Helmet use and maxillofacial injuries sustained following low speed motorcycle accidents

Effectiveness of road safety interventions: An evidence and gap map

Background

Road Traffic injuries (RTI) are among the top ten leading causes of death in the world resulting in 1.35 million deaths every year, about 93% of which occur in low- and middle-income countries (LMICs). Despite several global resolutions to reduce traffic injuries, they have continued to grow in many countries. Many high-income countries have successfully reduced RTI by using a public health approach and implementing evidence-based interventions. As many LMICs develop their highway infrastructure, adopting a similar scientific approach towards road safety is crucial. The evidence also needs to be evaluated to assess external validity because measures that have worked in high-income countries may not translate equally well to other contexts. An evidence gap map for RTI is the first step towards understanding what evidence is available, from where, and the key gaps in knowledge.

Objectives

The objective of this evidence gap map (EGM) is to identify existing evidence from all effectiveness studies and systematic reviews related to road safety interventions. In addition, the EGM identifies gaps in evidence where new primary studies and systematic reviews could add value. This will help direct future research and discussions based on systematic evidence towards the approaches and interventions which are most effective in the road safety sector. This could enable the generation of evidence for informing policy at global, regional or national levels.

Search Methods

The EGM includes systematic reviews and impact evaluations assessing the effect of interventions for RTI reported in academic databases, organization websites, and grey literature sources. The studies were searched up to December 2019.

Selection Criteria

The interventions were divided into five broad categories: (a) human factors (e.g., enforcement or road user education), (b) road design, infrastructure and traffic control, (c) legal and institutional framework, (d) post-crash pre-hospital care, and (e) vehicle factors (except car design for occupant protection) and protective devices. Included studies reported two primary outcomes: fatal crashes and non-fatal injury crashes; and four intermediate outcomes: change in use of seat belts, change in use of helmets, change in speed, and change in alcohol/drug use. Studies were excluded if they did not report injury or fatality as one of the outcomes.

Data Collection and Analysis

The EGM is presented in the form of a matrix with two primary dimensions: interventions (rows) and outcomes (columns). Additional dimensions are country income groups, region, quality level for systematic reviews, type of study design used (e.g., case-control), type of road user studied (e.g., pedestrian, cyclists), age groups, and road type. The EGM is available online where the matrix of interventions and outcomes can be filtered by one or more dimensions. The webpage includes a bibliography of the selected studies and titles and abstracts available for preview. Quality appraisal for systematic reviews was conducted using a critical appraisal tool for systematic reviews, AMSTAR 2.

Main Results

The EGM identified 1859 studies of which 322 were systematic reviews, 7 were protocol studies and 1530 were impact evaluations. Some studies included more than one intervention, outcome, study method, or study region. The studies were distributed among intervention categories as: human factors (n = 771), road design, infrastructure and traffic control (n = 661), legal and institutional framework (n = 424), post-crash pre-hospital care (n = 118) and vehicle factors and protective devices (n = 111). Fatal crashes as outcomes were reported in 1414 records and non-fatal injury crashes in 1252 records. Among the four intermediate outcomes, speed was most commonly reported (n = 298) followed by alcohol (n = 206), use of seatbelts (n = 167), and use of helmets (n = 66). Ninety-six percent of the studies were reported from high-income countries (HIC), 4.5% from upper-middle-income countries, and only 1.4% from lower-middle and low-income countries. There were 25 systematic reviews of high quality, 4 of moderate quality, and 293 of low quality.

Authors' Conclusions

The EGM shows that the distribution of available road safety evidence is skewed across the world. A vast majority of the literature is from HICs. In contrast, only a small fraction of the literature reports on the many LMICs that are fast expanding their road infrastructure, experiencing rapid changes in traffic patterns, and witnessing growth in road injuries. This bias in literature explains why many interventions that are of high importance in the context of LMICs remain poorly studied. Besides, many interventions that have been tested only in HICs may not work equally effectively in LMICs. Another important finding was that a large majority of systematic reviews are of low quality. The scarcity of evidence on many important interventions and lack of good quality evidence-synthesis have significant implications for future road safety research and practice in LMICs. The EGM presented here will help identify priority areas for researchers, while directing practitioners and policy makers towards proven interventions.

Patterns of maxillofacial trauma in helmet vs. non helmet wearing two wheeler drivers in a tertiary care center

BACKGROUND/AIMS

The frequency and patterns of maxillofacial fractures vary by country, based on demographic, socioeconomic, cultural and environmental factors. Wearing a helmet is an efficient form of head protection for two-wheeler drivers and is now required in the vast majority of countries. The aim of this study was to compare the patterns of maxillofacial trauma in patients who wore helmets and those who did not.

MATERIALS AND METHODS

The data were gathered from clinical records of patients presenting with maxillofacial trauma between January 2019 and February 2022. The inclusion criteria were met by subjects involved in two-wheeler accidents with comprehensive case records and radiological investigations.

RESULTS

A total of 177 people presented following maxillofacial trauma. The mean age was 34.2 ± 12.7 years. There were 151 (85.3%) males and 26 (14.6%) females. One hundred and two patients had not been wearing a helmet, while 75 patients were wearing a helmet at the time of the accident. Mandible fractures were the most common injury in both groups, followed by zygomatic arch fractures (which were more common in non-helmet users) and dentoalveolar fractures in helmet users.

CONCLUSION

There was a significant difference in the pattern and severity of maxillofacial trauma in helmet users and non-helmet users.

The impact of mandatory helmet law on the outcome of maxillo facial trauma: a comparative study in kerala

INTRODUCTION

Motorcyclists comprise the majority of road-traffic victims in low and middle income countries,and consequently, the majority of the road-traffic victims globally. Simple measures can be taken to make safer on the roads, which include enforcement of safety measures like seat belt and helmets. The compulsory Helmet law was enforced in Kerala on 18/06/07. Resistance to legislation on motorcycle helmets still coexists world wide with debate on the effectiveness of helmets. In an attempt to analyze the protective effect of helmets on facial injuries a comparative study was conducted in Government Dental College, Calicut, which is a major trauma centre in northern Kerala.

METHODS

Data for the present study was obtained from the patients who have reported to the Emergency Department of Oral and Maxillofacial Surgery, Government Dental College, Calicut, for a period of 6 months immediately after the implementation of strict helmet rule in Kerala. For the study all patients with a history of nonfatal motor cycle accident sustaining facial injuries were included. The results were compared with the study conducted in the same institution in the pre law period.

RESULTS

The study demonstrates the protective effect of motorcycle helmets in decreasing the morbidity of maxillofacial trauma.There was a marked decrease in incidence of motorcycle-related injuries, remarkable increase in helmet usage and better outcome in helmeted individuals in the post law period.

CONCLUSION

Road traffic injury control is a public health problem. Health and medical professionals have an ethical responsibility to educate and arrange for the safety of individuals. Helmets are effective in preventing or reducing the severity of motorcycle-related injuries and in a developing country like India, enforced mandatory motor cycle helmet law is potentially one of the most cost effective interventions available.

Motorcycle-related injuries in the United Arab Emirates

OBJECTIVES

To study the anatomical distribution, severity, outcome, and age by nationality of hospitalized motorcycle-related injured patients in Al-Ain, United Arab Emirates so as to improve preventive measures.

METHODS

All motorcycle riders involved in a road traffic collision and admitted to Al-Ain Hospital for more than 24 h or who died in hospital after arrival were studied. Patient data were retrieved from Al-Ain Hospital Trauma Registry. Data had been prospectively collected during four and half years (March 2003-October 2007). Demography of patients, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), Hospital stay, mortality, nationality, time, day of week, and month of occurrence were analyzed.

RESULTS

There were 95 patients (93 males). Mean (SD) age was 29.8 (11.5) years. 35% were United Arab Emirates (UAE) nationals. Upper limbs were most frequently involved (54%) followed by lower limbs (48%), head (41%), and face (30%). On arrival at hospital, median (range) ISS was 4.5 (1-36) and median (range) GCS was 15 (3-15). Mean (range) hospital stay was 8.8 (1-79) days. 14 patients (15%) were admitted to the Intensive Care Unit. In-hospital mortality was 6%. UAE national victims were significantly younger and had more abdominal injuries than expatriates, who had lower limb injuries.

CONCLUSIONS

The most common mechanism of motorcycle crashes was hitting a moving vehicle. Young UAE national motorcyclists are at a higher risk of being injured compared with non UAE nationals. This may be due to risk-taking behavior of young motorcyclists who are mainly riding for leisure. Extremities were the most common injured body region. Severe head injury was the main cause of death. This signifies the need for effective application of motorcycle helmet law in the UAE along with other preventive measures that might include increasing the licensing age.

Does wearing helmets reduce motorcycle-related death? A global evaluation

BACKGROUND

The high risk of injury and death of motorcycle riders is a major global health problem. This study aimed to evaluate the effect of helmet wearing on motorcycle riders' death rates on a global level.

METHODS

Data for motorcycle riders were collected from 70 countries. These data included motorcycle-related death rates per 100,000 population, helmet non-usage percentage, Gross National Income per capita (GNI), number of registered motorized 2-3 wheelers, the effectiveness of law enforcement in each country, and whether there was standards for helmets use or not. Correlations between studied variables were done using Pearson correlation. Multiple linear regression models were used to define factors affecting motorcycle-related death rates.

RESULTS

The correlation between motorcycle-related death rate and helmet non-usage, was almost significant (p=0.056, r=0.28). Helmet non-usage percentage was significantly correlated with GNI (p<0.0001, r=-0.61) and effectiveness of the law (p<0.0001, r=-0.73). A multiple linear regression model which was highly significant (adjusted R-squared=0.3, F=6.69, p<0.001) has shown that helmet non-usage percentage (p=0.003), motorcycle per person ratio (p=0.01) and the presence of helmet standards (p=0.05) were positively associated with motorcycle-related death rates. A simple linear regression model between helmet usage and road traffic death rate has shown that for each 10% increase in helmet usage, one life per 1,000,000 inhabitants can be saved per year.

CONCLUSION

Helmet non-usage percentage was the most significant factor affecting motorcyclists' death rate. Wearing a motorcycle helmet reduces the risk of death from a motorcycle crash. Enforcement of motorcycle helmet laws should be effectively supported by motorcycle safety programs.

Epidemiology of mandibular fractures treated in a Brazilian level I Trauma Public Hospital in the city of São Paulo, Brazil

This article reviews cases of mandibular fractures treated at the Service of Oral and Maxillofacial Surgery of the Hospital Complex of Mandaqui (SUS/SP), which is a reference hospital complex for trauma in the northern area of the city of São Paulo, Brazil. Ninety-eight patients with mandibular fractures were seen at the hospital between January and December, 2001. Out of this total, 91 cases whose files were deemed adequate in terms of data accuracy and completeness were reviewed. The following data were collected for the study: age, gender, etiology, anatomical fracture site, treatment modality, relation to other facial bone fractures, hospitalization time and posttrauma complications. Motorcycle accident was the major cause of mandibular fractures followed by physical aggression and height fall. The mandibular anatomical sites of higher fracture incidence were: body, symphysis and condyle. The most commonly performed treatment modes were conservative approach or open reduction and intraosseous fixation. In conclusion, motorcycle accidents were associated with a larger number of facial fractures and most predominantly affect 21-30 year-old males. On the average, motor vehicle accident victims had more (and more severe) fractures than physical aggression victims. Complications were mostly associated with angle fractures and hospitalization period. Polytraumatized patients presented greater morbidity for complications.

Patterns of Injury and Outcomes Associated with Motocross Accidents

Motocross has become a popular recreation activity in Southern California, particularly in the Inland Empire area. In order to evaluate the patterns of injury and outcomes associated with motocross accidents, the Trauma Registry data and charts of all patients with motocross-related injuries from January 2000 to December 2001 were reviewed. Of the 270 patients studied, 265 were males and 5 were females, with a mean age of 26 years (range, 5–61). The mean Injury Severity Score was 6.8 (range, 1–38). Injuries involved extremity trauma in 52 per cent of patients closed head injuries in 33 per cent, blunt chest trauma in 23 per cent, abdominal trauma in 15 per cent, spinal trauma in 14 per cent, and pelvic trauma in 8 per cent. Surgery was required in 96 patients (36%), most commonly for treatment of orthopedic injuries. After initial evaluation, 179 patients were admitted (66%), 60 were discharged home (22%), 29 were transferred for higher level of care (11%), and two expired (1%). The mean hospital length of stay was 2.3 days (range, 1–9). Motocross accidents are most commonly associated with extremity injuries and closed head trauma. Although the overall mortality is low, the morbidity is high, with a large proportion of patients requiring surgery.