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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 53  |  Issue : 4  |  Page : 244-247

Evaluation of neurotrauma in motorcycle-related accidents at a tertiary hospital in Egypt


Department of Neurosurgery, Cairo University, Cairo, Egypt

Date of Submission03-Jun-2016
Date of Acceptance07-Aug-2016
Date of Web Publication17-Mar-2017

Correspondence Address:
Omar El Falaky
Department of Neurosurgery, Cairo University, Cairo, 11562
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-1083.202385

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  Abstract 

Background
Although traffic laws in Egypt obligate drivers to wear helmets, they are not strictly followed, resulting in an increased incidence of neurotrauma during accidents.
Objective
The aim of the present study was to evaluate head and spine injuries as a result of motorcycle accidents in 1 year.
Patients and methods
This study was conducted in the Neurosurgical Emergency Department of Cairo University Hospitals. Only motorcycle-related neurotrauma patients were included. Demographic data, types of lesions inflicted, operations and procedures carried out, hospital stay, and outcome were investigated by analyzing admission files and operation records. The results were then compared with the published literature.
Results
Out of 117 patients, there were 93% males and 7% females. The age group 20–40 years represented 61.5% of the cases. Extradural hematoma was present in 42 (36%) cases, fissure fracture and base of skull fracture in 64%, brain contusion in 29%, and spine fracture in four (0.034%). Helmeted drivers represented only 9.5% of the patients. Thirty-nine percent of patients had other associated injuries than of head and spine. Operations were performed on 45 (38.5%). Nearly half of the operation procedures comprised evacuation of extradural hematoma. Others included elevation of depressed fracture, frontal sinus repair, decompressive craniotomy, and spinal fixation surgeries. Hospital stay ranged from 2 to 28 days with an average of about 4.5 days; furthermore, 22.2% of the victims became handicapped and dependent.
Conclusion
Following safety measures during motorcycling significantly reduces morbidity and mortality at time of accidents. Although these patients have a short median hospital stay but surgery rates are obviously high. Follow-up for victims may reveal other potential burdens and help in the reintegration of society.

Keywords: motorcycle-related accidents, neurotrauma, tertiary hospital


How to cite this article:
El-Fiki A, El Falaky O. Evaluation of neurotrauma in motorcycle-related accidents at a tertiary hospital in Egypt. Egypt J Neurol Psychiatry Neurosurg 2016;53:244-7

How to cite this URL:
El-Fiki A, El Falaky O. Evaluation of neurotrauma in motorcycle-related accidents at a tertiary hospital in Egypt. Egypt J Neurol Psychiatry Neurosurg [serial online] 2016 [cited 2017 Nov 22];53:244-7. Available from: http://www.ejnpn.eg.net/text.asp?2016/53/4/244/202385


  Introduction Top


Cairo is a city governorate with centralization problem in decision making, found in many of the state ministries. Unfortunately, this contributes to increasing population of the Cairo urban area, approaching 21 million. This is negatively reflected on transportation overcrowding and thus extending rush hours sometimes to 12 h.

The use of motorcycles has gained popularity in comparison with cars because they are easy to drive, consume less fuel, and shorten transportation time, but safety measures in motorcycles are not like cars [1]. The use of safety-coded helmets is valuable in reducing injury severity in about 70% of motorcycles accidents [2] and 40% of mortality compared with drivers who do not wear helmets [2],[3]. This also leads to decreasing the consumption of hospital resources and improves healthcare services [4],[5].

Most motorcycle drivers are young and do not have driving license and subsequently do not wear helmets. In addition to exceeding speed limits, passengers on the same motorcycle may reach three and sometimes four, exceeding the allowed weight and disturbing the dynamics of the motorcycle and as a result putting more lives at stake. This makes accidents more frequent especially with the poor conditions of the roads. In developing countries, motorcycle accidents are a major cause of morbidity, especially among the youth [6].

The aim of this study was to evaluate the types and severity of neurotrauma occurring as a result of motorcycle accidents, as well as to highlight the effects of safety measures. The study was intended to contribute data that can facilitate some legislations that may reduce motorcycle accidents and their long-term impact on the persons involved.


  Patients and methods Top


This prospective, observational, cross-sectional study was conducted during the period from November 2013 to November 2014 in the Neurosurgical Emergency Department, which includes 75 beds and 25 ICU beds, at Kasr El Ainy Cairo University Hospitals, which is the largest tertiary hospital in Egypt. Patients admitted to other emergency departments with motorcycle-related trauma were excluded.

Patients included in this study had a detailed medical history documented, including variables such as age, sex, site of injury (head or spine), and associated injuries. A full and thorough medical exam was carried out on all patients including general and local neurological examination. Data obtained from examination sheets were recorded. A routine post-admission computed tomography scan of the brain was performed using a 64-multidetector row computed tomography scanner (Toshiba 64 Aquilion, Toshiba Medical Systems, California, USA) for evaluating all patients. Moreover, radiography and MRI were used for some patients involving spinal injuries; follow-up imaging was also performed in cases that required surgery.

Data were obtained from causality admission files and operation records. A full record of all surgeries done, outcome, hospital and ICU stay, and condition on discharge and follow-up was analyzed.


  Results Top


During this 1-year study, 117 patients were admitted to the Neurosurgical Emergency Department with motorcycle-related accidents. The majority were males (109 cases), representing about 93%, in comparison with females (eight cases), who represented only 7%. Patients’ age ranged from 4 to 77 years with a mean age of 28.5 years.

Age was stratified into 10-year blocks with the majority of cases coming under the age group 20–30 (41%) years. The [Figure 1] shows the relation between numbers in relation to the age group.
Figure 1 Age distribution of the patients in the study.

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About 109 cases (the majority of the accidents) were motorcycle-related, whereas there were only eight cases of tricycle-related accidents. Among the victims, pedestrians represented about 10% (12 cases), whereas the other 90% were drivers or passengers. Ninety-five (90.5%) drivers were not wearing helmets, whereas only 9.5% were wearing helmets.

Four (3.5%) patients had spine trauma with two cervical fractures, one dorsal, and one lumbar fracture, and all were operated upon for stabilization.

Head injuries were present in 113 (96.5%) cases with different types of intracranial lesions as shown in the following bar chart, with the most common lesions being extradural hematoma (36%) and brain contusions (29%). Many cases had more than one lesion. Associated body injuries were found in 39 (34%) cases, which were mainly other bone fractures and lung contusions ([Figure 2]).
Figure 2 Types of intracranial lesions found in the study population.

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Totally, 45 (38.5%) cases required surgery, which comprised evacuation of extradural hematoma in 22 cases, elevation of depressed skull fractures in 13 cases, repair of frontal air sinus in eight cases, decompressive craniotomy in one case, and stabilization of spinal fracture in one case. Blood transfusion − either intraoperative or postoperative − was carried out for 12 cases. The following pie chart shows the percentage and number of operations carried out in relation to the total number of operated cases ([Figure 3]).
Figure 3 Types of surgical intervention performed upon the study population. EDH, epidural hematoma.

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On admission, the Glasgow Coma Scale was assessed; in 110 (94%) patients it was more than 12, and in about seven cases, ICU admission and ventilation were mandatory.

About 65 (55.5%) patients were discharged on the second or third day, whereas 34 (29%) patients were discharged within the first week. For 18 patients, hospital stay was prolonged to more than 1 week; in some cases it was prolonged up to 3 weeks, including for three (2.5%) mortality cases. However, generally, hospital stay ranged from 2 to 28 days with an average of about 4.5 days ([Figure 4]).
Figure 4 Distribution of patients in the study according to duration of hospital stay.

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It was observed that real handicapping occurred in about 28 patients where the neural tissue function was either impaired or lost or where hospital-acquired infection occurred.

We considered other potential handicapping situations that may affect other aspects of the patient’s life, like social and financial burdens. This happened in about 40 cases who required regular antiepileptic treatment for a long time or follow-up visits for operated cases, in addition to the decline in the work performance, which occurred in 10 cases with post-traumatic behavioral changes. The following bar chart shows the type and number of handicapped cases ([Figure 5]).
Figure 5 Type and number of complications and handicap in the study population.

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  Discussion Top


The use of safety helmets is known to reduce morbidity in motorcycle-related accidents by 70% and mortality by 40% in comparison with drivers not wearing them [2],[3].

The use of safety-coded helmets is crucially important in reducing morbidity and mortality in motorcycle-related accidents [1],[2],[3],[4],[5].

The WHO had ranked Egypt as one of the countries with the highest mortality rates, at 41.6 deaths per 100 000 population. This was in the first global assessment of the road safety situation in 178 countries in 2009 [8].

Road traffic injuries represent 62.9% of injury-related deaths, 70% of which affect the economically productive age group [8].

Our study is the first in the Middle East to evaluate the types and severity of neurotrauma that occurs as a result of motorcycle-related accidents.

The number of cases included in our study were collected only in 1 year, which indicates a very high flow in our hospital compared with what was published in Jamaica by Crandon [9], who included only 143 patients in 7 years.

Regarding the demographic data, our results are nearly in agreement with those of other published studies related to motorcycle accidents in developing countries [1],[6],[10],[11].

Approximately, most of the cases (61.5%) were in the economically productive age group (20–40 years); however, younger age also reached a significant percent (24%). In these situations, lack of driving skills and attention may be an initiating factor for accidents. But the most important risk factor was not wearing helmets in about 90.5% of the cases, which is high in comparison with the findings of Crandon [9] in Jamaica, where the number of unhelmeted drivers reached only 60%.

Poor road conditions, absence of multispeed lanes and separate lanes for low-velocity vehicles, and the previously mentioned risk factors result usually in low-velocity head injury. Fissure fractures and extradural hematoma are the most common intracranial lesions.In our study, operations were carried out for 45 (38.5%) patients, which is a relatively high number with no comparable data in other researches [1],[6],[10],[11]; nearly half of these operations comprised evacuation of extradural hematomas.

About 89.5% of the cases were discharged before 1 week, with 55.5% going home before day 4, which is in contrast to the Jamaican study in which hospital stay was recorded to be much longer. This may be attributed to the high flow in our hospital and the lack of available beds.

We had about 28 (22.2%) patients who became dependent on their relatives and were not productive; this percent is nearly double of what was obtained by Crandon [9] in Jamaica.

These results may help to raise public awareness of safety measures through social campaigns, media, and collaboration with different ministries in charge to decrease motorcycle-related accidents and increase road safety in general.

Potential handicapping situations need to be further investigated because they may mask a larger percent of patients’ social and financial burdens, especially as they usually start after discharge and need long-term follow-up, which is really difficult in developing countries.


  Conclusion Top


Following safety measures during motorcycling effectively reduces accident morbidity and mortality. Although motorcycle-related trauma is of low velocity but surgery rates are relatively high. A multidisciplinary approach is important to reduce handicapping burdens that affect both persons and the state. Long-term follow-up and society integration for the victims are needed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Motorcycle Accident Cause Factors and Identification of Countermeasures, Volume 1: Technical Report. Hurt HH, Ouellet JV, Thom DR. Traffic Safety Center, University of Southern California, Los Angeles, California 90007, Contract No. DOT HS-5-01160, January 1981 (Final Report)   Back to cited text no. 1
    
2.
World Health Organization. World report on road traffic injury prevention; 2004. Available at: http://www.who.int/violence_injury_prevention/publications/road_traffic/world_report/en/index.html  Back to cited text no. 2
    
3.
Liu B, Ivers R, Norton R, Blows S, Lo SK. Helmets for preventing injury in motorcycle riders. Cochrane Database Syst Rev 2008; 1:CD004333.  Back to cited text no. 3
    
4.
Brandt MM, Ahrns KS, Corpron CA, Franklin GA, Wahl WL. Hospital cost is reduced by motorcycle helmet use. J Trauma 2002; 53:469–471.  Back to cited text no. 4
    
5.
Eastridge BJ, Shafi S, Minei JP, Culica D, McConnel C, Gentilello L. Economic impact of motorcycle helmets: impact to discharge. J Trauma 2006; 60:978–983.  Back to cited text no. 5
    
6.
Solagberu BA, Ofoegbu CKP, Nasir AA, Ogundipe OK, Adekanye AO, Abhur-Rahman LO. Motorcycle injuries in a developing country and the vulnerability of riders, passengers, and pedestrians. Inj Prev 2006; 12:266–268.  Back to cited text no. 6
    
7.
McGwin G Jr, Whatley J, Metzger J, Valent F, Barbone F, Rue LW. The effect of state motorcycle licensing laws on motorcycle driver mortality rates. J Trauma 2004; 56:415–419.  Back to cited text no. 7
    
8.
WHO Regional Office for the Eastern Mediterranean (Cairo, Egypt). A national decade of action for road safety 2011–2020. Available at: http://applications.emro.who.int/dsaf/dsa1229.pdf  Back to cited text no. 8
    
9.
Crandon IVV, Harding HE, Cawich SO, Frankson MA, Gordon-Strachan G, McLennon N et al. The impact of helmets on motorcycle head trauma at a tertiary hospital in Jamaica. BMC Res Notes 2009; 2:172.  Back to cited text no. 9
    
10.
Naddumba EK. Musculoskeletal trauma services in Uganda. Clin Orthop Relat Res 2008; 466:2317–2322.  Back to cited text no. 10
    
11.
Odelowo EO. Pattern of trauma resulting from motorcycle accidents in Nigerians: a two-year prospective study. Afr J Med Med Sci 1994; 23:109–112.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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Introduction
Patients and methods
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