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Berlet LJ, Ascari RA, Silva OM da et al. Profile of the victims of motorcycle accidents...

English/PortugueseJ Nurs UFPE on line., Recife, 8(7):2004-12, July., 2014 2004

ISSN: 1981-8963 DOI: 10.5205/reuol.5963-51246-1-RV.0807201423

PROFILE OF THE VICTIMS OF MOTORCYCLE ACCIDENTS ADMITTED IN THEINTENSIVE THERAPY UNIT IN A PUBLIC HOSPITAL

PERFIL DAS VTIMAS DE ACIDENTES MOTOCICLSTICOS ADMITIDAS NAS TERAPIAS

INTENSIVAS DE UM HOSPITAL PBLICOPERFIL DE LAS VCTIMAS DE ACCIDENTES DE MOTOCICLETA INGRESADAS EN LAS TERAPIAS

INTENSIVAS DE UN HOSPITAL PBLICOShirley da Luz Gomes1, Yara Antunes dos Santos2, Sandra Beatriz Pedra Branca Dourado3,Danieli Maria Matias

Colho4, Maria ElieteBatista Moura5

ABSTRACTObjective: to describe the epidemiological profile of motorcycle accident victims admitted in the intensivecare unit in a public hospital. Method: this was anepidemiological and analytical study with a quantitativeapproach that included 86 charts from patients hospitalized in the ICUat the Neuro and General sectors in anurgent care facility in Teresina-PI. The data were tabulated in the Statistical software Social Package for theSocial Sciences -SPSS, version 18.0 for Windows. The study was initiated following approval by the EthicsCommittee,protocol No. 11984/04/2012. Results: 88.4% of the victimsare men, 38.4% of these were single,

with ages ranging from 15 to 25 years; 24.4% had middle school education level. Regarding the use of helmets,94% of the records did not have information about its use at the time of the accident. Conclusion: motorcycleaccidents constitute an undeniable serious public health problem and indicate the need for the planning ofeducational and preventive actions. Descriptors: Traffic Accidents; Prevention of Accidents; Epidemiology.

RESUMOObjetivo: descrever o perfil epidemiolgico das vtimas de acidentes motociclsticos admitidas nas unidadesde terapia intensiva de um hospital pblico. Mtodo: estudo epidemiolgico e analtico de abordagemquantitativa com amostra de 86 pronturiosdos pacientes internados nas UTIs da Neuro e Geral de um hospitalde urgncias em Teresina-PI. Os dados foram tabulados no Programa estatstico Social Package for the SocialSciences(SPSS), verso 18.0 for Windows. A pesquisa foi iniciada aps a aprovao do projeto de pesquisa noComit de tica, parecer n 11984/04/2012. Resultados: 88,4% das vtimas eram homens, destes, 38,4% eramsolteiros, com faixa etria dos 15 aos 25 anos; 24,4% possuam nvel de escolaridade fundamental. Quanto aouso do capacete, em 94% dos pronturios catalogados no havia informao sobre o uso do equipamentomomento do acidente.Concluso: inegavelmente os acidentes motociclsticos constituem-se um graveproblema de sade pblica e h necessidade de planejamento de aes educativas e preventivas.Descritores:Acidentes de Trnsito; Preveno de Acidentes; Epidemiologia.

RESUMENObjetivo: describir el perfil epidemiolgico de las vctimas de accidente de motocicleta ingresadas en lasunidades de terapia intensiva de un hospital pblico. Metodologa:estudio epidemiolgico y analtico, conabordaje cuantitativo, con una muestra de 86 historias clnicas de pacientes ingresados en las UTI deNeurologa y General de un hospital de urgencia en Teresina-PI. Los datos fueron ordenados en el Programaestadstico Social Package for the Social Sciences (SPSS), versin 18.0 for Windows. La investigacin se inicidespus de la aprobacin del proyecto de investigacin por el Comit de tica, n 11984/04/2012.Resultados:un 88,4% de las vctimas eran hombres, de estos, un 38,4% estaban solteros, de la franja etariaentre los 15 y los 25 aos; un 24,4% tenan la educacin bsica. Respecto al uso de casco, y un 94% de los

histricos mdicos no haba informacin sobre el uso del elemento de proteccin al momento del accidente.Conclusin:no se puede negar que los accidentes de motocicleta son un grave problema para la salud pblicay que es necesario planear acciones educativas preventivas. Descriptores:Accidentes de Trnsito; Prevencinde Accidentes; Epidemiologa.1Egress RN, Unified Teaching Center in Teresina/CEUT. Teresina (PI), Brazil. E-mail: [email protected]; 2Egress RN, UnifiedTeaching Center in Teresina/CEUT. Teresina (PI), Brazil. E-mail: [email protected]; 3RN, Professor, Master in Genetics andToxicology, Unified Teaching Center in Teresina/CEUT. Teresina (PI), Brazil. E-mail:[email protected]; 4RN, Professor Master inSciences and Health, Unified Teaching Center in Teresina/CEUT. Teresina (PI), Brazil. E-mail: [email protected]; 5RN,Professor,Post-doctorate, Undergraduate/Graduate School of Nursing, Federal University of Piau/Graduate School Professional Master fordegrees in Family Health, UNINOVAFAPI University Center. Teresina (PI), Brazil. E-mail: [email protected]

ORIGINAL ARTICLE
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ISSN: 1981-8963 DOI: 10.5205/reuol.5963-51246-1-RV.0807201423

According to comparative data conductedby the National Confederation ofMunicipalities (CNM), 57,116 deaths fromtraffic accidents for every 100,000 inhabitants

were recorded in 2008 in Brazil. In the UnitedStates, 37,261 deaths were recorded fromtraffic accidents and in the European Union,38,876. The data show that the Braziliantransit kills 2.5 times more than in the UnitedStates, and 3.7 times more than in theEuropean Union.1

In Brazil, such as in the rest of the world,the industrial development provided aconsiderable increase in the automobile fleet.

A parallel significant increase of trauma byexternal causes is observed as mainlyassociated to inadequate human andbehavioral issues in addition to insufficientgovernment surveillance.2 The motorcyclesfleet stands out because these vehicles bringseveral attractive features that becomeincentives for their acquisition such as lowmaintenance cost, and because of this reason,the application for licenses has increasedremarkably in all Brazilian States in the recent

years. The big disadvantage is less protection,because motorcycles have no structure ordevices that offer security to their users.3

The Brazilian Transit Code - CTB institutedlaws among measures for the prevention oftrauma by accidents, especially involvingmotorcycles, such as the use of helmets fordrivers and passengers; the lack of use ofhelmets is liable to penalties. The CTB hasalso made mandatory that two-wheeled

vehicles transit with the headlights on to bebetter perceived, which helps to reduceaccidents and consequently trauma.4

The trauma is caused by a chain of eventscreated between the individual and a high-risksituation for example: car accidents,produced by transfer of energy, injury fromexternal agents, which include: physical,mechanical, and chemical. These areresponsible for deaths or physical or

psychological disabilities that burden thehealth system with prolonged hospitalizationsand long-term recovery programs;5despite itsimpact on public health and its high costs tosociety, traumas have long been neglected asan illness, in part, for being regarded as an"accident", something arising from a casualevent, uncontrollable. However, what in factmost often occurs is that the trauma injurieshappen in predictable situations, plausible ofprevention.6

Due to the severity of injuries, the victimsfrom trauma arising from accidents require

physical structure, availability of inputs,technological support, and specialized humanresources to ensure permanent and continuousassistance in observation and maintenance ofvital conditions and intervention in emergencysituations. In this order, the intensive care

units (ICU) are units of great importance inthe maintenance of life and rehabilitation ofvictims; however, the lack of ICU beds formany patients contributes to their highmortality rates.7

Concerned about this scenario and realizingthe gap of Brazilian studies about the profileof the victim of motorcycle accidents in theICU, this study seek to provide subsidies forthe formulation of multi-professional conducts

in caring for these patients. This study aims todescribe the epidemiological profile ofmotorcycle accident victims admitted in theintensive care units in a public hospital inTeresina. The specific objectives were todescribe the socio-demographic and clinicaldata of patients, and analyze the relationshipbetween the age by age groups with theoccurrence of thoracic trauma, traumaticbrain and skull injuries, and the clinicalcondition of patients at the time of discharge

from the ICU.

This was an epidemiological, descriptive,retrospective, and analytical study with aquantitative approach, which is characterizedby the descriptions and analysis of dataobtained from the charts of patientshospitalized in the ICU at the Neuro andGeneral sectors from an urgent care facility in

Teresina-PI, between January and Decemberof 2010.

The study was conducted in a publichospital in the city of Teresina-Piau, whichwas founded in May 5, 2008 and currently has227 beds in six clinics and three intensive careunits. Many of the specialties offered by thehospital make it a reference to the Northernand Northeastern regions.

The hospital has three intensive care units

(neurological, general, and pediatric) witheight beds in each unit. It also stands out forbeing a teaching, research, and extensionprograms center with residency in InternalMedicine, General Surgery, and Orthopedicsfor several private and public colleges. Allmedical records from patients admitted to thehospital in the neurological and general ICUs,because of motorcycle trauma and in theperiod from January to December of 2010,were included in the study.

METHOD

INTRODUCTION


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ISSN: 1981-8963 DOI: 10.5205/reuol.5963-51246-1-RV.0807201423

The data were collected by the authorswith the use of the data collection instrumentdivided as follows: socio-demographic data asage, gender, marital status, education, andclinical data such as the use of helmets at thetime of the accident, type of trauma, surgery,

type of surgery, and discharge clinicalconditions.

The data was tabulated in the Statisticalsoftware Social Package for the SocialSciences -SPSS, version 18.0 for Windows.Descriptive analyses of the socio-demographicand clinical data were performed using simpleand absolute frequencies and measures ofcentral tendency and dispersion.

Bivariate analyses were also carried out

with the association between variables. Ageby age groups was considered as anindependent variable and the skull-encephalictrauma and clinical condition at the time ofdischarge from the ICU as dependentvariables. A significance level of 5% (p < 0.05)was considered in all statistical tests usingPearson's Chi-square test or Fisher test whenit was not possible to use the Chi-square test.

The study respected the confidentiality andanonymity of patients, was registered in theNational System of Ethics and Research(BRAZIL PLATFORM), and subsequentlysubmitted to the Research Ethics Committee

from the Emergency Hospital of Teresina(HUT) and the Committee of Ethics inResearch from the Integral Diferencial College- FACLD, in accordance with resolution No.196/96 from the National Health Council,which deals with guidelines and regulatory

norms for research involving humans. Theresearchers obtained authorization from theinstitution through an InstitutionalAuthorization Request and signature of theterm of faithful depositary by the head of theMedical and Statistical File Service (SAME) inthat hospital.8

The presentation of results is divided into

three parts: in the first and second, thedescriptive analyses of demographic data andclinical data are performed; in the third part,bivariate analyses were performed withassociation between the variable age and thevariables skull encephalic trauma and clinicalcondition of patients at the time of dischargefrom the ICU.

Socio-demographic Data

During the year of 2010 there were 394admissions in the General and NeurologicalICU; of these, 86 were victims of motorcycleaccidents, 21.83%. These patients had thefollowing demographic characteristics.

Table 1.Demographic distribution of the study population accordingto age, gender, and marital status. Teresina 2012 (N = 86)

Age n %15 |--- 25 41 47.725 |--- 35 22 25.635 |--- 45 12 14.045 |--- 55 5 5.855 |--- 65 6 7.0

Total 86 100.0

Average age = 28,85 years / dp = 12,18 yearsGender Marital statusMarried

(%)Single

(%)Other

(%)Notinformed

(%)Total(%)

Male 34.9 38.4 10.5 4.7 88.5Female 1.2 9.3 0.0 1.2 11.6Total 36.0 47.7 10.5 5.8 100.0

Source: SAME HUT, 2012.The global analysis in Table 1 revealed

that 47.7% of riders were in the age group of15 to 25 years, with a variance between 15and 65 years, average age of 29.85 years, and

standard deviation of 12.18 years. It alsorevealed that 88.4% of victims of motorcycleaccidents are men, of these, 38.4% weresingle.

Table 2. Distribution of the study population according toeducation level. Teresina 2012 (N = 86).

Education n %Not informed 33 38.4Middle school 21 24.4Incomplete Middle school 13 15.1Complete High school; 13 15.1Incomplete High school 02 2.3Complete college 02 2.3Incomplete college 01 1.2Illiterate or just reads and writes the name. 01 1.2Total 86 100.0

Source: SAME HUT, 2012.

RESULTS


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ISSN: 1981-8963 DOI: 10.5205/reuol.5963-51246-1-RV.0807201423

As for the education, Table 2 shows thatthe highest percentage of patients showed

middle school level (24.4%).

Figure 1. Information about the use of helmets at the time of the accident. Teresina 2012(N = 86). Source: SAME HUT, 2012.

Figure 1 reports that in 94% of the recordsthere was no information about the use or notof helmets at the time of the accident; 6% ofthe charts with information showed that thesepatients were not wearing a helmet.

Clinical dataTable 3 reveals that 93% of patients

suffered skull encephalic trauma followed byskull encephalic trauma with 91.9%, the spinal

cord trauma showed the lowest percentagewith 3.5%. The table also shows that 74patients underwent surgical procedures, ofthese, 86.5% had neurosurgery and 71.6%general surgery. The orthopedic surgeries andvascular surgeries showed a percentage of19%, the lowest percentage was of thoracicsurgeries, with 13.5%.

Table 3. Types of traumas suffered by the patients.Teresina 2012 (N = 86).

Types of Traumas Yes Non % n %

External Surface lesions 80 93.0 06 7.0Skull-Encephalic Trauma 79 91.9 07 8.1Trauma in the limbs 22 25.6 64 74.4Thoracic Trauma 20 23.3 66 76.7Abdominal Trauma 10 11.6 76 88.4Spinal cord Trauma 03 3.5 83 96.5Types of surgeryNeurosurgery 74 86.5 10 13.5General Surgery 53 71.6 21 28.4Orthopedic Surgery 14 19 60 81.1Vascular Surgery 14 19 60 81.1Thoracic Surgery 10 13.5 64 86.5

Source: SAME HUT, 2012. Bivariate Analyses

The statistical analyses were conducted withassociation to the variable age by age groupswith the following variables: skull encephalic

trauma and clinical condition of patients at thetime of discharge from the ICU.

Table 4. Association between age, brain and skull encephalic trauma and clinicalconditions of patients at the time of discharge from the ICU. Teresina 2012 (N =86).

Age Skull-Encephalic Trauma Total%

pYES

%

NO

%15 |--- 25 47.7 47.725 |--- 35 23.3 2.3 25.635 |--- 45 10.5 3.5 14.0 = 0.01*45 |--- 55 4.7 1.2 5.855 |--- 65 5.8 1.2 7.0

Total 91.9 8.1 100.0Clinical condition

Age Withsequelae% Without sequelae% Death%15 |--- 25 30.2 2.3 15.1 47.725 |--- 35 14.0 11.6 25.635 |--- 45 7.0 2.3 4.7 14.0 =0. 397.45 |--- 55 3.5 2.3 5.855 |--- 65 2.3 4.7 7.0

Total 57.0 4.7 38.4 100.0

Fonte: SAME HUT, 2012.


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ISSN: 1981-8963 DOI: 10.5205/reuol.5963-51246-1-RV.0807201423

The data in Table 4 show that the agegroups with the highest percentages of skullencephalic trauma were from 15 to 25 yearsold and 25 to 35 years old with 47.7% and23.3%, respectively, and significance of p =0.01. Regarding the clinical condition at the

time of discharge, the numbers show that30.2% of patients in the age group between 15and 25 years old were discharged withsequelae, most deaths occurred in this sameage group (15.1%) and thus, the test did nothave statistical significance (p = 0.397).

In regards to ICU admissions, Brazilian andinternational studies specifically elaborate on

this topic, and when approached, it is done aspart of research about trauma. A study on thistopic was held in the capital of Tanzania, anAfrican country, in which the researchersdescribed that in the 841 ICU admissionsbetween 2008 and 2010, 152 (18%) weremotorcycle riders.9 These figures aredisquieting because despite that the Africanstudy analyzed the issue over two years,which differs from the present research thatwas only over one year, it stands out that the

percentages found in the current study areproportionally double of those reported inTanzania, showing that the indexes are higherin Brazil.

In addition to this theme, other authorsstate that the admission to the ICU is crucialto the final outcome of patients presentedwith multiple serious traumas because theserequire human, logistic, and financial support,only found in this specialized environment.10

With respect to gender and age groups, astudy on the profile of patients with traumacaused by motorcycle accidents admitted inan emergency service in the city of Teresina,showed percentages close to this study, with37.54% of victims at ages ranging from 15 to24 years, 95.02% male, and 53.16% singles.2

Similar numbers were found in a studyconducted in the State of Cear. The patientswere between the ages of 18 and 29 years,

with a predominance of males, 45.1% and98.4%, respectively. Another investigationheld in Brasilia-DF with 580 deaths thatoccurred from 1996 to 2007 has shown that94.3% were males and 73.8% were between 20and 39 years old.11-2International studies showsimilar numbers; a quantitative research withpatients from Nigeria showed that 82.7% weremen and 37.1% in the age group between 20and 30 years old. Accordingly, another studyconducted in Jamaica revealed that 93.7%were men with an average age of 23 years. 13-4

This predominance of young males in thenational and international research isassigned, according to some authors, to theage's immaturity, self-confidence, and thetendency to defy limits. A qualitative studyconducted in So Paulo, which aimed to

describe the social representations ofmotorcycle accident victims, noted that somespeeches revealed that the motorcycle is asynonym of freedom, excitement, adrenaline,and the act of infringing the laws and livingdangerously is worshipped like a heroic act.3,15

With regard to education, most victims hadmiddle school level, which characterizes thelow level of education in the studiedpopulation, a factor that can influence on

little or no education in driving.A previous study conducted in the State ofPiau showed that many of the casualties wereusing the motorcycle in farms where theywork; many of these riders did not go throughany preparation or supervision of responsibleauthorities because many vehicles were notlicensed.2 Another study found that 51.6% ofstudied victims of motorcycle accidents didnot possess a driver's license and they weremostly from the countryside of the State of

Cear.11Conversely, the studies conducted in the

Southern and Southeastern regions in Brazilshow that the social profile of motorcyclists isdifferent. For example, in a study conductedin So Paulo in 2005, out of 1,519 patients,only 0.5% was illiterate and, 41.5% hadcomplete middle school education. Anotherwork done in Brasilia showed that only 12.4%of respondents had middle school education,

as well as a study conducted in Porto Alegre -Rio Grande do Sul, that revealed that 6.7%had higher education.12,16 -7

With these results, it can be stressed thatthe high rates of people with low educationlevels influence the knowledge of laws andtraffic signals, noting that education isparamount to the reduction of the existingsocio-economic differences between theNortheast, Southern, and Southeastern regions

in the country.With reference to the use of helmets, the

results showed that in 94% of the recordsthere was no information about the use or notof helmets, therefore, it was not possible toidentify the percentage of motorcycle riderswho wore a helmet; in addition, the 6% whoshowed this information in their records werenot wearing a helmet. These are importantdata because the use of individual protectionequipment is mandatory as it reduces theseverity of cranial lesions. A study conductedin Sergipe report similar numbers in which it

DISCUSSION


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ISSN: 1981-8963 DOI: 10.5205/reuol.5963-51246-1-RV.0807201423

was observed that 69.1% of victims had norecord on the charts about wearing a helmet.3

International and Brazilian studies areunanimous in stating that the helmet reducessignificantly the incidence of deaths by cranialbrain trauma (TCE). However, it is common

for motorcyclists to ride without a helmet;many are the reasons for such behaviorincluding decreased vision, risk of neckinjuries, and reduction in noise from thetraffic.3,18 -20

In opposition to the research cited above, astudy reports that in some municipalities ofCear, representatives of the municipalitiesprepared organic laws by releasing themandatory use of helmets, which clearly

violates the Brazilian transit code.3

Another research also stresses that 49% ofvictims of motorcycle accidents haveundergone surgical procedures, includingneurosurgery.2 As for the types of traumas,another author also describes in his study thatthe lesions with external surface and TCEstood out among traumas of greaterpredominance suffered by motorcyclists. Thiscan be associated to the lack of protectivegear. 21

Statistical tests showed that there was asignificant association between the age groupof 15 to 25 years and the occurrence of skull-encephalic trauma (p = 0.01). After assessingthese numbers, Graph 1 shows that the vastmajority of patients did not use helmets, orused it incorrectly at the time of theaccident. One study supports this assertion,reporting that in 432 victims of an accidentwith motorcycles, 61% reported not wearing

the helmet correctly, and had more severecranial injuries.22

The percentage of TCE in this study wasvery high when compared with other studies,such as those held in Goinia, Fortaleza, SoPaulo, and Porto Alegre that showed thefollowing percentages, respectively: 4.1%,37.2%, 9%, and 6.17%.11-2,16 -23

The TCE is seen by the WHO as a 21-century epidemic, similar to malaria and

HIV/AIDS, mainly in developing countries.These injuries, when associated with patientswho are victims of motorcycle accidents, leadto increased chances of mortality because theencephalic trauma not only reaches the brainbut can cause multi-systemic disorders.Another fact is the occurrence of associatedlesions that occur in 20% of cases, whichinclude complex neurological deficits andneuroendocrine and neuroclinical

complications causing sequelae that aremostly irreversible.16-24

A multicenter study performed by a groupof Brazilian scholars corroborates suchinformation and shows that traffic-relateddeaths represent almost 30% of all deaths byexternal causes in Brazil, and the mortalitytrend has grown in the recent years. This

growth is not explained just by increasing thefleet of motorcycles, but mainly by theseverity of injuries that they suffer becausethe rider only has the helmet as protection ina frontal crash; and, in the present study, itwas not possible to say whether they use it ornot. 25

The patients in this study were mostly

young, male, and single. Their fate is mostlikely attributed to the immaturity of age,self-confidence, and a tendency to defylimits. The low level of education of thevictims was identified, most of them hadcompleted middle school, and this factor caninfluence their knowledge about laws andtraffic signals.

Regarding the use of helmets, this studyhad one limitation because in almost allconsulted charts there were no records on theuse of personal protective equipment, andthis fact is extremely important since thisinformation can guide clinical and educationalconducts in traffic.

On the admission of these victims ofmotorcycle accidents in the ICU, mostsuffered TCE and underwent neurosurgery,characterizing the severity of trauma andinjuries arising from these accidents.

Concerning the clinical conditions at the

discharge from the ICU, patients weredischarged with sequelae generating a socialand economic burden for the government andtheir families; a high number of deaths wasobserved among young people.

The data presented in this study are similarto the characteristics of motorcyclists foundin other studies. This is why the growingnumber of motorcycles is worrisome; becauseit is a low-cost way of transportation to which

many have access, it has been causingdamages that are most often irreversible. Thishighlights the need for greater attention tothe education of drivers, better monitoringand enforcement of traffic laws, and greaterpublic exposure to the consequences of theseaccidents, especially those involvingmotorcycles.

The results obtained in this studyconfirmed the importance of motorcyclists

among victims of traffic accidents in the Stateof Piau. Thus, the competent authorities

CONCLUSION


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need to implement effective programs for theeducation and establishment of preventiveactions in order to warn and educate thepopulation about the dangers of riskybehaviors in driving a motorcycle, aimed atreducing the quantity and intensity of bodily

injuries; thus, sequelae and deaths can beavoided.

It is expected that the results obtained canserve as the basis for the multi-professionalconduct, it is also hoped that further researchare carried out aiming at complementing theresults found in this study.

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(CNM). Estudos tcnicos Mapeamento dasmortes por acidentes de trnsito no Brasil.Braslia: Ministrio Nacional dos municpios,2009.

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ISSN: 1981-8963 DOI: 10.5205/reuol.5963-51246-1-RV.0807201423

Submission: 2013/03/27Accepted: 2014/05/14Publishing: 2014/07/01

Corresponding Address

Sandra Beatriz Pedra Branca DouradoConj. Santa Sofia

R.03, Q.03, C.13CEP 64011-010 Teresina (PI), Brazil

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