Profile of trauma victims of motorcycle accidents treated at hospital São Paulo

The Burden of Motorcycle Crash Injuries on the Public Health System in Kisumu City, Kenya

BACKGROUND

In Kenya, the increased use of motorcycles for transport has led to increased morbidity, mortality, and disability. These injuries exert a burden on the public health system, yet little information exists on health care resource usage by motorcycle crash injury patients. We aimed to estimate the burden of motorcycle crash injuries on the health system in Kisumu City.

METHODS

We conducted a 6-month prospective study of all motorcycle crash injury patients who presented to 3 Tier III public and private hospitals in Kisumu City between May and November 2019. We collected data on demographics, emergency department (ED) visits, admissions, anatomic injury site, services used, and injury severity. We reviewed hospital records to obtain denominator data on all the conditions presenting to the EDs.

RESULTS

A total of 1,073 motorcycle crash injury cases accounted for 2.0%, 12.0%, and 13.6% of total emergency visits, total injuries, and total admissions to the hospitals, respectively. Men were overrepresented (P<.001). The mean age was 29.6 years (±standard deviation [SD] 12.19; range=2-84). The average injury severity score was 12.83. Surgical interventions were required by 89.3% of patients admitted. Of the 123 patients admitted to the intensive care unit, 42.3% were due to motorcycle accident injuries.

CONCLUSION

Motorcycle injuries impose a major burden on the Kisumu City public health system. Increased promotion and reinforcement of appropriate interventions and legislation can help prevent accidents and mitigate their consequences. Focusing on motorcycle injury prevention will reduce accident-related morbidity, hospitalization, severity, and fatalities and the impact on the public health system.

Costs and 30-day readmission after lower limb fractures from motorcycle crashes in Queensland, Australia: A linked data analysis

BACKGROUND

Lower limb trauma is the most common injury sustained in motorcycle crashes. There are limited data describing this cohort in Australia and limited international data establishing costs due to lower limb trauma following motorcycle crashes.

METHODS

This retrospective cohort study utilised administrative hospitalisation data from Queensland, Australia from 2011-2017. Eligible participants included those admitted with a principal diagnosis coded as lower extremity or pelvic fracture following a motorcycle crash (defined as the index admission). Multiply injured motorcyclists where the lower limb injury was not coded as the primary diagnosis (i.e. principal diagnosis was rather coded as head injury, internal organ injures etc.) were not included in the study. Hospitalisation data were also linked to clinical costing data. Logistic regression was used to determine risk factors for 30-day readmission. Costing data were compared between those readmitted and those who weren't, using bootstrapped t-tests and ANVOA.

RESULTS

A total of 3342 patients met eligibility, with the most common lower limb fracture being tibia/fibula fractures (40.8%). 212 participants (6.3%) were readmitted within 30-days of discharge. The following were found to predict readmission: male sex (OR 1.84, 95% CI 1.01-1.94); chronic anaemia (OR 2.19, 95% CI 1.41-3.39); current/ex-smoker (OR 1.60, 95% CI 1.21-2.12); emergency admission (OR 2.77, 95% CI 1.35-5.70) and tibia/fibula fracture type (OR 1.46, 95% CI 1.10-1.94). The most common reasons for readmission were related to ongoing fracture care, infection or post-operative complications. The average hospitalisation cost for the index admission was AU$29,044 (95% CI $27,235-$30,853) with significant differences seen between fracture types. The total hospitalisation cost of readmissions was almost AU$2 million over the study period, with an average cost of $10,977 (95% CI $9,131- $13,059).

CONCLUSIONS

Unplanned readmissions occur in 6.3% of lower limb fractures sustained in motorcycle crashes. Independent predictors of readmission within 30 days of discharge included male sex, chronic anaemia, smoking status, fracture type and emergency admission. Index admission and readmission hospitalisation costs are substantial and should prompt health services to invest in ways to reduce readmission.

Hospitalizations due to gastrointestinal Chagas disease: National registry

OBJECTIVES

Analyze the hospitalizations of patients admitted for Chagas disease with gastro-intestinal involvement (CD-GI) in the Brazilian Unified Health System, describe the epidemiological profile, mortality and costs.

METHODS

This is an observational study that uses secondary data from the National Hospital Information System (SIH-SUS) for the years 2017-2019. CD-GI admissions were defined by specific ICD-10 codes that identify the main diagnosis.

RESULTS

From 2017 to 2019, there were 4,407 hospitalizations for CD-GI in Brazil, considering only public hospitals and those associated with the SUS. This corresponds to an average of 1,470 hospitalizations per year, or 0.6 per 100,000 inhabitants, with significant regional variation. Hospitalizations increased with age and were slightly higher in men. More than 60% were emergencies and in 50% the procedure performed was surgical. The most used code was the one for megaesophagus followed by megacolon. In-hospital mortality was 5.8% and 17.2% went to intensive care units. The median cost was USD$ 553.15 per hospitalization, and an overall cost of USD$ 812,579.98 per year to the SUS budget.

CONCLUSION

The numbers, rates and costs presented here are possibly underestimated but they give us an idea of the overall profile of hospitalizations due to CD-GI, which are not rare and are related to significant in-hospital mortality. CD-GI is a neglected manifestation of a neglected disease.

Facial injury burden of personal mobility devices: a single-center retrospective analysis

Background: Personal mobility devices (PMDs) have become an increasingly popular transport modality globally. With increasing social interest in and demand for PMDs, the number of individuals visiting emergency departments with PMD-related injuries has also increased annually. This study aimed to evaluate injury patterns and treatment costs for patients treated in the department of plastic surgery in a trauma center.Methods: In this retrospective study, data concerning patients with PMD-related injuries from January 2017 to December 2021 were reviewed. The data retrieved included age, sex, alcohol consumption, helmet use, the type of impact, onset of injury, place of first visit, type of injury, admission status, operation status, and treatment cost. Multiple linear regression analysis was performed to determine the effects of various factors on cost.Results: Data were collected from 93 patients. Until 2019, the annual number of PMD-related accidents was less than 10; however, this number increased sharply in 2020. The average cost of hospitalization was USD 7,698 whereas the average cost of non-hospitalization was USD 631. Only fractures had a significant association with total cost in linear regression analysis (<i>p</i> < 0.001).Conclusion: The prevalence of PMD use and related injuries requiring plastic surgery during the study period showed significant health and financial costs both to the patients involved and to society. This cost could be reduced through stricter regulations concerning PMD use, advocating the use of protective gear, and promoting greater awareness of safety measures and of the consequences of PMD-related accidents.

The Orthopedic Injury Burden of Personal Mobility Devices in Singapore - Our Experience in the East Coast

PURPOSE

Personal mobility devices (PMDs) have become increasingly popular as a modality of transport worldwide. Starting out as novelty toys, PMDs are gradually being adopted as the mainstream mode of travel. There is an increasing number of accidents involving both PMD riders and other road users since its introduction, leading to a concomitant increase in demand for healthcare resources to manage the injuries. The main objective of this study was to evaluate the inpatient cost and the orthopedic injury pattern due to PMD accidents.

METHODS

All patients admitted to the Department of Orthopedic Surgery between December 2016 to February 2018 with injuries due to PMD accidents were recruited. Data collection was performed retrospectively on the demographic profiles, injury patterns, admission related outcomes and expenditures of these patients.

RESULTS

43 patients were included in this study. The mean duration of admission was 7.81 days and the median cost of admission was S$7835.01 (approximately US$5620). These were comparable to accidents arising from other modes of transport, such as motorcycles and bicycles. In addition, more than 80% of patients were not wearing protective gear at time of accident. These patients had a slightly higher median cost payable per patient as compared to those who donned protective gear, with a difference of S$1669.78 (approximately US$1221).

CONCLUSION

There is a significant health and financial cost to the individual and society from PMD injuries and admission. This can be reduced with strict regulations on PMD use, advocating protective gear use, and promoting awareness on safety measures and the consequences of PMD accidents. The most common injury mechanism and orthopedic injury type for PMD accidents are different from motorcycle accidents.

Motorcycle accidents: characteristics of victims admitted to public hospitals and circumstances

Background

Motorcycle accidents are a considerable cause of morbidity and mortality in Brazil, with high social and economic costs. Victims are mostly men, young and vulnerable.

Objective

To characterize motorcycle accident victims and circumstances among patients admitted to a public hospital.

Methods

We administered a questionnaire to 74 victims of motorcycle accidents in the period from January through July 2018 among patients admitted to a referral hospital for elective orthopedic surgery in Salvador, Bahia, Brazil.

Results

Most victims were male (98.4%), up to 31 years old (49%), black or brown (84%) and had low educational level (54%). Motorcycling was the occupation of 50.8%. Drinking was less frequent among motorcyclists in the capital compared to the interior of the state (16 vs. 26%) and a larger proportion had a driving license (72 vs. 39%).

Conclusion

Main victims of motorcycling accident victims were male, with low educational level, and without a driving license. Actions are needed to promote road safety, including educational programs to protect life and reduce the social and economic costs of accidents.

Female motorcycle mortality in Brazilian municipalities, 2005, 2010 and 2015

OBJECTIVE

To analyze the spatial distribution of female mortality due to motorcycle accidents in Brazilian municipalities between 2005 and 2015, as well as the variation in rates in the same period.

METHODS

Female mortality rates for the years 2005, 2010 and 2015 were estimated considering a three-year moving average around the base year, standardized by the direct method. Rates were standardized using the same pattern (Brazilian females in 2010) for each year. Then, the empirical Bayes estimator was used to reduce the effect of the random fluctuation. The percentage variation of the standardized rates was also analyzed for different population sizes (less than ten thousand, less than 50 thousand, more than 100 thousand and more than one million inhabitants).

RESULTS

Bayesian rates showed a clear increase in female mortality due to motorcycle accidents, especially in the North, Northeast and Midwest regions. In the municipalities of the South and Southeast regions, mainly in the period between 2010 and 2015, there was an apparent decrease in mortality. The percentage variation showed a reduction in the indicator analyzed in the period between 2010 and 2015 for the largest municipalities in the South and Southeast regions. For almost all regions and population sizes, the period between 2010 and 2015 showed a deceleration in the growth of rates.

CONCLUSION

The analysis clearly shows concentrations of municipalities with higher mortality, while also showing that the phenomenon has spread to a greater number of municipalities. The studied period allows the identification of different dynamics in female mortality, in a period of significant variation in mortality due to motorcycle accidents.

Pattern of mandibular fractures and helmet use among motorcycle crash victims in Tanzania

BACKGROUND

The maxillofacial structures are commonly affected in motorcycle crashes, with the mandible being one of the most frequently fractured bones. Helmets have been shown to have a protective effect in preventing maxillofacial injuries, however, its effect on the occurrence of mandibular fractures is not very well established.

OBJECTIVES

To evaluate the pattern of mandibular fractures among motorcycle crash victims in Tanzania, and determine the role of helmets in occurrence of mandibular fractures among the motorcyclists.

METHODOLOGY

This was a 6-months prospective, cross-sectional study that recruited motorcycle crash victims who reported with mandibular fractures following motorcycle crash at Muhimbili National Hospital. A specially designed questionnaire was used for data collection. For purpose of analysis, the Statistical Package for Social Sciences software version 20 was used.

RESULTS

The study included a total of 132 participants of whom majority were male (120, 90.9%). The peak age incidence was 21-40 years in 76.5% of the victims. More than half (89, 67.4%) of the victims were riders during the crash. Helmet use was reported in 42.3% of the victims, and majority (67.3%) were usinghalf-face helmets. The symphysis region was the frequently fractured anatomical location (50, 37.9%). More than half of the victims had multiple site involvement, with higher odds observed in individuals wearing half-face helmets.

CONCLUSION

Young males were affected ten times more than females. Most of the victims were riders during the crash. The symphysis region was the frequently fractured anatomical site. There was no difference in occurrence of mandibular fractures between those who wore and those who did not wear helmets during the crashes. However, the severity of mandibular fractures was dependent on the type of helmet used.

Clinical validation of nursing diagnosis "00085 Impaired Physical Mobility" in multiple traumas victims

OBJECTIVE

to clinically validate the nursing diagnosis "Impaired Physical Mobility", identifying its prevalence, defining characteristics, related factors, and associated conditions with the calculation of accuracy measures and generation of Decision Trees, as well as clinically and etiologically characterize the multiple traumas victims.

METHOD

methodological, cross-sectional study of clinical validation type, using diagnostic accuracy measures and generating decision tree.

RESULTS

the sample consisted of 126 patients, 73% male, with a mean age of 38.29 years. The frequency of the nursing diagnosis studied was 88.10%; the defining characteristic with the highest prevalence was "Difficulty turning" (58.73%), with a predictive power of 98.6%; the associated condition "Alteration in bone structure integrity" stood out with 72.22%. The accuracy measures also indicated their predictive power.

CONCLUSION

the components aforementioned were considered predictors of this diagnosis. This study contributed to improve the identification of clinical indicators associated with advanced methods of diagnostic validation, directing care and reducing the variability present in clinical situations.

Predictors of hospitalization and surgical intervention among patients with motorcycle injuries

Background

To describe the distribution of injuries, hospitalization rates by body areas injured, and surgery-requiring admissions, and to identify independent predictors of admission to a regional hospital in Jamaica.

Methods

A cross-sectional study was conducted among persons presenting to the St Ann’s Bay Regional Hospital in Jamaica (2016–2018) with injuries sustained from motorcycle crashes. A census was done of patients admitted to the surgery ward from the emergency room, as well as those referred to the Orthopaedic Outpatient Department. Trained members of the orthopedic team administered a pretested questionnaire within 24 hours of presenting to the orthopedic service to elicit data on sociodemographic characteristics, motor vehicle collision circumstance and motor bike specifications, physical injuries sustained and medical management, as well as compliance with legal requirements for riding a motorcycle. Associations between variables were examined using χ² tests and logistic regression.

Results

There were 155 participants in the study, and 75.3% of motorcyclists with injuries required admission. The average length of stay was approximately 10 days. Surgery was required for 71.6% of those admitted. Lower limb injuries constituted 55% of all injuries. The independent predictors for admission were alcohol use and total body areas involved. Motorcycle crash victims who used alcohol close to the time of crash were three times more likely to be admitted to hospital than those who did not consume alcohol. As the total body areas involved increased by one, there was a threefold increase in the likelihood of being admitted. Additionally, the greater the number of body areas involved, the greater was the likelihood of admission.

Discussion

Lower limb injuries are the most commonly reported injuries among victims of motorcycle crashes. Alcohol and total body areas involved are independent predictors of admission to hospital. In the planning of trauma delivery services, this information should be taken into account.

Level of Evidence

Level IV.

[Spatial analysis of motorcycle-related mortalities in Brazilian municipalities]

Analysis of the distribution of motorcycle-related mortality rates in Brazilian municipalities is fundamental to understand and seek to minimize the occurrence of this growing phenomenon. The main objective of this work is to analyze the spatial distribution of motorcycle rider mortality rates in Brazil, based on more robust and reliable estimates. An attempt was also made to identify the presence of spatial clusters in the distribution of such mortality rates in given municipalities. The rates were estimated based on the average number of motorcyclist deaths recorded in the years 2014, 2015 and 2016. These rates were then directly standardized and graduated based on the local empirical Bayesian estimator. A Local Indicator of Spatial Autocorrelation (LISA) indicated the presence of spatial patterns. The Northeast and Mid-West regions concentrated most of the municipalities with high mortality rates as well and most of the clusters of municipalities with a high-high distribution pattern. Graduated Bayesian estimation was effective to deal with the occurrence of extreme values, thereby improving the reliability of the estimates and enhancing the visualization of the rates on the map.