Injuries following motorcycle crashes at a level-1 trauma center in Riyadh

Demographic and clinical characteristics of children with limb loss in Saudi Arabia: A retrospective study

PURPOSE

The aim of this study was to describe the demographic and clinical characteristics of children with limb loss in Saudi Arabia.

METHODS

This is a retrospective study on children attending a limb loss clinic in a tertiary hospital in Riyadh, Saudi Arabia, between July 2012 and June 2020. Descriptive statistics were computed to describe the sample characteristics. A Chi-Squared test was conducted to explore the relationship between a child's sex with the type of limb loss (congenital or acquired) and extent of limb loss (major and minor) and the association between child's age and the mechanism of injury in traumatic limb loss.

RESULTS

A total of 122 children aged 2-16 years were included of whom 52% were boys. Congenital limb loss represented 57% of the sample with upper extremity loss accounting for 63.7% of all limb loss in this type. Trauma-related limb loss represented the most frequent etiology (88.2%) in the acquired limb loss group. Road traffic accidents accounted for 51.7% of the mechanism of injuries in trauma-related limb loss. Child's sex was not associated with the type of limb loss nor the extent of limb loss ( p > 0.05). In addition, child's age was not associated with the mechanism of injury in traumatic limb loss ( p > 0.05).

CONCLUSION

Child's sex was not a determinant of type nor the extent of limb loss. Most of the acquired limb loss was trauma-related with road traffic accidents as the most common mechanism of injury. The findings of this study illuminate the importance of ongoing prosthetic care for children with a limb loss because young children may require multiple prostheses as they grow in age and size.

Motorcycle-related crashes before and during the COVID-19 pandemic: A comparative retrospective observational study from the Middle East

BACKGROUND

During the COVID-19 pandemic, there was a boom in the delivery sector, with a significant increase in the demand and number of motorcycle delivery drivers in Qatar, which made them vulnerable to injury. We aimed to evaluate the incidence, pattern, and outcome of patients injured by motorcycle-related crashes (MCC) before and during the pandemic.

METHODS

A retrospective observational study included all adult patients admitted with motorcycle-related injuries before the pandemic (March 2018 to February 2020) and during the pandemic (March 2020 to March 2022). Comparative analyses were performed based on (work versus non-work related MCCs) and (pre- versus during the pandemic injuries).

RESULTS

510 patients with MCC were identified, of which 172 (33.7 %) were admitted in the pre-pandemic and 338 (66.3 %) during the pandemic. The mean age of patients was 29.2±7.8 years; 56 % were aged 20-29 years, and 99.4 % were males. Work-related MCCs were more frequent among the younger age group (60.9 % vs. 52.1 %; p=0.001) during the early evening, i.e., 6:00 to 9:00 p.m. (21.9 % vs. 13.9 %; p=0.004). However, non-work related MCC occurred more frequently between midnight and 3:00 am (20.2 % vs. 10.9 %; p=0.004), and such patients were more likely non-compliant for protective devices use (19.3 % vs. 6.1 %; p=0.001) and ride under the influence of alcohol (13.2 % vs. 7.4 %; p=0.03). During the pandemic, the proportion of alcohol consumers (13 % vs. 5.8 %; p=0.01) and work-related MCC (50.9 % vs. 22.7 %; p=0.001) increased significantly compared to the pre-pandemic period.

CONCLUSION

The overall burden of MCC increased during the pandemic, and the frequency of MCC involving commercial drivers surged significantly during the pandemic period as opposed to the non-work MCC, which predominated in the pre-pandemic period. Work-related MCCs were more frequent among younger age groups, mainly involving South Asians with frequent accidents in the evening time. However, recreation-related MCCs occurred more frequently at midnight, and victims were non-compliant with the protective gear. Furthermore, there is a need for prospective studies to examine the broader scope of risk factors that are associated with the work-related MCC, especially involving food deliveries, and for focused safety programs for motorcycle delivery drivers and recreational motorcyclists.

The Documentation of Injuries Caused by Traffic Accidents

BACKGROUND

Persons injured in traffic accidents may have injuries of characteristic types that are of significance for the complex reconstruction of the accident and whose medicolegally sound clinical documentation is highly important. This is of particular relevance for the approximately 55 000 persons who are severely injured in traffic accidents in Germany each year. Gaps in documentation are often disadvantageous for the injured persons.

METHODS

This review is based on pertinent publications retrieved by a selective literature review, with additional consideration of relevant textbooks in traffic medicine and legal medicine, as well as the guidelines of the AWMF (Association of the Scientific Medical Societies in Germany).

RESULTS

Injuries in traffic accidents typically differ depending on the mode of participation of the injured person in traffic. They must be examined with a view toward the sequence of events of the accident and documented in medicolegally sound fashion. In particular, because of the different mechanical forces involved, it is important to document the seat that the injured person occupied in the automobile, the nature of the collision (pedestrian vs. automobile; bicycle, e-bike, e-scooter, and motorcycle accidents), and the protective devices that were in use.

CONCLUSION

The precise documentation of injuries and examination findings, with critical consideration of their plausibility in relation to the sequence of events of the accident as far as it is known, is an important duty of the physician. This documentation serves as the basis for further judicial steps leading to compensation when legally appropriate.

Patterns of Maxillofacial Injures Caused by Motorcycle Accidents

Introduction  Motorcycles are used as a common means of transportation, and motorcycle accidents are responsible for a major portion of trauma injuries. Objectives  The purpose of this study was to analyze the patterns of facial injuries in motorcyclists, to evaluate the types of injuries, and to investigate if the accident-related factors had any impact on the characteristics of the injuries. Methods  This retrospective observational study included 74 patients with maxillofacial injuries following motorcycle-related accidents. Investigated data were divided into four main categories: sociodemographic, accident-related, injury-related, and treatment-related. Results  All the patients were males with a mean age (±SD) of 25.03 (±9.986) years. Most accidents ( n  = 44, 59.4%) occurred in the evening. Most of the patients ( n  = 40, 54%) were traveling on motorcycle models that had maximum speed of over 120 km/h. Furthermore, 15 patients (18.9%) were under the influence of alcohol during the crashes and only one patient was wearing a helmet. Fractures of the maxillofacial bones were observed in 50 (67.5%) crash victims; 24 of them (48%) had middle third fractures, 11 (22%) had mandibular fractures, and 15 patients (30%) presented with a combination of lower, middle, and upper third fractures. Conclusion  Almost all patients were not wearing helmets at the moment of the crash. The most common fractured site was the maxilla. The majority of the patients received surgical treatment. Increased enforcement of safety measures for riders and raising awareness about the dangers of motorcycle crashes are required measures to improve traffic safety and, ultimately, population health.

Motorcycle-related trauma in Ireland

Introduction

Motorcyclists are over-represented in collision statistics in Ireland. There is a lack of descriptive studies assessing the impact and injury pattern of this trauma cohort. This study examines this trauma subset using data collected by the Major Trauma Audit (MTA) by the National Office of Clinical Audit (NOCA) to identify patient demographics, injury mechanism and type, treatments received, and outcomes.

Methods

All motorcycle-related trauma cases recorded on the MTA, NOCA in Ireland for the period 2014 to 2019 were gathered and analysed.

Results

There were 704 cases identified; 94% of cases were male. The median (interquartile range (IQR)) age was 38.2 (26.7–49.7). There were 6.4% ( n = 45) aged 0–18 years, 88.2% ( n = 621) aged 18–64 and 5.4% ( n = 38) greater than 65 years. The median injury severity score (ISS) overall of this trauma cohort was 13 (IQR 9–24) but 306 patients (43.5%) had an ISS > 15. The most severe injury body region with 35.4% ( n = 249) was the limbs. Most patients arrived during the summer months with Sunday the highest day of attendance ( n = 181, 25.7%). May to August were the months with the most attendance ( n = 366, 52%). Most patients were discharged home ( n = 372, 52.8%) and 43.8% ( n = 308) required transfer to at least one other hospital for definitive care. There were 19 patients (2.7%) who died after arrival to hospital.

Conclusion

Motorcycle trauma predominantly affects a young male population with moderate severity injury characteristics. A significant proportion of patients present at weekends during the summer months, likely the result of recreational riding. A large cohort of patients requires transfer for definitive care, which has significant implications for trauma care pathways. National policies to enforce safety measures and public awareness for recreational motorcycle use may improve traffic safety and ultimately population health.

The Patterns of Acquired Upper and Lower Extremity Amputation at a Tertiary Centre in Saudi Arabia

Introduction: Upper and lower extremity amputations are associated with variable degrees of physical disability. In Saudi Arabia, disability still represents a major challenge for healthcare systems. There are insufficient data to describe the incidence and prevalence of impairment and disability. This study attempts to identify the patterns of limb amputations at a tertiary centre.

Methods: A retrospective chart review of the data of patients who received integrated tertiary healthcare in an amputation rehabilitation program (ARP) from 2013 to 2018 at King Fahad Medical City, Riyadh, Saudi Arabia was conducted. Data were collected using the demographic data and clinical history of amputees.

Results: A total of 412 patients were included in the study. Transtibial amputation (70%) and partial hand amputation (48%) were the most common levels for lower and upper limb amputations, respectively. There was a significantly higher rate of lower limb amputations secondary to vascular causes than that of upper limb amputations, which were more related to traumatic causes. Most patients, 213 (52%), were enrolled in an amputation rehabilitation program over a year after their amputation.

Conclusion: Vascular amputation is the most common cause of amputation. Most patients entered the rehabilitation program over a year after amputation. National guidelines for the prevention and management of the risk factors for vascular amputations should be developed.

Cost of healthcare rehabilitation services following road traffic injuries: Results from a Level-I trauma center in Saudi Arabia

BACKGROUND

Road traffic injuries (RTIs) are the second leading cause of mortality in Saudi Arabia. The high rate of RTIs puts a strain on rehabilitation services. Yet, little is known of the economic burden of nonfatal RTIs and rehabilitation services. This study, therefore, aims to describe the annual rehabilitation costs associated with RTIs at a local trauma center.

MATERIALS AND METHODS

This study was conducted among all the 17 years or older patients hospitalized at King Abdulaziz Medical City in Riyadh following RTIs and required rehabilitation care. We included 299 patients who met the inclusion criteria and were followed for one year after discharge from the index hospital. The data was abstracted through retrospective review of patients' medical records. All rehabilitative services utilized by the healthcare system were recorded. To describe the economic burden, the mean, median, standard deviation, and interquartile range (IQR) were calculated. Total costs were aggregated for all patients to estimate overall costs.

RESULTS

The study population was relatively young (31 years ± 14.4). The total annual rehabilitation cost of patients was Saudi Riyals (SAR) 6,113,781 (IQR: 20,589.3 - 3,125 = 17,464.3), and the average for each patient was SAR 20,447 (median = 7875). Patients aged 40-59 years and ≥60 years accounted for the highest average rehabilitation cost of SAR 31,563.99 and 32,639.21, respectively. Rehabilitation visits incurred the highest cost (mean SAR 1,494,124), followed by bed utilization which cost SAR 1,311,972 and radiology examination at SAR 1,032,261. The cost of motorcycle injuries was relatively higher (SAR 44,441.0) than other injury mechanisms.

CONCLUSION

This study underlines the economic burden of rehabilitation services resulting from RTIs. Public health interventions are needed to reduce the burden of RTIs by dealing with their preventable causes and improving road safety measures. These findings may be useful to policymakers and researchers to support and improve rehabilitation services in Saudi Arabia.

Epidemiology and factors associated with all-terrain vehicle accidents in children: A retrospective cross-sectional study of a trauma registry in Saudi Arabia

Background:

All-terrain vehicle (ATV) accidents have a substantial impact on the pediatric population in Saudi Arabia; however, few local studies are available. An in-depth study of this issue and adequate implementation of regulations are required to prevent additional casualties. The aim of this study was to describe the epidemiology of ATV injuries in the pediatric population and the outcomes associated with the injuries.

Methods:

We conducted a retrospective chart review at a Level 1 trauma center in Riyadh. All patients, aged ≤14 years and admitted due to an ATV accident, from 2004 to 2018 were included in this study. Demographic information, hospital course, and injury outcomes were extracted from the King Abdulaziz Medical City trauma registry. Each medical record was reviewed for short-term complications and the mechanism of injury. The primary outcome measure was the type of injury associated with ATV accidents; the secondary outcomes were injury site and mechanism of injury, and the association between the impact of injury and the clinical and demographic variable.

Results:

In total, 165 patients were involved in ATV accidents and met our inclusion criteria. The mean age was 8 ± 4 years, and 79% (131/165) were boys. Over 50% (84/165) of the sample had lower limb injuries. The majority of patients had fracture injuries (37%, 61/165), followed by amputations (30%, 50/165). Of the amputation group, the majority (86%, 43/50) was from 1 to 5 years compared to the no amputation group (P < 0.001). For the amputation group, 67% (33/50) had a limb trapped in the chain of the vehicle as to the mechanism of injury.

Conclusion:

The majority of patients had lower-extremity injuries, specifically fractured (37%) or amputated (30%) with children from age 1–5 years having a significantly higher proportion of hospital admission compared to the rest of the study population. Despite the existing legislation for ATV use in children, they are not enforced. The finding of this study recommends urgent implementation of these regulations for both ATV retailers and users and promotes public awareness about the severity of such injuries.

Patterns of traumatic injuries and outcomes to motorcyclists in a developing country: A cross-sectional study

OBJECTIVE

Motorcyclists are frequently involved in road traffic accidents and may suffer polytraumatic injuries, contributing a substantial burden on healthcare systems particularly in lower-middle-income countries. This study aimed to describe patterns of injury, in-hospital course, and outcomes of road accident trauma in motorcyclists, including polytrauma, at a Trauma Facility in Pakistan.

METHODS

A retrospective review was conducted by using relevant trauma codes to extract data from records for all victims presenting with motorcycle trauma between January 2018 and June 2019, to a tertiary care hospital in Pakistan. Data collected included victim characteristics, mechanism of accident, patterns of traumatic injury, management, in-hospital complications, and outcomes. Polytrauma was defined as traumatic injuries in two or more anatomic regions with abbreviated injury scale (AIS) ≥ 3. Multivariable logistic regression, adjusted for age, gender, and mechanism of accident, was performed to identify in-hospital complications and outcomes associated with polytrauma.

RESULTS

A total of 514 victims, 90.9% male and 39.5% aged between 18-30 years, were included in this study. The victim was the motorcycle driver in 94.6% of cases. The most common mechanism of accident was motorcycle vs. other motor vehicle (56.2%). Patients were mostly admitted under the services of Orthopedic Surgery (50.8%) and Neurosurgery (30%), with common sites of injury being the lower extremity (42.6%), head (38.1%), and upper extremity (26.8%). Polytrauma occurred in 19.5% of victims. Patients were managed surgically in 77.3% of cases, with the most common procedure being open reduction of fractures (48.1%). Blood transfusion was required in 4.1% of patients. The commonest in-hospital complication was acute kidney injury (23.7%). The median length of stay was 3 days, and 4.1% of patients expired in the hospital. Polytrauma was significantly associated with the need for blood transfusion (2.642 [1.053-6.630]), AKI (2.212 [1.339-3.652]) and hospital length of stay (1.059 [1.025-1.094]), but not with mortality.

CONCLUSION

Although orthopedic injuries occur most frequently in motorcycle trauma, polytrauma necessitating multi-disciplinary management and complicating hospital stay is also common. Understanding patterns of injuries and management in motorcycle trauma will enable trauma teams in a developing country like Pakistan to devise evidence-based management protocols, especially for cases of polytrauma.