title: Crash characteristics and patterns of injury among hospitalized motorised two-wheeled vehicle users in urban India.
abstract: BACKGROUND
  Traffic crashes and consequent injuries represent a growing public health concern in India, particularly in light of increasing motorization. Motorised two-wheeled vehicles (MTV) constitute a large portion of the vehicle fleet in India. We report the crash characteristics and injury patterns among a cohort of MTV riders and pillions presenting to hospital post-crash.
  
  
  METHODS
  Consecutive MTV riders and pillions, whether alive or dead, injured in a road traffic crash presenting to the emergency departments of two government hospitals and three branches of a private hospital in urban Hyderabad, India, were recruited to this study.
  
  
  RESULTS
  378 MTV users were enrolled to the study of whom 333 (88.1%) were male, 252 (66.7%) were riders and median age was 31.3 years. A total of 223 (59%) MTV users were injured in multi-vehicle crashes while one-third had a frontal impact. The majority (77%) were assessed as having a Glasgow coma score (GCS) of 13-15, 12% a GCS of 9-12 and 11% a GCS of 3-8. No difference was seen in the severity distribution of injuries based on GCS among riders and pillions. Open wounds and superficial injuries to the head (69.3%) and upper extremity (27%) and lower extremity (24%) were the most common injuries. 43 (11%) sustained an intracranial injury, including 12 (28%) with associated fracture of the bones of the head. There were few differences in types of injuries sustained by riders and pillions though riders had a significantly lower risk of crush injuries of the lower extremity than pillions (relative risk, RR 0.25, 95% CI 0.08-0.81) and female pillions were at a significantly lower risk of sustaining fractures of the lower extremity than male pillions (RR 0.30, 95% CI 0.09 - 0.94). Overall, 42 (11%) MTV users died, of which 42.8% died before reaching the hospital. Only 74 (19.6%) MTV users had worn a helmet correctly and failure to wear a helmet was associated with a five times greater risk of intracranial injury (RR 4.99, 95% CI 1.23-20.1). Of the 19 pre-hospital deaths, 16 (84%) had not worn a helmet.
  
  
  CONCLUSIONS
  Head injuries accounted for the major proportion of injuries sustained in MTV users. Non-helmet use was associated with increased risk of serious head injuries. The data presented on the nature and severity of injuries sustained by MTV users can assist with planning to deal with these consequences as well as prevention of these injuries given the high use of MTV in India.
authors.affiliation: George Institute for International Health and School of Public Health, University of Sydney, Sydney, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Fitzharris
authors.forename: Rakhi
authors.initials: R
authors.lastname: Dandona
authors.forename: G Anil
authors.initials: GA
authors.lastname: Kumar
authors.forename: Lalit
authors.initials: L
authors.lastname: Dandona
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000328:Adult; D017677:Age Distribution; D001642:Bicycling / Q000293:injuries; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D006259:Craniocerebral Trauma / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D006260:Head Protective Devices / Q000706:statistics & numerical data; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009049:Motorcycles; D009104:Multiple Trauma / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D011336:Probability; D012307:Risk Factors; D012309:Risk-Taking; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D015996:Survival Rate; D014505:Urban Population; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D055815:Young Adult