[Injury patterns in motorcycle accident victims]

THE IMPACT OF COVID-19 ON THE PROFILE OF MOTORCYCLE ACCIDENTS ATTENDED AT A TERTIARY HOSPITAL IN CAMPINAS

Traffic-accidents are a public health problem with repercussions on population morbimortality.

Objective

To analyze the impact of the pandemic on the profile of motorcycle accidents assisted at the Tertiary Hospital in 2020.

Methods

Cross-sectional, descriptive retrospective study in 2017 and 2020 of 260 medical records of care for motorcycle accidents in the emergency room of the Tertiary Hospital. Statistical analysis of data and their correlations using the chi-square test (p < 0.05).

Results

Of the 105 medical records in 2017, 83% are men, mean age 29.8 years, and death rate of 3.90%. Fractures in 98.10%, 64.10% exposed and predominantly the tibia (61.90%). Of the 155 medical records in 2020, 91.61% are men, mean age 31.21 years, and no deaths. Fractures in 94.84%, 37.42% exposed and predominantly the tibia (28.57%). Between 2017 and 2020, Infosiga-SP showed a relevant reduction (p < 0.001) of deaths in the hospital environment (52.46% to 31.91%).

Conclusion

The incidence of motorcycle accidents increased, in-hospital deaths dropped, but the epidemiological profile of accidents at the Hospital remained unchanged. Level of Evidence III, Comparative Retrospective Study.

THE IMPACT OF MOTORCYCLE ACCIDENTS IN A REFERENCE HOSPITAL DURING THE COVID-19 PANDEMIC

ABSTRACT Objective: This study aimed to analyze the relationship between the number of motorcycle accidents attended at a reference Hospital for trauma in Campinas, state of São Paulo, and the pandemic by COVID-19 during the year 2020. Methods: This is a cross-sectional, descriptive retrospective study carried out at Hospital PUC- Campinas, through the analysis of medical records of patients, victims of motorcycle trauma undergoing orthopedic surgical management in 2020. The phases of the pandemic and the isolation rates according to the São Paulo Plan were studied. Chi-Square tests, and the Least Squares method were applied for statistical calculations. Results: 155 medical records were analyzed, of which 91.61% of the patients were male. Of those admitted, 94.84% suffered fractures and 51.61%, polyfractures. There was a correlation between the average isolation rates and the number of accidents. In the 14-day period, as the average isolation rate increased by 10%, there was an increase of approximately 3 accidents in that period. In the 7-day analysis, 1.7 more traumas were observed for every 10% increase in the average isolation. Conclusion: The results suggest that by increasing the average isolation rate, the number of traumas per motorcycle treated at the institution increased. Level of Evidence III, Comparative Retrospective Study.

Tendência da taxa de mortalidade por acidentes de trânsito entre motociclistas no estado de São Paulo, Brasil, de 2015 a 2020

RESUMO Objetivo: Avaliar a tendência da taxa de mortalidade de motociclistas decorrentes de lesões por acidentes de trânsito no estado de São Paulo, Brasil, nos anos de 2015 a 2020. Métodos: Estudo ecológico de delineamento de série temporal com dados secundários provenientes do Sistema de Informações Gerenciais de Acidentes de Trânsito do Estado de São Paulo (INFOSIGA), referentes aos óbitos de motociclistas decorrentes de lesões por acidentes de trânsito no estado de São Paulo, de 2015 a 2020. A variação percentual anual foi calculada pelo modelo de regressão de Prais-Winsten, utilizando o programa STATA 14.0. Resultados: Foram notificados 11.343 óbitos de motociclistas resultantes de lesões por acidentes de trânsito. A maior proporção de óbitos ocorreu entre indivíduos do sexo masculino (88,1%), entre 18 e 24 anos de idade (27,9%), nas duas regiões mais populosas e urbanizadas do estado. A distribuição da taxa de mortalidade apresentou mínima variação no período analisado, de 4,22 a 4,42 óbitos/100 mil habitantes. Entre as variáveis sociodemográficas analisadas, a tendência da mortalidade de motociclistas foi estacionária em sua maioria. Conclusão: A análise da taxa de mortalidade de motociclistas decorrentes de lesões por acidentes de trânsito no estado de São Paulo apresentou tendência estacionária.

Use of Propeller Flap in the Coverage of Soft-Tissue Injury in the Lower Limb

Objective  To evaluate the use of a propeller flap to cover soft-tissue injuries in the lower limb.

Materials and Methods  A retrospective study, with review of medical records, and a convenience sample of 14 patients operated between July 2018 and June 2019. The following clinical aspects were evaluated: sex; age group; type of injury; cause of the injury; initial diagnosis; affected location; techniques for incision and identification; surgical planning; flap design; postoperative period; result of the propeller flap; and complications.

Results  The sample was composed of male patients (100%), with a mean age of 36.4 years, and 92.7% of the injuries resulted from motorcycle accidents, mostly on the right side (71.4%). The surgical planning of the propeller flap followed the same procedure in all cases. Immediate postsurgical complications were present in 35.7% of the cases, and they included excessive bleeding (14.3%), partial necrosis (14.3%), and flap dehiscence (7.1%). In total, 13 patients had excellent coverage, and only 1 had flap loss.

Conclusion  The propeller-flap technique to cover lesions in the lower limb proved to be a good alternative in most cases evaluated, with a good surgical result, although complications were observed in some cases.

EPIDEMIOLOGICAL PROFILE OF MOTORCYCLE ACCIDENT VICTIMS IN UNIVERSITY HOSPITAL

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.

Clinical aspects of patients with traumatic lesions of the brachial plexus following surgical treatment

Objective

To evaluate sociodemographic and clinical aspects of patients undergoing operations due to traumatic lesions of the brachial plexus.

Method

This was a retrospective study in which the medical files of a convenience sample of 48 patients operated between 2000 and 2010 were reviewed. The following were evaluated: (1) range of motion (ROM) of the shoulder, elbow and wrist/hand, in degrees; (2) grade of strength of the shoulder, elbow and wrist/hand; (3) sensitivity; and (4) visual analogue scale (VAS) (from 0 to 10). The Student's t, chi-square, Friedman, Wilcoxon and Kruskal–Wallis tests were used (p < 0.05).

Results

The patients’ mean age was 30.6 years; 60.4% of them had suffered motorcycle accidents and 52.1%, multiple trauma. The mean length of time until surgery was 8.7 months (range: 2–48). Thirty-one patients (64.6%) presented complete rupture of the plexus. The frequent operation was neurosurgery in 39 cases (81.3%). The ROM achieved was ≥30° in 20 patients (41.6%), with a range from 30° to 90° and mean of 73° (p = 0.001). Thirteen (27.1%) already had shoulder strength ≥M3 (p = 0.001). Twenty-seven patients (56.2%) had elbow flexion ≥80°, with a range from 30° to 160° and mean of 80.6° (p < 0.001). Twenty-two had strength ≥M3 (p < 0.001). Twenty-two patients (45.8%) had wrist extension ≥30° starting from flexion of 45°, with a range from 30° to 90° and mean of 70° (p = 0.003). Twenty-seven (56.3%) presented wrist/hand extension strength ≥M3 (p = 0.002). Forty-five (93.8%) had hypoesthesia and three (6.2%) had anesthesia (p = 0.006). The initial VAS was 4.5 (range: 1.0–9.0) and the final VAS was 3.0 (range: 1.0–7.0) (p < 0.001).

Conclusion

Traumatic lesions of the brachial plexus were more prevalent among young adults (21–40 years), men, people living in urban areas, manual workers and motorcycle accidents, with multiple trauma and total rupture of the plexus. Neurosurgery, with a second procedure consisting of muscle-tendon transfer, was the commonest operation. Surgery for traumatic lesions of the brachial plexus resulted in significant improvement in the ROM and strength of the shoulder, elbow and wrist/hand, improvement of the sensitivity of the limb affected and reduction of the final pain.

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

OBJECTIVE:

To evaluate retrospectively, through analysis of medical records, the epidemiological aspects of patients traumatized by motorcycle accidents treated at the orthopedics ward, Hospital São Paulo, Brazil.

METHODS:

It is a retrospective observational study. The analysis of patients' medical records comprised the period from January 2008 to December 2009. The data checked were: age, gender, type of collision, type and location of fracture, treatment performed (conservative or surgical), type of surgery, cost of synthesis material and hospitalization, period of hospitalization and postoperative complications. After data collection, statistical analysis was performed.

RESULTS:

We analyzed 381 victims involved in motorcycle accidents. Patients were predominantly male (85%), with a mean age of 30.7 years old. Referring to distribution and site of lesions, 75.5% of individuals had lower limb fractures and in 95.4% of the cases, the treatment of choice was surgery. Twenty-nine patients were rehospitalized due to postoperative complications, such as exposure and failure of synthesis material, wound infection, necrosis, osteomyelitis, and pseudoarthrosis.

CONCLUSION:

It was possible to identify useful characteristics for planning preventative strategies to reduce the rate of motorcycle accidents and redirect public investment in health. Level of Evidence III, Retrospective Study.

[Motorcycle accident mortality time trends in Brazil, 1996-2009]

OBJECTIVE

To analyze motorcycle accidents mortality trends in Brazil.

METHODS

A descriptive time series study of mortality from motorcycle accidents in Brazil between 1996 and 2009 according to state and age group. The data on mortality were obtained from the National Mortality Information System of Ministry of Health and the population data from the Brazilian Institute of Geography and Statistics. Standardized mortality rates were calculated for the entire period for the country as a whole and for each state. Annual variability in mortality rates was estimated using Prais-Winsten generalized linear correlation.

RESULTS

Between 1996 and 2009 the mortality rate increased from 0.5 to 4.5 per 100.000 habitants (an increase of 800.0% in mortality rates during the period studied and an average annual increase of 19.0%). High mortality rates in 2009 were observed in the states of Piauí, Sergipe and Mato Grosso. The largest increases were observed in states in the North, Northeast and Midwest of Brazil.

CONCLUSIONS

There was a significant increase in motorcycle accident mortality rates for the country as a whole during the studied period, mainly in states in the Northeast.

Influence of type of helmet on facial trauma in motorcycle accidents

The mandatory use of helmets by motorcyclists has lowered the incidence of facial trauma, but we know little about the effects of different models of helmet on such injuries. We aimed to find out how different types of helmet affect facial injuries. We collected retrospective data from the medical records of 157 patients treated in a trauma centre in metropolitan São Paulo between January and December 2011. Patients wearing open-face helmets were twice as likely to require an operation as those wearing full-face helmets. The type of helmet is strongly associated with the treatment required.

Characteristics and current direct costs of hospital admissions due to occupational accidents in the southwest of Bahia from 2005 to 2007

OBJECTIVE

This study aimed to identify the profile and cost of admissions for occupational accidents, under the Unified Health System (UHS) in municipalities of the southwest of Bahia, in the period of 2005 to 2007.

METHODS

It was conducted a descriptive study using the records of the Hospital Information System (HIS), from which were extracted data about the sociodemographic, occupational and hospitalization profiles. To express the results, indicators were used as absolute frequencies and proportions, the average stay, Total Cost of Hospitalization (TCH), Hospital Mortality (HM), Average Spenditure (AS) and Cost per Day (CD).

RESULTS

962 admissions were recorded, of which 94.1% were related to path accidents. Among the admitted subjects 65.7% were male, and the most affected age groups were 5 to 14 and 15 to 24 years. There were forearm fractures on 26 cases of typical accidents. 248 cases of intracranial injuries happened during commuting to work, which accounted for 78.2% of traffic accidents and 28.8% of falls. The average stay was of 2.6 days and the deaths occurred in 0.5% of patients discharges. The total cost of the admissions was of R$ 243,125.06, being the AS of R$ 252.73 and CD of R$ 97.44, lower than the external causes. The frequencies of the variables related to the occupation were not verified due to missing values.

CONCLUSION

The data from the HIS Systems were limited for identify the profile of the admitted workers. However, they are important and can be used on occupational health surveillance.

Profile of Motorcycle Victims from the Emergency Service of a University Hospital

Objective

Epidemiological survey of motorcycle accidents occurring in a city with over one million inhabitants and treated at university hospital of reference between the months of July and November 2010.

Methods

Cross sectional study using structured interview (standardized form) to document the data collection: age, gender, income, using time and capacity of the motorcycle.

Results

From 114 cases, it was observed that the profile of the victim of motorcycle accident treated at this hospital is a young person, male, possessing a driver's license for less than five years, with a monthly income average around one thousand reais (local currency), owner of a motorcycle with low capacity (less than 150 cc) and low educational attainment. The accidents occurred predominantly in the urban area, in the afternoons and one third of them were considered work-related accidents, death generated in 3 per cent of cases and open fractures in 11 per cent of them.

Conclusion

The incidence of motorcycle accidents involved mainly young men with little experience in traffic and low level of education.

Potencial evocado auditivo de tronco encefálico no prognóstico do coma superficial

O coma é a redução persistente do nível de consciência, arresponsivo a estímulos, devido à baixa atividade cerebral. Para verificar o nível de consciência, um recurso frequentemente utilizado é a Escala de Coma de Glasgow. Outro método que se destaca é o Potencial Evocado Auditivo de Tronco Encefálico, o qual avalia a atividade elétrica das vias auditivas ascendentes, desde o trajeto periférico até o mesencéfalo. O exame é simples, imune a medicamentos depressores e ambientes eletricamente carregados, sendo o mais adequado dos potenciais para a monitoração dos estados de coma. O presente estudo teve por objetivo verificar as características do Potencial Evocado Auditivo de Tronco Encefálico no estado de coma leve (Glasgow 7 - 8) e suas respectivas contribuições. Foi realizado um estudo prospectivo transversal em dois pacientes em coma (Glasgow 7), estado secundário a traumatismo cranioencefálico. Os resultados do exame evidenciaram presença de atividade elétrica em toda extensão da via estudada, em ambos os casos, com indicações de diferentes alterações, quanto à redução na latência entre os intervalos, morfologia e replicação das ondas. Tais diferenças foram contempladas com a evolução de cada caso: caso 1 evoluiu a alta hospitalar e caso 2 evoluiu a óbito. Os resultados confirmaram os achados da literatura, que descreve que a presença do Potencial Evocado Auditivo de Tronco Encefálico normal está associada à boa evolução do caso clínico, enquanto alterações no exame podem sinalizar para um mau prognóstico.

Road safety impacts of the motorcycle in Brazil

Brazil has had high indices of traffic injuries and deaths since the 1950s, mostly related to the increasing and irresponsible use of the automobile. Upon approval of the Brazilian Transit Code (CTB) in 1997, traffic injuries and deaths began to diminish, despite an increase in vehicle fleet size, a phenomenon that had never occurred previously. Concurrently, starting in 1991 and with a great intensity after 1996, there has been a sizeable increase in motorcycle production and use, facilitated and encouraged by public officials. Between 1995 and 2000 annual sales figures for motorcycles doubled and reached 2 million units in 2008. Traffic deaths associated with motorcycles increased exponentially, rising from 725 in 2006 to 10,143 in 2010, eliminating the advances gained by the CTB in reducing auto-related injuries. This article analyses the process and its impacts on road safety. The first part summarises the main public policy decisions related to the theme. Part two analyses changes in traffic safety after the introduction of this new technology. Part three looks at the possible political, economic and social motives that lie behind this process. The final part suggests solutions to the great prejudice caused to society and the nation.

Mortality of motorcyclists in traffic accidents in the Brazilian Federal District from 1996 to 2007

OBJECTIVE

To describe sociodemographic characteristics and analyze temporal trends in the mortality of motorcyclists injured in traffic accidents.

METHODS

This was a time-series study with data from 580 motorcyclist deaths in the Brazilian Federal District from 1996 to 2007. The data were obtained from the Mortality Information System. Mortality rates specific for age and sex, the standardized rates (direct method), and the ratio of deaths per fleet (motorcycles) were calculated. The centralized moving average of the standardized mortality rate for men was calculated for a three-year period, and a linear regression model was constructed to study the evolution of mortality. The joinpoint method (inflection point) was used to calculate the annual increase in the standardized mortality rate.

RESULTS

Most of the motorcyclists killed were male (94.3%), mixed skin color (71.0%), and between the ages of 20 and 39 years (73.8%). The standardized mortality rate for resident motorcyclists (men) was 1.9 to 7.2 deaths/100,000 men between 1996 and 2007. Between 1998 and 2007, the ratio of deaths per fleet increased from 2.0 deaths/10,000 motorcyclists to 10.0 deaths/10,000 motorcyclists among men. There was an estimated annual increase of 0.48 deaths/100,000 men (95%CI 0.31, 0.65; p <0.001). The percent increase of the annual standardized mortality rate for males was 36.2% in the period from 1998-2007 (95%CI 21.2%, 53.2%; p <0.05).

CONCLUSIONS

The mortality rate resulting from motorcycle road accidents has increased dramatically. This increase is partially explained by the increase of the fleet of motorcycles. Individual characteristics of drivers, as well as local traffic conditions, need to be investigated for the planning of preventive policies.

Lesões do aparelho locomotor nos acidentes com motocicleta

Estudo realizado no município de São Paulo entre janeiro de 2001 e julho de 2002 e tem como objetivo analisar o perfil do indivíduo envolvido em acidentes motociclísticos avaliando: o perfil do condutor, as circunstâncias dos acidentes, as lesões e o uso de equipamentos de segurança. Foram encontrados 387 pacientes sendo 354(91,0%) do sexo masculino, entre 16 e 44 anos e considerados os indivíduos que necessitaram somente do tratamento traumato-ortopédico. O mecanismo de trauma mais comum envolveu a colisão entre a moto com outro veículo (67,0%), numa velocidade entre 20-60km/h (73,0%), em pessoas com menor experiência (67,0%) na idade entre 21-24 anos (45,0%), nos quais 532 (53,9%) lesões ocorreram nos membros inferiores. Quanto ao tipo de lesão tivemos 393(39,8%) ferimentos, 314(31,8%) contusões e 212(21,5%) fraturas [ossos do pé 34(16%), fêmur 32(15,1%), tornozelo 27(12,7%), tíbia 25(11,8%)]. A reincidência foi observada em 231(60,0%) acidentes e somente 6,0% dos pacientes não usavam equipamentos de proteção.O aumento da velocidade relacionou-se à um índice maior de fraturas quando foi aplicado o teste de Mann-Whitney (p=0,001). Pesquisas de engenharia mecânica e de engenharia de tráfego, associadas à rigorosa fiscalização e conscientização da população, devem ser consideradas o método mais efetivo , que é o da prevenção.

Perfil das vítimas de trauma por acidente de moto atendidas em um serviço público de emergência

No Brasil, observa-se um aumento dos acidentes envolvendo motocicletas. Este estudo objetivou caracterizar as vítimas desse tipo de acidente atendidas em um serviço de emergência no Piauí. Pesquisa quantitativa com amostra de 430 vítimas. A análise mostrou predominância do sexo masculino, na faixa etária de 15 a 24 anos e procedentes do próprio estado. Observou-se que 301 dessas vítimas eram condutores da motocicleta, 81 passageiros e 48 foram atropelados por moto. Verificou-se que 76,05% das vítimas sofreram acidente de quinta-feira a domingo, 80,75% apresentaram seqüelas temporárias e 52,33% dos acidentes ocorreram no período noturno. Os tipos de lesão corresponderam em 69,3% dos casos a ferimentos; 51,4% a fraturas; 27,44% a hematomas; e 20,7% a traumatismos cranioencefálicos. Entre as vítimas de acidente, condutores da moto e suspeitos de ingestão de álcool, 52,07% não utilizavam capacete no momento do acidente. A maioria das vítimas recebeu alta hospitalar e 14 foram a óbito. Conclui-se que o trauma provocado pelos acidentes envolvendo motocicletas merece atenção, especialmente em relação ao planejamento de ações preventivas, assim como controle de sua ocorrência no estado.

RJDA. Análise comparativa entre os mecanismos de trauma, as lesões e o perfil de gravidade das vítimas, em Catanduva - SP

OBJETIVO: Realizar uma análise comparativa entre os principais mecanismos de trauma, a gravidade das vítimas e os principais ferimentos que proporcionaram. MÉTODO: Estudo randomizado de 1486 fichas de vítimas traumatizadas atendidas pela Unidade de Resgate do Corpo de Bombeiros em Catanduva - SP, no período de janeiro/1997 a dezembro/2003. Foi realizada uma avaliação a partir dos itens ferimentos, Revised Trauma Score e mecanismos de trauma, cujas variáveis foram expressas em porcentagens e correlacionadas pelo Teste X². RESULTADOS: Houve predomínio de acidentes motociclísticos com 42,2% dos traumas. As regiões corpóreas mais acometidas foram os membros inferiores/cintura pélvica (32,2%). Os ferimentos superficiais acometeram 88% das vítimas. Para todos os eventos, prevaleceram vítimas com RTS=6 excetuando-se os acidentes envolvendo veículos pesados em que 25% das vítimas obtiveram RTS<2. As quedas representaram 63,4% dos eventos quando excluimos da análise os acidentes de trânsito. Houve correlação estatística somente entre o mecanismo de trauma e a região corpórea lesada (p<0,01). Os membros inferiores/pelve foram mais acometidos em atropelamentos e acidentes de moto. Cabeça/pescoço foram lesados nas agressões, nas quedas e nos acidentes envolvendo veículos pesados e automóveis. Os ciclistas apresentaram similaridade de lesões em cabeça/pescoço e membros inferiores/pelve. CONCLUSÕES: Em Catanduva prevaleceram motociclistas traumatizados, e acometidos, principalmente, os membros inferiores e a pelve. A maioria das vítimas sofreu ferimentos superficiais, decorrentes de traumas leves.

The TRISS method applied to the victims of traffic accidents attended at a tertiary level emergency hospital in a developing country

In Brazil, trauma occupies third place among the various causes of death and is the first cause of death among young people. Among the various approaches to the study of trauma, analysis of the organisation and quality of care has been frequently reported in the literature. The objective of the present study was to assess the quality of care for victims of trauma due to traffic accidents provided at the Emergency Unit of the University Hospital, Faculty of Medicine of Ribeirão Preto, SP, Brazil. The quality of care was compared between two different periods, i.e., before and after the introduction of modifications in prehospital care, and was also compared to the North American standards of the Major Trauma Outcome Study (MTOS). The Trauma Score and Injury Severity Score (TRISS) was used to calculate the probability of survival and the Z statistic was used for comparison with the MTOS. During both periods studied, the results were inferior to those obtained by the MTOS, although positive signs were detected at the Emergency Unit regarding the organisation of the system of trauma care during the study period.

Características dos acidentes de trânsito e das vítimas atendidas em serviço pré-hospitalar em cidade do Sul do Brasil, 1997/2000

Os acidentes de trânsito e os traumas deles resultantes constituem um importante problema social e de saúde pública. O objetivo deste trabalho foi o de analisar as características dos acidentes e das vítimas atendidas pelo único serviço de atenção pré-hospitalar de Londrina, Paraná, Brasil, o Serviço Integrado de Atendimento ao Trauma e às Emergências (SIATE), de 1997 a 2000. Foram estudadas 14.474 vítimas registradas no banco de dados do SIATE. Em todos os anos de estudo, mais de 70,0% das vítimas eram do sexo masculino e tinham de 10 a 39 anos; os motociclistas foram o principal tipo de vítima em todos os anos, com valores superiores a 40,0%. A maioria acidentou-se no mês de dezembro, nos finais de semana, principalmente no sábado, e durante a noite. Esses resultados corroboram os observados em outros estudos, evidenciando a necessidade de implementação de medidas preventivas direcionadas à população jovem e masculina, especialmente a composta por motociclistas.

Diagnóstico de lesões e qualidade de vida de motociclistas, vítimas de acidentes de trânsito

O estudo caracteriza motociclistas, vítimas de acidentes de trânsito, residentes em Maringá-Paraná e atendidos em centros de referência para tratamento do trauma, segundo gravidade do trauma, partes do corpo afetadas e região corpórea da lesão mais grave, além de identificar, dentre essas vítimas, possíveis diferenças na qualidade de vida daqueles que apresentaram trauma crânio-encefálico. O Injury Severity Score foi utilizado para análise de gravidade do trauma, e o instrumento genérico Medical Outcomes Study 36-Item Short-Form Health Survey para avaliação da qualidade de vida das vítimas. Quanto à gravidade das lesões, predominaram as vítimas de trauma leve, 73,14%. A maioria (59,70%) sofreu lesões nos membros inferiores, seguidos pelos membros superiores (58,21%) e cabeça (31,34%). Os membros destacaram-se entre as demais regiões como os segmentos corpóreos mais gravemente lesados. Na comparação da qualidade de vida após trauma das vítimas, com e sem trauma crânio-encefálico, não se evidenciaram diferenças.

An autopsy case of a stunt man who jumped into seawater riding a motorcycle: a case report

We report a rare case of the death of a stunt man who jumped into the sea driving a motorcycle on location for a TV drama. A special ramp had been constructed for the jump. The stunt man and a passenger drove up the ramp at a speed of 60-70 km/h and jumped into the sea from a height of about five metres. Both men swam up, but the driver fell unconscious at the surface. He was sent to hospital, but did not recover. The autopsy revealed a deep laceration of the right axilla with complete rupture of the axillary artery, bone fractures of the right ribs and the right pelvis, and a small laceration of the upper lobe of the right lung. Other visceral organs were not injured. We finally judged that his cause of death was exsanguination due to rupture of the right axillary artery on the basis of the presence of a small amount of blood inside the heart and ischemic organs. All injuries were probably inflicted by a collision with the motorcycle upon reaching the water surface; the axillary injury might be due to the left handlebar piercing into the part.

The new Brazilian traffic code and some characteristics of victims in southern Brazil

OBJECTIVE

The aim was to study characteristics of traffic accident victims before and after the implementation of the new Brazilian traffic code, in January 1998.

SUBJECTS AND METHODS

The study population was car and motorcycle occupants seen in a pre-hospital care service in Londrina, Parana State (Brazil) before the introduction of the new Brazilian traffic code, from 22 January to 21 July 1997, and after its implementation during the same period in 1998. Victims were analyzed over the time periods according to helmet and seat belt use, gender, underage driving, and alcohol on the breath.

RESULTS

Use of seat belts increased from 45% to 62.6% and of helmets from 31.2% to 66.2% after the introduction of the new Brazilian code. The proportion driving under age 18 and with perceptible alcoholic breath declined significantly only among motorcycle riders. There was a 20% decline in car occupant injuries along with a 9% reduction in motorcycle related injuries after the change of the law.

CONCLUSION

Results favor the hypothesis that rigorous legislation increases safer practices in traffic, at least during the first months of its implementation.

[Characteristics of the victims of traffic accidents in a city of the southern region of Brazil]

OBJECTIVE

To evaluate the magnitude of morbidity and mortality and describe some of the characteristics of road accident victims.

METHODS

The study population was composed of 3,643 victims of road accidents which occurred in Londrina, PR (Brazil), during the first semester of 1996. There were included victims from accidents registered by the Military Police, those who died at the accident scenario or on their way to the hospital, those who received emergency care or were hospitalized through the Unified Care System. It was observed a period of 180 days for death verification.

RESULTS

The mean incidence and mortality rates were 1,582.2 and 29. 0 per 100,000 inhabitants, respectively. These rates, however, have demonstrated great variability in relation to several characteristics (place of residence, gender, age and the victim's mode of transport). The majority of victims were motorcyclists, followed by cyclists and pedestrians who, altogether, accounted for 76.9% of the total, and 81.5% of those who died.

CONCLUSIONS

These results suggest that road accidents constitute a major cause of morbidity and mortality and that specific preventive measures should be considered in order to reduce such accidents, especially those that involve the most vulnerable road passers.

[Nature and severity of injuries in traffic accident victims]

The objective of this retrospective study is to characterize the nature and severity of injuries of hospitalized traffic accident victims using the "Abbreviated Injury Scale" (AIS). Two-hundred and twenty such patients in a trauma reference hospital in Sao Paulo, Brazil were assessed. One-hundred and eleven of them were pedestrians, eighty-three vehicular passengers and twenty-six motorcyclists. The most common injuries were of the limbs, pelvic girdle and head/neck. Injury severity in all these patients was AIS = 3. Two-thirds of the forty-five victims who died were pedestrians.

[Characteristics of mortality in traffic accidents in an area of Southern Brazil]

OBJECTIVE

The mortality by traffic accidents is discussed by means of the characterization of residents who died as a result of accidents in 1992.

MATERIAL AND METHOD

The study population was made up of all the victims of accidents which occurred in 1992 and who died in the same year.

RESULTS AND CONCLUSIONS

The majority of victims were males between the ages of 20 and 49 years who were pedestrians (29%), motorcycle riders (34%) or cyclists (18%). The accidents occurred mostly in the early afternoon and evening at crossroads of the busiest avenues. It may be concluded that even in the interior towns the consequences of traffic accidents constitute one of the principal hazards to the population's health and reveal a distinct pattern that calls for measures specific prevention.

[Evaluation of the severity of head injuries using anatomical and physiological indices]

The purpose of this study was the analysis of head injury severity based on physiologic and anatomic indexes, shown by hospitalized patients from the Intensive Care Unit. The study was characterized according to patients' age, gender, external cause and remaining time at the Intensive Care Unit, and it was verified that from the total of admitted patients the most of them were young adult males with a remaining time percentage of 6.28 days, Most frequent external cause was traffic motor vehicle accidents (65.72%). The study also considers the lesions and trauma severity according to the Abbreviated Injury Scale/ Injury Severity Score (AIS/ISS), reporting that the lesions were classified as severe lesions non-life threatening (AIS-3) and severe lesions life threatening (AIS-4). It was verified that the body region most affected was head and neck (57.65%). In relation to the trauma severity (ISS), most of the patients reached ISS 16. The study also presents the head injury severity by determining the consciousness level using the Glasgow Coma Scale (GCS); most of the patients showed severe head injury or GCS from 3 to 8. Analysis regarding a possible relation between the GCS and the AIS/ISS was performed to evaluate the head injury severity, considering the fact that the patient was victim of head injury or head injury and other body lesions. No meaning statistical element was observed regarding the relation between the GCS-1 and the AIS from the head region, except when analyzed by groups of severity, or GCS-1 3 to 8 and AIS-head 4 to 5; GCS-1 9 to 12 and AIS-head 2 to 3. Similarly, no meaning statistical relation between the GCS-1 and the ISS, isolated head injury or head injury and other body lesions and the ISS or the GCS. It is expected that this study may contribute with new data for the continuous assistance improvement of patients, with head injury severity either related to other lesions or not, offered both by the Nursing and Health teams.