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Suzuki T, Sugiki D, Matsumoto A, Akao T, Matsumoto H. Ascending colon injury and ileal perforation due to blunt abdominal trauma: A case report. Radiol Case Rep 2024; 19:1776-1780. [PMID: 38390424 PMCID: PMC10883779 DOI: 10.1016/j.radcr.2024.01.090] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
A rare case of an ascending colon injury and ileal perforation in a 34-year-old male patient due to blunt abdominal trauma caused by a road traffic accident is reported in this study. This paper reports the clinical and imaging findings of seat belt syndrome. The seat belt syndrome primarily involves soft tissue injury; however, lacerations of the colon, small intestine, and mesentery have rarely been reported in the literature. However intestinal injuries, including bowel perforation and mesenteric injuries due to seat belt syndrome, must not be underestimated because they usually require emergency laparotomy because of accompanying peritonitis and hemorrhaging, and can be lethal if left untreated. Therefore, when an ascending mesocolon hematoma and free gas in the peritoneal cavity are present, gastrointestinal perforation due to seat belt syndrome should be suspected. In this case, gastrointestinal perforation was suspected based on the computed tomography findings, and emergency surgery was performed; the patient's course was uneventful without any postoperative complications. Early diagnosis and management are essential to prevent associated morbidity and mortality.
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Affiliation(s)
- Toshiyuki Suzuki
- Department of Surgery, Hanyu General Hospital, Hanyushi Saitama, Japan
- Department of Emergency and Critical Care Medicine, Emergency and Critical Care Center, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Japan
| | - Daisuke Sugiki
- Department of Emergency and Critical Care Medicine, Emergency and Critical Care Center, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Japan
| | - Akiyo Matsumoto
- Department of Surgery, Hanyu General Hospital, Hanyushi Saitama, Japan
| | - Takahiko Akao
- Department of Surgery, Hanyu General Hospital, Hanyushi Saitama, Japan
| | - Hiroshi Matsumoto
- Department of Surgery, Hanyu General Hospital, Hanyushi Saitama, Japan
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Dasukil S, Verma S, Jena AK, Mohapatra M. Frequency of concomitant injuries in maxillofacial trauma in a tertiary health care centre in India: A 5-year retrospective study. Chin J Traumatol 2024:S1008-1275(24)00035-X. [PMID: 38616471 DOI: 10.1016/j.cjtee.2024.03.008] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 12/09/2023] [Accepted: 01/23/2024] [Indexed: 04/16/2024] Open
Abstract
PURPOSE Road traffic accidents (RTA), assaults, falls, and sports-related injuries are the leading causes of maxillofacial trauma. Due to quite different geographical environment and fast urbanization, the use of various protective equipment is restricted in India. Thus, compared to other countries, there might be a significant difference in the pattern and frequency of associated injuries among subjects with maxillofacial trauma. The present study was conducted to identify the causes and pattern of various maxillofacial fractures and the frequency of other related injuries among subjects with maxillofacial trauma. METHODS This is a cross-sectional retrospective study recording 2617 subjects with maxillofacial trauma. The patient demographics, causes of trauma, types of maxillofacial injury, and associated soft and hard tissue injuries were recorded. The types of maxillofacial and associated injuries were diagnosed from details of clinical examinations and the interpretation of various radiographs available in the file. The associated injuries were divided into head injury, other bony injuries, and soft tissue and vital structure injuries. Descriptive statistics and the test of proportion were used. A p value < 0.05 was considered as a level of significance. RESULTS The maxillofacial injuries were significantly common in patients aged 16 - 45 years (66.7%) than in patients aged ≤ 15 and > 46 years (33.3%) (p < 0.001). The RTA was the most common cause of maxillofacial injury (n = 2139, 81.7%), followed by fall (n = 206, 7.9%), other causes of injury (n = 178, 6.8%), and assaults (n = 94, 3.6%). The maxillofacial injury by 2-wheel vehicle accidents was significantly higher than that by 4-wheel vehicle and other vehicle accidents (p < 0.001). There was a significant correlation between alcohol and RTA (p < 0.001). The head injury (n = 931, 61.1%) was the most common associated injury, followed by soft tissue and vital structures injuries (n = 328, 21.5%) and other bone injuries (n = 264, 17.3%). DISCUSSION Head injury was the most common associated injury followed by soft tissue and vital structures and bone injuries among subjects with maxillofacial trauma. Clavicle fracture and injury to the lower extremities were the most common hard and soft tissue-associated injuries.
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Affiliation(s)
- Saubhik Dasukil
- Department of Dentistry, All India Institute of Medical Sciences, Sijua, Bhubaneswar, Odisha, India.
| | - Shiwangi Verma
- Department of Dentistry, All India Institute of Medical Sciences, Sijua, Bhubaneswar, Odisha, India
| | - Ashok Kumar Jena
- Department of Dentistry, All India Institute of Medical Sciences, Sijua, Bhubaneswar, Odisha, India
| | - Mounabati Mohapatra
- Department of Dentistry, All India Institute of Medical Sciences, Sijua, Bhubaneswar, Odisha, India
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Chen DY, Wu PF, Zhu XY, Zhao WB, Shao SF, Xie JR, Yuan DF, Zhang L, Li K, Wang SN, Zhao H. Risk factors and predictive model of cerebral edema after road traffic accidents-related traumatic brain injury. Chin J Traumatol 2024:S1008-1275(24)00007-5. [PMID: 38458896 DOI: 10.1016/j.cjtee.2024.02.001] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/06/2023] [Accepted: 01/29/2024] [Indexed: 03/10/2024] Open
Abstract
PURPOSE Cerebral edema (CE) is the main secondary injury following traumatic brain injury (TBI) caused by road traffic accidents (RTAs). It is challenging to be predicted timely. In this study, we aimed to develop a prediction model for CE by identifying its risk factors and comparing the timing of edema occurrence in TBI patients with varying levels of injuries. METHODS This case control study included 218 patients with TBI caused by RTAs. The cohort was divided into CE and non-CE groups, according to CT results within 7 days. Demographic data, imaging data, and clinical data were collected and analyzed. Quantitative variables that follow normal distribution were presented as mean ± standard deviation, those that do not follow normal distribution were presented as median and quartiles. Categorical variables were expressed as percentages. The Chi-square test and logistic regression analysis were used to identify risk factors for CE. Logistic curve fitting was performed to predict the time to secondary CE in TBI patients with different levels of injuries. The efficacy of the model was evaluated using the receiver operator characteristic curve. RESULTS According to the study, almost half (47.3%) of the patients were found to have CE. The risk factors associated with CE were bilateral frontal lobe contusion, unilateral frontal lobe contusion, cerebral contusion, subarachnoid hemorrhage, and abbreviated injury scale (AIS). The odds ratio values for these factors were 7.27 (95% CI: 2.08 - 25.42, p = 0.002), 2.85 (95% CI: 1.11 - 7.31, p = 0.030), 2.62 (95% CI: 1.12 - 6.13, p = 0.027), 2.44 (95% CI: 1.25 - 4.76, p = 0.009), and 1.5 (95% CI: 1.10 - 2.04, p = 0.009), respectively. We also observed that patients with mild/moderate TBI (AIS ≤ 3) had a 50% probability of developing CE 19.7 h after injury (χ2 = 13.82, adjusted R2 = 0.51), while patients with severe TBI (AIS > 3) developed CE after 12.5 h (χ2 = 18.48, adjusted R2 = 0.54). Finally, we conducted a receiver operator characteristic curve analysis of CE time, which showed an area under the curve of 0.744 and 0.672 for severe and mild/moderate TBI, respectively. CONCLUSION Our study found that the onset of CE in individuals with TBI resulting from RTAs was correlated with the severity of the injury. Specifically, those with more severe injuries experienced an earlier onset of CE. These findings suggest that there is a critical time window for clinical intervention in cases of CE secondary to TBI.
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Affiliation(s)
- Di-You Chen
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China; Department of Radiology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Peng-Fei Wu
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Xi-Yan Zhu
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Wen-Bing Zhao
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Shi-Feng Shao
- Wound Trauma Medical Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Jing-Ru Xie
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Dan-Feng Yuan
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Liang Zhang
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Kui Li
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Shu-Nan Wang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, 400042, China.
| | - Hui Zhao
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China.
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Khatun MS, Hossain MA, Kabir MA, Rahman MA. Identification and analysis of accident black spots using Geographic Information System (GIS): A study on Kushtia-Jhenaidah national highway (N704), Bangladesh. Heliyon 2024; 10:e25952. [PMID: 38371970 PMCID: PMC10873738 DOI: 10.1016/j.heliyon.2024.e25952] [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: 08/19/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/20/2024] Open
Abstract
Road accidents, mostly on national highways, pose a significant public health and economic burden in Bangladesh, requiring in-depth analysis for road safety measures. This study comprehensively analyzes accident trends, characteristics, causes, and consequences by identifying the accident black spots on the Kushtia-Jhenaidah National Highway (N704). Accident records from 2017 to 2021 were collected from nearby police stations. Additionally, using a cluster random sampling approach, a questionnaire survey with 100 respondents (50% drivers and 50% general road users) was also conducted to capture diverse perceptions and behaviors. The study utilizes descriptive methods, such as trends analysis and frequency distributions, alongside spatial analysis techniques, including severity index, Kernel Density Estimation, and hotspot analysis. Findings indicate a decrease in accidents from 2018 to 2021, yet a concerning rise in fatalities in 2021. Trucks (47.9%) emerge as the primary contributor among 169 vehicles involved in accidents. Head-on collisions (36%) are prevalent, attributed to both human and environmental factors, including driver inexperience (56%), mobile phone use while driving (78%), lack of proper training (12%), overspeeding (28.3%), and nighttime driving (54%) influenced by seasons and land use. Mostly, victims aged from 20 to 40, where men are more affected by fatalities (70.7%) and women by injuries (86.3%). Out of 35 identified accident spots, including Battail, Bittipara Bazar, Laxmipur Bazar, Modhupur Bazar, IU Main Gate, Sheikhpara Bazar, and DM College Front, are designated as blackspot zones based on the frequency of accidents, deaths, and injuries. The study concludes by recommending targeted interventions, driver training, infrastructure improvements, regulatory measures, and victim assistance in collaboration with local and national agencies to enhance road safety and mitigate accident risks.
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Affiliation(s)
- Most Suria Khatun
- Dept. of Geography and Environment, Islamic University, Kushtia-7003, Bangladesh
| | - Md Anik Hossain
- Dept. of Geography and Environment, Islamic University, Kushtia-7003, Bangladesh
| | - Md Anisul Kabir
- Dept. of Geography and Environment, Islamic University, Kushtia-7003, Bangladesh
| | - Md Asikur Rahman
- Dept. of Geography and Environment, Islamic University, Kushtia-7003, Bangladesh
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Kumar V, Barik S, Raj V, Varshney S. Prevention of "bygone futures" due to road traffic injuries in children. Eur J Trauma Emerg Surg 2023:10.1007/s00068-023-02378-7. [PMID: 37870567 DOI: 10.1007/s00068-023-02378-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023]
Abstract
Road traffic injuries remain one of the common and leading causes of death among children and adolescents till the age of 19 years. Road safety is important for children since their physical activity, active travel, independence and development are largely affected by it. Solutions for road safety with benefits for people as well as an economy exist which should be implemented effectively and efficiently. These solutions which combine engineering, legislation and behavioural interventions should be implemented in an integrated Safe Systems Approach. The future of the children must be safeguarded from these injuries and every effort towards it being converted into "bygone figures" must be done diligently and honestly. The various risk factors and interventions possibly explained in this review article shall help in better understanding of the causes and possible guidelines at a policy level to prevent road traffic injuries in children.
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Affiliation(s)
- Vishal Kumar
- Orthopedics, All India Institute of Medical Sciences, Deoghar, India
| | - Sitanshu Barik
- Orthopedics, All India Institute of Medical Sciences, Deoghar, India.
| | - Vikash Raj
- Orthopedics, All India Institute of Medical Sciences, Deoghar, India
| | - Saurabh Varshney
- Orthopedics, All India Institute of Medical Sciences, Deoghar, India
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Koch DA, Hagebusch P, Lefering R, Faul P, Hoffmann R, Schweigkofler U. Changes in injury patterns, injury severity and hospital mortality in motorized vehicle accidents: a retrospective, cross-sectional, multicenter study with 19,225 cases derived from the TraumaRegister DGU ®. Eur J Trauma Emerg Surg 2023; 49:1917-1925. [PMID: 36890307 PMCID: PMC9994772 DOI: 10.1007/s00068-023-02257-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/24/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE In the last 20 years, the number of fatalities due to road traffic accidents (RTA) in Germany has steadily decreased from 7503 to 2724 per year. Due to legal regulations, educational measures and the continuous development of safety technology the number of severe traumatic injuries and injury patterns are most likely to change. The aim of the study was to analyse severely injured motorcyclists (MC) and car occupants (CO) that were involved in RTAs in the last 15 years and investigate the development and changes of injury patterns, injury severity and hospital mortality. METHODS We retrospectively evaluated data from the TraumaRegister DGU® (TR-DGU) considering all RTA-related injured MCs and COs (n = 19,225) that were registered in the TR-DGU from 2006 to 2020 with a primary admission to a trauma center with continuous participation (14 of 15 years) in the TR-DGU, an Injury Severity Score (ISS) ≥ 16 and aged between 16 and 79 years. The observation period was divided into three 5-year interval subgroups for further analysis. RESULTS The mean age increased by 6.9 years and the ratio of severely injured MCs to COs changed from 1:1.92 to 1:1.45. COs were in 65.8% male and more often severely injured in the age groups under 30, while the majority of severely injured MCs were in the age group around 50 years and in 90.1% male. The ISS (- 3.1 points) as well as the mortality of both groups (CO: 14.4% vs. 11.8%; MC: 13.2% vs. 10.2%) steadily decreased over time. Nevertheless, the standardized mortality ratio (SMR) hardly changed and stayed < 1. Regarding the injury patterns, the greatest decline of injuries with AIS 3 + were to the head (CO: - 11.3%; MC: - 7.1%), in addition, a decrease of injuries to extremities (CO: - 1.5%; MC: - 3.3%), to the abdomen (CO: - 2.6%; MC: - 3.6%), to the pelvis in COs (- 4.7%) and to the spine (CO: + 0.1%; MC: - 2.4%) were observed. Thoracic injuries increased in both groups (CO: + 1.6%; MC: + 3.2%) and, furthermore, pelvic injuries in MCs (+ 1.7%). Another finding was the increase of the utilization of whole body CTs from 76.6 to 95.15%. CONCLUSION The severity of injuries and their incidence, especially head injuries, have decreased over the years and seem to contribute to a decreasing hospital mortality of polytraumatized MCs and COs injured in traffic accidents. Young drivers and an increasing number of seniors are the age groups at risk and require special attention and treatment.
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Affiliation(s)
- Daniel Anthony Koch
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389 Frankfurt am Main, Germany
| | - Paul Hagebusch
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389 Frankfurt am Main, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Ostmerheimer Straße 200, 51109 Cologne, Germany
| | - Philipp Faul
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389 Frankfurt am Main, Germany
| | - Reinhard Hoffmann
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389 Frankfurt am Main, Germany
| | - Uwe Schweigkofler
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389 Frankfurt am Main, Germany
| | - TraumaRegister DGU
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389 Frankfurt am Main, Germany
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Ostmerheimer Straße 200, 51109 Cologne, Germany
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Fang CY, Tsai HY, Yong CY, Ohiro Y, Chang YC, Teng NC. A 10-year retrospective study on mandibular fractures in Northern Taiwan. J Dent Sci 2023; 18:1330-1337. [PMID: 37404622 PMCID: PMC10316488 DOI: 10.1016/j.jds.2023.04.010] [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: 02/25/2023] [Revised: 04/12/2023] [Indexed: 07/06/2023] Open
Abstract
Background/purpose The mandible is an independent and protruding bone structure in the lower third portion of the human facial skeleton. Because of its prominent and unprotected position, the mandible is a primary site of facial trauma. Previous studies have not comprehensively discussed the association between the mandibular fractures and concomitant fractures of facial bones, the trunk, or limbs. This study analyzed the epidemiology of mandibular fractures and their correlation with concomitant fractures. Materials and methods The present study enrolled 118 patients with a total of 202 mandibular fracture sites during at any time from January 1, 2012, to December 31, 2021, in northern Taiwan. Results According to the study results, the patients between 21 and 30 years of age had the highest occurrence of trauma, and road traffic accidents (RTAs) constituted the primary cause of mandibular fractures. Fall-related injuries were significant in patients >30 years of age. By the analysis of Pearson's contingency coefficient, the number of mandibular fractures was not significantly associated with concomitant fractures of the extremities or the trunk. However, accompanying maxillary fractures can be regarded as an indication of concomitant extremity or trunk fractures in patients with mandibular fractures. Conclusion Three-site mandibular fractures are not necessarily accompanied by extremity and trunk fractures; however, clinicians should implement multidisciplinary examination and management in patients with mandibular fractures accompanied by maxillary fractures. Maxillary fractures can be regarded as an indication of concomitant fractures of other facial bones, the extremities, or the trunk.
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Affiliation(s)
- Chih-Yuan Fang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Oral and Maxillofacial Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Han-Yu Tsai
- Department of Dentistry, Wang Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chen-Yin Yong
- Department of Oral and Maxillofacial Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yoichi Ohiro
- Oral and Maxillofacial Surgery, Division of Oral Pathobiological Science, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Yu-Chao Chang
- School of Dentistry, Chung Shan Medical University, Taichung, Taiwan
- Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Nai-Chia Teng
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
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Shu PC, Motah M, Massi DG, Ngunyi YL, Budzi NM, Mefire AC. Thoracolumbar spine injury in Cameroon: etiology, management, and outcome. BMC Musculoskelet Disord 2023; 24:386. [PMID: 37189065 DOI: 10.1186/s12891-023-06481-z] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Thoracolumbar spine injury (TLSI) is a major concern worldwide despite its low prevalence. Studies demonstrate a gradual rise in annual incidence. There have been improvements in its management. However, a lot is still to be done. TLSI secondary to trauma usually occurs abruptly and leaves demeaning consequences, especially in our setting where the prognosis from several studies is poor. This study aimed to describe the etiology, management principles, and prognosis of TLSI in Douala General Hospital and as such contribute data on those aspects in the research community. METHOD This was a hospital-based five-year retrospective study. The study population was patients treated for TLSI in the Douala General Hospital from January 2014 to December 2018. Patients' medical records were used to retrieve data. Data analysis was done using SPSS Version 23. Logistic regression models were fitted to assess the association between dependent and independent variables. Statistical significance was set at 95% CI, with a P-value < 0.05. RESULTS We studied a total of 70 patients' files including 56 males. The mean age of occurrence of TLSI was 37.59 ± 14.07 years. The most common etiology was road traffic accidents (45.7%) and falls (30.0%). Half of our patients (n = 35) had an incomplete neurological deficit (Frankel B - D). Paraplegia was the most common motor deficit (42.9%). The lumbar spine was affected in 55.7% of cases. The most common CT scan finding was fracture of the vertebrae (30%) while the most reported MRI finding was disc herniation with contusion (38.5%). More than half (51.4%) of our patients were referred from peripheral health centers. The median arrival time was 48 h (IQR: 18-144) with 22.9% reporting after a week post-injury. Less than half (48.1%) benefited from surgery, and 41.4% of our population benefited from in-hospital rehabilitation. The median in-hospital delay time for surgery was 120 h (IQR: 66-192). While the median time between injury and surgery was 188 h (IQR: 144-347). The mortality rate was 5.7% (n = 4). Almost all (86.9%) of the patients developed complications and we had a 61.4% improvement in neurological status upon discharge. Being covered by health insurance was a predictor of improved neurological status (AOR = 15.04, 95%CI:2.90-78.20, P = 0.001) while being referred was a predictor of a stationary neurological status upon discharge (AOR = 0.12, 95%CI:0.03-0.52, P = 0.005). The average hospital stay was 20 days. We did not identify any predictors of lengthy hospital stay. CONCLUSION Road traffic accident is the most common etiology of TLSI. The arrival time to a neurosurgery specialized center after a traumatic injury, and the in-hospital delay time for surgery is high. Reduction of these delays, encouraging universal health insurance coverage, and improving on management to reduce complications would better the outcome of TLSI which is comparable with those in other studies.
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Affiliation(s)
| | - Mathieu Motah
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Neurology unit, Douala General Hospital, Douala, Cameroon
| | - Daniel Gams Massi
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Neurology unit, Douala General Hospital, Douala, Cameroon
| | - Yannick Lechedem Ngunyi
- Faculty of Health Sciences, University of Buea, Buea, Cameroon.
- Mbonge District Hospital, Mbonge, Cameroon.
| | - Ngenge Michael Budzi
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Cameroon Baptist Convention health services, Yaoundé, Cameroon
| | - Alain Chichom Mefire
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Douala Gyneco-obstetric and pediatric hospital, Douala, Cameroon
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Kamabu K, La O Soria J, Tumwesigye D, Okedi XF, Kyomukama L, Muhumuza J, Musinguzi B, Kavuma D, Vivalya BMN, Loduk M, Abdullah WS. 24 h mortality and its predictors among road traffic accident victims in a resource limited setting; a multicenter cohort study. BMC Surg 2023; 23:97. [PMID: 37101207 PMCID: PMC10131391 DOI: 10.1186/s12893-023-02011-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/19/2023] [Indexed: 04/28/2023] Open
Abstract
INTRODUCTION The incidence of road traffic accidents (RTAs) is on the rise contributing to the global burden of mortality as a major global health threat. It has been estimated that 93% of RTAs and more than 90% of the resulting deaths occur in low and middle income countries. Though death due to RTAs has been occurring at an alarming rate, there is paucity of data relating to incidence and predictors of early mortality. This study was aimed at determining the 24 h mortality and its predictors among RTA patients attending selected hospitals in western Uganda. METHODS This was a prospective cohort that consecutively enrolled 211 RTA victims admitted and managed in emergency units of 6 hospitals in western Uganda. All patients who presented with a history of trauma were managed according to the advanced trauma life support protocol (ATLS). The outcome regarding death was documented at 24 h from injury. Data was analyzed using SPSS version 22 for windows. RESULTS Majority of the participants were male (85.8%) aged 15-45 years (76.3%). The most common road user category was motorcyclists (48.8%). The 24 h mortality was 14.69%. At multivariate analysis, it was observed that a motorcyclist was 5.917 times more likely to die compared to a pedestrian (P = 0.016). It was also observed that a patient with severe injury was 15.625 times more likely to die compared to one with a moderate injury (P < 0.001). CONCLUSION The incidence of 24 h mortality among road traffic accident victims was high. Being motorcycle rider and severity of injury according to Kampala trauma score II predicted mortality. Motorcyclists should be reminded to be more careful while using the road. Trauma patients should be assessed for severity, and the findings used to guide management since severity predicted mortality.
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Affiliation(s)
- Kinyamaniyi Kamabu
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda.
| | - Jorge La O Soria
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda
| | - Deus Tumwesigye
- Department of Surgery, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Xaviour Francis Okedi
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda
| | - Lauben Kyomukama
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda
| | - Joshua Muhumuza
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda.
| | - Brian Musinguzi
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda
| | - Daniel Kavuma
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda
| | - Bives Mutume Nzanzu Vivalya
- Department of Psychiatry, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Michael Loduk
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda
| | - Wani Shabani Abdullah
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda
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Tavakkoli M, Takian A, Mohammadi M, Heidari H, Kouchakinejad-Eramsadati L, Yousefzade-Chabok S, de Savigny D, Fink G, Künzli N, Cobos Muñoz D. Assessing the design of road traffic death information systems in Iran: A participatory systems approach. Int J Med Inform 2023; 172:105005. [PMID: 36787688 DOI: 10.1016/j.ijmedinf.2023.105005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/15/2022] [Accepted: 01/23/2023] [Indexed: 01/27/2023]
Abstract
AIM To describe and analyze the information architecture and information pathways of the road traffic death recording, registration and reporting system in Guilan Province, northernIran. METHODS We used Business Process Mapping, a qualitative approach. This participatory and iterative approach consists of a document review, key informant interviews, development of a process map and a participatory workshop with key stakeholders to illuminate and validate the findings. We classified the tasks performed in the system into three phases: (1) Identification and recording; (2) Notification and registration, and (3) Production of statistics. RESULTS We identified 13 stakeholders, with operating and influencing roles in the process of identification, registration and production of statistics about road traffic deaths in Guilan province. The three main sources of road traffic death statistics are the Ministry of Health and Medical Education, the National Organization for Civil Registration and the Forensic Medicine Organization. Our results reveal a highly fragmented system with minimal cross-sectoral data exchange. Each stakeholder operates in a silo resulting in delays and redundancies in the operating system. In the absence of an effective communication among stakeholders, the information exchange was dependent on the family of the deceased. These fragmented information silos alter the compilation of cause of death statistics and result in under-reporting and discrepancies in road traffic deaths figures. CONCLUSIONS Designing a comprehensive road traffic information system that provides accurate and timely information requires an understanding of the information flow and the entangled web of different stakeholders operating in the system. Participatory systems approaches such as process mapping can assist in capturing the complexity of the system and the integration process by facilitating stakeholders' engagement and ownership in improving the design of the system.
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Affiliation(s)
- Maryam Tavakkoli
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Amirhossein Takian
- Department of Global Health & Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahtab Mohammadi
- Deputy of Public Health, Guilan University of Medical Sciences, Rasht, Iran
| | - Hamid Heidari
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | | | - Don de Savigny
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Günther Fink
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Nino Künzli
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Daniel Cobos Muñoz
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
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11
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Yimer GM, Adem YF, Haile Y. Determinants of post-traumatic stress disorder among survivors of road traffic accidents in dessie comprehensive specialized hospital North-East Ethiopia. BMC Psychiatry 2023; 23:218. [PMID: 36997932 PMCID: PMC10064700 DOI: 10.1186/s12888-023-04673-4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 03/12/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Post-traumatic stress disorder is the most common mental disorder occurring among survivors of road traffic accidents. However, it remains under-explored and is not taken into account in the health policies of Ethiopia. Therefore, this study aimed to identify determinant factors of post-traumatic stress disorder among survivors of road traffic accident patients in Dessie Comprehensive Specialized Hospital, North-East Ethiopia. METHODS A facility-based unmatched case-control study design was employed from February 15 to April 25, 2021, in Dessie Comprehensive Specialized Hospital, with a total sample size of 139 cases and 280 controls selected by using a simple random sampling technique. Data were collected by pretested, interview with a structured questionnaire. The data were entered using Epi-Info, then exported and analyzed using STATA. The bi-variable and multivariable binary logistic regression model was used to identify determinant factors of post-traumatic stress disorder among survivors of road traffic accident. Adjusted odds ratio with a 95% confidence level was used as a measure of association. Variables with a p-value less than 0.05 were considered as statistically significant. RESULT A total of 135 cases and 270 controls participated in this study, with a response rate of 97% and 96%, respectively. In the final multivariable analysis, being male [AOR = 0.43, 95% CI: 0.32-0.99], primary educational status [AOR = 3.4, 95% CI: 1.04-11], presence of personal psychiatric history [AOR = 2.12, 95% CI: 1.17-3.92], presence of fracture [AOR = 2.41, 95% CI: 1.2-4.8], witness of death [AOR = 2.25, 95% CI: 1.26-4.30], presence of comorbidity [AOR = 2.29, 95% CI: 1.28-4], good social support [AOR = 0.71, 95% CI: 0.12-0.68] were significantly associated with post-traumatic stress disorder among survivors of road traffic accident patients. CONCLUSION PTSD following road traffic accidents is common. A multi-disciplinary approach was therefore essential in the management of road traffic accident survivors at the orthopedic and trauma clinics. Patients with poor social support, bone fracture, witnessed death, comorbidity, and females should be routinely screened for post-traumatic stress disorder in all road traffic accident survivors.
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Affiliation(s)
- Geleta Mussa Yimer
- Department of Epidemiology and Biostatics', School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yonas Fissha Adem
- Department of Public Health, Dessie College of Health Sciences, P.O.Box: 1212, Dessie, Ethiopia.
| | - Yosef Haile
- Department of Public Health, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
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12
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Mamo DE, Abebe A, Beyene T, Alemu F, Bereka B. Road traffic accident clinical pattern and management outcomes at JUMC Emergency Department; Ethiopia. Afr J Emerg Med 2023; 13:1-5. [PMID: 36582970 PMCID: PMC9792392 DOI: 10.1016/j.afjem.2022.11.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 11/10/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
Background Road Traffic Accident is an incident on a way or street open to public traffic. It becomes one of the most significant public health problems in the world especially in developing countries. In Ethiopia, it represents a significant risk for morbidity and mortality. It is also the major public health problem even though studies done on this topic in the study area is limited. Objective To assess clinical pattern, associated factors and management outcomes among road traffic accident Victims attending emergency department of Jimma University Medical Center. Methods Hospital based cross sectional study design was employed to review patients' chart visited the hospital from March to April 2021. A systematic random sampling technique was applied. The data were collected using pretested checklist and analyzed using SPSS version 26. Descriptive statistics and multivariate logistic regression were computed. Variables with P<0.05 were considered statistically significant. Results About 49.6%) were pedestrians injured of which motorcycle accounted 42.9%. More than half of victims never got any type of prehospital care. On arrival, 38.7% were classified as Red of which 71.4% of them were managed surgically. About 84.9% of victims were discharged with improvement whereas12.6% were died. Victims with head injury (AOR= 16.61: 95% CI; 3.85, 71.71), time elapsed to reach nearby health facility (AOR= 3.30; 95 CI (1.13, 9.60), condition of patient at Emergency Department (AOR= 7.78; 95% CI: 2.33, 26.06), GCS at admission (AOR= 20.12; 95% CI: 7.23, 55.96) and days spent in hospital (AOR= 6.85; 95% CI 5.81, 8.06) were independent predictors of unfavorable outcome. Conclusion Road Traffic Accident represents a significant risk for morbidity and mortality in Ethiopia, of which head injury and multiple sites injury increase injury severity. Targeted approaches to improving care of the injured victims may improve outcomes. Thus, the clinician should take into consideration the clinical presentation and give due attention to the identified contributing factors in its management.
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Affiliation(s)
- Dereje Endale Mamo
- Department of Nursing, College of Health Sciences, Dilla University, Southern Nations, Nationalities and Peoples (SNNP), Ethiopia,Corresponding author.
| | - Asmamaw Abebe
- Department of Emergency Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Temesgen Beyene
- Department of Emergency Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Filipos Alemu
- Department of Nursing, College of Health Sciences, Dilla University, Southern Nations, Nationalities and Peoples (SNNP), Ethiopia
| | - Bayisa Bereka
- School of Nursing, Institute of health, Jimma University, Jimma, Ethiopia
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13
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Alemayehu M, Woldemeskel A, Olani AB, Bekelcho T. Epidemiological characteristics of deaths from road traffic accidents in Addis Ababa, Ethiopia: a study based on traffic police records (2018-2020). BMC Emerg Med 2023; 23:19. [PMID: 36803192 PMCID: PMC9940670 DOI: 10.1186/s12873-023-00791-0] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
INTRODUCTION Road traffic accidents are a major cause of fatal and nonfatal injuries, causing permanent disabilities, and other indirect health complications. Each year, road traffic accidents (RTA) cause a lot of fatalities and injuries in Ethiopia, putting the country among the list of the most affected countries by RTA in the world. Despite the high rates of road traffic collisions in Ethiopia, very little is known about the factors that contribute to fatal RTA in the country. OBJECTIVES the objective of this study is to assess the epidemiological characteristics of deaths from road traffic accidents in Addis Ababa, Ethiopia: A study based on traffic police records (2018-2020). METHOD A retrospective observational study design was conducted used in this study. All road traffic accident victims reported to Addis Ababa police station between 2018 and 2020 were study population and the collected data was evaluated with Statistical Package for the Social Sciences (SPSS) version 26 software. Binary logistic regression model was used to indicate the association between dependent and independent variables. Statistically, significant associations were declared at P < 0.05. RESULT There were 8458 recorded road traffic accidents in Addis Ababa during 2018-2020. Among these accidents, 1274 (15.1%) caused death while 7184 (84.1%) caused an injury. Males accounted for 77.1% of the decedents (sex ratio of almost 3.36:1). The majority 1020 (80%) of the fatality occurred on a straight road and 1106 (86.8%) of the fatality occurred in dry weather. Weekday 1.243 (AOR, 1.234, 95 CI, 1.071-1.443), driver educational status below grade twelve 0.326(AOR 0.326, CI, 0.285-0.374), and commercial truck vehicle 1.682 (OR, 1.696, CI, 1.410-2.040) were statistically associated with fatality after adjusting for potential confounding variables. CONCLUSION The prevalence of RTA fatality in Addis Ababa is high. The accidents that occurred during the weekdays were more fatal. Driver's educational status, weekdays, and vehicle type were factors associated with mortality. There is a need to introduce road safety interventions that targeted identified factors in this study to reduce fatalities attributed to RTIs.
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Affiliation(s)
- Micheal Alemayehu
- Department of Emergency and Critical care, Tirunesh Beijing General Hospital, Addis Ababa, Ethiopia.
| | - Asfawesen Woldemeskel
- Department of Medicine, College of health sciences, Ethiopia police University, Addis Ababa, Ethiopia
| | - Ararso Baru Olani
- grid.442844.a0000 0000 9126 7261Department of Nursing, College of health sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Tariku Bekelcho
- grid.442844.a0000 0000 9126 7261Department of Nursing, College of health sciences, Arba Minch University, Arba Minch, Ethiopia
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14
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Aolayan K, Almohammadi T, Alotaibi A. A diaphragmatic hernia in a traumatic patient simulating a hemorrhage: A case report. Trauma Case Rep 2023; 43:100754. [PMID: 36632332 PMCID: PMC9826946 DOI: 10.1016/j.tcr.2023.100754] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 01/05/2023] Open
Abstract
A traumatic diaphragmatic rupture occurs in approximately 5 % of all trauma cases, making diagnosis difficult. Images can be used for most diagnoses; however, some can be detected intraoperatively. Based on its presentation, mechanism, side, diagnostic modality, and surgical approach, the diaphragmatic hernia can be discussed from several perspectives. In this report, we present the case of a 39-year-old female who suffered a rupture of her right diaphragm following a motor vehicle accident. Her symptoms mimic those of hemorrhage. A repair was performed through an abdominal approach, and the patient was discharged from the hospital without complications.
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Affiliation(s)
- Khulud Aolayan
- Department of Surgery, King Fahad Hospital, Medina, Saudi Arabia
| | | | - Abdulrahman Alotaibi
- Department of Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia,Corresponding author.
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15
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Qalb A, Arshad HSH, Nawaz MS, Hafeez A. Risk reduction via spatial and temporal visualization of road accidents: a way forward for emergency response optimization in developing countries. Int J Inj Contr Saf Promot 2023; 30:310-320. [PMID: 36597796 DOI: 10.1080/17457300.2022.2164312] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
To achieve an effective emergency response and road safety, this study aims to assist a semi-automated dynamic system to analyze and predict the spatial distribution and temporal pattern of road crashes. Kasur, an intermediate city of Pakistan, was selected and data including location, time and reasons of accidents for five years (2014-2018) was utilized. Radar charts, Getis-Ord Gi* statistic, Moran's I spatial auto-correlation, and time series indices were engaged to present temporal, spatial and spatial-temporal variation of accidents, using python-based tools and jupyter notebook. A dynamic user interface was created using Github and Tableau to visualize a real-time zoom-able spatiotemporal variation of accidents. The results explain that out of 12 months, October faces the peak while April sees the least of road accidents. 7am is the peak hour for accidents and the weekends record a significantly higher number of road accidents as compared to weekdays. The city core witnesses the major hotspot areas with huge cluster of accidents. The findings contribute towards a well-informed decision support system, the knowledge of spatial analytics and its application in road safety science, and the preparedness of the rescue agencies for rapid response to reduce the impacts of road accidents.
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Affiliation(s)
- Aqsa Qalb
- Department of City and Regional Planning, University of Management and Technology, Lahore, Pakistan
| | - Hafiz Syed Hamid Arshad
- Department of City and Regional Planning, University of Management and Technology, Lahore, Pakistan
| | - Muhammad Shafaat Nawaz
- Department of City and Regional Planning, University of Management and Technology, Lahore, Pakistan
| | - Asra Hafeez
- Department of City and Regional Planning, University of Management and Technology, Lahore, Pakistan
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Smith S, McCreanor V, Watt K, Hope M, Warren J. Costs and 30-day readmission after lower limb fractures from motorcycle crashes in Queensland, Australia: A linked data analysis. Injury 2022; 53:3517-3524. [PMID: 35922339 DOI: 10.1016/j.injury.2022.07.028] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/20/2022] [Accepted: 07/17/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Lower limb trauma is the most common injury sustained in motorcycle crashes. There are limited data describing this cohort in Australia and limited international data establishing costs due to lower limb trauma following motorcycle crashes. METHODS This retrospective cohort study utilised administrative hospitalisation data from Queensland, Australia from 2011-2017. Eligible participants included those admitted with a principal diagnosis coded as lower extremity or pelvic fracture following a motorcycle crash (defined as the index admission). Multiply injured motorcyclists where the lower limb injury was not coded as the primary diagnosis (i.e. principal diagnosis was rather coded as head injury, internal organ injures etc.) were not included in the study. Hospitalisation data were also linked to clinical costing data. Logistic regression was used to determine risk factors for 30-day readmission. Costing data were compared between those readmitted and those who weren't, using bootstrapped t-tests and ANVOA. RESULTS A total of 3342 patients met eligibility, with the most common lower limb fracture being tibia/fibula fractures (40.8%). 212 participants (6.3%) were readmitted within 30-days of discharge. The following were found to predict readmission: male sex (OR 1.84, 95% CI 1.01-1.94); chronic anaemia (OR 2.19, 95% CI 1.41-3.39); current/ex-smoker (OR 1.60, 95% CI 1.21-2.12); emergency admission (OR 2.77, 95% CI 1.35-5.70) and tibia/fibula fracture type (OR 1.46, 95% CI 1.10-1.94). The most common reasons for readmission were related to ongoing fracture care, infection or post-operative complications. The average hospitalisation cost for the index admission was AU$29,044 (95% CI $27,235-$30,853) with significant differences seen between fracture types. The total hospitalisation cost of readmissions was almost AU$2 million over the study period, with an average cost of $10,977 (95% CI $9,131- $13,059). CONCLUSIONS Unplanned readmissions occur in 6.3% of lower limb fractures sustained in motorcycle crashes. Independent predictors of readmission within 30 days of discharge included male sex, chronic anaemia, smoking status, fracture type and emergency admission. Index admission and readmission hospitalisation costs are substantial and should prompt health services to invest in ways to reduce readmission.
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Affiliation(s)
- Samuel Smith
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Australia; School of Medicine, University of Queensland, Brisbane, Australia; College of Public Health, Medical and Veterinary Science, James Cook University, Townsville, Australia; Jamieson Trauma Institute, Metro North Health, Herston, Australia.
| | - Victoria McCreanor
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia; Jamieson Trauma Institute, Metro North Health, Herston, Australia
| | - Kerrianne Watt
- College of Public Health, Medical and Veterinary Science, James Cook University, Townsville, Australia; Queensland Ambulance Service, Department of Health, Brisbane, Australia
| | - Matthew Hope
- School of Medicine, University of Queensland, Brisbane, Australia; Jamieson Trauma Institute, Metro North Health, Herston, Australia; Department of Orthopaedic Surgery, Princess Alexandria Hospital, Brisbane, Australia
| | - Jacelle Warren
- Jamieson Trauma Institute, Metro North Health, Herston, Australia; Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
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17
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Benhamed A, Gossiome A, Ndiaye A, Tazarourte K. Characteristics and comparison between e-scooters and bicycle-related trauma: a multicentre cross-sectional analysis of data from a road collision registry. BMC Emerg Med 2022; 22:164. [PMID: 36175859 PMCID: PMC9520117 DOI: 10.1186/s12873-022-00719-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Urban mobility has drastically evolved over the last decade and micromobility rapidly became an expanding segment of contemporary daily transportation routines. E-scooter riders and bicyclists may share similar trauma characteristics, but this has been little explored. The objective was to describe and compare the characteristics of e-scooter and bicycle-related trauma. METHODS We conducted a cross-sectional analysis of data from the Rhône road collision registry (January 1, 2019 to December 31, 2019). We included all e-scooter or bicycle riders injured in traffic collisions during the study period; there were no exclusion criterion. RESULTS A total of 2,779 patients were included; 825 (29.7%) were e-scooter riders and 1,954 (70.3%) were bicyclists. E-scooter riders were younger (median [IQR]: 24 [20-32] vs 29 [20-45] years, p < 0.001) and less frequently male (64.2% vs 73.4%, p < 0.001). Most e-scooter and bicycle road collisions were consequent to a fall or loss of vehicle control (74.2% vs 67.7%, p < 0.001). E-scooter riders were less frequently wearing a helmet at the time of the road collision (6.1% vs 30.7%, p < 0.001) and had more frequently head (24.2% vs 19.9%, p = 0.01) and face (30.6 vs 20.5%, p < 0.001) injuries compared to bicyclists. The median injury severity score was 2 [1-4] in both groups with no significant difference (p = 0.77). CONCLUSIONS E-scooter and bicycle-related trauma patients were mainly young males with minor injuries and most of them sustained a road collision with no third-party. However, they suffered from different injury patterns; e-scooter riders suffered more frequently face and head injuries than bicycle riders, which may be at least partly the consequence of less frequent helmet use among e-scooter riders compared to bicyclists. Hence the two groups of users should not be considered as a single trauma entity. This issue should be promptly addressed to bring down the incidence of preventable injuries and avoid healthcare costs.
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Affiliation(s)
- Axel Benhamed
- Service SAMU-Urgences, Hospices Civils de Lyon, Centre Hospitalier Universitaire Édouard Herriot, 5 place d'Arsonval, 69003, Lyon, France. .,INSERM U1290 (RESHAPE), Université Claude Bernard Lyon 1, 69003, Lyon, France.
| | - Amaury Gossiome
- Service SAMU-Urgences, Hospices Civils de Lyon, Centre Hospitalier Universitaire Édouard Herriot, 5 place d'Arsonval, 69003, Lyon, France
| | - Amina Ndiaye
- IFSTTAR, Université Gustave Eiffel, 69675, Lyon, France
| | - Karim Tazarourte
- Service SAMU-Urgences, Hospices Civils de Lyon, Centre Hospitalier Universitaire Édouard Herriot, 5 place d'Arsonval, 69003, Lyon, France.,INSERM U1290 (RESHAPE), Université Claude Bernard Lyon 1, 69003, Lyon, France
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18
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Krahelski O, Sivarajah S, Eardley W, Smith TO, Hing CB. Major trauma associated with mobility scooters: An analysis of the trauma audit research network. Injury 2022; 53:3011-3018. [PMID: 35779969 DOI: 10.1016/j.injury.2022.06.019] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 05/31/2022] [Accepted: 06/10/2022] [Indexed: 02/02/2023]
Abstract
AIMS To establish the incidence and nature of injuries seen in patients following mobility scooter incidents. METHODS The Trauma Audit and Research Network (TARN) database was used to collect data concerning injuries associated with mobility scooters. The data was taken from incidents that occurred between February 2014 and November 2020. The data analysed included: patient demographics, injury mechanism and patterns and associated mortality rates. RESULTS 1,504 patients were identified of which 61.4% were male. The median age was 76.2 years (IQR 63.5-84.9). The median injury severity score (ISS) was 9 (IQR 9-17), with major trauma (ISS ≥16) being observed in 29.4% of patients. Injuries to the limb were most common, although injuries to the head were most severe. Vehicle collisions accounted for 65.4% of injuries and were most closely associated with the most severe incidents. The median length of stay in hospital was 12 days, excluding the patients who died. Overall, mortality following injury was 10.6%, but the mortality rate was 15.4% in those aged 75 years and over, and 24.2% in those sustaining severe trauma. CONCLUSION As the population ages, injury characteristics of those with both major and non-major trauma changes. Mobility scooter use is prevalent amongst older people, and we provided a detailed analysis of injuries sustained with their use across a national database. The length of stay and the inherent resource use, because of admission following mobility scooter trauma, is considerable. These injuries particularly affect the 'most elderly' and carry a considerable mortality burden.
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Affiliation(s)
- O Krahelski
- Epsom and St. Helier NHS Foundation Trust, London, United Kingdom
| | - S Sivarajah
- St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - W Eardley
- James Cook University Hospital, Middlesbrough, United Kingdom; Department of Health Sciences, University of York, United Kingdom
| | - T O Smith
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - C B Hing
- St George's University Hospitals NHS Foundation Trust, London, United Kingdom.
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Dubey A, Rupani R, Sharma V, Singh RK, Kumari S, Verma AK. Reflected near-infrared photography: Digging deeper into post-mortem examination. J Forensic Leg Med 2022; 90:102397. [PMID: 35841695 DOI: 10.1016/j.jflm.2022.102397] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 06/27/2022] [Accepted: 07/06/2022] [Indexed: 11/27/2022]
Abstract
AIM This research aims to investigate the utility of the Near Infra-Red (NIR) photographic technique in visualizing forensic evidence in a post-mortem examination. MATERIAL AND METHODS A total of twenty-six deceased (male: n = 15; female: n = 11) were brought to the Mortuary of King George's Medical University, Chowk, Lucknow, Uttar Pradesh, India (226003), and were used to investigate the applicability of the human visible spectrum (HVS) & near-infrared photography. In the investigation, a modified Nikon D5300 crop-framed digital single-lens reflex camera was used for NIR Photography in combination with a Micro-Nikkor 105 mm, f/2.8, (Nikon Inc., Melville, NY, USA), Hoya R72 (760nm-860nm) infrared filter and a Nikon D5600 crop-framed digital single-lens reflex camera in combination with Nikkor 50mm lens for Human Visible Spectrum (HVS) Photography. RESULTS The finding of the study reported that the application of the NIR photography would be the best of the investigative techniques for visualization and photo-documentation of forensically relevant post-mortem findings, such as - trace evidences (e.g., blood spots & soil particles on dark clothing), in external findings (e.g., contusion on victim's body) also for internal findings in a road traffic accident (RTA), gunshot, and drowning victim (e.g., mud particles in the trachea of drowning victim & localizing contusion of the scalp in road traffic accident cases). CONCLUSION Human visible spectrum (HVS) photographs taken with Nikon D5600 provides substantial evidence for documentation purpose, the best results for trace evidence & contusion visualization in Post-mortem examination of the deceased were achieved with the NIR Photography in combination with indirect sunlight & room light as an infrared light source. (At a wavelength of 760nm-860nm).
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Affiliation(s)
- Anurag Dubey
- Forensic Medicine & Toxicology Department, KGMU, India.
| | - Raja Rupani
- Forensic Medicine & Toxicology Department, KGMU, India.
| | - Vishal Sharma
- Forensic Medicine & Toxicology Department, KGMU, India.
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Liang M, Min M, Guo X, Song Q, Wang H, Li N, Su W, Liang Q, Ding X, Ye P, Duan L, Sun Y. The relationship between ambient temperatures and road traffic injuries: a systematic review and meta-analysis. Environ Sci Pollut Res Int 2022; 29:50647-50660. [PMID: 35235122 DOI: 10.1007/s11356-022-19437-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Abstract
Traffic accidents cause considerable economic losses and injuries. Although the adverse effects of a change in ambient temperatures on human health have been widely documented, its effects on road traffic safety are still debated. This systematic review and meta-analysis was performed to synthesize available data on the association between ambient temperature and the risks of road traffic accidents (RTAs) and traffic accident injuries (TAIs). We searched 7 different databases to locate studies. The subgroup analyses were stratified by temperature type, temperature exposure, region, mean temperature, mortality, study period, statistical model, and source of injury data. This study was registered with PROSPERO under the number CRD42021264660. This is the first meta-analysis to investigate the association between ambient temperature and road traffic safety. A total of 34 high-temperature effect estimates were reported, and two additional studies reported the relationship between low temperatures and TAI risk. The meta-analysis results found a significant association between the high temperature and RTAs, and the pooled RR was 1.025 (95%CI 1.014, 1.035). The risk of TAI was also significantly associated with temperature increases. Subgroup analyses found that using daily mean temperatures, the RR value of road traffic accidents was 1.024 (95%CI 0.939, 1.116), and the RR value of road traffic injuries was 1.052 (95%CI 1.024, 1.080). Hourly temperatures significantly increased the risk of RTA, while the risk of TAI was not significantly increased by hourly temperature. The sensitivity analysis indicated that the results were stable, and no obvious publication bias was detected. The results of this systematic review and meta-analysis suggest that increases in ambient temperature are associated with an increased risk of RTAs and TAIs. These findings add to the evidence of the impact of ambient temperature on road traffic safety.
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Affiliation(s)
- Mingming Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Min Min
- Anhui Institute of Medical Information (Anhui Medical Association), No.15 Gongwan Road, Hefei, 230061, Anhui, People's Republic of China
| | - Xianwei Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Qiuxia Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Hao Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Ning Li
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Wanying Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Qiwei Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Xiuxiu Ding
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Pengpeng Ye
- The National Center for Chronic and Noncommunicable Disease Control and Prevention, the Chinese Center for Disease Control and Prevention, Beijing, 100050, China
| | - Leilei Duan
- The National Center for Chronic and Noncommunicable Disease Control and Prevention, the Chinese Center for Disease Control and Prevention, Beijing, 100050, China.
| | - Yehuan Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China.
- Center for Evidence-Based Practice, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China.
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Jamil O, Al Shdefat S, Arshad Z, Thahir A, Anwar F, Davies BM, Chou DTS. Cycling-related orthopaedic fractures admitted to the Major Trauma Centre in the cycling capital of the UK. Arch Orthop Trauma Surg 2022; 142:2747-53. [PMID: 34345936 DOI: 10.1007/s00402-021-04097-3] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The popularity of cycling in the United Kingdom is increasing, with a further rise likely due to recent government cycling promotion schemes. This study aims to characterise fractures sustained due to cycling-related collisions in patients presenting to a Major Trauma Centre, in the region with the highest cycling rates in the United Kingdom. METHODS A retrospective analysis of cycling injuries presenting to our centre between January 2012 and December 2020 was performed using a prospectively collected electronic database. Comparison of fracture characteristics was made according to patient age and mechanism of injury (collision with a motorised vehicle versus collision with a non-motorised object.). RESULTS Of the 737 patients who suffered a cycling-related injury, 292 (39.6%) suffered at least 1 fracture to the appendicular skeleton. Overall, fractures were most commonly seen in those over 50 years of age. Upper limb fractures were more common than lower limb fractures. Fractures sustained during motorised injuries were more likely to require surgical intervention than those sustained during non-motorised collisions. CONCLUSION This study provides valuable information regarding the nature, epidemiology and treatment of fractures sustained following cycling-related accidents, adding to the paucity of similar literature in the field. Given the likely increase in future cycling uptake, our results are important to clinicians treating patients with cycling-related injuries and policymakers designing safety interventions.
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O'Sullivan L, Deasy C, O'Sullivan Í. Paediatric major trauma: demographics, management and outcomes at Cork University Hospital. Ir J Med Sci 2021. [PMID: 34743298 DOI: 10.1007/s11845-021-02848-0] [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: 05/19/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To establish the demographics, injury patterns, management and outcomes of paediatric major trauma patients at Cork University Hospital (CUH). METHODS This was a retrospective, descriptive study. Data from all CUH paediatric major trauma cases that were recorded in the Trauma Audit and Research Network (TARN) database from January 2014 to July 2018 were examined. All patients were under the age of sixteen and fulfilled NOCA's Major Trauma Audit inclusion criteria (Appendix). RESULTS A total of 163 patients were included, with a mean age of 9 years (standard deviation 4.8 years); 33% (n = 54) had an Injury Severity Score (ISS) > 15. The majority (62%) was male. Paediatric trauma accounts for 6% of TARN eligible cases at CUH. The most common mechanism of injury was falls < 2 m (35%) followed by road trauma (26%). Fifty-one percent were brought by ambulance; 45% self presented. Six percent were transferred out of CUH for definitive care. Limb injuries occurred in 45% of patients (n = 74) and head injury in 29% (n = 47). Head injuries were isolated in 62% (n = 29). Injuries to chest or face were rarely isolated. The mean ISS was 12 (SD 7). The majority of patients (62%) presented out of hours. The median length of stay was 5 days (Interquartile range 3-8 days). Four patients died (mortality rate 2%), all male, two due to head injury and two due to asphyxia by hanging. CONCLUSIONS Paediatric trauma is of low volume, creating challenges in terms of preparedness. The annual number of paediatric major trauma presentations to CUH, including road trauma cases, remains roughly constant.
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Philip G, Dominic S, Poorna T A, EK J. Pattern of maxillofacial fractures in a Tertiary Referral Centre in Central Kerala - A comparison between the Pre-COVID and COVID periods. J Oral Biol Craniofac Res 2021; 12:45-48. [PMID: 34697583 PMCID: PMC8529532 DOI: 10.1016/j.jobcr.2021.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/16/2021] [Accepted: 09/28/2021] [Indexed: 12/21/2022] Open
Abstract
Our aim was to observe if there was any appreciable difference in the etiology and pattern of maxillofacial fractures during the pre-COVID-19 and COVID-19 periods in Central Kerala, South India. This retrospective study was conducted with data over a period of two years from the central database registry of our hospital. Age, sex, etiology, date of injury, and site of facial fractures were recorded and compared between both the time periods. Increase in facial fractures due to fall at home (p value < 0.01) and decrease in mass casualty cases (p value < 0.01) were observed during the COVID-19 period. Pedestrians involved were significantly more in the pre-COVID-19 period (p value < 0.01) and heavy vehicle accidents producing facial fractures were significantly more in the COVID-19 period (p value < 0.01). Frontal bone (p value = 0.008), nasal bone (p value < 0.001) and zygomatico-maxillary complex fractures (p value < 0.001) occurred significantly more in the COVID-19 time period whereas naso-orbito-ethmoidal (p value = 0.003), mandibular (p value = 0.011) and dentoalveolar fractures (p value < 0.001) were seen significantly more in the pre-COVID-19 period. There was decrease in the total number of maxillofacial cases during the COVID-19 period. However, this was not significant when only the number of facial fractures were compared between the two periods. This study provided an insight on the differences in etiology and pattern of maxillofacial fractures during the pre-COVID-19 and COVID-19 periods. Road traffic accidents involving two wheelers predominate during the COVID-19 period also, prompting further critical exploration of the reasons behind this finding.
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Affiliation(s)
- George Philip
- Department of Oral and Maxillofacial Surgery, Government Dental College, Kottayam, India
- Corresponding author.
| | - Shiney Dominic
- Department of Oral and Maxillofacial Surgery, Government Dental College, Thrissur, India
| | - Anish Poorna T
- Department of Oral and Maxillofacial Surgery, Government Dental College, Kottayam, India
| | - Joshna EK
- Department of Oral and Maxillofacial Surgery, Government Dental College, Kottayam, India
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Nagassima Rodrigues Dos Reis K, McDonnell JM, Ahern DP, Evans S, Gibbons D, Butler JS. Changing Demographic Trends in spine trauma: The presentation and outcome of Major Spine Trauma in the elderly. Surgeon 2021; 20:e410-e415. [PMID: 34600828 DOI: 10.1016/j.surge.2021.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/21/2020] [Revised: 11/30/2020] [Accepted: 08/19/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Major trauma has seen a demographic shift in recent years and it is expected that the elderly population will comprise a greater burden on the major trauma service in the near future. However, whether a similar trend exists in those undergoing operative intervention for spinal trauma remains to be elucidated. AIMS To compare the presentation and outcomes of patients ≥65 years of age sustaining spine trauma to those <65 years at a national tertiary referral spine centre. METHODS The local Trauma Audit Research Network (TARN) database was analysed to identify spinal patients referred to our institution, a national tertiary referral centre, between 01/2016 and 05/2019. Patients were divided into a young cohort (16-64 years old) and an elderly cohort (> 64 years old). No explicit distinction was made between major and minor spine trauma cases. Variables analysed included patient demographics, injury severity, mortality, interventions, mechanism of injury and length of hospital stay. RESULTS A total of 669 patients were admitted of which 480 patients underwent operative intervention for spinal trauma. Within the elderly cohort, this represented 75.3% of cases. Among the younger population, road traffic collisions were the most common mechanism of injury (37.1%), while low falls (<2 m) (57.4%) were the most common mechanism among the older population. Patients ≥65 years old had significantly longer length of stay (21 days [1-194] v 14 days [1-183]) and suffered higher 30-day mortality rates (4.6% [0-12] v 0.97% [0-4]). CONCLUSION Orthopaedic spinal trauma in older people is associated with a significantly higher mortality rate as well as a longer duration of hospitalization. Even though severity of injury is similar for both young and old patients, the mechanism of injury for the older population is of typically much lower energy compared to the high energy trauma affecting younger patients.
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Affiliation(s)
| | - Jake M McDonnell
- Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, Ireland.
| | - Daniel P Ahern
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine, Trinity College Dublin, Ireland
| | - Shane Evans
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Denys Gibbons
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Joseph S Butler
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland
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Abhilash KPP, Paul AJ, Das S, Hazra D, Jain S, Dhinakar Arelly SP. Changing pattern of trauma during the COVID-19 Pandemic. Med J Armed Forces India 2021; 77:S338-44. [PMID: 34334902 DOI: 10.1016/j.mjafi.2021.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/08/2021] [Indexed: 11/21/2022] Open
Abstract
Background The COVID-19 pandemic compelled the Indian government to enforce a complete nationwide lockdown on 24th March 2020. Methods This retrospective study was done to analyse the profile of trauma patients presenting to the emergency department (ED) from January to August 2020. Data from 69 days of lockdown and 83 days of pre-lockdown periods were used to calculate the 30-day incidence rates. Results During the 7-month study period, 5220 patients presented to our ED with trauma; 2296 in the prelockdown phase (83 days), 1205 during the lockdown phase (69 days), and 1719 during the postlockdown phase (92 days). There was a significant decrease (36.7%) in the 30-day incidence rate of trauma victims presenting to the ED during the lockdown phase (525) compared with the prelockdown phase (830). The 30-day incidence of road traffic accidents (RTA), fall from height, fall on level ground and other trauma decreased by 53.2%, 26%, 23.2% and 12.9%, respectively, while assault cases increased by 8.3% during the lockdown period as compared with the prelockdown period. During the lockdown period, the 30-day incidence of trauma victims with a positive blood alcohol content decreased by 39.6% with a significant drop in the strict lockdown month of April 2020. Conclusions A significant reduction in the incidence rate of trauma victims, especially RTA and geriatric trauma was seen during the gruelling lockdown period of the COVID 19 pandemic.
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Abstract
Vehicular runover of pedestrians is a commonly reported occurrence in literature. The usual presentations at autopsy are avulsion of the intra-abdominal viscera, solid organ crushing, hemorrhage, fracture of pelvic bone and vertebra, and herniation of the abdominal contents. There are reports of many cases where the abdominal and thoracic viscera have herniated out of their respective compartment following rupture of the diaphragm. Herniation of the intestine through natural orifices or other anatomical openings of the body has also been reported. This herniation occurs following a reduction in the anteroposterior diameter and acute increase in intra-abdominal pressure, displacing the abdominal contents out of their normal position through some natural anatomical openings inside the body following the path of least resistance. We report an interesting case of vehicular runover where the intestinal coils have come out of the body at the ankle. The authors describe the plausible mechanism and the route through which the intestine could have traversed.
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Affiliation(s)
- Siddhartha Das
- Department of Forensic Medicine and Toxicology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Puducherry 605006, India.
| | - Kirthika Ravi
- Department of Forensic Medicine and Toxicology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Puducherry 605006, India
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Ahmed S, Ashraf M, Sahanand S, Rajan DV. Can ACL Tears be Restricted to Sports Injuries Alone? A Retrospective Analysis. Indian J Orthop 2021; 55:402-8. [PMID: 34306554 DOI: 10.1007/s43465-021-00387-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 02/17/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The number of people injured following a road traffic accident (RTA) are as high as 2-5 crores around the world every year. The literature from western population suggests that ACL injuries are encountered mostly following high velocity sports injuries in clinical practise. But, in India there are a large group of individuals presenting with ACL injuries following RTAs. METHODS We performed a retrospective analysis of all patients with ACL injuries presenting to our hospital following RTAs. All the information pertaining to the ligaments injured, vehicular factors, time of the day and environmental factors were recorded. The data was then analysed statistically. RESULTS Most injuries occurred in the 31-40 year age group and velocity in the same range. Injuries due to bike skid predominated in our study amounting to 55.9%. Interestingly, very low velocities accidents due to stray dogs accounted to 43.8% and they occur mostly at night. CONCLUSION The number of patients presenting with RTA related ACL injuries in our country are numerous. Hence, we have made an attempt to show that ACL injuries can occur even at low velocity following motor vehicle accidents in contrast to the western population, where sports related injuries are the most common etiology for such mishaps.
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Woyessa AH, Heyi WD, Ture NH, Moti BK. Patterns of road traffic accident, nature of related injuries, and post-crash outcome determinants in western Ethiopia - a hospital based study. Afr J Emerg Med 2021; 11:123-131. [PMID: 33680733 PMCID: PMC7910177 DOI: 10.1016/j.afjem.2020.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 04/13/2020] [Revised: 09/04/2020] [Accepted: 09/05/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Ethiopia is one of the countries with the worst road traffic accident records in the world and it ranks second among east African countries. There have not been sufficient studies that mainly reflect the post-crash determinants of deaths and this study was therefore done to assess the overall nature of injuries and the post-crash outcome determinants of road the traffic accident in western part of Ethiopia. Methods This was a hospital-based prospective study conducted from 1 January 2019 to 31 December 2019 using an area sampling technique. Five administrative zones in west Ethiopia were initially selected as a geographical cluster; out of which, four zones were randomly selected. Then, a total of four hospitals were conveniently selected. Finally, 327 people injured in road traffic accidents and brought to the selected hospitals were consecutively included. Results Overall, 189 (66.1%) of the casualties have sustained multiple injuries and 65 (24.0%) of them have got severe injuries. About 38.8% and 13.6% have respectively died and discharged with permanent disabilities. A longer distance from receiving hospital (AOR: 1.4, 95% CI [0.48–4.08]), singleness in the number of injury (AOR: 4.3, 95% CI [2.08–9.8]), and lack of receiving pre-hospital care (AOR: 4.072, 95% CI [1.197–13.85]) had statistical associations with increased number of death. On the other hand, injured people who were taken to the hospitals by police officers (AOR: 0.371, 95% CI [0.160–0.860]) than emergency medical technicians and those who were transported by other vehicles (AOR: 2. 58, 95% CI [1.21–5.52]) than ambulance have ironically survived more. Conclusion This study concludes that the road traffic accidents related deaths occur largely due to the seriousness of injuries and are exacerbated by lack of adequate pre-hospital emergency care services, costing the lives of many Ethiopians.
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Affiliation(s)
- Ashenafi Habte Woyessa
- Wollega University, Institute of Health Science, School of Nursing and Midwifery, Department of Emergency and Critical Care Nursing, Nekemte, Ethiopia
- Corresponding author.
| | - Worku Dechasa Heyi
- Wollega University, Institute of Health Science, Department of Public Health, Nekemte, Ethiopia
| | - Nesru Hiko Ture
- Wollega University, Institute of Health Science, School of Nursing and Midwifery, Department of Emergency and Critical Care Nursing, Nekemte, Ethiopia
| | - Burtukan Kebede Moti
- Wollega University, Institute of Health Science, School of Nursing and Midwifery, Department of Nursing, Nekemte, Ethiopia
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Papadimitriou-Olivgeris M, Panteli E, Koutsileou K, Boulovana M, Zotou A, Marangos M, Fligou F. Predictors of mortality of trauma patients admitted to the ICU: a retrospective observational study☆. Braz J Anesthesiol 2020; 71:23-30. [PMID: 33712248 PMCID: PMC9523669 DOI: 10.1016/j.bjane.2020.12.006] [Citation(s) in RCA: 2] [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] [Received: 06/15/2019] [Accepted: 06/27/2020] [Indexed: 11/24/2022] Open
Abstract
Background and objectives Worldwide, trauma is one of the leading causes of morbidity and mortality. The aim of the present study is to identify the predictors of mortality of trauma patients requiring Intensive Care Unit (ICU) admission. Methods This retrospective study was conducted in the ICU of our institution in Greece during a six-year period (2010–215). Results Among 326 patients, trauma was caused by road traffic accidents in .5%, followed by falls (21.1%) and violence (7.4%). Thirty-day mortality was 27.3%. Multivariate analysis showed that higher New Injury Severity Score (NISS), severe head/neck injury, acute kidney injury, septic shock and hemorrhagic shock were significantly associated with mortality while higher Revised Injury Severity Classification, version II (RISC II) and the administration of enteral nutrition were associated with survival. NISS showed the higher accuracy in predicting 30-day mortality followed by RISC II, while scores based only in physiological variables had lower predictive ability. Conclusions Increased mortality was strongly associated with the severity of the injury upon admission. Traumatic brain injury, septic shock and acute kidney injury have also been found among the strongest predictors of mortality. NISS can be considered as a statistically superior score in predicting mortality of severely injured patients.
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Affiliation(s)
- Matthaios Papadimitriou-Olivgeris
- University of Patras, School of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Patras, Greece; University Hospital of Lausanne, Department of Infectious Diseases, Lausanne, Switzerland; University of Patras, School of Medicine, Division of Infectious Diseases, Patras, Greece.
| | - Eleftheria Panteli
- University of Patras, School of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Patras, Greece
| | - Kyriaki Koutsileou
- University of Patras, School of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Patras, Greece
| | - Maria Boulovana
- University of Patras, School of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Patras, Greece
| | - Anastasia Zotou
- University of Patras, School of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Patras, Greece
| | - Markos Marangos
- University of Patras, School of Medicine, Division of Infectious Diseases, Patras, Greece
| | - Fotini Fligou
- University of Patras, School of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Patras, Greece
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Bakhsh K, Zimri FK, Mohammad E, Atiq-Ur-Rehman, Saaiq M. Presentation and outcome of femoral infected non-unions in children and adolescents. Pak J Med Sci 2020; 37:201-205. [PMID: 33437277 PMCID: PMC7794135 DOI: 10.12669/pjms.37.1.3354] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives To document the presentation of infected non-unions of femur in pediatric and adolescent population and evaluate the outcome of segmental bone transport with the Ilizarov method. Methods This prospective case series study was carried out over a period of five years, from January 01, 2015 to December 31, 2019. The study included all children and adolescent patients who presented with femoral infected non unions. The study excluded patients above the age of 16 years and those who had pathological fractures secondary to bone pathologies such as cysts, tumors or metabolic bone diseases. Results Out of 31 patients, 27(87.09%) were males and 4(12.90%) were females. The mean age was 13.48±1.98 years. The underlying mechanisms that lead to the causation of fractures included road traffic accidents (n=23;74.19%), fall from height (n=7;22.58%) and firearm injuries (n=1;3.22%). The bone gaps ranged from 3-5 cm with a mean of 4.00± 0.856 cm. Bone union was achieved among 28(90.32%) patients. Infection was eradicated among 27(87.09%) patients whereas the remaining patients continued to suffer persistent infection. The most common complications included pin tract inflammation/ infection among (n=31;100%) patients and stiffness of knee joint among (n=19;61.29%) patients. Conclusion Majority of the patients were males, aged 9-16 years. Road traffic accidents were the commonest cause of the fractures. The Ilizarov method of segmental bone transport was effective in treating the majority of infected non-unions.
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Affiliation(s)
- Karim Bakhsh
- Dr. Karim Bakhsh, FCPS. Department of Orthopedics, Bolan Medical Complex Hospital, Quetta, Pakistan
| | - Faridullah Khan Zimri
- Dr. Faridullah Khan Zimri, FCPS. Department of Orthopedics, NIRM, Islamabad, Pakistan
| | - Eid Mohammad
- Dr. Eid Mohammad, FCPS. Department of Orthopedics, Bolan Medical Complex Hospital, Quetta, Pakistan
| | - Atiq-Ur-Rehman
- Dr. Atiq-Ur-Rehman, FCPS. Department of Orthopedics, Bolan Medical Complex Hospital, Quetta, Pakistan
| | - Muhammad Saaiq
- Dr. Muhammad Saaiq, FCPS. Department of Plastic Surgery, NIRM, Islamabad, Pakistan
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Vishal, Prakash O, Rohit, Prajapati VK, Shahi AK, Khaitan T. Incidence of Maxillofacial Trauma Amid COVID-19: A Comparative Study. J Maxillofac Oral Surg 2020; 21:420-425. [PMID: 33250599 PMCID: PMC7680068 DOI: 10.1007/s12663-020-01484-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 08/12/2020] [Accepted: 11/13/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction Pandemic caused by novel coronavirus has created an unprecedented situation of lockdown in India. This retrospective study was undertaken to evaluate the impact of COVID-19 restrictions on cases of maxillofacial trauma and its etiologic variation by comparing it with the previous year archived data. Materials and Methods Patients with maxillofacial fracture visiting during the lockdown period (Phase) were compared to the patient’s record during the same time period in the year 2019 (Control). They were subcategorised based on the etiology of trauma, i.e., road traffic accident (RTA), self-fall, physical assault and animal attacks. Age and gender variations were also assessed. Degree of significance was calculated using t test and p value obtained. Result Mean age of trauma patients during lockdown and control period was 32.66 and 27.93 years, respectively. Number of cases of overall trauma had significantly decreased. Cases of RTA and self-fall were 22 and 4 in lockdown compared to 135 and 16 during control phase. Cases of physical assault increased by 50%, i.e., from 9 to 6 on comparison of both the phases. Animal attack maxillofacial injuries were 2 in each group. Conclusion RTA and subsequent drop in numbers of maxillofacial trauma can be shown as the benefit of lockdown nonetheless on the other side increase in number of physical assaults also shows how isolation and restrictions have psychological negative impact on society.
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Affiliation(s)
- Vishal
- Department of Oral and Maxillofacial Surgery, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, 834009 India
| | - Om Prakash
- Department of Oral and Maxillofacial Surgery, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, 834009 India
| | - Rohit
- Department of Oral and Maxillofacial Surgery, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, 834009 India
| | - V K Prajapati
- Department of Oral and Maxillofacial Surgery, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, 834009 India
| | - Ajoy Kumar Shahi
- Department of Oral and Maxillofacial Surgery, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, 834009 India
| | - Tanya Khaitan
- Dept of Oral Medicine and Radiology, Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand 834009 India
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Boscolo-Berto R, Macchi V, Porzionato A, Parenti A, Petrelli L, Raimondo A, De Caro R. Post-traumatic aneurysmal rupture involving the circle of Willis affected by fibromuscular dysplasia. A case report and systematic review. Leg Med (Tokyo) 2020; 47:101742. [PMID: 32653857 DOI: 10.1016/j.legalmed.2020.101742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/02/2019] [Revised: 04/27/2020] [Accepted: 06/26/2020] [Indexed: 11/26/2022]
Abstract
The fatal rupture of a saccular aneurysm at the junction between the left anterior cerebral artery and anterior communicating artery affected by fibromuscular dysplasia (FMD) is a rare condition. Here is reported the case of a subject involved in a road traffic accident a few minutes before the death, which opened the debate on the real cause of death in a forensic setting. By autopsy, the examination of the brain revealed subarachnoid haemorrhage with flooding of the ventricles due to the breached saccular aneurysm of the junction between the left anterior cerebral artery and anterior communicating artery, in FMD mainly affecting the circle of Willis arteries. A spontaneous aneurysmal rupture was excluded on the basis of probabilistic analysis, in the presence of alternative hypotheses that could explain the facts. The passenger's delayed loss of consciousness may be explained as much by a hypertension-linked rupture of the aneurysm triggered by the emotional stress experienced, as by the traumatic shaking/impact of the aneurysm against the bony skull structures, in a subject predisposed to aneurysm frailty due to FMD. Overall, the concausal role of both the road traffic accident, typified by high kinetic energy, and the presence of a pre-existing aneurysmatic weakness due to FMD is fully recognized. The identification of anatomical variants, jointly with uncommon diseases at the examination of the brain base arteries in any case of isolated basal subarachnoid haemorrhage, may avoid wrong legal consequences even when the cause of death seems to be obviously of simple traumatic origin.
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Affiliation(s)
- Rafael Boscolo-Berto
- Institute of Human Anatomy, Department of Neurosciences, University of Padova, Padova, Italy
| | - Veronica Macchi
- Institute of Human Anatomy, Department of Neurosciences, University of Padova, Padova, Italy
| | - Andrea Porzionato
- Institute of Human Anatomy, Department of Neurosciences, University of Padova, Padova, Italy
| | - Anna Parenti
- Institute of Human Anatomy, Department of Neurosciences, University of Padova, Padova, Italy
| | - Lucia Petrelli
- Institute of Human Anatomy, Department of Neurosciences, University of Padova, Padova, Italy
| | | | - Raffaele De Caro
- Institute of Human Anatomy, Department of Neurosciences, University of Padova, Padova, Italy.
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Caldin M, Rocchi P, Zoia A, Botto A, Bertolini G, Zappa G, Furlanello T. Thyroid axis and adrenal activity in 28 day survivor and nonsurvivor dogs involved in recent road traffic accidents: A cohort study of 420 dogs. Res Vet Sci 2020; 132:243-249. [PMID: 32645514 DOI: 10.1016/j.rvsc.2020.06.021] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 11/27/2022]
Abstract
The objective of this retrospective cohort study was to determine the impact of a recent trauma on thyroid axis and adrenal activity in dogs and to assess the usefulness of urinary cortisol-to-creatinine ratio (UCCR), basal serum thyroid-stimulating hormone (TSH), total thyroxine (tT4), and free thyroxine (fT4) concentrations in predicting outcome in dogs traumatized by a road traffic accident (RTA). An RTA exposed group of 210 dogs was evaluated within 24 hours of the trauma. Their data were compared with data from a matched group of dogs with other diagnoses. UCCR was positively correlated with the trauma severity and was higher in the exposed group than in the nonexposed group (median 101.500 vs. 21.02; p < 0.0001). tT4 values were statistically similar between the two groups, but were correlated with a trauma score, while TSH (median = 0.050 vs. 0.080 ng/mL; p < 0.0001) and fT4 (median = 15.850 vs. 17.950 pmol/L; p = 0.0037) were significantly lower for the exposed group. Nonsurvivors in comparison to survivors presented and higher median UCCR (181.800 vs. 93.850 respectively; p = 0.020), and a lower serum fT4 (12.700 vs. 16.500 pmol/L, respectively; p = 0.0046). A similar pattern had been observed for tT4. TSH levels were not predictive of survival. This study provides insights into the endocrine characteristics of dogs suffering from acute trauma. UCCR was higher while fT4 and TSH were both lower in RTA-injured dogs than in dogs affected by other conditions. Furthermore low fT4 and tT4, and a high UCCR could be useful prognostic factors in dogs affected by RTA trauma.
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Affiliation(s)
- Marco Caldin
- From San Marco Veterinary Clinic and Laboratory, via dell'Industria 3, Veggiano, Italy
| | - Paola Rocchi
- From San Marco Veterinary Clinic and Laboratory, via dell'Industria 3, Veggiano, Italy
| | - Andrea Zoia
- From San Marco Veterinary Clinic and Laboratory, via dell'Industria 3, Veggiano, Italy
| | - Angelica Botto
- From San Marco Veterinary Clinic and Laboratory, via dell'Industria 3, Veggiano, Italy
| | - Giovanna Bertolini
- From San Marco Veterinary Clinic and Laboratory, via dell'Industria 3, Veggiano, Italy
| | - Giovanni Zappa
- From San Marco Veterinary Clinic and Laboratory, via dell'Industria 3, Veggiano, Italy
| | - Tommaso Furlanello
- From San Marco Veterinary Clinic and Laboratory, via dell'Industria 3, Veggiano, Italy.
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Abstract
Background There is concern about the detrimental effects of shift-workers’ increasing working hours particularly when driving sleep deprived. The approach to measuring the magnitude of driving impairment caused by sleep deprivation was by comparing it to alcohol. The study compared driving performance after 24-h of wakefulness to performance with a BrAC of just over 22 μg/100mls of breath which is equal to 50 mg of alcohol per 100mls of blood (Scottish drink-drive limit). The effectiveness of coffee as a countermeasure for driver fatigue and the association between subjective impairment and actual performance was also investigated. Methods A study of 30 participants (11 male and 19 female; mean age 21) was conducted. Subjects were tested under three conditions: fully rested, sleep deprived, and alcohol intoxicated – BrAC mean [SD] 25.95 μg [2.78]. Under each condition, subjects were tested before and after coffee ingestion. This involved driving simulation (Lane Change Task and Reaction Test) and subjective Likert scales (Karolinska Sleepiness Scale and driver impairment scale). Outcome measures included lane tracking adaptive mean deviation, reaction time, and subjective sleepiness and impairment ratings. Results Compared to alcohol, sleep deprived mean reaction times were slower (2.86 s vs. 2.34 s) and lateral control of the vehicle was reduced (lane tracking adaptive mean deviation: 0.5 vs. 0.3). Coffee did not produce an improvement when sleep deprived, and instead, performance deteriorated. Females were less impaired following sleep deprivation than males. Following prolonged wakefulness, the correlation between subjective impairment and actual performance was significant. Conclusions It was concluded that sleep deprivation has a greater impact on driving performance than a BrAC of 22 μg/100mls of breath, as measured by driving simulation. Coffee is not an effective countermeasure for sleep deprived driving and drivers’ ability to judge this impairment is suggested to be limited.
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Affiliation(s)
- Joanna Lowrie
- University of Dundee, Nethergate, Dundee, DD1 4HN, Scotland.
| | - Helen Brownlow
- The Centre for Forensic & Legal Medicine, 2 Park Pl, Dundee, DD1 4HR, Scotland
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Gorleku PN, Edzie EK, Dzefi-Tettey K, Setorglo J, Piersson AD, Ocansey S, Morny EK, Armah CD. Computed tomography estimation of the prevalence of neuro-ophthalmic injuries in head trauma patients seen in a tertiary health facility in Ghana. Heliyon 2020; 6:e04200. [PMID: 32613105 PMCID: PMC7322250 DOI: 10.1016/j.heliyon.2020.e04200] [Citation(s) in RCA: 2] [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] [Received: 01/20/2020] [Revised: 04/09/2020] [Accepted: 06/08/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Prevalence of traumatic brain injury (TBI) is extremely high and potentially associated with severe incapacitating consequences. Literature reports that 90% of road traffic deaths and injuries including TBI occur in low and middle-income countries including Ghana. Computed Tomography (CT) scan is the imaging modality of choice for the initial assessment of the extent of head injury. Some Neuro-ophthalmic injuries (NOI) may sometimes be ambiguous and indistinct although a serious injury with potential damaging consequences. Data on the prevalence of NOI post trauma is non-existent in Ghana to inform policy. The onus therefore lies on the Radiologist who will review the head CT scan to be very meticulous not to miss any NOI if present. We therefore decided to diligently review a large cross-sectional retrospective post trauma head CT scans for occurrence of NOI. OBJECTIVE To determine the incidence of NOI secondary to head trauma and the possible loss of vision thereof in a retrospective study using patients' head CT scan data from a tertiary hospital's CT centre in Cape Coast, Ghana. METHOD All head CT scans secondary to trauma for the period January 2016 to December 2018, were retrieved and carefully analysed. A total number of 1043 of head CT scan images were analyzed by Consultant Radiologists. RESULTS Results showed out of 1043 CT scans reviewed, 742 (71,1%) were males and 301 (28.9%) were females. A total of 609 (58.4%) out of the 1043 patients sustained NOIs of various anatomical types. More Males 398 (65.4%) sustained NOI than females 211 (34.6%). The incidence of NOI was more among the youth as majority 167 (27.4%) of the patients were within the 18-29 years followed by 30-39 years bracket of 148 (24.3%). Fourteen anatomical types of NOI were elicited and further analysis revealed, intra-ocular foreign body to be the highest 107 (17.6%) cases, orbital floor fractures injury was 92 (15.1%) cases, with globe rupture injury and intraocular hemorrhage recording 79 (13.0%) cases each. Optic nerve injury was the least revealing 7 (1.1%) cases. There was a relationship between the gender of patient and the propensity to sustain NOI as males were more disposed to NOI than females. Road traffic accident (RTA) was the main pervasive cause of TBI and this accounted for 71.9% of all cases, followed by fall from height 24%, and the least cause of TBI was ascribed to gunshot injury of 0.33%. CONCLUSION Prevalence of NOI is high. Urgent measures must therefore be implemented to reduce the RTA menace in general and to mitigate the associated NOI and possible loss of vision thereof.
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Affiliation(s)
- Philip N. Gorleku
- Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
- P.M.B University of Cape Coast, Cape Coast, Ghana
| | - Emmanuel K. Edzie
- Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
- P.M.B University of Cape Coast, Cape Coast, Ghana
| | - Klenam Dzefi-Tettey
- Department of Radiology, Korle-Bu Teaching Hospital, Accra, Ghana
- PMB, Accra, Ghana
| | - Jacob Setorglo
- P.M.B University of Cape Coast, Cape Coast, Ghana
- Department of Medical Biochemistry, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Albert D. Piersson
- P.M.B University of Cape Coast, Cape Coast, Ghana
- Department of Imaging Technology & Sonography, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Stephen Ocansey
- P.M.B University of Cape Coast, Cape Coast, Ghana
- Department of Optometry, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Enyam K.A. Morny
- P.M.B University of Cape Coast, Cape Coast, Ghana
- Department of Optometry, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Celso D.G. Armah
- P.M.B University of Cape Coast, Cape Coast, Ghana
- Department of Optometry, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
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Herath M, Bautz P, Parker D, Dobbins C. The importance of wearing a seatbelt correctly - A case report of blunt trauma causing complete shearing transection of the gastroduodenal junction. Int J Surg Case Rep 2020; 72:197-201. [PMID: 32544828 PMCID: PMC7298554 DOI: 10.1016/j.ijscr.2020.05.008] [Citation(s) in RCA: 3] [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: 04/15/2020] [Revised: 05/02/2020] [Accepted: 05/02/2020] [Indexed: 11/25/2022] Open
Abstract
Seat belt related injuries can cause significant morbidity and mortality in road traffic accidents. We present a case where an improperly worn seatbelt caused traumatic shearing transection of the gastroduodenal junction. A systematic multidisciplinary assessment approach enabled all injuries to be identified early. The patient underwent damage control exploratory laparotomy then delayed reconstruction of the alimentary tract.
Introduction Global mortality as a result of road traffic accidents (RTA) has reduced significantly since mandatory implementation of seatbelts. Whilst seatbelt related injury, or “seatbelt syndrome,” is a recognised phenomenon, unrestrained passengers have considerably worse survival outcomes. Improper positioning of seatbelts, as is discussed in the following case, can cause extensive injury. Presentation of case Our patient is a 35-year-old female who was a restrained front seat passenger in a car vs. tree collision at 80 km/h. Her seat belt was worn with the shoulder strap under her left axilla. She sustained multiple injuries including complete transection of the gastroduodenal junction. In addition to this she had splenic, liver, transverse colonic, left lower rib and humeral injury. She underwent damage control laparotomy with splenectomy; re-look with gastrojejunostomy and transverse colonic resection with defunctioning ileostomy. She made a good recovery and was discharged after a 4 week admission. Discussion Improperly worn seatbelts redistribute decelerative forces to sensitive regions. A multidisciplinary approach is required to effectively manage complex multi-system trauma. In trauma the simplest reconstructive measures can be the most effective and minimise risk of further complications for the patient. Conclusion Improperly worn seatbelts pose a significant risk to patients. A traumatic complete gastroduodenal transection can be effectively reconstructed with gastrojejunostomy anastomosis.
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Affiliation(s)
- Matheesha Herath
- The Royal Adelaide Hospital, Port Road, Adelaide, South Australia, 5000, Australia.
| | - Peter Bautz
- The Royal Adelaide Hospital, Port Road, Adelaide, South Australia, 5000, Australia
| | - Dominic Parker
- The Royal Adelaide Hospital, Port Road, Adelaide, South Australia, 5000, Australia
| | - Christopher Dobbins
- The Royal Adelaide Hospital, Port Road, Adelaide, South Australia, 5000, Australia
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Abstract
Background In the globe, 1.3 million deaths and around 50 million non-fatal injuries were reported. From all deaths, 90% occur in developing countries. Ethiopia is considered as one of the worst countries in the globe where road traffic accident causes a lot of fatalities and injuries of road users every year. The main objective of the study was to identify the main predictors of fatal car accident. Methods The retrospective research design was applied. 255 records were taken from Finote Selam traffic police office, northwest part of Ethiopia from September 2009 to January 2018. The statistical analysis was performed by using SPSS version 23 software. Chi-square for association test and ordinal logistic regression for predictor identification were used. Results Age of drivers were the responsible causes of fatal road traffic accident (p-value = 0.033). The more experienced drivers decreased the occurrence of fatal traffic accidents. In addition, increasing vehicle service year reduced the occurrence of accidental death. Besides, the occurrence of fatal car accident in autumn season was 0.44 times less than that of in summer season. Additionally, drivers’ educational level was played a crucial role in a road traffic accident. For instance, drivers whose educational level was below 12th grade were the most responsible factor for car accident deaths. What is more, it was seen that drivers who drove their vehicles could minimize the occurrence of fatal traffic accident (p-value = 0.010). Conclusion In conclusion, fatal road traffic accidents happened due to drivers’ lack of sufficient driving experience and low educational level. In addition, driving on weekends and driving on summer season were disclosed as responsible for fatal car accident. Moreover, drivers with younger age and those who drove a new vehicle likely caused fatal car accident. However, drivers who drive their vehicles seemed to be less responsible for fatal car accident than that of employed.
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Affiliation(s)
- Melaku Tadege
- Department of Statistics, Injibara University, Injibara, Amhara, Ethiopia.
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Safarpour H, Khorasani-Zavareh D, Mohammadi R. The common road safety approaches: A scoping review and thematic analysis. Chin J Traumatol 2020; 23:113-121. [PMID: 32178997 PMCID: PMC7156955 DOI: 10.1016/j.cjtee.2020.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 08/07/2019] [Revised: 01/20/2020] [Accepted: 02/12/2020] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Comparison of effective road safety approaches with those of relatively similar countries can be used to identify possibilities for safety improvement. Since there is no clear and comprehensive study of countries' current and successful approaches to road safety in the world, the aim of this study was to identifying common road safety approaches in the world. METHODS This study was performed using scoping review and thematic analysis. The study followed the approach proposed by Arksey and O'Malley. In this study all articles were selected without time limit by searching in the following databases: Web of Science, PubMed, Scopus, ProQuest, and Embase. An initial search of 5612 papers was found and finally, 20 papers met the inclusion criteria and were analyzed. RESULTS There were different road safety approaches in different countries around the world, which were classified in three themes: traditional approach, systemic approach, and vision zero. The traditional approach includes the sub-theme of the road-user approach, and the causal approach. The systemic approach also includes sub-themes of sustainable safety, safety system, and the United Nations plan for decade of action. CONCLUSION A systemic approach to road safety seems to be welcomed by most developed and developing countries, and a paradigm shift towards a safe system has taken place. Also, given the successful results of implementing vision zero in leading countries, most countries are trying to design and implement this approach. Finally, the choice and implementation of road safety approaches varies according to the principles, priorities and infrastructure of each country.
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Affiliation(s)
- Hamid Safarpour
- Department of Health in Emergencies and Disasters, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davoud Khorasani-Zavareh
- Workplace Health Promotion Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Corresponding author.
| | - Reza Mohammadi
- Department of Neurobiology, Care Sciences and Society, H1, Division of Family Medicine and Primary Care, Huddinge, Sweden
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Liang M, Zhang Y, Qu G, Yao Z, Min M, Shi T, Duan L, Sun Y. Epidemiology of fatal crashes in an underdeveloped city for the decade 2008-2017. Int J Inj Contr Saf Promot 2020; 27:253-260. [PMID: 32148158 DOI: 10.1080/17457300.2020.1737140] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The road traffic accident is an important public health issue affecting social development and public safety. The purpose of this study is to describe the situation of traffic accidents, and to explore the relationship between fatal traffic accidents and risk factors in Suzhou city of Anhui province in China. The accident data was obtained from the Traffic Police Detachment of the Suzhou Public Security Bureau. Other vehicle, population and road information are derived from Suzhou Statistical Yearbook. Descriptive analysis was used to summarize road traffic accident participants' characteristics. The binary logistic regression model was used to analyze the factors that affected fatal traffic accident. There are 7,795 cases involved 18,774 road traffic participants. By logistic regression, we found that in Suzhou, overloading makes traffic accidents more likely to be the most fatal traffic accidents (adjusted OR = 5.33, 95%CI: 2.60-10.93). Speeding, drive after drinking, fatigue driving and pedestrian reasons might also increase the probability of fatal traffic accidents. These findings would help transportation authorities identify dangerous driving behaviors and take the necessary measures to improve road safety in undeveloped areas.
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Affiliation(s)
- Mingming Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yun Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Guangbo Qu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Zhenhai Yao
- AAnhui Meteorological Service Center, Anhui Meteorological Bureau, Hefei, Anhui, China
| | - Min Min
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Tingting Shi
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Leilei Duan
- Division of Injury Prevention and Mental Health, National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing, P.R. China
| | - Yehuan Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,Center for Evidence-Based Practice, Anhui Medical University, Hefei, Anhui, China
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Kattan AE, Almarghoub MA, Alnujaim NH, Barasain O, AlLababidi NH. Bilateral scaphoid fractures: Case report and literature review. Int J Surg Case Rep 2020; 66:412-5. [PMID: 31981789 DOI: 10.1016/j.ijscr.2020.01.005] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/25/2019] [Accepted: 01/08/2020] [Indexed: 11/21/2022] Open
Abstract
Scaphoid is the most common carpal bone involved in fractures. Presentation of bilateral scaphoid fracture is extremely rare. Bilateral scaphoid fractures rarely occur after RTA. High index of suspicion and good clinical judgment are required to detect bilateral scaphoid fractures.
Background Traumatic bilateral scaphoid fractures are extremely rare. Here, we report an unusual mechanism of bilateral scaphoid fracture after road traffic accident. Case report A 32-year-old male presented with bilateral wrist pain to our plastic surgery clinic six months after he was involved in a road traffic accident. He was diagnosed with bilateral scaphoid fracture based on his CT scan findings. It is noteworthy that at the time of collision, he had grasped the steering wheel strongly to brace himself and had suffered no significant injuries except for bilateral wrist pain. Discussion The diagnosis may be missed in our case because of bilateral hand pain complaints and normal X-ray report. Thus, we suggest that CT scan should be performed in similar incidents, particularly in case of normal X-ray reports. Conclusion It is recommended that CT scan should be performed in similar mechanism of injury with a high index of suspicion.
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Badsi S, El Kaouini A, Diyas S, Housni B. [Rupture of the descending thoracic aorta following sudden traumatic deceleration injury]. Pan Afr Med J 2020; 35:17. [PMID: 32341738 PMCID: PMC7170740 DOI: 10.11604/pamj.2020.35.17.15777] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 11/14/2019] [Indexed: 11/30/2022] Open
Abstract
La rupture aigue post traumatique de l’aorte thoracique constitue la seconde cause de mortalité chez les accidentés de la route; 80% des patients décèdent sur les lieux de l’accident. L’atteinte de sa portion descendante en dehors de l’isthme est rare et évaluée à moins de 3%. Nous rapportons le cas d’un homme de 60 ans, victime d’un accident de la voie publique (AVP) dont le mécanisme était un motocycliste heurté par une voiture avec points d’impacts au niveau du membre supérieur droit et thoracique. Cet AVP a occasionné une fracture des deux os de l’avant bras et une rupture de l’aorte thoracique descendante (ATD). Le traitement a consisté en premier temps à une suture de la brèche aortique complétée par la mise en place d’une prothèse synthétique circonférentielle avec anastomose aorto-aortique et en 2ème temps à la mise en place d’une plaque vissée de l’avant bras. L’évolution était bonne et le malade fut transféré au Service de Chirurgie Vasculaire.
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Affiliation(s)
- Soufiane Badsi
- Service de Réanimation, CHU Mohamed VI, Faculté de Médecine et de Pharmacie d'Oujda, Université Mohammed 1 Oujda, Oujda, Maroc
| | - Abderrahim El Kaouini
- Service de Réanimation, CHU Mohamed VI, Faculté de Médecine et de Pharmacie d'Oujda, Université Mohammed 1 Oujda, Oujda, Maroc
| | - Soufiane Diyas
- Service de Réanimation, CHU Mohamed VI, Faculté de Médecine et de Pharmacie d'Oujda, Université Mohammed 1 Oujda, Oujda, Maroc
| | - Brahim Housni
- Service de Réanimation, CHU Mohamed VI, Faculté de Médecine et de Pharmacie d'Oujda, Université Mohammed 1 Oujda, Oujda, Maroc
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Inamasu J, Nakatsukasa M. Traumatic brain injury among two-wheeled motor vehicle riders in Utsunomiya, Japan: a comparison between mopeds and motorcycles. Eur J Trauma Emerg Surg 2021; 47:1477-82. [PMID: 31686153 DOI: 10.1007/s00068-019-01259-2] [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: 07/31/2019] [Accepted: 10/25/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Two-wheeled motor vehicles are dichotomized into mopeds and motorcycles (MCs) based on their engine capacity. While efforts have been made, mostly by European researchers, to evaluate the possible difference in the frequency/severity of riders' traumatic brain injury (TBI) between the two categories, the results have been inconsistent. METHODS To evaluate whether such differences exist in Japan, a single-center, retrospective observational study was conducted on two-wheeled motor vehicle riders wearing a helmet during high-energy road traffic accident (RTA). Between January 2011 and December 2017, 127 moped and 128 MC helmeted riders involved in RTAs had been treated in our institution. RESULTS Moped riders were significantly older than MC riders (50.7 ± 25.0 years vs. 35.1 ± 18.6 years, p = 0.04). The frequency of TBI was significantly higher in moped riders than in MC riders (21.3% vs. 10.9%; p = 0.03). However, the frequency of other bodily injuries did not differ significantly. Among the riders with TBI, neither injury severity nor outcomes differed significantly. Multivariate regression analysis showed that the presence of altered mental status was predictive of TBI (OR 23.398; 95% CI 9.187-59.586; p < 0.001). Moped riders trended to have a higher likelihood of sustaining TBI (OR 2.122; 95% CI 0.870-5.178; p = 0.098). CONCLUSIONS Mopeds are frequently utilized by elderly in Japan, which may have been causally associated with the higher frequency of TBI in moped riders, while other causes, including the difference in helmet type, may also be involved. This study is limited by its small sample size and retrospective design, and multi-center prospective studies are warranted.
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Angerpointner K, Weber S, Tschech K, Schubert H, Herbst T, Ernstberger A, Kerschbaum M. Posttraumatic stress disorder after minor trauma - A prospective cohort study. Med Hypotheses 2019; 135:109465. [PMID: 31731059 DOI: 10.1016/j.mehy.2019.109465] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/27/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) can arise as a reaction to a traumatic experience. While many data concerning PTSD in severely injured patients are available, little is known about this disease in slightly injured patients after road traffic accidents. It is rather assumed that PTSD does not exist after objectively slight injuries. METHODS In total, 36 patients (Injury Severity Score < 16) after road traffic accidents were included in this prospective cohort study. Next to demographic and accident-specific data, the PDI (Peritraumatic Distress Inventory: individual experienced distress directly during or immediately after the traumatic event), THQ (Trauma History Questionnaire) and the BDI-II (Beck Depression Inventory-II: self-report measurement tool to examine the severity of depression) were assessed immediately after trauma (t0). Six weeks (t1) and 3 months (t2) after trauma the Impact of Event Scale - Revised (IES-R), a screening instrument for PTSD, and the BDI-II were collected. RESULTS Overall 2 patients showed critical measurement values in IES-R after 6 weeks. A strong correlation between PDI and IES-R at t1 and t2 could be detected (p < 0.05). Furthermore, a significant correlation of BDI-II and IES-R after 6 weeks and 3 months was found (p < 0.05). Neither age or sex showed a significant correlation to IES-R (p ≥ 0.05). CONCLUSION The present study showed that symptoms of PTSD can also occur after minor trauma. Especially high peritraumatic distress is associated with developing a PTSD. The occurrence of PTSD should be considered not only in severely injured patients, but also in slightly injured patients after road traffic accidents.
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Affiliation(s)
| | - Stefanie Weber
- AARU Audi Accident Research Unit, University Hospital Regensburg, Regensburg, Germany.
| | - Karen Tschech
- AARU Audi Accident Research Unit, University Hospital Regensburg, Regensburg, Germany.
| | - Hannah Schubert
- AARU Audi Accident Research Unit, University Hospital Regensburg, Regensburg, Germany.
| | - Tanja Herbst
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany.
| | - Antonio Ernstberger
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany.
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Pietzka S, Kämmerer PW, Pietzka S, Schramm A, Lampl L, Lefering R, Bieler D, Kulla M. Maxillofacial injuries in severely injured patients after road traffic accidents-a retrospective evaluation of the TraumaRegister DGU® 1993-2014. Clin Oral Investig 2019; 24:503-513. [PMID: 31377860 PMCID: PMC7223802 DOI: 10.1007/s00784-019-03024-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 07/11/2019] [Indexed: 12/20/2022]
Abstract
Objectives It was the aim of the study to analyse the prevalence of maxillofacial trauma (MFT) in severely injured patients after road traffic accidence (RTA) and to investigate associated factors. Materials and methods In a retrospective study, data from patients after RTA by the TraumaRegister DGU® from 1993 to 2014 were evaluated for demographical and injury characteristics. The predictor variable was mechanism of injury and the outcome variables were type of injury, severity and hospital resources utilization. Results During the investigation period, n = 62,196 patients were enclosed with a prevalence of maxillofacial injuries of 20.3% (MFT positive). The injury severity score of MFT-positive patients was higher than in the MTF-negative subgroup (27 ± 12.8 vs. 23.0 ± 12.7). If MFT positive, 39.8% show minor, 37.1% moderate, 21.5% serious and 1.6% severe maxillofacial injuries. Injuries of the midface occurred in 60.3% of MTF-positive patients. A relevant blood loss (> 20% of total blood volume) occurred in 1.9%. MFT-positive patients had a higher coincidence with cervical spine fractures (11.3% vs. 7.8%) and traumatic brain injuries (62.6% vs. 34.8%) than MFT-negative patients. There was a noticeable decrease in the incidence of facial injuries in car/truck drivers during the study period. Conclusions Every 5th patient after RTA shows a MFT and the whole trauma team must be aware that this indicates a high prevalence of traumatic brain and cervical spine injuries. Clinical relevance Even if sole injuries of the face are seldom life threatening, maxillofacial expertise in interdisciplinary trauma centres is strongly recommended.
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Affiliation(s)
- Sebastian Pietzka
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital Ulm, Ulm, Germany
- Department of Cranio-Maxillo-Facial-Surgery, University Hospital Ulm, Ulm, Germany
| | - Peer W. Kämmerer
- Department of Cranio-Maxillo-Facial-Surgery, University Medical Centre Mainz, Mainz, Germany
| | - Silke Pietzka
- Department of Dental Care and Centre for Dental Specialties, German Armed Forces Hospital Ulm, Ulm, Germany
| | - Alexander Schramm
- Department of Cranio-Maxillo-Facial-Surgery, German Armed Forces Hospital Ulm, Ulm, Germany
- Department of Cranio-Maxillo-Facial-Surgery, University Hospital Ulm, Ulm, Germany
| | - Lorenz Lampl
- Department of Anaesthesiology and Intensive Care Medicine, German Armed Forces Hospital of Ulm, Ulm, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Witten, Germany
| | - Dan Bieler
- Department of Trauma Surgery and Orthopaedics, Reconstructive Surgery, Hand Surgery and Burn Medicine, German Armed Forces Central Hospital Koblenz, Ruebenacher Strasse 170, 56072 Koblenz, Germany
| | - Martin Kulla
- Department of Anaesthesiology and Intensive Care Medicine, Emergency Medicine Section, HEMS Christoph 22, German Armed Forces Hospital of Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
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Kourouma K, Delamou A, Lamah L, Camara BS, Kolie D, Sidibé S, Béavogui AH, Owiti P, Manzi M, Ade S, Harries AD. Frequency, characteristics and hospital outcomes of road traffic accidents and their victims in Guinea: a three-year retrospective study from 2015 to 2017. BMC Public Health 2019; 19:1022. [PMID: 31366335 PMCID: PMC6668061 DOI: 10.1186/s12889-019-7341-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 05/29/2019] [Accepted: 07/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Road traffic accidents (RTA) remain a global public health concern in developing countries. The aim of the study was to document the frequency, characteristics and hospital outcomes of road traffic accidents in Guinea from 2015 to 2017. METHODS We conducted a retrospective cohort study using medical records of RTA victims from 20 hospitals and a cross-sectional study of RTA cases from eight police stations in eight districts in Guinea, West Africa. Data analysis included descriptive statistics, trends of RTA, a sequence of interrupted time-series models and a segmented ordinary least-squares (OLS) regression. RESULTS Police stations recorded 3,140 RTA over 3 years with an overall annual increase in RTA rates from 14.0 per 100,000 population in 2015, to 19.2 per 100,000 population in 2016 (37.1% annual increase), to 28.7 per 100,000 population in 2017 (49.5% annual increase). Overall, the injury rates in 2016 and 2017 were .05 per 100,000 population higher on average per month (95% CI: .03-.07). Deaths from RTA showed no statistical differences over the 3 years and no association of RTA trends with season was found. Overall, 27,751 RTA victims were admitted to emergency units, representing 22% of all hospitals admissions. Most victims were males (71%) and young (33%). Deaths represented 1.4% of all RTA victims. 90% of deaths occurred before or within 24 h of hospital admission. Factors associated with death were being male (p = .04), being a child under 15 years (p = .045) or an elderly person aged ≥65 years (p < .001), and having head injury or coma (p < .001). CONCLUSIONS RTA rates in Guinea are increasing. There is a need for implementing multisectoral RTA prevention measures in Guinea.
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Affiliation(s)
- Karifa Kourouma
- Centre National de Formation et de Recherche en Santé Rurale (CNFRSR) de Maferinyah, PB: 4099, Maferinyah, Forécariah, Guinea.
| | - Alexandre Delamou
- Centre National de Formation et de Recherche en Santé Rurale (CNFRSR) de Maferinyah, PB: 4099, Maferinyah, Forécariah, Guinea.,Department of Public Health, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Léopold Lamah
- Department of Traumatology and Orthopedics, University Teaching Hospital of Donka, Conakry, Guinea
| | - Bienvenu Salim Camara
- Centre National de Formation et de Recherche en Santé Rurale (CNFRSR) de Maferinyah, PB: 4099, Maferinyah, Forécariah, Guinea
| | - Delphin Kolie
- Centre National de Formation et de Recherche en Santé Rurale (CNFRSR) de Maferinyah, PB: 4099, Maferinyah, Forécariah, Guinea
| | - Sidikiba Sidibé
- Centre National de Formation et de Recherche en Santé Rurale (CNFRSR) de Maferinyah, PB: 4099, Maferinyah, Forécariah, Guinea.,Department of Public Health, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Abdoul Habib Béavogui
- Centre National de Formation et de Recherche en Santé Rurale (CNFRSR) de Maferinyah, PB: 4099, Maferinyah, Forécariah, Guinea
| | - Philip Owiti
- International Union Against Tuberculosis and Lung Disease, Paris, France.,The National Tuberculosis, Leprosy and Lung Disease Program, Ministry of Health, Nairobi, Kenya
| | - Marcel Manzi
- Medical Department, Médecins Sans Frontière Bruxelles, Bruxelles, Belgium
| | - Serge Ade
- International Union Against Tuberculosis and Lung Disease, Paris, France.,Faculté de Médecine, Université de Parakou, Parakou, Benin
| | - Anthony D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France.,London School of Hygiene and Tropical Medicine, London, UK
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Azami-Aghdash S, Sadeghi-Bazarghani H, Rezapour R, Heydari M, Derakhshani N. Comparative Study of Stewardship of Road Traffic Injuries Prevention with a Focus on the Role of Health System; Three Pioneer Countries and Three Similar to Iran. Bull Emerg Trauma 2019; 7:212-222. [PMID: 31392219 DOI: 10.29252/beat-070302] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective To compare the stewardship of road traffic accidents (RTIs) prevention in three pioneer countries and three similar ones to Iran. Methods In this descriptive comparative study, the United States of America, Sweden, and Brazil as the pioneer countries in RTIs prevention were compared to the India, Pakistan, and Turkey as the countries socioeconomically similar to Iran. Embase, PubMed, Scopus, IranDoc, IranMedex, SID, and MagIran were searched. Also a hand search conducted on websites and search engines using related keywords. Results In the pioneer countries in RTIs prevention there was a delegation to a particular organization. In the other three countries a part of the Ministry of Transportation had the overall responsibility of RTIs. In Iran there was uncertainty in the stewardship of RTIs prevention. There was little evidence on the role and activities of health systems in RTIs prevention. Conclusion It seems necessary to define a lead agency organization on RTIs prevention in Iran with sufficient authority and resources. This study also recommends conducting reliable studies to investigate the possible roles that the health system of a country can assume regarding the RTIs prevention.
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Affiliation(s)
- Saber Azami-Aghdash
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Ramin Rezapour
- Department of Health Services Management, Iranian Center of Excellence in Health Management, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahdiyeh Heydari
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Naser Derakhshani
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
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Al-Hassani A, Ahmad K, El-Menyar A, Abutaka A, Mekkodathil A, Peralta R, Al Khalil M, Al-Thani H. Prevalence and patterns of maxillofacial trauma: a retrospective descriptive study. Eur J Trauma Emerg Surg 2019. [PMID: 31227848 DOI: 10.1007/s00068-019-01174-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 06/12/2019] [Indexed: 12/04/2022]
Abstract
Introduction We aimed to describe the prevalence and pattern of maxillofacial trauma in Qatar. Methods This is a retrospective study of trauma registry data at Hamad General Hospital during the period from January 2011 to December 2014. The study included all traumatic maxillofacial patients who underwent CT scan and were admitted during the study period. Results A total of 1187 patients with maxillofacial injuries were included in the study and 18.5% of all trauma admissions were related to maxillofacial injuries. Young age and males were predominantly affected. Mechanisms of injury were mainly traffic-related and fall. Orbital injuries were the commonest followed by maxillary injuries. The median and range face abbreviated injury score (AIS) was 2 [1–3] with 66% had a score of 2. Maxillofacial fractures were frequently associated with traumatic brain injuries. One out of five patients was managed with surgery and had median length of stays in ICU and hospital 5 and 7 days, respectively. Overall, in-hospital mortality was 8.3%. Mortality in isolated maxillofacial was low (0.3%) in comparison to 15% in polytrauma patients (p = 0.001). Multivariable regression analysis showed that Injury Severity Score, face AIS and Glasgow Coma Scale were predictors of mortality with age-adjusted odd ratio of 1.15, 2.48 and 0.82; respectively. Conclusions Maxillofacial trauma requiring admission is not uncommon in our trauma center and mostly it is mild to moderate in severity. Associated injuries are present in most of the maxillofacial injured patients and further diagnostic investigations should be part of the assessment in maxillofacial injuries.
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Rastogi S. Coma with Glasgow Coma Scale Score 3 at Admission following Acute Head Injury: Experiencing the Complete Recovery Supported through Ayurveda - A Case Report. Complement Med Res 2019; 26:353-360. [PMID: 30965329 DOI: 10.1159/000498912] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 02/08/2019] [Indexed: 11/19/2022]
Abstract
Road traffic accidents (RTAs) are a common cause of untimely death, particularly of youth. RTA mortality and morbidity are predominantly associated with trauma to the brain tissue resulting in traumatic brain injury (TBI). The Glasgow Coma Scale (GCS) is commonly employed to predict the prognosis of such cases at the time of hospital admission. A lower GCS score is invariably found to be associated with poor prognosis, often resulting in death or severely com-promised recovery. A 17-year-old male suffering from TBI due to a RTA was treated with Ayurveda after initially been kept under modern neurological care. The whole course of Ayurvedic therapy began 2 weeks after the initial trauma, continued for about 3 months, and resulted in coma reversal with near complete recovery. This case is one among few reports describing a complete recovery despite presence of bad prognostic predictors in TBI. This is the first such case reported where Ayurveda was used as the intervention in case of TBI, resulting in coma reversal and near complete recovery of neurological deficits.
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Affiliation(s)
- Sanjeev Rastogi
- State Ayurvedic College and Hospital, Lucknow University, Lucknow, India,
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Duko B, Tadesse F, Oltaye Z. Patterns of road traffic injury and potential consequences among patients visiting Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia. BMC Res Notes 2019; 12:186. [PMID: 30922359 PMCID: PMC6439992 DOI: 10.1186/s13104-019-4192-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 12/11/2018] [Accepted: 03/13/2019] [Indexed: 11/10/2022] Open
Abstract
Objective Road traffic injury (RTI) is the leading cause of death among aged 15–29 years, although low and middle income countries only have half of the vehicles, they have 80% of road traffic related death. This study aimed to assess the probability of road traffic injury occurrence and potential consequences among patient visiting at emergency department of Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia. Retrospective cross-sectional study was conducted from March 8 to April 6/2018 among 350 patients who were recruited using systematic random sampling techniques. Binary logistic regression analysis was used for data analysis. Results A total of 350 patients medical charts were reviewed at emergency department. The prevalence of road traffic accident was 40.9%. Being male (AOR = 1.84: 95% CI 1.11–3.09), being in age group of 20–29 (AOR = 2.58: 95% CI 1.14–5.84) and being in urban area of residence (AOR = 2.46; 95% CI 1.51–4.02) were significantly associated with road traffic accident. Conducting further research on road traffic injury and risk factors recommended.
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Affiliation(s)
- Bereket Duko
- Faculty of Health Sciences, College of Medicine and Health Sciences, Hawassa University, P.O. Box 1560, Awasa, Ethiopia.
| | - Fikru Tadesse
- Faculty of Health Sciences, College of Medicine and Health Sciences, Hawassa University, P.O. Box 1560, Awasa, Ethiopia
| | - Zewdie Oltaye
- Faculty of Health Sciences, College of Medicine and Health Sciences, Hawassa University, P.O. Box 1560, Awasa, Ethiopia
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Baru A, Azazh A, Beza L. Injury severity levels and associated factors among road traffic collision victims referred to emergency departments of selected public hospitals in Addis Ababa, Ethiopia: the study based on the Haddon matrix. BMC Emerg Med 2019; 19:2. [PMID: 30606106 PMCID: PMC6318925 DOI: 10.1186/s12873-018-0206-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 11/23/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Globally, about 1.25 million people die annually from road trafficcollisions. Evidence from global safety report shows a decreasing trend of road traffic injury indeveloped countries while there is an increasing trend in many developing countriesincluding Ethiopia. This study is aimed at assessing factors affecting injury severity levels of road traffic collision victims referred to selected public hospitals in Addis Ababa based on the Haddon Matrix. METHODS Ahospital-based cross-sectional study designwas implemented to randomly select a total of 363 road traffic collision victims. The collected data was cleaned andentered into Epidata version 3.1 and exported to SPSS Version 21 for analysis. Bivariate and multivariate logisticregression models were used to examine the association between explanatory and outcome variables. RESULTS A total of 363 individual sustained road traffic injuries were included to the study. Theprevalence of severe injury among road traffic accident victims was 36.4%. The following variables were significantly associated with increased injury severity: motorbike rider or motorbike passenger without helmet, adjusted odds ratio (AOR) 4.7(95% CI: 1.04-21.09); driving under the influence of alcohol, crude odds ratio (COR) 2.64(95% CI;1.23-5.64); victim with multiple injuries, AOR 3.88(95% CI: 2.26-6.65); vehicle size, AOR 2.14(95% CI: 1.01-4.52); collision in dark lighting condition, AOR 1.93(95% CI: 1.01-3.65); collision in cross city/rural, AOR 1.95(95% CI: 1.18-3.24) and vehicle occupant travelling unrestrained on the back of a truck, AOR3.9 (95% CI: 1.18-12.080). On the other hand, victims extricated at the scene by health care professional, AOR 0.33(95% CI: 0.13-0.83); victims extricated at the scene by police AOR 0.47(95% CI: 0.24-0.94); strict traffic police control at the scene of the collision, AOR 0.49(95% CI: 0.27-0.88) were significantly associated with less severe injuries. CONCLUSIONS Findings reported in this paper suggest the need forimmediate and pragmatic steps to be taken to curb the unnecessary loss of livesoccurring on the roads. In particular, there is urgent need to introduce road safety interventions.
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Affiliation(s)
- Ararso Baru
- College of Medicine and Health Sciences, Arbaminch University, Arbaminch, Ethiopia
| | - Aklilu Azazh
- Department of Emergency Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lemlem Beza
- Department of Emergency Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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