Epidemiologic Characteristics of Patients Presenting with Head Injury due to Road Traffic Accident and Factors Associated with Outcome: Experience of a Tertiary Care Center in Northern Kerala

Abstract

Background In India, most factors related to road traffic accident (RTA) causation and outcome go improperly documented, and database regarding RTA-related traumatic brain injury (TBI) seems inadequate. Two-wheeler drivers form the largest segment of people affected by RTA. The socioeconomic and neurologic burden, imposed by TBI due to RTAs (largely preventable), is overwhelmingly significant, especially for a developing country like India.

Materials and Methods Descriptive study involving patients, presenting to the casualty of Government Medical College, Kozhikode, Kerala, was performed, and various demographic features were analyzed. Usage of helmet and history of alcohol intake were also noted. Patients were evaluated according to their presenting Glasgow coma scale (GCS), investigated and either operated or managed conservatively, and their outcome was assessed with Glasgow outcome score (GOS) at 3 months.

Results Bike drivers formed the single largest proportion of RTA victims (53.7%). Proportion of helmet users was 17.9%, whereas 21.9% were found with history of alcohol intake. There was a consistent trend toward a favorable outcome in patients with no alcohol intake (17.08% deaths compared with 34.07% patients with alcohol intake) and with helmet usage (14.55% compared with 22.18% in patients without helmet). However, the absolute contribution of these factors cannot be inferred.

Conclusion Various factors related to RTA need evaluation for pooling and compilation of data at regional and national levels. Mandatory helmet laws and strict implementation and provision of subsidized helmets (standard, full coverage) will go a long way in reducing the burden on limited health resources.

Keywords

road traffic accident - helmet - alcohol

• References

• 1 Agrawal A, Galwankar S, Kapil V. et al. Epidemiology and clinical characteristics of traumatic brain injuries in a rural setting in Maharashtra, India. 2007–2009. Int J Crit Illn Inj Sci 2012; 2 (03) 167-171
• 2 Tripathi M, Tewari MK, Mukherjee K, Mathuriya SN. Profile of patients with head injury among vehicular accidents: an experience from a tertiary care centre of India. Neurol India 2014; 62 (06) 610-617
• 3 Wadhwaniya S, Gupta S, Tetali S, Josyula LK, Gururaj G, Hyder AA. The validity of self-reported helmet use among motorcyclists in India. WHO South-East Asia J Public Health 2015; 4 (01) 38-44
• 4 Shibata A, Fukuda K. Risk factors of fatality in motor vehicle traffic accidents. Accid Anal Prev 1994; 26 (03) 391-397
• 5 Das A, Botticello AL, Wylie GR, Radhakrishnan K. Neurologic disability: a hidden epidemic for India. Neurology 2012; 79 (21) 2146-2147
• 6 Road accidents in India—2016. New Delhi, Delhi: Ministry of Road Transport & Highways Transport Research Wing; 2016
• 7 Report of Road Safety Cell: Ministry of Transport. Govt. of India; 1993
• 8 Ramamurthi B. Road accidents, epidemiology and prevention. Neurol India 1995; 43 (Suppl) 9-15
• 9 Mahapatra AK. Current management of head injury. Neuroscience Today 1997; 1: 197-204
• 10 Fife D, Faich G, Hollinshead W, Boynton W. Incidence and outcome of hospital-treated head injury in Rhode Island. Am J Public Health 1986; 76 (07) 773-778
• 11 Editorial: Head injuries: a neglected field in India. National Medical Journal 1991; 4: 44-53
• 12 Sambasivan M. Epidemiology of neurotraumic. Neurol India 1993; 3 (Suppl) 41
• 13 MacLeod J, DiGiacomo JC, Tinkoff G. An evidence-based review: helmet efficacy to reduce head injury and mortality: EAST practice management guidelines. J Trauma 2010; 69 (05) 1101-1111
• 14 Yadukul S, Devadass PK, Gururaj G. Role of helmet in preventing head injury among two wheeler occupants in fatal road traffic injuries. Indian Journal of Forensic Medicine & Toxicology 2016; Jan–Jun 10 (01) 6-10
• 15 Gururaj G. Head Injuries & Helmets: Helmet Legislation and Enforcement in Karnataka and India. Bangalore, India: National Institute of Mental Health & Neuro Sciences; 2005
• 16 Yu WY, Chen CY, Chiu WT, Lin MR. Effectiveness of different types of motorcycle helmets and effects of their improper use on head injuries. Int J Epidemiol 2011; 40 (03) 794-803
• 17 Helmets: A Road Safety Manual for Decision Makers and Practitioners. Geneva, Switzerland: World Health Organization; 2006
• 18 Sarkar S, Peek C, Kraus JF. Fatal injuries in motorcycle riders according to helmet use. J Trauma 1995; 38 (02) 242-245
• 19 Richter M, Otte D, Lehmann U. et al. Head injury mechanisms in helmet-protected motorcyclists: prospective multicenter study. J Trauma 2001; 51 (05) 949-958
• 20 Richards PG. Detachment of crash helmets during motorcycle accidents. Br Med J (Clin Res Ed) 1984; 288 (6419) 758
• 21 Peek-Asa C, McArthur DL, Kraus JF. The prevalence of non-standard helmet use and head injuries among motorcycle riders. Accid Anal Prev 1999; 31 (03) 229-233
• 22 Conrad P, Bradshaw YS, Lamsudin R, Kasniyah N, Costello C. Helmets, injuries and cultural definitions: motorcycle injury in urban Indonesia. Accid Anal Prev 1996; 28 (02) 193-200
• 23 NHTSA. The Economic Impact of Motor Vehicle Crashes. Washington, DC: Dept of Transportation (US), National Highway Traffic Safety Administration (NHTSA); 2000. http://www.dot.gov/safety.html
• 24 The Economic Impact of Motor Vehicle Crashes 2000. Washington, DC: Dept of Transportation, National Highway Traffic Safety Administration; 2000. http://www-nrd.nhtsa.dot.gov/Pubs/
• 25 U.S. Dept. of Transportation, National Highway Traffic Safety Division. Traffic Safety Facts 1996: Alcohol. Washington, DC: National Center for Statistics & Analysis, Research & Development; 1997
• 26 Stewart RM, Myers JG, Dent DL. et al. Seven hundred fifty-three consecutive deaths in a level I trauma center: the argument for injury prevention. J Trauma 2003; 54 (01) 66-70 discussion 70–71
• 27 Fabbri A, Marchesini G, Morselli-Labate AM. et al. Positive blood alcohol concentration and road accidents. A prospective study in an Italian emergency department. Emerg Med J 2002; 19 (03) 210-214
• 28 Pories SE, Gamelli RL, Vacek P, Goodwin G, Shinozaki T, Harris F. Intoxication and injury. J Trauma 1992; 32 (01) 60-64
• 29 Waller PF, Stewart JR, Hansen AR, Stutts JC, Popkin CL, Rodgman EA. The potentiating effects of alcohol on driver injury. JAMA 1986; 256 (11) 1461-1466
• 30 National Highway Traffic Safety Administration. Traffic Safety Facts. 2006
• 31 Corrigan JD. Substance abuse as a mediating factor in outcome from traumatic brain injury. Arch Phys Med Rehabil 1995; 76 (04) 302-309
• 32 Kolakowsky-Hayner SA, Gourley III EV, Kreutzer JS, Marwitz JH, Cifu DX, Mckinley WO. Pre-injury substance abuse among persons with brain injury and persons with spinal cord injury. Brain Inj 1999; 13 (08) 571-581
• 33 Tien HC, Tremblay LN, Rizoli SB. et al. Association between alcohol and mortality in patients with severe traumatic head injury. Arch Surg 2006; 141 (12) 1185-1191 discussion 1192
• 34 O'Phelan K, McArthur DL, Chang CW, Green D, Hovda DA. The impact of substance abuse on mortality in patients with severe traumatic brain injury. J Trauma 2008; 65 (03) 674-677
• 35 Jorge RE, Starkstein SE, Arndt S, Moser D, Crespo-Facorro B, Robinson RG. Alcohol misuse and mood disorders following traumatic brain injury. Arch Gen Psychiatry 2005; 62 (07) 742-749
• 36 Bombardier CH, Thurber CA. Blood alcohol level and early cognitive status after traumatic brain injury. Brain Inj 1998; 12 (09) 725-734
• 37 Kelly MP, Johnson CT, Knoller N, Drubach DA, Winslow MM. Substance abuse, traumatic brain injury and neuropsychological outcome. Brain Inj 1997; 11 (06) 391-402
• 38 Tate PS, Freed DM, Bombardier CH, Harter SL, Brinkman S. Traumatic brain injury: influence of blood alcohol level on post-acute cognitive function. Brain Inj 1999; 13 (10) 767-784
• 39 Onwuchekwa RC, Echem RC. An epidemiologic study of traumatic head injuries in the emergency department of a tertiary health institution. J Med Trop 2018; 20: 24-29
• 40 Proceedings First Safe Community Conference on Cost of Injury. Viborg, Denmark: October 2002: 33-38