Outcome and Management of Occipitofrontal Contrecoup Head Injury.

Contrecoup brain injury refers to the classical opposite of the primary impact. Tamil Nadu has the highest rate of road traffic accident in India. Madurai has peak mortality due to accidents in India. Previous studies done on contrecoup head injury had shown patterns of injuries and mechanism of injury. Outcome and management of only occipitofrontal contrecoup head injury has been taken in this study. Mortality in this specific group is very high. Seventy-six patients of this specific head injury were admitted at Government Rajaji Hospital, Madurai. Patients were assessed for Glasgow coma scale (GCS), age, sex, progression of volume, mortality, traumatic brain injury-induced coagulopathy, and pillion rider outcome. Fourteen patients were surgically treated by decompressive craniectomy. Conservative management was done by antiepileptic and antiedema measures. Mostly affected were males ( n = 54) followed by females ( n = 22). GCS on admission mean value 9. In our study, mortality was 32% with sudden death of three patients due to hypothalamic compression. Hospital stay of the patient was significantly increased with progression of lesion with mean 9 days and p -value less than 0.01. Pillion riders ( n = 18) were also affected in our study. Traumatic brain injury-induced coagulopathy ( n = 12) was also detected, which was treated by injection tranexamic acid and injection vitamin K, thereby not leading to any death due to coagulopathy with significant p -value less than 0.01. We recommend helmet for both main and pillion rider with strict speeding regulations.

Perceptions, barriers, and strategies regarding helmet use by female pillion riders in Pakistan: A qualitative study.

INTRODUCTION: Despite the existence of a national motorcycle helmet law that applies to both riders and pillion riders, the use of helmets among female pillion riders is low in Pakistan. This study aimed to explore perceptions, barriers, and strategies related to helmet use by female pillion riders. METHODS: Data was collected from nine focus group discussions held with female pillion riders and male riders working at the Aga Khan University. Focus group discussions were transcribed verbatim and checked for accuracy before being imported into NVivo2. Transcriptions were analyzed using a thematic analysis approach. RESULTS: Four overarching themes emerged, including: (1) motorcycle as mode of transportation, (2) law on helmet use and its enforcement, (3) barriers to helmet use among female pillion riders, and (4) strategies to improve helmet use among female pillion riders. Female participants never wore a helmet or considered wearing it even though "safety" was the most important benefit of helmet usage expressed. The motorcycle is an economical mode of transportation for families, particularly those in the middle and lower socioeconomic groups. Helmet laws are not strictly enforced for pillion riders, including females. Possible barriers to helmet use among female pillion riders included discomfort in wearing a helmet, uninvited attention from others, concerns about physical appearance, and substandard quality and design of helmets. Suggested strategies for implementing helmet use among female pillion riders encompassed awareness generation through media, complementary distribution of helmets, strict law enforcement in the form of fines, and the influence of religious leaders regarding social norms and cultural barriers. CONCLUSION: Motorcycles are a risky mode of transport, and there are several social and cultural barriers regarding helmet use by female pillion riders. Enforcing helmet laws for female pillion riders, raising awareness about helmet laws, and making helmet use among pillion riders a norm are some essential steps to take to promote helmet use among female pillion riders in Pakistan.

Knowledge, attitude, and practice toward road safety regulations among college students in Telangana state.

BACKGROUND: Road traffic continues to be a major developmental issue and a public health concern. Road accidents in India kill almost 1.5 lakh people annually, and India accounts for almost 11% of the accident-related deaths in the world. Prevention of road traffic accidents is very crucial by creating awareness and taking proper measures toward road safety. AIMS: The aims of this study were to assess the knowledge about road safety regulations and to assess the attitude and practices regarding road safety regulations. SETTINGS AND DESIGN: This cross-sectional study was conducted in a pharmacy college. SUBJECTS AND METHODS: Study participants were all 4 academic years' pharmacy students who know driving two- or four-wheeler motor vehicle. Data were collected from a sample of 132 by predesigned pretested semi-structured questionnaire. STATISTICAL ANALYSIS USED: Data were presented in proportions with confidence interval using SPSS ver. 22. RESULTS: 81.1% of the participants knew the minimum age to obtain driving license. Only 16% follow the road signs strictly and 76% wear helmet for long-distance ride. Poor attitude was observed for wearing helmet for short-distance ride, pillion rider wearing helmet, and drink and drive. CONCLUSIONS: Majority of the participants were aware of road safety regulations. In spite of having positive attitude toward road safety measures by participants, they could not translate attitude into practice.

Survival following accidental scarf strangulation.

Injury or death by strangulation, unless otherwise explained, is almost always homicidal. Accidental strangulation may occur but only very rarely. We present such a case of accidental strangulation and survival in a motorbike pillion rider. A long scarf (dupatta) clad woman, sitting at the back of a two wheeler motorbike, fell after her long scarf got caught in the back wheel. The lady was first taken to a local clinic and then later was referred to a hospital for a suspected spine injury where she made an uneventful recovery. This case report exposes the precarious position of women pillion riders wearing a long scarf and emphasizes the need for extra caution and the need for wheel guards on spoked wheels in particular.

A cross-sectional observational study of helmet use among motorcyclists in Wa, Ghana.

Motorcyclists' injuries and fatalities are a major public health concern in many developing countries including Ghana. This study therefore aimed to investigate the prevalence of helmet use among motorcyclists in Wa, Ghana. The method used involved a cross-sectional roadside observation at 12 randomly selected sites within and outside the CBD of Wa. A total of 14,467 motorcyclists made up of 11,360 riders and 3107 pillion riders were observed during the study period. Most observed riders (86.5%) and pillion riders (61.7%) were males. The overall prevalence of helmet use among the observed motorcyclists was 36.9% (95% CI: 36.1-37.7). Helmet use for riders was 45.8% (95% CI: 44.8-46.7) whilst that for pillion riders was 3.7% (95 CI: 3.0-4.4). Based on logistic regression analysis, higher helmet wearing rates were found to be significantly associated with female gender, weekdays, morning periods and at locations within the CBD. Riders at locations outside the CBD were about 7 times less likely to wear a helmet than riders within the CBD (48.9% compared to 42.3%; χ(2)(1)=49.526; p<0.001). The study concluded that despite the existence of a national helmet legislation that mandates the use of helmets by both riders and pillion riders on all roads in Ghana, helmet use is generally low in Wa. This suggests that all stakeholders in road safety should jointly intensify education on helmet use and pursue rigorous enforcement on all road types especially at locations outside the CBD to improve helmet use in Wa.

Comparison of severity and pattern of injuries between motorcycle riders and their pillions: a matched study.

INTRODUCTION: Motorcyclists and their pillion riders are the most vulnerable group of road users in Singapore, accounting for 50% of all road traffic accident fatalities in 2011. This study aims to compare the severity and pattern of injuries between matched pairs of riders and pillions. METHODS: Thirty-two matched pairs who presented to the A&E of an urban hospital from 1 August 2011 to 20 March 2012 were enrolled. Data were obtained from the hospital's trauma registry records, clinical records and accident victims were interviewed individually. Analysis was done using Stata 10 and considered rider-pillion pairs. RESULTS: Thirty-one pairs agreed to participate. There was no statistically significant difference in the ISS between riders and pillions (p=0.25). There was no significant difference in the probability of survival, Revised Trauma Score, distribution of injuries, total duration of admission and ICU stay between riders and pillions. When one party of the matched pair sustained a head, face, thoracic, abdominal/pelvic, extremity or external injury, the likelihood that the other party had an injury in the same region was 31%, 14%, 10%, 14%, 56% and 68% respectively. Cohen's kappa values were 0.28, 0.15, 0.05, 0.17, 0.24 and -0.16 for the respective regions. DISCUSSION: By comparing the severity and pattern of injuries between naturally matched pairs on the same motorcycle, one can account for potential confounding by the type and impact of collision, rider experience, amount of time to availability of medical aid, and other factors that may influence the outcome. Our study shows no statistically significant difference in the ISS and distribution of injuries between riders and pillions of matched pairs. Therefore, future health and insurance policies should provide equal coverage for both riders and pillions. Medical practitioners should approach riders and pillions similarly as there is no significant difference in their injury distribution. When one party of a matched pair presents with a head, extremity or external injury, care should be taken to look for an injury in the same region in the other party. CONCLUSION: Our study shows that there is no statistically significant difference in the ISS of riders and pillions. The pattern of injury is also similar. This study provides us useful information in the clinical management of motorcyclists and their pillions.