RESEARCH ARTICLES

Profile of trauma victims from motorcycle accidents assisted in a public hospital

Lorena Sousa Soares^I; Diêgo Afonso Cardoso Macêdo de Sousa^II; Ana Larissa Gomes Machado^III; Grazielle Roberta Freitas da Silva^IV

^I Nurse. MSc. in Nursing. Lecturer, Nursing course (Amílcar Ferreira Sobral Campus) – Federal University of Piauí (Universidade Federal do Piauí - UFPI). Floriano, Piauí, Brazil. E-mail: lorenacacaux@hotmail.com
^II Nurse, Northern Regional Hospital (Hospital Regional Norte). Emergency Care Resident. Sobral, Ceará, Brazil. E-mail: diegoacms@hotmail.com
^III Nurse. MSc. in Clinical Care. Lecturer, Nursing course (Campus Sen. Helvídio Nunes Barros) – UFPI. Picos, Piauí, Brazil. E-mail: analarissa2001@yahoo.com.br
^IV Nurse. PhD in Nursing. Lecturer, Postgraduate degree - MSc. in Nursing, UFPI. Teresina, Piauí, Brazil. E-mail: grazielle_roberta@yahoo.com.br

DOI: http://dx.doi.org/10.12957/reuerj.2015.15599

ABSTRACT

This study aims primarily at delineating the profile of trauma victims from motorcycle accidents. This is a quantitative and descriptive study, conducted at an emergency department in the city of Picos, PI, Brazil. Data was collected from November, 2010 to May, 2011, out of the application of a tool. The population consisted of 80 victims. Results showed a predominance of males, with 71 (88.8%) cases, 43 (53.8%) were single, and 44 (55%) had no monthly income. Accident occurrence figures show that 20 (25%) were on Saturday, 60 (75%) in day time, and 35 (43.8%) on the way home. According to accident risk variables, most victims had no driver’s license and did not wear helmets. Conclusions show that nursing can conduct programs for prevention and health promotion to minimize the consequences for individuals and for society.

Keywords: Traffic accidents; motorcycle; epidemiology; emergency relief.

INTRODUCTION

Traffic accidents accounted for more than 1.2 million deaths and caused injuries to 20 to 50 million people in 2010. They are the 11^th cause of death and the 9^th cause of sequelae among the general population and are even the leading cause of death among the population from 5 to 44 years of age. This trend is alarming, and traffic accidents are estimated to become the 5^th leading cause of death by 2030. The most vulnerable groups are pedestrians, cyclists and motorcyclists, and more than 90% of deaths from traffic accidents occur in low- and medium-development countries, which total 48% of the vehicle fleet and 2/3 of the world's population¹.

A total of 333 accidents occurred in Picos, the study city, in 2009, causing 51 deaths and injuring 253 people. Furthermore, the rate of fatalities/10,000 vehicles in the state of Piauí (PI) was 10.8, far above the national average of 0.1^2,3.

The number of motorcycles per thousand inhabitants increased from 69.6 to 128.1 (84%) in the period from 1998 to 2010 in the city of Londrina (state of Paraná, PR). The 3,968 victims recorded in 2010 accounted for a 151.8% increase compared to 1998 (1,576). The rate of injured motorcyclists per thousand inhabitants nearly doubled (from 396.4 to 783.1). The number of victims per thousand motorcycles also increased, albeit to a lesser extent (53.1 to 61.1), indicating that this situation is a national issue⁴.

Picos shows heavy traffic and poor organisation thereof, which greatly affects the city dynamics because it is a leading Brazilian road junction, the third largest city in the State of Piauí and the headquarters of a macro-region consisting of 42 cities.

Accordingly, this study primarily aimed to characterise the trauma victims of motorcycle accidents treated at a public hospital.

LITERATURE REVIEW

Brazil is currently experiencing an epidemic of motorcycle accidents, which has caused an increase in the number of motorcycle accident victims treated. A total of 145,920 hospitalisations of traffic accident victims were financed by the Unified Health System (Sistema Único de Saúde, SUS) in 2010, with a cost of approximately BRL 187 million. The dynamics of that phenomenon, with multifactorial causes, affects its victims with different degrees of severity depending on the type of accident (run-over, motorcycle accident and accidents with other types of motor vehicles) and the demographic features (gender, age, ethnicity, marital status and educational level)^2,5.

The country has a motorised fleet of 66,116,077 vehicles, including 26% motorcycles, scooters and mopeds. The highest concentration occurs in the South and Southeast Regions, which contain 60% of the motorcycles circulating in the country, and the Southeast region accounts for nearly half the hospitalisations from accidents involving this type of vehicle (44.9%). The rates of automobiles and motorcycles are virtually similar in the Northeast region (43% automobiles and 41% motorcycles), and the rate of motorcycles (45%) already surpasses the rate of automobiles (36%) in the North region³.

Brazil ranks fifth worldwide among the record holders in traffic deaths, behind India, China, the United States and Russia, according to the Global status report on road safety, published in 2009. Currently, trauma is one of the most important and significant social problems. Deaths from heart disease or cancer decrease the life expectancy of citizens by 10 to 15 years on average, whilst deaths from trauma shortens highly productive lives by 30 to 40 years because the issue primarily affects young people².

METHODOLOGY

This cross-sectional analytical study employed a quantitative approach and was conducted in an emergency department located in the municipality of Picos (PI). This study site was chosen because it is the only reference hospital for urgent and emergent care of the macro-region of Picos and is the University Hospital in which the principal investigator conducted her lectures.

The research subjects were the motorcycle accident victims who were necessarily admitted to the above hospital at the time of data collection. Thus, the sample totalled 80 motorcycle accident victims, defined according to the equation for finite-population sample size calculation, with data collected in November 2010 and February, April and May 2011.

Data collection was performed by applying a previously developed individual instrument containing variables such as gender, age, education level, motorcyclist activity during the accident, first responders, geographical location of the occurrence, prevalent time of the day, category (with driver's license or not), injuries, alcohol abuse and helmet use. It is noteworthy that the instrument was previously tested to assess its objectivity and relevance regarding the proposed objectives.

The data were tabulated using the software Statistical Package for the Social Sciences (SPSS) version 17.0, which was also used for data treatment, and the data analysis was performed using descriptive and analytical statistics.

Considering that this study involved humans, all ethical principles were followed, and the project was approved by the Research Ethics Committee of the Federal University of Piauí (Universidade Federal do Piauí, UFPI) under protocol 0270.0.045.000-10.

RESULTS AND DISCUSSION

Socioeconomic data, grouping the surveyed individuals according to gender, age group, education level, marital status, monthly income and origin, are outlined in Table 1.

Analysis of the results regarding gender revealed that 71 of the 80 sample participants (88.7%) were male and 9 (11.2%) female. Furthermore, the predominant age groups of the study sample corresponded to accident victims aged from 18 to 29 years, with a percentage of 40.0%.

The results showed that 32 (40.0%) respondents had incomplete primary education, 16 (20%) said they were illiterate, and only 3 (3.5%) had completed higher education. Regarding the marital status, the participants were predominantly single (43 [53.5%]), corresponding to approximately half the sample, which is related to the fact that most victims of this type of accident are young people.

Regarding the socioeconomic status, half of the accident victims (44 patients) had no monthly income, accounting for 55% of the sample, followed by those receiving one and two times the minimum wage per month, with 25 (31.2%) cases, and then by participants earning less than one minimum wage per month, with 8 (10.0%) cases. Only 3 (3.7%) victims earned more than three minimum wages per month, corresponding to the three individuals with higher education.

The analysis regarding the accident circumstances and their effects on the occurrence and complications from the accidents also indicated that 54 (67.5%) participants were not from Picos, but rather from its macro-region – only 32.5%, corresponding to 26 subjects, were from Picos. Regarding the geographical location of the accidents, 57 (71.2%) accidents occurred in cities of the Picos macro-region, and only 23 (28.7%) occurred in the municipality of Picos.

The day of the week with the highest incidence of accidents among respondents was Saturday, with 20 (25%), followed by Sunday, with 15 (18.7%); Tuesday, with 13 (16.2%); and Monday, with 12 (15.0%), which indicates that most accidents occurred on weekends.

Regarding the period in which the accidents occurred, accidents were more prevalent in the morning and afternoon, both with 30 (37.5%) cases, closely followed by the evening, with 20 (25%) cases. As for the time of the accident, most accidents, 29 (36.2%), occurred from noon to 6 pm, whereas the lowest number of accidents, 11 (13.7%), occurred in the time period from midnight to 6 am.

According to the data analysed, the motorcycle accident victims were mostly helped by people present at the time of the accident, with 44 (55%) cases, followed by accident victims rescued by the Emergency Ambulance Service (Serviço de Atendimento Móvel de Urgência, SAMU), with 17 (21.2%) cases.

At the time of the accident, a total of 35 (43.7%) motorcyclists were driving home, and 26 (32.5%) were riding for leisure. Based on the data described above, including period of the day and time of the accident, most motorcyclists may have been using their motorcycle as a work vehicle. Regarding the subjects, 67 (83.7%) cases were motorcycle drivers, and only 2 (2.5%) accident victims were hit by a motorcycle.

The accident risk factors are outlined in Table 2 and show that simple safety measures may decrease the occurrence thereof.

TABLE 2: Distribution of patients who were motorcycle accident victims according to the accident risk variables. Picos (PI), 2011 (N=80)

Most accident victims had no driver's license (Carteira Nacional de Habilitação, CNH); 57 (71.2%) used no helmet at the time of the accident, and only 21 (26.2%) used a helmet. These data are worrisome because the use of a helmet is a mandatory requirement to ride motorcycles, both for drivers and passengers. It is worth noting that 2 (2.5%) accident victims were not using a helmet because they were hit by motorcycles. Furthermore, regarding the blood alcohol levels at the time of the accident, 55 (68.7%) accident victims say they had consumed no type of alcohol whatsoever; 25 (31.2%) reported having consumed some amount of alcohol.

The rates regarding the number of accidents the motorcyclist had already experienced were very similar: 57.5% of participants said this occurrence was their first accident, and 34 (42.5%) reported having already experienced another type of motorcycle accident, regardless of severity.

For almost all accident victims, the sequelae were temporary; only 3 (3.7%) showed permanent sequelae, corresponding to the percentage of patients with medical diagnoses of Traumatic Brain Injury (TBI) and reduced neurological levels. It is noteworthy that this analysis was performed at the time of the interview and that it is possible that patients subsequently progressed to irreversible clinical conditions, leading to permanent sequelae.

Lower limbs (LLs) corresponded to approximately half (45 [56.2%]) of the injured body parts; 17 (33.7%) respondents had injuries in their upper limbs (ULs), with only 3 (3.7%) reporting head injuries. Half of the study group had injuries on the left side, showing a possible predisposition for injuries in that side, as shown in Table 3.

TABLE 3: Distribution of patients who were motorcycle victim accidents according to the main sequelae and their anatomic location. Picos (PI), 2011. (N=80)

The vast majority of injuries were fractures, followed by 7 (7.7%) abrasions. This finding is explained by the fact that the study hospital treats most patients referred for orthopaedic surgery because patients with greater complications, including TBI and cervical trauma, are referred to the reference hospital in Teresina (PI), the State's capital.

The study sample consisted of 80 motorcycle accident victims, admitted to the surgical ward of a hospital in the city of Picos - PI, including 71 (88.7%) men. The predominance of males in studies involving motorcycle accidents is striking and ranges from 75.4% to 96%^4-9. However, a significant increase in the ratio of female victims has been observed^4,6.

In regards to the age group, 40.0% of victims were aged from 18 to 29 years, and 30% were included in the age group from 30 to 39 years. Several Brazilian studies report that approximately 70% of traffic accident victims are aged between 10 to 39 years and therefore belong to the age group of adolescents and young adults^4,10.

Several behavioural theories propose some explanatory hypotheses for the fact that young people are involved in a greater number of accidents, including inexperience, lack of a driver's license and driving skills, and difficulty in perceiving danger and solving problems. There is also a strong behavioural tendency among young motorcyclists for judging the risk of driving the vehicle optimistically, which is related to certain individual characteristics, including age, gender and their life experiences. Other causes include a greater tendency to drive over the speed limit, peer pressure, challenge- and thrill-seeking, lack of familiarity with traffic laws and driving skills, driving under the influence of alcohol and/or drugs, impulsiveness and abuse ⁶.

Regarding education level, only 3 (3.7%) accident victims had a higher education, 32 (40%) only had incomplete primary education, and 16 (20%) could not read/write. These findings are similar to other studies, wherein most victims had an education level not exceeding secondary education^8,9.

In regards to monthly income, 44 (55%) victims had no monthly income, and 25 (31.2%) had a monthly income ranging from 1 to 2 times the minimum wage. Unlike the findings from the present study, other authors noted that 42% of accident victims had a monthly income of approximately 1 to 2 minimum wages, and 2% reported earning 7 to 8 times the minimum wage^11,12. The low education level of motorcycle accident victims (40% of them only had incomplete primary education) may be related to the low incomes found in this study.

The privileged location of Picos has promoted its position as a hub city, absorbing workers from surrounding municipalities, wherein the economic response and job opportunities are scarce. Therefore, although 54 (67.5%) accident victims were originally from the Picos macro-region, they sought specialised care in the municipality because it is not only an economic hub but also a healthcare centre where the reference hospital in the region for meeting such demand is located.

Some agreement regarding the occurrence of accidents on weekends has been recorded among researchers. Thus, evidence from Brazilian studies has shown that nonfatal motorcycle accident victims were more frequent in accidents occurring on Fridays and Saturdays, and fatal victims mostly resulted from accidents on Saturdays and Sundays^4,6. The severity and incidence of accidents rises in the evenings and on weekends, which is related to the amount of free-flowing traffic without congestion and driving under the influence of alcohol resulting from the known devastating effect of combining alcoholic beverages and high speeds⁵.

Another study analysing the characteristics of accidents regarding the day of the week of their occurrence observed a rise in the number of victims from Fridays, with a greater concentration on Saturdays, in all years, relating this fact with possible alcoholic beverage consumption, which is more common on these days of the week¹¹. These findings were not confirmed in the present study because, although 43.7% of accidents occurred on Saturdays and Sundays, 25 (31.2%) accidents occurred on Mondays and Tuesdays.

Regarding the period of the day when the accidents occurred, 30 (37.5%) accidents occurred in the morning, the same frequency of accidents was observed in the afternoon, and only 20 (25%) accidents occurred during the evening, similar to a study conducted in Rio Branco (Acre, AC)¹². These findings contrast the findings from other authors, who recorded a small rise in the number of accidents in the evening period compared to daytime accidents ^6,9. The increased occurrence of morning and afternoon accidents presumably results from work-related accidents because they occurred from 6 am - 12 pm (26.2%) and from 12 pm - 6 pm (36.2%), i.e., the commuting hours.

The accumulation of fatigue, climatic effects, requirements, pressures and demands, anxiety and concerns wear on individuals' physical and mental states as the hours go by. Both situations observed regarding the time periods and days of the week during which accidents preferentially occur indicate a surveillance strategy incompatible with business hours only, a finding that has been corroborated by several other studies; a traffic monitoring strategy intended to curb abuses and to effectively reduce accidents must necessarily extend to the night-time and weekends, thus covering all circumstances relating to accidents⁶.

According to the data, half of the victims were assisted by bystanders and lay people, and only 17 (21.2%) were rescued by the SAMU. A study conducted in the state of Ceará also revealed the shortage of specialised services for the care and rescue of victims¹⁰. Although firemen and ambulances equipped for emergency medical care provide assistance at the accident sites, these services are present only in the capital and in some reference cities. This situation is similar to what occurs in Picos, wherein only the municipality has SAMU because its macro-region has no emergency ambulance service available.

Initial care with primary assessment, stabilisation and transport of traffic accident victims to the best reference centre to continue providing emergency care minimises the occurrence of injuries resulting from inefficient care at the site. Furthermore, this type of initial care generates information to improve the most effective public policies regarding the measures of disease/accident prevention, awareness, protection, health recovery and rehabilitation of individuals. Therefore, the need for devoting more attention to Prehospital Care in an attempt to minimise the morbidity and mortality in trauma care has become globally consensual¹³.

Only 8 (10%) subjects had driver's licenses for motorcycles; such a prerequisite was not applicable to 13 (16.2%) subjects because they were either passengers or hit by motorcycles and mostly had no driver's licenses (CNH). However, a study conducted in the state of Ceará concluded that high rates of drivers without licenses prevail in cities within the state, primarily resulting from the lack of local surveillance and the difficulty involved in getting a driver's license⁹. This reality is similar to that of the state of Piauí.

The data showed that 21 (26.2%) victims used a helmet. Such use was not applicable to 2 (2.5%) because they were hit by motorcycles, and 57 (71.3%) motorcyclists used no helmet at the time of the accident. A gradual increase in the prevalence of helmet use has been observed compared to previous years, despite the high amount of information ignored⁴. The protection that helmets give to motorcycle users is demonstrated in the literature, which may reduce the mortality rates by motorcycle traffic accidents by up to 42% and the risk of TBI by more than 69%. A total of 40% of the 178 countries analysed in the World report on road traffic injury prevention had laws on motorcycle helmets, which included drivers and passengers. The importance of standardisation and regulation of the use of helmets effective in protecting the brain area and their correct adjustment and strapping is also noteworthy.

As for the consumption of alcoholic beverages, other studies on alcohol consumption concluded that 141 (32.8%)⁹ and 120 (39.2%)¹⁰ were driving under the influence of alcohol, while 289 (68.2%)⁹ and 186 (60.8%)¹⁰ were not drunk at the time of the accident. These findings are similar to the present study, wherein 25 (31.2%) victims were driving under the influence of alcohol, while 55 (68.7%) had not consumed alcohol.

Analysis of the results related to previous history of accidents indicated that 34 (42.5%) subjects had already been victims of other motorcycle accidents, regardless of injury severity, data that differ from those of another study, wherein only one-quarter of respondents had already suffered motorcycle accidents⁸. However, the authors of other studies observed that 51% of motorcyclists had already been involved in more than one motorcycle accident and that drivers who had their driver's licenses for less than five years had a higher risk for death from traffic accidents^5,14.

The occurrence of sequelae was observed for all body parts examined in the study. Among the sample of 80 patients, 77 (96.2%) had temporary sequelae, and 3 (3.7%) permanent sequelae. The severity of economic and social losses that traffic accidents represent for society is inferred, especially considering the predominant age group of young adults with sequelae. These data are similar to findings from another study, wherein 49.5% of accident victims had sequelae, with 80.7% corresponding to temporary sequelae and 19.2% to permanent sequelae^6,10.

Studies profiling motorcycle accident victims regarding the injured body area have shown that the limbs are one of the most affected body parts in more than half the victims and that the LLs are the most severely and commonly affected body area^9,13,15. These data are similar to the findings from the present study, wherein 45 (56.2%) injuries occurred in the LLs and 27 (33.7%) in the ULs, given that they are the most unprotected areas. However, in another study, the head was the most affected body part (30.0%), followed by the LLs (26.8%) and the ULs (19.0%)¹⁶.

Motorcycle drivers comprise the group most commonly involved in motor vehicle accidents and suffering the most serious injuries. This fact is related to their greater vulnerability, given the lack of a physical vehicular structure able to protect drivers from strong impacts, which renders them more likely to be projected and run over^6,17,18. Motorcycles are associated with serious risks and are an increasing concern in large cities. The demand for this type of vehicle grows given the increasingly heavy traffic and low cost of acquisition and maintenance. However, it should also be noted that they are currently used as a great work tool by motorcycle couriers, especially in large urban centers^6,17.

CONCLUSION

The main study goal was reached, that is, the profile of trauma victims was characterised. Furthermore, nursing plays a key role in that context, especially regarding the implementation of accident prevention and health promotion programmes for victims, thereby minimising the numbers of occurrences and consequences for individuals and society. Furthermore, a quality information system is another key factor to consider because such a system will provide essential information to support research in the area, to implement policies and prevention and health promotion strategies, and to evaluate the measures taken.

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