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Giovannini E, Santelli S, Pelletti G, Bonasoni MP, Lacchè E, Pelotti S, Fais P. Motorcycle injuries: a systematic review for forensic evaluation. Int J Legal Med 2024; 138:1907-1924. [PMID: 38763926 PMCID: PMC11306388 DOI: 10.1007/s00414-024-03250-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/05/2024] [Indexed: 05/21/2024]
Abstract
The intricate interplay of exposure and speed leave motorcyclists vulnerable, leading to high mortality rates. During the collision, the driver and the passenger are usually projected away from the motorcycle, with variable trajectories or final positions. Injuries resulting from the crash can exhibit distinct and specific characteristics depending on the circumstances of the occurrence.The aim of this study is to provide a systematic review of the literature on injuries sustained by motorcyclists involved in road accidents describing and analyzing elements that are useful for forensic assessment.The literature search was performed using PubMed, Scopus and Web of Science from January 1970 to June 2023. Eligible studies have investigated issues of interest to forensic medicine about during traffic accidents involving motorcycle. A total of 142 studies met the inclusion criteria and were classified and analyzed based on the anatomical regions of the body affected (head, neck, thoraco-abdominal, pelvis, and limb injuries). Moreover, also the strategies for preventing lesions and assessing injuries in the reconstruction of motorcycle accidents were examined and discussed.This review highlights that, beyond injuries commonly associated with motorcycle accidents, such as head injuries, there are also unique lesions linked to the specific dynamics of accidents. These include factors like the seating position of the passenger or impact with the helmet or motorbike components. The forensic assessment of injury distribution could serve as support in reconstructing the sequence of events leading to the crash and defining the cause of death in trauma fatalities.
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Affiliation(s)
- Elena Giovannini
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Simone Santelli
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Guido Pelletti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy.
| | - Maria Paola Bonasoni
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Via Amendola 2, Reggio Emilia, 42122, Italy
| | - Elena Lacchè
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Susi Pelotti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Paolo Fais
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
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Yakubu MA, Aidoo EN, Ampofo RT, Ackaah W. Bivariate ordered probit modelling of motorcycle riders and pillion passengers' injury severities relationship and associated risk factors. Int J Inj Contr Saf Promot 2024:1-9. [PMID: 38712985 DOI: 10.1080/17457300.2024.2349554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 04/26/2024] [Indexed: 05/08/2024]
Abstract
This study simultaneously modelled the injury severity of motorcycle riders and their pillion passengers and determine the associated risk factors. The analysis is based on motorcycle crashes data in Ashanti region of Ghana spanning from 2017 to 2019. The study implemented bivariate ordered probit model to identify the possible risk factors under the premise that the injury severity of pillion passenger is endogenously related to that of the rider in the event of crash. The model provides more efficient estimates by considered the common unobserved factors shared between rider and pillion passenger. The result shows a significant positive relationship between the two injury severities with a correlation coefficient of 0.63. Thus, the unobservable factors that increase the probability of the rider to sustain more severe injury in the event of crash also increase that of their corresponding pillion passenger. The rider and their pillion passenger injury severities have different propensity to some of the risk factors including passengers' gender, day of week, road width and light condition. In addition, the study found that time of day, weather condition, collision type, and number of vehicles involved in the crash jointly influence the injury severity of both rider and pillion passenger significantly.
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Affiliation(s)
- Mohammed A Yakubu
- Department of Statistics and Actuarial Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Eric N Aidoo
- School of Mathematical and Computer Sciences, Heriot-Watt University, Dubai Campus, UAE
| | - Richard T Ampofo
- Department of Mathematics and Statistics, Wright State University, Dayton, OH, USA
| | - Williams Ackaah
- Division of Traffic and Transportation Engineering, Building and Road Research Institute of CSIR, Kumasi, Ghana
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Thombre A, Ghosh I, Agarwal A. Examining factors influencing the severity of motorized two-wheeler crashes in Delhi. Int J Inj Contr Saf Promot 2024; 31:111-124. [PMID: 37882684 DOI: 10.1080/17457300.2023.2267040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 10/02/2023] [Indexed: 10/27/2023]
Abstract
Failure to meet road safety targets has necessitated urgent actions from stakeholders worldwide, especially in developing countries like India. Road safety of motorized two-wheelers (MTWs), one of India's most preferred travel modes for urban commutes, is in danger and witnessing threatening figures of fatalities and injuries. Most of the studies in the domain of MTW safety were conducted in developed countries, with very limited research in countries having a significant proportion of MTWs. The present work investigates police-reported crash data to identify the contributory factors of motorized two-wheeler crash severity. Data from MTW crash-prone areas were selected from Delhi, which is leading in road traffic fatalities among the million-plus urban cities in India. A binary logistic regression model was developed using the data for 2016-2018 period. The model results show that the odds of fatal motorized two-wheeler crashes increase when the following circumstances apply: crash occurs on underpasses; involves bus, truck, heavy motor vehicle (lorry, crane) as the striking vehicle; when hit-and-run type of crash occurs and when older age-group (> = 55) riders are involved. Finally, based on the findings, countermeasures were suggested to facilitate policymakers and traffic enforcement agencies, in improving the road safety situation of MTW users.
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Affiliation(s)
- Anurag Thombre
- Department of Civil Engineering, Indian Institute of Technology Roorkee, Roorkee, India
| | - Indrajit Ghosh
- Department of Civil Engineering, Indian Institute of Technology Roorkee, Roorkee, India
| | - Amit Agarwal
- Department of Civil Engineering, Indian Institute of Technology Roorkee, Roorkee, India
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Liasidis P, Benjamin E, Jakob D, Lewis M, Demetriades D. Injury patterns and outcomes in motorcycle passengers. Eur J Trauma Emerg Surg 2023; 49:2447-2457. [PMID: 37367970 DOI: 10.1007/s00068-023-02296-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 05/29/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Contemporary trauma literature on injuries to motorcycle passengers is scarce. The aim of this study was to examine the injury patterns and outcomes of motorcycle passengers with regard to helmet use. We hypothesized that helmet utilization affects both injury type and outcomes. METHODS The National Trauma Data Bank was queried for all motorcycle passengers who were injured in traffic accidents. Participants were stratified according to helmet utilization into helmeted (HM) and nonhelmeted (NHM) groups. Univariate and multivariate analyses were performed to compare the injury patterns and outcomes between the groups. RESULTS A total of 22,855 patients were included for analysis, of which 57.1% (13,049) used helmet. The median age was 41 years (IQR 26-51), 81% were female, and 16% of patients required urgent operation. NHM had higher risk of major trauma (ISS > 15: 26.8% vs 31.6%, p < 0.001). The most frequently injured body region in NHM was the head (34.6% vs 56.9%, p < 0.001), whereas in HM patients was the lower extremities (65.3% vs 56.7%, p < 0.001). NHM patients were more likely to require admission to the ICU, mechanical ventilation, and had significantly higher mortality rate (3.0% vs 6.3%, p < 0.001). The strongest predictors of mortality were GCS < 9 on admission, hypotension on admission, and severe head injury. Helmet utilization was associated with decreased odds of death (OR 0.636; 95% CI 0.531-0.762; p < 0.001). CONCLUSION Motorcycle collisions can lead to significant injury burden and high mortality in motorcycle passengers. Middle-age females are disproportionally affected. Traumatic brain injury is the leading cause of death. Helmet use is associated with decreased risk of head injury and death.
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Affiliation(s)
- Panagiotis Liasidis
- Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County and University of Southern California Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Elizabeth Benjamin
- Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County and University of Southern California Medical Center, University of Southern California, Los Angeles, CA, USA.
- Department of Surgery, Emory University, Grady Memorial Hospital, Glenn Memorial Building, 3rd Flr, 69 Jesse Hills Jr Dr SE, Atlanta, GA, 30303, USA.
| | - Dominik Jakob
- Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County and University of Southern California Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Meghan Lewis
- Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County and University of Southern California Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Demetrios Demetriades
- Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County and University of Southern California Medical Center, University of Southern California, Los Angeles, CA, USA
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Lusetti A, Dagoli S, Banchini A, Gentile M, Lezzi P, Cecchi R. Over 30-year retrospective analyses of moped-motorcycle fatal road accidents in the northern area of the Italian region of Emilia Romagna and review of the literature: Aiming for further preventive measures in the future. Leg Med (Tokyo) 2022; 59:102139. [PMID: 36055135 DOI: 10.1016/j.legalmed.2022.102139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/25/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022]
Abstract
Road traffic injuries are a major cause of morbidity and mortality worldwide, with pedestrians and riders of two-wheeled motor vehicles being the most vulnerable. The present study aims to determine the epidemiological characteristics of fatal motorcycle crashes in a portion of the Italian region of Emilia Romagna, and to compare them with the data available in literature. Data were retrieved from autopsy reports on 350 subjects who died following road accidents involving moped or motorcycle in the cities of Parma, Piacenza, and Reggio Emilia. Two types of data were extrapolated: circumstantial and traumatological. The population was divided into subgroups according to gender, crash time, alcohol positivity, presence or absence of the helmet, and the period elapsed between the accident and death. Most of the considered road accidents occurred during the day and on weekends. 25.5 % of the victims tested positive for alcohol. As far as traumas are concerned, the limbs resulted to be the most affected body segment, followed by the head (87.4 %), the thorax (85.7 %), the abdomen (65.7 %), and lastly the neck (50.3 %). According to similar studies, the sample victim of a moped/ motorcycle accident is a young male subject. The results obtained allow us to demonstrate that the mandatory use of the helmet has reduced skull and brain injury over the years. At present, no law regulates the use of protections for other body parts. Regulatory interventions in this sense would be desirable given the ever more rapid technical evolutions in the field of motorcycles.
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Affiliation(s)
- Andrea Lusetti
- Legal Medicine, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy
| | - Sara Dagoli
- Legal Medicine, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy
| | - Antonio Banchini
- Legal Medicine, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy
| | - Martino Gentile
- Legal Medicine, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy
| | - Pancrazio Lezzi
- Legal Medicine, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy
| | - Rossana Cecchi
- Legal Medicine, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy.
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Delaney PG, Eisner ZJ, Bustos A, Hancock CJ, Thullah AH, Jayaraman S, Raghavendran K. Cost-Effectiveness of Lay First Responders Addressing Road Traffic Injury in Sub-Saharan Africa. J Surg Res 2021; 270:104-112. [PMID: 34649070 DOI: 10.1016/j.jss.2021.08.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/29/2021] [Accepted: 08/27/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND To investigate the cost-effectiveness of training lay first responders (LFRs) to address road traffic injury (RTI) in sub-Saharan Africa (SSA) as the first step toward formal emergency medical services (EMS) development. MATERIALS/METHODS Cost data from five LFR programs launched between 2008 and 2019 in SSA was collected for LFR cost estimation, including three prospective collections from our group. We systematically reviewed literature and projected aggregate disability-adjusted life years (DALYs) from RTI in SSA that are addressable by LFRs to inform cost-effectiveness ratios ($USD cost per DALY averted). Cost-effectiveness ratios were then compared against African per capita gross domestic product (GDP) to determine the cost-effectiveness of LFRs addressing RTIs in SSA, following WHO-CHOICE guidelines, which state cost-effectiveness ratios less than GDP per capita are considered "very cost-effective." RESULTS Average annual cost per LFR trained across five programs was calculated to be 16.32USD (training=4.04USD, supplies=12.28USD). Following WHO and Disease Control Priorities recommendations for adequate emergency catchment, initial training of 750 LFRs per 100,000 people would cost 12,239.47USD with projected total annual DALYs averted equal to 227.7 per 100,000. Cost per DALY averted would therefore be 53.75USD with appropriate LFR availability, less than sub-Saharan African GDP per capita (1,585.40USD) and the lowest sub-Saharan African GDP per capita (Burundi, 261.20USD). CONCLUSION Following WHO-CHOICE guidelines, training LFRs can be a highly cost-effective means to address RTI morbidity and mortality across sub-Saharan Africa. With EMS unavailable for 91.3% of the African population, training LFRs can be an affordable first step toward formal EMS development.
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Affiliation(s)
- Peter G Delaney
- University of Michigan Medical School,Ann Arbor, Michigan; LFR International, Los Angeles, California; Michigan Center for Global Surgery, Ann Arbor, Michigan.
| | - Zachary J Eisner
- LFR International, Los Angeles, California; Washington University in St. Louis, St. Louis, Missouri
| | - Aiza Bustos
- LFR International, Los Angeles, California; Washington University in St. Louis, St. Louis, Missouri
| | - Canaan J Hancock
- LFR International, Los Angeles, California; Washington University in St. Louis, St. Louis, Missouri
| | | | - Sudha Jayaraman
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Krishnan Raghavendran
- Michigan Center for Global Surgery, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan
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Obanife HO, Ismail NJ, Lasseini A, Shehu BB, Otorkpa EJ. Risk Factors, Pattern and Outcome of Motorcycle-associated Head Injury in Sokoto: An Analysis of 184 Cases. INDIAN JOURNAL OF NEUROTRAUMA 2021. [DOI: 10.1055/s-0040-1722553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Abstract
Background Road traffic accident (RTA) is the eighth leading cause of death worldwide. Motorcycle-associated head injury is the leading cause of road traffic associated morbidity and mortality in developing countries. Even though the incidence and mortality of head injury from motor cycle crash is on the increase in developing countries, especially in the African continent, most of the studies published in the literature on this subject matter took place in the developed Western countries.
Materials and Methods This was a retrospective cross-sectional study of data from patients managed in our institution between December 2014 and November 2016.
Results One hundred and eighty-four patients were analyzed. None of the patients used safety helmet for protection. The mean age was 27.6 ± 17.2 years with male female ratio of 6.7:1. Lone crash by cyclists and collisions accounted for 66.8% and 33.1% of the cases, respectively. Passengers and riders comprised 75% of the patients, while 25% were vulnerable pedestrians. The most frequently abused substance by the patients was tramadol (65.52%). Severe head injury and pupillary abnormality were found in 23.9% and 45.5% of the patients, respectively. Cranial CT scan showed abnormalities in 40.2% of the patients. Surgery was done in 28.3% of the patients with mortality rate of 20.7%.
Conclusions The use of motorcycle as a mean of transportation has caused significant negative impact on the society. Young people, who constitute the workforce, are majorly affected, and this invariably leads to a serious economic burden on the concerned families and communities.
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Affiliation(s)
- Henry Olayere Obanife
- Department of Surgery, Division of Neurosurgery, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Nasiru Jinjiri Ismail
- Regional Centre for Neurosurgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Ali Lasseini
- Regional Centre for Neurosurgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Bello B. Shehu
- Regional Centre for Neurosurgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Ega J. Otorkpa
- Department of Surgery, Division of Neurosurgery, University of Abuja Teaching Hospital, Abuja, Nigeria
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BITTAR CINTIAKELLY, CLIQUET JÚNIOR ALBERTO, COSTA VINÍCIUSSAMUELDIASALVESDA, PACHECO ANACAROLINADEFREITAS, RICCI RENATOLAZARIN. SOCIOECONOMIC IMPACT OF MOTORCYCLE ACCIDENT VICTIMS IN THE EMERGENCY ROOM OF A HOSPITAL (PART 2). ACTA ORTOPEDICA BRASILEIRA 2020; 28:149-151. [PMID: 32536797 PMCID: PMC7269133 DOI: 10.1590/1413-785220202803230036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Objective: To evaluate the socioeconomic impact of motorcycle accidents of a metropolis
with one million inhabitants treated by a university hospital in 2017. To
study hospital cost and time of victims, evaluate definite and
incapacitating sequelae, and analyze patient’s insertion in the labor market
six months after the accident. Methods: Retrospective study of 62 victims of motorcycle accidents treated in the
emergency room and referred for surgical procedure in a university hospital.
Data were collected from medical records and answers via telephone six
months after the trauma. Results: Injuries related to motorcycle accident resulted in high hospital costs.
Average loss per patient was R$ 17,555. Of those who answered the functional
impact questionnaire, 64% were on paid leave by INSS and 84% presented
partial or permanent physical disabilities after the accident. Only 9 people
(36%) received any kind of financial benefit from public authorities. Conclusion: High costs are directly related to hospitalization time and surgical needs.
Most victims needed financial help and had their social lives aggravated.
Investments in motorcyclists’ awareness of traffic laws and use of safety
equipment are needed, as well as in road infrastructure. Level of
evidence II, Prognostic studies.
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Cheong HS, Tham KY, Chiu LQ. Injury patterns in elderly cyclists and motorcyclists presenting to a tertiary trauma centre in Singapore. Singapore Med J 2020; 62:482-485. [PMID: 32211913 DOI: 10.11622/smedj.2020038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION With Singapore's ageing population, there are increasing numbers of elderly cyclists and motorcyclists. Compared to younger riders, this cohort sustains more injuries and has poorer outcomes. This study aimed to describe and compare patient demographics, injury patterns and outcomes among elderly cyclists and motorcyclists at a Level 1 trauma centre. METHODS Data of all cyclists, motorcyclists and pillion riders aged 65 years and above who presented to the emergency department after accidents from 1 January 2013 to 31 December 2017 was extracted from the hospital's trauma registry and reviewed. RESULTS Cyclists and motorcyclists formed 42.0% and 58.0%, respectively, of 157 recruited patients. At the time of the accident, 40.8% of the patients were employed. The mean age of the patients was 71.6 ± 5.8 years. Extremities and pelvic girdle injuries (61.1%) were the most frequent, followed by chest injuries (48.4%), and head and neck injuries (40.1%). Among severe injuries (defined as Abbreviated Injury Scale score ≥ 3), chest injuries (39.5%) were the most common, followed by head and neck injuries (36.3%). The overall mortality rate was 9.6%, with cyclists at nearly three times the risk compared to motorcyclists. More cyclists than motorcyclists (18.2% vs. 11.0%) required intensive care. There were no significant differences in the length of hospital stay between cyclists and motorcyclists. CONCLUSION Elderly riders have unique injury patterns and consume significant healthcare resources. Trauma systems need to acknowledge this changing injury epidemiology and equip trauma centres with the necessary resources targeted at elderly patients. Future work should focus on strategies to minimise extremity and chest injuries.
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Affiliation(s)
- Hui Shyuan Cheong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Kum Ying Tham
- Department of Emergency Medicine, Tan Tock Seng Hospital, Singapore
| | - Li Qi Chiu
- Department of Emergency Medicine, Tan Tock Seng Hospital, Singapore
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BITTAR CINTIAKELLY, CLIQUET JÚNIOR ALBERTO, COSTA VINÍCIUSSAMUELDIASALVESDA, PACHECO ANACAROLINADEFREITAS, RICCI RENATOLAZARIN. EPIDEMIOLOGICAL PROFILE OF MOTORCYCLE ACCIDENT VICTIMS IN UNIVERSITY HOSPITAL. ACTA ORTOPEDICA BRASILEIRA 2020; 28:97-99. [PMID: 32425673 PMCID: PMC7224324 DOI: 10.1590/1413-785220202802230035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: To evaluate the epidemiological profile of motorcycle accident victims in a
metropolis with more than one million inhabitants attended in a university
hospital of reference in 2017. Methods: a retrospective study through the analysis of medical records of 105
motorcycle accident victims in Campinas (SP) attended in a university
hospital of reference and who needed surgical procedure in 2017. Results: 87 patients (82.9%) were men. Multiple fractures were observed in 61
patients (58.1%) and polytrauma was found in 14 patients (13.3%). Tibial
fracture was the most frequent, present in 65 cases (61.9%). Exposed
fractures occurred in 68 patients (64.7%). Among the polytrauma victims, the
most frequent injury was traumatic brain injury (TBI), present in seven
patients (6.6%). The mean age was 29.8 years (range 6-63 years). The average
length of hospital stay was 14 days (1-87). Conclusion: It is essential to investigate and evaluate the victims’ epidemiological
profile, as well as the resulting injuries, in order to provide adequate
support for the implementation of measures aimed at primary prevention and
awareness of the most affected groups. Level of Evidence II,
Prognostic studies - Investigating the effect of a patient
characteristic on the outcome of disease.
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Fletcher C, McDowell D, Thompson C, James K. Helmet use among motorcycle accident victims in the north-east region of Jamaica. Int J Inj Contr Saf Promot 2019; 26:399-404. [PMID: 31429368 DOI: 10.1080/17457300.2019.1653931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Currently in Jamaica, motorcyclists account for the largest group of fatalities among all road users. Between 2016 and 2018, a cross sectional study was conducted at the Saint Ann's Bay Regional Hospital involving 155 participants. There were 98.7% males, ages ranged from 14-64 years and more than two thirds of the motorcyclists were under 40 years. Only 29.4% wore helmets, and of those motorcyclists, 52.8% indicated they were only riding for a short distance. Increasing age correlated with increased helmet compliance. Persons with motorcycles greater than 150 cubic centimetres were also more likely to wear a helmet. Interventions to promote increased helmet compliance should take these factors into account in conjunction with enhancing law enforcement.
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Affiliation(s)
- Cary Fletcher
- Department of Orthopaedics, Saint Ann's Bay Regional Hospital, Saint Ann's Bay, St. Ann, Jamaica
| | - Derrick McDowell
- Department of Orthopaedics, Saint Ann's Bay Regional Hospital, Saint Ann's Bay, St. Ann, Jamaica
| | - Camelia Thompson
- Department of Community Health and Psychiatry, University of the West Indies at Mona, Mona, Jamaica
| | - Kenneth James
- Department of Community Health and Psychiatry, University of the West Indies at Mona, Mona, Jamaica
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Yadollahi M, Jamali B. Severity and injury characteristics among matched hospitalized motorcycle drivers and their passengers. Chin J Traumatol 2019; 22:223-227. [PMID: 31235286 PMCID: PMC6667746 DOI: 10.1016/j.cjtee.2018.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 01/15/2019] [Accepted: 04/13/2019] [Indexed: 02/04/2023] Open
Abstract
PURPOSE After car accident, motorcycle accident ranks as the second leading cause of traffic fatality in Iran. This study aimed to compare the severity and clinical presentations between drivers and passengers under the same injury circumstance. METHODS This study was conducted in the trauma center of Shiraz, Iran in 2017. Data on demographics, triage level, blood pressure, respiratory rate, Glasgow coma scale (GCS), injured body region, injury severity score (ISS), revised trauma score (RTS), and result of accident were compared between pairs of drivers and passengers. The agreement of any type of injury between drivers and passengers evaluated by Kappa test. RESULTS This study included 143 matched pairs of drivers and passengers. Most of the pairs (84.5%) did not use helmet and 77.2% of the riders do not have driving license. ISS was significantly higher in drivers than passengers. In the unmatched pairs, drivers and passengers showed no difference in sustaining injuries in the face, head & neck, chest and soft tissue, but drivers were found more likely to suffer from injuries in the abdomen, extremities, pelvis and spine than passengers. Once one part of the matched pair suffered injury in the head & neck, face, chest, abdomen, extremities and soft tissue & skin injury, the probability that the other part had an injury in the same region was 50%, 9%, 13%, 7%, 22% and 34% respectively. Kappa value for these body regions was 0.006, 0.009, -0.006, 0.068, 0.063 and 0.001, respectively, which was significant in abdomen and extremities. CONCLUSION Although drivers had higher level of injury severity and some different injury distributions, we recommend equal treatment to drivers and passengers. We also recommend related authorities to develop policies on helmet use, driving license and third-party insurance.
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Lam C, Pai CW, Chuang CC, Yen YC, Wu CC, Yu SH, Hung KS, Chiu WT. Rider factors associated with severe injury after a light motorcycle crash: A multicentre study in an emerging economy setting. PLoS One 2019; 14:e0219132. [PMID: 31251789 PMCID: PMC6599117 DOI: 10.1371/journal.pone.0219132] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 06/17/2019] [Indexed: 01/13/2023] Open
Abstract
Objective In Taiwan, light motorcycles (LMCs) with cylinder capacities between 50 and 250 cc are widely used for daily commute. These vehicles are operated in a mixed traffic environment and prohibited on highways. In light of increasing motorcycle casualties, we conducted a multicentre study to analyse rider factors affecting injury severity. Methods Riders hospitalised upon LMC crashes were contacted. Information on demographics, comorbidities, and riding behaviours was collected through questionnaires and linked to hospital data. The injury severity score (ISS) and length of hospitalisation (LOH) were used as injury severity measures. Results In total, 725 patients (mean age: 37.7 years; 64% men) completed their questionnaires. Multivariate analysis results showed that age ≥ 65 years, half-face helmets, protective clothing, collisions with a bus/truck or car, and fatigue riding were risk factors for having an ISS of ≥9. Age ≥ 65 years; motorcycle crashes ≥2 times in the previous year; anaemia; rural crashes; half-face helmets; protective boots; collisions with a bus/truck, car, or a stationary object; alcohol/stimulating refreshment consumption; and fatigue riding were risk factors for increased LOH. A protective factor was individuals working in commerce. Collisions with opening car doors caused low risks of having an ISS of ≥9 and a short LOH. Conclusion Certain factors were significantly associated with riders’ injury severity and related medical resource consumption. Because of differences in the power output, use, and riding environment, risk factors for severe injuries in LMC crashes are dissimilar from those for heavy motorcycles (cylinder capacities > 250 cc) in developed countries and deserve more attention for injury prevention. Further in-depth evaluation of significant factors based on this study’s results can yield valuable information to reduce severe injuries after LMC crashes in countries and areas with a high dependency on motorcycles, even considering the popularity of electric motorcycles.
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Affiliation(s)
- Carlos Lam
- Emergency Department, Department of Emergency and Critical Care Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chih-Wei Pai
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Chia-Chang Chuang
- Department of Emergency Medicine, National Chen Kung University Hospital, College of Medicine, National Chen Kung University, Tainan, Taiwan
| | - Yu-Chun Yen
- Research Center of Biostatistics, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Chia-Chieh Wu
- Emergency Department, Department of Emergency and Critical Care Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Shih-Hsiang Yu
- Institute of Transportation, Ministry of Transportation and Communications, Executive Yuan, Taipei, Taiwan
| | - Kuo-Sheng Hung
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Neurosurgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- * E-mail: (KSH); (WTC)
| | - Wen-Ta Chiu
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
- * E-mail: (KSH); (WTC)
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Ngunde PJ, Akongnwi ACN, Mefire CA, Puis F, Gounou E, Nkfusai NC, Nwarie UG, Cumber SN. Prevalence and pattern of lower extremity injuries due to road traffic crashes in Fako Division, Cameroon. Pan Afr Med J 2019; 32:53. [PMID: 31143358 PMCID: PMC6522147 DOI: 10.11604/pamj.2019.32.53.17514] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 01/07/2019] [Indexed: 12/30/2022] Open
Abstract
Introduction Low and middle income countries are disproportionately affected with road traffic injuries and the lower extremity is one of the most affected anatomical body parts. There exist very limited data on the pattern of lower extremity injuries in the Cameroon especially in the South West Region. We therefore, hypothesized that lower limb injuries are common in road traffic crashes and motorized two wheelers are the commonest cause. Methods This was a hospital based prospective, cross sectional study. It involved four hospitals (Limbe and Buea Regional Hospitals, Baptist hospital Mutengene and Tiko District Hospital) in the Fako Division. It was carried out for three months. Victims of road traffic crashes received at emergency department of these hospitals during this period were assessed. Crash characteristics and injury characteristics were assessed and recorded. Results We analyzed 411 crash victims, 197(47.93%) had lower extremity injuries. The male to female ratio was 1.4:1. Majority of crash victims were in their 3rd and 4th decades of life. The mean age of patients who had lower limb injuries was 33.30(±16.04). The most vulnerable road users were pedestrians (26.52%) and passengers on motor bikes (38.44%) and the commonest mechanism by which crash victims sustained injuries were: bike-car collisions (22.84%), and bike-pedestrian collisions (19.29%). Commercial motor bikes (62.77%) and taxis (22.38%) were the road users most involved in road traffic collisions. The leg 98(49.75%), thigh 23(11.68%), and knee 20(10.15%) were the most injured anatomical parts of the lower extremity. Fractures 68 (34.52%), lacerations 53(26.90%), and bruises 49(24.87%) were the most recurrent pattern of lower extremity injuries. Conclusion In view of our findings we conclude therefore as follows: The prevalence of lower extremity injuries from Road Traffic Crashes in our study area was 47.93%. Associated risk factors to the road traffic crashes as identified by the victims were bad roads (10.15%) and bad weather (5.05%). The safety gargets were not adequately utilized by our victims, with 87.72% confirming that they did not wear the helmet and 87.50% affirming that they did not wear the seat belt at the time of the crash. The occupations mostly affected in our series were pupils and students (20.3%) and business people (19.2%), then the bike riders (15.23%). We thus recommend that the laws on the use of road safety gargets, especially helmets and seatbelts, be enforced, with riding and driving speeds reduced to below 60km/hour. Road usage should be avoided in bad weather and pedestrians lanes and zebra crossings be provided to minimize pedestrian-car or -bike collision.
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Affiliation(s)
- Palle John Ngunde
- Department of Medicine and surgery, Faculty of Health Sciences, University of Buea, Buea Cameroon
| | | | - Chichom Alain Mefire
- Department of Medicine and surgery, Faculty of Health Sciences, University of Buea, Buea Cameroon
| | - Fokam Puis
- Department of Medicine and surgery, Faculty of Health Sciences, University of Buea, Buea Cameroon
| | - Eleanor Gounou
- Department of Medicine and surgery, Faculty of Health Sciences, University of Buea, Buea Cameroon
| | - Ngwayu Claude Nkfusai
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon
| | - Udoamaka Glory Nwarie
- Department of Medicine and surgery, Faculty of Health Sciences, University of Buea, Buea Cameroon
| | - Samuel Nambile Cumber
- Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.,Section for Epidemiology and Social Medicine, Department of Public Health, Institute of Medicine (EPSO), The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Obimakinde OS, Olajuyin OA, Rabiu TB, Olanrewaju OJ. Crash Characteristics and Pattern of Motorcycle Related Facial Bone Fractures in a Sub-Urban Nigerian Teaching Hospital. Niger J Surg 2018; 24:71-75. [PMID: 30283215 PMCID: PMC6158988 DOI: 10.4103/njs.njs_39_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Context: Recent studies indicated that significant proportion of facial fractures attributed to road traffic mishaps in the middle- and low-income countries are caused by motorcycle (MC) crashes. However, there is limited information on crash characteristics of such injuries. This study was designed to examine the crash characteristics, pattern of fracture, and sociodemographics of patients with facial bone fractures due to MC crashes in our institution. Subjects and Methods: Data on patients’ sociodemographics, pattern of presentation, type(s) of fracture, patient status, crash characteristics, level of consciousness, and treatment offered were collected and analyzed. Results: A total of 151 patients, aged 7–59 years were reviewed during the study period. A male preponderance was observed (M:F = 4:1) and the patients were predominantly motorcyclists (64.8%, n = 98). The most common mechanism of crash was collision with another MC (51.6%, n = 78). A total of 194 fractures were reviewed and the mandible (58.8%, n = 114) was more commonly affected than the midface (41.2%, n = 80). The predominant site on the mandible was the body (31.6%) while zygoma (32.5%) was the most affected part of the midface. Patient status was found to have a statistically significant relationship with loss of consciousness (P = 0.02). Eighty-two fracture sites (42.3%) were managed with open reduction and internal fixation. Conclusions: Facial bone fractures occur in a significant proportion of MC crashes and riders are predominantly affected. In addition, a larger proportion of commuters rarely wear crash helmet which could have offered protection. Continual advocacy on preventive measures and enforcement of road safety regulations is hereby advised.
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Affiliation(s)
- Obitade S Obimakinde
- Department of Oral and Maxillofacial Surgery, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Oyebanji A Olajuyin
- Department of Otorhinolaryngology, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Taopheeq B Rabiu
- Department of Surgery, Neurological Surgery Unit, Ladoke Akintola University Teaching Hospital, Osogbo, Nigeria
| | - Olusoji J Olanrewaju
- Department of Family Dentistry, Lagos State University Teaching Hospital, Lagos, Nigeria
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Tadros A, Owen S, Hoffman SM, Davis SM, Sharon MJ. Emergency department visits by pediatric patients sustained as a passenger on a motorcycle. TRAFFIC INJURY PREVENTION 2018; 19:71-74. [PMID: 28613096 DOI: 10.1080/15389588.2017.1341629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Currently only 5 out of the 50 states in the United States have laws restricting the age of passengers permitted to ride on a motorcycle. This study sought to characterize the visits by patients under the age of 16 to U.S. emergency departments (EDs) for injuries sustained as a passenger on a motorcycle. METHODS In this retrospective cohort study, data were obtained from the Nationwide Emergency Department Sample (NEDS) for the years 2006 to 2011. Pediatric patients who were passengers on a motorcycle that was involved in a crash were identified using International Classification of Diseases, Ninth Revision (ICD-9) External Cause of Injury codes. We also examined gender, age, disposition, regional differences, common injuries, and charges. RESULTS Between 2006 and 2011 there were an estimated 9,689 visits to U.S. EDs by patients under the age of 16 who were passengers on a motorcycle involved in a crash. The overall average patient age was 9.4 years, and they were predominately male (54.5%). The majority (85%) of these patients were treated and released. The average charges for discharged patients were $2,116.50 and amounted to roughly $17,500,000 during the 6 years. The average cost for admission was $51,446 per patient and totaled over $54 million. The most common primary injuries included superficial contusions; sprains and strains; upper limb fractures; open wounds of head, neck, and trunk; and intracranial injuries. CONCLUSION Although there were only about 9,700 visits to U.S. EDs for motorcycle crashes involving passengers less than 16 years old for 2006 to 2011, the total cost of visits that resulted in either ED discharge or hospital admission amounted to over $71 million.
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Affiliation(s)
- Allison Tadros
- a School of Medicine, Department of Emergency Medicine , West Virginia University , Morgantown , West Virginia
| | - Stephanie Owen
- a School of Medicine, Department of Emergency Medicine , West Virginia University , Morgantown , West Virginia
| | - Shelley M Hoffman
- a School of Medicine, Department of Emergency Medicine , West Virginia University , Morgantown , West Virginia
| | - Stephen M Davis
- a School of Medicine, Department of Emergency Medicine , West Virginia University , Morgantown , West Virginia
| | - Melinda J Sharon
- a School of Medicine, Department of Emergency Medicine , West Virginia University , Morgantown , West Virginia
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Chichom-Mefire A, Palle-Ngunde J, Fokam P, Mokom-Awa A, Njock R, Ngowe-Ngowe M. Injury patterns in road traffic victims comparing road user categories: Analysis of 811 consecutive cases in the emergency department of a level I institution in a low-income country. INTERNATIONAL JOURNAL OF SURGERY OPEN 2018. [DOI: 10.1016/j.ijso.2017.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Adeleye AO, Ogun MI. Clinical Epidemiology of Head Injury from Road-Traffic Trauma in a Developing Country in the Current Era. Front Neurol 2017; 8:695. [PMID: 29326652 PMCID: PMC5736536 DOI: 10.3389/fneur.2017.00695] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 12/05/2017] [Indexed: 11/30/2022] Open
Abstract
Objectives Africa and other Asian low middle-income countries account for the greatest burden of the global road-traffic injury (RTI)-related head injury (HI). This study set out to describe the incidence, causation, and severity of RTI-related HI and associated injuries in a Nigerian academic neurosurgical practice. Methods This is a retrospective cross-sectional analysis of RTI-related HI from a prospective HI registry in an academic neurosurgery practice in Nigeria. Results All-terrain RTI accounted for 80.6% (833/1,034) of HI over a 7-year study period. All age groups were involved, mean 33.06 years (SD 18.30), mode 21–30, 231/833 (27.7%). The male:female ratio was 631:202, ≈3:1. The road trauma occurred exclusively from motorcycle-and motor-vehicle crash (MCC/MVC), MCC caused 56.8% (473/833) of these; the victims were vulnerable road users (VRU) in 74%, and >90% belong in the low socioeconomic class. Using the Glasgow Coma Scale grading, the HI was moderate/severe in 52%; loss of consciousness occurred in 93%, the Abbreviated Injury Severity-head > 3 in 74%, and computed tomography (CT) Rotterdam score > 3 in 52%. Significant extracranial injuries occurred in many organ systems, 421/833 (50.5%) having Injury Severity Score (ISS) > 25. Surgical lesions included extensive brain contusions in 157 (18.8%); acute extradural hematoma in 34 (4.1%); acute subdural hematoma in 32 (3.8%); and traumatic intracerebral hemorrhage in 27 (3.2%), but only 97 (11.6%) received operative care for various logistic reasons. The in-hospital outcome was good in 71.3% and poor in 28.7%; the statistically significant (p < 0.001) determinants of this outcome profile were the severity of the HI, the CT Rotterdam score, and the ISS. Conclusion In this study from Nigeria, RTI-related HI emanates from significant trauma to vulnerable road users and are caused exclusively by motorcycles and motor vehicles.
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Affiliation(s)
- Amos O Adeleye
- Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Neurological Surgery, University College Hospital (UCH), Ibadan, Nigeria
| | - Millicent I Ogun
- Clinical Nursing Department, University College Hospital (UCH), Ibadan, Nigeria
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Chichom-Mefire A, Nwanna-Nzewunwa OC, Siysi VV, Feldhaus I, Dicker R, Juillard C. Key findings from a prospective trauma registry at a regional hospital in Southwest Cameroon. PLoS One 2017; 12:e0180784. [PMID: 28723915 PMCID: PMC5516986 DOI: 10.1371/journal.pone.0180784] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 06/21/2017] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Trauma is a leading cause of morbidity and mortality worldwide. Data characterizing the burden of trauma in Cameroon is limited. Regular, prospective injury surveillance can address the shortcomings of existing hospital administrative logs and medical records. This study aims to characterize trauma as seen at the emergency department (ED) of Limbe Regional Hospital (LRH) and assess the completeness of data obtained by a trauma registry. METHODS AND FINDINGS From January 2008 to October 2013, we prospectively captured data on injured patients using a strategically designed, context-relevant trauma registry instrument. Indicators around patient demographics, injury characteristics, delays in accessing care, and treatment outcomes were recorded. Descriptive, bivariate, and multivariate statistical analyses were conducted. About 5,617 patients, aged from 0.5-95years (median age of 26 years), visited the LRH ED with an injury; 67% were male. Students (27%) were the most affected occupation category. Road traffic injuries (RTIs) (56%), assault (22%), and domestic injuries (13%) were the leading causes of injury. Two-thirds of RTIs were motorcycle-related. Working in transportation (AOR 4.42, p<0.001) and law enforcement (AOR 1.73, p = 0.004) were significant predictors of having a RTI. The trauma registry showed a significant improvement in completeness of all data (p<0.001) and it improved over time compared with previous administrative records. However, proportions of missing data still ranged from 0.5% to 8.2% and involved respiratory rate or Glasgow Coma scale. CONCLUSIONS Implementation of a context-appropriate trauma registry in resource-constrained settings is feasible. Providing valuable, high-quality data, the trauma registry can inform trauma care quality improvement efforts and policy development. Study findings indicate the need for injury prevention interventions and policies that will prioritize high-risks groups, such as those aged 20-29 years, and those in occupations requiring frequent road travel. The high incidence of motorcycle-related injuries is concerning and calls for a proactive solution.
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Affiliation(s)
- Alain Chichom-Mefire
- Department of Surgery, Faculty of Health Sciences, University of Buea and Regional Hospital Limbe, Buea, Cameroon
| | - Obieze C. Nwanna-Nzewunwa
- Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
| | - Vincent Verla Siysi
- Department of Surgery, Faculty of Health Sciences, University of Buea and Regional Hospital Limbe, Buea, Cameroon
| | - Isabelle Feldhaus
- Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
| | - Rochelle Dicker
- Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
| | - Catherine Juillard
- Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
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Pillion riders beware: Motorcycle fire following road side accident – An autopsy case report. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2016. [DOI: 10.1016/j.ejfs.2016.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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