Road traffic fatalities in rural and remote Australia from 2006 to 2017: The need for targeted action

Road Fatalities in Children Aged 0-17: Epidemiological Data and Forensic Aspects on a Series of Cases in a Single-Centre in Romania

INTRODUCTION

Road Traffic Accidents (RTAs) are the leading cause of premature death in young people aged 5-29. Globally, 186,300 children aged 9 years and under die from RTAs each year. Romania had the highest mortality rate in children aged 0 to 14 for 2018-2020. This study aimed to assess the involvement of children aged 0-17 years in fatal RTAs by analyzing medico-legal autopsy records in a 5-year period at Timisoara Institute of Legal Medicine (TILM), Romania.

MATERIALS AND METHODS

A retrospective analysis of medico-legal autopsy records of road fatalities in children aged 0-17 years, from TILM in a 5-year period (2017-2021), was conducted.

RESULTS

Of all medico-legal autopsies in the 5-year period, 23 cases (5.8%) involved road fatalities in children aged 17 and under. Preschoolers accounted for 10 cases, followed by the age group 15-17 years (n = 9). Most children sustained fatal injuries as passengers (n = 13), followed by child pedestrians (n = 7). This research follows four representative cases, each being a different type of child road fatality regarding the type of road user, the age of the victim, and the involvement of other risk factors.

CONCLUSIONS

Our findings emphasize the tragedy of road fatalities in children and the need to determine risk factors and prevention strategies to reduce the enormous global crisis involving these vulnerable victims.

The burden of head trauma in rural and remote North Queensland, Australia

BACKGROUND

Head trauma is a leading cause of death and disability worldwide. Young males, Indigenous people, and rural/remote residents have been identified as high-risk populations for head trauma, however, Australian research is limited. Our aim was to define and describe the incidence, demographics, causes, prehospital interventions, and outcomes of head trauma patients transported by aeromedical services within North Queensland, Australia. We hypothesized that young, Indigenous males living remotely would be disproportionately affected by head trauma.

METHODS

We conducted a retrospective study of all head trauma patients transferred by air to or between Townsville, Cairns, Mount Isa and Mackay Hospitals between January 1, 2016 and December 31, 2018. Patients were identified from the Trauma Care in the Tropics data registry and followed for a median 30-months post-injury. Primary endpoints were patient and injury characteristics. Secondary outcome measures were hospital stay and mortality.

RESULTS

A total of 981 patients were included and 31.1 % were Indigenous. Sixty-seven percent of injuries occurred remotely and the median time from injury to hospital was 5.8-hours (range 67-3780 min). Eighty percent of severe head injuries occurred in males (p = 0.007). Indigenous and remote patients were more likely to sustain mild injuries. The most common mechanism of injury overall was vehicle accident (37.5 %), compared to assault in the Indigenous subgroup (46.6 %, p<0.001). The overall mortality rate was 4.9 %, with older age and lower initial Glasgow Coma Score significant predictors of in-hospital mortality. Prehospital intubation was associated with a 7-fold increased risk of mortality (p = 0.056), while patients that received tranexamic acid (TXA) were almost 5-times more likely to die.

CONCLUSIONS

In North Queensland, young Indigenous males are at highest risk of traumatic head injuries. Vehicle accidents are an important preventable cause of head injury in the region. TXA administration is an important consideration for remote head trauma retrievals, in which time to emergency care is prolonged. Appropriate treatment and risk stratification strategies considering time to definitive care, severity of injury, and other prehospital patient factors require further investigation.