Patterns of Injuries from Road Traffic Crashes

Abstract

Dear Editor,

Road traffic injuries (RTIs) remain a major public health problem in the world. RTIs are forecasted to become the seventh leading cause of mortality worldwide by the year 2030.[1] In 2016, RTIs were reported to cause approximately 1.35 million deaths and up to 50 million injured individuals.[2] It has further been observed that people suffering from RTIs have a variety of injury types.[3] This may be explained by the observation that the extent, severity, and impact of injury are mainly a product of the amount of energy, which is usually concentrated outside the band of human tolerance. The severity of injury has important implications in the delivery of health-care services. Measuring the characteristics of RTIs is crucial in efforts of identifying priorities for programs that aim at reducing injuries and their consequences.

Injury severity is described broadly as the impact of injury on the extent of tissue damage (the pathological evidence of trauma) and the physiological response of the body to that damage.[4] Initial estimates of the severity of nonfatal injuries have been based chiefly on the use of the health-care services, which include encounters with health-care systems, such as hospitalization, visits to emergency departments, and admissions to rehabilitation facilities. Some other metrics have been developed over time to more directly assess the characteristics of injuries. Patterns of RTIs are largely operationalized using injury severity scores. The scores can be anatomical scoring systems, physiological response scales, a combination of both or probability of survival scales.[3] The descriptions, merits, and limitations of these injury severity measurement scales are widely discussed in the literature.[4] In general, injury severity has different dimensions such as threat to life, threat to disability, injury burden, or cost. Historically, the focus in the literature has been on threat-to-life severity measures, thus giving them a sound foundation. Further, to obtain data for international comparisons, the most convenient choice is to use a measure of injury severity limited to the threat–to-life dimension, which can be derived from hospitalization data for most countries. Therefore, injury severity scores that focus on threat to life can be utilized as a universal indicator for the characteristics of RTIs.

A study in the USA found that only 3% of RTI patients had a serious injury.[5] Another study in the same country observed that serious injury to be 44 in every 100,000 person-years.[6] In the Netherlands, it is reported that three in every ten casualties had a serious severity.[7] In Yemen, 17% of road crash victims had severe injuries and needed admission.[8] Serious RTIs were minimal in Oman.[9] In Cameroon, a minority of RTIs was severe.[10] In Libya, over a quarter of RTIs were serious.[11]

In Kenya, one study reports that over half of road traffic crash victims admitted at a major referral hospital had serious injuries.[12] A second study in Nakuru County in Kenya examined the patterns of injury severity. A total of 141 road traffic crash victims were studied. The mean age of the patients was 35.17 (standard deviation = 13.12) years, with males being dominant. Most of the patients (63.8%) suffered from major trauma as assessed by the Abbreviated Injury Score of ≥3. Injuries of the extremities were most common, with 77% of the patients. A logistic model showed that only patients involved in collision crashes were at a higher risk of sustaining major injury (odds ratio = 2.40, 95% confidence interval = 1.02–5.65). The need to minimize major trauma partly through reducing the probability of the occurrence of collision type of crashes was thus apparent.

The available evidence on patterns of injury severity after road traffic crashes provides some understanding of the relative seriousness of injuries concerning the threat to life and resource utilization. The available literature suggests that the patterns of injury severity vary by region. This underscores the need to provide context-specific injury severity patterns after road traffic crashes.