UT Southwestern Electronic Theses and Dissertations
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Browsing UT Southwestern Electronic Theses and Dissertations by Subject "Accidents, Traffic"
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Item Characterization of Road Traffic Injuries at Hospital Traumatológico Ney Arias Lora in Santo Domingo, Dominican Republic(2020-03-16) Walsh, Maura Siobhan; Chang, Mary; Abdelnaby, Abier; Nwariaku, FiemuBACKGROUND: Over 1.35 million people die each year due to road traffic accidents (RTAs), and up to 50 million more sustain non-fatal injuries. They are the eighth leading cause of death worldwide, and the primary cause of death in young people between the ages of 15 and 29. Our study focused on RTAs in the second largest trauma hospital in the capital city of the Dominican Republic, Santo Domingo. The country currently claims the fifth spot globally for deaths due to road traffic accidents per capita, and is second globally for fatalities due to motorcycle accidents. OBJECTIVE: The objective of this study is to gather pertinent information about RTAs suffered by 362 patients admitted to Hospital Traumatológico Ney Arias Lora (HTNAL) to then inform interventions to decrease RTAs and the severity of their resulting injuries. METHODS: This study involves an analysis of several factors of RTAs suffered by patients admitted to HTNAL. These include gender, age, rural or urban location, the kind of vehicle, the number of passengers per vehicle; whether the patient was a driver, passenger, or pedestrian; the kinematics of the accident, the use and/or availability of 911, the distance from the hospital, time of day, the influence of alcohol, the use of a helmet or seatbelt, length of stay in the hospital, the kind of injury, the severity of the injury, and resulting permanent disability or death. Inclusion criteria were any patient admitted after sustaining injuries in a motor vehicle accident. There were no exclusion criteria. Researchers performed a retrospective paper chart review on 120 charts from 2013-2014, before the institution of a 911 system, and 125 charts from the beginning of 2017, after a 911 system had been in place for over two years. Due to lack of much of the data from the aforementioned list of factors within the charts, researchers also interviewed 117 patients and/or their family members who were admitted to HTNAL during July 2017. Verbal consent was obtained prior to each interview. RESULTS: Of the 362 patients included in this study, 85.4% were male and 14.6% were female. The mortality rate was 11.3% for males and 7.5% for females, for an overall rate of 10.8%. 12.9% of motorcyclists died in the hospital, compared with 2.9% of automobile occupants and 4.3% of pedestrians. Over half of the patients were involved in a traffic accident in Santo Domingo (52.3%). The average distance travelled for patients who were referred to HTNAL was 90.1 km. The highest frequency of accidents per hour occurred during evening rush hour on weekdays. The overwhelming majority of admitted patients were driving or riding a moto (two-wheel vehicles, such as motorcycles and mopeds), and this trend was more evident among males (81.7% of males, 49% of females). Only 21.8% of motorcyclists were recorded wearing a helmet, and none of the helmet users in this study died. The most common injury among motorcyclists was definite moderate/severe traumatic brain injuries (39.1%). Non-helmet users were 4.6 times more likely to suffer a TBI than those who did (95% CI: [1.4, 15.4]), and patients who suffered a definite moderate/severe traumatic brain injury were 11.6 times more likely to die than those who did not (OR = 11.6, 95%CI: (4.73, 28.22)). CONCLUSION: Death due to motor vehicle accidents is a public health crisis in the Dominican Republic. The root of this problem is multifactorial, as are the solutions. In this study, all of the deaths from motorcycle accidents were secondary to TBI in non-helmet users. This highlights one solution that could have a large effect on survivability after accidents--proper helmet usage. This could be done through public health campaigns, more rigorous enforcement of helmet laws, and programs to distribute helmets. Other possible solutions include improving data systems such as trauma registries and medical charting, continual assessment of road quality and identification of hotspots for accidents, and QI evaluations of pre-hospital care and trauma protocols.Item Epidemiology of Traumatic Brain Injuries at a Major Government Hospital in Cambodia(2017-03-02) Peeters, Sophie Monique; Mihalic, Angela; Madden, Christopher; Gatson, JoshuaBACKGROUND: Traumatic brain injury (TBI) is a critical public health problem worldwide with a significant socioeconomic burden. While improved safety regulations in high-income countries have resulted in a decline in traffic-related TBI, the incidence of TBI in low-income countries is on the rise. We illustrate the trends and factors involved in TBI in a large Cambodian governmental hospital in Phnom Penh. Additionally, suggestions for improvement of the country's road traffic safety are discussed. METHODS: This is a cross-sectional study of all patients who presented with traumatic brain injury to Department of Neurosurgery at Preah Kossamak Hospital in Phnom Penh, Cambodia between November 2013 and March 2016. RESULTS: Traumatic brain injuries in Cambodia are on the rise. 34% occur during rush hour, 5 to 9pm, and 40% during the weekend. The vast majority (74%) is due to road traffic accidents, of which 81% are motorcycle related. Helmet wear remains low at 13% and recent alcohol use was reported as 38%. The most common diagnosis is skull fracture. The subdural to epidural hematoma ratio was 1:1.05. Lastly, in both subdural and epidural hematomas the frontal lobe was most commonly involved, with 60% of epidural hematomas associated with a lucid interval. CONCLUSIONS: Our study suggests prevention and management of TBIs can have a measurable public health impact in Cambodia. Initiative examples include helmet safety awareness campaigns, stricter penalties, improvement of pre-hospital care, and more efficient triage. High proportion of un-helmeted motorcycle accidents correlates with a rise in epidural hematomas.