Prospective audit of the pattern, severity and circumstances of injury sustained by vehicle occupants as a result of road traffic accidents

Still in Plight: Traumatic Injuries and Their Acute Health Effects in Karachi, Pakistan

Introduction Traumatic injuries are a leading cause of mortality and morbidity, with significant social and economic impacts. Karachi, Pakistan, a densely populated city with a high incidence of traumatic injuries, faces inadequacies in its trauma-care setup, including a lack of resources and unorganized care, which highlights the need for improved trauma management strategies and trauma registries. The purpose of this research is to present a fundamental profile of traumatic injuries in terms of their health-related consequences in Karachi, Pakistan. The objective is to identify the nature, affected body parts, and severity of traumatic injuries to identify areas for effective safety measures and reduce morbidity and mortality. Methodology This descriptive, cross-sectional study was conducted at Jinnah Postgraduate Medical Center (JPMC) in Karachi, Pakistan, from June to August 2021. The study included trauma patients over the age of 18 who presented at the accident and emergency department (ED) of JPMC during the study period. Data were collected using a structured questionnaire, and statistical analysis was performed using IBM SPSS Statistics. The study aimed to identify the demographic and clinical characteristics of trauma patients presenting to the ED. Results This study of 363 trauma patients found road traffic injuries (62.4%) as the most common mechanism of injury, with extremities (48.5%) being the most affected body part. The majority of trauma victims did not receive prehospital care (65.3%), highlighting a need for improved emergency response systems and public awareness. Open wounds (41.0%) were the most common nature of injury, with falls being the leading mechanism of fractures. The severity of injuries was mostly moderate (48.2%). Conclusion This study highlighted the need for targeted prevention strategies to reduce the health-related burden on the population of Karachi, Pakistan. Future research should focus on longitudinally monitoring all injured patients to identify high-risk populations, injury patterns, and preventative outcomes.

Changes in injury patterns, injury severity and hospital mortality in motorized vehicle accidents: a retrospective, cross-sectional, multicenter study with 19,225 cases derived from the TraumaRegister DGU®

PURPOSE

In the last 20 years, the number of fatalities due to road traffic accidents (RTA) in Germany has steadily decreased from 7503 to 2724 per year. Due to legal regulations, educational measures and the continuous development of safety technology the number of severe traumatic injuries and injury patterns are most likely to change. The aim of the study was to analyse severely injured motorcyclists (MC) and car occupants (CO) that were involved in RTAs in the last 15 years and investigate the development and changes of injury patterns, injury severity and hospital mortality.

METHODS

We retrospectively evaluated data from the TraumaRegister DGU® (TR-DGU) considering all RTA-related injured MCs and COs (n = 19,225) that were registered in the TR-DGU from 2006 to 2020 with a primary admission to a trauma center with continuous participation (14 of 15 years) in the TR-DGU, an Injury Severity Score (ISS) ≥ 16 and aged between 16 and 79 years. The observation period was divided into three 5-year interval subgroups for further analysis.

RESULTS

The mean age increased by 6.9 years and the ratio of severely injured MCs to COs changed from 1:1.92 to 1:1.45. COs were in 65.8% male and more often severely injured in the age groups under 30, while the majority of severely injured MCs were in the age group around 50 years and in 90.1% male. The ISS (- 3.1 points) as well as the mortality of both groups (CO: 14.4% vs. 11.8%; MC: 13.2% vs. 10.2%) steadily decreased over time. Nevertheless, the standardized mortality ratio (SMR) hardly changed and stayed < 1. Regarding the injury patterns, the greatest decline of injuries with AIS 3 + were to the head (CO: - 11.3%; MC: - 7.1%), in addition, a decrease of injuries to extremities (CO: - 1.5%; MC: - 3.3%), to the abdomen (CO: - 2.6%; MC: - 3.6%), to the pelvis in COs (- 4.7%) and to the spine (CO: + 0.1%; MC: - 2.4%) were observed. Thoracic injuries increased in both groups (CO: + 1.6%; MC: + 3.2%) and, furthermore, pelvic injuries in MCs (+ 1.7%). Another finding was the increase of the utilization of whole body CTs from 76.6 to 95.15%.

CONCLUSION

The severity of injuries and their incidence, especially head injuries, have decreased over the years and seem to contribute to a decreasing hospital mortality of polytraumatized MCs and COs injured in traffic accidents. Young drivers and an increasing number of seniors are the age groups at risk and require special attention and treatment.

Epidemiology of Trauma Patients Admitted to a Trauma Center in New Delhi, India

Introduction

The rapid economic and automobile growth in India leads to a rapid increase in road traffic accidents (RTAs) and factors affecting it. This study evaluates the epidemiology of trauma patients’ reports to the major trauma center in New Delhi, India.

Materials and methods

The 1,583 patients over 6 months reporting to the casualty of the trauma center attached to Lok Nayak Hospital, New Delhi were included in the study. The patients reporting to the outpatient department as follow-up visits were not included in the study. The data were collected with the help of a structured pro forma.

Results

The data depicted the RTAs as the most common cause affecting adults between 20 years and 40 years. The study reports other risk factors like alcohol intoxication and motorcycle riders. Mostly, the patients present in a semiconscious and disoriented state requiring fluid resuscitation. Abrasions and bruises in the extremities stand out as the most common injury pattern. The fractures suffered were the most common injury suffered by the patients.

Conclusion

Our study shows that RTAs and workplace injuries are the predominant causes of trauma affecting mostly the adults. This study defines the correlation of various parameters with causation and distribution of the trauma in the sample population. This study was performed to improve the understanding of the mode of trauma, severity of injuries, and outcome in our hospital, so that effective prevention and comprehensive management strategies could be made.

Clinical significance

This study signifies the fundamental study for the occurrence, distribution, and prevention of trauma in the society. The acquisition of knowledge of different patterns of trauma patients along with other descriptive factors helps to understand the causation of this disease as well as development of preventive measures. This can form the basis of hospital and regional trauma management strategies.

How to cite this article

Harna B, Arya S, Bahl A. Epidemiology of Trauma Patients Admitted to a Trauma Center in New Delhi, India. Indian J Crit Care Med 2020;24(12):1193–1197.

Epidemiology of trauma in an acute care hospital in Singapore

Background:

Trauma injury is the leading cause of mortality and hospitalization worldwide and the leading cause of potential years of productive life lost. Patients with multiple injuries are prevalent, increasing the complexity of trauma care and treatment. Better understanding of the nature of trauma risk and outcome could lead to more effective prevention and treatment strategies.

Materials and Methods:

A retrospective review of 1178 trauma patients with Injury Severity Score (ISS) ≥ 9, who were admitted to the Acute and Emergency Care of an acute care hospital between January 2011 and December 2012. The statistical analysis included calculation of percentages and proportions and application of test of significance using Pearson's chi-square test or Fisher's exact test where appropriate.

Results:

Over the study period, 1178 patients were evaluated, 815 (69.2%) males and 363 (30.8%) females. The mean age of patients was 52.08 ± 21.83 (range 5-100) years. Falls (604; 51.3%) and road traffic accidents (465; 39.5%) were the two most common mechanisms of injury. Based on the three most common mechanisms of injury, i.e. fall on the same level, fall from height, and road traffic accident, the head region (484; 45.40%) was the most commonly injured in the body, followed by lower limbs (377; 35.37%) and thorax (299; 28.05%).

Conclusion:

Fall was the leading cause of injury among the elderly population with road traffic injuries being the leading cause among the younger group. There is a need to address the issues of injury control and prevention in these areas.

Injuries sustained in noncombat motor vehicle accidents during Operation Iraqi Freedom

OBJECTIVE

To examine injuries sustained in noncombat motor vehicle accidents (MVAs) during Operation Iraqi Freedom by injury type, site, and severity.

METHODS

Three hundred and forty-eight military personnel injured in noncombat MVAs from March 2004-June 2007 were identified from clinical records completed near the point of injury.

RESULTS

On average, personnel suffered two injuries per accident. The most frequent MVA mechanism was non-collision due to loss of control (30%). Overall, 16% were injured in a collision accident and 19% in a rollover accident. Rollovers were associated with more severe injuries. A greater proportion of drivers sustained head/neck/face injuries, whereas gunners and pedestrians had higher percents of extremity injuries.

CONCLUSIONS

This analysis provides a thorough overview of injuries incurred in nonbattle MVAs in the combat environment. Future research should combine injury data with accident reports to elucidate areas for improvements in vehicle safety.

Use of a structural deformity index as a predictor of severity among trauma victims in motor vehicle crashes

BACKGROUND

Information obtained from vehicle crash scenes, called kinematics, may prove useful in the management of victims and may complement anatomical and physiological findings.

OBJECTIVES

In addition to analyzing the significance of age, gender, position occupied in the vehicle, the use of restraint systems, and ejection from the vehicle, the objective was to carry out a preliminary study of what we have defined as the Structural Deformity Index (SDI) to verify its usefulness in predicting injury severity at the scene of a motor vehicle crash. The index consists of various parameters that can be easily identified at the crash scene.

METHOD

An historical cohort of vehicle occupants involved in crashes in the Navarra province of Spain from January 1, 2001 to December 31, 2002 was studied. Information was collected from the database of the Navarra Severe Trauma Victim group study. Bivariate statistical analysis and multivariate logistic regression models were employed for statistical management.

RESULTS

There were 212 vehicle occupants identified. Significant differences in severity of injury, and of mortality, were observed based on age, ejection from the vehicle, and a high SDI. Logistic regression showed significant differences in injury severity by age (odds ratio [OR] 6.55, 95% confidence interval [CI] 1.6-26.7) and high SDI (OR 1.84, 95% CI 1-3.3), as well as differences in the patient death rate by age (OR 6.92, 95% CI 1.2-38.9) and high SDI (OR 3.28, 95% CI 1.5-6.8).

CONCLUSIONS

The SDI is useful to the first responders, enabling them to alert and transmit objective, reliable information to the emergency coordination center, thus efficiently activating health care resources. In addition, use of the SDI may assist prehospital and hospital health care providers to suspect the presence of particular serious injuries when anatomical and physiological criteria are not definitive.

Discharge against medical advice

An audit of surgical patients who requested discharge against medical advice over a 5 year period (July 1996-July 2001) at the University of BeninTeaching Hospital showed that 78 patients (66 males and 12 females) were involved. The age range was 3 days to 85 years (mean 37.86 years). The 21-40 age group was the most involved. Trauma in general accounted for the most common clinical condition that caused a patient to discharge against medical advice (64 or 82%), while fracture involving the long bones was the most common condition (37 or 47.4%). The plausible reasons for this practice have been outlined including measures that may help to reduce discharge against medical advice in a developing country.

Hospital charges to injured drinking drivers in Washington State: 1989-1993

The Washington State Patrol Crash Database and computerized hospitalization records for 1989-1993 were used to determine total hospital charges billed for motor vehicle collision injuries to drivers whose crash reports contained any indication of alcohol use. In this population-based study, total hospital charges were summed, and mean charges and lengths of stay were computed within alcohol use and insurance coverage status categories in an attempt to evaluate the hospital charges billed to public funding and private insurance. Of the total hospital charges for drivers with injuries from motor vehicle collisions for which a police-reported indicator of alcohol use status was available, 43% (U.S.$64.8 million) were for drivers who reportedly had been drinking. At the time of discharge, Medicaid was identified as the payor for 47% of these hospitalizations. The mean hospital charge billed per collision was greater for drinking (U.S.$18,258) than nondrinking drivers (U.S.$14,181). Drinking drivers also had longer hospital stays, even after adjustment for patient age, gender and injury severity. During this time in Washington state, the average annual amount billed at discharge for initial inpatient care of injuries to drivers who reportedly had been drinking at the time of the motor vehicle collision was U.S.$13 million. This includes only the amount assessed by the hospital at the time of discharge for treatment of the initial injury and does not include other related medical charges for rehabilitation or outpatient care, or for doctors' or laboratory fees. As increasing pressures of managed and capitated care lead to a shift of financial risk from the federal government and insurers to states and providers, the financial burden of specific, potentially preventable conditions such as this will receive greater attention.

[Estimation of the use of seat belts: an observational study and a telephone survey]

OBJECTIVE

To estimate the prevalence of safety-belt use in a telephone survey and an observational survey.

PATIENTS AND METHODS

Observational survey. Trained interviewers studied 4,067 front-seat occupants, at ten intersections of Madrid, according to "National Highway Traffic Safety Administration" guidelines. TELEPHONE SURVEY: We selected 433 front seat occupants from the Madrid city residential telephone directory. The questionnaire was completed by trained interviewers.

RESULTS

Prevalence by the observational survey was 58.5%, and was significantly higher at interurban intersections (OR = 2.1) than city intersections. In the telephone survey, the overall prevalence was 94% at interurban area and 64% at city area and it was associated with no history of lines and positive opinion of effectiveness of safety belts.

CONCLUSIONS

The safety belt prevalence observed is low, especially in the urban area. The telephone survey overestimates the safety belt use, but contributes with useful information for planning strategies.

Traffic accident mapping in Bangkok metropolis: a case study

Results from an analysis of traffic accidents from a study of the police records of four police stations in the Bangkok metropolis are presented. The main emphasis in this study was put on the development of a measure for traffic accident density. The traffic flow was estimated at the various study locations by trained experts. By relating the frequency of traffic accidents found in the police records to the independently estimated traffic flow, a measure for traffic accident occurrence, the traffic accident density, was constructed and estimated for the 47 areas in four study locations. The spatial risk structure was estimated and three risk groups were identified. Each area was classified into its associated risk group, and traffic accident maps for the four study locations in the Bangkok metropolis are provided here. The implication for prevention strategies is discussed.

Side impact motor vehicular crashes: patterns of injury

Side impact collisions represent a serious risk for injury for motor vehicle occupants. In 1992 side impact collisions were found in approximately 20% of all fatal motor vehicle crashes. This type of collision provides less protection to the occupants and is associated with a specific pattern of injuries. Because elderly drivers are frequently involved in side impact collisions, they are especially at risk for major trauma.