Unsafe Practices of Motorcycle Riders in El Petén, Guatemala: A Community Observational Study and a Retrospective Institutional Review.

INTRODUCTION: Outcomes from trauma at the major referral hospital [Hospital Nacional de San Benito (HNSB)] in El Petén, Guatemala, have not been analyzed. Empirical evidence demonstrated a high number of motorcycle accidents (MAs). We hypothesized a large incidence of head trauma with poor outcomes in MAs compared to all other forms of blunt trauma. METHODS: Our hypothesis was tested by performing a community observational study and a retrospective chart review in El Petén, Guatemala. An independent observer catalogued 100 motorcycle riders on the streets of El Petén for riding practices as well as helmet utilization. HNSB does not have electronic medical records. For this study, we performed a retrospective chart review of randomly selected nonconsecutive trauma admission at HNSB between March 2018 and June 2023. Blunt trauma was compared between MAs versus all others. Variables were examined by parametric and nonparametric tests as well as contingency table analyses. RESULTS: Most motorcycles riders involved multiple individuals (2.61 ± 0.79/motorcycle). Seventy riders included children (median = 1.0 [Q1-Q3 range = 1.0-3.0]/motorcycle). Overall, only three riders were wearing helmets. Forty-one were women. Of patients presenting to HNSB with trauma, 91 charts were reviewed (33.0 [20.0-37.0] y old; male 89%), 76.7% were blunt, and 23.3% were penetrating trauma. Within blunt trauma, 57.1% were MAs versus 42.9% all others; P = 0.13. MAs were younger (29.5 [20.0-37.0] versus 34.0 [21.8-45.8] y old; P < 0.05) and of similar gender (male 82.5% versus 96.6%; P = 0.1). More MAs had a computed tomography (70.0% versus 30.0%; P < 0.01) and they were more likely to present with head trauma (72.5% versus 46.7%; P = 0.04) but similar Glasgow Coma Scale (15.0 [13.5-15.0] versus 15.0 [12.5-15.0]; P = 0.7). MAs were less likely to require surgical intervention (37.5% versus 56.7%; P = 0.05) but had similar hospital length of stay (4.0 [2-6] versus 4.0 [2-10.5] d; P = 0.5). CONCLUSIONS: Unsafe motorcycle practices in El Petén are staggering. Most trauma at HNSB is blunt, and likely from MAs. More patients with MAs presented with head trauma. However, severe trauma might be transferred to higher level hospitals or mortality might occur on scene, which will need further investigations. Assessment of mortality from trauma admissions is ongoing. These findings should lead to enforcement of safe motorcycle practices in El Petén, Guatemala.

Cost-utility analysis of an alcohol policy in Thailand: a case study of a random breath testing intervention.

BACKGROUND: Road traffic injuries are a major concern worldwide, with Thailand facing high accident mortality rates. Drunk driving is a key factor that requires countermeasures. Random breath testing (RBT) and mass media campaigns recommended by the World Health Organisation intend to deter such behaviour. This study aimed to evaluate the cost-effectiveness of implementing RBT in combination with mass media campaigns in Thailand. METHODS: A Markov simulation model estimated the lifetime cost and health benefits of RBT with mass media campaigns compared to mass media campaigns only. Direct medical and non-medical care costs were evaluated from a societal perspective. The health outcomes were quality-adjusted life years (QALY). Costs and outcomes were discounted by 3% per year. Subgroup analyses were conducted for both sexes, different age groups, and different drinking levels. Probabilistic sensitivity analyses were conducted over 5,000 independent iterations using a predetermined distribution for each parameter. RESULTS: This study suggested that RBT with mass media campaigns compared with mass media campaigns increases the lifetime cost by 24,486 THB per male binge drinker and 10,475 THB per female binge drinker (1 USD = 35 THB) and results in a QALY gain of 0.43 years per male binge drinker and 0.10 years per female binge drinker. The intervention yielded incremental cost-effectiveness ratios (ICERs) of 57,391 and 103,850 THB per QALY for male and female drinkers, respectively. Moreover, the intervention was cost-effective for all age groups and drinking levels. The intervention yielded the lowest ICER among male-dependent drinkers. Sensitivity analyses showed that at a willingness-to-pay (WTP) threshold of 160,000 per QALY gained, the RBT combined with mass media campaigns had a 99% probability of being optimal for male drinkers, whereas the probability for females was 91%. CONCLUSIONS: RBT and mass media campaigns in Thailand are cost-effective for all ages and drinking levels in both sexes. The intervention yielded the lowest ICER among male-dependent drinkers. Given the current Thai WTP threshold, sensitivity analyses showed that the intervention was more cost-effective for males than females.

Identification of determinant factors for crash severity levels occurred in Addis Ababa City, Ethiopia, from 2017 to 2020: using ordinal logistic regression model approach.

BACKGROUND: Road traffic Injuries (RTI) are multifaceted occurrences determined by the combination of multiple factors. Also, severity levels of injuries from road traffic accidents are determined by the interaction of the composite factors. Even though most accidents are severe to fatal in developing countries, there is still a lack of extensive researches on crash severity levels and factors associated with these accidents. Hence, this study was intended to identify severity levels of road traffic injuries and determinant factors in Addis Ababa City, Ethiopia. METHODS: The study was conducted in Addis Ababa, the capital city of Ethiopia, using secondary data obtained from the Addis Ababa Police Commission office. The ordinal logistic regression model was used to investigate road traffic injury severity levels and factors worsening injury severity levels using the recorded dataset from October 2017 to July 2020. RESULTS: A total of 8458 car accidents were considered in the study, of which 15.1% were fatal, 46.7% severe, and 38.3% were slight injuries. The results of the ordinal logistic regression analysis estimation showed that being a commercial truck, college and above level educated driver, rollover crash, motorbike passengers, the crash day on Friday, and darkness were significantly associated factors with crash injury severity levels in the study area. On the contrary, driving experience (> 10 years), passenger of the vehicle, two-lane roads, and afternoon crashes were found to decrease the severity of road traffic injuries. CONCLUSIONS: Road traffic injury reduction measures should include strict law enforcement in order to maintain road traffic rules especially among commercial truckers, motorcyclists, and government vehicle drivers. Also, it is better to train drivers to be more alert and conscious in their travels, especially on turning and handling their vehicles while driving.

Spatial and temporal analysis of road traffic crashes and ambulance responses in Lagos state, Nigeria.

BACKGROUND: Sub-Saharan African countries, Nigeria inclusive, are constrained by grossly limited access to quality pre-hospital trauma care services (PTCS). Findings from pragmatic approaches that explore spatial and temporal trends of past road crashes can inform novel interventions. To improve access to PTCS and reduce burden of road traffic injuries we explored geospatial trends of past emergency responses to road traffic crashes (RTCs) by Lagos State Ambulance Service (LASAMBUS), assessed efficiency of responses, and outcomes of interventions by local government areas (LGAs) of crash. METHODS: Using descriptive cross-sectional design and REDcap we explored pre-hospital care data of 1220 crash victims documented on LASAMBUS intervention forms from December 2017 to May 2018. We analyzed trends in days and times of calls, demographics of victims, locations of crashes and causes of delayed emergency responses. Assisted with STATA 16 and ArcGIS pro we conducted descriptive statistics and mapping of crash metrics including spatial and temporal relationships between times of the day, seasons of year, and crash LGA population density versus RTCs incidence. Descriptive analysis and mapping were used to assess relationships between 'Causes of Delayed response' and respective crash LGAs, and between Response Times and crash LGAs. RESULTS: Incidences of RTCs were highest across peak commuting hours (07:00-12:59 and 13:00-18:59), rainy season and harmattan (foggy) months, and densely populated LGAs. Five urban LGAs accounted for over half of RTCs distributions: Eti-Osa (14.7%), Ikeja (14.4%), Kosofe (9.9%), Ikorodu (9.7%), and Alimosho (6.6%). On intervention forms with a Cause of Delay, Traffic Congestion (60%), and Poor Description (17.8%), had associations with LGA distribution. Two densely populated urban LGAs, Agege and Apapa were significantly associated with Traffic Congestion as a Cause of Delay. LASAMBUS was able to address crash in only 502 (36.8%) of the 1220 interventions. Other notable outcomes include: No Crash (false calls) (26.6%), and Crash Already Addressed (22.17%). CONCLUSIONS: Geospatial analysis of past road crashes in Lagos state offered key insights into spatial and temporal trends of RTCs across LGAs, and identified operational constraints of state-organized PTCS and factors associated with delayed emergency responses. Findings can inform programmatic interventions to improve trauma care outcomes.

Effect of Nighttime on Prehospital Care and Outcomes of Road Traffic Injuries in Asia: A Cross-Sectional Study of Data from the Pan-Asian Trauma Outcomes Study (PATOS).

Introduction: Emergency response to a road traffic injury (RTI) plays a crucial role in patient survival, and the quality of the emergency response should be consistent regardless of the time of day. The aim of this study was to investigate prehospital care and survival outcomes compared between emergency response to RTI during the day and emergency response to RTI at night in Asia.Method: This cross-sectional study used data from the Pan-Asian Trauma Outcome Study (PATOS) that was conducted during 2015-2018. We included RTI patients who were transported to the emergency department (ED) by ground ambulance. That group was then categorized according to the time that the ambulance arrived on-scene. On-scene arrival during 8:00 am to 7:59 pm was defined as the daytime group, and arrival during 8:00 pm to 7:59 am was defined as the nighttime group. Multiple logistic regression was employed to identify factors associated with nighttime prehospital interventions and survival outcomes after adjustment for age, alcohol consumption, and injury severity score (ISS).Results: The final analysis included 20,105 RTI patients. Of those, 12,043 (60%) accidents occurred during the daytime, and 8,062 (40%) occurred at night. RTI patients at night were younger (mean age: 35.7 ± 17.3 vs. 39.5 ± 20.7; p < 0.001), had more alcohol consumption (15.0% vs. 4.2%; p < 0.001), and had more severe injuries (mean ISS: 6.5 ± 7.5 vs. 5.8 ± 7.0; p < 0.001) compared to the daytime group. The nighttime group had increased prehospital immobilization (adjusted odds ratio [aOR]: 1.22, 95% confidence interval [CI]: 1.14-1.31) and more prehospital intravenous (IV) access (aOR 1.36, 95%CI: 1.22-1.51). There was no significant difference in either basic or advanced airway management between the daytime and nighttime groups. The nighttime group had decreased survival in the ED (aOR: 0.80, 95%CI: 0.65-0.98); however, nighttime on-scene arrival did not impact survival to discharge (aOR: 1.10, 95%CI: 0.91-1.33).Conclusion: In the PATOS community, RTI patients that sustained their injuries at night received significantly more prehospital immobilization and IV access, and they had significantly decreased survival in the ED. The results of this study can be used to develop and enhance strategies to improve the care and outcomes of nighttime RTI in Asia.

Demographics of road injuries and micromobility injuries among China, India, Japan, and the United States population: evidence from an age-period-cohort analysis.

BACKGROUND: Micromobility sharing platforms have involved skyrocketing numbers of users in multiple countries since 2010. However, few studies have examined the overall impact of the growing micromobility market on road injuries. METHOD: We use road injury data from the Global Burden of Disease Study database to examine the effect of age, period, and cohort on micromobility injury-related deaths and incidence. We compared four countries that vary in demographic background and road infrastructure. By comparing the countries, we analyzed the relationship between the trends in road injuries and these factors. RESULTS: We found an overall upward trend in micromobility injuries. A higher risk of micromobility-related injuries was witnessed in China and the US in 2015-2019, and people older than 45 showed a growing micromobility-related mortality and incidence rate in China, India, and the US. Cohorts after 1960 showed higher micromobility injury incidence risks in China and India, but the population born after 1990 in India showed a slightly lower risk compared to those before it. CONCLUSIONS: The boosted usage of micromobility devices explains these increasing trends. Road infrastructure and separated traffic ease the collisions from micromobility devices. The overall situation calls for improvement in legislation as well as road infrastructure.

Factors associated with the severity of road traffic injuries from emergency department based surveillance system in two Mexican cities.

BACKGROUND: Limited data from low- and middle-income countries (LMICs) on the severity of road traffic injuries (RTIs) and their relation to different variables of interest are routinely obtained. Knowledge on this subject relies on evidence from high-income countries, which might not be the same as in LMICs. This information is greatly needed to advance and inform local and regional efforts towards the United Nations' Decade of Action and the Sustainable Development Goals. METHODS: From May 2012 to November 2014, a RTI surveillance system was implemented in two referral hospitals in two Mexican cities, León and Guadalajara, with the objective of exploring the relationship between Injury Severity Score (ISS) and different sociodemographic characteristics of the injured as well as different variables related to the event and the environment. All individuals suffering RTIs who visited the Emergency Rooms (ER) were included after granting informed consent. A Zero-Truncated Negative Binomial Model was employed to explore the statistical association between ISS and variables of interest. RESULTS: 3024 individuals participated in the study: 2185 (72.3%) patients from León and 839 patients (27.7%) from Guadalajara. Being male, in the 20-59 age-group, having less schooling, events occurring in Guadalajara, on Sundays, at night, and arriving at ER via public/private ambulance were all associated with an increased log count of ISS. Found a significant interaction effect (p-value< 0.05) between type of road user and alcohol intake six hours before the accident on severity of the injury (ISS). The use of illicit drugs, cellphones and safety devices during the event showed no association to ISS. CONCLUSIONS: Our study contributes to the statistical analysis of ISS obtained through RTI hospital surveillance systems. Findings might facilitate the development and evaluation of focused interventions to reduce RTIs in vulnerable users, to enhance ER services and prehospital care, and to reduce drink driving.

Characteristics, reasons and patterns of Road Traffic Injuries presenting in emergency department of a tertiary care public hospital in Karachi.

Objectives: To determine the main characteristics, reasons and patterns of road traffic injuries (RTIs) in a tertiary care public hospital of Karachi. Methods: It was a hospital based cross sectional study conducted in a public tertiary care hospital emergency department with a sample size 425 selected conveniently. Participants included the consenting victims or caretaking attendants of road traffic injuries (RTIs) from 25th May to 28th June in 2019. A structured questionnaire was developed after literature review and was translated into "Urdu" language. The questionnaire collected detailed information on socio-demographic characteristics, possible reasons of RTI's such as condition of vehicle, over speeding and breaking traffic rules. Data was analyzed by using software SPSS version 20. Results: Almost half of RTI victims (43.1%) belonged to the age group 18-29. Majority of the victims were males (86.6%). The most common vehicle involved was motorbike (87.50%) followed by Rickshaw (6.8%) and Car (2.4%). Majority of RTIs occurred on main road (75.30%). The most common sites of injuries were lower limb (64%), upper limb (37.60%) and head (32.2%). The severe injuries were significantly more likely to happen in events in which direct collision with other vehicle/thing was involved, road conditions were wet and pedestrian were crossing the road. Conclusion: Motorbikes were involved in majority of RTIs. Main reasons of RTIs included irresponsible road behaviors including over-speeding, careless road crossing, breaking the signal and riding on wet roads which lead to moderate to severe injuries in almost two thirds of participants.

Policy implications for Road Safety: An Experience from Iran.

Proclaiming the second Decade of Action for Road Safety 2021-2030 with the ambitious target of preventing at least 50% of road traffic deaths and serious injuries by 2030, in continuation of the first UN call for the Decade of Action on Road Safety (2010-2020) encouraged countries to intensify national, regional and international collaboration, with a view to meeting the ambitious road safety-related targets. In this regard, Iran has implemented the national road safety strategy and action plan under the supervision of the road safety commission as the lead agency in which the MOHME is one of the members. Moreover, as the main burden of road traffic injuries is on the health sector, to ensure universal access to health care services in the pre-hospital, hospital, post-hospital, and rehabilitation centers for road traffic victims and families, the road traffic injuries sub-committee affiliated with the Iranian Non-Communicable Diseases Committee (INCDC), developed the National Service Framework for Road Traffic Injuries through a multi-sectoral mechanism. The aim of this paper is to share Iran's experience in terms of policy implications for RTI prevention and control. Sharing the lessons learned on the role of the health sector in meeting the ambitious road safety targets will help other countries to strengthen political commitment to road safety and move toward setting regional and global road traffic casualty reduction targets.

The level and trend of road traffic injuries attributable mortality rate in Iran, 1990-2015: a story of successful regulations and a roadmap to design future policies.

BACKGROUND: Road-Traffic-Injuries (RTIs) are predicted to rise up to the fifth leading cause of worldwide death by 2030 and Iran has the third highest RTIs mortality among higher-middle income countries. Although the high mortality of RTI in Iran is a warning, it provides the opportunity to indirectly assess the implemented RTI-related regulations' effectiveness via high-resolution relevant statistics and, hence, Iran could serve as a guide for countries with similar context. In order to do so, we utilized this study to report the time and spatial trends of RTIs-related mortality in different age and sex groups and road user classes in Iran. METHODS: Based on the national death-registration-system (DRS), cemeteries data, and the demographic characteristics, and after addressing incompleteness, we estimated mortality rates using spatiotemporal and Gaussian process regression models. We assessed Pearson seatbelt and helmet use and RTIs-attributable Age-Standardized-Morality-Rate (ASMR) associations. We also predicted RTIs-death-numbers, 2012-2020, by fitting a Generalized Additive Model to assess the status of achieving relevant sustainable development goal (SDG), namely reducing the number of RTIs-related deaths by half. RESULTS: Overall RTIs-attributable death and ASMR at the national level increased from 12.64 [95% UI, 9.52-16.86] to 29.1 [22.76-37.14] per 100,000 people in the time period of 1990-2015. The trend consisted of an increasing segment in 1990-2003 followed by a decreasing part till 2015. The highest percentage of death belonged to the three-or-more-wheels motorized vehicles. Pedestrian injuries percentage increased significantly and the highest mortality rate occurred in 85 years and older individuals. Low prevalence of seatbelt and helmet use were observed in provinces with higher than the median ASMR due to the relevant cause of each. RTIs-attributable death number is expected to reduce by 15.99% till 2020 which is lower than the established SDG goal. CONCLUSIONS: Despite the observed substantial moderation in the RTI-ASMR, Iran is till among the leading countries in terms of the highest mortality rates in the world. The enforced regulations including speed limitations (particularly for elder pedestrians) and mandatory use of seatbelt and helmet (for young adult and male drivers) had a considerable effect on ASMR, nevertheless, the RTI burden reduction needs to be sustained and enhanced.

Development of quality indicators to measure pre-hospital emergency medical services for road traffic injury.

BACKGROUND: Pre-Hospital Emergency Care (PEC) is a fundamental property of prevention of Road Traffic Injuries (RTIs). Thus, this sector requires a system for evaluation and performance improvement. This study aimed to develop quality indicators to measure PEC for RTIs. METHODS: Following the related literature review, 14 experts were interviewed through semi-structured interviews to identify Quality Measurement Indicators (QMIs). The extracted indicators were then categorized into three domains: structure, performance, and management. Finally, the identified QMIs were confirmed through two rounds of the Delphi technique. RESULTS: Using literature review 11 structural, 13 performance, and four managerial indicators (A total of 28 indicators) were identified. Also, four structural, four performance, and three managerial indicators (A total of 11indicators) were extracted from interviews with experts. Two indicators were excluded after two rounds of Delphi's technics. Finally, 14 structural, 16 performance and, seven managerial indicators (A total of 37indicators) were finalized. CONCLUSION: Due to the importance and high proportion of RTIs compared to other types of injuries, this study set out to design and evaluate the QMIs of PEC delivered for RTIs. The findings of this research contribute to measuring and planning aimed at improving the performance of PEC.

Effect of COVID-19 on epidemiological characteristics of road traffic injuries in Suzhou: a retrospective study.

BACKGROUND: To present the new trends in epidemiology of road traffic injuries (RTIs) during the Coronavirus disease 2019 (COVID-19) pandemic in Suzhou. METHODS: Pre-hospital records of RTIs from January to May in 2020 and the same period in 2019 were obtained from the database of Suzhou pre-hospital emergency center, Jiangsu, China. Data were extracted for analysis, including demographic characteristics, pre-hospital vital signs, transport, shock index, consciousness, pre-hospital death. A retrospective study comparing epidemiological characteristics of RTIs in Suzhou during the 5-month period in 2020 to the parallel period in 2019 was performed. RESULTS: A total of 7288 RTIs in 2020 and 8869 in 2019 met inclusion criteria. The overall volume of RTIs has statistical difference between the 2 years (p < 0.001), with fewer RTIs in 2020 compared with 2019. Electric bicycle related RTIs increased during the pandemic (2641, 36.24% vs 2380, 26.84%, p < 0.001), with a higher incidence of RTIs with disorder of consciousness (DOC) (7.22% vs 6.13%, p = 0.006). CONCLUSIONS: Under the impact of COVID-19, the total number of RTIs in Suzhou from January to May 2020 decreased. This observation was coupled with a rise in electric bicycle related injuries and an increase in the incidence of RTIs with DOC.

Survival after traumatic out-of-hospital cardiac arrest in Vietnam: a multicenter prospective cohort study.

BACKGROUND: Pre-hospital services are not well developed in Vietnam, especially the lack of a trauma system of care. Thus, the prognosis of traumatic out-of-hospital cardiac arrest (OHCA) might differ from that of other countries. Although the outcome in cardiac arrest following trauma is dismal, pre-hospital resuscitation efforts are not futile and seem worthwhile. Understanding the country-specific causes, risk, and prognosis of traumatic OHCA is important to reduce mortality in Vietnam. Therefore, this study aimed to investigate the survival rate from traumatic OHCA and to measure the critical components of the chain of survival following a traumatic OHCA in the country. METHODS: We performed a multicenter prospective observational study of patients (> 16 years) presenting with traumatic OHCA to three central hospitals throughout Vietnam from February 2014 to December 2018. We collected data on characteristics, management, and outcomes of patients, and compared these data between patients who died before hospital discharge and patients who survived to discharge from the hospital. RESULTS: Of 111 eligible patients with traumatic OHCA, 92 (82.9%) were male and the mean age was 39.27 years (standard deviation: 16.38). Only 5.4% (6/111) survived to discharge from the hospital. Most cardiac arrests (62.2%; 69/111) occurred on the street or highway, 31.2% (29/93) were witnessed by bystanders, and 33.7% (32/95) were given cardiopulmonary resuscitation (CPR) by a bystander. Only 29 of 111 patients (26.1%) were taken by the emergency medical services (EMS), 27 of 30 patients (90%) received pre-hospital advanced airway management, and 29 of 53 patients (54.7%) were given resuscitation attempts by EMS or private ambulance. No significant difference between patients who died before hospital discharge and patients who survived to discharge from the hospital was found for bystander CPR (33.7%, 30/89 and 33.3%, 2/6, P > 0.999; respectively) and resuscitation attempts (56.3%, 27/48, and 40.0%, 2/5, P = 0.649; respectively). CONCLUSION: In this study, patients with traumatic OHCA presented to the ED with a low rate of EMS utilization and low survival rates. The poor outcomes emphasize the need for increasing bystander first-aid, developing an organized trauma system of care, and developing a standard emergency first-aid program for both healthcare personnel and the community.

Pattern of road traffic injuries in the Rethymnon region, Crete, Greece: a secondary hospital-based study.

INTRODUCTION: Despite the significant progress that has been made during the last decade, Greece still faces the effects of road traffic accidents (RTAs) to a great extent every year. This study represents an epidemiological approach to road traffic injuries (RTIs) presenting to a secondary hospital in a geographical area with very low-quality road network; it aims to indicate possible preventive measures and actions. METHODS: The present study was conducted in Rethymnon General Hospital between January 2018 and February 2020. Data from all trauma patients who presented to the emergency department (ED) after RTAs were retrospectively collected from patient medical records. The severity of injury sustained by road traffic victims was graded using the Injury Severity Score (ISS). RESULTS: During the study period, 1582 trauma patients presented to the ED after RTAs. There were 1079 men and 503 women and the median age was 30 years. In total, 818 motorcycle-related injuries (51.7%), 497 automobile-related injuries (31.4%), 165 bicycle-related injuries (10.4%) and 102 pedestrian injuries (6.4%) were documented. Of the 1582 trauma patients, 58.2% (921) presented with injuries to the extremities, 35.3% (554) presented with thoracic injuries, 34.4% (541) presented with head injuries, 30% (475) presented with spinal column injuries, 17.4% (271) presented with facial injuries, 12.9% (203) presented with abdominal injuries and 10.3% (162) presented with pelvic injuries. A significant increase in the number of incidents was noticed during the tourist season. Median ISS was 2 (IQR=4). 53.7% of patients who were transferred to the hospital by ambulance had an ISS≤4. In 41 cases, transportation to a tertiary hospital was necessary, six patients had emergency operations and 13 others died in the ED. The median length of hospital stay was 3 (IQR=6) days. CONCLUSION: Actions that could possibly mitigate the burden of RTIs in the district of Rethymnon include upgrading the level of law enforcement, implementing educational strategies and information campaigns against inappropriate ambulance use, encouraging facilities to develop trauma registries and ensuring adequate hospital staffing.

Trauma Care in India: Capacity Assessment Survey From Five Centers.

BACKGROUND: India is in the process of strengthening the trauma care system, and assessment of the current situation using standard guidelines has immense use. This study reports the status of trauma care facilities in India, with a broad framework of guidelines for essential trauma care by the World Health Organization. MATERIALS AND METHODS: This study is part of a multicentric intervention study to standardize structured trauma care services in five Indian cities. Thirty trauma care facilities (five level I, 10 level II, and 15 level III facilities) were included. Data on the availability of equipment and manpower were collected. Availability of knowledge + skills and equipment + supplies was assessed based on the guidelines for essential trauma care by World Health Organization. RESULTS: There is almost 100% availability of services and equipment in level I hospitals, but availability varied between 50% and 100% at level II facilities. Very fewer number of services are available at level III facilities. Inadequacy of equipment is reported in level II and III facilities. Only level I facilities have required human resources. Availability of resources in terms of knowledge and equipment of different skills indicated that overall optimal level is observed in level I hospitals. Level II facilities are more deficient in nursing and paramedic staff, and level III facilities reported deficiencies in all categories. CONCLUSIONS: A significant imbalance between recommended resources and the resources that are available in the trauma care facilities was noted. Hence, the study warrants urgent strengthening of trauma care facilities, particularly of level II and III facilities.

Multiple-scale spatial analysis of paediatric, pedestrian road traffic injuries in a major city in North-Eastern Iran 2015-2019.

BACKGROUND: Paediatric, pedestrian road traffic injuries (PPRTIs) constitute a major cause of premature death in Iran. Identification of high-risk areas would be the primary step in designing policy intervention for PPRTI reduction because environmental factors play a significant role in these events. The present study aims to determine high-risk areas for PPRTIs at three different geographical scales, including the grid network, the urban neighbourhood and the street levels in Mashhad, Iran during the period 2015-2019. METHODS: This cross-sectional retrospective study was based on all pedestrian accidents with motor vehicles involving children (less than 18 years of age) between March 2015 and March 2019 in the city of Mashhad, which is the second-most populous city in Iran. The Anselin Local Moran's I statistic and Getis-Ord Gi* were performed to measure spatial autocorrelation and hotspots of PPRTIs at the geographical grid network and neighbourhood level. Furthermore, a spatial buffer analysis was used to classify the streets according to their PPRTI rate. RESULTS: A total of 7390 PPRTIs (2364 females and 4974 males) were noted during the study period. The children's mean age was 9.7 ± 5.1 years. Out of the total PPRTIs, 43% occurred on or at the sides of the streets, 25 of which labelled high-risk streets. A high-high cluster of PPRTI was discovered in the eastern part of the city, while there was a low-low such cluster in the West. Additionally, in the western part of the city, older children were more likely to become injured, while in the north-eastern and south-eastern parts, younger children were more often the victims. CONCLUSIONS: Spatial analysis of PPRTIs in an urban area was carried out at three different geographical scales: the grid network, the neighbourhood and the street level. The resulting documentation contributes reliable support for the implementation and prioritization of preventive strategies, such as improvement of the high-risk streets and neighbourhoods of the city that should lead to decreasing numbers of PPRTIs.

Potential for establishing an injury surveillance system in India: a review of data sources and reporting systems.

BACKGROUND: Unintentional injuries account for 10% of deaths worldwide; the majority due to road traffic injuries, falls, drowning, poisoning and burns. Effective surveillance systems provide evidence for informed injury prevention and treatment and improve recovery outcomes. Our objectives were to review existing sources of unintentional injury data, and quality of the data on the burden, distribution, risk factors and trends of unintentional injuries in India and to describe strengths and limitations of health facility-based data for potential use in injury surveillance systems. METHODS: We searched national and international organisations' websites to identify unintentional injury-related mortality and morbidity data sources in India. We reviewed and evaluated data collection methods for surveillance attributes recommended by World Health Organization (WHO). We visited health facilities at all levels from public and private sectors, emergency transport centres, insurance offices and police stations in settings reporting significant number of injuries. In these sites, we interviewed key stakeholders using an explorative approach on current data collection processes and challenges to establishing an injury surveillance system based on WHO guidelines. RESULTS: Major gaps were highlighted in injury mortality and morbidity data in India, including ill-defined causes of injury deaths and lack of standardisation in classification and coding. Site visits revealed that reporting standards of injuries varied, with issues around clarity of definitions, accountability, time points and lack of reporter/coder training. Major challenges were lack of dedicated staff and training. CONCLUSIONS: There is an important need to build human resource capacity, integrate data sources, standardise and streamline data collected, ensure accountability and capitalise on digital health information systems including insurance databases.

Determinants of road traffic injuries in Iranian children; results from a National Representative Demographic- Health Survey 2010.

BACKGROUND: Road Traffic Injuries (RTIs) are a leading cause of disabilities and mortalities in Iran. The occurrence of RTIs among children is increasing. This study aims are to assess RTIs among Iranian children and to determine the main socio-economics determinants. METHODS: The National Institute of Health Research (NIHR) in collaboration with the Iran Ministry of Health (MoH) conducted a nationwide survey: The Multiple Indicator Demographic and Health Survey 2010 (IrMIDHS 2010). The Survey was undertaken by Medical Universities in Iran. Based on multistage clustered randomized sampling, 30,960 households were included in the survey. We performed a multivariate logistic regression to determine the main socio-economic factors associated with RTIs among children. RESULTS: Approximately 0.9% of the children received RTIs in 2010. Main socio-economics contributors to RTIs involving Iranian children included household size (Adjusted OR: 1.06 (CI 95% 1.01, 1.14), sex (Adjusted ORfemale: 0.38 (CI 95% 0.29, 0.50), living with both parents (Adjusted OR: 0.55 (CI 95% 0.13, 0.95), being in the 2nd (Adjusted OR: 0.81 (CI 95%: 0.60, 0.90) or 4th income quartile (Adjusted OR: 0.13 (CI 95%: 0.02, 0.92) rather than the 1st income quartile, being aged five to nine (Adjusted OR: 1.39 (CI 95%: 1.10, 2.10), or aged 15 to 18 (Adjusted OR: 2.94 (CI 95%: 2.07, 4.97), and residency in a non- owned or non-tenancy house (Adjusted OR: 0.42 (CI 95%: 0.23 0.74). CONCLUSIONS: Children need safe places for playing and doing their daily activities. Policy and regulation development aimed at protecting children from road traffic injuries needs to take into consideration the socio-economic factors associated with risk of road traffic injury among children.

Ethnic variations in falls and road traffic injuries resulting in hospitalisation or death in Scotland: the Scottish Health and Ethnicity Linkage Study.

OBJECTIVES: To investigate ethnic differences in falls and road traffic injuries (RTIs) in Scotland. STUDY DESIGN: A retrospective cohort of 4.62 million people, linking the Scottish Census 2001, with self-reported ethnicity, to hospitalisation and death records for 2001-2013. METHODS: We selected cases with International Classification of Diseases-10 diagnostic codes for falls and RTIs. Using Poisson regression, age-adjusted risk ratios (RRs, multiplied by 100 as percentages) and 95% confidence intervals (CIs) were calculated by sex for 10 ethnic groups with the White Scottish as reference. We further adjusted for country of birth and socio-economic status (SES). RESULTS: During about 49 million person-years, there were 275,995 hospitalisations or deaths from fall-related injuries and 43,875 from RTIs. Compared with the White Scottish, RRs for falls were higher in most White and Mixed groups, e.g., White Irish males (RR: 131; 95% CI: 122-140) and Mixed females (126; 112-143), but lower in Pakistani males (72; 64-81) and females (72; 63-82) and African females (79; 63-99). For RTIs, RRs were higher in other White British males (161; 147-176) and females (156; 138-176) and other White males (119; 104-137) and females (143; 121-169) and lower in Pakistani females (74; 57-98). The ethnic variations differed by road user type, with few cases among non-White motorcyclists and non-White female cyclists. The RRs were minimally altered by adjustment for country of birth or SES. CONCLUSION: We found important ethnic variations in injuries owing to falls and RTIs, with generally lower risks in non-White groups. Culturally related differences in behaviour offer the most plausible explanation, including variations in alcohol use. The findings do not point to the need for new interventions in Scotland at present. However, as the ethnic mix of each country is unique, other countries could benefit from similar data linkage-based research.

Epidemiologic study of traffic crash mortality among motorcycle users in Iran (2011-2017).

PURPOSE: Motorcycle accident is a major cause of road traffic injuries and the motorcyclists are considered as vulnerable road users. The present study aimed to determine the epidemiological characteristics of fatal motorcycle crashes in Iran. METHODS: In this cross-sectional study, a total of 28,356 motorcycle traffic fatalities registered in the Legal Medicine Organization of Iran were analyzed during the period between March 2011 and March 2017. The examined variables included demographic characteristics, helmet use, crash mechanisms, crash location, position state, type of counterpart vehicle, cause of death and place of death. In the study, road traffic mortalities involving drivers and/or passenger of motorcycles were included. Cases or events registered without these conditions were excluded from the study. To analyse the data, SPSS statistics 25 and GraphPad Prism 8 softwares were used. RESULTS: Of the 122,682 fatal traffic injury cases, 28,356 (23.1%) were motorcycle users, of whom 95.3% were male and 4.7% were female. Most of the motorcycle fatalities belonged to the age group of 18-24 years (29.1%). Head trauma was the major cause of death (59.0%). Also, the overall proportion of safety helmet use among motorcycle crash victims was estimated at 37.4%. Most of the road traffic crash cases (46.8%) happened out of city and half of people (49.9%) died in hospital. About 77.4% of the victims were motorcycle riders and 21.1% were pillion passengers. The highest rate of mortality belonged to the self-employed (38.4%) and then workers (21.8%) and students (10.2%). In addition, most fatalities occurred in people with low education (77.5%) and the least occurred in university graduates (5.5%). Among 31 provinces of Iran, Fars had the highest (9.3%) occurrence rate and Kohgiluyeh and Buyer-Ahmad had the lowest (0.5%). Most of the crash mechanisms were due to motorcycle-vehicle crashes (80.2%), followed by rollover (9.8%). CONCLUSION: Comprehensive public education and special rules are needed to reduce the rate of deaths in motorcycle crashes.