poster102_headinjuries

8/8/2019 poster102_headinjuries

1/5

Head Injuries in Road Traffic Accidents.

Afaf Farghaly*, Roshdy El-Khayat1, Wafaa Awad , and Safaa GeorgeForensic Medicine and Clinical Toxicology, and Neurosurgery1 Departments, Facultyof Medicine, Assiut University, Assiut, Egypt.

Abstract:

Head Injury is recognized as a major public health problem and those due toroad traffic accidentsaccount for the great majority world wide. This study had beendesigned to evaluate the epidemiology of head injuries in road traffic accidentsamongtrauma patients attending Assiut University Hospitals. This is a prospective hospital

based study and was conducted in the Causality Department of Assiut UniversityHospitals during the period from April 2004 to April 2005. The incidence of headinjuries, age, sex and type of victims were evaluated. Radiological examinationGlasgow Coma Scale (GCS), Glasgow Outcome Scale (GOS) and the relation

between both Scales were investigated in cases of pure head injuries. Causes of death

were also determined.Key words: Epidemiology, Traffic, Accidents.

Introduction:

The World Health Organization in 1996 published research (Murray &Lopez,1996) estimating that in the rank order of leading causes of " years lost due todeath and disability", road accidents would change from being the 9 th leading cause inthe world in 1990 to the 3rd most major cause by 2020.

Developing countries bear the brunt of the fatalities and disabilities from roadtraffic crashes, accounting for more than 85% of the world's road fatalities and about

90% of the total disability adjusted life years(DALYs) lost due to road traffic injuries.The problem is increasing in these countries at a fast rate, while it is declining in allindustrialized nations(Odero, 2004).

About 10 percent of global road deaths in 1999 took place in Sub- SaharanAfrica where only 4 percent of global vehicles are registered. Conversely, in the entiredeveloped world, with 60 percent of all globally registered vehicles, only 14 percentof road deaths occurred (Jacop&Aeron-Thomas,2000). However, given the widelyrecognized problem of under reporting of road deaths in Africa, the true figures arelikely to be much higher.

The annual cost of road crashes is in excess of US$ 500 billion, and in thedeveloping world the estimated cost is about US$ 65 billion each year. A considerablewaste of scarce financial (and other) resources, typically costing between one and four

per cent of a country's gross national product per annum (Jacobes et al., 1999).

The Egyptian Ministry of Internal Affaires in March, 2001 reported that, 6%of accidents were due to roads and environmental conditions, 24% were due tovehicle transportation while the human factors represent about 70% of the causes ofaccidents (Eweas, 2001).

Head injury is recognized as a major health problem and those due to road

traffic accidents accounts for the great majority world wide. Motor vehicle accidents

1


2/5

represents 45 per cent of the causes of head injuries and occurs more frequently inyoung adults (Youngerman,2004).

Results:

The total number of head injured cases were 1331 out of 43,310 (total number

of trauma patients) with an incidence of 3.07%.Head injuries due to road trafficaccidents represented 60.9% (810 cases) . 35.8% of cases ( 290) were in age group of20-< 30 years, followed by the age group of 10-60 (4.9%) and


3/5

Patients with radiological findings (139) were classified according to GlasgowComa Scale (GCS) into: severe (GCS < 8), moderate (GCS 9-12) and mild (GCS 13-15) (Fig.5). They were also classified according to Glasgow Outcome Scale (GOS)into: recovered patients, patients with moderate disability, those with severe disability,vegetative state and death (Fig.6). The relation between GCS and GOS revealed that:

Complete recovery occurred in 93.7% of cases with GCS 13-15 while recovery was notrecorded among patients with GCS < 8. Death occurred in 66.6% of patients with GCS< 8 and 3.3% in GCS 9-12 (table1). Causes of death were evaluated and found to becirculatory failure, brain death, multiple organ failure, and other causes (Fig.7).

22.3%

Death

57.6%

Recovery

9.4%

Moderate

disability

3.6%

Severe

disability

7.2%

Vegeta-

tive

32%

Severe

22%

Moderate

46%

Mild

Figure (5):Distribution of victims of Figure (6): Distribution of victims ofhead injuries due to road traffic head injuries due to road traffic

accidents according to GCS. accidents according to GOS.

Table (1): Relation between GCSand GOS at discharge

8 9-12 13-15 TotalGCS

GOS

No % No

% No % No %

Recovery 0 0 20 66.7 60 93.7

80 57.6

Moderatedisability

2 4.5 7 23.3 4 5.3 13 9.4

Severe

disability

3 6.7 2 6.7 0 0 5 3.6

Vegeta-tive

10 22.2 0 0 0 0 10 7.2

Death 30 66.6 1 3.3 0 0 31 22.3

16.13%

Circulatory

failure

32.26%

Brain death

35.58%

Multiple

organfailure

16.03%

Other

causes

Figure (7): Causes of deathamong victims of head injuries

due to road traffic accidents.

Discussion:

The road traffic accidents have become "the most serious problems facing thiscentury whether measured in dollar costs, physician contacts, deaths or loss of

productive years of life. In this study epidemiology of head injuries in road traffic

3


4/5

accidents among trauma patients attending Assiut university Hospitals during theperiod from April 2004 to April 2005 had been evaluated.

The incidence of head injuries is found to be 3. 07%. The annual incidence ofhead injuries in the United States had been estimated to be 0.18%to 0.22% (Bazarian et

al.,2005).The incidence of head injuries in USA is ascribed to the whole population andso it appears to be small in comparison with incidence in the present study where it isascribed to trauma patients attending Assiut University Hospitals. Road trafficaccidents constituted the main cause of head injuries as they represented 60.9%, whichis more than that recorded by Marcus (2003)who found that road traffic accidentsaccount for 40 to 50% of all head injuries. In spite of this, the incidence of head injuriesand the road traffic accidents as a main cause are considered low when we know thatmany patients with mild head injuries may not attend the hospitals and those of severehead injuries associated with death at the scene of accident or during transportation tothe hospital were not accounted in data collection for epidemiological studies of headinjuries. Male to female ratio of head injured patients is found to be 6:1, which is a high

ratio in comparison with other studies e.g. men have about twice as many head injuriesas women in the study of Youngerman (2004).This can be explained by the fact that

ales a

nd supervision of children and elderly by theirrelatives. The same was reported by smith (2004) who stated that head injury is most

Deigo that 62% of head injuries were to occupants of vehicles. The higher percentage of pedestrians in this study may be attributed to failure of controlling and

e due to type of head injuries included in the currentwith positive radiological findings). GOS is assessed in relation to GCSresults revealed that prediction of outcome from GCS must put in

m re exposed more to trauma during driving or travailing (the most common causeof head injuries).

The peak percentage of head injuries among patients of road traffic accidents isfound in patients aged from 20 to


5/5

5

3 of them had only lacerated wounds in the scalp,

nts revealed radiological findings. The victims of pure head injuries dueaccidents were classified according to GCS and GOS and the relation

ty R : Finalot.gov/

pidemiol Feb; vol.119 (2): 186-201.

ain

Critical Care. J. Neurotrauma Nov; vol. 13(11): 641- 734.

. Neurosurg; vol. 75: 37-49.

-Youngerman S. (2004): Head injury, Age 4 and older. J. Neurosurgery Sep; vol.100(3): 381-385.

hospital based study the incidence of head injuries was found to be 3.07%. 60.9% ofhead injuries was due to road traffic accidents. The highest incidence was in the agegroup of 20-

poster102_headinjuries

Documents