Patterns of road traffic injuries in a vulnerable population in Hyderabad, India

Unsafe Practices of Motorcycle Riders in El Petén, Guatemala: A Community Observational Study and a Retrospective Institutional Review

INTRODUCTION

Outcomes from trauma at the major referral hospital [Hospital Nacional de San Benito (HNSB)] in El Petén, Guatemala, have not been analyzed. Empirical evidence demonstrated a high number of motorcycle accidents (MAs). We hypothesized a large incidence of head trauma with poor outcomes in MAs compared to all other forms of blunt trauma.

METHODS

Our hypothesis was tested by performing a community observational study and a retrospective chart review in El Petén, Guatemala. An independent observer catalogued 100 motorcycle riders on the streets of El Petén for riding practices as well as helmet utilization. HNSB does not have electronic medical records. For this study, we performed a retrospective chart review of randomly selected nonconsecutive trauma admission at HNSB between March 2018 and June 2023. Blunt trauma was compared between MAs versus all others. Variables were examined by parametric and nonparametric tests as well as contingency table analyses.

RESULTS

Most motorcycles riders involved multiple individuals (2.61 ± 0.79/motorcycle). Seventy riders included children (median = 1.0 [Q1-Q3 range = 1.0-3.0]/motorcycle). Overall, only three riders were wearing helmets. Forty-one were women. Of patients presenting to HNSB with trauma, 91 charts were reviewed (33.0 [20.0-37.0] y old; male 89%), 76.7% were blunt, and 23.3% were penetrating trauma. Within blunt trauma, 57.1% were MAs versus 42.9% all others; P = 0.13. MAs were younger (29.5 [20.0-37.0] versus 34.0 [21.8-45.8] y old; P < 0.05) and of similar gender (male 82.5% versus 96.6%; P = 0.1). More MAs had a computed tomography (70.0% versus 30.0%; P < 0.01) and they were more likely to present with head trauma (72.5% versus 46.7%; P = 0.04) but similar Glasgow Coma Scale (15.0 [13.5-15.0] versus 15.0 [12.5-15.0]; P = 0.7). MAs were less likely to require surgical intervention (37.5% versus 56.7%; P = 0.05) but had similar hospital length of stay (4.0 [2-6] versus 4.0 [2-10.5] d; P = 0.5).

CONCLUSIONS

Unsafe motorcycle practices in El Petén are staggering. Most trauma at HNSB is blunt, and likely from MAs. More patients with MAs presented with head trauma. However, severe trauma might be transferred to higher level hospitals or mortality might occur on scene, which will need further investigations. Assessment of mortality from trauma admissions is ongoing. These findings should lead to enforcement of safe motorcycle practices in El Petén, Guatemala.

Pattern of Road Traffic Injuries and Their Pre-hospitalization Factors Reported at a Public Tertiary Healthcare Facility and Rural Private Healthcare Facility in Rajasthan, India

OBJECTIVE

We aimed to report the pattern of road traffic injuries (RTIs) and pre-hospitalization factors of road traffic injuries among the accident victims reported at an urban and a rural healthcare facility in the Jaipur district, Rajasthan.

METHODS

This cross-sectional study was conducted in a tertiary-level, urban public healthcare facility in Jaipur city and a secondary-level, rural private facility in nearby Chomu town. The study participants were all those who encountered road traffic injury and visited any of these healthcare facilities to seek care. The study tool included information on demographics, type of road user, vehicles, accidents, roads, environment, and other pre-hospitalization factors. Data collectors were nurses trained to collect data using the tablet-based application. Data were analyzed using proportions/percentages. Bivariate analysis was done to assess the significance of differences between categories of factors and between rural and urban facilities.

RESULTS

Among 4,642 cases, 93.8% were enrolled in the urban facility, and the remaining were enrolled in the rural facility. Predominantly, males (83.9%) and young adults 18-34 years (58.9%) were reported in both study facilities. Among the accident victims reported at the urban facility, major groups were educated up to the primary level (25.1%) or graduate level (21.9%). About 60% of them were drivers. Most of these injuries occurred on urban roads (50.2%) or two-lane roads (42%). About three-fourths of the injured were using two-wheeler geared vehicles, and 46.7% were overtaking or turning the vehicle when the accident happened. The majority of cases (61.6%) did not require hospitalization. Among the rural facility participants, 27.2% were graduates, and 24.7% were below primary education. Most of these injuries happened on the national highway (35.8%) or rural roads (33.3%). Most of them used two-wheeler geared (80.1%) at the time of the accident. Most were injured while doing normal straight driving (80.5%). Most participants (80.1%) in the rural facility did not follow the traffic rules, and 43.9% required hospitalization.

CONCLUSION

Young males were the most affected age group by road traffic injuries. Differential patterns of road traffic injuries and pre-hospital factors were observed in urban and rural areas.

Association of adolescents' independent mobility with road traffic injuries in Karachi, Pakistan: a cross-sectional study

OBJECTIVE

Participation in walking, cycling and taking public transportation without adult supervision is defined as independent mobility of children and adolescents. The association between adolescents' independent mobility and road traffic injury (RTI) is unclear. The purpose of this study is to determine measures of adolescents' independent mobility associated with RTIs in an urban lower middle-income setting.

STUDY DESIGN

Cross-sectional survey.

SETTING

Schools in Karachi, Pakistan.

PARTICIPANTS

Adolescents aged 10-19 years in grades 6-10 were enrolled from private and public schools.

OUTCOME

Any self-reported lifetime RTI sustained as a pedestrian, as a cyclist or while in a car or another vehicle that resulted in any first aid at home/school or consultation in a healthcare setting.

EXPOSURE

Self-reported independent mobility was assessed by four variables. (1) Any travel companion from school to home on the survey day, (2) parental permission to cross main roads alone, (3) parental permission to travel by public bus alone and (4) activity/activities outside the home on the previous weekend alone.

RESULTS

Data from 1264 adolescents, 10-19 years old, were included. Most were females (60%). Adolescents who had parental permission to cross main roads alone (adjusted OR (aOR) 1.39; 95% CI 1.04 to 1.86) and who participated in one or more activities outside the home alone on the previous weekend (aOR 2.61; 95% CI 1.42 to 5.13) or participated in a mixture of activities with and without adult accompaniment (aOR 2.50; 95% CI 1.38 to 4.89) had higher odds of RTIs.

CONCLUSIONS

Parental permission to cross main roads alone and participation in activity/activities outside the home on the previous weekend alone were two measures of independent mobility associated with higher odds of RTIs among adolescents. The study provides an understanding of the risk posed by adolescents' independent mobility in road traffic environments.

Challenges related to pedestrian safety: a qualitative study identifying Iranian residents' perspectives

The pedestrians are among the most vulnerable group. This study was conducted to explain the challenges associated with pedestrian safety by taking into account the perspectives of Iranian residents in Tabriz. In this qualitative study, applying purposeful sampling approach, we recruited 49 residents to participate in structured qualitative interviews. To collect data, 3 Focus Group Discussions (FGDs) with 28 participants, and 21 individual interviews were conducted. Data analysis was performed applying conventional content analysis. MAXQDA10 was applied for the purpose of data management. After data analysis, six themes emerged including: (a) Pedestrians' own obstacles and challenges, (b) Driver' related obstacles and challenges, (c) Penal system related obstacles and challenges, (d) Advocacy-related obstacles and challenges, (e) Infrastructural obstacles and challenges, and (f) Management obstacles and challenges. Pedestrian safety was identified as a major but extremely intricate urban traffic and transportation issue. To promote pedestrian safety, it is essential for the municipal agencies to focus on the public's convenience through providing need-based infrastructures especially suiting to the elderlies. The agencies, here, must also introduce pedestrian penal system, penalty for using phone while driving, or superior road crossing mechanisms such as those discussed inside. The agencies should also focus on gross political commitment, and a broad strategy involving education, engineering and enforcement, institutional co-ordination within and between different levels of government and with private actors.

Acidentes de trânsito com condutores de veículos: incidência e diferenciais entre motociclistas e motoristas em estudo de base populacional

RESUMO: Objetivos: Estimar incidências de acidentes de trânsito entre condutores de veículos a motor e verificar diferenciais do evento entre as vítimas motociclistas e motoristas de automóvel. Métodos: Foi conduzido um inquérito domiciliar no município de Jequié, Bahia, em 2013, com 1.406 condutores selecionados por amostragem por conglomerado. As estimativas de incidência cumulativa de acidentes de trânsito foram ponderadas pelo desenho amostral e, para comparação entre categorias de condutores, foram estimadas razões de incidência (RI) e intervalos de confiança de 95% (IC95%) com regressão de Poisson. Diferenciais do evento entre vítimas motociclistas e motoristas foram avaliados com teste do χ2 de Rao-Scott (p ≤ 0,05). Resultados: O envolvimento em acidentes de trânsito nos 12 meses anteriores à entrevista foi referido por 10,6% dos condutores. Para acidentes que causaram lesão física, a incidência foi de 4,3%. Motociclistas apresentaram o dobro do risco de envolvimento em acidentes (RI = 2,03; IC95% 1,40 - 2,94) e maiores proporções de lesões (p < 0,001), de interrupção de atividades habituais de vida (p = 0,003) e de atendimento em serviços de emergência (p = 0,008). Fatores relacionados ao tempo e local de ocorrência não se diferenciaram entre grupos. Conclusão: Maior incidência de acidentes e proporções mais elevadas de lesões e de outras repercussões desses eventos recaíram sobre motociclistas. Tais achados reafirmam a condição de vulnerabilidade desse grupo e explicitam diferentes impactos que uma causa prevenível de morbimortalidade apresenta em cada grupo de condutores.

Pattern of Road Traffic Injuries in Rural Bangladesh: Burden Estimates and Risk Factors

Globally, road traffic injury (RTI) causes 1.3 million deaths annually. Almost 90% of all RTI deaths occur in low- and middle-income countries. RTI is one of the leading causes of death in Bangladesh; the World Health Organization estimated that it kills over 21,000 people in the country annually. This study describes the current magnitude and risk factors of RTI for different age groups in rural Bangladesh. A household census was carried out in 51 unions of seven sub-districts situated in the north and central part of Bangladesh between June and November 2013, covering 1.2 million individuals. Trained data collectors collected information on fatal and nonfatal RTI events through face-to-face interviews using a set of structured pre-tested questionnaires. The recall periods for fatal and non-fatal RTI were one year and six months, respectively. The mortality and morbidity rates due to RTI were 6.8/100,000 population/year and 889/100,000 populations/six months, respectively. RTI mortality and morbidity rates were significantly higher among males compared to females. Deaths and morbidities due to RTI were highest among those in the 25–64 years age group. A higher proportion of morbidity occurred among vehicle passengers (34%) and pedestrians (18%), and more than one-third of the RTI mortality occurred among pedestrians. Twenty percent of all nonfatal RTIs were classified as severe injuries. RTI is a major public health issue in rural Bangladesh. Immediate attention is needed to reduce preventable deaths and morbidities in rural Bangladesh.

Regional disparities in road traffic injuries and their determinants in Brazil, 2013

BACKGROUND

In recent decades middle-income countries have experienced a rapid increase in the number of cars and motorcycles. Increased deaths and hospitalizations due to road traffic injuries (RTI) has been observed in several countries as a result. In this study we assessed the determinants of RTIs in Brazil by mode of transportation and compared differences in RTI rates among macro-regions.

METHODS

We used data from the National Health Survey (NHS) conducted in 2013 by the Brazilian Institute of Geography and Statistics and the Ministry of Health. NHS is a comprehensive household survey which includes a representative sample (N = 60,198) of individuals aged 18 years or older. The prevalence and determinants of RTI were estimated according to different modes of transport (car/van, motorcycle, and other) and regions of the country. Bivariate and multivariable logistic regression models were applied to assess crude and adjusted odds ratios, respectively, and their 95 % CI for RTI determinants.

RESULTS

The prevalence of RTI for the Southeast, South, Central-West, Northeast and North regions of Brazil was 2.4 %, 2.9 %, 4.4 %, 3.4 % and 4.8 %, respectively, pointing to important differences among regions. High percentages of motorcyclists were observed in the Northeast and North regions. For motorcyclists, factors associated with RTIs were being male (OR = 2.6;95 % CI:2.3;3.0), aged 18-29 (OR = 3.2; 95 % CI:2.7;3.8) and 30-39 years (OR = 2.0;95 % CI:1.7;2.5), black (OR = 1.4;95 % CI:1.1;1.7), having elementary educational (OR = 1.5;95 % CI:1.1;1.9), reporting binge drinking behavior (OR = 1.3;95 % CI:1.1;1.5), and living in the Central-West (OR = 2.0;95 % CI:1.6;2.5), Northeast (OR = 1.8;95 % CI:1.5;2.1) and North (OR = 2.0;95 % CI:1.6; 2.5) regions of the country. The independent variables associated with RTI for car/van occupants were being male (OR = 1.7;95 % CI:1.4;2.1), aged 18-29 (OR = 1.5;95 % CI:1.1;2.0) and 30-39 years (OR = 2.5;95 % CI:1.9;3.2), reporting binge drinking behavior (OR = 2.0;95 % CI:1.6;2.5) and living in the South region (OR = 1.6;95 % CI:1.3;2.1).

CONCLUSIONS

There were considerable regional disparities in RTI rates across Brazil's regions. Motorcyclists contributed to the high RTI rates in these regions as did demographic factors and behaviors such as alcohol use. These findings can help guide interventions to reduce the burden of RTIs in Brazil.

A pilot study of a hospital-based injury surveillance system in a secondary level district hospital in India: lessons learnt and way ahead

Background

Reliable epidemiological information on injury burden and pattern is essential to formulate effective injury control and prevention strategies. Injury surveillance systems are globally gaining ground as a tool for collecting such systematic data on injuries, but less so in low and middle income countries. This study describes the experience of setting up a District Level Hospital-Based Injury Surveillance System in India and the pattern of injuries encountered therein.

Methods

A prospective study was conducted during Jan-Dec 2012 at the emergency department of a District Hospital in Fatehgarh Sahib in a North Indian state of Punjab. A comprehensive injury proforma was devised to record information on all injury cases reporting to the hospital. Emergency Medical Officers were trained to record data.

Results

A total of 649 injuries were reported in 2012. The surveilance system used the existing resources at the hospital to collect data without the need for additional manpower, equipments etc. About 78 % of injuries reported were unintentional in nature. More than half (52.9 %) of the patients had injuries due to Road Traffic Crashes. Head (29.7 %) was the most common site of injury. Incised injury (50.2 %) was the most common type of injury and most of the injuries occurred while travelling (61.8 %).

Conclusion

Developing better and sustainable systems of routine injury surveillance or trauma registries is essential to generate reliable information for formulating effective intervention policies.

Injury pattern in lethal motorbikes-pedestrian collisions, in the area of Barcelona, Spain

INTRODUCTION

There are several studies about M1 type vehicle-pedestrian collision injury pattern, and based on them, there has been several changes in automobiles for pedestrian protection. However, the lack of sufficient studies about injury pattern in motorbikes-pedestrian collisions leads to a lack of optimization design of these vehicles. The objective of this research is to study the injury pattern of pedestrians involved in collisions with motorized two-wheeled vehicles.

METHODS

A retrospective descriptive study of pedestrian's deaths after collisions with motorcycles in an urban area, like Barcelona was performed. The cases were collected from the Forensic Pathology Service database of the Institute of Legal Medicine of Catalonia. The selected cases were categorized as pedestrian-motorcycle collision, between January 1st, 2005 and December 31st, 2014. Data were collected from the autopsy, medical, and police report. The collected information was then analyzed using Microsoft Excel statistical functions.

RESULTS

Traumatic Brain Injury is the main cause of death in pedestrian hit by motorized two-wheeled vehicles (62.85%). The most frequent injury was the subarachnoid hemorrhage, in 71.4% of cases, followed by cerebral contusions and skull base fractures (65.7%). By contrast, pelvic fractures and tibia fractures only appeared in 28.6%.

CONCLUSIONS

The study characterizes the injury pattern of pedestrians involved in a collision with motorized two-wheeled vehicles in an urban area, like Barcelona, which has been found to be different from other vehicle-pedestrian collisions, with a higher incidence of brain injuries and minor frequency of lower extremities fractures in pelvis, tibia and fibula.

Traumatic injury among females: does gender matter?

BACKGROUND

Trauma remains one of the leading causes of morbidity and mortality worldwide. Generally, the incidence of traumatic injuries is disproportionately high in males. However, trauma in females is underreported.

AIM

To study the epidemiology and outcome of different mechanisms and types of traumatic injuries in women.

METHODS

We conducted a traditional narrative review using PubMed, MEDLINE and EMBASE, searching for English-language publications for gender-specific trauma between January 1993 and January 2013 using key words "trauma", "gender", "female" and "women".

RESULTS

Among 1150 retrieved articles, 71 articles were relevant over 20 years. Although it is an important public health problem, traumatic injuries among females remain under-reported.

CONCLUSION

There is a need for further research and evaluation of the exact burden of traumatic injuries among females together with the implementation of effective community based preventive programs.

Road traffic injury mortality and its mechanisms in India: nationally representative mortality survey of 1.1 million homes

OBJECTIVES

To quantify and describe the mechanism of road traffic injury (RTI) deaths in India.

DESIGN

We conducted a nationally representative mortality survey where at least two physicians coded each non-medical field staff's verbal autopsy reports. RTI mechanism data were extracted from the narrative section of these reports.

SETTING

1.1 million homes in India.

PARTICIPANTS

Over 122 000 deaths at all ages from 2001 to 2003.

PRIMARY AND SECONDARY OUTCOME MEASURES

Age-specific and sex-specific mortality rates, place and timing of death, modes of transportation and injuries sustained.

RESULTS

The 2299 RTI deaths in the survey correspond to an estimated 183 600 RTI deaths or about 2% of all deaths in 2005 nationally, of which 65% occurred in men between the ages 15 and 59 years. The age-adjusted mortality rate was greater in men than in women, in urban than in rural areas, and was notably higher than that estimated from the national police records. Pedestrians (68 000), motorcyclists (36 000) and other vulnerable road users (20 000) constituted 68% of RTI deaths (124 000) nationally. Among the study sample, the majority of all RTI deaths occurred at the scene of collision (1005/1733, 58%), within minutes of collision (883/1596, 55%), and/or involved a head injury (691/1124, 62%). Compared to non-pedestrian RTI deaths, about 55 000 (81%) of pedestrian deaths were associated with less education and living in poorer neighbourhoods.

CONCLUSIONS

In India, RTIs cause a substantial number of deaths, particularly among pedestrians and other vulnerable road users. Interventions to prevent collisions and reduce injuries might address over half of the RTI deaths. Improved prehospital transport and hospital trauma care might address just over a third of the RTI deaths.

Large-scale road safety programmes in low- and middle-income countries: an opportunity to generate evidence

The growing burden of road traffic injuries, which kill over 1.2 million people yearly, falls mostly on low- and middle-income countries (LMICs). Despite this, evidence generation on the effectiveness of road safety interventions in LMIC settings remains scarce. This paper explores a scientific approach for evaluating road safety programmes in LMICs and introduces such a road safety multi-country initiative, the Road Safety in 10 Countries Project (RS-10). By building on existing evaluation frameworks, we develop a scientific approach for evaluating large-scale road safety programmes in LMIC settings. This also draws on '13 lessons' of large-scale programme evaluation: defining the evaluation scope; selecting study sites; maintaining objectivity; developing an impact model; utilising multiple data sources; using multiple analytic techniques; maximising external validity; ensuring an appropriate time frame; the importance of flexibility and a stepwise approach; continuous monitoring; providing feedback to implementers, policy-makers; promoting the uptake of evaluation results; and understanding evaluation costs. The use of relatively new approaches for evaluation of real-world programmes allows for the production of relevant knowledge. The RS-10 project affords an important opportunity to scientifically test these approaches for a real-world, large-scale road safety evaluation and generate new knowledge for the field of road safety.

Does wearing helmets reduce motorcycle-related death? A global evaluation

BACKGROUND

The high risk of injury and death of motorcycle riders is a major global health problem. This study aimed to evaluate the effect of helmet wearing on motorcycle riders' death rates on a global level.

METHODS

Data for motorcycle riders were collected from 70 countries. These data included motorcycle-related death rates per 100,000 population, helmet non-usage percentage, Gross National Income per capita (GNI), number of registered motorized 2-3 wheelers, the effectiveness of law enforcement in each country, and whether there was standards for helmets use or not. Correlations between studied variables were done using Pearson correlation. Multiple linear regression models were used to define factors affecting motorcycle-related death rates.

RESULTS

The correlation between motorcycle-related death rate and helmet non-usage, was almost significant (p=0.056, r=0.28). Helmet non-usage percentage was significantly correlated with GNI (p<0.0001, r=-0.61) and effectiveness of the law (p<0.0001, r=-0.73). A multiple linear regression model which was highly significant (adjusted R-squared=0.3, F=6.69, p<0.001) has shown that helmet non-usage percentage (p=0.003), motorcycle per person ratio (p=0.01) and the presence of helmet standards (p=0.05) were positively associated with motorcycle-related death rates. A simple linear regression model between helmet usage and road traffic death rate has shown that for each 10% increase in helmet usage, one life per 1,000,000 inhabitants can be saved per year.

CONCLUSION

Helmet non-usage percentage was the most significant factor affecting motorcyclists' death rate. Wearing a motorcycle helmet reduces the risk of death from a motorcycle crash. Enforcement of motorcycle helmet laws should be effectively supported by motorcycle safety programs.

Outcome of road traffic injuries received in the emergency room of a teaching hospital, Southeast Nigeria

Road traffic injuries (RTI) are a rapidly growing public health problem in developing countries. This study was aimed at assessing the early outcome of RTIs received in our hospital emergency room. Understanding this will help to achieve optimum injury outcome. A prospective study was conducted on all patients presenting with RTIs to the emergency room of the Ebonyi University Teaching Hospital, Abakaliki, from 1 March 2007 to 29 February 2008. Out of 363 patients: 72.45% were treated in the emergency unit and discharged; 12.7% left against medical advice; 10.9% were admitted to the ward; and 4.7% died. Self-discharge against medical advice was significantly related to the type of injury (78.3% had fracture/dislocation) and gender (P = 0.001). The patronage of traditional bone setters, because of cultural belief that they have supernatural ability to treat fractures, was the major reason given by those who left against medical advice. The morbidity and mortality rate was significantly related to the road type (P = 0.005 - a higher rate was observed for RTIs received on intercity roads than intracity ones) and the type of crash (P = 0.03 - more than half from head on collisions). Although the mortality rate was within the expected range, the preventable death rate was high, and the majority of deaths occurred within the 'golden hour' . Improvement in pre-hospital and emergency room care of patients with RTIs, as well as public awareness of the availability and efficacy of orthodox orthopaedic trauma care, are needed in the developing countries.

The frequency and predictors of helmet use among Iranian motorcyclists: A quantitative and qualitative study

OBJECTIVE

This study examines the rate of helmet use and identifies barriers and facilitators of wearing helmets among Iranian motorcyclists. A mixed-method approach was used, including a structured seasonal survey with specific observations of a random sample of 6010 riders and qualitative methods that included 29 in-depth interviews and seven focus groups (n=31).

RESULTS

Only 10% of motorcyclists wear a standard helmet while riding. However, another 23% of motorcyclists used non-standard or partial helmets that covered only part of the head and do not prevent head trauma injuries effectively. We observed only 2 of 264 child passengers and 22 of 1951 adult passengers wearing helmets. Almost no one used protective pants or clothing made to be more visible in traffic. Themes emerged from qualitative interviews and were grouped into three main categories: (1) helmet characteristics; (2) social and cultural factors; and (3) personal and psychological factors.

CONCLUSION

Overall, the motorcyclists in our study believed that wearing a safety helmet protects them against serious injuries or death during a crash; however, only a small percentage of the motorcyclists used safety helmets. National intervention programs addressing motorcycle safety should aim to overcome barriers to and promote facilitators of helmet use, including providing inexpensive standard helmets, banning manufacturing/using unsafe partial or dummy helmets, as well as enforcing helmet use on a consistent basis.

Crashes involving motorised rickshaws in urban India: characteristics and injury patterns

INTRODUCTION

Motorised three-wheeled vehicles (motorised rickshaw) are popular in Asian countries including India. This study aims to describe the crash characteristics and injury patterns for motorised rickshaw occupants and the road users hit-by-motorised rickshaw in urban India.

METHODS

Consecutive cases of road traffic crashes involving motorised rickshaw, irrespective of injury severity, whether alive or dead, presenting to the emergency departments of two large government hospitals and three branches of a private hospital in Hyderabad city were recruited. Crash characteristics,details of injuries, injury severity parameters and outcome were documented in detailed interviews.

RESULTS

A total of 139 (18%) of the 781 participants recruited were injured as a motorised rickshaw occupant (11%) or were hit by a motorised rickshaw (7%) in 114 crashes involving motorised rickshaw. Amongst motorised rickshaw occupants, single-vehicle collisions (54%) were more frequent than multivehicle collisions (46%), with overturning of motorised rickshaw in 73% of the single-vehicle collisions.Mortality (12%), the mean Injury Severity Score (5.8) and rate of multiple injured (60%) indicated a substantial trauma load. No significant differences in injury pattern were found between motorised rickshaw occupants and hit-by-motorised rickshaw subjects, with the pattern being similar to that of the pedestrians and two-wheeled vehicle users. With bivariate analysis for motorised rickshaw occupants,the risk of fatal outcome (odds ratio (OR) 2.60, 95% confidence interval (CI): 0.64–10.54), upper limb injury (OR 2.25, 95% CI: 0.94–5.37) and multiple injuries (OR 2.03, 95% CI 0.85–4.83) was high, although not statistically significant in multi-motorised-vehicle collisions as compared with the single-vehicle collisions or overturning. The risk of having multiple injuries (OR 4.55, 95% CI: 1.15–17.95) was significantly higher in motorised rickshaw occupants involved in front collisions. Being a front-seat motorised rickshaw passenger in a vehicle collision increased the risk of having a fatal outcome (OR 7.37,95% CI: 0.83–65.66) and a Glasgow coma score 12 (OR 2.21, 95% CI: 0.49–9.89), although not significantly when compared to the back-seat passengers.

CONCLUSION

These findings can assist with planning to deal with the consequences and prevention of road traffic injuries due to crashes involving motorised rickshaw, given the high use of these and substantial morbidity of related injuries in India. The need for improved understanding of the risk characteristics of motorised rickshaw is highlighted.

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.