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Inamasu J, Kujirai D, Izawa Y, Kase K, Shinozaki H. Difference in severity and distribution of bodily injuries following collision between drivers of K-cars and standard vehicles. Injury 2019; 50:205-209. [PMID: 30268513 DOI: 10.1016/j.injury.2018.09.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/30/2018] [Accepted: 09/19/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although K-cars, small four-wheeled vehicles with an engine capacity of <660 cc, have been used almost exclusively in Japan, they have recently become increasingly popular in other countries. Therefore, reporting the characteristics of bodily injuries sustained by K-car drivers after road traffic accidents (RTAs) may be important not only for health professionals but also for car manufacturers. METHODS A single-center, retrospective observational study was conducted using prospectively acquired data. Between January 2010 and December 2017, 494 restrained drivers (331 men/163 women with a mean age of 45.1 years) whose vehicles had been severely damaged in RTAs underwent whole-body computed tomography prospectively. They were subsequently dichotomized into 221 K-car drivers and 273 standard vehicle drivers and compared for severity and distribution of bodily injuries. RESULTS K-car drivers tended to be older and were significantly more likely to be female than standard vehicle drivers. The frequency of subjects with severe bodily injuries significantly higher among K-car drivers than among standard vehicle drivers (21.7% vs. 14.3%; p = 0.04), and the frequency of bowel/mesentery injuries tended to be higher in the former (9.0% vs. 4.4%; p = 0.06). However, the frequency of abdominal solid viscus injuries did not differ significantly between the two groups. Multivariable regression analysis showed that age [odds ratio (OR): 1.022; 95% confidence interval (CI): 0.998-1.047; p = 0.07] and K-cars (OR: 3.708; 95% CI: 0.984-6.236; p = 0.05) tended to be associated with bowel/mesentery injuries in restrained drivers. The frequency of pelvic/hip fractures also tended to be higher in K-car drivers than in standard vehicle drivers (5.9% vs. 2.6%; p = 0.10). By contrast, the severity and frequency of the upper torso injuries were similar between the two groups. CONCLUSIONS Compared to standard vehicle drivers, K-car drivers seem to experience more severe bodily injuries after severe RTAs. Despite there being no answer for the increased frequency of only hollow viscus injuries but not solid viscus injuries among restrained K-car drivers, advanced age may, at least in part, be responsible. Given the limitations inherent to this study's single-center, retrospective design, multi-center prospective studies are warranted to verify our findings.
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Affiliation(s)
- Joji Inamasu
- Department of Emergency Medicine, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan.
| | - Dai Kujirai
- Department of Emergency Medicine, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Yoshimitsu Izawa
- Department of Emergency Medicine, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Kenichi Kase
- Department of Emergency Medicine, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Hiroharu Shinozaki
- Department of General Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
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Shahbazi F, Hashemi Nazari SS, Soori H, Khodakarim S. Socioeconomic Inequality in Mortality from Road Traffic Accident in Iran. J Res Health Sci 2019; 19:e00437. [PMID: 31133631 PMCID: PMC6941628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 01/01/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Although the epidemiology of road traffic accidents (RTAs) and their determining factors have been extensively investigated and debated in Iran, yet there is no data regarding socioeconomic inequalities in mortality from RTA in Iranian context. Since effective interventions to control, management and diminish the negative influence of RTAs would require understanding of numerous contributing factors, including the inequalities We aimed to quantify for the first time the socioeconomic differential in mortality or injuries from RTAs. STUDY DESIGN A cross-sectional study. METHODS Overall, 50755 died and injured people from RTA from Mar 2015 to Feb 2016 were evaluated. The data were taken from traffic police department in Iran. We calculated concentration index (CI) to measure socioeconomic inequality in traffic-related mortality & injury. Data were analyzed using Stata software. RESULTS The mortality and injury rate from accidents was 1130.80 per 10000 accidents. The concentration index was negative for mortality rate (-0.11) of RTA, indicating the higher concentration of the rates among deprived groups. CONCLUSION People with low socioeconomic level were more at risk for fatal accidents and injuries. Therefore, specific interventions on road safety should be delivered in the deprived drivers which uses from low safety level vehicles.
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Affiliation(s)
- Fatemeh Shahbazi
- 1 Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Saeed Hashemi Nazari
- 1 Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
,2 Safety Promotion and Injury Prevention Research Center, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
,Correspondence: Seyed Saeed Hashemi Nazari (PhD) Tel: +98 21 22432040 E-mail:
| | - Hamid Soori
- 1 Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
,2 Safety Promotion and Injury Prevention Research Center, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheila Khodakarim
- 3 Department of Epidemiology, School of Paramedical Science, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Woo TH, Wu CL. Determining the initial impact of rear-end collisions by trace evidence left on the vehicle from tires: A case report. Forensic Sci Int 2018; 291:17-22. [PMID: 30125767 DOI: 10.1016/j.forsciint.2018.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 03/05/2018] [Accepted: 03/12/2018] [Indexed: 10/17/2022]
Abstract
If an automobile happens to crash into the back of another vehicle while travelling at high speeds, both vehicles will be seriously damaged. Consequently, it is not easy to reconstruct the initial collision state between the two vehicles or determine whether or not the risk perception of the driver is normal. The entire picture of the accident cannot be fully understood and thus clarifying the relevant legal responsibility is difficult. The trace evidence of tires, such as pattern, direction, and impression examination as well as other characteristics, can be carefully observed and used as evidence in accident reconstruction. A case report of a fatal collision involving a bus crashing into the frame of a full trailer on a freeway is examined in this study. The police agency used the characteristics of the trace evidence of the bus tires to reconstruct the initial collision state of the two vehicles to clarify the cause of the accident, and these determination guidelines can be used by police while handling similar cases in the future. This case uses new information regarding the initial collision state of road traffic accidents for reconstruction and provides knowledge and interest for the forensic community.
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Affiliation(s)
- T Hugh Woo
- Department of Transportation and Logistics Management, National Chiao Tung University, Taiwan.
| | - Chun Liang Wu
- Department of Transportation and Logistics Management, National Chiao Tung University, Taiwan.
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Inamasu J, Nakaya M, Kujirai D, Mayanagi K, Nakatsukasa M. Frequency and characteristics of traumatic brain injury in restrained drivers involved in road traffic accidents. Acta Neurochir (Wien) 2018; 160:1921-9. [PMID: 30116903 DOI: 10.1007/s00701-018-3656-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND While seatbelt is an important device protecting drivers from traumatic brain injury (TBI), it has rarely been reported how often and in what circumstances restrained drivers sustain TBI after road traffic accident (RTA). Whole-body computed tomography (WBCT) for blunt trauma patients may provide a unique opportunity to investigate the frequency and characteristics of TBI sustained by restrained drivers. METHODS A single-center, retrospective observational study was conducted using prospectively acquired data. Between January 2013 and December 2017, 409 restrained drivers (284 men/125 women, mean age of 45.0 ± 19.1 years) whose vehicle had been severely damaged in RTAs underwent WBCT for evaluation of injuries. Multivariate regression analysis was performed to identify variables predictive of TBI. Influence of collision patterns (frontal, lateral or rollover) on the frequency and severity of TBI was evaluated. Relationship between collision patterns and CT findings was also reviewed. RESULTS Thirty-one restrained drivers (7.6%) sustained TBI after RTA. The distribution of Glasgow Coma Scale (GCS) scores among the 31 drivers was 15 in 9, 13-14 in 9, 9-12 in 4, and ≤ 8 in 9, indicating that the majority of TBIs were classifiable as mild. The frequency of TBI in alert and oriented drivers, i.e., those with a GCS score of 15, was 2.9%. Multivariate regression analysis showed that both altered mental status (OR, 4.933; 95% CI, 1.135-21.431) and loss of consciousness (OR, 6.492; 95% CI, 1.669-25.249) were associated with TBI. The frequency of TBI tended to be higher in drivers with rollover collision than those with frontal collision (6 vs. 13%, p = 0.07). Interhemispheric acute subdural hematoma and subcortical petechial hemorrhage seemed to be characteristic CT findings in drivers with frontal and lateral collision, respectively. CONCLUSIONS The key finding of this study, i.e., that (1) TBI was observed in 7.6% of restrained drivers with severe vehicular damage, may provide useful information to neurosurgeons who take care of RTA victims. The majority of the TBIs were mild without need for neurosurgical intervention. While association may exist between type of collision and type of brain injury, further studies with prospective design are warranted.
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Yohannes K, Gebeyehu A, Adera T, Ayano G, Fekadu W. Prevalence and correlates of post-traumatic stress disorder among survivors of road traffic accidents in Ethiopia. Int J Ment Health Syst 2018; 12:50. [PMID: 30250501 PMCID: PMC6147045 DOI: 10.1186/s13033-018-0229-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 09/15/2018] [Indexed: 12/02/2022] Open
Abstract
Background Post-traumatic stress disorder is the most common mental disorders occurring among survivors of road traffic accident. However, research into post-traumatic stress disorder and correlates in low and middle-income countries is limited. To the best of our knowledge, there is no published study of the post-traumatic stress disorder and associated factors conducted in Ethiopia. Therefore, this study aimed to determine the prevalence of post-traumatic stress disorder and associated factors among survivors of road traffic accident. Methods Institution based cross-sectional study was conducted in May 2016. Data were collected using a pretested, structured, standardized post-traumatic stress disorder Checklist-Specific version (PCL-S) questionnaire. Systematic sampling technique was used to select the study participants. Binary logistic regression analysis was used to identify associated factors. Odds ratio with 95% CI was computed to assess the strength of associations. Results The prevalence of post-traumatic stress disorder was found to be 22.8% (CI 19.2, 26.6) among survivors of road traffic accident. In the multivariable analysis, Being female [AOR = 2.23, 95% CI 1.40, 3.56], having poor social support [AOR = 2.1, 95% CI 1.34, 3.46], duration since accident (1–3 months) [AOR = 1.72, 95% CI 1.07, 2.76] and having depression [AOR = 3.46, 95% CI 1.99, 5.99] were significantly associated with PTSD among survivors of road traffic accident. Conclusion In the current study the magnitude of post-traumatic stress disorder was high. Being female, poor social support, duration since the accident (1–3 months) and depression were found to be significant predictors of post-traumatic stress disorders. The finding suggests a need for early screening for post-traumatic disorder among survivors of road traffic accidents.
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Affiliation(s)
- Kalkidan Yohannes
- 1College of Medicine and Health Sciences Department of Psychiatry, Dilla University, POBox 245, Dilla, Ethiopia
| | - Abebaw Gebeyehu
- 2Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Adera
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Getinet Ayano
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Wubalem Fekadu
- College of Medicine and Health Sciences Department of Psychiatry, Bahirdar University, Bahidar, Ethiopia
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Arif MZ, Rajanikanth BR, Prasad K. Soft Tissue Injuries of the Maxillofacial Region Occurring from Motorcycle Accidents. J Maxillofac Oral Surg 2019; 18:432-9. [PMID: 31371887 DOI: 10.1007/s12663-018-1149-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 08/27/2018] [Indexed: 10/28/2022] Open
Abstract
Introduction Soft tissue injuries are the most common type of injury occurring from a motorcycle accident. Not many studies have been conducted to determine the incidence and pattern of soft tissue injuries and the effectiveness of helmet to prevent them. Methods In this prospective cross-sectional study, all the patients attending three centres in North Bangalore, with facial injuries occurring from a motorcycle accident, were included. The subjects were analysed for the type of collision, helmet use, type of helmet use and incidence and pattern of extra-oral and intra-oral soft tissue injuries. Results A total number of 311 motorcyclists were included in this study for a period of 18 months (December 2015-June 2017). The most prominent age group was 21-30 years. Abrasions were the most common type of injury followed by the lacerations, contusions and communication. Injuries to the middle third and lower third of the face were significantly higher in non-helmeted and open-face-helmeted patients. Middle third injuries were most common in the full-face helmet group. Conclusion Abrasions are the most common type of soft tissue injury, and most common site was the nose, followed by the forehead, orbit and chin. Full-face helmets are more effective and protective as compared to open-face helmets. Open-face helmets offer minimal protection against facial injuries occurring from road traffic accidents.
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Monchal T, Ndiaye A, Gadegbeku B, Javouhey E, Monneuse O. Abdominopelvic injuries due to road traffic accidents: Characteristics in a registry of 162,695 victims. Traffic Inj Prev 2018; 19:529-534. [PMID: 29509045 DOI: 10.1080/15389588.2018.1447669] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 02/28/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Road traffic accidents (RTAs) are the first cause of abdominopelvic injuries (APIs). The objective of this study was to describe the characteristics and severity of APIs due to traffic accidents in a large French trauma registry and to identify risk factors for API. METHODS All victims from the French Rhône registry of victims of RTAs were analyzed from 1996 to 2013. This registry contained data that were issued over a 20-year period from 245 medical departments, from prehospital care until re-adaptation, and forensic medicine departments. All APIs, defined as an injury between the diaphragm and the pelvic bone, were extracted and studied. RESULTS Among 162,695 victims, 10,165 had an API (6.7%). Accidents frequently involved young men and 2 cars. Mean Injury Severity Score (ISS) was 8.7. Mortality rate was 5.6%. Soft tissue injuries largely predominated (n = 6,388; 54.4% of patients). Overall, 2,322 victims had a pelvic bone injury. Internal abdominal organs were involved in 2,425 patients; the most frequent were the spleen, liver, and kidney. Wearing of the seat belt appeared to be a significant protective factor in API, including serious injuries. A partial analysis over the past 2 years among the most severe patients hospitalized in the intensive care unit indicated that nonoperative management was carried out in two thirds of the wounded. In uni- or multivariate analysis, sex, age, type of user, antagonist, time of occurrence, associated severe lesions, or wearing of the seat belt were statistically associated with the occurrence of API, highlighting a more dangerous user profile. CONCLUSIONS Abdominopelvic injuries concern a minority of road traffic injuries, but they are responsible for significant mortality. Large solid organs are the most frequently affected. Women drivers wearing a seat belt and driving in town during the day appear to be more protected against API.
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Affiliation(s)
- Tristan Monchal
- a Department of General Surgery , Sainte Anne Military Hospital , Toulon , France
| | - Amina Ndiaye
- b UMR Epidémiologique et de Surveillance Transport Travail Environnement, IFSTTAR (French Institute of Science and Technology for Transport, Spatial Planning, Development and Networks), Université Lyon1 , UMR , Bron , France
| | - Blandine Gadegbeku
- b UMR Epidémiologique et de Surveillance Transport Travail Environnement, IFSTTAR (French Institute of Science and Technology for Transport, Spatial Planning, Development and Networks), Université Lyon1 , UMR , Bron , France
| | - Etienne Javouhey
- b UMR Epidémiologique et de Surveillance Transport Travail Environnement, IFSTTAR (French Institute of Science and Technology for Transport, Spatial Planning, Development and Networks), Université Lyon1 , UMR , Bron , France
- c Pediatric Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon , Bron , France
| | - Olivier Monneuse
- d Emergency and Trauma Surgery Department , Hôpital Édouard Herriot, Hospices Civils de Lyon , France
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Dai W, Liu A, Kaminga AC, Deng J, Lai Z, Yang J, Wen SW. Prevalence of acute stress disorder among road traffic accident survivors: a meta-analysis. BMC Psychiatry 2018; 18:188. [PMID: 29895273 PMCID: PMC5998549 DOI: 10.1186/s12888-018-1769-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/29/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Road traffic accident (RTA), an unexpected traumatic event, may not only lead to death and serious physical injuries, but also could put survivors at an increased risk for a wide range of psychiatric disorders, particularly acute stress disorder (ASD). Early assessment of trauma-related psychological responses is important because acute trauma responses in the early post-traumatic period are among the robust predictors of long-term mental health problems. However, estimates of the prevalence of ASD among RTA survivors varied considerably across studies. Therefore, this meta-analysis aimed to identify the pooled prevalence of ASD among RTA survivors. METHODS A systematic literature search in the databases of PubMed, PsycINFO, PsycARTICLES, Embase and Web of Science was performed from their inception dates to December 2017. Subject headings were used to identify relevant articles, and the search strategy was adjusted across databases. Heterogeneity across studies was evaluated by Cochran's χ2 test and quantified by the I2 statistic. Subgroup analyses were performed to identify the pooled prevalence in relation to the country of study, instrument used to identify ASD, age, gender and traumatic brain injury. When significant heterogeneity was observed, the influence of some potential moderators was explored using meta-regression analyses. RESULTS Thirteen eligible studies conducted in 8 countries were included. A total of 2989 RTA survivors were assessed, of which 287 were identified with ASD. The overall heterogeneity was high across studies (I2=96.8%, P < 0.001), and the pooled prevalence of ASD among RTA survivors was 15.81% (95% confidence interval: 8.27-25.14%). Subgroup analyses indicated that the prevalence of ASD among RTA survivors differed significantly with regard to the country of study, instrument used to identify ASD, age and gender (P < 0.05). Meta-regression analyses showed that mean age of participants and quality assessment score were significant moderators for heterogeneity (P < 0.05). CONCLUSIONS Nearly one-sixth of RTA survivors suffer from ASD, indicating the need for regular assessment of early trauma responses among RTA survivors, as well as the importance of implementing early psychological interventions.
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Affiliation(s)
- Wenjie Dai
- 0000 0001 0379 7164grid.216417.7Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan China ,0000 0001 2182 2255grid.28046.38OMNI Research Group, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, ON Canada ,0000 0000 9606 5108grid.412687.eOttawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON Canada ,0000 0001 2182 2255grid.28046.38School of Epidemiology, Public Health, and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
| | - Aizhong Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.
| | - Atipatsa C. Kaminga
- 0000 0001 0379 7164grid.216417.7Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan China ,grid.442592.cDepartment of Mathematics, Mzuzu University, Mzuzu, Malawi
| | - Jing Deng
- 0000 0001 0379 7164grid.216417.7Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan China
| | - Zhiwei Lai
- Immunization Programme Department, Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan China
| | - Jianzhou Yang
- grid.254020.1Department of Preventive Medicine, Changzhi Medical College, Changzhi, Shanxi China
| | - Shi Wu Wen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China. .,OMNI Research Group, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. .,Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada. .,School of Epidemiology, Public Health, and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
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Abstract
Road traffic accidents are still a major cause of morbidity and mortality. With well-established whole-body CT protocols in trauma, radiologists are an integral part of trauma diagnosis and management teams. Five well-recognized traumatic syndromes (seat belt syndrome, handlebar syndrome, scapulothoracic dissociation, dashboard syndrome, and brake pedal injury) with their frequent associated complications should be diagnosed precociously according to the accident mechanism to avoid diagnostic delays and poor prognosis even if the circumstances seem minor.
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Affiliation(s)
- Sanaa Kissi
- Department of Diagnostic Imaging and Interventional Radiology, Caen University Hospital Center, Normandy University (UNICAEN), Caen, France.
| | - L Fournier
- Department of Diagnostic Imaging and Interventional Radiology, Caen University Hospital Center, Normandy University (UNICAEN), Caen, France
| | - N How Kit
- Department of Diagnostic Imaging and Interventional Radiology, Caen University Hospital Center, Normandy University (UNICAEN), Caen, France
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Abebe Y, Dida T, Yisma E, Silvestri DM. Ambulance use is not associated with patient acuity after road traffic collisions: a cross-sectional study from Addis Ababa, Ethiopia. BMC Emerg Med 2018; 18:7. [PMID: 29433441 PMCID: PMC5810000 DOI: 10.1186/s12873-018-0158-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/06/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Africa accounts for one sixth of global road traffic deaths-most in the pre-hospital setting. Ambulance transport is expensive relative to other modes of pre-hospital transport, but has advantages in time-sensitive, high-acuity scenarios. Many countries, including Ethiopia, are expanding ambulance fleets, but clinical characteristics of patients using ambulances remain ill-defined. METHODS This is a cross-sectional study of 662 road traffic collisions (RTC) patients arriving to a single trauma referral center in Addis Ababa, Ethiopia, over 7 months. Emergency Department triage records were used to abstract clinical and arrival characteristics, including acuity. The outcome of interest was ambulance arrival. Secondary outcomes of interest were inter-facility referral and referral communication. Descriptive and multivariable statistics were computed to identify factors independently associated with outcomes. RESULTS Over half of patients arrived with either high (13.1%) or moderate (42.2%) acuity. Over half (59.0%) arrived by ambulance, and nearly two thirds (65.9%) were referred. Among referred patients, inter-facility communication was poor (57.7%). Patients with high acuity were most likely to be referred (aOR 2.20, 95%CI 1.16-4.17), but were not more likely to receive ambulance transport (aOR 1.56, 95%CI 0.86-2.84) or inter-facility referral communication (aOR 0.98, 95%CI 0.49-1.94) than those with low acuity. Nearly half (40.2%) of all patients were referred by ambulance despite having low acuity. CONCLUSIONS Despite ambulance expansion in Addis Ababa, ambulance use among RTC patients remains heavily concentrated among those with low-acuity. Inter-facility referral appears a primary contributor to low-acuity ambulance use. In other contexts, similar routine ambulance monitoring may help identify low-value utilization. Regional guidelines may help direct ambulance use where most valuable, and warrant further evaluation.
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Affiliation(s)
- Yonas Abebe
- Department of Emergency and Critical Care Nursing, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tolesa Dida
- Department of Emergency and Critical Care Nursing, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Engida Yisma
- School of Allied Health Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Robinson Research Institute, School of Medicine, The University of Adelaide, Adelaide, Australia
| | - David M. Silvestri
- National Clinician Scholars Program and Department of Emergency Medicine, Yale School of Medicine, New Haven, USA
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Chelly H, Bahloul M, Ammar R, Dhouib A, Mahfoudh KB, Boudawara MZ, Chakroun O, Chabchoub I, Chaari A, Bouaziz M. Clinical characteristics and prognosis of traumatic head injury following road traffic accidents admitted in ICU "analysis of 694 cases". Eur J Trauma Emerg Surg 2017; 45:245-253. [PMID: 29234838 DOI: 10.1007/s00068-017-0885-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 12/01/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND The aim of the present study is to analyze the clinical and epidemiological characteristics of Traumatic Brain Injury (TBI) following Road Traffic Accidents (RTAs). Moreover, we aim to evaluate the outcome of the TBI victims referred to our medico-surgical Intensive Care Unit (ICU), and to define predictive factors associated with poor prognosis. METHODS A retrospective study over a 4-year period (2009 to 2012) of 694 patients with head injuries, incurred during road traffic accidents, admitted to the Intensive Care Unit (ICU) of a university hospital (Sfax-Tunisia). Basic demographic, clinical, biological, and radiological data were recorded on admission and during the ICU stay. RESULTS There were 592 males (85.3%), and 102 female patients. The mean age was at 31.8 ± 17.8 years (range 1-91). The mechanism of the accident was detailed in 666 patients (96%). The majority of the victims were motorcycle riders and/or passengers (40.5%), followed by pedestrians (29.1%). Extra-cranial pathology was present in 452 patients (65%). A total of 677 patients (97.6%) required intubation, mechanical ventilation, and sedation. Mean ICU stay was 16 ± 17.4 days. A total of 187 patients (26.9%) died during their hospital stay. The GOS performed within a mean delay of 6 months after hospital discharge was as follows: 198 deaths (28.5%), 13 vegetative state (1.9%), and 349 (50.3%) good recovery and/or moderate disability. A multivariate analysis showed that the factors which correlated with a poor prognosis (mortality and severe disability) were: age > 38 years, Glasgow coma scale score < 8, subdural hematoma, and development of secondary systemic insults (respiratory, circulatory, and metabolic). CONCLUSION In Tunisia, traumatic brain injury due to RTAs is a frequent cause of ICU admission, especially among young adults, and is associated with high mortality and morbidity rates. The majority of the victims were motorcycle riders and/or passengers and pedestrians. The factors associated with a poor outcome were: age > 38 years, Glasgow Coma Scale score < 8, subdural hematoma, and development of secondary systemic insults (respiratory, circulatory, and metabolic). As a consequence, prevention is highly warranted.
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Affiliation(s)
- Hedi Chelly
- Department of Intensive Care, Habib Bourguiba University Hospital, 3029, Sfax, Tunisia
| | - Mabrouk Bahloul
- Department of Intensive Care, Habib Bourguiba University Hospital, 3029, Sfax, Tunisia.
| | - Rania Ammar
- Department of Intensive Care, Habib Bourguiba University Hospital, 3029, Sfax, Tunisia
| | - Ahmed Dhouib
- Department of Intensive Care, Habib Bourguiba University Hospital, 3029, Sfax, Tunisia
| | | | | | - Olfa Chakroun
- Departement of Emergency Medicine, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Imen Chabchoub
- Department of Pediatrics, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Anis Chaari
- Department of Intensive Care, Habib Bourguiba University Hospital, 3029, Sfax, Tunisia
| | - Mounir Bouaziz
- Department of Intensive Care, Habib Bourguiba University Hospital, 3029, Sfax, Tunisia
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Rubin G, Peleg K, Givon A, Rozen N. Upper extremity open fractures in hospitalized road traffic accident patients: adult versus pediatric cases. J Orthop Surg Res 2017; 12:157. [PMID: 29065899 PMCID: PMC5655987 DOI: 10.1186/s13018-017-0657-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 10/16/2017] [Indexed: 11/10/2022] Open
Abstract
Background Fractures in pediatrics show epidemiological characteristics which are different from fractures in adults. The objective of this study was to examine the injury profiles of open upper extremity fractures (UEFs) in all modes of injury related to road traffic accidents (RTAs) in adult and pediatric hospitalized patients. Methods Data on 103,465 RTA patients between 1997 and 2013 whose records were entered in a centralized country trauma database were reviewed. Data on open UEFs related to mode of injury (car, motorcycle, bicycle, and pedestrian) was compared between adult (18+ years) and pediatric (0–17 years) RTA patients. Results Of 103,465 RTA cases, 17,263 (16.7%) had UEFs. Of 73,087 adults, 13,237 (18.1%) included UEFs and of 30,378 pediatric cases, 4026 (13.2%) included UEFs (p < 0.0001). Of 17,263 cases with UEFs, we reviewed 22,132 fractures with 2, 743 (12.4%) open fractures. Adults had a greater risk for open fractures (2221, 13%) than the pediatric cases (522, 10.3%) (p < 0.0001). Overall, of a total of 22,132 UEFs, most of the fractures were in the radius (22.8%), humerus (20.3%), clavicle (17.5%), and ulna (15.4%). The adult pedestrian group had a significantly higher risk for open UEFs than the pediatric group (11 vs 8%, p = 0.0012). Conclusions This study demonstrates the difference between adult and pediatric open fractures in hospitalized RTAs. We showed that adults had a greater risk for open UEFs compared to children, and the adult pedestrian group particularly had a significantly higher risk for open UEFs than the pediatric group.
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Affiliation(s)
- Guy Rubin
- Orthopaedic Department, Emek Medical Center, Afula, Israel. .,Faculty of Medicine, Technion, Haifa, Israel.
| | - Kobi Peleg
- National Center for Trauma & Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Adi Givon
- National Center for Trauma & Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Nimrod Rozen
- Orthopaedic Department, Emek Medical Center, Afula, Israel.,Faculty of Medicine, Technion, Haifa, Israel
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Mumtaz U, Zahur Z, Raza MA, Mumtaz M. Ultrasound And Supine Chest Radiograph In Road Traffic Accident Patients: A Reliable And Convenient Way To Diagnose Pleural Effusion. J Ayub Med Coll Abbottabad 2017; 29:587-590. [PMID: 29330983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Portable bed side ultrasound and supine chest radiograph of 80 traumatic patients excluding very clinically unstable patients who subsequently underwent CT scan chest was done for traumatic effusion showing that ultrasound had a higher sensitivity than CXR, 88.23% and 77.94%, respectively, and a similar specificity of 100% and 100%, respectively. Objective of the study is to compare the diagnostic accuracy of high resolution ultrasound and supine chest x-ray in detection of pleural effusion in road traffic accident patients keeping plain CT chest as gold standard. METHODS This study was conducted in PIMS and PAEC General Hospital, Islamabad from 1st January to 15th December 2015. The current study examined total of 80 trauma (blunt and penetrating) patients coming to emergency departments of both hospitals specifically those who had road traffic accident history. Their portable bed side ultrasound and supine chest radiograph were performed for assessing pleural effusion and subsequently CT scan chest was done for confirmation as it's a gold standard. RESULTS Using CT findings as gold standard the sensitivity, specificity, positive predictive value and negative predictive value was assessed for both ultrasonography and chest radiography and found to be 88.23%,100%, 100%, 40% and 77.94%, 100%, 100%, 55.55% respectively with diagnostic accuracy of ultrasound 90% as compared to 81.25% for supine chest x-rays when compared with gold standard. CONCLUSIONS Ultrasound and chest x-ray can be used as a useful and suitable adjunct to CT in road traffic accident patients as these are easily available, non-invasive, no contrast required, can be performed on bed side and carries no or little radiation risk.
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Affiliation(s)
- Uzma Mumtaz
- Department of Radiology, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | - Zainab Zahur
- Department of Radiology, Pakistan Atomic Energy Commission General Hospital, Islamabad, Pakistan
| | - Muhammad Ali Raza
- Department of Paediatrics, Ayub Teaching Hospital Abbottabad, Pakistan
| | - Madiha Mumtaz
- Student Quaid e Azam Medical College Bahawalpur, Pakistan
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Ang BH, Chen WS, Lee SWH. Global burden of road traffic accidents in older adults: A systematic review and meta-regression analysis. Arch Gerontol Geriatr 2017; 72:32-38. [PMID: 28527382 DOI: 10.1016/j.archger.2017.05.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/16/2017] [Accepted: 05/07/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE OF THE STUDY This study aims to estimate the burden of road traffic accidents and death among older adults. DESIGN AND METHODS A systematic literature review was conducted on 10 electronic databases for articles describing Road Traffic Accident(RTA) mortality in older adults until September 2016. A random-effects meta-regression analyses was conducted to estimate the pooled rates of road traffic accidents and death. RESULTS A total 5018 studies were identified and 23 studies were included. Most of the reported older adults were aged between 60 and 74 years, with majority being male gender and sustained minor trauma due to Motor-Vehicle Collision (MVC). The overall pooled mortality rate was 14% (95% Confidence Interval, CI: 11%, 16%), with higher mortality rates in studies conducted in North America (15%, 95% CI: 12%, 18%) and older adults admitted to trauma centers (17%, 95% CI: 14%, 21%). Secondary analysis showed that the very elderly adults (aged >75years) and pedestrians had higher odds of mortality death (Odds Ratio, OR: 2.05, 95% CI: 1.25, 3.38; OR: 2.08, 95% CI: 1.63, 2.66, respectively). IMPLICATION A new comprehensive trauma management guidelines tailored to older adults should be established in low and middle-income countries where such guidelines are still lacking.
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Affiliation(s)
- Boon Hong Ang
- School of Science, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor, Malaysia
| | - Won Sun Chen
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor, Malaysia; Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Global Asia in the 21 st Century (GA21) Platform, Monash University Malaysia, Malaysia.
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Mahdian M, Fazel MR, Sehat M, Khosravi G, Mohammadzadeh M. Epidemiological Profile of Extremity Fractures and Dislocations in Road Traffic Accidents in Kashan, Iran: a Glance at the Related Disabilities. Arch Bone Jt Surg 2017; 5:186-192. [PMID: 28656167 PMCID: PMC5466864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 08/30/2016] [Indexed: 06/07/2023]
Abstract
BACKGROUND Apart from the mortality, road traffic injuries are associated with significant morbidities. This study has aimed to examine the pattern of traffic accident-related extremity fractures/dislocations and their related disabilities. METHODS A retrospective hospital-based study was conducted to assess the characteristics of limb fractures/dislocations among road traffic accident victims registered in Trauma Research Center registry of Kashan University of Medical Sciences, Kashan, Iran, during 2012-2013. Age and sex distribution, cause of injury, and site of fractures/dislocations were recorded. Years lived with disability (YLD) was calculated as a scale to measure the disability. One-way ANOVA and chi-square tests were used for data analysis. RESULTS From a total of 962 subjects, 812 (84.4%) were males (the male/female sex ratio: 5.4:1). The mean age of victims was 32.7±17.9. Leg (37%) and forearm (19%) fractures were the most frequent fractures. Shoulder dislocations were among the most affected joints accounting for 36.6% of the cases. The total calculated YLD was 135.6 (34.4 for temporal and 101.2 for lifelong disabilities, and totally 117.3 and 18.3 for males and females, respectively). The highest YLD was for motorcyclists (104) and while the most YLD was for 15-29 years (68.2). CONCLUSION Young men motorcyclist accidents are a major problem in Kashan region. Generally, they have been accounted for the highest YLD due to fractures/dislocations, especially in lower extremity. Although the calculated YLD will be decreased with increasing age, the elder people also had the high rate of traffic-related limb injuries.
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Affiliation(s)
- Mehrdad Mahdian
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohammad R Fazel
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Mojtaba Sehat
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
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Fararouei M, Sedaghat Z, Sadat SJ, Shahraki G. Risk factors for being the at-fault driver: A case-control study. Traffic Inj Prev 2017; 18:262-266. [PMID: 27715286 DOI: 10.1080/15389588.2016.1244604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 09/29/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE It is estimated that road traffic accidents are globally responsible for approximately 1.2 million deaths and 20 to 50 million injuries. About 70% of traffic incidences (TIs) occur in developing countries and among countries with high TI rates; Iran is the first. The aim of this study was to measure the association between being responsible for a traffic accident and some vehicle, human; and environmental related factors in Yasuj, a city with a high incidence of road traffic injuries and deaths in Iran. METHODS This is a time-, date-, and place-matched case-control study conducted in 2015 using all traffic accidents registered and investigated by police during 2012. In total, 194 drivers were considered the at-fault driver in a traffic accident and the 194 drivers in the same collisions were included in the analysis. RESULTS Based on the results from multivariate conditional logistic regression, significant associations between vehicle maneuver (ORTurn to right or left/Moving forward = 11.10, 95% confidence interval [CI], 1.77-69.58, P = .01) and age (odds ratio [OR] = 1.11, 95% CI, 1.004-1.22, P = .04) and the chance of being an at-fault driver were found. CONCLUSION Driver behavior-related interventions including training and law enforcement seem to be more effective in reducing road traffic accidents in Iran.
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Affiliation(s)
- Mohammad Fararouei
- a HIV/AIDS Research Center, Shiraz University of Medical Sciences , Iran
| | - Zahra Sedaghat
- b Research Center for Health Sciences, Department Epidemiology , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Seyed Javad Sadat
- c Faculty of Nursing and Midwifery , Yasuj University of Medical Sciences , Yasuj , Iran
| | - Gholamhossein Shahraki
- d Social Determinants of Health Research Center , Yasuj University of Medical Sciences , Yasuj , Iran
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Zainal Abidin H, Muhd Besari A, Nadarajan C, Wan Shukeri WF, Mazlan MZ, Chong SE, Salmuna Ayub ZN. Acute bacteremic pneumonia due to melioidosis developing in the intensive care setting. IDCases 2017; 8:63-65. [PMID: 28417070 PMCID: PMC5390664 DOI: 10.1016/j.idcr.2017.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/23/2017] [Accepted: 03/23/2017] [Indexed: 11/19/2022] Open
Abstract
Patients who are diagnosed with melioidosis pose significant challenges to the medical team involved because it involves a high rate of morbidity and mortality. Managing cases of melioidosis is multidisciplinary as it may manifest under various clinical situations. In endemic area, melioidosis can occur in immunocompetent youths with no recognisable risk factors.
In Malaysia, melioidosis is commonly encountered as this infection is known as part of the endemic area for the disease. Managing cases of positive Burkholderia pseudomallei infection can involve multidisciplinary unit mainly, microbiologist, infectious disease team and intensive care as it may be quite difficult to distinguish melioidosis from a number of other diseases on the clinical setting alone. Laboratory diagnosis plays a vital role in determining the direction of management. Investigations such as culture, polymerase chain reaction (PCR) and serology should be evaluated once the disease is suspected. In this particular case, the patient is a young adult involved in a road traffic accident. Unlike any other cases with melioidosis, he had no potential risk factors which may have contributed to the severity of the disease and it is likely that the site of the accident was the source of acquisition of this gram negative bacterium.
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Affiliation(s)
- Huda Zainal Abidin
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
| | - Alwi Muhd Besari
- Department of Internal Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
| | - Chandran Nadarajan
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
| | - Wan Fadzlina Wan Shukeri
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
| | - Mohd Zulfakar Mazlan
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
| | - Soon Eu Chong
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Malaysia
| | - Zeti Norfidiyati Salmuna Ayub
- Department of Microbiology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
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Hussain K, Abu-Khumra SKA, Alnajjar FJK, Abdo MM. Triple trouble: A case of traumatic cervical spinal cord injury in a patient with ossification of posterior longitudinal ligament and disc prolapse. Turk J Emerg Med 2016; 16:129-131. [PMID: 27857994 PMCID: PMC5103061 DOI: 10.1016/j.tjem.2015.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 02/02/2015] [Accepted: 02/11/2015] [Indexed: 11/23/2022] Open
Abstract
We describe the case of a trauma patient who presented to our emergency department with signs and symptoms suggestive of cervical cord injury. The patient had an underlying ossification of the posterior longitudinal ligament with multiple cervical disc prolapses from C3 to C7. The presence of these two factors increased the impact of the traumatic cervical cord injury. The patient underwent spinal decompression via laminectomy. Unfortunately, his neurological status did not show any significant improvement after the surgery. Our aim is to highlight the association between ossification of the posterior longitudinal ligament and spinal cord injury in trauma patients.
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Affiliation(s)
- Kosar Hussain
- Department of Internal Medicine, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Sally Khalid Ahmed Abu-Khumra
- Department of Emergency Medicine, Rashid Hospital Trauma Center, Dubai Health Authority, Dubai, United Arab Emirates
| | - Firas Jaafar Kareem Alnajjar
- Department of Emergency Medicine, Rashid Hospital Trauma Center, Dubai Health Authority, Dubai, United Arab Emirates
| | - Motea Mohamad Abdo
- Department of Emergency Medicine, Rashid Hospital Trauma Center, Dubai Health Authority, Dubai, United Arab Emirates
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Nangana LS, Monga B, Ngatu NR, Mbelambela EP, Mbutshu LH, Malonga KF. Frequency, causes and human impact of motor vehicle-related road traffic accident (RTA) in Lubumbashi, Democratic Republic of Congo. Environ Health Prev Med 2016; 21:350-355. [PMID: 27146069 DOI: 10.1007/s12199-016-0536-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/25/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Road traffic accident (RTA)-related trauma remains a public health issue. The aim of this study was to determine the frequency, causes and human impact of motor vehicle-related RTA in Lubumbashi, Democratic Republic of Congo. METHODS A prospective cross-sectional study was conducted in the first semester of the year 2015 in which 288 drivers (144 RTA-causing drivers and 144 control drivers who have been declared not guilty by road safety agents) involved in 144 motor vehicle-related RTA were interviewed, and only data on all RTA involving two motor vehicles with at least four wheels were recorded and analyzed. RESULTS Results showed a total of 144 RTA that involved two motor vehicles with four wheels occurring during the study period which affected 104 people, including 93 injury and 11 fatality cases. The mean age of RTA-causing drivers was 33.8 ± 7.4, whereas it was 35 ± 8.8 for control drivers. The majority of RTA-causing drivers (53.4 %) did not attend a driving school. Over speeding (32 %), distracted driving (22 %), overtaking (16 %) and careless driving/risky maneuver (15 %) and driving under the influence of alcohol (9 %) were the main causes of RTA occurrence. In addition, the absence of a valid driving license [aOR = 12.74 (±2.71); 95 % CI 3.877-41.916; p = 0.015], unfastened seat belt for the RTA-causing driver [aOR = 1.85 (±0.62); 95 % CI 1.306-6.661; p = 0.048] and presence of damages on RTA-causing vehicle [aOR = 33.56 (24.01); 95 % CI 1.429-78.352; p = 0.029] were associated with the occurrence of RTA-related fatality. CONCLUSION This study showed a relatively high frequency of RTA occurring in Lubumbashi and suggests the necessity to reinforce road traffic regulation.
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Affiliation(s)
- Luzitu Severin Nangana
- Ecole de Santé Publique, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Ben Monga
- Ecole de Santé Publique, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Nlandu Roger Ngatu
- Graduate School of Health Sciences and Nursing, and Disaster Nursing Global Leading doctoral Program (DNGL), University of Kochi, Ike Campus. 2751-1 Ike, Office No C222, Kochi-city, Kochi prefecture, 781-8515, Japan.
| | | | - Lukuke Hendrick Mbutshu
- Ecole de Santé Publique, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Kaj Francoise Malonga
- Ecole de Santé Publique, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
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Al Beteddini OS, Abdulla S, Omari O. Traumatic abdominal wall hernia: A case report and literature review. Int J Surg Case Rep 2016; 24:57-9. [PMID: 27180322 PMCID: PMC4873567 DOI: 10.1016/j.ijscr.2016.03.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 03/26/2016] [Accepted: 03/26/2016] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Traumatic abdominal wall hernia is a rare but serious diagnosis resulting from blunt abdominal trauma. The clinical diagnosis is not usually straightforward and the hernia is often discovered at the time of the surgical exploration for intra-abdominal injuries or by imaging studies. PRESENTATION OF CASE A 25-year-old obese, restraint, male patient was the victim of a high-speed road traffic accident. Among other injuries, he showed extensive skin maceration and bruising over the lower abdomen and flanks upon presentation, however he did not need any surgical intervention. Contrast-enhanced computed tomography scan of the abdomen and pelvis demonstrated extensive abdominal wall muscular disruption over both flanks with herniation of the right colon. Counselled to follow up in 4-6 weeks to have the hernia surgically repaired, he showed up after 8 months with a large muscular defect resulting in a large hernia containing small and large bowel loops. DISCUSSION The timing and type of the surgical repair of traumatic abdominal wall hernia depends upon the size of the hernia defect and the presence of associated intra-abdominal injuries. Delayed repair; however, may result in a large defect making primary, non-prosthetic repair impossible and increases the risk of abdominal compartment syndrome after surgical correction. CONCLUSION Traumatic abdominal wall hernia presents a diagnostic as well as a therapeutic challenge. The therapeutic approach is governed by a multitude of factors emphasizing the need of a patient-tailored, case by case management plan.
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Affiliation(s)
- Osama S Al Beteddini
- Department of Surgery, Johns Hopkins Aramco Healthcare/Dhahran Health Center, Saudi Aramco, PO Box: 76, Dhahran 31311, Eastern Province, Saudi Arabia.
| | - Samir Abdulla
- Department of Surgery, Johns Hopkins Aramco Healthcare/Dhahran Health Center, Saudi Aramco, PO Box: 76, Dhahran 31311, Eastern Province, Saudi Arabia.
| | - Osama Omari
- Department of Surgery, Johns Hopkins Aramco Healthcare/Dhahran Health Center, Saudi Aramco, PO Box: 76, Dhahran 31311, Eastern Province, Saudi Arabia.
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Tay EL, Lee SWH, Jamaluddin SF, Tam CL, Wong CP. The epidemiology of childhood brain injury in the state of Selangor and Federal Territory of Kuala Lumpur, Malaysia. BMC Pediatr 2016; 16:56. [PMID: 27122016 PMCID: PMC4847198 DOI: 10.1186/s12887-016-0590-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/19/2016] [Indexed: 11/10/2022] Open
Abstract
Background There are limited studies describing the epidemiology of childhood brain injury, especially in developing countries. This study analyses data from the Malaysian National Trauma Database (NTrD) registry to estimate the incidence of childhood brain injury among various demographic groups within the state of Selangor and Federal Territory of Kuala Lumpur. Methods This study analysed all traumatic brain injury cases for children ages 0–19 included in the 2010 NTrD report. Results A total of 5,836 paediatric patients were admitted to emergency departments (ED) of reporting hospitals for trauma. Of these, 742 patients (12.7 %) suffered from brain injuries. Among those with brain injuries, the mortality rate was 11.9 and 71.2 % were aged between 15 and 19. Traffic accidents were the most common mode of injury (95.4 %). Out of the total for traffic accidents, 80.2 % of brain injuries were incurred in motorcycle accidents. Severity of injury was higher among males and patients who were transferred or referred to the reporting centres from other clinics. Glasgow Coma Scale (GCS) total score and type of admission were found to be statistically significant, χ2 (5, N = 178) = 66.53, p < 0.001, in predicting patient outcomes. According to this analysis, the overall rate of childhood brain injury for this one year period was 32 per 100,000 children while the incidence of significant (moderate to severe) brain injury was approximately 8 per 100,000 children. Conclusions This study provides an overview of traumatic brain injury rates among children within the most populous region of Malaysia. Most brain injuries occurred among older male children, with traffic, specifically motorcycle-related, accidents being the main mode of injury. These findings point to risk factors that could be targeted for future injury prevention programs.
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Affiliation(s)
- Ee Lin Tay
- Tan Sri Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia Campus, Petaling Jaya, Malaysia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia Campus, Petaling Jaya, Malaysia
| | | | - Cai Lian Tam
- Tan Sri Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia Campus, Petaling Jaya, Malaysia
| | - Chee Piau Wong
- Tan Sri Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia Campus, Petaling Jaya, Malaysia.
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Boadi-Kusi SB, Kyei S, Asare FA, Owusu-Ansah A, Awuah A, Darko-Takyi C. Visual function among commercial vehicle drivers in the central region of Ghana. J Optom 2016; 9:54-63. [PMID: 26364760 PMCID: PMC4705311 DOI: 10.1016/j.optom.2015.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 06/10/2015] [Accepted: 06/10/2015] [Indexed: 06/05/2023]
Abstract
AIM To determine the relationship between some visual functions: colour vision defects, abnormal stereopsis, visual acuity and the occurrence of road traffic accident (RTAs) among commercial vehicle drivers in the central region of Ghana, and to assess their knowledge of these anomalies. METHOD A descriptive cross-sectional study employing a multi-stage random sampling approach was conducted in the major commercial towns within the central region of Ghana. Participants were taken through a comprehensive eye examination after the administration of a structured questionnaire. RESULTS 520 male commercial vehicle drivers were enrolled for this study with a mean age of 39.23 years ±10.96 years and mean visual acuity of 0.02±0.08 logMAR. Protans were more likely to be involved in RTAs (χ(2)=6.194, p=0.034). However, there was no statistically significant association between abnormal stereopsis (OR=0.89 95% CI: 0.44-1.80, p=0.56), poor vision due to refractive error (χ(2)=3.090, p=0.388) and the occurrence of RTAs. While 86.9% were aware of abnormal stereopsis, only 45% were aware of colour vision defects. There was a statistically significant association between stereopsis anomaly and colour vision defect (r=0.371, p<0.005). CONCLUSION The study found an association between protanopia and RTAs but none between stereopsis anomalies, refractive errors and the occurrence of RTAs. Drivers were less knowledgeable on colour vision defects as compared to stereopsis anomalies.
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Affiliation(s)
- Samuel Bert Boadi-Kusi
- Department of Optometry, School of Physical Sciences, University of Cape Coast, Cape Coast, Ghana; Discipline of Optometry, School of Health Sciences, University of KwaZulu-Natal, South Africa.
| | - Samuel Kyei
- Department of Optometry, School of Physical Sciences, University of Cape Coast, Cape Coast, Ghana; Discipline of Optometry, School of Health Sciences, University of KwaZulu-Natal, South Africa
| | - Frederick Afum Asare
- Department of Optometry, School of Physical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Andrew Owusu-Ansah
- Department of Optometry, School of Physical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Agnes Awuah
- Department of Optometry, School of Physical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Charles Darko-Takyi
- Department of Optometry, School of Physical Sciences, University of Cape Coast, Cape Coast, Ghana
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Giri KY, Singh AP, Dandriyal R, Indra N, Rastogi S, Mall SK, Chowdhury S, Singh HP. Incidence and pattern of mandibular fractures in Rohilkhand region, Uttar Pradesh state, India: A retrospective study. J Oral Biol Craniofac Res 2015; 5:140-5. [PMID: 26587379 PMCID: PMC4623881 DOI: 10.1016/j.jobcr.2015.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 07/27/2015] [Indexed: 11/16/2022] Open
Abstract
AIMS To understand and evaluate the significance of various aetiological factors in determining the incidence and dictating the patterns of mandibular fractures in Rohilkhand region. METHODS The patient records and radiographs for 144 patients treated for mandibular fractures were reviewed between the time periods from January 2012 to December 2013. Data on age, gender, aetiology, use of intoxicants, head injury, associated injuries, days of the week, anatomic site and multiple fractures within the mandible were recorded and assessed. RESULTS Maximum incidence of fractures was observed among the individuals in 3rd decade (35.4%) followed by 2nd and 4th decades, which exhibited 32 and 30 cases (22.2% and 20.8%), respectively. Male to female ratio was biased (4:1) portraying a male predominance. Road traffic accidents (RTAs) were observed to be the predominant aetiological factor responsible accounting for 79.2% of the total injuries followed by assaults (11.8%) and falls (9%). Parasymphysis exhibited the highest incidence (32.63%) amongst the anatomic sites, followed by body (18.75%), angle (16.66%), condyle (15.27%), symphysis (12.50%), ramus (2.77%) and coronoid (1.38%). CONCLUSION The study reveals that majority of affected patients were in the 2nd and 3rd decades. A definitive relationship existed between RTA and the incidence of mandibular fractures. The frequency further increased with consumption of social intoxicants. The most commonly fractured site was parasymphysis either isolated or associated with other fractures in the mandible.
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Affiliation(s)
- Kolli Yada Giri
- Professor and HOD, Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Pilibhit By Pass Road, Bareilly, Uttar Pradesh, India, 243006
| | - Aishwarya Pratap Singh
- Post Graduate Student, Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Pilibhit By Pass Road, Bareilly, Uttar Pradesh, India, 243006
| | - Ramakant Dandriyal
- Professor, Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Pilibhit By Pass Road, Bareilly, Uttar Pradesh, India, 243006
| | - Niranjanaprasad Indra
- Reader, Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Pilibhit By Pass Road, Bareilly, Uttar Pradesh, India, 243006
| | - Sanjay Rastogi
- Reader, Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Pilibhit By Pass Road, Bareilly, Uttar Pradesh, India, 243006
| | - Sunil Kumar Mall
- Senior Lecturer, Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Pilibhit By Pass Road, Bareilly, Uttar Pradesh, India, 243006
| | - Shouvik Chowdhury
- Senior Lecturer, Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Pilibhit By Pass Road, Bareilly, Uttar Pradesh, India, 243006
| | - Himanshu Pratap Singh
- Senior Lecturer, Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Pilibhit By Pass Road, Bareilly, Uttar Pradesh, India, 243006
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74
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Abstract
Driving is a complex process that places considerable demands on cognitive and physical functions. Many complications of diabetes can potentially impair driving performance, including those affecting vision, cognition and peripheral neural function. Hypoglycemia is a common side-effect of insulin and sulfonylurea therapy, impairing many cognitive domains necessary for safe driving performance. Driving simulator studies have demonstrated how driving performance deteriorates during hypoglycemia. Driving behavior that may predispose to hypoglycemia while driving is examined. Studies examining the risk of road traffic accidents in people with insulin-treated diabetes have produced conflicting results, but the potential risk of hypoglycemia-related road traffic accidents has led to many countries imposing restrictions on the type and duration of driving licenses that can be issued to drivers with diabetes. Guidance that promotes safe driving practice has been provided for drivers with insulin-treated diabetes, which is the group principally addressed in this review.
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Affiliation(s)
- Alex J Graveling
- JJR Macleod Centre for Diabetes & Endocrinology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZP UK
| | - Brian M Frier
- The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, EH16 4TJ UK
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75
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Kumar S, Bansal YS, Singh D, Medhi B. Alcohol and Drug Use in Injured Drivers - An Emergency Room Study in a Regional Tertiary Care Centre of North West India. J Clin Diagn Res 2015; 9:HC01-4. [PMID: 26393144 DOI: 10.7860/jcdr/2015/14840.6239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 06/17/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Statistics show an increasing proportion of alcohol and drug use in drivers in more recent times throughout the world. It has been found that among the various human factors, alcohol consumption, using drugs and subsequent driving on the roads are major risk factors. Traffic regulations in India penalises drivers who drive beyond permissible alcohol limit of 30 mg%. Consumption of psychoactive drugs such as opioid, cannabis and benzodiazepines has been reported mainly among youngsters. Hardly any data is available in Indian context particularly from North-West Zone of India. STUDY OBJECTIVE To study the pattern of alcohol, opioid, cannabis and benzodiazepines use in injured drivers presenting to a designated trauma centre in Chandigarh zone of North-West India. MATERIALS AND METHODS Consenting injured drivers who presented to the trauma centre in Chandigarh from September 2013 to January 2014 were included. Urine samples collected from the subjects were screened for abusive drug exposure (opioid, cannabis and benzodiazepines) and alcohol using commercial bedside urine immunoassay kits. In urine alcohol positive cases blood samples were collected and analysed for alcohol concentration using standard gas chromatography. Retrograde extrapolation method was used to assess BAC at the time of accident. RESULTS A total of 200 injured drivers were included in this study. We found substance consumption in 54.5% of drivers and alcohol (40.5%) was the most prevalent substance consumed followed by opiates (13%), cannabis (7%) and benzodiazepines (7%). More than one substance was shown in urine of 11.5% of drivers. Among 81 alcohol positive screening cases, the quantitative analysis was successfully done for 76 cases. Except one, all cases showed BAC value more than 30 mg% which is the legal limit for driving any vehicle in India. The values of alcohol concentration in blood at the time of accident were in the range of 20 to 391 mg%. CONCLUSION This study has shown that drivers are consuming not only alcohol but other psychoactive drugs also. Indian traffic regulatory authorities are penalising drunk drivers by doing road side breath alcohol testing with no protocols for drug screening. Appropriate measures should be adopted to screen traffic offenders for psychoactive drugs also.
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Affiliation(s)
- Senthil Kumar
- Senior Resident, Department of Forensic Medicine, PGIMER , Chandigarh, India
| | | | - Dalbir Singh
- Professor, Department of Forensic Medicine, PGIMER , Chandigarh, India
| | - Bikash Medhi
- Additional Professor, Department of Pharmacology, PGIMER , Chandigarh, India
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76
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Bogstrand ST, Larsson M, Holtan A, Staff T, Vindenes V, Gjerde H. Associations between driving under the influence of alcohol or drugs, speeding and seatbelt use among fatally injured car drivers in Norway. Accid Anal Prev 2015; 78:14-19. [PMID: 25725424 DOI: 10.1016/j.aap.2014.12.025] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 12/08/2014] [Accepted: 12/11/2014] [Indexed: 06/04/2023]
Abstract
Since 2005, all fatal road traffic crashes in Norway have been analyzed in-depth by multidisciplinary investigation teams organized by the Norwegian Public Roads Administration (NPRA). During the period 2005-2010, 608 drivers of cars or vans were killed in road traffic crashes. Blood samples were collected from 372 (61%) of the drivers and analyzed for alcohol and a large number of psychoactive drugs at the Norwegian Institute of Public Health (NIPH). After coupling the analytical results with the NPRA crash database, 369 drivers with a fatal outcome were identified and included. Alcohol or drug concentrations in blood above the legal limits were found in 39.8% of the drivers who were investigated for alcohol or drug impairment; 33.9% had blood alcohol concentrations above 0.5g/L or concentrations of drugs above the equivalent Norwegian legal impairment limits or concentrations of amphetamines above 200μg/L. Among drivers with a fatal outcome who had been impaired by alcohol or drugs, 64.6% were unbelted and 71.7% were speeding when the crash occurred; whereas 24.2% and 33.2% of the sober drivers were unbelted or speeding, respectively. Statistically significant associations were found between impairment by alcohol or amphetamines and driving unbelted or speeding. Excessive speeding is one of the main reasons for road traffic crashes and together with being unbelted the main reasons for a fatal outcome. This behavior might in many cases be due to increased risk-taking or negligence of safety measures as a result of alcohol or drug use.
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Affiliation(s)
- Stig Tore Bogstrand
- Division of Forensic Medicine and Drug Abuse Research, Norwegian Institute of Public Health, P.O. Box 4404 Nydalen, NO-0403 Oslo, Norway; Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4956 Nydalen, NO-0424 Oslo, Norway; Lovisenberg University College, Lovisenberggt. 15b, NO-0456 Oslo, Norway.
| | - Magnus Larsson
- Division for Traffic Safety, Environment and Technology, the Norwegian Public Roads Administration, P.O. Box 8142 Dep, NO-0033 Oslo, Norway
| | - Anders Holtan
- Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4956 Nydalen, NO-0424 Oslo, Norway
| | - Trine Staff
- Division for Traffic Safety, Environment and Technology, the Norwegian Public Roads Administration, P.O. Box 8142 Dep, NO-0033 Oslo, Norway
| | - Vigdis Vindenes
- Division of Forensic Medicine and Drug Abuse Research, Norwegian Institute of Public Health, P.O. Box 4404 Nydalen, NO-0403 Oslo, Norway
| | - Hallvard Gjerde
- Division of Forensic Medicine and Drug Abuse Research, Norwegian Institute of Public Health, P.O. Box 4404 Nydalen, NO-0403 Oslo, Norway
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77
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Batailler P, Hours M, Maza M, Charnay P, Tardy H, Tournier C, Javouhey E. Health status recovery at one year in children injured in a road accident: a cohort study. Accid Anal Prev 2014; 71:267-272. [PMID: 24956131 DOI: 10.1016/j.aap.2014.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 05/14/2014] [Accepted: 06/03/2014] [Indexed: 06/03/2023]
Abstract
Despite the frequency of traumatic injuries due to road accidents and potential importance of identifying children at risk of impaired recovery one year after a road accident, there is a lack of data on long-term recovery of health status, except in children with severe traumatic brain injury. The aim of the present study was to evaluate predictive factors of recovery in children one year after road traffic injuries. The prospective cohort study was composed of children aged <16 years, admitted to public or private sector hospitals in the Rhône administrative area of France following a road accident. Recovery of health status one year after the accident and information concerning quality of life and the consequences of the accident for the child or family 1 year after the accident were collected by questionnaire, usually completed by the parents. Victims were in majority male (64.6%) and had mild or moderate injuries (81.9% with Maximum Abbreviated Injury Scale (M-AIS) <3). One year after the accident, 75.0% of the mild-to-moderate and 34.8% of the severe cases estimated health status as fully recovered. After adjustment, severity score (M-AIS≥3) and lower limb injury (AIS>1) were associated with incomplete recovery of health status: weighted odds ratio (ORw), 4.3 [95% confidence interval (95% CI), 1.3-14.6] and ORw, 6.5 [95% CI, 1.9-21.7], respectively. Recovery status correlated significantly with quality of life physical scores (r=0.46), especially body pain (r=0.48) and role/social-physical (r=0.50) and, to a lesser extent, quality of life psychosocial scores (r=0.21). In a cohort of children injured in a road accident, those with high injury severity score and those with lower limb injuries are less likely to recover full health status by 1 year. Impaired health status was associated with a lower physical quality of life score at 1 year.
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Affiliation(s)
- Pierre Batailler
- Epidemiological Research and Surveillance Unit in Transport Occupation and Environment-Université de Lyon, F-69622 Lyon, France; Université Lyon 1, UMRESTTE, F-69373 Lyon, France; IFSTTAR, UMRESTTE, F-69675 Bron, France
| | - Martine Hours
- Epidemiological Research and Surveillance Unit in Transport Occupation and Environment-Université de Lyon, F-69622 Lyon, France; Université Lyon 1, UMRESTTE, F-69373 Lyon, France; IFSTTAR, UMRESTTE, F-69675 Bron, France
| | - Maud Maza
- Epidemiological Research and Surveillance Unit in Transport Occupation and Environment-Université de Lyon, F-69622 Lyon, France; Université Lyon 1, UMRESTTE, F-69373 Lyon, France; IFSTTAR, UMRESTTE, F-69675 Bron, France
| | - Pierrette Charnay
- Epidemiological Research and Surveillance Unit in Transport Occupation and Environment-Université de Lyon, F-69622 Lyon, France; Université Lyon 1, UMRESTTE, F-69373 Lyon, France; IFSTTAR, UMRESTTE, F-69675 Bron, France
| | - Hélène Tardy
- Epidemiological Research and Surveillance Unit in Transport Occupation and Environment-Université de Lyon, F-69622 Lyon, France; Université Lyon 1, UMRESTTE, F-69373 Lyon, France; IFSTTAR, UMRESTTE, F-69675 Bron, France
| | - Charlène Tournier
- Epidemiological Research and Surveillance Unit in Transport Occupation and Environment-Université de Lyon, F-69622 Lyon, France; Université Lyon 1, UMRESTTE, F-69373 Lyon, France; IFSTTAR, UMRESTTE, F-69675 Bron, France
| | - Etienne Javouhey
- Epidemiological Research and Surveillance Unit in Transport Occupation and Environment-Université de Lyon, F-69622 Lyon, France; Université Lyon 1, UMRESTTE, F-69373 Lyon, France; IFSTTAR, UMRESTTE, F-69675 Bron, France; Pediatric Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.
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78
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Gupta A, Gupta AK, Patil K, Arora K. Eyelid Reconstruction: Everything Is Not Lost When All Is Lost. Indian J Surg 2015; 77:1428-9. [PMID: 27011590 DOI: 10.1007/s12262-014-1100-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 05/05/2014] [Indexed: 10/25/2022] Open
Abstract
Eyelid injuries are a common emergency room challenge in patients presenting with history of road traffic accidents. Overzealous debridement can result in tissue loss in which primary repair becomes impossible along with loss of critical landmarks especially in tissue as fragile as the eyelids. We present a 45-year-old male with avulsion injury of the right lower eyelid compounded by debridement at a primary health care facility. Nasolabial flap reconstruction was done with release of the bulbar conjunctiva to achieve aesthetic and functional endpoints. Adhering to the fundamental guidelines of repair of the eyelids as a primary and definitive surgery holds the crux to the best cosmetic and functional outcome.
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79
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Mittal G, Mittal S. Mandibular fractures at veer chandra singh garhwali government medical science and research institute, garhwal region, uttarakhand, India: a retrospective study. Ann Med Health Sci Res 2013; 3:161-5. [PMID: 23919182 PMCID: PMC3728855 DOI: 10.4103/2141-9248.113654] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Mandibular fractures constitute a substantial proportion of cases of maxillofacial trauma. Demographic data related to mandibular fractures are difficult to evaluate because of many variables associated with the studies. The information is as diverse as the countries and the people who inhabit them. Aim: This is a retrospective study designed to determine the site distribution, associated fracture and causes of mandibular fractures in patients presenting to the trauma centre of Veer Chandra Singh Garhwali Government Medical Science and Research Institute, Uttarakhand, India. Materials and Methods: Records of 121 patients with confirmed mandibular fractures presenting over a three year period (i.e., 1st January 2008 to 31st December 2010). Data obtained from record included age, sex, site of fracture and causes. Results: There were 48/121 (39.6%) males and 73/121 (60.3%) females. The most predominant age group of fracture was found to be 21-30 (53/121-43.8%) followed by 11-20 (25/121-20.6%). In this study history of fall was the most common cause of mandibular fracture (66/121-54.5%), followed by road traffic accidents (45/121-37.1%), fights and assault (08/121-6.6%) and industrial accidents (02/121-1.6%). In our study most of the patients suffered from fracture in the parasymphysis (35/139-25.1%) and angle region (32/139-23.0%) followed by body (30/139-21.5%), condyle (21/139-15.1%), symphysis (19/139-13.7%), and ramus (02/121-1.4%) area. Conclusion: In this study mandibular fractures were more prevalent in females especially during the second and third decade of life. History of fall was the most predominant cause of mandibular fracture. The most frequently affected sites were parasymphysis and angle.
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Affiliation(s)
- G Mittal
- Department of Dentistry, VCSGGMS and RI, Srinagar, Pauri, Garhwal, Uttarakhand, India
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80
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Abstract
Background: Hip fracture has been associated with various risk factors, including osteoporosis, excessive alcohol consumption, physical inactivity, visual impairment, aging, sex, rural/urban inhabitation, race and climatic variations. Mechanisms of hip fractures in many parts of the world have been documented, and include road traffic accident (RTA), gunshot injury, fall from heights and many others. There is paucity of such documentation in Owerri, Nigeria. Aim: This study was designed to investigate the mechanism of hip fractures in Owerri, Nigeria, and to determine its prevailing factors. Materials and Methods: The study was conducted in hospitals located in Owerri, Nigeria. Cases of hip fracture were identified from the medical register while data were sourced from the medical record department for hip fractures that occurred between 1st January 2002 and 31st December 2008 for patients resident in Owerri and aged between 10 years and above. Results: The study uncovered a total of 105 cases of hip fractures over the study period in 65% (n = 68) males and 35% (n = 37) females. Proportion of hip fractures as a result of fragility fracture mechanisms was significantly higher in females than in the males (P < 0.001), while the reverse was the case for RTA mechanisms. In the same vein, proportion of hip fractures as a result of moderate trauma mechanisms was significantly higher in the elderly than in the young patients (P < 0.001), while the reverse was the case for RTA mechanisms. Conclusion: Mechanism of hip fractures in Owerri, Nigeria, can be associated with gender and age. RTA had the largest single contributory mechanism of hip fractures in Owerri. Therefore, public health campaigns and promotions should be created to reduce the influence of RTA on hip fracture among this population. Among the elderly population, hip fracture was mostly sustained from fragility trauma mechanisms, suggesting that osteoporosis is a major contributory factor of hip fracture among this population.
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Affiliation(s)
- Ck Onwukamuche
- Department of Surgery, Orthopaedic Division, Federal Medical Centre, Owerri, Nigeria
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81
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Abstract
BACKGROUND To evaluate the cases of mandibular fractures treated by open reduction and rigid fixation at the Armed Forces Medical College, Pune. METHODS Two hundred and thirteen mandibular fractures cases were treated by open reduction and rigid fixation from Jun 1998 to Jun 2006. These were retrospectively analyzed based on the following patient related factors i.e. mode of injury, age and sex distribution, site of injury, associated injuries and surgical treatment. RESULT The significant finding was that the most common etiology for fracture mandible was road traffic accidents (RTA), [196 (92%)]. Of the patients who reported, 147 (95.4%) were males in the third decade of life. 96 (45%) patients had parasymphysis fractures, 65 (30.5%) had angle fractures, 33 (15%) subcondylar fractures, 17 (7.9%) body fractures and 2(0.9%) had ramus fracture. Early intervention using open reduction and internal fixation was the protocol followed which resulted in minimum morbidity and complications. CONCLUSION As RTA especially two wheelers accidents appeared to be the most common cause of mandibular fractures, use of suitably designed protective head gear (crash helmets) is advisable. Moreover open reduction and rigid internal fixation appears to be the suitable treatment modality in successful treatment of mandibular fractures in reducing morbidity and complications and ensuring early return to normalcy.
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Affiliation(s)
- GK Thapliyal
- Senior Specialist (Oral & Maxillofacial Surgery), AFDC, New Delhi
| | - R Sinha
- Professor & Head, Department of Dental Surgery, AFMC, Pune-40
| | - PS Menon
- Associate Professor (Oral & Maxillofacial Surgery), Department of Dental Surgery, AFMC, Pune-40
| | - A Chakranarayan
- Resident (Oral & Maxillofacial Surgery), Department of Dental Surgery, AFMC, Pune-40
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