Epidemiologic study of traffic crash mortality among motorcycle users in Iran(2011e2017)

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 selfemployed (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.     

Epidemiological characteristics of fatal pedestrian accidents in Fars Province of Iran: a community-based survey

Objective: To determine the epidemiological characteristics of fatal pedestrian accidents in Fars Province of Iran.Methods: This cross-sectional study was conducted in Fars Province of Iran during a 29-month period from March 2009 to July 2011.The data were from the Fars Forensic Medicine Registry.In 4 923 recorded road traffic accident fatalities,971 deaths were due to pedestrian accidents.The demographic and accident-related information were analyzed by SPSS version 11.5.P value less than 0.05 was considered significant.Results: The mean age of decedents was (47.2±26.2)years,ranging from 6 months to 103 years old.Males accounted for 69.8％ of all deaths.Fatal accidents were most common in September; 56.1％ of the fatal injuries occurred on intracity roads and 33.1％ on extracity roads.Fatal head injuries were present in 60.54％ of cases.Evaluation of the injury site and the cause of death found that they were significantly associated with age,interval between injury and death.Besides,the type of roads played an important role in mortality.Conclusion: Although the clinical management of trauma patients has been improved in our country in the recent decade,decreasing the burden of injuries needs coordination among trauma system organizations.     

Moped and motorcycle accidents--similarities and discrepancies

Injury patterns and epidemiologic data from 211 moped accident victims and 214 motorcycle accident casualties admitted to hospital over a 5-year period (1977-1981) have been analyzed and compared. The number of those injured in motorcycle accidents tripled; the number of moped accident victims slightly decreased in the period studied. Differences in injury pattern, sex ratio, cause of accident, and age distribution were noted. Among mopedists, head injuries were more common but these injuries decreased significantly after the adoption of helmet use laws for mopedists also in 1978. There were more females involved in moped accidents and the mean age was considerably higher among mopedists. Of those injured in moped accidents, 21% were 60 years old or older and accounted for 56% of fatalities in this group. The most frequent cause of moped accidents was collision with a car, and over turning or running off the road in motorcycle accidents. The difference in injury severity was unexpectedly small, although there was a tendency toward more severe injuries in motorcyclists. Moped accidents are so similar to motorcycle accidents that it seems unjustified to regard mopeds as harmless 'bicycles with a helper motor.' The need for formal registration, driving license, and helmet use laws for mopeds is apparent.     

北京市道路交通事故伤特点分析

目的：分析具有北方地区特点的北京市道路交通伤的特点，为相应地区道路交通伤的防治提供参考。方法：资料源于地处北京市中等交通繁华地区的首都军队急救中心，调查其道路交通伤的发生率、伤员性别特点、年龄分布、职业、事故发生时间、交通方式、创伤严重度计分和死亡情况.结果：本组交通伤多发生于7、8月份，发生于2月者较少。男性机动车(包括摩托车)伤员的构成比明显大于女性，女性非机动车伤员的构成比明显大于男性。伤员年龄愈趋于两极(年龄愈大或愈小)，其行人交通事故致伤方式所占比例愈高.伤后早期(7d以内)主要死亡原因是脑疝、原发性脑干损伤和休克，伤后晚期(7d以后)主要死亡原因是感染和多脏器功能障碍综合征。结论：在不同地区或不同人群中，道路交通伤的发生具有不同的特点，应该采取不同的防治措施.     

Time analysis of fatal traffic accidents in Fars Province of Iran

Objective:To analyze the time factor in road traffic accidents (RTAs) in Fars Province of Iran.Methods:This study was conducted in Fars Province,Iran from November 22,2009 to November 21,2011.Victims'i...     

Ascending aorta disruption after thoracic blunt trauma

Blunt traumatic aortic injury is the second leading cause of death after motor vehicle accidents. The most frequent localisation of aortic lesion is the isthmus, especially in those who survived the accident. Here we report a case of blunt traumatic aortic injury with unusual localisation and modality. A 31 years old man sustained a motorcycle accident, being run over by a car. Computed tomography scan showed an atypical ascending aorta lesion, confirmed by intraoperative finding. The patient underwent emergency ascending aorta replacement with Dacron tubular graft. The patient was discharged uneventfully on 35th postoperative day, after multiple maxillofacial surgeries for concomitant injuries.     

Autopsy assessment of liver lacerations. A study of 62 cases

The results of 127 consecutive autopsies on victims of motor vehicle, train and tractor accidents were analysed to determine the incidence, extent and severity of liver injury as well as to formulate a method of grading such injuries relevant to forensic autopsy practice. All liver lacerations noted were assigned an injury-assessment index. The features which emerge from the study are as follows: (i) almost 50% of the the victims had liver lacerations; (ii) in almost 75% of these, multiple lacerations were present; and (iii) in over 33% of those with liver lacerations severe liver injury in the form of lobal transection was present. The implementation of injury-assessment indices as a matter of routine in the grading of traumatic lesions at autopsy is suggested.     

广州市五所医院臂丛神经损伤流行病学回顾性研究

目的通过对广州市五所医院臂丛神经损伤患者的流行病学调查，了解臂丛损伤的构成及其发病学特点。方法回顾性调查广州市五所医院近十年收治的452例臂丛损伤的病例。根据性别、年龄、损伤部位等，分析该群体的流行病学特征。结果20～39岁年龄组占64．6％，男女性别比为6：1。工人、农民工占62．4％，无业人员占11．7％。摩托车伤占45．1％，机动车辆伤占20．4％。损伤类型：全臂丛损伤占33．6％，上中干损伤占17．3％，上干损伤占12．6％。臂丛损伤合并多发伤的占74．6％，其中头部外伤占多发伤的57．0％。结论臂丛损伤主要发生在青壮年男性，摩托车和机动车辆伤是臂丛损伤的主要原因；加强臂丛交通伤的预防医学，有助于减少臂丛损伤的发生率。     

Two-year mortality in 760 patients transported by helicopter direct from the road accident scene.

Of 760 direct admissions to a specialized trauma center, 173 (22.7%) victims of motor vehicle accidents died. Excluding patients dead on arrival, the mortality rate was 14.5%. Autopsy reports were reviewed and showed that the major cause of death was head injury (49.7%). Uncontrollable hemorrhage from massive trauma was the next most common problem and usually proved fatal in the first 24 hours after admission. The incidence of sepsis and renal failure increased with prolongation of CCRU stay. Following admission, respiratory failure was not a common cause of death (3%). Because of direct helicopter rather than ambulance transport from the scene of the motor vehicle accident, earlier attention was paid to diagnosis of trauma and treatment of respiratory insufficiency with mechanical ventilation. Because of the early initiation of therapy, there was rapid restoration of circulating volume and tissue perfusion. This may account for the low mortality.     

Analysis of Shahid Rajaee hospital administrative data on injuries resulting from car accidents in Shiraz, Iran: 2011e2014 data

Purpose: The administrative data from trauma centers could serve as potential sources of invaluable information while studying epidemiologic features of car accidents. In this cross-sectional analysis of Shahid Rajaee hospital administrative data, we aimed to evaluate patients injured in car accidents in terms of age, gender, injury severity, injured body regions and hospitalization outcome in the recent four years (2011-2014). Methods: The hospital registry was accessed at Shiraz Trauma Research Center (Shiraz, Iran) and the admission''s unit data were merged with the information gathered upon discharge. A total number of 27,222 car accident patients aged over 15 years with International Classification of Diseases 10th revision (ICD-10) external causes of injury codes (V40.9-V49.9) were analyzed. Injury severity score and injured body regions were determined based on converting ICD-10 injury codes to Abbreviated Injury Scale (AIS-98) severity codes using a domestically developed electronic algorithm. A binary logistic regression model was applied to the data to examine the contribution of all independent variables to in-hospital mortality. Results: Men accounted for 68.9% of the injuries and the male to female ratio was 2.2:1. The age of the studied population was (34 ± 15) years, with more than 77.2% of the population located in the 15e45 years old age group. Head and neck was the most commonly injured body region (39.0%) followed by extremities (27.2%). Injury severity score (ISS) was calculated for 13,152 (48.3%) patients, of whom, 80.9% had severity scores less than 9. There were 332 patients (1.2%) admitted to the intensive care units and 422 in-hospital fatalities (1.5%) were recorded during the study period. Age above 65 years [OR=7.4, 95% CI (5.0-10.9)], ISS above 16 [OR=9.1, 95% CI (5.5-14.9)], sustaining a thoracic injury [OR=7.4, 95% CI (4.6-11.9)] and head injury [OR=4.9, 95% CI (3.1-7.6)] were the most important independent predictors of death following car accidents. Conclusion: Hospital administrative databases of this hospital could be used as reliable sources of information in providing epidemiologic reports of car accidents in terms of severity and outcomes. Improving the quality of recordings at hospital databases is an important initial step towards more comprehensive injury surveillance in Fars, Iran.     

Cervical fractures in autopsy records]

We reviewed the autopsy records of 1872 cases of death because of politrauma, gunshot wounds and suicidal hanging. The analysis included causes and frequency of cervical spine fractures, their most common localisation, architecture of bone destruction and their influence on cervical cord. The most common cause of cervical spine injury was motor vehicle accidents. We examined 82 specimens with traumatic fractures of cervical spine obtained from accident victims. About half of the injuries occurred in upper cervical spine. The most common fracture localisation was C2 with dens fracture as the most frequent injury. The most common spinal cord lesion was complete rupture mainly at the upper cervical spine level.     

Fracture of the sternum in motor vehicle accidents and its association with mediastinal injury

Sternal fractures occurred in 78 out of 2097 consecutive victims of road traffic accidents who required to attend hospital; an incidence of 3.7 per cent. They were most common in restrained, front seat vehicle occupants involved in frontal collisions, and their frequency increased with age. There was a positive association with visceral chest injury but the latter was not thought to be the cause of death in any individual. Follow-up of survivors 2-4 years later revealed potential cardiac sequelae in 6 per cent.     

Abdominal injuries sustained in severe traffic accidents by seatbelt wearers

In Finland during the period 1972-1983, there were 3,564 severe traffic accidents involving one or more victims dying within 30 days of the accident. Forty-two of the victims had been wearing a seatbelt and had an abdominal trauma as the main cause of death or as first diagnosis of injury. Small intestine and colon injuries were more common in the severely injured victims than was the case with the fatally injured ones and in these accidents the injury mechanism was always deceleration or contusion, which was in most cases caused by the seatbelt. Liver injuries seem to be the major abdominal cause of fatality, and in the fatally injured group, half of the victims sustained the fatal abdominal injury through gross crushing impact. When the direction of the impact was analyzed, all the victims seated on the receiving side of the vehicle in lateral impact collisions sustained an abdominal injury with fatal outcome. It seems that the seatbelt is less effective in protecting wearers from severe or fatal abdominal injuries in lateral impact collisions.     

Analysis and identification of the hidden relationships between effective factors in the mortality rate caused by road accidents: A case study of Fars Province, Iran

Purpose: An analysis and identification of the hidden relationships between effective factors in the mortality rate caused by road accidents in Fars Province of Iran to prevent and reduce traffic accidents in the future. Methods: This cross-sectional study was conducted to integrate all the pervious researches performed on mortality rate of road traffic accidents in Fars Province from March 21, 2013 to March 20, 2017. In order to reveal the relationships between the factors affecting mortality rates of road traffic accidents, the data regarding road traffic accidents extracted from resources such as Legal Medicine Organization, Traffic Police, Accident & Emergency Department, as well as Department of Roads and Urban Development of Fars Province, then cleaned and the applicable attributes embedded in the data all aggregated for further analysis. It should be noted that the data not related to Fars Province were deleted, the data analyzed, converted and the aggregation between various attributes identified. The aggregation between these different attributes as well as the FP-growth algorithm and two indexes of support and confidence calculated and interesting and effective rules extracted. In the end, several accident-provoking factors, the degree of consecutive and interdependence of each one in road accidents identified and introduced. The statistical analysis was conducted by using Rapid Miner software. Results: Of the 6216 people dead due to road traffic accidents, 4865 (79.02%) were male and 1292 (20.98%) were female, 59 of them have no clear gender. The largest portion of people died of road traffic accidents belonged to married and self-employed men who collided with motorcycles in autumn. Moreover, young individuals (aged 19e40 years) with secondary educational level who died of accidents in summer at 12:00 a.m. and then 5:00 p.m. in outer city main roads of Kazerun-Shiraz, then DarabShiraz, Fasa-Darab and in within-city main streets had the highest mortality rates. Among women, the middle-aged group (aged 41e65 years) followed by young-aged group (aged 19e40 years) with elementary educational level and then illiterate accounted for the highest mortality rate of road traffic accidents. The automobiles involved in accidents included Pride, Peugeot 405, Peykan pickup, Samand, Peugeot Pars, other vehicles and motorcycles. Conclusion: The high mortality rate of illiterate and low-literate in various age groups indicates that educational level plays a crucial role as a factor in road accidents, requiring related organizations such as Traffic Police and Ministry of Education to take necessary measures and policies.     

Mortality pattern according to autopsy findings among traffic accident victims in Yazd, Iran

Objective： To describe mortality pattern and to determine undiagnosed fatal injuries according to autopsy findings among road traffic accident victims in Yazd, Iran.
Methods： In this retrospective study, 251 victims of road traffic accidents who were admitted to a tertiary trauma hospital over a two-year period （2006 and 2007） and received medical cares were included. Hospital records were reviewed to gather demographic characteristics, road user type, and medical data. Autopsy records were also reviewed to determine actual causes of death and possible undiagnosed injuries occurred in the initial assessment of the emergency unit or during hospitalization.
Results： There were 202 males （80.5%） and 49 females （19.5%）. The mean （＋SD） age of fatalities was 34.1 （＋21.5） years. Pedestrian-vehicle accidents were the most common cause of trauma （100 cases, 39.8%）. The most common cause of death was central nervous system injury （146 cases, 58.1%）. The other causes were skull base fractures （10%）, internalbleeding （8%）, lower limb hemorrhage （8%）, skull vault fractures （4%）, cervical spinal cord injury （3.6%）, airway compromise （3.2%）, and multifactor cases （5.1%）, respectively. Thirty-six fatal injuries in 30 victims （12%） mainly contributed to death according to autopsy, but were not diagnosed in initial assessments. The head （72.2%） and cervical spine （13.8%） regions were the two most common sites for undi- agnosed injuries.
Conclusion： Training courses for emergency unit medical staff with regard to interpreting radiological findings of head and neck and high clinical suspicion for cervical spine injuries are essential to improve the quality of early hospital care and reduce the mortality and morbidity of traffic accident patients.     

Injuries of the jejunum and ileum. A series of 188 patients

Bullet and stab wounds accounted for approximately 70% of penetrating jejunum and ileum injuries. Blunt injuries were the result of motor vehicle accidents. Injuries were most common in men in the 21-30-year age group. Treatment was by suture or resection. Complications related to the bowel injury occurred in 10 patients, and were the cause of death in 6 (3%).     

Epidemiology of road traffic mortality and injuries in Yazd, Iran during 2003-2008

Objective: Road traffic crashes (RTCs) are considered to be the second highest cause of mortality in Iran. The purpose of this study was to describe the morbidity and mortality of RTC during 2003-2008.Methods: Data were got from national health sources of Iran. These data included population, the number of RTCs,consequent fatalities, cause and place of death from 2003 to 2008.Results: RTC incidence rate increased from 868.5 per 100 000 population in the year 2003 to 1 643.6 in 2008. A total of 2 565 deaths from RTC were recorded in Yazd from 2003 to 2008. RTC mortality rate increased from 46.1 per 100 000 population in 2003 to 46.9 in 2006, then declined to 38.8 in 2008. During this time period, overall traffic injury incidence per 100 000 population increased from 368.8 in 2003 to 647.9 in 2006, then declined to 527.9 in 2008. Head injuries were the most common cause of road traffic-related mortality from 2003 to 2008. Following road traffic accidents, most of the deaths occurred before arriving hospital.Conclusions: Road traffic crash-related mortality and morbidity in Yazd in the recent six years are increased, but decreased in the last two years. This decline is most probably the result of a variety of interventions, including laws,police enforcement, improvements in traffic and transport,health care resources and media and public education.     

Relationship between using cell phone and the risk of accident with motor vehicles: An analytical cross-sectional study

Purpose: Traffic accidents are one of the major health problems in the world, being the first cause of burden of illness and the second leading cause of death in Iran. The Sistan-Baluchestan province is one of the most accidental provinces of Iran with the highest rate of accidents-caused deaths. This study was conducted to determine the risk factors associated with traffic accidents in Zahedan through 2013 to 2016. Methods: This analytical cross-sectional study was carried out on 223 drivers from Zahedan who were traumatized by traffic accident and sent to Zahedan hospitals. The data were obtained through interviews taken by the trained interviewers via refereeing to the medical records and collected in the researcher-made checklist. Census was obtained from the study subjects. For data analysis, independent t-test, one-way ANOVA, Chi-square and logistic regression were used with the Stata software version 11.0. Results: In this study, 223 male subjects with the mean age of (32.54 ± 12.95) years, 39.8% single and 60.2% married, entered for investigation. Most accidents (38.8%) occurred between 12:00 to 17:59. While driving, 47.1% of the study subjects were using cell phones, 89.1% had manual use of mobile phones, 21.9% had a habit of sending short message service (SMS) and 23.4% had sent SMS within 10 min before the accident. The one way analysis of variance showed that the mean age of individuals with marital status, driving experience, education and accident with motorcycle were significantly different (p < 0.05). Also, the multivariate logistic regression test indicated a significant relationship of smoking, ethnicity, insurance and SMS typing while driving with motorcycle accident (p < 0.05). Conclusion: In this study, SMS and smoking while driving had the highest risk among the variables studied in the motorcycle accidents. Therefore, effective education attempting to enhance people''s awareness about the consequences of using cell phone and smoking during driving to reduce traffic accidents seems necessary.     

Burden of traffic accidents among pedestrians of Fars province, southern Iran;estimate of years of life lost in a sample of Iranian population from 2009 to 2013

Purpose: Traffic injuries are among the leading causes of mortality and morbidity worldwide. Pedestrians have been considered as a high-risk group among road users, especially in middle- or low-income communities. This study attempted to determine the burden of pedestrians'' fatalities in Fars, the southern province of Iran using years of life lost (YLL) approach. Methods: The data used in this study were retrieved from Fars Forensic Medicine Organization database on pedestrian traffic accidents. The YLL from 2009 to 2013 was estimated using the method presented by World Health organization. Some epidemiological characteristics of pedestrians'' fatalities were analyzed by SPSS. Results: Although YLL among 1000 male pedestrians decreased from 2.5 in 2009 to 1.5 in 2013, it increased from 0.9 to 2.1 among 1000 females during the same period. Higher proportion of death was found in female, illiterate, and married pedestrians (p < 0.001). In addition, mortality was higher in pedestrians living the cities, during daytime, at home, and in hospitals (p < 0.001). Conclusion: Consistent with the global trends, burden of pedestrian accidents in Fars was also exceptionally high. Considering the national and cultural aspects of different countries, improving the safety of pedestrians demands a multi-dimensional approach with interventional factors concerning policies, rules, pedestrians, motor vehicles and environmental conditions taken into consideration.     

Epidemiology of traffic crash mortality in west of Iran in a 9 year period

Purpose: In Iran, the most common cause of injuries and the second leading cause of deaths are traffic accidents, and those problems impose a substantial financial burden on the society. This study aims to determine traffic accident mortality trends and their epidemiologic characteristics in the Kermanshah province, west of Iran. Methods: In a cross sectional study, road traffic fatality data from 2004 to 2013 were analyzed to determine the epidemiological pattern of traffic accident mortality. Trend assessment was performed to ascertain the decreasing or increasing status. Chi-square and one-way analysis of variance (ANOVA) tests, as well as Poisson regression were used to determine the significance of the data in time. Data were analyzed using Excel and statistical package of SPSS version 19. Results: Out of 5110 people that died in traffic accidents, 4024 (78.7%) were males. The state of accidents indicated that 404 (43.8%) female pedestrians died as a result of car crashes, and 1330 (41.4%) males died because of car collisions. 1554 (31.9%) deaths happened to pedestrians and 1556 (32.1%) to vehicle drivers, and the rest belonged to vehicle passengers. Head trauma was the cause of death for as much as 3400 (69.9%) cases. Fatal crashes in which pedestrians were involved mostly occurred between the hours 13:00 to 15:00, while the time for vehicle drivers was between 16:00 to 18:00. 2882 people (59.1%) died before reaching to health care facilities. Traffic crash mortality trend for pedestrians follows a linear pattern with a gentle downward slope, but the trend shows various swings when it comes to vehicle drivers. Conclusion: The number of traffic crash deaths from 2004 to 2013 indicates a decreasing trend in two groups of road users: vehicle drivers and car occupants. This can be due to some interventions such as modification of traffic rules and enhancement of police control which has been implemented in recent years. Moreover, more attention should be paid to promote the optimal health care services to save the lives of the injured from traffic accidents.