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CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2019; 08(01): 039-046
DOI: 10.1055/s-0039-1678468
Original Article
Neurological Surgeons' Society of India

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

Mandaka Parambil Rajeev
1   Government Medical College, Kozhikode, Kerala, India
,
Vattaparambil Shinihas
1   Government Medical College, Kozhikode, Kerala, India
,
Pankaj Singh Chauhan
1   Government Medical College, Kozhikode, Kerala, India
› Author Affiliations
Further Information

Publication History

Received: 29 July 2018

Accepted after revision: 03 October 2018

Publication Date:
22 April 2019 (online)

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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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 4 Shibata A, Fukuda K. Risk factors of fatality in motor vehicle traffic accidents. Accid Anal Prev 1994; 26 (03) 391-397
    CrossrefPubMedGoogle Scholar
  • 5 Das A, Botticello AL, Wylie GR, Radhakrishnan K. Neurologic disability: a hidden epidemic for India. Neurology 2012; 79 (21) 2146-2147
    CrossrefPubMedGoogle Scholar
  • 6 Road accidents in India—2016. New Delhi, Delhi: Ministry of Road Transport & Highways Transport Research Wing; 2016
    Google Scholar
  • 7 Report of Road Safety Cell: Ministry of Transport. Govt. of India; 1993
    Google Scholar
  • 8 Ramamurthi B. Road accidents, epidemiology and prevention. Neurol India 1995; 43 (Suppl) 9-15
    PubMedGoogle Scholar
  • 9 Mahapatra AK. Current management of head injury. Neuroscience Today 1997; 1: 197-204
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 11 Editorial: Head injuries: a neglected field in India. National Medical Journal 1991; 4: 44-53
    PubMedGoogle Scholar
  • 12 Sambasivan M. Epidemiology of neurotraumic. Neurol India 1993; 3 (Suppl) 41
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 15 Gururaj G. Head Injuries & Helmets: Helmet Legislation and Enforcement in Karnataka and India. Bangalore, India: National Institute of Mental Health & Neuro Sciences; 2005
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 17 Helmets: A Road Safety Manual for Decision Makers and Practitioners. Geneva, Switzerland: World Health Organization; 2006
    Google Scholar
  • 18 Sarkar S, Peek C, Kraus JF. Fatal injuries in motorcycle riders according to helmet use. J Trauma 1995; 38 (02) 242-245
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 20 Richards PG. Detachment of crash helmets during motorcycle accidents. Br Med J (Clin Res Ed) 1984; 288 (6419) 758
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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/
    Google Scholar
  • 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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 28 Pories SE, Gamelli RL, Vacek P, Goodwin G, Shinozaki T, Harris F. Intoxication and injury. J Trauma 1992; 32 (01) 60-64
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 30 National Highway Traffic Safety Administration. Traffic Safety Facts. 2006
    PubMedGoogle Scholar
  • 31 Corrigan JD. Substance abuse as a mediating factor in outcome from traumatic brain injury. Arch Phys Med Rehabil 1995; 76 (04) 302-309
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 36 Bombardier CH, Thurber CA. Blood alcohol level and early cognitive status after traumatic brain injury. Brain Inj 1998; 12 (09) 725-734
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 40 Proceedings First Safe Community Conference on Cost of Injury. Viborg, Denmark: October 2002: 33-38
    Google Scholar