Epidemiology of traffic crash mortality in west of Iran in a 9 year period

Purpose: In Iran, the most common cause of injuries and the second leading cause of deaths are traffic accidents, and those problems impose a substantial financial burden on the society. This study aims to determine traffic accident mortality trends and their epidemiologic characteristics in the Kermanshah province, west of Iran. Methods: In a cross sectional study, road traffic fatality data from 2004 to 2013 were analyzed to determine the epidemiological pattern of traffic accident mortality. Trend assessment was performed to ascertain the decreasing or increasing status. Chi-square and one-way analysis of variance (ANOVA) tests, as well as Poisson regression were used to determine the significance of the data in time. Data were analyzed using Excel and statistical package of SPSS version 19. Results: Out of 5110 people that died in traffic accidents, 4024 (78.7%) were males. The state of accidents indicated that 404 (43.8%) female pedestrians died as a result of car crashes, and 1330 (41.4%) males died because of car collisions. 1554 (31.9%) deaths happened to pedestrians and 1556 (32.1%) to vehicle drivers, and the rest belonged to vehicle passengers. Head trauma was the cause of death for as much as 3400 (69.9%) cases. Fatal crashes in which pedestrians were involved mostly occurred between the hours 13:00 to 15:00, while the time for vehicle drivers was between 16:00 to 18:00. 2882 people (59.1%) died before reaching to health care facilities. Traffic crash mortality trend for pedestrians follows a linear pattern with a gentle downward slope, but the trend shows various swings when it comes to vehicle drivers. Conclusion: The number of traffic crash deaths from 2004 to 2013 indicates a decreasing trend in two groups of road users: vehicle drivers and car occupants. This can be due to some interventions such as modification of traffic rules and enhancement of police control which has been implemented in recent years. Moreover, more attention should be paid to promote the optimal health care services to save the lives of the injured from traffic accidents.     

Blunt Thoracic and Abdominal Vascular Trauma and Organ Injury Caused by Road Traffic Accident

OBJECTIVES: To analyse the relationship between vascular trauma and associated injuries to intra-thoracic and abdominal organs caused by traffic accidents. Design retrospective study in a university hospital. MATERIALS AND METHODS: We investigated 458 consecutive patients who were admitted with blunt thoracic and/or abdominal trauma caused by road traffic accidents between 1986 and 1999. Vascular trauma was encountered in 54 patients (12%). RESULTS: The injured vessels were located in the abdomen in 45 patients and in the chest in nine patients. Mesenteric vessels were the most frequently injured vessels (33/45) in the abdomen, while the aorta and major vessels were most frequently injured (9/9) in the chest. Injury to the large/small intestine was often associated with mesenteric vessel injury (26/27). In the 190 patients with blunt abdominal organ injury, the frequency of mesenteric vessel injury was also highest, regardless of the injured organ. Vascular reconstruction was necessary only in one of 51 patients who underwent operation. CONCLUSIONS: Our results demonstrate that the mesenteric vessels are susceptible to blunt thoracic and abdominal trauma in road traffic accidents. Vascular reconstruction may be indicated for selected patients as long as the injuries to hollow organs are assessed carefully because of their strong association with vascular injury.     

1725例创伤急救患者的流行病学分析

目的了解外伤患者致伤原因和受伤时闯分布情况，为急救该类患者提供帮助。方法通过2005年1月至2006年12月本院出诊及收治的外伤患者共1725例的资料，其中2005年计921例，2006年计804例。分析致伤原因以及受伤和死亡时间段。结果①1725例中共死亡36例。其中2005年死亡22例，占当年病死率为2.3％；2006年死亡14例，占当年病死率为1．7％。②654例（占37．9％）为普通外伤，坠落伤22例（占1.3％）。坠落伤共死亡8例，其中2005年死亡5例，其中2006年死亡3例。③1071例（占62．1％）为交通伤，死亡28例，其中2005年死亡17例，2006年死亡11例。交通伤中有566例（51．9％），发生于18：00—0：00时，且酒后驾车人员肇事301例（占53．2％）。其中2005年198例（占65．8％），死亡12例；2006年103例（占34．2％），死亡6例。结论坠落伤和交通伤是患者死亡最主要的原因，特别是建筑工地的坠落伤较为常见，应加强建筑企业及工人的安全防范意识。交通伤中与电动车有关的损伤及死亡越来越多，应限制其车速，酒后驾车为夜问交通伤的主要原因，应加强监管力度。     

Notfallversorgung bei Verkehrsunfällen in einem Flächenstaat

A change is emerging in the hospital landscape due to health political measures, which in consequence also influences the prehospital medical care in emergencies. The main focus of this study was to gather information about emergency medical care after traffic accidents on the basis of data from Bavarian emergency medical services. In 2006 there were 14,261 traffic accidents in Bavaria where an emergency doctor attended the scene. The patients were primarily cared for by land-based rescue services and air rescue services were only used in 19.1% of the cases. Of the patients involved in a traffic accident 47.6% were transported to a primary health care hospital. A prehospital interval of more than 60 min occurred in 20% of the missions. Of the patients 96.2% were transported to tertiary or maximum care hospital by air rescue services but emergency facilities were, however restricted to daylight hours. There was a further limitation due to the routine duty hours in hospitals as only 36.7% of accidents occurred during this time intervall. An increase of admission post trauma in maximum care clinics occurred from 2002 until 2006 while simultaneously the prehospital period was extended. In order to assure sufficient trauma care for seriously injured persons a continuous 24 h availability of emergency trauma facilities is necessary. For this purpose it is necessary to establish regional trauma networks between receiving hospitals as well as air rescue services at night time. Furthermore, a cost-efficient compensation of the structural, personnel and logistic expenses for the treatment of the severely injured has to be assured.     

Analysis of lethality in the injured persons, suffering cranioabdominal trauma

The now observed enhancement of a human traumatism due to a traffic accidents occurrence demands the measures application, aimed on the improvement of results of the injured persons treatment. With this objective a retrospective analysis of the patients cases charts and of a court-medical expertise protocols was made of 161 injured persons, 69 of whom have died. Cranioabdominal trauma occupies a leading place in a tanatogenesis structure. Delivering of a timely aid to the injured persons in conditionally preventive and preventive lethal outcome constitutes the essential reserve for the treatment results improvement.     

Time analysis of fatal traffic accidents in Fars Province of Iran

Objective:To analyze the time factor in road traffic accidents (RTAs) in Fars Province of Iran.Methods:This study was conducted in Fars Province,Iran from November 22,2009 to November 21,2011.Victims'i...     

Statistical analysis on 2213 inpatients with traffic injuries from January 2003 to September 2005 in Ningbo city

Objective: To analyze the epidemiological conditions and characteristics of inpatients with traffic trauma in order to provide objective data for basic research and clinical application of traffic trauma. Methods: The data of 2213 inpatients with traffic trauma admitted to Lihuili Hospital, Ningbo Medical Centre, Ningbo, China, from January 2003 to September 2005 were studied retrospectively. According to the transportation ways, the patients were divided into four groups; pedestrians, bicyclists, motorcyclists, and automobilists. And the data of injured regions, combined injuries and causes of death were analyzed statistically. Results: Among the 2213 patients, there were 550 pedestrians (23. 5%), 521 bicyclists (24.9%), 738 motorcyclists (33.3%), and 404 automobilists (18.3%). Male patients were more than female ones, with the ratio of male to female of 2.8:1. Single region injury was found in 1663 patients (75.15%) and multiple injuries in 550 patients (24.85%). In total, 2849 regions were injured. Fracture of extremities (53.3%) occurred most often, craniocerebral trauma (19.4%) next, then followed in turn by thoraco-abdominal visceral injury (6.56%), spine fracture (5.37%), fracture of ribs (4.88%), and pelvic fracture (4.18 %). The percentage of multiple injuries (33.2%) was highest and the percentage of thoraco-abdominal injury (18.0%) was higher in motorcyclists. The percentages of craniocerebral trauma in pedestrians and bicyclists were 27.8% and 28.2%, respectively. The incidence of fracture of extremities in motorcyclists reached 73.8%, but with the lowest case-fatality ratio of 1.4%. The incidence of traffic accidents caused by motorcyclists themselves (32.8%) was highest. A total of 56 patients died, with the case-fatality ratio of 2.53%. Among the deaths, 47 died from craniocerebral injury, 6 from multiple fractures combined with hemorrhagic shock, 2 from combined injury in the thoraco-abdominal region, and 1 from cervical cord injury. Conclusions: Nowadays, the patients with traffic trauma are mainly pedestrians, bicyclists and motorcyclists, and they suffer generally from fracture of extremities and craniocerebral injury. The main cause of death is craniocerebral injury. Another characteristic of traffic trauma is that the ratio of multiple injuries is higher.     

Hospital management of abdominal trauma in Tehran, Iran: a review of 228 patients

Objective: Today, trauma is a major public health problem in some countries. Abdominal trauma is the source of significant mortality and morbidity with both blunt and penetrating injuries. We performed an epidemiological study of abdominal trauma (AT) in Tehran, Iran. We used all our sources to describe the epidemiology and outcome of patients with AT.Methods: This study was done in Tehran. The study population included trauma patients admitted to the emergency department of six general hospitals in Tehran during one year. The data were collected through a questionnaire that was completed by a trained physician at the trauma center. The statistical analysis was performed using the SPSS software (version 11.5 for Windows). The statistical analysis was conducted using the chi-square and P＜0.05 was accepted as being statistically significant.Results: Two hundred and twenty-eight (2.8%) out of 8 000 patients were referred to the above mentioned centers with abdominal trauma. One hundred and twenty-five (54.9%)of the patients were in their 2nd and 3rd decades of life and 189 (83%) of our patients were male. Road traffic accidents (RTA) were the leading cause of AT with 119 (52.2%) patients. Spleen was the commonly injured organ with 51 cases. Following the analysis of injury severity, 159 (69.7%) patients had mild injuries (ISS＜16) and 69 (30.3%) patients had severe injuries (ISS= 16). The overall mortality rate was 46 (20.2%).Conclusions: Blunt abdominal trauma is more common than penetrating abdominal trauma. Road traffic accidents and stab wound are the most common causes of blunt and penetrating trauma, respectively. Spleen is the most commonly injured organ in these patients. The mortality rate is higher in blunt trauma than penetrating one.     

Tree collisions in road traffic accidents - mechanism and pattern of injury

INTRODUCTION: In Germany, the county of Mecklenburg-Vorpommern has got the highest frequency of traffic accidents. 42 % of all deadly injured car accident victims in Mecklenburg-Vorpommern sustained a tree collision. Aim of this study was to analyze tree collisions regarding typical pattern and severity of injury. METHODS: During an on-going prospective, non-interventional accident survey within a defined area of the county of Mecklenburg-Vorpommern tree collisions with minimum one victim sustaining a Maximum Abbreviated Injury Scale of 1-6 injury were analyzed. RESULTS: In between January 2001 and June 2004 287 accidents were documented. 19 % (54) were tree collisions. 81 % of drivers were male. 36 of 54 tree collisions (67 %) occurred on straight roadways. The mean ISS was 31.3 (SD +/- 29.8), 30 % (23) of the passengers died. 70 of 78 individuals sustained more than one injury. With that, the combination of head- and chest trauma was most frequent and associated with the highest injury severity. DISCUSSION: Especially tree collisions lead to severe trauma. Interestingly, most accidents did occur on straight roadways.     

Traffic crash accidents in Tehran, Iran: Its relation with circadian rhythm of sleepiness

Purpose: Road traffic accidents are one of main problems in Iran. Multiple factors cause traffic accidents and the most important one is sleepiness. This factor, however, is given less attention in our country. Road traffic accidents relevant to sleepiness are studied. Methods: In this cross-sectional study, all road traffic accidents relevant to sleepiness, which were reported by police, were studied in Tehran province in 2009. Results: The risk of road traffic accidents due to sleepiness was increased by more than sevenfold (odds ratio=7.33) in low alertness hours (0:00-6:00) compared to other time of day. The risk of road traffic accidents due to sleepiness was decreased by 0.15-fold (odds ratio=0.15) in hours with maximum of alertness (18:00-22:00) of circadian rhythm compared to other time of day. Conclusion: The occurrence of road traffic accidents due to sleepiness has significant statistical relations with driving during lowest point of alertness of circadian rhythm.     

Spinal cord injuries from road traffic crashes in southeastern Iran

Objective ： To analyze the data of patients with spinal cord injury （SCI） induced by road traffic crashes in southeastern Iran for better understanding the pattern of these injuries and therefore for better designing health system planning. Methods ： In this historical cohort study, the patients who had been transferred to Level I trauma center in southeastern Iran due to road traffic accidents with radiographic documented SCI were evaluated. Results： Among 64 patients with SCI, 38 patients （59.4 %, 36 males and 2 females, aged 27.42 years ± 9.44 years on average） were injured by road traffic accidents. Car and motorcycle accidents were responsible for 26 cases （68.4%） and 12 cases （31.6%）, respectively. And 31patients （81. 6%） had complete SCI. Conus medularis （T12-L2 ） was the most affected level. Conclusions： Results are discussed in terms of preventive measures, specifically those concerning the use of restraint and helmet and driving behavior. This study should be extended nationally to gain a larger case series so that the SCI risk of particular vehicle configurations, considering other crash factors, can be more precisely quantified and the characteristics for low occurrence of SCI can be more precisely identified.     

Drug use in trauma victims

We examined the prevalence and characteristics of drug use in a large sample of fatally and nonfatally injured trauma victims. Routinely collected urine specimens from 452 emergency room patients and 160 persons autopsied at the Medical Examiner's Office (MEO) were analyzed for the presence of marijuana, cocaine, opiates and benzodiazepines using EMIT enzyme immunoassays. Blood alcohol levels were also measured. Tests were positive for at least one drug in 40.3% of the ER and 18.7% of the MEO samples. Marijuana was the most commonly detected drug in both groups. Specimens were more likely to be positive in younger persons and in males, and in victims of assaults and traffic accidents. Alcohol was present in the blood in more than one third of ER and MEO samples. Only 39.8% of ER samples and 52.3% of MEO samples were negative for both alcohol and drugs.     

The epidemiology of trauma of the genitourinary system after traffic accidents: analysis of a register of over 43,000 victims

OBJECTIVE: To analyse the frequency and type of injury to the genitourinary system, by user category, after traffic accidents. PATIENTS AND METHODS: The register which forms the basis of this study is unique in Europe and includes 43,056 victims of road traffic accidents, and was compiled between 1996 and 2001. The categories of road users included: motorists, motorcyclists, cyclists, pedestrians, van and bus users, and roller skaters. The urological complication rate was analysed for each category. RESULTS: In all, 199 cases of trauma of the genitourinary system (0.46%) were recorded. The most frequent urological complications were renal (43%) and testicular trauma (24%), the former most frequent in motorists (65%) and pedestrians (29%), and the latter in motorcyclists (41%). CONCLUSIONS: An analysis of this register provides better knowledge of the urogenital injuries after traffic accidents. Renal and testicular injuries are the most frequent.     

The current status of road user injuries among the elderly in Germany: a medical and technical accident analysis

BACKGROUND: The incidence and treatment of injuries involving the elderly road user are of increasing importance for all fields of trauma care to ensure the best possible outcomes. METHODS: Traffic accident reports were analyzed through technical and medical investigation for the involvement of elderly citizens. RESULTS: In 12,309 documented traffic accidents between 1985 and 1998, 1,843 elderly citizens (65 years and older) were involved, 1,260 of which were reported to have been injured. The mean Injury Severity Score among the injured elderly citizens was 7.3. Of the injured elderly road users, 39.5% were car occupants, 27.4% were bicyclists, 29.6% were pedestrians, 1.8% were truck occupants, and 1.7% were motorcyclists. Of the elderly road users in cars, 53% were not injured, in contrast to only 1.1% of the bicyclists and 0.8% of the pedestrians. Serious or severe injuries (Maximum Abbreviated Injury Scale, >/=2] occurred for 36.5% of the injured elderly road users as car occupants (unrestrained, 58%; restrained, 34%), 57.4% as bicyclists, and 65.4% as pedestrians CONCLUSION: A high rate of motor injuries is associated with vehicle accidents and increased levels of severity among the elderly population. This finding is especially evident for elder pedestrians and bicyclists. Also of note, the elderly even appear to be at risk for sustaining an increased level of injury severity when they are restrained or belt protected.     

Current situation of traffic accidents in children and adolescents. A medical and technical analysis

HYPOTHESIS: Analysis of the current injury situation in road users not exceeding 14 years of age involved in road traffic accidents to allow conclusions regarding future prophylaxis. METHODS: Traffic accident reports and medical records from children (< 15 years of age) were analyzed for the following parameters: Type, location and mechanism of injury, Abbreviated Injury Scale (AIS), Maximum AIS (MAIS), Injury Severity Score (ISS), Delta-v, collision speed, type and duration of treatment. RESULTS: In 12,309 traffic accidents occurring in the area of Hannover, Germany between 1985 and 1998, 7.5% (n = 2,317) of the involved persons and 10.5% (n = 1,734) of the injured road users were children and adolescents. 70% sustained MAIS 1 injuries, 28% MAIS 2-4 and 1.5% MAIS 5/6 injuries. The mean ISS was 3.38. 30.3% of the injured children were car occupants, 32.1% bicyclists, 33.3% pedestrians. 30.3% of the children were unrestrained car occupants, 42.1% used safety belts designed for adults, 36% used special devices. Half of the children in cars remained uninjured, whereas only 8% of the bicyclists and 2% of the pedestrians were not injured. Severe injuries occurred in 20% of bicyclists and pedestrians at a collision speed less than 30 km/h and in 80% at more than 50 km/h. Half of those crashes could have been avoided, if the colliding vehicle would had driven about 15 km/h slower. CONCLUSION: Children have an especially high risk of injury if they are involved in accidents as pedestrians, bicyclists and unrestrained car occupants. Besides of improvements of the inner and outer car design, the use of adjusted restraining systems and bicycle helmets is likely to prevent from severe injuries. Speed reduction is a considerable factor. According to our data, the injury severity for bicyclists and pedestrians increases progressively when the collision speed exceeds 50 km/h.     

Potential impact of the advanced trauma life support (ATLS). Program in a Third World country

Data from Trinidad and Tobago suggest there is a positive role for the ATLS program in Third World countries. Between 1970-1979 traffic accidents increased from 16,433 to 28,003 while deaths increased from 179 to 252 per year. Sixty-nine per cent of deaths were adult males mainly between 20-30 years old and most fatal accidents occurred between 6:00 and 10:00 p.m. particularly on weekends. Because expert consultants are not always immediately available within the hospital, initial trauma resuscitation is provided by emergency room physicians. Accordingly, 75% of trauma deaths occur in hospital with 65% of those dying within six hours of reaching the hospital alive. Compared to a similar sized North American population the death to injury ratio is at least doubled. The beneficial impact of the ATLS program in Third World countries is assured if ATLS quality control is maintained and can be assessed, as outlined, by comparing pre ATLS with post ATLS data.     

Selective application of cervical spine radiography in alert victims of blunt trauma: a prospective study

Four hundred sixty-seven adult victims of blunt trauma undergoing cervical spine radiography (CSR) were prospectively studied to identify any clinical parameters which would aid in the selective application of CSR. Eight persons (1.7%), six of whom were alert and two who presented comatose, sustained cervical spine injuries. In this study, persons injured in falls demonstrated a statistically significant greater risk of cervical spine injury compared to those injured in motor vehicle accidents (p = 0.001). In alert trauma victims, a statistical correlation with cervical spine injury was noted for individuals who had complaints of neck discomfort (p = 0.028) and for patients who manifested tenderness to neck palpation (p = 0.000039). No cervical spine injury was noted in any alert, not intoxicated, neurologically intact patient who had no complaints of neck discomfort upon questioning or palpation. We conclude that alert trauma victims with no complaints of neck discomfort upon questioning and with no tenderness on neck palpation need not undergo CSR.     

Evaluation of post traumatic distress in the first 6 months following SCI

STUDY DESIGN: Cross-sectional questionnaire. OBJECTIVES: To assess the degree of post traumatic stress symptomatology and its correlates amongst a group of new spinal cord injured patients. SETTING: The National Spinal Injuries Centre, Stoke Mandeville Hospital NHS Trust. METHOD: Eighty-five participants with an average age of 32.6 years were assessed between 6 and 24 weeks post injury. Seventeen participants were female. Seventy per cent had complete lesions. Forty per cent had paraplegia and 60% had tetraplegia. Road traffic accidents were the most common cause of injury followed by falls and then sporting accidents. The Impact of Event Scale was used to measure the experience of intrusive thoughts about the trauma and avoidance of trauma related stimuli. Anxiety (SAI), depression (BDI) and dependency (FIM) were also measured. RESULTS: High levels of distress were evident in 14% of the sample. Trauma-related distress was significantly higher in female patients or patients with high levels of anxiety or depression. CONCLUSION: In this sample, the rates of trauma-related distress following spinal cord injury were comparable to those found following other traumas and are of clinical significance.     

Thoraco-abdominal wound in peaceful time

The results of treatment of 63 injured persons with thoracicoabdominal trauma were analyzed. Injured persons with severe trauma and pronounced infringements of hemodynamic (41.25%); with severe injury of inferior organs and stable hemodynamical indexes (47.62%), light injury (11.12%) were detailed. Algorithm of curative-diagnostical measures for every group was elaborated. Among the injured persons 11 (17.46%) died.     

"Shift work" improves survival and reduces intensive care unit use in seriously injured patients

We assessed whether a trauma service model with an emphasis on continuity of care by using "shift work" will improve trauma outcomes and cost. This was a case-control cohort study that took place at a university-affiliated Level I trauma center. All patients (n=4283) evaluated for traumatic injuries between May 1, 2002 and April 30, 2004 were included. During Period I (May 1, 2002 to April 30, 2003), a rotating off-service team provided initial management between 5:00 PM and 7:00 AM. The "day team" provided all other care and was responsible for continuity of care. In Period II (May 1, 2003 to April 30, 2004), a dedicated trauma service consisting of two resident teams evaluated all injured patients. Variables included hospital and intensive care unit length of stay (LOS), mechanical ventilation requirements, hospital mortality, and hospital care costs. Demographics and injury mechanism for both periods were similar, but Injury Severity Score (ISS) in Period II was greater (ISS, 8.2% vs. 7.2%, P < 0.0001; ISS > 15, 18.5% vs. 15.4%). In the more severely injured (ISS > 15), patients in Period II had shorter hospital LOS (8.6 vs. 9.7 days, P = 0.98), a shorter ICU LOS (5.5 vs. 7.7 days, P = 0.039), shorter mechanical ventilator requirements (5.5 vs. 7.7 days, P = 0.32), improved hospital mortality rate (19.9% vs. 26.8%, P = 0.029), and decreased hospital costs (19,146 dollars vs. 21,274 dollars, P = 0.36). On multivariate analysis, factors affecting mortality and LOS included age, initial vital signs, injury type, and ISS. Overall, the two trauma service models resulted in similar outcomes. Although multivariate analysis revealed that treatment period did not affect mortality, our study revealed improved patient survival and reduction in LOS and cost for the severely injured in Period II.