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.     

Epidemiology of paediatric burn injuries in Hamadan,Iran

Burn injuries are prevalent worldwide, especially in developing countries; and they are significant paediatric injuries in Iran. This study was performed to analyse the epidemiology and aetiology of paediatric burns in Hamadan province in the west part of Iran from March 2004 to March 2007. The incidence rate of child hospitalisation for burns was 33.4 per 100 000 person-years. The median age was 3 years with 69% of the patients under 4 years. The male-to-female ratio of incidence rate for all age groups was 1.52. Scald was the leading cause in almost all age groups and caused 266 (71.7%) burns. Correlation analysis showed that younger children are more vulnerable to scald injury. The mean body surface area (BSA) of burns was 16.36 (SD = 11.42) in all cases. Flame was more fatal than other causes of burns. The total fatality rate in this study was 3.5%. Epidemiological findings reveal that scald, age, gender and residence in rural area are the major issues that should be discussed in considering childhood burns. Prevention efforts should focus on the reduction of scald injuries during food preparation or hot liquid spillage. These efforts should target rural infants, toddlers and boys.     

Risk factors and predictors of mortality in children after ejection from motor vehicle crashes

PURPOSE: Mortality after ejection from a motor vehicle crash (MVC) has been studied extensively in adults. The magnitude of this problem in children is relatively unknown. We retrospectively examined fatalities resulting from ejection after MVC in the state of Pennsylvania to define risk factors and predictors of mortality in children. METHODS: The records for all patients 0 to 16 years of age involved in an MVC and entered in the Pennsylvania Trauma Outcome Study between 1993 and 1997 were reviewed. We examined mortality, length of hospitalization, major injuries sustained, and impact of safety restraint devices. Significant differences were determined using chi2 test. RESULTS: There were 2,298 children involved in MVCs during this period; 189 were ejected. A total of 77% of the ejected passengers were greater than 10 years of age, 16% were 0 to 4 years of age, and 7% were 5 to 9 years of age. Overall, 88% of the ejected occupants were unrestrained. Ejection nearly tripled the overall mortality rate and significantly increased the Injury Severity Score for each age group. Infants and children 0 to 4 years of age had the highest fatality rate despite having a lower Injury Severity Score than all other age groups. Head injuries accounted for the majority of deaths in all age groups. Children older than 10 years of age had a higher incidence of associated chest, abdominal, and pelvic injuries. CONCLUSION: Our data show that most children ejected from MVCs were either unrestrained or improperly restrained. Head injuries were the most common cause of death in all age groups. Greater public awareness through educational programs targeting parents and children at risk may reduce this serious problem.     

Epidemiological data of patients hospitalized with burns and other traumas in some cities in the southeast of Brazil from 1991 to 1997

This retrospective analysis of burn patients and victims of other forms of trauma from Ribeir?o Preto and nearby cities admitted to hospitals in the city of Ribeir?o Preto, S?o Paulo, Brazil, was carried out to determine the frequency of injuries of all types in order to identify the extent of the problem of burns relative to other forms of trauma. Data concerning 921 patients with burns and 60,344 patients with other traumatic injuries hospitalized during the period from 1991 to 1997 are described. Burns corresponded to 1.5% of the total number of traumatic injuries. When data are reported as absolute numbers or as incidence rate of hospitalized burn patients, burns were two times more frequent among men in most age groups. The case fatality ratio due to burns was 8.4% (77 deaths among 921 patients), with a rate of 6.4% for men and 12.2% for women. The case fatality ratio was higher among women than men regardless of the city of residence. The case fatality ratio was 3.2 and 4.4 times greater for men and women burn victims from other towns than for burn victims from Ribeir?o Preto, indicating the need for additional equipment and training of medical and paramedical personnel in the initial measures to be taken with burn patients.     

Spinal fractures resulting from traumatic injuries

Objective： To illustrate mechanisms of spine fractures and the pattern of spinal injuries characterized by the major mechanisms in urban population of Iran. Methods： Data regarding spinal injuries including demographics, mechanism and level of spinal injury, abbreviated injury score, associated injuries and final fate of the patients were extracted from the Iranian national trauma registry database from 1999 to 2004. Results： A total of 619 patients with traumatic spine fractures were identified, of whom 68.5% were males. The peak frequency of these injuries occurred in the 21-40 year age-group. Accidental falls and road traffic crashes （RTCs） were the most common mechanisms of spinal fractures （47.2% and 44.1%, respectively）. RTCs tended to occur in younger patients compared with accidental falls. The most common spinal region for spinal fracture was the lumbar spine （53.63%）. Cervical spine fractures were significantly more common in RTCs, while lumbar spine fractures were more common in accidental falls （P〈0.001）. A total of 171 （27.6%）patients had associated non-spinal injuries, of whom 127 had associated extremity injuries, and 55 had head injuries. Thirty-six （5.6%） patients had spinal cord injury （SCI）.The injury severity score of the RTC group was significantly higher than that of accidental falls （P=-0.002）. Fifteen （4%） patients died of traumatic injuries. The rate of death was significantly higher in RTCs compared with accidental falls （5.1% vs 2.1%, P=0.039）. Conclusions： The patterns of spinal fractures are similar to those reported from developed countries. RTCs tend to affect the younger age population and are associated with a higher degree of associated injuries and mortality than accidental falls. Therefore preventive strategies should be based on reduction of the number and severity of RTCs.     

Trends in road traffic crashes and associated injury and fatality in the People's Republic of China, 1951-1999

The burden of road traffic injuries in the People's Republic of China is increasing as evidenced by trends since 1951. Data from the National Statistical Office, Ministry of Communications and the Traffic Administration Bureau were analyzed. Absolute numbers of crashes, fatalities, and injuries, as well as fatalities per 100,000 population and motorization (number of vehicles per 1000 population) were used as indices to measure trends. Regional variations in trends and the characteristics of people injured or killed were also analyzed. Road traffic crashes increased 68-fold, from around 6000 in 1951 to 413,000 in 1999. Excessive speed was the main reported cause of the crashes. The injuries increased 56-fold--from around 5000 to 286,000--and fatalities 97-fold--from 852 to around 84,000--over the same period. The crash, fatality and injury rates also increased after 1985, due to increased motorization spurred by rapid economic growth. The number of four-wheel motor vehicles increased from 60,000 in 1951 to just under a million four-wheel motor vehicles in 1975 and to 10 million in 1987. The number of four-wheel motor vehicles then rose to 50 million in 1999, with an additional 30 million motorcycles. The increase in motorization and fatalities affected all the provinces. Road traffic injuries are the leading cause of death for populations up to the age of 45 years and the leading cause of working-life years lost in China.     

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.     

National trends in pediatric firearm and automobile fatalities

BackgroundSuccessful public health policies and injury prevention efforts have reduced pediatric automobile fatalities across the United States. In 2019, firearm injuries exceeded motor vehicle crashes (MVC) as the leading cause of childhood death in Colorado. We sought to determine if similar trends exist nationally and if state gun laws impact firearm injury fatality rates.MethodsAnnual pediatric (≤19 years-old) fatality rates for firearm injuries and MVCs were obtained from the CDC WONDER database (1999–2020). State gun law scores were based on the 2014–2020 Gifford's Annual Gun Law Scorecard and strength was categorized by letter grades A-F. Poisson generalized linear mixed models were used to model fatality rates. Rates were estimated for multiple timepoints and compared between grade levels.ResultsIn 1999, the national pediatric fatality rate for MVCs was 248% higher than firearm injuries (Incidence Rate Ratio (IRR) 95% Confidence Interval (CI): 2.25–2.73, p<0.0001). By 2020, the fatality rate for MVCs was 16% lower than that of firearm injuries (IRR 95% CI: 0.75- 0.93, p = 0.0014). For each increase in letter grade for gun law strength there was an 18% reduction in the firearm fatality rate (IRR 95%CI: 0.78–0.86, p<0.0001). States with the strongest gun laws (A) had a 55% lower firearm fatality rate compared to those with the weakest laws (F).ConclusionFirearm injuries are the leading cause of death in pediatric patients across the United States. State gun law strength has a significant impact on pediatric firearm injury fatality rates. New public health policies, political action, media attention and safer guns are urgently needed to curb this national crisis.Level of Evidence/Study TypeLevel III, retrospective     

Road traffic fatalities among pedestrians, bicyclists and mo-tor vehicle occupants in Sirjan, Kerman, Iran

Objective: To analyze the crash and injury data in forensic medicine for years of 2004-2007. Methods: A sample of over 567 accident cases (9 pedestrians, 116 bicyclists, and 442 motor vehicle occupants) was considered from the Department of Foren-sic Medicine, Shahid Bahonar University of Kerman, in-volving drivers of all ages and covering a four-year period.Results: The male fatality rates were significantly higher than female ones. The groups at 15-30 years old and at 30-55 years old had the first and second highest numbers of deaths (40% and 34%, respectively). There were sub-stantial differences in distribution of injuries in motor ve-hicle occupants and pedestrians and bicyclists. Among motor vehicle occupants, there were more head injuries, such as skull fracture, brain contusion, subdural haemorrhage, and epidural haemorrhage. Nearly 77% of fatalities occurred during 08:00-22:00 in Sirjan. Internal bleeding was also higher in motor vehicle occupants. Pedestrians and bicyclists also had head injuries frequently.Conclusions: In spite of reduction of road traffic fatali-ties in Sirjan in 2007, it is still one of the cities with high road traffic fatality in the world. These results underline the im-portance of preventive strategies in transportation, sug-gesting that different methods are necessary to reduce fa-talities of various traffic participants.     

Occupational fatalities involving forklifts

BACKGROUND: Forklift rollovers account for approximately 18% of all fatalities involving forklifts and many of the more serious injuries in the workplace. METHODS: Proportionate mortality ratios were calculated by using Occupational Safety and Health Administration fatality inspection records for forklift rollovers that resulted in a fatality by industry. An analysis of variance procedure was performed on the average ages of the victims by industry. RESULTS: The retail trades industry had a significantly higher (p < 0.05) than expected proportion of fatalities attributable to forklift rollovers. The analysis of variance identified significant differences in the average ages of the victims; however, post hoc comparisons did not yield significant differences. CONCLUSION: The majority of the fatalities in the retail trades industry occurred in the building materials, garden supply, and hardware retail trades. Engineering and administrative prevention measures are discussed.     

Injury Patterns from Major Urban Terrorist Bombings in Trains: The Madrid Experience

BACKGROUND: Terrorist urban mass casualty incidents (MCI) in the last 3 years have targeted commuter trains at rush hour, producing large numbers of casualties. Civilian care providers are usually not familiar with the types of blast injuries sustained by victims of these MCI. METHODS: We focus on the injury patterns sustained by casualties of the Madrid, 11 March 2004, terrorist bombings, at the seven hospitals that received most victims. Data were gathered of casualties who had injuries other than superficial bruises, transient hearing loss from barotrauma without eardrum perforation, and/or emotional shock. The degree of severity in critical patients was assessed with the ISS. RESULTS: The bombings resulted in 177 immediate fatalities, 9 early deaths, and 5 late deaths. Most survivors had noncritical injuries, but 72 (14%) of 512 casualties assessed had an Injury Severity Score (ISS) >15. The critical mortality rate was of 19.5%. The most frequently injured body regions were the head-neck and face. Almost 50% of casualties had ear-drum perforation, and 60% of them were bilateral. There were 43 documented cases of blast lung injury, with a survival rate of 88.3%. Maxillofacial and open long-bone fractures were most prevalent. Gustillo's grade III of severity predominated in tibia-fibular and humeral fractures. Upper thoracic fractures (D1-6 segment) represented 65% of all vertebral fractures and were associated with severe blast to the torso. Severe burns were uncommon. Eye injuries were frequent, although most were of a mild-to-moderate severity. Abdominal visceral lesions were present in 25 (5%) patients. A multidisciplinary approach was necessary in most operated patients, and orthopedic trauma procedures accounted for 50% of the caseload in the first 24 h. CONCLUSIONS: Ninety-three percent of the fatalities of the Madrid trains terrorist bombings were immediate, and most survivors had noncritical injuries. Closed doors increased the immediate fatality rate in the trains. Severely wounded casualties presented specific patterns of injuries, some of them life-threatening and unusual in other types of trauma mechanisms. Ear-lobe amputations and upper thoracic spine fractures were markers of critical injuries.     

Analysis of clustered data in multicentre trauma studies

INTRODUCTION: In order to design multicentre studies an estimate of the correlation of the observations within each centre is necessary. A standard measure of the correlation between observations within each centre is the Intraclass Correlation Coefficient (ICC). METHOD: We used the National Trauma Data Bank (NTDB). By 2004, 448 trauma centres (including 110 level I and 123 level II trauma centres) from 43 states and US territories contributed over 1.2 million records to the NTDB. Data of patients directly transported from the scene of injury to level I or II trauma centres were used to calculate the ICC of in-hospital trauma fatality and emergency department (ED) shock rate. RESULTS: The ICCs of ED shock and in-hospital fatality rate were 0.010 (95% confidence interval (CI): 0.003-0.018) and 0.039 (95% CI: 0.028-0.050), respectively. The ICC of shock in the ED was the highest for penetrating injuries (0.017, 95% CI: 0.003-0.032) and the lowest for women (0.008, 95% CI: 0.002-0.013) although the observed difference between men and women was not statistically significant. The ICC of trauma fatality was the highest for penetrating injuries (0.073, 95% CI: 0.047-0.098), and the lowest for blunt injuries (0.029, 95% CI: 0.020-0.037). DISCUSSION: Although the calculated ICCs might seem so small as to be ignored, the required sample size in studies with exclusively exposed or non-exposed clusters depends on the ICC and the average number of subjects within clusters. Therefore, investigators should be aware of the influence that these ICCs might have on sample size and power of their studies.     

Analysis of fatal pedestrian injuries in Mexico City, 1994-1997

Currently, in Mexico City, 57% of deaths from traffic crashes are pedestrian injuries. The purpose of this study was to identify and analyse the magnitude, trends, risks, and geographic distribution of fatal pedestrian injuries during the period 1994-1997. A cross-sectional study design was used, based on the death certificates of persons who were in Mexico City during 1994-1997 and died due to pedestrian injuries. Mortality rates, trend analysis, standard mortality ratios (SMRs), and potential years of life lost index (PYLLI) were calculated by gender, age groups and region (these correspond to "delegations", which are political divisions of the city). Rates were derived according to place of occurrence and place of residence. A total of 3687 pedestrian fatalities were reported, and 71% of these were to Mexico City residents. The rate for males was 10.6/100000 with a slight decrease in rate from 1994 to 1997. For females, the rate was 4.0/100000, with an increase in rate during the same years. The present study allowed identification of the target population as well as regions with a high risk of fatal pedestrian injuries. From these data we have developed or recommended specific interventions for prevention and control of fatal pedestrian injuries in Mexico City.     

Etiology and outcome of burns in Tabriz, Iran. An analysis of 2963 cases.

BACKGROUND AND AIMS: Burn injuries still produce a significant morbidity and mortality in Iran. A 3-year retrospective review of burn victims hospitalized at a major burn center was conducted to determine the etiology and outcome of patients in Tabriz. MATERIAL AND METHODS: Two thousand nine hundred sixty + three patients were identified and stratified by age, sex, burn size, presence or absence of inhalation injury, cause of burn. There is one burn center in the East Azarbygan province serving 3.3 million people over an area of 47,830 sq.km. RESULTS: The overall incidence rates of hospitalization and death were 30.5% and 5.6% per 100000 person years. The mean patient age was 22 years, and the male: female ratio was 1.275. There were 555 deaths altogether (18.7%). The highest incidence of burns was in the 1-9 age group (29.2%). Patients with less than 40 percent of burned surface constituted 79.8% of injuries. The most common cause of burns was kerosene accident in adults and scald injuries in children. The mean length of hospitalization was 13 days. The mean body surface area burned was larger with higher mortality in females than in males (p < 0.001). Inhalation injuries were strongly associated with large burns and were present in all flame-burn fatalities. CONCLUSION: In our opinion, social factors are the main drive leading to an unacceptably high rate of burn injuries in our societies. Most of the burn injuries were caused by domestic accidents and were, therefore, preventable; educational programs might reduce the incidence of burn injuries.     

Motorcycle fatalities in Sweden

An analysis has been made of 129 motorcycle fatalities, 119 men and 10 women, who were killed in 125 accidents during 1979-1981. Sixty-seven of the 125 drivers were teenagers. Twenty-seven drivers had no licence. Ninety-nine riders were killed on sections of roads with a speed limit of 70 km/h or less. More than half of the decreased died in collisions with other vehicles. Eight lost their lives in accidents where an animal, in seven cases a moose, was involved, and six people died in wobbling accidents. The injuries were often multiple and serious, most of the riders died of head or cervical spine injuries (73) or of chest injuries (44). Altogether, 30 riders died in accidents in which people who were under the influence of alcohol were involved. Raising the minimum driving age, minimizing the possibility of illicit driving and elimination of such roadside hazards as poles and trees would reduce the fatality rate.     

Is the Annual Number of Deceased Donor Kidney Transplantations in Iran Lower Than the Middle Eastern Countries?

Deceased donor organ donation is inadequate; hence, the number of patients on the waiting lists is progressively growing in the world. However, in Iran the deceased donor rate has increased over the past 10 years, from less than 1% by the end of year 2000 to almost 16.3% (approximately 311 cases) of kidney transplantations in 2007. Although the percentage of deceased donor kidney transplantation in some countries of the region are higher than Iran, the absolute annual number in Iran is higher than the Middle Eastern countries. The outlook for deceased donor kidney transplantation practice in Iran is promising. Meanwhile, the annual number of kidney transplantations from deceased donors in Baqiyatallah hospital, as the second transplant unit in terms of the volume of kidney transplantation in Iran, increased from 0.4% in 2002 to 14% and 31% in 2007 and 2008, respectively.     

Brain injury-related fatalities in American football, 1945-1999

OBJECTIVE: Brain injuries have been the most common direct cause of death among American football players since the annual recording of football-related deaths began in 1931. This study examines the 55-year experience with brain injury-related fatalities in American football from 1945 to 1999, including not only the incidence but also the cause of death in discrete 5-year spans to focus on the variables that have either increased or decreased fatalities. In addition, we describe the types of injuries that have occurred, the activities in which the players were engaged at the time of injury, the level of play involved, and whether the injuries occurred during games or in practice sessions. METHODS: Data were collected nationwide regarding football fatalities in all organized football programs in public schools and in college, professional, and youth programs by conducting personal interviews and eliciting responses to questionnaires. The information collected included demographic data about the injured player, equipment data, injury type and body part involved, and pertinent information regarding the exact circumstances of the accident. RESULTS: We found that a total of 497 brain injury-related fatalities occurred among American football players during the period from 1945 through 1999. The causes of death were brain injuries in 69% of the cases, cervical spine injuries in 16%, and other injuries in 15%. Subdural hematoma was the type of injury associated with the majority (429, 86%) of brain injury-related fatalities. A majority (61%) of the brain injury-related fatalities occurred during participation in football games, and 75% of these were high school players. It should be noted that the number of high school football players is far greater (more than 1 million) than the number of either college (approximately 75,000) or professional (approximately 2000) players. The most frequent on-field activity involved when players sustained their fatal injuries was either tackling or being tackled (35%). CONCLUSION: Brain injury-related fatalities accounted for 69% of all football fatalities from 1945 through 1999. The greatest number and percentage of brain injury-related fatalities occurred during the 5-year span from 1965 through 1969, and the smallest number and percentage occurred during the 2 decades from 1975 through 1994. Most brain injury-related fatalities involved a subdural hematoma sustained by high school football players while either tackling or being tackled in a game. In the 2 decades from 1975 through 1994, there was a dramatic reduction in these fatalities, and the preventive measures that have received most of the credit are 1) the 1976 rule change that prohibits initial contact with the head and face when blocking and tackling and 2) the National Operating Committee on Standards for Athletic Equipment helmet standard, which went into effect in colleges in 1978 and in high schools in 1980.     

Nordic ski jumping fatalities in the United States: a 50-year summary

Nordic ski-jumping fatalities are rare events. Six jumping fatalities have occurred in the United States during the past 50 years. The fatality rate for nordic ski jumping, estimated to be roughly 12 fatalities/100,000 participants annually, appears to be within the range of fatality rates for other "risky" outdoor sports. Cervical fractures appear to be the most frequent fatal ski-jumping injury.     

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.     

Clinical characteristics of 1653 injured motorcyclists and factors that predictmortality from motorcycle crashes in Malaysia

PurposeAmongst the ASEAN countries, Malaysia has the highest road fatality risk (>15 fatalities per 100 000 population) with 50% of these fatalities involving motorcyclist. This contributes greatly to ward admissions and poses a significant burden to the general surgery services. From mild rib fractures to severe intra-abdominal exsanguinations, the spectrum of cases managed by surgeons resulting from motorcycle accidents is extensive. The objective of this study is to report the clinical characteristics and identify predictors of death in motorcycle traumatic injuries from a Malaysian trauma surgery centre.MethodsThis is a prospective cross-sectional study of all injured motorcyclists and pillion riders that were admitted to Hospital Sultanah Aminah and treated by the trauma surgery team from May 2011 to February 2015. Only injured motorcyclists and pillion riders were included in this study. Patient demography and predictors leading to mortality were identified. Significant predictors on univariate analysis were further analysed with multivariate analysis.ResultsWe included 1653 patients with a mean age of (35 ± 16.17) years that were treated for traumatic injuries due to motorcycle accidents. The mortality rate was 8.6% (142) with equal amount of motorcycle riders (788) and pillion riders (865) that were injured. Amongst the injured were male predominant (1 537) and majority of ethnic groups were the Malays (897) and Chinese (350). Severity of injury was reflected with a mean Revised Trauma Score (RTS) of 7.31 ± 1.29, New Injury Severity Score (NISS) of 19.84 ± 13.84 and Trauma and Injury Severity Score (TRISS) of 0.91 ± 0.15. Univariate and multivariate analysis revealed that age≥35, lower GCS, head injuries, chest injuries, liver injuries, and small bowel injuries were significant predictors of motorcycle trauma related deaths with p < 0.05. Higher trauma severity represented by NISS, RTS and TRISS scores was also significant for death with p < 0.05.ConclusionAge, lower GCS, presence of head, chest, liver, small bowel injuries and higher severity on NISS, RTS and TRISS scores are predictive of death in patients involved with motorcycle accidents. This information is important for prognostic mortality risk prevention and counselling.