Analysis of Patients with Severe Trauma Caused by Motorcycle Accidents 1

Analysis of Patients with Severe Trauma Caused by Motorcycle Accidents 1 1 You In-Gyu, 2 Lim Chung Hwan, 3 Shim Jae Goo 1, First Author Dept of Health Care, Hanseo University, semicoma72@daum.net *2,Corresponding Author Dept of Health Care, Hanseo University, lch116@hanseo.ac.kr 3 Dept.of Health Care Hanseo University, jg.shim@samsung.com Abstract A study of the factors that influence the survival of motorcycle accident patients has been done by retrogressive analysis after classifying them into a survival group and a death group. The patients registered with severe trauma when they visited the emergency room at H Hospital in Kyunggido Province from October 21 through December 211. In the analysis of the severity, both RTS, which is evaluated with vital signs, and ISS, which is evaluated with anatomical injuries, have been measured. Demographic characteristics such as sex and age have been examined in regard to the accident time, injured locations, helmet use, and emergency room arrival time. The hemoglobin value has also been measured as a hematological test criterion. There were 32 patients in total with serious injuries from motorcycle accidents, out of which 18 (56.3%) survived and 14 (43.8%) died. The overall average age was 46.3 (±17.5), while those of the death group and surviving group were 5.9 (±16.1) and 42.6 (±2.29), respectively No difference was found between the surviving group and the death group in regard to accident time. There was no statistical difference in the survival group regarding arrival time at the emergency room The RTS (Revised Trauma Score) is statistically significant with 7.487 (±.75) in the survival group and 5.624 (±1.37) in the death group. The ISS (Injury Severity Score) is statistically significant with 17.83 (±2.66) in the survival group and 29.35 (±15.75) in the death group (p <.5). There were 12 surviving people (37.5%) and 4 dead people (12.5%) who wore helmets, showing that helmet use enhances the chances of survival substantially (p <.5). The mortality rate of the patients with brain injuries was over twice as much as those without brain injuries. The study of patients with severe trauma shows that RTS and ISS are significant, and it is suggested that institutional arrangement is necessary to minimize losses by reinforcing helmet use education and enforcement to reduce death from brain injuries. 1. Introduction Keywords: RTS, ISS, Motorcycle Motor vehicle accidents are the ninth largest cause of death according to the death toll statistics reported in 21 by the National Statistical Office. This is a great shift compared to 2, when motor vehicle accidents were the fourth largest cause of death. When looking at the death toll by age, it is the second largest cause of death for ages ten to nineteen and twenty to twenty nine, and the third largest for ages thirty to thirty-nine. For it largely happens among young and healthy people, it is a serious problem increases social cost and loss of human resource [1]. Motorcycle accidents are 4.8% of the total motor vehicle accidents, but the number of deaths caused is 434, or 7.9%, which is a relatively high fatality rate compared to accidents from other types of vehicles. The U.S. National Highway Traffic Safety Administration announced that motorcycle accidents in 27 had a 34-times larger possibility of death compared to other types of accidents [2]. There is only a vague assumption that most drivers and riders involved in motorcycle accidents would be severely injured or killed, and that head injury would be the largest part of the injuries. Automobile accident tolls draw interest from various institutions, and fairly accurate statistics are published each year. However, there is no accurate research on motorcycle accidents regarding number, type, and fatality. Previous research on motorcycle accidents were mostly about risk elements in accidents or classifications of the severity 1 This study was supported by the 212 University Research Support Project of Hanseo University Advances in information Sciences and Service Sciences(AISS) Volume5, Number15, October 213 158

level of the injured area [3-5]. Research on elements that affect the degrees of injury severity is not well known. The present study examines patients who have been classified with serious injury and were hospitalized in the A&E of H Hospital in Anyang, South Korea, which is designated as a 'Special Center for Serious Illness by Type'. The patients are analyzed based on a registered system of severity level decided by the Central Emergency Medical Center of Ministry of Health and Welfare, with aims of studying elements that affect the survival and damage mechanisms by comparing patient groups that survived and the group that died, and also to compare the severity and the injured areas in patients with serious injury between automobile accidents and those by motorcycle accidents. 2. Research Subjects and Method 2. 1. Research Subjects Seriously injured patients were considered from motorcycle accidents among those who were taken into the A&E and registered from October 21 to December 211 at H Hospital in Kyunggido, which is designated as a 'Special Center for Serious Illness by Type'. The patients were classified into a group that survived and another that died for a retrospective analysis, and electronic bicycle cases were excluded. 2. 2. Research Method Demographic factors considered were sex, age, time of accident, injured part of the body, helmet use, arrival time at the A&E, and hemoglobin level in a blood exam upon their arrival to the A&E. The accident occurrence time was grouped by season and class. For class, those who arrived during the hospital office hours were grouped as regular, and the others were grouped as emergencies. Brain damage, which is considered the most important in motorcycle accidents, was used for analysis of the injured regions. The Time and cause of death were collected from the motorcycle accident fatalities. RTS (Revised Trauma Score) and ISS (Injury Severity Score) were measured to analyze the level of severity. RTS is a method that evaluates the severity with physical symptoms and is calculated based on the Glasgow Coma Scale (GCS), Systolic Blood Pressure (SBP), and Respiration Rate (RR). RTS is used in deciding the severity level by physical symptoms, appropriate treatment, and prognosis. AIS (Abbreviated Injury Scale) indicates the severity level in each of six body regions for ISS, which evaluates the severity level by anatomical damage, and it selects AIS scores from three higher body regions among six body regions listed in order of severity level, and is evaluated with the square sum of AIS scores from the three regions. Currently, centers that run 'Special Centers for Serious Illness by Type feeds by AIS 25 Update 28 version, distributed by the Central Emergency Medical Center, classify an ISS score above 15 and RTS score below 7 as serious patients. 3. Result 3. 1. Classification by sex and age A total of 32 seriously injured patients from motorcycle accidents were considered, out of which 18 (56.3%) survived and 14 (43.8%) died. The average age of the total was 46.3 (±17.5), and the average was 5.9 (±16.1) in the death group and 42.6 (±2.29) in the surviving group. Analysis of the smaller age group shows that there were 11 (34.4%) young adults from age to 39 out of the total motorcycle accidents, 13 (4.6%) from 4 to 59, and 8 over age 6, showing a larger distribution in the middle age, among which many fatalities were distributed. Only one female survived a motorcycle accident, whereas 14 males died and 17 survived (Table 1). 3. 2. Analysis by injured region and helmet wear 159

Brain damage, which is known to be the main death cause of motorcycle accident patients, was analyzed. Measuring patients only with brain damage and those that include it as the same group opposed to those without brain damage showed that brain damage patients were 2 (62.5%) in total. Patients with brain damage had twice higher rate of death compared to patients without brain damage. Analysis on helmet wear showed that 12 (37.5%) survived and 4 (12.5%) died from motorcycle accident with helmet, giving fairly high survival rate while more persons died from accidents without helmet, which is statistically significant(p <.5). This indicates that helmet wear affects the survival of motorcycle accident serious injury patients (Table 1). Sex Table 1.. Characteristics of patients severely injured by motorcycle accidents Death Survivors p-value* Male Female Age (years) -39 4-59 6 older Distribution of the incident (quarter) 1 (Jan-Mar) 2 (Apr-June) 3 (July-Sep) 4 (Oct-Dec) Accident time Regular Emergency Injured region Brain damage Brain damage none Helmet wear Helmet use No helmet * Fisher exact test 14 (43.8) () 3 (9.4)_ 7 (21.9) 2 (6.3) 9 (28.1) 5 (15.6) 1 (31.3) 1 (31.2) 3. 3. Classification of time distribution and arrival time at A&E 17 (53.1) 1 (3.1) 8 (25.) 6 (18.8) 3 (9.4) 3 (9.4) 2 (6.3) 1 (31.3) 9 (28.1) 9 (28.1) 1 (31.3) 8 (25.) 12 (37.5) 6 (18.8) The accident time distribution of seriously injured patients by motorcycle accidents showed that the fourth period had 14 individuals (43.8%), which is the most frequent, and the fatalities were distributed evenly. Accident times from 6 a.m. to 6 p.m., the normal office hours of the hospital, were classified as regular, and the rest were classified as emergencies. No difference was found between the surviving group and the death group by accident time (Table 1). The arrival time at the A&E was 85.444 (±118.42) minutes in the surviving group, and 47.71 (±49.81) minutes in the death group, showing no statistical difference (Table 2). Table 2. Severity analysis of seriously injured patients in motorcycle accidents Death(N=14) Survivors(N=18) Mean SD p-value RTS ISS GCS SBP RR Hemoglobin ER arrival time 5.624 (±1.37) 29.357 (±15.75) 7.714 (±5.54) 111.428 (42.4) 97.786 (±19.28) 11. (±3.46) 47.7 (±49.81) 7.487 (±.75) 17.833 (±2.66) 13.944 (±2.51) 125.556 (±26.4) 86.278 (±2.66) 13.367 (±1.47) 85.444 (±118.42) 6.669 22.875 11.219 119.376 91.312 12.331 68.656 1.46 11.94 5.117 34.448 2.586 2.764 92.31..5..256.118.14.248 RTS: Revised Trauma Score ISS: Injury Severity Score.562.42.372.328.194.37 16

GCS: Glasgow Coma Scale SBP: Systolic Blood Pressure RR: Respiration Rate 3. 4. Severity Analysis and Hematological Analysis In the severity analysis of seriously injured patients in motorcycle accidents, the RTS evaluation of physical symptoms was 7.487 (±.75) in the surviving group, and 5.624 (±1.37) in the death group, which is statistically significant (p <.5). This indicates that the vitality of seriously injured patients is related to death. The ISS evaluation of hematological damage was 17.83 (±2.66) in the surviving group and 29.35 (±15.75) in the death group, which is statistically significant (p <.5). The hematological level based on the hemoglobin level was 13.36 (±1.47)g/dL in the surviving group and 11. (±3.46)g/dL in the death group, being lower in the death group but without statistically significance (Table 2). 3. 5. Analysis of Death Cause and Death Time Brain stem paralysis was observed in 7 out of 14 fatalities (5%), which is the largest cause of death in seriously injured patients in motorcycle accidents. 3 died from hypervolemic shock (21.4%), 3 died from multiple organ dysfunction (21.4%), and 1 died from multiple hemopneumothorax (7.2%). Classification by instant death (death in 6 minutes), early death (from an hour to 4 hours), and later death (death after 4 hours) showed that there was no instant death, but there were two early deaths by hypervolemic shock, one by multiple organ dysfunction, and one by multiple hemopneumothorax. There were seven later deaths by brain stem paralysis from brain damage, one by hypervolemic shock, and two by multiple organ dysfunction (Table 3). Table 3. Analysis of cause of death and death time Death in 6 minutes Within 1-4 hours of death Brain stem paralysis Hypervolemic shock 2 (14.3%) Multiple organ dysfunction 1 (7.1%) Multiple hemopneumothorax 1 (7.1%) Death after 4 hours 7 (5%) 1 (7.1%) 2 (14.3%) 4. Discussion Motor vehicle accidents cause great losses to nations and individuals. Accidents with the younger generation in particular incur great expense and time for treatment and rehabilitation, and their halt in activity increases losses. Motorcycle accidents are known to have higher severity compared to other motor vehicle accidents [6]. Various studies on motorcycle accidents have been published previously according to many elements such as motorcycle transportation rate, cultural background, driving habits, road conditions, and helmet wear, for different countries and areas. The studies on countries by their economic conditions and motorcycle transportation rates did not classify all patients related to motorcycle accidents. This means the research did not classify by major and minor injuries, but was included in the same range. Therefore, this research targeted only the patients who were registered as seriously injured patients. Serious injury is different from other illnesses, and failure to provide appropriate treatment in a short period time could lead to a permanent loss by death or after effects. In order to reduce the death rate of seriously injured patients, accident prevention must be a priority, but a medical system that provides fast and appropriate treatment after an accident must also be organized. A severity level test on injured patients is necessary to carry this out successfully. The RTS, ISS, and GCS severity level tests were proven to be statistically significant, and these should be indicators of emergency treatment performance level by injury centers or hospitals. 161

Unlike other motor vehicle accidents, motorcycle accidents expose most of the body regions to the accident, giving direct shock to the driver's body. The rate of death by head damage is high, and even slight damage can give severe injury to the driver [7]. Baker reported that the accident rate is high among the younger generation below the age of forty [8]. The present study on serious injury from motorcycle accidents showed a higher accident rate in the middle age group than the youth group, but it did not show a statistical difference. Zambon reported that the motorcycle accident rate is relatively high among men and those with low income [4]. The present study did not include an economic analysis or research by income level. The research by Nakahara showed that night driving is a danger factor, but the present study did not show any difference in frequency between night and day. The domestic motorcycle accident toll from 1992 to 29 shows that accidents are most frequent at the ages of 18 to 2 (16.%) and from 2 to 22 (14.2%), showing larger frequency at night, but this research showed a higher rate during the day time [9]. The research by Williams on the relationship between motorcycle accidents and alcohol shows that motorcycle accidents have higher relevance to alcohol compared to other types of motor vehicle accidents, in both the surviving group and in the death group [1]. The present research could not prove the relevance between motorcycle accidents and alcohol, since no data on drinking involved in motorcycle accidents was provided. Safety protection wear is one of the factors that affect the severity of motorcycle accidents. The research by Evans and Gabella also reported that helmet wear can reduce the death rate by 29% [11-12]. The present research also showed that 7 were killed by head injury. Therefore, stronger regulations on helmet wear when riding motorcycles would reduce the severity by head damage, and the death rate. The road traffic laws in South Korea have also required motorcycle drivers to wear safety helmets since 199, and violators are charged with penalties by law. Some studies report that the rate of use of protection wear in other countries that require helmets is about 9% [13]. South Korea should also employ an institutional strategy to increase the rate of helmet wear. The limits of this study are that the research results from one university hospital in a particular area are hard to generalize. Also, data on elements such as speed at accidents, road conditions, drinking influence, accompanying passengers, and economic status was not provided, and only the seriously injured patients were the target of the research. Therefore, research using a national database instead of data from one hospital would be helpful in generalizing the severity analysis, and danger factors that affect the severity. 5. Conclusions Seriously injured patients from motorcycle accidents generally have higher death rates and severity. The analysis on the severity of the surviving group and the death group showed that RTS and ISS were statistically significant, and an institutional strategy to minimize loss, by stronger enforcement of regulations and helmet wear education, is required in order to minimize brain damage by helmet wear. This study provides a basic resource for lowering the death rate of injured patients from motorcycle accidents to 1-2%, which is the rate of developed countries. 6. References [1] Korea National Statistical Office, Annual report on the cause of death ststistics, 21. [2] NHTAS, Fatal two-vehicle motorcycle crashes, 27. [3] Ankarath S, Giannoudis PV, Barlow I, Injury patterns associated with mortality following motorcycle crashes, Injury, vol. 33, no. 6, pp. 473-7, 22. [4] Zambon F, Hasselberg M, Socioeconomic difference and motorcycle injuries: age at risk and injury severity among young drivers. A Swedish nationwide cohort study, Accid Anal Prev, vol. 38, no. 6, pp. 1183-9, 26. [5] Nakahara S, Chadbunchachai W, Temporal distribution of motorcyclist injuries and risk of fatalities in relation to age, helmet use, and rid-ing while intoxicated in Khon Kaen, Thailand, Accid Anal Prev, vol. 37, no. 5, pp. 652-6, 25 162

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