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Melur Sukumar G, Patel N, B R RG, Roy A, Akashanand A, Roy R, Sakhi P, P P, M N A, G G, Bachani AM. Prevalence and patterns of helmet use among motorized two-wheelers: findings from a large observational study in an Indian metropolis. Int J Inj Contr Saf Promot 2024:1-8. [PMID: 39183529 DOI: 10.1080/17457300.2024.2394484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 07/10/2024] [Accepted: 08/15/2024] [Indexed: 08/27/2024]
Abstract
Motorized two-wheeler users account for 45% of road fatalities in 2021 in India. Correct helmet use decreases the risk of fatalities, but information about the prevalence of correct helmet use is limited in the Indian context. This study aims to assess the prevalence of helmet use and factors associated with correct helmet use among motorized two-wheeler users in Bengaluru city, India. This observational cross-sectional assessment was conducted in a random-representative sample of 98021 motorized two-wheelers sampled from 15 intersections. Helmet use and other information were collected by trained Field Data Collectors via hand-held tablet devices and the KoBo collect application, following a globally used checklist. The prevalence of helmet use (all types) was 88% among riders and pillion together and 92.4% among riders. However, the prevalence of correct helmet use is 38% among riders, and non-standard helmet use is 27%. This study reveals a correct helmet use gap in Bengaluru city. The study recommends the need to shift enforcement, messaging, and intervention focus towards correct helmet use and the implementation of routine population-based surveillance for helmet use in the city.
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Affiliation(s)
- Gautham Melur Sukumar
- Department of Epidemiology, WHO Collaborating Centre for Injury Prevention and Safety Promotion, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Nishit Patel
- Johns Hopkins International Injury Research Unit (JH-IIRU), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ravikanthe Gowda B R
- Inspector General of Police (Central Range), Karnataka State Police, Bengaluru, India
| | - Aaheli Roy
- Department of Epidemiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Akashanand Akashanand
- Department of Epidemiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Runalika Roy
- Department of Epidemiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Padma Sakhi
- Department of Epidemiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Priyanka P
- Department of Epidemiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Anucheth M N
- Joint Commissioner of Police, (Traffic), Bengaluru, India
| | - Gururaj G
- WHO Collaborating Centre for Injury Prevention and Safety Promotion, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Abdulgafoor M Bachani
- Johns Hopkins International Injury Research Unit, Health Systems Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Mahajan C, Kapoor I, Prabhakar H. The Urban-Rural Divide in Neurocritical Care in Low-Income and Middle-Income Countries. Neurocrit Care 2024:10.1007/s12028-024-02040-z. [PMID: 38960992 DOI: 10.1007/s12028-024-02040-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/05/2024] [Indexed: 07/05/2024]
Abstract
The term "urban-rural divide" encompasses several dimensions and has remained an important concern for any country. The economic disparity; lack of infrastructure; dearth of medical specialists; limited opportunities to education, training, and health care; lower level of sanitation; and isolating effect of geographical location deepens this gap, especially in low-income and middle-income countries (LMICs). This article gives an overview of the rural-urban differences in terms of facilities related to neurocritical care (NCC) in LMICs. Issues related to common clinical conditions such as stroke, traumatic brain injury, myasthenia gravis, epilepsy, tubercular meningitis, and tracheostomy are also discussed. To facilitate delivery of NCC in resource-limited settings, proposed strategies include strengthening preventive measures, focusing on basics, having a multidisciplinary approach, promoting training and education, and conducting cost-effective research and collaborative efforts. The rural areas of LMICs bear the maximum impact because of their limited access to preventive health services, high incidence of acquired brain injury, inability to have timely management of neurological emergencies, and scarcity of specialist services in a resource-deprived health center. An increase in the health budget allocation for rural areas, NCC education and training of the workforce, and provision of telemedicine services for rapid diagnosis, management, and neurorehabilitation are some of the steps that can be quite helpful.
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Affiliation(s)
- Charu Mahajan
- Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Indu Kapoor
- Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Hemanshu Prabhakar
- Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Sahu SK, Radhakrishnan RV, Mohanty CR, Parija S, Palanisamy S, Mishra P, Sadangi D. Pattern and clinical profile of patients with ocular trauma presenting to the emergency department of a teaching hospital in India: A prospective observational study. Turk J Emerg Med 2024; 24:90-96. [PMID: 38766413 PMCID: PMC11100578 DOI: 10.4103/tjem.tjem_219_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/25/2024] [Accepted: 02/01/2024] [Indexed: 05/22/2024] Open
Abstract
OBJECTIVES One major contributor to avoidable ocular morbidity is ocular trauma (OT). The study aimed to document the epidemiological factors, pattern of injury, and outcome among patients with OT presenting to the emergency department (ED). METHODS This was a prospective observational study conducted in the ED of a tertiary care teaching hospital in Eastern India after due approval from the institutional ethics committee. The data were collected during the period from March 2021 to February 2022. Data pertaining to age, sex, type of injury, mechanism of injury, time and place of injury, details of tissue involvement, visual acuity, any prior history of injury, initial diagnosis, and management were noted. To estimate the severity of the injury and the probable visual outcome, we calculated through OT score (OTS), including one raw score and OTS. Statistical analysis was performed using the R, version 4.6.1. RESULTS A total of 180 patient's data were included for final analysis. The median (interquartile range) age of the patients was 32 (24-45) years. The majority were males (n = 147 [81.6%]) with a male-female ratio of 4.5:1. Road traffic accidents (RTA) were the common cause of injury (n = 122 [67.7%]). Unilateral eye involvement was the most common (n = 147 [81.6%]). In the pattern of injury, most of the patients sustained closed globe injuries (CGIs) (n = 158 [87.7%]). Among the CGIs, injury to the ocular adnexa and conjunctiva (n = 141 and 127, respectively) was the most common. Injury to the retina and choroids occurred in 20 (11%) patients. The vision was not affected in most of the cases (n = 125 [69.4%]) with a visual acuity of > 6/18. The majority (n = 120 [67%]) of the patients had an OTS of grade-4, followed by grade-2 (n = 22 [12%]). Most of the patients required only medical management (n = 100 [56%]), whereas 77 (43%) patients required surgical interventions. CONCLUSION OT was a common presentation in the ED. Male patients with monocular injuries involved in RTAs were mostly affected. The vision was preserved in most of the cases.
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Affiliation(s)
- Sandip Kumar Sahu
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | | | - Chitta Ranjan Mohanty
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sucheta Parija
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | | | - Priyadarshini Mishra
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Debasish Sadangi
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Sahu MR, Mohanty MK, Sasmal PK, Radhakrishnan RV, Mohanty CR, Shaji IM, Naveen A, Parida M. Epidemiology and patterns of road traffic fatalities in India pre- and post-motor vehicle (Amendment) act 2019: An autopsy-based study. Int J Crit Illn Inj Sci 2021; 11:198-203. [PMID: 35070908 PMCID: PMC8725808 DOI: 10.4103/ijciis.ijciis_51_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/12/2021] [Accepted: 08/14/2021] [Indexed: 11/04/2022] Open
Abstract
Background Road traffic accidents (RTAs) are a preventable cause of death. The government of India enacted the motor vehicle amendment (MVA) act on September 01, 2019, to curtail the alarming trend of RTAs and their associated fatality. The study objective was to compare the epidemiology and pattern of fatal RTAs before and after the MVA Act 2019 of India. Methods An autopsy-based cross-sectional study was conducted at the Department of Forensic Medicine and Toxicology (FMT) of a tertiary-care hospital from March 2019 to February 2020. The sample comprised 75 fatal RTA victims who underwent postmortem at FMT. Patients were studied in two groups: One pre-MVA group (n = 47) and one Post-MVA group (n = 28). The data were obtained from medical records and inquest reports with autopsy correlation. Data pertaining to sociodemographic profile, mechanism, injury profile including injury-severity-score (ISS) and survival-time was recorded. Results There was a 40.4% decline in mortality among RTA victims (P = 0.057) in the post-MVA group. The case fatality rate also declined during post-MVA implementation months compared to pre-MVA months (1.61 vs. 1.96). A significant correlation was noted between the ISS and survival-time of victims (P < 0.001, r = -0.522). The mean age of patients was 39.87 ± 17.44 years. Heavy motor vehicles along with motorized two-wheeler were the most common offending-vehicle. The median ISS of all victims was 41 (33-57). Head injury was the most common cause of death (60%). Conclusion Study results signal-toward early triumph of the new MVA act, probably due to enhanced adherence to safety gears and constructive behavioral change.
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Affiliation(s)
- Manas Ranjan Sahu
- Department of Forensic Medicine and Toxicology, Critical Care All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Manoj Kumar Mohanty
- Department of Forensic Medicine and Toxicology, Critical Care All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Prakash Kumar Sasmal
- Department of General Surgery, Critical Care All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | | | - Chitta Ranjan Mohanty
- Department of Trauma and Emergency, Critical Care All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ijas Muhammed Shaji
- Department of Trauma and Emergency, Critical Care All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Alagarasan Naveen
- Department of Forensic Medicine and Toxicology, Critical Care All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Madhusmita Parida
- Department of Anaesthesiology, Critical Care All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Epidemiological and clinical characteristics of road traffic crashes related thoracic traumas: analysis of 5095 hospitalized chest injury patients. J Cardiothorac Surg 2021; 16:220. [PMID: 34348741 PMCID: PMC8335466 DOI: 10.1186/s13019-021-01599-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Road traffic crashes related (RTCR) chest traumas remain important global public health challenge. The impact of boosting market of automobile vehicles in China during last decade on thoracic injury needs to be defined. This study aimed to review and analyze the demographic and clinical characteristics of RTCR thoracic injuries in China. METHODS Clinical records of patients with thoracic trauma admitted to thoracic surgery department between January 2003 and June 2020 were retrospectively retrieved and reviewed. Patients' profiles and clinical characteristics were comparatively analyzed between road traffic crashes caused injury and other injury mechanisms, and in RTCR chest trauma patients before January 2011 (2003 group), and after January 2011 (2011 group), when is considered as the beginning year of Chinese household vehicle era. RESULTS The study included 5095 thoracic trauma patients with mean age of 50.2 years, of whom 79.4% were male. Most of the patients (70.3%, n = 3583) had rib fractures. Associated injuries were present in 52.0% of the patients, of them 78.5% (n = 2080) were extremity fractures. Road traffic crashes accounted for 41.4% (n = 2108) of the injuries, most of them (98.0%) were related to motor vehicles. In comparison with other chest trauma mechanisms, RTCR chest injuries affected females and older males more frequently, with a higher incidence of rib fractures and sternum fractures, and higher injury severity scores (ISS) (all p < 0.05). Surgeries were required in 1495 (70.9%) patients of the RRTCR chest traumas, while the majority of non-RTCR thoracic injuries were managed conservatively or with tube thoracostomy (30.2%, n = 901). RTCR chest traumas caused longer hospital stay (13.0 ± 9.6 days vs. 11.8 ± 7.4 days, p = 0.001), higher ICU usage (30.7% vs. 19.6%, p = 0.001), higher rate of ventilator support (12.9% vs. 7.5%, p = 0.001), and higher mortalities (3.8% vs. 1.6%, p = 0.005) than that of non-RTRA chest injuries. For RTCR patients, when compared with 2003 group, 2011 group had similar patterns in terms of accident category, associated injury and treatment. However, 2011 group had more females (38.5% vs. 18.0%, p = 0.001) and older males (50.6 ± 9.7 vs. 47.9 ± 17.2, p = 0.001), with a higher ISS (18.3 ± 10.2 vs. 17.1 ± 8.9, p = 0.004), and fewer were managed with chest tubes (25.0% vs. 29.2%, p = 0.031). Clinical outcomes were not significantly different between the groups in terms of hospital length of stay, intensive care unit (ICU) usage, ICU length of stay, duration of ventilator hours and mortality. However, the 2011 group had more patients requiring ventilator support (14.4% vs. 10.6%, p = 0.011). CONCLUSIONS Road traffic crashes remain to be the major etiology of thoracic injuries in China, which usually affects middle-aged males, causing rib fractures with concomitant injuries frequently occurring to other organ systems. Treatments mainly include tube thoracotomy and surgical procedures. Although the clinical characteristics and outcomes of traffic accident related chest traumas are largely unchanged in spite of the rapid increasing numbers of motor vehicles, variations in the pattern of injuries by gender, age, injury severity and ventilator usage may still provide important information for targeted management.
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Jain M, Radhakrishnan RV, Mohanty CR, Behera S, Singh AK, Sahoo SS, Guru S, Barik S. Clinicoepidemiological profile of trauma patients admitting to the emergency department of a tertiary care hospital in eastern India. J Family Med Prim Care 2020; 9:4974-4979. [PMID: 33209831 PMCID: PMC7652149 DOI: 10.4103/jfmpc.jfmpc_621_20] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/10/2020] [Accepted: 07/02/2020] [Indexed: 11/10/2022] Open
Abstract
Context: Trauma is an immediate cause of patients flowing to the emergency department of any hospital. Besides epidemiology, clinical profile and treatment strategy forms an important aspect to reflect the gap in the existing public sector health-care system and the requirement. Aims: To evaluate the clinicoepidemiological profile of trauma patients admitting to an apex trauma hospital in east India. Settings and Design: A prospective observational study was performed during the time period of December 2018 to July 2019 on trauma patients admitted to the Trauma and Emergency department. Methods and Material: Patient's demographic profile, injury type, mechanism, the vehicle involved in the accident, and transportation were recorded. Various trauma scores (clinical) and outcome measures were recorded. Statistical Analysis Used: Statistical analysis was done by R version 3.6.1. Results: Male: female ratio was 407:93 with the 21–30 age group predominantly. 2–6 PM was the most common time of injury and ambulance was the predominant mode of transport (58%). Road traffic injury (RTI) accounted for 75% victims; two-wheelers (68%) dominated over others. Thirty percent (drivers 18%, pillion riders 12%) were wearing helmet; 41% were wearing seat belts (drivers 34%, passenger 12%). Twenty-five percent of drivers consumed alcohol. The median ± Interquartile range of injury severity score (ISS), revised trauma and trauma score and injury severity score were 17 (11–26), 7.8 (4.1–7.8), and 98.41 (95.95–99.30), respectively. Extremity injury (54% fractures) and head injury (50%) were the frontrunners in the pattern of injury, with half of the victims were polytrauma (ISS > 15). Conclusions: The injury was prominently RTI and the trauma victims/patients were young male drivers on two wheelers. The focus should be directed to make use of safety measures among the youth.
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Affiliation(s)
- Mantu Jain
- Department of Orthopedics, AIIMS, Bhubaneswar, Odisha, India
| | | | | | | | - Arvind Kumar Singh
- Department of Community and Family Medicine, AIIMS, Bhubaneswar, Odisha, India
| | | | - Satyabrata Guru
- Department of Trauma and Emergency, AIIMS, Bhubaneswar, Odisha, India
| | - Sadananda Barik
- Department of Trauma and Emergency, AIIMS, Bhubaneswar, Odisha, India
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