|Year : 2013 | Volume
| Issue : 3 | Page : 116-120
Socio-demographic profiles and outcome of motorcycle related head injury in a Nigerian Tertiary Health Institution
Ayodeji Salman Yusuf1, Timothy Olugbenga Odebode1, Adekunle Ganiyu Salaudeen2, Mustapha Faiz Alimi3, James Olaniyi Adeniran1
1 Department of Surgery, Faculty of Clinical Sciences, University of Ilorin, Ilorin, Nigeria
2 Department of Epidemiology and Community Health, Faculty of Clinical Sciences, University of Ilorin, Ilorin, Nigeria
3 Department of Epidemiology and Community Health, National Orthopaedic Hospital, Igbobi, Lagos, Nigeria
|Date of Web Publication||22-Nov-2013|
Ayodeji Salman Yusuf
Department of Surgery, Faculty of Clinical Sciences, University of Ilorin, PMB1515, Ilorin 240001
Background: Motorcycle increasingly has been used for commercial transportation in many Nigerian cities with attendance increase in the rate of motorcycle crashes. Head injury is responsible for high morbidity and most mortality following such crashes. The aim of this study is to determine the socio-demographic characteristics of head injured victims of motorcycle crashes, severity of head injury and management outcome. Materials and Methods: A 1 year prospective study of head injured motorcyclists and pedestrians knocked down by motorcycle were carried out at University of Ilorin Teaching Hospital using a pre-designed proforma. Information collected included the age, gender, literacy level, alcohol consumption, license status, crash helmet use, Glasgow coma score and Glasgow outcome score. The IBM statistical package for social sciences (version 15.0) statistical package was used for statistical analysis. Results: A total of140 patients with the median age of 30 years (ranged 3-90 years) were studied. They comprised 115 (82%) males and 25 (18%) females. Most patients (66%) had at least secondary education. People of varying occupations were involved in a motorcycle crash. All riders were males and most (71.8%) were unlicensed. Only 5.8% of riders wore crash helmets at the time of the crash and they all had a favorable outcome. At both extremes of age (<10 years and >70 years) more patients were involved as pedestrians. The only socio-demographic variable that influence outcome of head injury was the patient age. Outcome was better in younger age group (P = 0.004). There was 26.4% mortality. Most, 23 (88.4%), of patients with severe head injury died and none of them had good recovery (P < 0.0001). Conclusion: Our findings demonstrated high mortality among non-crash helmet wearing motorcyclists with motor cycle related head injury. The outcome was significantly influenced by age and head injury severity.
Keywords: Head injury, helmet, motorcyclists, outcome, socio-demographic
|How to cite this article:|
Yusuf AS, Odebode TO, Salaudeen AG, Alimi MF, Adeniran JO. Socio-demographic profiles and outcome of motorcycle related head injury in a Nigerian Tertiary Health Institution. Sahel Med J 2013;16:116-20
|How to cite this URL:|
Yusuf AS, Odebode TO, Salaudeen AG, Alimi MF, Adeniran JO. Socio-demographic profiles and outcome of motorcycle related head injury in a Nigerian Tertiary Health Institution. Sahel Med J [serial online] 2013 [cited 2019 Oct 18];16:116-20. Available from: http://www.smjonline.org/text.asp?2013/16/3/116/121921
| Introduction|| |
Motorcycle collisions account for a considerable rate of morbidity and mortality due to traffic accidents all over the world and head injury account for most fatal cases. ,, Motorcyclists (riders and passengers) are approximately twenty times more likely to die in a road traffic crash than car occupants.  Majority of those disabled or killed by motorcycle collisions are young and in economically productive age group leading to considerable physical and financial demands on the family and the health system.
In Nigeria and many low income countries people of different socio-demographic backgrounds commute on motorcycle daily. , The incidence of motorcycle crashes and attendant head injury have recently increased in major Nigerian cities partly because a majority of the motorcycle riders are unlicensed and have resisted the helmet-use law despite the proven efficacy of motorcycle helmets in reducing the incidence of severe and critical head injuries. ,,,,, Pedestrians are also exposed to the hazards of motorcycle crash.
There is a paucity of data on the socio-demographic prolife of head injured victims of motorcycle crash in Nigeria. This study was designed to determine the relationship between outcomes of motorcycle related head injury and socio-demographic and clinical variables among motorcycle crash victims presenting to our accident and emergency service over a 1 year period (April 2009 to March 2010).
| Materials and Methods|| |
This was a prospective study of socio-demographic characteristics, clinical variables and outcome of head injury in 140 consecutive patients who were riders, passengers or pedestrians sustaining motorcycle related head injuries. The study was carried out at the University of Ilorin Teaching Hospital, Ilorin, a tertiary heath institution North Central Nigeria. Patient's recruitment was carried out over 12 months, between 1 st April, 2009 and 31 st March, 2010 and patients were followed-up for additional 6 months post-injury. Head injury broadly refers to all types of injury to the scalp, skull and intracranial contents including the meninges, the brain and the brainstem.
A pre-designed study proforma was administered on all consenting patients/patients' care givers. Information on patient demographics (age, sex, literacy level and occupation), alcohol consumption within 8 h preceding injury, post-resuscitation Glasgow Coma score (GCS), cranial computed tomography (CT) scan, treatment modalities and duration of hospital stay and outcome of management were collated. Head injury severity was graded into mild (GCS 14-15), moderate (GCS 9-13) or severe (GCS 3-8),  while the outcome of head injury was measured by the Glasgow outcome score (GOS) at 6 months, at last contact or at death.  The GOS was further categorized as either favorable (good recovery or moderate disability) or unfavorable (severe disability, persistent vegetative state or death).  Patients who died before reaching the hospital were not included in the study. Data was analyzed using the statistical package for social sciences version 15.0. Chi-square test and fisher exact test where applicable were used to test the significance of the differences between categorical variables. The confidence level was set at 95% while P ≤ 0.05 was taken as significant.
| Results|| |
A total of 140 patients; 115 males and 25 females (4.4:1 ratio) aged 3-90 years, with a median and modal age (standard deviation) of 30 (17.9) years [Table 1] were admitted with motorcycle related head injury either as riders, passengers or pedestrians. Most of the patients (66%) had at least secondary education and they included 25 (17.9%) students, 21 (15%) commercial motorcycle riders, 19 (13%) artisans and 22 (16%) patients who were unemployed [Table 1].
A total of 71 patients (50.7%) were motorcycle riders, 36 (25.7%) were pedestrians and 33 (23.6%) were passengers. All riders were males with 50% (35) of them aged 20-30 years and 71.8% unlicensed to ride motorcycle [Table 1]. None of the 6 (5.8%) riders that wore a crash helmet at the time of the crash sustained severe head injury and they all had a favorable outcome.
At both extremes of age (<10 years and >70 years) more patients were involved as pedestrians having been knocked down by motorcycles [Figure 1]. Three (15%) of patients aged 20 years and below and 12 (15%) of those aged 21-40 years suffered severe head injury. On the contrary, most patients above 60 years (8 patients, 42%) suffered severe head injury. The relationship between patients age and severity of head injury was, however, not statistically significant (P = 0.118). Head injury was severe in 11 (15.5%) of the 71 riders, 9 (27.3%) of 33 passengers and 6 (16.7%) of 36 pedestrians [Table 2].
A total of 60 (42.8%) patients including 25 (34.7%), 21 (50%) and 14 (53%) with mild, moderate and sever severe head injury, respectively had cranial CT scan.
|Table 2: Relationship between selected variables and severity of head injury|
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Outcome was better in the younger age group with 89% of patients aged 20 year and below having favorable outcome while most 11 (61%) of the elderly had unfavorable outcome. The relationship between the age group of the patient and outcome was statistically significant (P = 0.004) [Table 3].
Most passengers 12 (36.4%) had unfavorable outcome while 20 (28.2%) riders and 9 (25.0%) pedestrians had unfavorable outcome. There was, however, no statistical relationship between outcome among motorcycle riders, passengers or pedestrians (P = 0.560).
Alcohol consumption during the 8 h preceding the crash was found in 12 (8.6%) patients, 9 (75%) of whom were riders and 3 (25%) were pedestrians while none of the passengers reported alcohol use during the 8 h preceding crash [Table 1]. Four (33%) of these 12 patients had unfavorable outcome while 37 (28.9%) of those who did not consume alcohol within the same period had unfavorable outcome. The relationship between reported alcohol consumption during the 8 h preceding crash and outcome of head injury was not significant (P = 0.747).
Most 111 (79.3%) of the patients were managed conservatively while the remaining 29 (20.7%) patients had neurosurgical intervention. Only 16 (61.5%) out of 26 patients with severe head injury were admitted into the intensive care unit (ICU).
Overall 73 (52.1%) patients had good recovery, 4 (2.9%) patients had severe disability and 37 patients died giving a mortality rate of 26.4%. Most (23, 88.4%) of the patients with severe head injury died and none of them had good recovery. 57 (79%) patients with mild head injury had good recovery. Head injury severity significantly predicts outcome (P < 0.0001) [Table 4].
| Discussion|| |
Most of our patients are young adult male with median age of 30 years consistent with findings in other studies on motorcycle crash injuries. ,,,,,,, The victims occupational profile represents the economically active and potentially productive members of the society. Only 6 (5.8%) riders and no passenger wore crash helmets at time of crash. Many studies have shown crash helmets to be effective in decreasing mortality and head injury severity in motorcycle crashes. ,,,,,,,,,,, Non-use of crash helmets has been previously reported in other parts of Nigeria and developing countries. ,,
This study found that about half (51%) of the patients were motorcycle riders. This is comparable with findings among motorcycle crash victims reported in other centers in Nigeria. , Most (72%) of these riders were not licensed and were mainly commercial motorcycle riders (74%). This is similar to the 63.9% reported in South-West Nigeria.  The riders were probably not trained and may not understand the road signs thereby constituting a vulnerable group. Pedestrians constituted 26% of the patients and this is higher than 14% previously reported in the same center among patients with general body injuries.  In most cities in Nigeria there are no pathways separating the pedestrians from motorcycles and other automobiles thus putting many pedestrians, usually children and elderly, at risk of accidents. 
The overall reported alcohol consumption within 8 h preceding crash among motorcycle riders and pedestrians were higher than reported in three tertiary centers in South-West Nigeria,  but much lower than the 30% reported alcohol use among riders in Ile-Ife.  In Benin, 47.1% of the patients who died from injuries sustained in a motorcycle crash had a mean blood alcohol level of 70 mg/dl.  However, blood alcohol level was not measured in the current study due to lack of facilities to assess blood alcohol level. There is at present no regulation on acceptable blood alcohol level among motorcyclists in Nigeria. In Britain and other European countries the presence of greater than 80-100 mg alcohol/100 ml of blood of a rider is a statutory offence. 
Despite availability of CT scan machine, only 50% and 53% of patients with moderate and severe head injury respectively had cranial CT. This low rate of CT scan might be mainly due to financial constraint. This test cost about an equivalent of 200 United States dollars in the study center, which is beyond the reach of most patients. The percentage CT scan utilization found in this study however, showed an improvement over 21% reported in Lagos among patients with severe head injury managed in ICU.  ICU management constitutes additional financial burden in patients with severe head injury. During the period of this study, the hospital had only three ICU bed spaces for use by all specialties in the hospital. There was no other hospital with ICU facility in catchment area of our institution. It is therefore not surprising that 38.5% of our patients with severe head injury could not be admitted into the ICU. These factors might have impacted directly on the outcome of patients' management.
Head injury severity is the most important determinant of outcome in patients with head injury and our present study confirmed this finding among motorcycle related head injury (P < 0.000). Interventions that enforce crash helmet use and other road safety measures among motorcyclists could improve outcome by reducing occurrence of severe head injury.
Age was a significant (P = 0.004) determinant of outcome with patients above 60 years having worse outcome. Age has been previously reported as an independent determinant of outcome in head injured patients. , Most investigators have stressed that younger individuals do better than the aged. Head injury tends to be more severe in the elderly possibly due to likely co-existing comorbidities associated with aging. Furthermore, the brain of the elderly is more vulnerable to hypoxic insults and has a decreased capacity for repair as it ages. 
| Conclusion|| |
Our findings demonstrated high mortality among non-crash helmet wearing motorcyclist with motor cycle related head injury. The outcome was significantly influenced by age and head injury severity.
| References|| |
|1.||Paden M. World Report on Road Traffic Injury Prevention-Summary. Geneva: WHO; 2004. p. 12. |
|2.||Solagberu BA, Ofoegbu CK, Nasir AA, Ogundipe OK, Adekanye AO, Abdur-Rahman LO. Motorcycle injuries in a developing country and the vulnerability of riders, passengers, and pedestrians. Inj Prev 2006;12:266-8. |
|3.||Oluwadiya KS, Kolawole IK, Adegbehingbe OO, Olasinde AA, Agodirin O, Uwaezuoke SC. Motorcycle crash characteristics in Nigeria: Implication for control. Accid Anal Prev 2009;41:294-8. |
|4.||Tham KY, Seow E, Lau G. Pattern of injuries in helmeted motorcyclists in Singapore. Emerg Med J 2004;21:478-82. |
|5.||Ankarath S, Giannoudis PV, Barlow I, Bellamy MC, Matthews SJ, Smith RM. Injury patterns associated with mortality following motorcycle crashes. Injury 2002;33:473-7. |
|6.||Bledsoe GH, Schexnayder SM, Carey MJ, Dobbins WN, Gibson WD, Hindman JW, et al. The negative impact of the repeal of the Arkansas motorcycle helmet law. J Trauma 2002;53:1078-86. |
|7.||Chiu WT, Kuo CY, Hung CC, Chen M. The effect of the Taiwan motorcycle helmet use law on head injuries. Am J Public Health 2000;90:793-6. |
|8.||Zargar M, Khaji A, Karbakhsh M. Pattern of motorcycle-related injuries in Tehran, 1999 to 2000: A study in 6 hospitals. East Mediterr Health J 2006;12:81-7. |
|9.||Maas AI, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurol 2008;7:728-41. |
|10.||Lin MR, Hwang HF, Kuo NW. Crash severity, injury patterns, and helmet use in adolescent motorcycle riders. J Trauma 2001;50:24-30. |
|11.||Li LP, Li GL, Cai QE, Zhang AL, Lo SK. Improper motorcycle helmet use in provincial areas of a developing country. Accid Anal Prev 2008;40:1937-42. |
|12.||Nicholas FM, Andrew DW, Christopher BT. A Lawrence of Arabia, Sir Hugh Cairns, and the Origin of Motorcycle Helmets. Neurosurgery 2002;50:176-9. |
|13.||Bledsoe GH, Li G. Trends in Arkansas motorcycle trauma after helmet law repeal. South Med J 2005;98:436-40. |
|14.||Hotz GA, Cohn SM, Popkin C, Ekeh P, Duncan R, Johnson EW, et al. The impact of a repealed motorcycle helmet law in Miami-Dade County. J Trauma 2002;52:469-74. |
|15.||Oginni FO, Ugboko VI, Ogundipe O, Adegbehingbe BO. Motorcycle-related maxillofacial injuries among Nigerian intracity road users. J Oral Maxillofac Surg 2006;64:56-62. |
|16.||Nzegwu MA, Aligbe JU, Banjo AA, Akhiwui W, Nzegwu CO. Patterns of morbidity and mortality amongst motorcycle riders and their passengers in Benin-City Nigeria: One-year review. Ann Afr Med 2008;7:82-5. |
|17.||Oginni FO, Ugboko VI, Adewole RA. Knowledge, attitude, and practice of Nigerian commercial motorcyclists in the use of crash helmet and other safety measures. Traffic Inj Prev 2007;8:137-41. |
|18.||Alan WJ. The Relationship between Blood Alcohol Concentration (BAC) and Breath Alcohol Concentration (BrAC): A Review of the Evidence. London: Road Safety Web Publication No. 15. Department for Transport; 2010. p. 11-3. |
|19.||Desalu I, Bankole OB, Olatosi JO, Kushimo OT, Arigbabu SO. Outcome of acute head injury admissions into the intensive care unit of the Lagos University Teaching Hospital. J Clin Sci 2004;4:5-8 |
|20.||Servadei F, Begliomini C, Gardini E, Giustini M, Taggi F, Kraus J. Effect of Italy's motorcycle helmet law on traumatic brain injuries. Inj Prev 2003;9:257-60. |
|21.||Odebode TO, Abubakar AM. Childhood head injury: Causes, outcome, and outcome predictors. A Nigerian perspective. Pediatr Surg Int 2004;20:348-52. |
|22.||Jiang JY, Gao GY, Li WP, Yu MK, Zhu C. Early indicators of prognosis in 846 cases of severe traumatic brain injury. J Neurotrauma 2002;19:869-74. |
[Table 1], [Table 2], [Table 3], [Table 4]