Patterns of injury in helmeted and nonhelmeted motorcyclists

In the present study, the incidence of severe brain injury was 600 percent higher for patients riding without a helmet and the incidence of all brain injuries was nearly twice as high in the nonhelmeted riders. All surviving patients with severe brain injury sustained residual long-term disability. The incidence of injury and death was much higher for motorcyclists than for occupants of automobiles involved in accidents. Riding a motorcycle is dangerous and riding without a helmet is fool-hardy. Helmets also protect the face, as facial fractures were twice as common in the nonhelmeted riders. There were no significant differences between nonhelmeted and helmeted motorcyclists in terms of overall injury as measured by an injury severity score of 16 or greater. Orthopedic injuries, in this study, were so common that orthopedic surgeons performed more major operations than all other surgical specialists combined. Depth of orthopedic coverage is essential to treat significant numbers of injured motorcyclists. Neurosurgeons are key members of a trauma care team. Helmet laws would help us utilize our limited neurosurgical capacity more effectively by reducing the incidence of brain injury. Medical professionals must educate the public regarding the societal and personal cost of unhelmeted motorcycle riding. Legislation mandating helmet usage for motorcycle riders must be sought.     

Abdominal injuries sustained in severe traffic accidents by seatbelt wearers

In Finland during the period 1972-1983, there were 3,564 severe traffic accidents involving one or more victims dying within 30 days of the accident. Forty-two of the victims had been wearing a seatbelt and had an abdominal trauma as the main cause of death or as first diagnosis of injury. Small intestine and colon injuries were more common in the severely injured victims than was the case with the fatally injured ones and in these accidents the injury mechanism was always deceleration or contusion, which was in most cases caused by the seatbelt. Liver injuries seem to be the major abdominal cause of fatality, and in the fatally injured group, half of the victims sustained the fatal abdominal injury through gross crushing impact. When the direction of the impact was analyzed, all the victims seated on the receiving side of the vehicle in lateral impact collisions sustained an abdominal injury with fatal outcome. It seems that the seatbelt is less effective in protecting wearers from severe or fatal abdominal injuries in lateral impact collisions.     

Fatal motorcycle accidents in Fars Province, Iran: a community-based survey

Objective: To identify the main characteristics of victims of motorcycle accidents in Fars Province, Iran. Methods: This cross-sectional study was conducted in Fars Province which has the fourth largest population of all 31 provinces in Iran from March 2009 to June 2010. We included data from all 542 recorded cases of fatalities due to motor vehicle accidents. Data were recorded from the forensic medicine registry consisting of demographic and accident-related information. Demographic information consisted of name, age, sex, status of fatal victim (motorcycle driver vs passenger) and educational level. Results: Of the 2 345 autopsy records from the forensic medicine archives, 542 (23.1%) gave the cause of death as motor vehicle accidents. Mean age of these victims was (31.4+/-6.5) years, and the male to female ratio was 28. Head injury was the most common cause of death in these victims, and overall they tended to have a low level of education. Motorcycle accidents frequently involved younger age groups (15-35 years), and head trauma related with non-use of a helmet was the most common cause of death. Conclusions: Head injury is frequent among victims in the province we studied. This situation may be related to the victims' low socioeconomic status and little education regarding traffic laws leading to speeding and disregard of these laws along with their weak enforcement.     

Injuries from motorcycle- and moped crashes in Sweden from 1987 to 1999

The objective of this paper is to study injuries from motorcycle and moped crashes in Sweden from 1987 to 1999. Databases at the National Board for Health and Welfare and codes from both ICD9 and ICD10 systems were used, including patterns of age, gender, E-code and type of injury. Length of hospital stay, type of injuries and trends over time was evaluated. To get a more detailed picture of the age distribution, type of vehicle used and number of killed, data from the Swedish National Road Administration were also used. In Sweden, 27,122 individuals received in-patient care due to motorcycle and moped injuries between 1987 and 1999. The motorcycle and moped injury rate was reduced in the second half of the studied period and so were the total days of treatment per year. Males had eight times the incidence of injuries compared to females. Riders under the age of 26 and in particular those at an age of 15 had the highest incidence rate. Head injuries were the most frequent diagnosis, followed by fractures to the lower limbs. Concussion was the most frequent head injury. Focal and diffuse brain injuries combined showed the same frequency as concussion. It is concluded that more preventative strategies must be presented before the injury rate can be reduced.     

Analysis of 86 fatal motorcycle frontal crashes in Chongqing, China

Objective: To analyze the injuries of motorcyclists involved in fatal motorcycle frontal crashes.Methods: A survey group involving multi-discipline experts was built to randomly collect data on fatal m...     

The patterns of facial injury suffered by patients in road traffic accidents: a case controlled study

Road traffic accidents cause severe facial injuries and are frequently associated with injuries to other organ systems. The aims of this study were to define the facial injuries suffered by victims of road trauma and assess the need for a multidisciplinary approach to their management. A retrospective study of all patients over 14years of age suffering facial injuries over a five year period was conducted. Data was collected on the nature of their facial and other injuries and the impact of interspeciality management on their treatment. Four hundred and nine patients were identified. The midface was injured more frequently than the mandible and the majority of patients had multiple facial injuries. Neurologic, orthopaedic, thoracic and abdominal injuries were common and impacted on the management of the patients' facial trauma. Road traffic accidents cause more severe facial trauma than other mechanisms of injury. Other organ systems are more likely to be injured and the management of these injuries often impacts on their facial injury treatment demanding high levels of interspeciality cooperation.     

Accidents in children and adolescents. Analysis of the accident event

BACKGROUND: Accidents are the most frequent cause of death in children and adolescents. The aim of this study was to determine factors, which affect injury severity and to compare the absolute number of accidents with exposition data. PATIENT AND METHODS: From 1 January 1999 to 31 December 2001 a school survey of 2325 pupils was carried out. The 3645 accidents sustained by children and adolescents aged between 6 and 17 years treated at the surgical emergency department of the University Hospital Dresden were analyzed. RESULTS: Of the 3645 patients, 620 (17%) were admitted to hospital and 3025 (83%) were treated as outpatients. The most frequent diagnosis of the hospitalized patients was commotio cerebri; 83% of 36 severely injured patients had a head injury. 55.5% (297 of 536) of children between 6 and 9 years were using a protective helmet. In contrast only 14% of adolescents carried a protective helmet. None of 50 injured bicycle drivers with helmet had an AIS for head injuries >2. Twenty-for of 233 injured bicycle drivers without helmet had an AIS for head injuries >2. CONCLUSIONS: Head injuries are the main cause of hospitalization in traumatized children and adolescents. However, the use of a protective helmet becomes significantly less frequent with increasing age.     

Medical and economic parameters of motorcycle-induced trauma

A retrospective study was conducted on all patients injured in a motorcycle accident who were admitted to the authors' institution during a one-year period. The 71 patients evaluated averaged 26 years of age; 79% were men, 75% were not wearing a helmet, and 24% were legally intoxicated. Sixty-six percent required surgical intervention and 36% a second procedure. There were 167 fractures, with an average of 2.4 per patient. The 27 patients requiring a blood transfusion averaged 10.5 units per patient. Motorcyclists not wearing a helmet had an increased risk of head injury (p less than .01). Those with head injuries had an increased need for intensive care (p less than .0001) and a ventilator (p less than .001). Patients with head injuries more commonly sustained fractures about the shoulder (p less than .015) than fractures to the lower extremity (p less than .005). The average hospital stay was 13 days, with a cost of $16,408 per patient. The cost was significantly higher in patients with a head injury ($21,945) than in patients without a head injury ($11,941). Patients sustaining a head injury were less likely to return to baseline functioning (p less than .001).     

Motorcycle injuries in Bermuda

Tourists who hire mopeds or motorcycles for personal use have a risk for accident. The incidence of tourist accidents in Bermuda was 1.57 accidents/1000 tourists evaluated over a 6-month period. The accident incidence increased as the tourist population got larger. Tourists of more than 40 years of age had the greatest increase in incidence for accident during this period. The risk of an injury requiring hospital stay was one patient for every 16,000 tourists visiting the island, and usually involved the fracture of an extremity. All accidents, major or minor, resulted in some form of skin injury.     

Epidemiologic study of traffic crash mortality among motorcycle users in Iran(2011e2017)

Purpose: Motorcycle accident is a major cause of road traffic injuries and the motorcyclists are considered as vulnerable road users. The present study aimed to determine the epidemiological characteristics of fatal motorcycle crashes in Iran. Methods: In this cross-sectional study, a total of 28,356 motorcycle traffic fatalities registered in the Legal Medicine Organization of Iran were analyzed during the period between March 2011 and March 2017. The examined variables included demographic characteristics, helmet use, crash mechanisms, crash location, position state, type of counterpart vehicle, cause of death and place of death. In the study, road traffic mortalities involving drivers and/or passenger of motorcycles were included. Cases or events registered without these conditions were excluded from the study. To analyse the data, SPSS statistics 25 and GraphPad Prism 8 softwares were used. Results: Of the 122,682 fatal traffic injury cases, 28,356 (23.1%) were motorcycle users, of whom 95.3% were male and 4.7% were female. Most of the motorcycle fatalities belonged to the age group of 18-24 years (29.1%). Head trauma was the major cause of death (59.0%). Also, the overall proportion of safety helmet use among motorcycle crash victims was estimated at 37.4%. Most of the road traffic crash cases (46.8%) happened out of city and half of people (49.9%) died in hospital. About 77.4% of the victims were motorcycle riders and 21.1% were pillion passengers. The highest rate of mortality belonged to the selfemployed (38.4%) and then workers (21.8%) and students (10.2%). In addition, most fatalities occurred in people with low education (77.5%) and the least occurred in university graduates (5.5%). Among 31 provinces of Iran, Fars had the highest (9.3%) occurrence rate and Kohgiluyeh and Buyer-Ahmad had the lowest (0.5%). Most of the crash mechanisms were due to motorcycle-vehicle crashes (80.2%), followed by rollover (9.8%). Conclusion: Comprehensive public education and special rules are needed to reduce the rate of deaths in motorcycle crashes.     

Neurological injury and death in all-terrain vehicle crashes in West Virginia: a 10-year retrospective review

OBJECTIVE: The purpose of this study was to profile all-terrain vehicle crash victims with neurological injuries who were treated at a Level I trauma center. METHODS: We retrospectively reviewed trauma registry data for 238 patients who were admitted to the Jon Michael Moore Trauma Center at the West Virginia University School of Medicine after all-terrain vehicle crashes, between January 1991 and December 2000. Age, helmet status, alcohol and drug use, head injuries, length of stay, disposition, and hospital costs were studied. Death rates, head injuries, age, helmet use, and safety legislation in all 50 states were compared. RESULTS: Eighty percent of victims were male, with an average age of 27.3 years. Only 22% of all patients were wearing helmets. Alcohol and/or drugs were involved in almost one-half of all incidents. Fifty-five of 238 patients sustained spinal axis injuries; only 5 were wearing helmets. One-third of victims (75 of 238 victims) were in the pediatric population, and only 21% were wearing helmets. Only 15% of victims less than 16 years of age were wearing helmets. There were a total of eight deaths; only one patient was wearing a helmet. CONCLUSION: In the United States, all-terrain vehicles caused an estimated 240 deaths/yr between 1990 and 1994, which increased to 357 deaths/yr between 1995 and 2000. Brain and spine injuries occurred in 80% of fatal crashes. West Virginia has a fatality rate approximately eight times the national rate. Helmets reduce the risk of head injury by 64%, but only 21 states have helmet laws. Juvenile passengers on adult-driven vehicles are infrequently helmeted (<20%) and frequently injured (>65%). We conclude that safety legislation would save lives.     

Unfälle von Kindern und Jugendlichen

Background

Accidents are the most frequent cause of death in children and adolescents. The aim of this study was to determine factors, which affect injury severity and to compare the absolute number of accidents with exposition data.

Patient and methods

From 1 January 1999 to 31 December 2001 a school survey of 2325 pupils was carried out. The 3645 accidents sustained by children and adolescents aged between 6 and 17 years treated at the surgical emergency department of the University Hospital Dresden were analyzed.

Results

Of the 3645 patients, 620 (17%) were admitted to hospital and 3025 (83%) were treated as outpatients. The most frequent diagnosis of the hospitalized patients was commotio cerebri; 83% of 36 severely injured patients had a head injury. 55.5% (297 of 536) of children between 6 and 9 years were using a protective helmet. In contrast only 14% of adolescents carried a protective helmet. None of 50 injured bicycle drivers with helmet had an AIS for head injuries >2. Twenty-for of 233 injured bicycle drivers without helmet had an AIS for head injuries >2.

Conclusions

Head injuries are the main cause of hospitalization in traumatized children and adolescents. However, the use of a protective helmet becomes significantly less frequent with increasing age.     

Pediatric transport related injuries in Tehran: the necessity of implementation of injury prevention protocols

Prehospital and hospital data was prospectively gathered on all hospitalized trauma patients admitted to six major trauma hospitals in Tehran from August 1999 to September 2000. Data from patients of under 19 years of age was analyzed for this article. From 8000 hospitalized trauma patients, 2354 cases (29%) belonged to this age group. Fall and transport related injuries (TRIs) with 1074 (46%) and 921 (39%) cases respectively, were the most common mechanism of injury. In TRIs, boys were affected 3.5 times as often as girls. Younger children were more prone to pedestrian-related injuries while teenagers were more prone to motorcycle related injuries. Head trauma was the most common cause of death and 28 out of 32 trauma deaths were attributed to this kind of injury. Lower extremity (513) and head injuries (322) were the most common injuries. Only a few of motorcyclists and car passengers used safety devices (helmet and seat belt respectively) at the time of accident.     

Driver's education may reduce annual incidence and severity of moped and scooter accidents. A population-based study

Background and aimsIn our previous study, the annual number of adolescents treated at Helsinki Children's Hospital and Töölö Trauma Centre for injuries from moped and scooter accidents increased five-fold between 2002 and 2007. In June 2011, the requirements for a moped/scooter license changed to include driver's education and a vehicle handling evaluation. The aim of this retrospective study was to assess the influence of legislative changes on moped and scooter related serious injuries in adolescents.Patients and methodsData from 520 patients (age 15–16) treated for trauma from moped and scooter accidents at our institutions between January 2008 and December 2013 were included. Case numbers were compared with population data from national databases. Overall incidence, trauma mechanism, injury profile, and proportion of patients requiring hospital admission were calculated for time periods before and after the law amendment.ResultsAfter the law change in 2011, the annual incidence of moped/scooter injuries among 15-year-olds in our area decreased from 0.8% in 2011 to 0.3% in 2013 (p < 0.001), and estimated incidence of injuries per new moped/scooter license declined from 1.8% in 2011 to 1.0% in 2013 (p = 0.001). Simultaneously, proportions of patients injured in collisions, diagnosed with multiple trauma or requiring in-patient care reduced.ConclusionsA change in moped/scooter license requirements may have a causal relationship with both reduced number and severity of moped/scooter related injuries in adolescents.     

Zuverlässigkeit notärztlicher Verdachtsdiagnosen

Background

Trauma is the leading cause of death in the patient group under 40 years of age. Within the prehospital management of seriously injured trauma victims the accuracy of the field triage by emergency physicians is of utmost importance.

Objective

The aim of this study was to determine the accuracy of prehospital emergency physician field triage in road traffic accident victims.

Material and methods

The study involved a retrospective analysis and comparison of prehospital and inhospital trauma records of road traffic accident victims treated by a Helicopter Emergency Medical Service (HEMS) team and transferred to a level I trauma centre. A comparison of prehospital and inhospital diagnostic findings was carried out according to an anatomical score (AIS).

Results

Included in the analysis were 479 patients with a mean age of 37.0?±?18.2 years, males 65.8?%, mean injury severity score (ISS) 15.5?±?13.5, ISS >?16 in 41,1?% and mortality 7.3?%. The leading causes of injury were motor vehicle accidents (56.2?%), followed by motorcycle (24.0?%) and bicycle accidents (11.6?%) as well as truck accidents (4.0?%) and pedestrian accidents (4.2?%). The most common body regions injured (AIS ≥?3) were the chest (37?%), head (25.1?%) and lower extremities (16.7?%). A correct prehospital field triage by emergency physicians was found for injuries with an AIS ≥?3 of the head 77?%, chest 69?%, abdomen 51?%, pelvis 49?%, extremities 70?%, neck/cervical spine 67?% and thoracic/lumbar spine 70?%. Overlooked injuries in the prehospital setting (AIS ≥?3) comprised predominantly injuries of the trunk (chest 12.6?%, abdomen 16.9?% and pelvis 15?%). Overlooked injuries were found significantly less for the head in patients with a Glasgow Coma Score ≤?8 on arrival at the scene (5.4?% versus 19?%, p?=?0.015), for the chest in patients with a S_pO₂?≤?96?% on arrival at the scene (18.1?% versus 35.5?%, p?=?0.004) and for the abdomen in patients with a systolic blood pressure <?90 mmHg on arrival at the scene (28.6?% versus 52.5?%, p?=?0.025).

Conclusion

Accurate field triage in seriously injured road accident victims, even by trained physicians, is difficult. This pertains especially to injuries to the abdomen and the pelvis. For the field triage a combination of anatomical and physiological criteria as well as the mechanism of injury should be used to increase accuracy.     

Traumatic internal carotid artery dissection due to compression by a helmet strap

It is well known that wearing a helmet can reduce the risk of head injury in a traffic accident. We report a case of traumatic cervical internal carotid artery dissection due to compression by the strap of a helmet after a motorcycle accident. A 21 year-old man fell off his motorcycle and his head was struck at the right parietal region. His helmet prevented head injury, but the helmet strap which was fixed around his neck compressed his cervical internal carotid artery. He lost consciousness and developed left hemiparesis two hours after being admitted to an emergency department. Cerebral angiography revealed dissection of he right cervical internal carotid artery. This lesion was treated successfully by stent placement two months after the accident. The cause of carotid dissection was thought to be compression of his neck by the helmet strap. If the strap of a helmet is fixed around the neck, it can cause carotid artery injury during an accident, so it can be concluded that the strap of a helmet should be fixed firmly at the chin.     

Injured moped riders who required admission to hospital in Sweden from 1987 to 1994.

OBJECTIVES: To find out the incidence, extent of injury, medical consequences, and mortality rate of moped riders involved in crashes in Sweden. DESIGN: Retrospective case study. SETTING: The Swedish Hospital Discharge Register (SHDR). SUBJECTS: 4716 moped riders, a total of 5857 admissions to Swedish hospitals from 1987-94. INTERVENTIONS: Statistical analysis of the Register. MAIN OUTCOME MEASURES: Incidence of injured moped riders in Sweden, mortality rate, types of injuries, and medical consequences. RESULTS: From 1987 to 1994, Swedish hospitals admitted 4716 moped riders (5857 admissions) injured in crashes, which corresponds to a mean of 8.5 injured/100 000 population a year. Of these 3993 were male (85%) and 723 female (15%), with a median age of 16 years (range 3-93). Twenty-four percent of those admitted to hospital spent more than a week there. The annual number of injured moped riders did not change significantly during this period. The total number of deaths in hospital was 59 (1%). Among those who died in hospital, 32 (54%) had head injuries, 16 (27%) fractures, and 5 (9%) abdominal or thoracic injuries. CONCLUSION: The number of injured moped riders in Sweden is low. Fractures of the extremities were most common, followed by injuries to the head and brain. The usual victim was a teenager or young man. Of the patients treated in hospital few died, most of whom were elderly men.     

All-terrain vehicle injuries. A review at a rural level II trauma center

All-terrain vehicles (ATVs) have become a major source of morbidity and mortality with more than 600 deaths nationwide. Nearly half of those injured are children under 16 years. Twenty three ATV accidents were seen at the Guthrie Medical Center over a 30 month period ending in August 1986. Ten patients (43.5%) were under 16 years old. Of those injured who were older, alcohol was involved in 70 per cent of the accidents. Five accidents occurred on highways (21.7%), in spite of laws banning their use on public roads. Rollover type accidents and collisions were the most frequent mechanisms of injury (39% and 35%). Of 18 patients known not to have worn a helmet, 61 per cent sustained a closed head injury. In all, there were 88 injuries in 23 patients. Common injuries included lacerations (13), long bone fractures (13), renal contusions (11) and head injury (11). There were two deaths (8.7%), two cord transections with permanent disability, and a below-knee amputation. ATVs present a serious hazard to adult and children riders alike. Age limits, state licensing, safety programs, and protective equipment are all recommended as a means to reduce injury and death from recreational riding.     

Features of head injury in a developing country--Taiwan (1977-1987)

Certain features of head-injured patients admitted to the Chang Gung Memorial Hospital in Taiwan during the period 1977 to 1987 were reviewed. The most common causes of injury were motorcycle accidents (56.3%) and street accidents with pedestrian injury (29.47%). The age groups with the greatest incidence of injury were aged 16-20 years, 21-25 years, and 25-30 years. The pedestrian group involving the highest incidence of injury was less than 10 years of age. Overall mortality was 17.26%. The injured pedestrian group had the highest mortality (19.1%). Initial clinical assessment was recorded using the Glasgow Coma Scale. Head-injured patients with a GCS less than 8 had a mortality in the injured pedestrian group of 46%, whereas the mortality rate in the motorcycle accident group was 41%. Additional features studied were time of occurrence of injury and pattern of injury. Information gathered from this study would suggest the need to establish a Head Injury Prevention Program in Taiwan. This of course implies major cooperation among the providers of health care delivery, the medical profession, legislators, and the government at all levels.     

Motorised Two-Wheeler Crash and Helmets: Injury Patterns, Severity, Mortality and the Consequence of Gender Bias

Background

India records the maximum number of deaths from motorised two-wheeler vehicle (MTV) accidents in the world with mandatory helmet laws for males but not females. This study was designed to investigate injury patterns, severity, mortality, and helmet usage among hospital admitted victims of a MTV crash with a paired subgroup analyses on female victims.

Methods

Hospital trauma registry from January 2011 to July 2012 for all adult victims of a MTV crash was analysed for outcomes of mortality, serious head injury, severe facial injury, and cervical spine injury while adjusting for age, gender, use of alcohol/drugs, injury severity score, and presence of shock by multivariable logistic regression model. Groups of helmeted victims (HV) and nonhelmeted victims (NHV) were identified.

Results

A total of 2,718 victims were included. HV suffered maximum injuries to the lower extremity (29.04 %) and had reduced adjusted odds of death (odds ratio (OR) 0.65; 95 % confidence interval (CI) 0.48–0.86), serious head injury (OR 0.34; CI 0.26–0.45), cervical spine injury (OR 0.74; CI 0.54–1.06), and serious facial injury (OR 0.87; CI 0.57–1.26) compared with NHV who suffered maximum injuries to the head (24.49 %). Compliance with helmet use was 52.91 and 7.94 % among males and females respectively. A total of 224 pairs of male driver and female pillion involved in same MTV crash were identified, and the predominantly helmeted male had reduced odds of death (OR 0.44; CI 0.21–0.84) and severe head injury (OR 0.42; CI 0.24–0.72) compared with overwhelmingly nonhelmeted females.

Conclusions

Helmet laws must be strictly enforced, and society should think about the cost being born by its fairer counterpart by the gender-based differential law.