Characterization of Road Traffic Injuries at Hospital Traumatológico Ney Arias Lora in Santo Domingo, Dominican Republic

BACKGROUND: 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.