sectional study. The pillion riders of fatal motorized 2-wheeler road accident cases that were subjected to autopsy were studied over a period of 2 years. We analyzed 73 cases of pillion riders. Females (60%) were the most commonly affected group. The upper extremities were injured in 55 cases (75.3%) and the lower extremities in 49 cases (67.1%). The shoulder (41%), hand (31.3%), and elbow (23.2%) were the predominantly injured anatomical regions of the upper limb. In the lower extremity, knee (41%) and foot (21.9%) were mostly affected. Forty-nine (67.1%) and 48 (65.8%) cases had abrasions in the upper limbs and lower limbs, respectively, followed by lacerations and contusions. Upper extremity injuries are more common compared with lower extremity. The majority of the pillion riders were seated in a side-saddle position, and self-fall from the bike without any collision with other vehicles was the most common mode of injury. Thus, appropriate seating posture with safety gear can be used to reduce extremity injuries.

Predictors of mortality of trauma patients admitted to the ICU: a retrospective observational study☆

Background and objectives

Worldwide, trauma is one of the leading causes of morbidity and mortality. The aim of the present study is to identify the predictors of mortality of trauma patients requiring Intensive Care Unit (ICU) admission.

Methods

This retrospective study was conducted in the ICU of our institution in Greece during a six-year period (2010–215).

Results

Among 326 patients, trauma was caused by road traffic accidents in .5%, followed by falls (21.1%) and violence (7.4%). Thirty-day mortality was 27.3%. Multivariate analysis showed that higher New Injury Severity Score (NISS), severe head/neck injury, acute kidney injury, septic shock and hemorrhagic shock were significantly associated with mortality while higher Revised Injury Severity Classification, version II (RISC II) and the administration of enteral nutrition were associated with survival. NISS showed the higher accuracy in predicting 30-day mortality followed by RISC II, while scores based only in physiological variables had lower predictive ability.

Conclusions

Increased mortality was strongly associated with the severity of the injury upon admission. Traumatic brain injury, septic shock and acute kidney injury have also been found among the strongest predictors of mortality. NISS can be considered as a statistically superior score in predicting mortality of severely injured patients.

Crash characteristics and patterns of injury among hospitalized motorised two-wheeled vehicle users in urban India

Background

Traffic crashes and consequent injuries represent a growing public health concern in India, particularly in light of increasing motorization. Motorised two-wheeled vehicles (MTV) constitute a large portion of the vehicle fleet in India. We report the crash characteristics and injury patterns among a cohort of MTV riders and pillions presenting to hospital post-crash.

Methods

Consecutive MTV riders and pillions, whether alive or dead, injured in a road traffic crash presenting to the emergency departments of two government hospitals and three branches of a private hospital in urban Hyderabad, India, were recruited to this study.

Results

378 MTV users were enrolled to the study of whom 333 (88.1%) were male, 252 (66.7%) were riders and median age was 31.3 years. A total of 223 (59%) MTV users were injured in multi-vehicle crashes while one-third had a frontal impact. The majority (77%) were assessed as having a Glasgow coma score (GCS) of 13–15, 12% a GCS of 9–12 and 11% a GCS of 3–8. No difference was seen in the severity distribution of injuries based on GCS among riders and pillions. Open wounds and superficial injuries to the head (69.3%) and upper extremity (27%) and lower extremity (24%) were the most common injuries. 43 (11%) sustained an intracranial injury, including 12 (28%) with associated fracture of the bones of the head. There were few differences in types of injuries sustained by riders and pillions though riders had a significantly lower risk of crush injuries of the lower extremity than pillions (relative risk, RR 0.25, 95% CI 0.08–0.81) and female pillions were at a significantly lower risk of sustaining fractures of the lower extremity than male pillions (RR 0.30, 95% CI 0.09 – 0.94). Overall, 42 (11%) MTV users died, of which 42.8% died before reaching the hospital. Only 74 (19.6%) MTV users had worn a helmet correctly and failure to wear a helmet was associated with a five times greater risk of intracranial injury (RR 4.99, 95% CI 1.23–20.1). Of the 19 pre-hospital deaths, 16 (84%) had not worn a helmet.

Conclusion

Head injuries accounted for the major proportion of injuries sustained in MTV users. Non-helmet use was associated with increased risk of serious head injuries. The data presented on the nature and severity of injuries sustained by MTV users can assist with planning to deal with these consequences as well as prevention of these injuries given the high use of MTV in India.

Road traffic collisions in Bursa, Turkey, during 2003, 2004 and 2005

AIM

To highlight the demographic pattern of road traffic injuries in Bursa and to improve emergency care and health facility-based treatment.

METHODS

Records of all registered road traffic collisions maintained by the Uludağ University Emergency Department in Bursa for the period 2003 to 2005 and trauma files of 1307 road traffic collision victims were examined in this study. A form was designed to document patients' age, gender, type of trauma, time of trauma (hour, day, month and year), type and time to hospital of transport, presence of safety devices, presence of alcohol and blood alcohol concentration, localisations of wounds, trauma scores and outcomes.

RESULTS

Of the 1307 cases, 418 (32%) were female and 889 (68%) were male. Ages ranged from 3 months to 87 years; mean age (+/-S.D.) was 34.8 (+/-17.3) years. The mean (+/-S.D.) ages of women and men were 35+/-17.6 and 34.7+/-17.2 years, respectively. Trauma was most commonly sustained within the motor vehicle (72.2%), followed by pedestrian injuries (21.7%), motorcycle injuries (5.5%) and bicycle injuries (0.6%). Collisions were most frequent in summer (34.7%) and on Fridays and weekends (48.5%). Seat belts were used in only 1.8% of incidents. In 90 cases (6.9%) alcohol was found in the blood; mean blood alcohol concentration was 139.2+/-88.3mg/dl.

CONCLUSIONS

The identification of RTC characteristics may contribute to the development of injury prevention measures. Road travel requires extra attentiveness at peak accident times. Seat-belt use should increase, as well as use of other safety equipment such as collision helmets. Shorter transportation time of casualties to hospital would improve outcome.

Impact of a program for the prevention of traffic accidents in a Southern Brazilian city: a model for implementation in a developing country

BACKGROUND

Traffic accidents constitute the main cause of death in the first decades of life. Traumatic brain injury is the event most responsible for the severity of these accidents. The SBN started an educational program for the prevention of traffic accidents, adapted from the American model "Think First" to the Brazilian environment, since 1995, with special effort devoted to the prevention of TBI by using seat belts and motorcycle helmets. The objective of the present study was to set up a traffic accident prevention program based on the adapted Think First and to evaluate its impact by comparing epidemiological variables before and after the beginning of the program.

METHODS

The program was executed in Maringá city, from September 2004 to August 2005, with educational actions targeting the entire population, especially teenagers and young adults. The program was implemented by building a network of information facilitators and multipliers inside the organized civil society, with widespread population dissemination. To measure the impact of the program, a specific software was developed for the storage and processing of the epidemiological variables.

RESULTS

The results showed a reduction of trauma severity due to traffic accidents after the execution of the program, mainly TBI.

CONCLUSIONS

The adapted Think First was systematically implemented and its impact measured for the first time in Brazil, revealing the usefulness of the program for reducing trauma and TBI severity in traffic accidents through public education and representing a standardized model of implementation in a developing country.