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BACKGROUND: The increased popularity of cycling is leading to an anticipated increase in cycling-related traffic accidents and a need to better understand the demographics and epidemiology of craniospinal injuries in this vulnerable road user group. This study aims to systematically investigate and characterise cycling-related head and spine injuries seen in the Major Trauma Centre for the Eastern region, which has the highest cycling rates in the UK. METHODS: We performed a retrospective cohort study comparing the incidence, patterns, and severity of head and spine injuries in pedal cyclists presenting to the Major Trauma Centre in Cambridge between January 2012 and December 2020. Comparisons of injury patterns, characteristics, and associations were made according to mechanism of injury, helmet use, patient age and gender. RESULTS: A total of 851 patients were admitted after being involved in cycling-related collisions over the study period, with 454 (53%) sustaining head or spine injuries. The majority of victims (80%) were male and in mid-adulthood (median age 46 years). Head injuries were more common than spine injuries, with the most common head injuries being intracranial bleeds (29%), followed by skull fractures (12%), and cerebral contusions (10%). The most common spine injuries were cervical segment fractures, particularly C6 (9%), C7 (9%), and C2 (8%). Motorised collisions had a higher prevalence of spine fractures at each segment (p < 0.001) and were associated with a higher proportion of multi-vertebral fractures (p < 0.001). These collisions were also associated with impaired consciousness at the scene and more severe systemic injuries, including a lower Glasgow coma scale (R = -0.23, p < 0.001), higher injury severity score (R = 0.24, p < 0.001), and longer length of stay (R = 0.21, p < 0.001). Helmet use data showed that lack of head protection was associated with more severe injuries and poorer outcomes. CONCLUSION: As cycling rates continue to increase, healthcare providers may expect to see an increase in bicycle-related injuries in their practice. The insights gained from this study can inform the treatment of these injuries while highlighting the need for future initiatives aimed at increasing road safety and accident prevention.
Study of 851 cycling-related trauma patients in Cambridge, UK, shows high rates of head & spine injuries.Motorised collisions were associated with more severe injuries and impaired consciousness at the scene.The lack of helmet use was linked to more severe head injuries and impaired consciousness, but not to a longer hospital stay.Rising cycling rates may lead to increased incidence of these injuries in clinical practice.Our findings may be relevant for clinicians treating cycling-related traumatic injuries to head and spine.
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The number of fatalities associated with traffic accidents has been declining owing to improvements in vehicle safety performance and changes in the law. However, injuries in children can lead to social and economic losses. We examined 10-year changes in the characteristics of traffic trauma among pediatric motor vehicle passengers by analyzing data from the Japan Trauma Data Bank (JTDB). Among the 36,715 injured motor vehicle passengers under the age of 15 years who were registered in the JTDB from 2004 to 2019, we compared the groups injured during 2004-2007 (n = 94) and 2017-2019 (n = 203). Physiologically, the 2004-2007 group had a lower body temperature and Glasgow Coma Scale score as well as a higher mortality. Anatomical severity was higher in the 2004-2007 group for the head, face, and neck, according to the Abbreviated Injury Scale. In terms of treatment, only craniotomy as a primary surgery was significantly lower in the 2017-2019 group. The 2017-2019 group had significantly higher rates of receiving whole-body computed tomography (CT). Because the rate of performing CT has increased, with no changes in the injury severities of the trunk and extremities, limiting the number of CT examinations is suggested for pediatric motor vehicle passengers involved in road traffic collisions. The severity of trunk and extremity injuries has not improved in more than 10 years; further preventive measures for these injuries should be considered.
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Head injuries are common for cyclists involved in collisions. Such collision scenarios result in a range of injuries, with different head impact speeds, angles, locations, or surfaces. A clear understanding of these collision characteristics is vital to design high fidelity test methods for evaluating the performance of helmets. We review literature detailing real-world cyclist collision scenarios and report on these key characteristics. Our review shows that helmeted cyclists have a considerable reduction in skull fracture and focal brain pathologies compared to non-helmeted cyclists, as well as a reduction in all brain pathologies. The considerable reduction in focal head pathologies is likely to be due to helmet standards mandating thresholds of linear acceleration. The less considerable reduction in diffuse brain injuries is likely to be due to the lack of monitoring head rotation in test methods. We performed a novel meta-analysis of the location of 1809 head impacts from ten studies. Most studies showed that the side and front regions are frequently impacted, with one large, contemporary study highlighting a high proportion of occipital impacts. Helmets frequently had impact locations low down near the rim line. The face is not well protected by most conventional bicycle helmets. Several papers determine head impact speed and angle from in-depth reconstructions and computer simulations. They report head impact speeds from 5 to 16 m/s, with a concentration around 5 to 8 m/s and higher speeds when there was another vehicle involved in the collision. Reported angles range from 10° to 80° to the normal, and are concentrated around 30°-50°. Our review also shows that in nearly 80% of the cases, the head impact is reported to be against a flat surface. This review highlights current gaps in data, and calls for more research and data to better inform improvements in testing methods of standards and rating schemes and raise helmet safety.
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Ciclismo , Traumatismos Craniocerebrais , Humanos , Ciclismo/lesões , Traumatismos Craniocerebrais/prevenção & controle , Simulação por Computador , Dispositivos de Proteção da Cabeça , Aceleração , Acidentes de TrânsitoRESUMO
BACKGROUND: Globally, road traffic collisions (RTCs) are a common cause of death and disability. Although many countries, including Ireland, have road safety and trauma strategies, the impact on rehabilitation services is unclear. This study explores how admissions with RTC related injuries to a rehabilitation facility has changed over 5 years and how they contrast to major trauma audit (MTA) serious injury data from the same timeframe. METHODS: A retrospective review of healthcare records with data abstraction in accordance with best practice was performed. Fisher's exact test and binary logistic regression were used to determine associations and statistical process control was used to analyse variation. All patients discharged with an International Classification of Diseases (ICD) 10 coded diagnosis of Transport accidents from 2014 to 2018 were included. In addition, serious injury data was abstracted from MTA reports. RESULTS: 338 cases were identified. Of these, 173 did not meet the inclusion criteria (readmissions) and were excluded. The total number analyzed was 165. Of these, 121 (73%) were male and 44 (27%) were female and 115 (72%) were under 40 years of age. The majority [128 (78%)] had traumatic brain injuries (TBI), 33 (20%) had traumatic spinal cord injuries and 4 (2.4%) had traumatic amputation The numbers varied over the time period of the study but showed normal variation and not special cause variation which suggests no significant impact of policy in the time frame. There was a large discrepancy between the number of severe TBIs reported in the MTA reports and the numbers admitted with RTC related TBI to the National Rehabilitation University Hospital (NRH). This suggests there may be many people not accessing the specialist rehabilitation services they require. CONCLUSION: Data linkage between administrative and health datasets does not currently exist but offers huge potential for understanding the trauma and rehabilitation ecosystem in detail. This is required to better understand the impact of strategy and policy.
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Lesões Encefálicas Traumáticas , Ecossistema , Humanos , Masculino , Feminino , Estudos Retrospectivos , Hospitalização , Acidentes de Trânsito , Hospitais de Reabilitação , PolíticasRESUMO
INTRODUCTION: Following a motor vehicle collision some patients will remain trapped. Traditional extrication methods are time consuming and focus on movement minimisation and mitigation. 'Chain cabling' is an alternative method of extrication used in some countries. The optimal extrication strategy and the effect of extrication methods on spinal movement is unknown. This study compares 'chain cabling' to the established roof removal method of extrication on spinal movement. METHODS: Biomechanical data were collected using Inertial Measurement Units on a single healthy volunteer during multiple experiments. The extrication types examined were chain cabling and roof removal. Measurements were recorded at the cervical and lumbar spine, and in the anteroposterior (AP) and lateral (LR) planes. Total movement (travel), maximal movement, mean, standard deviation and confidence intervals are reported. RESULTS: Eight experiments were performed using each technique. The smallest mean overall movements were recorded during roof-off extrication (cervical spine 0.6 mm for AP and LR, lumbar spine 3.9 mm AP and 0.3 mm LR). The largest overall mean movements were seen with chain cabling extrication (cervical spine AP 5.3 mm. LR 6.1 mm and lumbar spine 6.8 mm AP and 6.3 mm LR). CONCLUSION: In this study of a healthy volunteer, roof-off extrication was associated with less movement than chain cabling. The movement associated with chain cabling extrication was similar to that previously collected for other extrication types.
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Acidentes de Trânsito , Vértebras Cervicais , Humanos , Voluntários Saudáveis , Movimentos da CabeçaRESUMO
BACKGROUND: There have been major improvements in the trauma system and injury prevention in Al-Ain City. We aimed to study the impact of these changes on the incidence, pattern, injury severity, and outcome of hospitalized motorcycle-related injured patients in Al-Ain City, United Arab Emirates. METHODS: This is a retrospective analysis of two separate periods of prospectively collected data which were retrieved from Al-Ain Hospital Trauma Registry (March 2003 to March 2006 compared with January 2014 to December 2017). All motorcycle-injured patients who were admitted to Al-Ain Hospital for more than 24 h or died in the Emergency Department or after hospitalization were studied. RESULTS: The incidence of motorcycle injuries dropped by 37.1% over the studied period. The location of injury was significantly different between the two periods (p = 0.02, Fisher's exact test), with fewer injuries occurring at streets/highways in the second period (69.1% compared with 85.3%). The anatomical injury severity of the head significantly increased over time (p = 0.03), while GCS on arrival significantly improved (p < 0.0001), indicating improvements in both prehospital and in-hospital trauma care. The mortality of the patients significantly decreased (0% compared with 6%, p = 0.002, Fisher's exact test). CONCLUSIONS: The incidence of motorcycle injuries in our city dropped by almost 40% over the last 15 years. There was a significant reduction in the mortality of hospitalized motorcycle-injured patients despite increased anatomical severity of the head injuries. This is attributed to improvements in the trauma care system, including injury prevention, and both prehospital and in-hospital trauma care.
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Traumatismos Craniocerebrais , Motocicletas , Acidentes de Trânsito , Países em Desenvolvimento , Humanos , Estudos RetrospectivosRESUMO
The accumulation of ßAPP caused by axonal injury is an active energy-dependent process thought to require blood circulation; therefore, it is closely related to the post-injury survival time. Currently, the earliest reported time at which axonal injury can be detected in post-mortem traumatic brain injury (TBI) tissue by ßAPP (Beta Amyloid Precursor Protein) immunohistochemistry is 35 min. The aim of this study is to investigate whether ßAPP staining for axonal injury can be detected in patients who died rapidly after TBI in road traffic collision (RTC), in a period of less than 30 min.We retrospectively studied thirty-seven patients (group 1) died very rapidly at the scene; evidenced by forensic assessment of injuries short survival, four patients died after a survival period of between 31 min and 12 h (group 2) and eight patients between 2 and 31 days (group 3). The brains were comprehensively examined and sampled at the time of the autopsy, and ßAPP immunohistochemistry carried out on sections from a number of brain areas.ßAPP immunoreactivity was demonstrated in 35/37 brains in group 1, albeit with a low frequency and in a variable pattern, and with more intensity and frequency in all brains of group 2 and 7/8 brains from group 3, compared with no similar ßAPP immunoreactivity in the control group. The results suggest axonal injury can be detected in those who died rapidly after RTC in a period of less than 30 min, which can help in the diagnosis of severe TBI with short survival time.
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Lesões Encefálicas Traumáticas , Traumatismos Craniocerebrais , Acidentes de Trânsito , Precursor de Proteína beta-Amiloide/metabolismo , Axônios/metabolismo , Encéfalo/metabolismo , Humanos , Imuno-Histoquímica , Estudos RetrospectivosRESUMO
Road traffic collisions are a major cause of traumatic brain injury. However, the relationship between road traffic collision dynamics and traumatic brain injury risk for different road users is unknown. We investigated 2065 collisions from Great Britain's Road Accident In-depth Studies collision database involving 5374 subjects (2013-20). Five hundred and ninety-five subjects sustained a traumatic brain injury (20.2% of 2940 casualties), including 315 moderate-severe and 133 mild-probable injuries. Key pathologies included skull fracture (179, 31.9%), subarachnoid haemorrhage (171, 30.5%), focal brain injury (168, 29.9%) and subdural haematoma (96, 17.1%). These results were extended nationally using >1 000 000 police-reported collision casualties. Extrapolating from the in-depth data we estimate that there are â¼20 000 traumatic brain injury casualties (â¼5000 moderate-severe) annually on Great Britain's roads, accounting for severity differences. Detailed collision investigation allows vehicle collision dynamics to be understood and the change in velocity (known as delta-V) to be estimated for a subset of in-depth collision data. Higher delta-V increased the risk of moderate-severe brain injury for all road users. The four key pathologies were not observed below 8â km/h delta-V for pedestrians/cyclists and 19â km/h delta-V for car occupants (higher delta-V threshold for focal injury in both groups). Traumatic brain injury risk depended on road user type, delta-V and impact direction. Accounting for delta-V, pedestrians/cyclists had a 6-times higher likelihood of moderate-severe brain injury than car occupants. Wearing a cycle helmet during a collision was protective against overall and mild-to-moderate-to-severe brain injury, particularly skull fracture and subdural haematoma. Cycle helmet protection was not due to travel or impact speed differences between helmeted and non-helmeted cyclist groups. We additionally examined the influence of the delta-V direction. Car occupants exposed to a higher lateral delta-V component had a greater prevalence of moderate-severe brain injury, particularly subarachnoid haemorrhage. Multivariate logistic regression models created using total delta-V value and whether lateral delta-V was dominant had the best prediction capabilities (area under the receiver operator curve as high as 0.95). Collision notification systems are routinely fitted in new cars. These record delta-V and automatically alert emergency services to a collision in real-time. These risk relationships could, therefore, inform how routinely fitted automatic collision notification systems alert the emergency services to collisions with a high brain injury risk. Early notification of high-risk scenarios would enable quicker activation of the highest level of emergency service response. Identifying those that require neurosurgical care and ensuring they are transported directly to a centre with neuro-specialist provisions could improve patient outcomes.
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BACKGROUND: Motorized 2-3-wheelers-related death is high due to the exposed body of the driver/passenger and the high speed. The United Nation (UN) Decade of Action for road safety aimed to reduce road traffic deaths by 50% by the year 2020. We aimed to study the factors affecting the death rates of motorized 2-3 wheelers injured victims and whether the reduction in the death rates has met the UN target. METHODS: Data were retrieved from the WHO Global Status Reports on Road Safety published over 2009 to 2018 which covered the years of 2007 to 2016. Studied variables included motorized 2-3 wheelers death rates, percentage of helmet-wearing rate, helmet law enforcement, speed law enforcement, gross national income per capita, vehicles/person ratio, and motorized 2-3 wheelers/person ratio. A mixed linear model was used to define factors affecting the change of motorized 2-3 wheelers death rates over time. RESULTS: The global mean motorized 2-3 wheelers death rates increased from 2.37/100,000 population to 3.23/100,000 population over the studied decade (a relative ratio of 1.36) which was not statistically significant. Factors that affected mortality included GNI (p = 0.025), motorized 2-3 wheelers per person ratio (p < 0.0001), percentage of helmet wearing rate (p = 0.046), and the interaction between vehicle/person ratio and motorized 2-3 wheelers/person ratio (p = 0.016). There was a significant increase in the death rates over time in the low-income countries (a relative ratio of 2.52, p = 0.019, Friedman test), and middle-income countries (a relative ratio of 1.46, p < 0.0001, Friedman test), compared with a significant decrease in the high-income countries (a relative ratio of 0.72, p < 0.0001, Friedman test). CONCLUSIONS: Global mortality of motorized 2-3 wheelers has increased by a relative ratio of 1.36 over a recent decade. The UN target of reducing death was not met. The increase was related to the increase in motorized 2-3 wheelers per person ratio and economic inequity which has to be addressed globally. The economic global gap significantly impacts the mortality rates of motorized 2-3 wheelers.
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Acidentes de Trânsito , Dispositivos de Proteção da Cabeça , Acidentes de Trânsito/prevenção & controle , HumanosRESUMO
INTRODUCTION: The course of road traffic collision (RTC) victims with femoral fractures (FFx) from injury to death was reviewed. We sought to correlate the presence of femoral fractures with the overall severity of injury from RTCs using objective indices and to identify statistically significant associations with injuries in other organs. PATIENTS AND METHODS: A case-control study based on forensic material from 4895 consecutive RTC-induced fatalities, between 1996 and 2005. Injuries were coded according to the Abbreviated Injury Scale-1990 Revision (AIS-90), and the Injury Severity Score (ISS) was calculated. Victims were divided according to the presence of femoral fractures in all possible anatomic locations or not. Univariate comparisons and logistic regression analysis for probabilities of association as odds ratios (OR) were performed. RESULTS: The FFx group comprised 788 (16.1%) victims. The remaining 4107 victims constituted the controls. The FFx group demonstrated higher ISS (median 48 vs 36, p < 0.001) and shorter post-injury survival times (median 60 vs 85 min, p < 0.001). Presence of bilateral fractures (15.5%) potentiated this effect (median ISS 50 vs 43, p = 0.006; median survival time 40 vs 65, p = 0.0025; compared to unilateral fractures). Statistically significant associations of FFx were identified with AIS2-5 thoracic trauma (OR 1.43), AIS2-5 abdominal visceral injuries (OR 1.89), AIS1-3 skeletal injuries of the upper (OR 2.7) and lower limbs (OR 3.99) and AIS2-5 of the pelvis (OR 2.75) (p < 0.001). In the FFx group, 218 (27.7%) victims survived past the emergency department and 116 (53.2%) underwent at least one surgical procedure. Complications occurred in 45.4% of hospitalized victims, the most common being pneumonia (34.8%). CONCLUSION: This study has documented that femoral fractures are associated with increased severity of injury, shorter survival times and higher incidence of associated thoracic, abdominal and skeletal extremity injuries, compared to controls. These findings should be considered for an evidence-based upgrading of trauma care.
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Acidentes de Trânsito , Fraturas do Fêmur , Autopsia , Estudos de Casos e Controles , Fraturas do Fêmur/etiologia , Humanos , Escala de Gravidade do FerimentoRESUMO
OBJECTIVE: Mass casualty incidents (MCIs) have gained increasing attention in recent years due multiple high-profile events. MCI preparedness improves the outcomes of trauma victims, both in the hospital and prehospital settings. Yet most MCI protocols are designed for high-income countries, even though the burden of mass casualty incidents is greater in low-resource settings. RESULTS: Hôpital Universitaire de Mirebalais (HUM), a 300-bed academic teaching hospital in central Haiti, developed MCI protocols in an iterative process after a large MCI in 2014. Frequent MCIs from road traffic collisions allowed protocol refinement over time. HUM's protocols outline communication plans, triage, schematics for reorganization of the emergency department, clear delineation of human resources, patient identification systems, supply chain solutions, and security measures for MCIs. Given limited resources, protocol components are all low-cost or cost-neutral. Unique adaptations include the use of 1) social messaging for communication, 2) mass casualty carts for rapid deployment of supplies, and 3) stickers for patient identification, templated orders, and communication between providers. CONCLUSION: These low-cost solutions facilitate a systematic response to MCIs in a resource-limited environment and help providers focus on patient care. These interventions were well received by staff and are a potential model for other hospitals in similar settings.
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Planejamento em Desastres , Incidentes com Feridos em Massa , Planejamento em Desastres/métodos , Serviço Hospitalar de Emergência , Haiti , Humanos , Triagem/métodosRESUMO
BACKGROUND: The COVID-19 Pandemic lockdowns restricted human and traffic mobility impacting the patterns and severity of road traffic collisions (RTCs). We aimed to study the effects of the COVID-19 Pandemic on incidence, patterns, severity of the injury, and outcomes of hospitalized RTCs trauma patients in Al-Ain City, United Arab Emirates. METHODS: We compared the data of two cohorts of patients which were collected over two periods; the Pandemic period (28 March 2020 to 27 March 2021) and the pre-pandemic period (28 March 2019 to 27 March 2020). All RTCs trauma patients who were hospitalized in the two major trauma centers (Al-Ain and Tawam Hospitals) of Al-Ain City were studied. RESULTS: Overall, the incidence of hospitalized RTC trauma patients significantly reduced by 33.5% during the Pandemic compared with the pre-pandemic period. The mechanism of injury was significantly different between the two periods (p < 0.0001, Fisher's Exact test). MVCs were less during the Pandemic (60.5% compared with 72%), while motorcycle injuries were more (23.3% compared with 11.2%). The mortality of hospitalized RTC patients was significantly higher during the Pandemic (4.4% compared with 2.3%, p = 0.045, Fisher's Exact test). Logistic regression showed that the significant factors that predicted mortality were the low GCS (p < 0.0001), admission to the ICU (p < 0.0001), and the high ISS (p = 0.045). COVID-19 Pandemic had a very strong trend (p = 0.058) for increased mortality. CONCLUSIONS: Our study has shown that the numbers of hospitalized RTC trauma patients reduced by 33.5% during the COVID-19 Pandemic compared with the pre-pandemic period in our setting. This was attributed to the reduced motor vehicle, pedestrian and bicycle injuries while motorcycle injuries increased. Mortality was significantly higher during the Pandemic, which was attributed to increased ISS and reduced GCS.
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COVID-19 , Pandemias , Acidentes de Trânsito , Controle de Doenças Transmissíveis , Mortalidade Hospitalar , Humanos , SARS-CoV-2 , Emirados Árabes Unidos/epidemiologiaRESUMO
BACKGROUND: Various strategies to reduce the spread of COVID-19 including lockdown and stay-at-home order are expected to reduce road traffic characteristics and consequently road traffic collisions (RTCs). We aimed to review the effects of the COVID-19 pandemic on the incidence, patterns, and severity of the injury, management, and outcomes of RTCs and give recommendations on improving road safety during this pandemic. METHODS: We conducted a narrative review on the effects of COVID-19 pandemic on RTCs published in English language using PubMed, Scopus, and Google Scholar with no date restriction. Google search engine and websites were also used to retrieve relevant published literature, including discussion papers, reports, and media news. Papers were critically read and data were summarized and combined. RESULTS: Traffic volume dropped sharply during the COVID-19 pandemic which was associated with significant drop in RTCs globally and a reduction of road deaths in 32 out of 36 countries in April 2020 compared with April 2019, with a decrease of 50% or more in 12 countries, 25 to 49% in 14 countries, and by less than 25% in six countries. Similarly, there was a decrease in annual road death in 33 out of 42 countries in 2020 compared with 2019, with a reduction of 25% or more in 5 countries, 15-24% in 13 countries, and by less than 15% in 15 countries. In contrast, the opposite occurred in four and nine countries during the periods, respectively. There was also a drop in the number of admitted patients in trauma centers related to RTCs during both periods. This has been attributed to an increase in speeding, emptier traffic lanes, reduced law enforcement, not wearing seat belts, and alcohol and drug abuse. CONCLUSIONS: The COVID-19 pandemic has generally reduced the overall absolute numbers of RTCs, and their deaths and injuries despite the relative increase of severity of injury and death. The most important factors that affected the RTCs are decreased mobility with empty lines, reduced crowding, and increased speeding. Our findings serve as a baseline for injury prevention in the current and future pandemics.
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COVID-19 , Pandemias , Acidentes de Trânsito/prevenção & controle , Controle de Doenças Transmissíveis , Humanos , Pandemias/prevenção & controle , SARS-CoV-2RESUMO
BACKGROUND: Motor vehicle collisions (MVCs) are a common cause of major trauma and death. Following an MVC, up to 40% of patients will be trapped in their vehicle. Extrication methods are focused on the prevention of secondary spinal injury through movement minimisation and mitigation. This approach is time consuming and patients may have time-critical injuries. The purpose of this study is to describe the outcomes and injuries of those trapped following an MVC: this will help guide meaningful patient-focused interventions and future extrication strategies. METHODS: We undertook a retrospective database study using the Trauma Audit and Research Network database. Patients were included if they were admitted to an English hospital following an MVC from 2012 to 2018. Patients were excluded when their outcomes were not known or if they were secondary transfers. RESULTS: This analysis identified 426,135 cases of which 63,625 patients were included: 6983 trapped and 56,642 not trapped. Trapped patients had a higher mortality (8.9% vs 5.0%, p < 0.001). Spinal cord injuries were rare (0.71% of all extrications) but frequently (50.1%) associated with other severe injuries. Spinal cord injuries were more common in patients who were trapped (p < 0.001). Injury Severity Score (ISS) was higher in the trapped group 18 (IQR 10-29) vs 13 (IQR 9-22). Trapped patients had more deranged physiology with lower blood pressures, lower oxygen saturations and lower Glasgow Coma Scale, GCS (all p < 0.001). Trapped patients had more significant injuries of the head chest, abdomen and spine (all p < 0.001) and an increased rate of pelvic injures with significant blood loss, blood loss from other areas or tension pneumothorax (all p < 0.001). CONCLUSION: Trapped patients are more likely to die than those who are not trapped. The frequency of spinal cord injuries is low, accounting for < 0.7% of all patients extricated. Patients who are trapped are more likely to have time-critical injuries requiring intervention. Extrication takes time and when considering the frequency, type and severity of injuries reported here, the benefit of movement minimisation may be outweighed by the additional time taken. Improved extrication strategies should be developed which are evidence-based and allow for the expedient management of other life-threatening injuries.
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Acidentes de Trânsito/estatística & dados numéricos , Escala de Gravidade do Ferimento , Acidentes de Trânsito/mortalidade , Adulto , Pressão Sanguínea , Feminino , Escala de Coma de Glasgow , Hemorragia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Pneumotórax/epidemiologia , Sistema de Registros , Estudos Retrospectivos , Traumatismos da Coluna Vertebral/epidemiologia , Reino Unido/epidemiologia , Ferimentos e Lesões/epidemiologiaRESUMO
BACKGROUND/AIM: Because bicyclists and motorcyclists with oral and maxillofacial injuries often suffer from disabilities requiring long-term treatment, reducing the severity of such injuries is a valuable objective for improving these people's quality of life (QOL). The aims of this study were, first, to present the prevalence and patterns of oral and maxillofacial injuries of bicyclists and motorcyclists and to compare the features of these injuries and, second, to determine the factors contributing to long-term hospitalization for these patients and to propose effective preventive measures. MATERIAL AND METHODS: This was a single-center retrospective analysis. Hospital records from 2011 through 2018 were reviewed for all patients who had sustained oral and maxillofacial injuries in bicycle or motorcycle collisions and had presented at a university hospital which was the only hospital in the region attended 24 hours per day by oral and maxillofacial surgeons. Characteristics of the oral and maxillofacial injuries, injury severity, and factors influencing the length of hospitalization were examined. RESULTS: Records of 130 patients (82 bicyclists and 48 motorcyclists) with a mean age of 28.0 years were analyzed. Thirty-three patients (25.4%) had maxillofacial fractures, with 41 fracture lines while 103 patients (79.2%) had dental injuries and 57 patients (43.8%) had soft-tissue injuries. The distribution and prevalence of oral and maxillofacial injuries were similar for bicyclists and motorcyclists. However, motorcyclists had significantly higher Abbreviated Injury Scale (AIS) scores for facial injuries and the maximum AIS score than did bicyclists. According to a multiple regression analysis, the number of fracture lines and the requirement for intermaxillary fixation were independent factors influencing long-term hospitalization (standard regression coefficients: 6.795 and 6.715, respectively; P < .001). CONCLUSIONS: The number of fracture lines and the use of intermaxillary fixation were independent factors influencing long-term hospitalization of both bicyclists and motorcyclists with oral and maxillofacial injuries.
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Traumatismos Maxilofaciais , Ferimentos e Lesões , Acidentes de Trânsito , Adulto , Ciclismo , Hospitalização , Humanos , Traumatismos Maxilofaciais/epidemiologia , Traumatismos Maxilofaciais/terapia , Qualidade de Vida , Estudos RetrospectivosRESUMO
BACKGROUND: Traffic collision fatality rates per mile travelled have declined in Abu Dhabi similar to many developed countries. Nevertheless, the rate is still significantly higher than the average of countries with similar GDP and socio-demographic indicators. The literature on the subject in the UAE is limited especially in the area of studying drivers behaviour. This study aims to find determinants of risky driving behaviours that precipitate having a road traffic collision (RTC) in the United Arab Emirates (UAE). METHODS: A cross-sectional, survey-based study was employed. Participants were 327 active drivers who were attending Abu Dhabi Ambulatory Health Care Services clinics. They were provided with a questionnaire consisting of demography, lifestyle history, medical history, driving history, and an RTC history. They were also given a driving behaviour questionnaire, a distracted driving survey, depression screening and anxiety screening. RESULTS: Novice drivers (less than 25 years old) were 42% of the sample and 79% were less than 35 years. Those who reported a history of an RTC constituted 39.8% of the sample; nearly half (47.1%) did not wear a seatbelt during the collision. High scores in the driving behaviour questionnaire and high distraction scores were evident in the sample. Most distraction-prone individuals were young (90.5% were less than 36 years old). High scores in the driving behaviour questionnaire were also associated with high distraction scores (p < 0.001). Respondents with high depression risk were more likely to be involved in the RTC. With each one-point increase in the driver's distraction score, the likelihood of a car crash being reported increased by 4.9%. CONCLUSION: Drivers in the UAE engage in risky behaviours and they are highly distracted. Some behaviours that contribute to severe and even fatal injuries in RTCs include failing to wear a seatbelt and being distracted. Younger people were more likely distracted, while older drivers were more likely to have higher depression scores. Depression is suggested as a determinant factor in risky driving. These findings are informative to other countries of similar socioeconomic status to the UAE and to researchers in this field in general.
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Acidentes de Trânsito/estatística & dados numéricos , Condução de Veículo/estatística & dados numéricos , Assunção de Riscos , Cintos de Segurança/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Inquéritos e Questionários , Emirados Árabes Unidos , Adulto JovemRESUMO
BACKGROUND: The UN Decade of Action for Road Safety aimed to reduce road traffic deaths by half by year 2020. We aimed to study risk factors affecting global pedestrian death rates overtime, and whether the defined target of its reduction by WHO has been achieved. METHODS: The studied variables were retrieved from the WHO Global Status Reports on Road Safety published over 2010-2018. These covered years 2007-2016 and included the estimated road traffic death rates per 100,000 population, policies to promote walking and cycling, enforcement levels of national speed limits, the gross national income per capita and the vehicle/person ratio in each country. A mixed linear model was performed to define the factors affecting the change of pedestrian death rates overtime. RESULTS: Global pedestrian mortality decreased by 28% over 10 years. This was significant between years 2007 and 2010 (p = 0.034), between years 2013 and 2016 (p = 0.002) but not between 2010 and 2013 (p = 0.06). Factors that reduced pedestrian death rates included time (p < 0.0001), GNI (p < 0.0001), and vehicle/person ratio (p < 0.0001). There was a significant drop overtime in both the middle-income, and high-income countries (p < 0.0001, Friedman test), but not in the low-income countries (p = 0.35, Friedman test). CONCLUSIONS: Global pedestrian mortality has dropped by 28% over a recent decade, which is less than the 50% targeted reduction. This was mainly driven by improved GNI and using more vehicles. The economical gap between poor and rich countries has a major impact on pedestrian death rates.
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Prevenção de Acidentes/métodos , Acidentes de Trânsito/mortalidade , Saúde Global , Pedestres , Humanos , Fatores de Risco , Organização Mundial da SaúdeRESUMO
Three-dimensional scanning and documentation methods are becoming increasingly employed by law enforcement personnel for crime scene and accident scene recording. Three-dimensional documentation of the victim's body in such cases is also increasingly used as the field of forensic radiology and imaging is expanding rapidly. These scanning technologies enable a more complete and detailed documentation than standard autopsy. This was used to examine a fatal pedestrian-vehicle collision where the pedestrian was killed by a van while crossing the road. Two competing scenarios were considered for the vehicle speed calculation: the pedestrian being projected forward by the impact or the pedestrian being carried on the vehicle's bonnet. In order to assist with this, the impact area of the accident vehicle was scanned using laser surface scanning, the victim was scanned using postmortem CT and micro-CT and the data sets were combined to virtually match features of the vehicle to injuries on the victim. Micro-CT revealed additional injuries not previously detected, lending support to the pedestrian-carry theory.
Assuntos
Acidentes de Trânsito , Simulação por Computador , Fêmur/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Imageamento Tridimensional , Pedestres , Automóveis , Conjuntos de Dados como Assunto , Fêmur/lesões , Medicina Legal/métodos , Humanos , Tomografia Computadorizada por Raios X , Microtomografia por Raio-XRESUMO
INTRODUCTION: In addition to their high mortality rates, road traffic collisions (RTC) are considered a burden within those who do survive. In Africa, injuries related to RTC have been identified as the 10th most common cause of disability-adjusted life years lost for all ages and categories. Moreover, non-fatal RTC are the biggest cause associated with the burden of musculoskeletal disorders (MSD) in Africa. Despite this, the epidemiology of MSD related to non-fatal RTC within this region is still unknown.The objective of this review is to identify and summarise available data regarding the prevalence, incidence and patterns of MSD resulting from non-fatal RTC in Africa. METHODS AND ANALYSIS: A systematic review of observational epidemiological studies will be conducted. On October 2019, MEDLINE, Embase, CINAHL Plus, PsycINFO, Web of Science, Global Health and African Journals OnLine will be searched for literature that is in English and published between 1990 and 2018. Two reviewers (MY ad TG) will independently screen results and extract the data, with a third reviewer (FF) resolving any discrepancies through discussion. Additionally, two reviewers (MY and TG) will independently assess the quality of the eligible studies using the US National Institutes of Health National Heart, Lung, and Blood Institute Quality Assessment Tool.Within the eligible studies, data on citation, methods and results will be extracted. Extracted data will be analysed using a narrative synthesis. Findings will be presented in tables, with the main outcomes being prevalence, incidence and disease pattern of MSD and determinants of non-fatal RTC. The final systematic review will be conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. ETHICS AND DISSEMINATION: As individual patients will not be involved in this study, no ethical approval will be sought. Findings from this review will be disseminated through peer-reviewed journals and relevant conferences. TRIAL REGISTRATION NUMBER: CRD42019139538.
Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Doenças Musculoesqueléticas/epidemiologia , África/epidemiologia , Efeitos Psicossociais da Doença , Avaliação da Deficiência , Humanos , Incidência , Doenças Musculoesqueléticas/etiologia , Prevalência , Anos de Vida Ajustados por Qualidade de Vida , Projetos de Pesquisa , Revisões Sistemáticas como AssuntoRESUMO
Introduction: Musculoskeletal disorders (MSDs) are common following a road traffic collision (RTC) in England. Establishing the anatomical distribution of MSDs following RTC that present to physiotherapists may improve understanding and clinical practice. This study examined anatomical distribution of MSDs that present to physiotherapists within a litigant population following a RTC in England. Methods: A retrospective review of physiotherapy records was conducted at a private practice in North-East England. Data were collected from 2105 patients between January 2014 and December 2015. The primary outcome was anatomical regions with MSDs. Descriptive data is reported. Results: Overall, 90% of patients presented with a neck/upper back disorder, while 52% presented with a lower back disorder. Of the assessed patients, 46% presented with one MSD, 45% presented with two MSDs while 9% presented with ≥3 MSDs. Further analysis showed that those who presented to physiotherapy later and were not motor vehicle occupants (MVOs) were more likely to have upper-limb, lower-limb, or lumbar MSDs. Younger patients, who presented sooner and were non-MVO were more likely to have multiple regions affected by MSDs. Conclusions: This study presents epidemiological evidence that MSDs following a RTC occur primarily in the neck/upper back or lower back regions, and that multiple MSDs are common.