Epidemiological, Characteristics and Outcomes of Road Traffic Accident Among Patients in Emergency Units

Introduction

Traffic accidents are one of the most unfortunate reasons that claim dozens of lives every day around the world, in addition to the occurrence of many injuries and serious damage to the means of transportation, despite the increase in awareness campaigns in global traffic weeks, and throughout the year as well, and the causes of traffic accidents are many [1-3]. There is a continuous increase in the number of victims due to traffic accidents; In 2016, the number of deaths resulting from car accidents reached 1.35 million people around the world, but this percentage is considered constant with the increase in population numbers around the world, and the increase in the number of cars, and this indicates the efforts made to maintain the safety of road users, which led to a lack of It gets worse, knowing that one of the sustainable development goals, which is to reduce the death rates from accidents by 50% by 2020, has not yet been achieved [4-6]. Life and death; the care of the injured is a very delicate matter; If it is done wrong, it may lead to the death of the injured, or aggravate his injury, and this can be avoided by registering in specialized training programs in ambulance, and caring for the injured from accidents [7-8].
The continent of Africa is the highest in recording death rates from accidents, and the ages of deaths resulting from traffic accidents range between young people and children from 5 to 29 years old, while males cause road accidents at a higher rate than females, accounting for 73% of deaths that result from accidents [9-10]. Therefore, the RTA occurred among the youngest under the age of 25 years [11]. Traffic accidents leave a lot of damage, whether economic, social, or human, and these accidents have several consequences and many costs, and these costs, for example: treatment of the injured, the length of their care, and the loss of the production process due to injury [12-13]. In addition to the loss of welfare and material losses service to the injured, rescue operations, police work, investigations into the cause of the accident, and in addition to these losses, the costs and damages resulting from accidents are also borne by the families of the victims and injured [14]. While the costs of accidents in developing countries are estimated at 65 billion dollars annually; that is, it exceeds the amounts provided annually for development aid, and it must be said that all efforts made for maintain the safety of drivers while driving on the roads have not achieved the required results [15].
Adolescents, especially those ages between 16 to 19 years, should be educated and given sufficient experience and the necessary skill to take responsibility for driving and to keep them safe on the roads because of its great role in avoiding accidents [16]. Statistics indicate that the aforementioned age group is the most likely to die as a result of car accidents, and they cause four times more horrific accidents than the age group between 25 to 69 years [17]. Technology plays an important role in preventing car accidents, reducing the risk of injury, and maintaining the safety of both drivers and pedestrians, such as: sending warning signals before a collision occurs, enabling the driver to avoid an accident, facilitating the detection of blind spots on the vehicle, and improving brake systems [18]. Therefore, the driver must choose a car with high safety specifications, and advanced technology to improve safety while driving and, asking about the vehicle’s specifications before purchasing it [19]. This study aimed to identify the epidemiological, characteristics and outcomes of Road Traffic accident among patients in emergency unit during the study period.

Methodology

A retrospective cross sectional study was conducted among 198471 patients with road traffic injuries were registered on fifteen provinces in Iraq. The data reported on the present study were collected between January 2020 and December 2020. Data were collected including medical history, patient symptoms, clinical signs and the radiological findings. Data onto patients were recorded including cause and location of injury, frequency and type of injury (frequency of soft tissue injuries and bone fractures), as well as age and gender distribution. Duration of recovery and associated complication was also recorded. Road traffic injuries were classified into [20], soft-tissue injuries, fractures and injuries of organs. Soft-tissue injuries were classified into abrasion, contusion and laceration. Fractures were classified into; skull (fissure and depressed fractures) and long bones. The Glasgow Coma Scale was used to assess the severity of brain injury. A conservative or operative intervention done for all the cases was also recorded. Traffic accidents are classified according to the E code of the International Classification of Diseases (ICD).
By definition, this category includes all accidents involving at least one vehicle for any kind. The definition used in the present study embraces also pedestrians injured in an accident not involving another person or vehicle, e.g. an injury caused by slipping or stumbling [21]. Objective measures of injury severity -the injury severity score (ISS) and the 1990 revision of the abbreviated injury scale (AIS-90) was determined. The AIS is a scale for categorizing injury type and severity. The body is divided into six regions (i.e., head or neck, face, chest, abdomen, extremities, and external) in which injuries are graded from 1 (minor) to 6 (clinically untreatable). The maximal AIS (MAIS), which is the highest single AIS code in a patient with multiple injuries, was determined. The ISS, which is useful for assessing the severity of multiple injuries, is the sum of the squares of the highest AIS coded in each of much three most severely injured body regions [22]. Statistical analyses performed included descriptive analysis, chi square test, Fisher’s exact test, and Mann-Whitney’s U test. This was followed by logistic regression analyses to determine the impact on the main causes of craniofacial injuries. The SPSS Version 16.0 (SPSS Inc., Chicago, IL) and Epi Info™ Version 3.5 were used for statistical analyses.

Results

Out of 198471 of RTA patients, half of them 54.7% occurred in the age group 15 to 44 years old and 20.8 % in the age 4 to 14 years old. Male cases 70.2% were more than 29.8% female cases. 61.2% were unemployed and 65% were married. Car constitutes the large victim group of road traffic accident fatalities and injuries (32.9%), followed by motorcycle (25.7%), 16.1% by minibus and 15.3% by lorry (Table1). In Table 2 shows that the highest frequency 22.4% of them had fractures ;followed by 17.4% had spinal injuries, 15.9% had burnt abdominal injuries, 10.7% and 10.2% had TBJ and burnt chest injuries respectively. In Figure 1 shows the highest frequency (39.4%) 78201/198471 had injury in head and neck rejoin followed by (16.6%) 33025/198471 in abdominal rejoin and (16.2%) 32121/198471 in upper extremity rejoin. The studied cases were divided into six groups according to abbreviated injury severity scale (AIS), the highest number of patients scored AIS 3(32.8%) and the least number (6.5%) scored AIS 6 (Table 3). According to outcome of studied cases involved in road traffic accidents,32.8% discharged after recovery , 5.6% absconded,22.2% transferred to other hospital or unit and , 39.4% died (Table 4). Out of 78219 victims, 24158cases (30.9%) died instantly and 54061 (69.1) % died after a period of hospitalization (Table 5). Out of the hospitalized victims, 21.8% died in the first 24 h, 33.8% died in a period of 1–10 days, 18. 4% died in 11–20 days, and 26% died in more than 21 days (Table 6).

Table 1: Characteristics of RTA among patients in emergency units.

Table 2: Type of injuries.

Table 3: Distribution of cases according to Abbreviated Injury Severity Scale (AIS).

Table 4: Distribution of cases according to outcomes of RTA.

Table 5: Survival time of Fatal Vehicular Accidents.

Table 6: Period of hospitalization until death.

Figure 1: Distribution of RTA by body rejoins.

Discussion

This study aimed to identify the epidemiological, characteristics and outcomes of Road Traffic accident among patients in emergency unit during the study period. The most common age group affected in this study was 15 to 44 years old (54.7%) and is agreement with other studies from other countries [23-25]. The ages in this category are the most active and energetic and the most of them are car users and, therefore it’s represented the largest number of injuries and deaths resulting from accidents and, this has an impact on the economic, social and psychological level as well. Preventive measures are important to this category and, thus reduce the risks of exposure to severe danger that has an impact on the body. The result of accident is either disability or loss of life. Also, adolescents and young adults have different behavior when driving cars, including drinking, speeding, neglecting seat belts, risking driving at night, and racing against young people as a form of betting. Recent studies conducted in some countries indicate that young drivers between the ages of 18 and 27 years are more likely to be killed compared with other age groups, as well as lack of experience and risk are two factors associated with the occurrence of collision accidents among adolescents.
In our study, we found that the majority 70.2% of those exposed to accidents are males, and this is due to the predominance of men. As some of them become more aggressive in the street, as well as the dominance of men over the drivers of transport vehicles, because most of them spend their time outside the home and similar higher incidence of traffic accidents among males has been found by many other researchers [26-27]. In this study we found that the majority of victims of RTA 61.2% were unemployed and this finding in line with other finding done it in Nepal by Karkee [7], the author found that the majority of studied samples are unemployed. Most men prefer self-employment, especially in developing countries that suffer from unemployment and lack of job opportunities for their citizens. The higher percentage of victims 65% were married and compared with other results has done it in Iran by Hamzeh [4], Africa by Sango [9], Nigeria by Labinjo [13], they reported the majority of victims are married. Car accident represented the majority of victims of road traffic accidents (32.9%), the same has been reported by Downing [28], but Kraus, et al. [29], found in San Diego that 62% of head injuries were to occupants of vehicles.
The higher percentage of car accident in this study may be attributed to failure of directing and controlling traffic. The type of road is also one of the risk factors, especially on external roads, where there are scarce paths, sidewalks and traffic lights, as well as lighting, as it poses the greatest danger and causes a high risk of death, especially at night, in addition to weather factors such as fog and rain, which cause poor visibility and this leads to the accident [30-31]. Previous studies indicate that drivers acquire many dangerous and harmful driving habits, especially in developing countries, and fail to comply with traffic rules. In some countries, the seat belt is ignored for the driver of the vehicle and other protective equipment such as the helmet for motorcyclists [32-33]. On the other hand the most commonly injury in similar studies was to the head (69.63 %) followed by chest (33.62%) [34]. Out of 198471 cases, there is 44361 (22.4%) had a fatal skull fracture. Similar findings were seen in few other studies. Most commonly found a spinal injury (17.4 %) which is consistent with the findings by other researchers [35-36].
Pre-hospital mortality was found to be in 24158 cases (30.9%). The rest (69.1 %) was taken to hospital where later they succumbed to their injuries. This is nearly consistent with the study conducted in Iran with higher cases of pre-hospital mortality [37]. The present study observed that the most frequent lesions were in the head / neck (39.4%) followed by abdominal injuries (16.6 %) and in upper extremity (16.2%) and this finding in line with other findings in Thailand [1], Italy [30], Nepal [23], United Arab Emirate [33], they reported the head and neck the major lesions by RTA.

Conclusion and Policy Implication

In addition to the fact that road traffic injuries pose a significant health risk leading to a high rate of morbidity, disability and death, they have a significant social and economic impact on the victim, his family, and the nation as a whole. This study shows that most deaths in traffic accidents, brought to hospital, occur either immediately or within 24 hours of injury which is very worrying and highlights the need to take urgent steps to provide care services to them as quickly as possible. It also shows in our study that head injuries remain the most common and serious type of trauma seen in our hospital’s emergency department and that quality neurosurgical care is essential for these patients. There is an urgent need to highlight the risk factors, conditions and chain to events that lead to accidents and it will be very useful for policy-making and health. In summary, it has been shown in this study that males, of younger ages, pose a higher risk, mortality and morbidity. Our findings may be useful for forensic experts, clinicians, and mechanical engineers looking for new vehicle occupant safety devices.
Deaths, injuries and disability after traffic accidents place a significant financial burden on the budgets of developing countries like ours. This problem must be resolved as soon as possible before causing more deaths in light of studies on the causes and prevention of traffic accidents and the support of international organizations.

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