Original Article
Profile of patients with head injury among vehicular accidents: An experience from a tertiary care centre of India Manjul Tripathi, Manoj K. Tewari, Kanchan K. Mukherjee, Suresh Narayan Mathuriya Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Abstract
Address for correspondence: Prof. Kanchan K Mukherjee, Department of Neurosurgery Postgraduate Institute of Medical Education and Research Chandigarh-160 012, India. E-mail: [email protected] Received : 28-09-2014 Review completed : 09-10-2014 Accepted : 07-12-2014
Background: Pattern of injuries among drivers, pillion riders and co‑passengers of two and four‑wheeler vehicles need to be separately evaluated and addressed. Materials and Methods: A prospective study was conducted on 1545 patients (1314 males and 231 females) between 01 April, 2011 to 31 December, 2011, to evaluate the profile of head injury patients due to road traffic accidents, admitted in Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh. Proper subset of cases and controls with or without helmet, seat belt and history of alcohol intake were compared. Data was analyzed to evaluate the incidence, severity, pattern of head injury and outcome of the patients. Results: Male drivers of two‑wheeler vehicular accidents (71.4%) were most commonly injured. Among helmeted patients, only 4.8% sustained severe head injuries compared to 23.7% of un‑helmeted patients. Only full coverage helmets were effective in preventing head injury. Among helmeted patients with a proper chinstrap, 2.6% suffered critical injuries compared to 14% of non‑strapped ones. In 142 patients, helmet was at position after the crash and only 0.7% of these sustained severe head injuries. Drunk driving was noticed among 19% and 6% of two‑ and four‑wheeler vehicular occupants, respectively. Only 7.5% of the four‑wheel vehicular occupants were wearing seat belt at the time of accident. Conclusions: Injury profile of two‑ and four‑wheeler vehicular accident victims is entirely different. A ready supply of affordable helmets of appropriate quality and strict legislation for safety constraints is the need of the hour for road safety. Key words: Alcohol, driver, head injury, helmet, pillion‑rider, seat belt, two‑wheeler
Introduction Road traffic accidents (RTAs) have been the bane of the modern civilization accounting for considerable loss to Access this article online Quick Response Code:
Website: www.neurologyindia.com PMID: *** DOI: 10.4103/0028-3886.149382
610
the nation. General callous attitude for safety measures, poor law enforcement and uncontrolled motorization have caused significant increase in incidence of RTAs. World Health Organization (WHO) puts RTAs as the sixth leading cause of deaths in India, with a greater share of hospitalizations, deaths, disabilities and socioeconomic losses in young and middle aged population.[1] Lack of reliable and good quality national or regional data has thwarted its actual magnitude. The pattern of injury between two‑wheeler and four‑wheeler vehicular accidents is entirely different and needs to be evaluated accordingly. The aim of present study was to evaluate Neurology India | Nov-Dec 2014 | Vol 62 | Issue 6
Tripathi, et al.: Profile of head injury patients
the profile of patients of two and four wheeler vehicular accidents in terms of their demographic profile, injury pattern, injury severity, usage of safety constraints, incidence of drunk driving and outcome.
Materials and Methods This prospective study was conducted at Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, from 01 April, 2011 to 31 December, 2011. All the cases of traumatic head injury (THI) that is, drivers and the pillion riders of motorized two‑wheeled vehicles (TWVPs) and driver and co‑passenger of motorized four‑wheeled vehicles (FWVPs) were enrolled. Proper subset of cases and controls with or without helmet, seat belt and history of alcohol intake were compared. Injury severity was assessed by Glasgow coma scale (GCS). Patients were re‑assessed after 3‑month interval with Glasgow Outcome Score (GOS). Data was analyzed to evaluate the incidence, severity, and pattern of head injury and outcome of THI patients. Spearman ranked sum analysis and multivariate analysis were used to evaluate correlation and statistical significance among various factors.
two‑wheeler vehicles (TWVP) while 199 to four‑wheeler vehicles (FWVP). Demographic profile Among 1346 TWVPs, drivers significantly outnumbered pillion riders (5.76:1) [Figure 1a and b]. The median age of the drivers and pillion riders was 30 and 36 years, respectively. Of 199 FWVPs, maximum were co‑passengers that is, 1.34:1. Overall, the most commonly affected age group was 18‑29 years comprising 45.43% and 46.43%, respectively in TWVP and FWVP patients. The overall male:female patient ratio was 10.8:1 [Tables 1 and 2]. Table 1: Comparative analysis of injured patients among two‑ and four‑wheeler vehicular accidents Total no. of patients Driver Pillion rider/Co‑passenger Most commonly affected age group < 40: ≥40 age group
Two‑wheeler
Four‑wheeler
1346 1019 327 18‑29 years (46.43%) 2.08:1
199 85 114 18‑29 years (45.43%) 2.26:1
Table 2: Gender distribution among two‑and four‑wheeler vehicular accidents
Results
Two‑wheeler Male Female
Total 1545 patients of RTAs were admitted during the nine‑month period. Of these, 1346 patients belonged to
Driver Pillion rider/co‑passenger
a
b
c
d
961 190
58 137
Four‑wheeler Male Female 81 82
4 32
Figure 1: (a and b) Age group profile of male and female patients among two-wheeler vehicular accidents, (c and d) Age group profile of male and female patients among four-wheeler vehicular accidents (X axis, age in years; Y, Number of patients)
Neurology India | Nov-Dec 2014 | Vol 62 | Issue 6
611
Tripathi, et al.: Profile of head injury patients
Helmet usage rate Despite legislation and many public awareness programs, only 13.4% of all TWVPs (16.5% drivers and 3.7% pillion riders) were wearing helmet at the time of accident (P
Profile of patients with head injury among vehicular accidents: An experience from a tertiary care centre of India Manjul Tripathi, Manoj K. Tewari, Kanchan K. Mukherjee, Suresh Narayan Mathuriya Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Abstract
Address for correspondence: Prof. Kanchan K Mukherjee, Department of Neurosurgery Postgraduate Institute of Medical Education and Research Chandigarh-160 012, India. E-mail: [email protected] Received : 28-09-2014 Review completed : 09-10-2014 Accepted : 07-12-2014
Background: Pattern of injuries among drivers, pillion riders and co‑passengers of two and four‑wheeler vehicles need to be separately evaluated and addressed. Materials and Methods: A prospective study was conducted on 1545 patients (1314 males and 231 females) between 01 April, 2011 to 31 December, 2011, to evaluate the profile of head injury patients due to road traffic accidents, admitted in Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh. Proper subset of cases and controls with or without helmet, seat belt and history of alcohol intake were compared. Data was analyzed to evaluate the incidence, severity, pattern of head injury and outcome of the patients. Results: Male drivers of two‑wheeler vehicular accidents (71.4%) were most commonly injured. Among helmeted patients, only 4.8% sustained severe head injuries compared to 23.7% of un‑helmeted patients. Only full coverage helmets were effective in preventing head injury. Among helmeted patients with a proper chinstrap, 2.6% suffered critical injuries compared to 14% of non‑strapped ones. In 142 patients, helmet was at position after the crash and only 0.7% of these sustained severe head injuries. Drunk driving was noticed among 19% and 6% of two‑ and four‑wheeler vehicular occupants, respectively. Only 7.5% of the four‑wheel vehicular occupants were wearing seat belt at the time of accident. Conclusions: Injury profile of two‑ and four‑wheeler vehicular accident victims is entirely different. A ready supply of affordable helmets of appropriate quality and strict legislation for safety constraints is the need of the hour for road safety. Key words: Alcohol, driver, head injury, helmet, pillion‑rider, seat belt, two‑wheeler
Introduction Road traffic accidents (RTAs) have been the bane of the modern civilization accounting for considerable loss to Access this article online Quick Response Code:
Website: www.neurologyindia.com PMID: *** DOI: 10.4103/0028-3886.149382
610
the nation. General callous attitude for safety measures, poor law enforcement and uncontrolled motorization have caused significant increase in incidence of RTAs. World Health Organization (WHO) puts RTAs as the sixth leading cause of deaths in India, with a greater share of hospitalizations, deaths, disabilities and socioeconomic losses in young and middle aged population.[1] Lack of reliable and good quality national or regional data has thwarted its actual magnitude. The pattern of injury between two‑wheeler and four‑wheeler vehicular accidents is entirely different and needs to be evaluated accordingly. The aim of present study was to evaluate Neurology India | Nov-Dec 2014 | Vol 62 | Issue 6
Tripathi, et al.: Profile of head injury patients
the profile of patients of two and four wheeler vehicular accidents in terms of their demographic profile, injury pattern, injury severity, usage of safety constraints, incidence of drunk driving and outcome.
Materials and Methods This prospective study was conducted at Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, from 01 April, 2011 to 31 December, 2011. All the cases of traumatic head injury (THI) that is, drivers and the pillion riders of motorized two‑wheeled vehicles (TWVPs) and driver and co‑passenger of motorized four‑wheeled vehicles (FWVPs) were enrolled. Proper subset of cases and controls with or without helmet, seat belt and history of alcohol intake were compared. Injury severity was assessed by Glasgow coma scale (GCS). Patients were re‑assessed after 3‑month interval with Glasgow Outcome Score (GOS). Data was analyzed to evaluate the incidence, severity, and pattern of head injury and outcome of THI patients. Spearman ranked sum analysis and multivariate analysis were used to evaluate correlation and statistical significance among various factors.
two‑wheeler vehicles (TWVP) while 199 to four‑wheeler vehicles (FWVP). Demographic profile Among 1346 TWVPs, drivers significantly outnumbered pillion riders (5.76:1) [Figure 1a and b]. The median age of the drivers and pillion riders was 30 and 36 years, respectively. Of 199 FWVPs, maximum were co‑passengers that is, 1.34:1. Overall, the most commonly affected age group was 18‑29 years comprising 45.43% and 46.43%, respectively in TWVP and FWVP patients. The overall male:female patient ratio was 10.8:1 [Tables 1 and 2]. Table 1: Comparative analysis of injured patients among two‑ and four‑wheeler vehicular accidents Total no. of patients Driver Pillion rider/Co‑passenger Most commonly affected age group < 40: ≥40 age group
Two‑wheeler
Four‑wheeler
1346 1019 327 18‑29 years (46.43%) 2.08:1
199 85 114 18‑29 years (45.43%) 2.26:1
Table 2: Gender distribution among two‑and four‑wheeler vehicular accidents
Results
Two‑wheeler Male Female
Total 1545 patients of RTAs were admitted during the nine‑month period. Of these, 1346 patients belonged to
Driver Pillion rider/co‑passenger
a
b
c
d
961 190
58 137
Four‑wheeler Male Female 81 82
4 32
Figure 1: (a and b) Age group profile of male and female patients among two-wheeler vehicular accidents, (c and d) Age group profile of male and female patients among four-wheeler vehicular accidents (X axis, age in years; Y, Number of patients)
Neurology India | Nov-Dec 2014 | Vol 62 | Issue 6
611
Tripathi, et al.: Profile of head injury patients
Helmet usage rate Despite legislation and many public awareness programs, only 13.4% of all TWVPs (16.5% drivers and 3.7% pillion riders) were wearing helmet at the time of accident (P
