Abstract
Background
Road Traffic Accident is an incident on a way or street open to public traffic. It becomes one of the most significant public health problems in the world especially in developing countries. In Ethiopia, it represents a significant risk for morbidity and mortality. It is also the major public health problem even though studies done on this topic in the study area is limited.
Objective
To assess clinical pattern, associated factors and management outcomes among road traffic accident Victims attending emergency department of Jimma University Medical Center.
Methods
Hospital based cross sectional study design was employed to review patients' chart visited the hospital from March to April 2021. A systematic random sampling technique was applied. The data were collected using pretested checklist and analyzed using SPSS version 26. Descriptive statistics and multivariate logistic regression were computed. Variables with P<0.05 were considered statistically significant.
Results
About 49.6%) were pedestrians injured of which motorcycle accounted 42.9%. More than half of victims never got any type of prehospital care. On arrival, 38.7% were classified as Red of which 71.4% of them were managed surgically. About 84.9% of victims were discharged with improvement whereas12.6% were died. Victims with head injury (AOR= 16.61: 95% CI; 3.85, 71.71), time elapsed to reach nearby health facility (AOR= 3.30; 95 CI (1.13, 9.60), condition of patient at Emergency Department (AOR= 7.78; 95% CI: 2.33, 26.06), GCS at admission (AOR= 20.12; 95% CI: 7.23, 55.96) and days spent in hospital (AOR= 6.85; 95% CI 5.81, 8.06) were independent predictors of unfavorable outcome.
Conclusion
Road Traffic Accident represents a significant risk for morbidity and mortality in Ethiopia, of which head injury and multiple sites injury increase injury severity. Targeted approaches to improving care of the injured victims may improve outcomes. Thus, the clinician should take into consideration the clinical presentation and give due attention to the identified contributing factors in its management.
Keywords: Road traffic accident, Clinical pattern, Management outcomes, Jimma University Medical Center
African Relevance.
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Prehospital delay for victims of RTA in developing countries is under studied.
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Emergency medical care providers in Africa are low in number and inadequate pre-hospital care is reported.
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The mortality and disability from RTA are not well reported in Africa, and in Ethiopia too.
Alt-text: Unlabelled box
Introduction
A road traffic accident (RTA) is an accident occurring on a road or road open to public transport, resulting in the death or injury of one or more individuals and the presence of at least one moving vehicle [1]. According to World Health Organization (WHO), every day more than 3000 people die from road traffic accidents which constitutes almost 1.3 million people losing their lives each year [2]. By 2030, if an appropriate measure is not taken, it is predicted to become the fifth driving cause of death on the planet [2]. It triggers general medical problems in the regions, and worldwide. About 20 to 50 million people experience non-lethal wounds [3].
Motor vehicle accidents (MVA) are preventable and treatable if appropriate measures are taken before they occur and immediately following the accident [4]. Despite the attempts made to enhance road and law enforcement efforts, the motor vehicle accident rate rose by 0.3% from 2000 to 2012 globally. In one WHO reports, the proportion of road accident fatalities to total deaths in the world has grown by 2.2% from 1.255 million deaths in 2012 [5]. Road Traffic Accident (RTA) is ranked ninth among the key causes of Disability Adjusted Life Years, and its ranking is predicted to increase to a third by 2020. In addition, 96% of all children killed worldwide are due to traffic collisions [6]. Injuries kill more people worldwide every year than HIV, Tuberculosis, and malaria combined in Sub-Saharan Africa [7].
RTA is currently becoming a global public health issue, particularly in countries with low and medium incomes. Ethiopia is one of the 50 countries with the world's deadliest roads, according to a WHO survey in 2015 [8]. Deaths arising from road traffic accidents are a major cause of death and injury with a disproportionate number occurring in African countries. In Ghana, studies have shown that road accidents are one of the major causes of death and injury [9]. Road traffic collisions are responsible for substantial morbidity and mortality which is a major health concern worldwide. It is the current leading cause of death for children and young adults (5-29 years), and the eighth for all age groups [10].
Various studies conducted in Ethiopia have shown that the country's trend in RTA morbidity and mortality has risen from year to year. It also leads to poverty by causing loss of productivity, harm to materials, injury, disability, sorrow, and death. RTA is also one of the top three causes of death for people between the ages of 5 and 44 [11].
Even though RTA was one of the most common causes of morbidity and mortality among almost all age groups, clinical pattern, and management outcome is not well cited. In addition, the management outcome of RTA may be varied from place to place and time to time due to different factors. Moreover, there is no study in the South Western part of Ethiopia including the study hospital. Therefore, this study will have a great contribution to exploring the existing trends regarding patterns and management outcomes. The result of this study finding will help clinicians, the traffic law enforcer, and researchers. This study result will ultimately have its implication in the reduction of morbidity and mortality secondary to RTA.
Methods
Study area and period
A hospital-based cross-sectional study was conducted at Jimma University medical center (JUMC) from March to April 2021. It is located in Jimma Town in the Southwest of Ethiopia at 352 km from the capital city, Addis Ababa. There are five hospitals in the Town; two governmental and three non-governmental ownership. JUMC is the only teaching and referral hospital in the southwestern part of the country, providing services for approximately 15,000 inpatients, 160,000 outpatient attendants, 11,000 emergency cases, and 4500 deliveries in a year coming to the hospital from the catchment population of about 15-20 million people.
Population
All records of road traffic accident victims who visited the hospital were the source population. A selected record of RTA patients visiting the Emergency department, surgical and orthopedic wards of JUMC from March 15, 2020 to April 15, 2021 was study population. Single population proportion formula was used to estimate 357 desired samples included in the study. To reach these 357 victims, after all RTA patients’ record were obtained from the patients’ registration logbook, a systematic random sampling technique was used in which every 3rd card was selected. Incomplete records (absence of major variables in the chart) and records lost from data room were excluded from the study and replaced by others cards.
Data collection method and quality control
The data were extracted from each victim's medical record by using a checklist adapted from WHO injury surveillance guidelines [12]. Content and construct validity of the instruments was done by consulting senior professionals from the school of Nursing and further modification was done. The researchers then, pre-tested the questionnaire at Shenen Gibe Hospital on 18 patients for evaluation and refining. A reliability test was done and chrombach's alpha coefficient was 0.74. Since the data were collected from medical records, to decrease misinterpretation of data, the data collectors were trained on how to extract appropriate data and there was close daily monitoring and supervision at the data collection site. For a single victim's medical card, there were two data collectors and they cross-checked the data collected by one data collector by comparing it with the information on the medical records.
Data processing and analysis
After data collection, it was checked for completeness, coded, and entered into Epi Data statistical software package version 4.6. Then, the data were exported to SPSS version 26 and analyzed. Descriptive statistics was used to describe the distribution of variables under study. Those variables having P-value <0.25 in the bivariate analysis were transferred to the multivariable analysis and those variables having P-value <0.05 at 95% confidence level were considered as statistically associated with management outcome of RTA.
Ethical considerations
An ethical issue was considered while conducting the study. Primarily, an official letter with Ref. No EM/SM/2016/2021 was obtained from Research Ethical Review Committee of Addis Ababa University followed by Jimma University. Finally, approval was gathered from JUMC. The objective and purposes of the study were explained to staff members of the record office. Then, for retrieval of individual record and confidentiality of information, a written consent was given to the record office of the hospital. After completion of data collection, medical records were returned back to their original place properly. This study was conducted in accordance with the Declaration of Helsinki. The collected data were utilized only for research purposes.
Operational definitions
Disposition outcome: is an outcome after the victim is seen by the Emergency Physician at the Emergency department and planned to be discharged with improvement, admitted, referred, or Against medical advice(AMA).
Favorable outcome- is a positive outcome (improved and discharged) of RTA victims attended at JUMC.
Unfavorable outcome- is the negative result (referred to other hospitals died or left against medical advice) of an RTA victim visited at JUMC [20].
The severity of injury: We were not able to measure injury objectively because we used chart review. Injury is classified into three categories based on the extent of the injury and the treatment required.
Minor injury: Superficial injuries (bruises and lacerations).
Moderate injury: Injuries beyond subcutaneous tissue but not including the visceral organs requiring some skilled treatment.
Severe injury: Injuries requiring intensive surgical and/or medical treatment [21].
Results
Socio demographic characteristics
A total of 357 trauma victims’ registries were reviewed and included for analysis. The mean and (SD) of the age of the victims was 27 ± 13.7 years. Of all victims who visited the hospital, the most commonly affected age group was between 16-30 years old, accounting for 150 (42.0%) followed by age 31-45 years 99 (27.7%). This study also identified the sex of victims, 270 (75.6%) were male and 87 (24.4%) were female respectively with male to female ratio of 3.1 to 1. Nearly two-thirds (64.7%) of the victims were from rural residence (Table 1).
Table 1.
Socio-demographic characteristics of RTA victims who visited JUMC from March 2020 to April 2021, Jimma, Ethiopia (n = 357).
| Variables | Category | Frequency | (%) |
|---|---|---|---|
| Age | ≤ 15 years | 75 | 21.0 |
| 16-30 years | 150 | 42.0 | |
| 31-45 years | 99 | 27.7 | |
| 46-59 years | 24 | 6.7 | |
| ≥ 60 years | 9 | 2.5 | |
| Sex | Male | 270 | 75.6 |
| Female | 87 | 24.4 | |
| Occupation | Government | 57 | 16.0 |
| Student | 147 | 41.2 | |
| Farmer | 54 | 15.1 | |
| Merchant | 39 | 10.9 | |
| Housewife | 60 | 16.8 | |
| Address | Rural | 231 | 64.7 |
| Urban | 126 | 35.3 |
Clinical patterns of road traffic accidents
Among 357 cases reviewed, 141 (39.5%) of them sustained multiple injuries followed by lower limb injuries, 108 (30.3%) in which closed wounds accounted for 219 (61.3%). Nearly two third (60.5%) of victims developed fracture 216 (60.5%) followed by blunt abdominal injury which accounted for 54 (15.1%). On the other hand, among the victims affected 177 (49.6 %) were pedestrians followed by passenger 93 (26.1 %). The majority of the MVAs occurred during the day, 228 (63.9%) whereas the remaining 129 (36.1%) occurred at night time. About 153 (42.9%) of injuries were caused by Motor cycle followed by Minibus 69 (19.3%). Regarding the mechanism of injury, more than one-third (40.4%) of the victims reported that they collided with the other vehicle followed by falling down from the moving vehicle (23.5%). In addition, the largest proportion of victims (34.5%) was transported to their nearby health facility using a private vehicle whereas only 93 (26.1%) of them used the Ambulance. The time it takes to reach the initial health facility was in greater than 1 hour, 180 (50.4%). Almost half (47.9%) of the victims were come to JUMC after visiting other health institutions followed by those from the scene (40.3%). Nearly half 174 (48.7%) of the victims sustained severe injury followed by moderate injury which accounted for 132 (37%) (Table 2).
Table 2.
Pattern and injury severity among RTA victims who visited JUMC from March 2020 to April 2021, Jimma, Ethiopia (n = 357).
| Variables | Category | Frequency | (%) |
|---|---|---|---|
| Anatomic part of the body injured | Upper Limbs | 37 | 10.4 |
| Lower Limbs | 108 | 30.3 | |
| Pelvic Area | 15 | 4.2 | |
| Chest Area | 5 | 1.4 | |
| Head Injury | 51 | 14.3 | |
| Multiple injuries | 141 | 39.5 | |
| Characteristics of injury | Fracture | 216 | 60.5 |
| Dislocation | 6 | 1.7 | |
| Laceration | 22 | 6.2 | |
| Abrasion | 59 | 16.5 | |
| Blunt abdominal injury | 54 | 15.1 | |
| Types of wound | Open wound | 87 | 24.4 |
| Closed wound | 219 | 61.3 | |
| Comminuted | 51 | 14.3 | |
| Classification of the Victims | Pedestrian | 177 | 49.6 |
| Driver | 84 | 23.5 | |
| Passenger | 93 | 26.1 | |
| Assistant Driver | 3 | 0.8 | |
| Time of Accident | Night time | 129 | 36.1 |
| Day time | 228 | 63.9 | |
| Type of vehicles | Isuzu | 42 | 11.8 |
| Motor Cycle | 153 | 42.9 | |
| Public Bus | 27 | 7.6 | |
| Minibus | 69 | 19.3 | |
| Bajaj | 66 | 18.5 | |
| Mechanism of injury | Fall down | 129 | 36.1 |
| Roll over | 84 | 23.5 | |
| Collision | 144 | 40.4 | |
| Mode of Transportation | Ambulance | 93 | 26.1 |
| Commercial Vehicle | 63 | 17.6 | |
| Police vehicle | 42 | 11.8 | |
| Private vehicle | 123 | 34.5 | |
| Carried by people | 36 | 10.1 | |
| The time it takes to initial HF | ≤ 1 hour | 177 | 49.6 |
| > 1 hour | 180 | 50.4 | |
| Place where the patient comes | Scene | 144 | 40.3 |
| Hospital | 171 | 47.9 | |
| Health Center | 27 | 7.6 | |
| Private institution | 12 | 3.4 | |
| Self | 3 | 0.8 | |
| The severity of injury | Minor injury | 51 | 14.3 |
| Moderate injury | 132 | 37 | |
| Severe injury | 174 | 48.7 |
Management and its outcomes
More than one-third (42%) of the victims never got any type of treatment before arriving to this referral hospital. Regarding the condition of the victim at the ED, 180 (50.4%) were unstable and six (1.7%) were dead on arrival. Furthermore, nearly half (48.7%) of them were resuscitated and about 37% were given analgesia. On triage paper, more than one-third (38.7%) of the victims were classified as Red and more than two-thirds (71.4%) of them received surgical treatment among which 22.8% were admitted to ICU. In addition, almost half (48.1%) of the patients who were admitted had mild GCS followed by moderate GCS 132 (37%) on admission. Almost two-thirds (62.2%) of patients admitted stayed in this hospital for less than two weeks followed by those who stayed between 15 to 24 days (20.2%) (Table 3).
Table 3.
Condition of the patient, management given, and average number of days the patient stayed in the hospital from March 2020 to April 2021, Jimma Ethiopia, 2021 (n = 357).
| Variables | Category | Frequency | Percent |
|---|---|---|---|
| Treatment at initial HF | Yes | 207 | 58.0 |
| No | 150 | 42.0 | |
| Type of treatment given initially | Basic FA | 36 | 10.1 |
| Resuscitation | 57 | 16.0 | |
| Analgesia | 81 | 22.7 | |
| Antibiotics | 39 | 10.9 | |
| Condition of the patient at ED | Stable | 171 | 47.9 |
| Unstable | 180 | 50.4 | |
| Died on arrival | 6 | 1.7 | |
| The care given in ED | Resuscitation | 174 | 48.7 |
| Analgesia | 132 | 37.0 | |
| Wound care | 21 | 5.9 | |
| Antibiotics | 30 | 8.4 | |
| Place where patient kept at ED | Triage | 129 | 36.1 |
| Red area | 138 | 38.7 | |
| Front evaluation | 63 | 17.6 | |
| Other* | 27 | 7.6 | |
| Type of treatment given | Conservative | 33 | 9.2 |
| Surgical | 255 | 71.4 | |
| Medical | 69 | 19.3 | |
| Type of Ward | Orthopedics | 85 | 33.3 |
| Surgery | 112 | 43.9 | |
| ICU | 58 | 22.8 | |
| Mental status (GCS) of the victim | 13-15 | 174 | 48.7 |
| 9-12 | 132 | 37 | |
| 3-8 | 51 | 14.3 | |
| Length of Hospital stay(in days) | ≤14 | 158 | 62.2 |
| 15-24 | 52 | 20.2 | |
| 25-34 | 32 | 12.6 | |
| ≥35 | 13 | 5 |
*Others: Those victims who were kept in waiting areas and had yellow category.
Note: HF; Health facility, ED; Emergency department, FA; First Aid, GCS; Glasgow Coma Scale.
About three fourth (71.4%) of the victims were admitted and 87 (24.4%) of them were sent home. However, about 12.6% of victims admitted with RTA had lost their lives including those who died on arrival (Table 4).
Table 4.
Disposition and discharge outcome of RTA patients at JUMC from March 2020 to April 2021, Jimma Ethiopia, 2021.
| Outcome | Category | Frequency | Percent |
|---|---|---|---|
| Disposition Outcome | Sent home | 87 | 24.4 |
| Admitted | 255 | 71.4 | |
| Referred | 6 | 1.7 | |
| Died on arrival | 6 | 1.7 | |
| Against Medical Advice | 3 | 0.8 | |
| Discharge outcome | Died | 45 | 12.6 |
| Improved | 303 | 84.9 |
On multivariate analysis, anatomical sites, mechanism of injury, time to reach an initial health facility, time of the day, condition of a patient at ED, type of treatment given, GCS at admission, and days spent in hospital were independent factors associated with unfavorable outcomes. Anatomical sites (head injury) (AOR= 7.72: 95% CI;1.29,46.13), fall down injury (AOR= 0.23; 95% CI: 0.08, 0.68), the time elapsed to reach nearby health facility (AOR= 3.30; 95 CI (1.13, 9.60), time of the day (AOR= 2.79; 95% CI; 1.06, 7.34), condition of a patient at ED (AOR= 7.78; 95% CI: 2.33, 26.06), GCS at admission (AOR= 20.12; 95% CI: 7.23,55.96) and days spent in hospital (AOR= 6.85; 95% CI 5.81, 8.06) had statistically proved associations with unfavorable outcome (Table 5).
Table 5.
Factors associated with management outcome of injury related to RTA at JUMC, Jimma, Southwest Ethiopia, 2021.
| Variables | Victims’ outcome (%) |
AOR (95% CI) | P-value | ||
|---|---|---|---|---|---|
| Favorable | Unfavorable | ||||
| Anatomical sites | Extremity | 44.7 | 7.7 | 1 | 0.03 |
| Pelvic area | 5.3 | 7.7 | 7.72(1.29,46.13) | ||
| Head injury | 13.2 | 23.1 | 16.61(3.85,71.71) | <0.01 | |
| Mechanism of Injury | Fall down | 17.9 | 38.5 | 0.23(0.08,0.68) | 0.01 |
| Roll over | 22.6 | 30.8 | 0.31(0.10,0.95) | 0.14 | |
| Collision | 38.7 | 15.4 | 1 | ||
| Time of accident | Night | 65.1 | 53.8 | 2.79(1.06,7.34) | 0.04 |
| Day | 34.9 | 46.2 | |||
| The time it takes | ≤ 1 hour | 54.7 | 15.4 | 1 | 0.03 |
| > 1 hours | 45.3 | 84.6 | 3.30(1.13, 9.60) | ||
| Condition of a patient at ED | Stable | 54.7 | 15.4 | 1 | <0.001 |
| Unstable | 45.3 | 84.6 | 7.78(2.33,26.06) | ||
| Type of Rx given | Conservative | 8.5 | 15.4 | 1 | |
| Surgical | 75.5 | 38.5 | 0.23(0.07,0.81) | 0.02 | |
| Medical | 16.0 | 46.2 | 1.15(0.31,4.19) | 0.84 | |
| Mental status (GCS) on admission | Mild | 51.9 | 23.1 | 1 | <0.001 |
| Moderate | 38.7 | 23.1 | 1.50(0.55,4.07) | ||
| Severe | 9.4 | 53.8 | 20.12(7.23,55.96) | ||
| Days spent in hospital | ≤ 14 days | 39.6 | 23.1 | 6.85(5.81,8.06) | <0.001 |
| > 14 days | 60.4 | 76.9 | 1 | ||
Discussion
Road Traffic Collisions have become a major public health and economic problem worldwide [13]. Many studies have revealed that there has been a rapid increase in the number of road traffic accidents in many developing nations including Ethiopia over the last several decades [14]. This study indicated that out of 357 RTA victims, the most commonly affected age group was 16-30 years, (42.0%) and more than three fourth (75.6%) of patients were male victims. This may be due to increased daily movement for work, and the increased level of participation in high-risk activities. Regarding the type of injury, a musculoskeletal fracture was the most frequent type of injury (60.5%) due to the fact that the majority of the study participants were motorcycle drivers and passengers who sustained collision injuries. Almost half (49.6%) of the victims were pedestrians in this study.
In multivariable logistic regression, the chances of unfavorable outcomes among patients who sustained a head injury were 17 times more than those who experienced other body injuries. This finding agrees with the study done in Saudi Arabia where the OR was 17 compared to this study (AOR=17.4) [15]. Prehospital delay > 1 hour before reaching the initial health facility increased the odds of unfavorable outcomes more than three times as compared to their counterparts. This study is lower than the study done in Shanghai, China where the OR was 34 compared to this study (AOR 34.4) [16]. This showed delay to visit nearby health institutions after injury increases the risk of complication and death due to heavy blood loss and damage of major organs. The collisions happening in dark conditions were almost three times more likely to cause unfavorable outcomes than those happening in daylight. This might be due to the fact that an accident that happens during night time is usually associated with severe injuries because the driver may get into sleep, substance use, and speed of the vehicle. Therefore, prehospital delays and the severity of injuries sustained at night point need for systems and infrastructure changes in Ethiopia.
Victims who were unstable during presenting to ED were eight times more chances of developing unfavorable management outcomes than their counterparts. This is associated with the severity of injury and multi-organ damage in these patients as manifested by derangement in vital signs. This study is in line with the study done in Dar es Salaam, Tanzania [17]. Moreover, the likelihood of death among patients who had low GCS or were in a deep coma during admission was twenty times more as compared to patients with mild GCS. This study is lower than the study done in Guinea where the OR was 39 compared to this study (AOR 38.7) [18]. The difference might be due to the fact that the study participants included in the later study were patients with traumatic brain injury secondary to motor vehicle accidents. This study is in line with the study done in Malawi compared to this study (AOR 39) [19]. This result suggests that patients with low GCS are highly liable for a bad outcome that could be due to major organ failure, especially severe head injury. Thus in patients who arrive at ED with lower GCS, clinicians should have a high index of suspicion for deterioration.
Conclusion
RTA represents a significant risk for morbidity and mortality in Ethiopia, of which head injury and multiple sites injury increase injury severity. The anatomical site, mechanism of injury, time to reach an initial health facility, time of the day, condition of a patient at ED, type of treatment given, GCS at admission, and days spent in the hospital were among independent predictors of management outcome. Targeted approaches to improving the care of the injured victims may improve outcomes. Thus, the clinician should take into consideration the clinical presentation of RTA and give due attention to the identified contributing factors in the management of RTA. Besides, law enforcers should also give emphasis on the identified type and mechanisms of accidents.
Dissemination of Results
The result of the study was submitted to Addis Ababa University, College of health science, school of Medicine, and Department of Emergency Medicine and Critical Care. It was also disseminated to JUMC, Jimma Zone Health Office, and other concerned and interested organizations. Finally, the result will be published in a renowned journal for public use.
Authors’ contribution
Authors contributed as follows to the conception or design of the work; the acquisition, analysis, or interpretation of data for the work; and drafting the work or revising it critically for important intellectual content: D.E. contributed 50%; A.A. 20%; T.B., F.A., and B.B. contributed 10% each. All authors approved the version to be published and agreed to be accountable for all aspects of the work.
Declaration of Competing Interest
The authors declared no conflicts of interest.
Funding Statement
Addis Ababa University covered the survey cost and there is no additional fund for this particular study.
Footnotes
These authors contributed equally to this work
References
- 1.Asefa F, Assefa D, Tesfaye G. Magnitude of, trends in, and associated factors of road traffic collision in central Ethiopia. BMC Public Health. 2014;14(1):1072. doi: 10.1186/1471-2458-14-1072. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Wang T, Wang Y, Xu T, Li L, Huo M, Li X, et al. Epidemiological and clinical characteristics of 3327 cases of traffic trauma deaths in Beijing from 2008 to 2017: a retrospective analysis. Medicine. 2020;99(1):e18567. doi: 10.1097/MD.0000000000018567. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Lugo LH, García HI, Cano BC, Arango Lasprilla JC, Alcaraz OL. Multicentric study of epidemiological and clinical characteristics of persons injured in motor vehicle accidents in Medellín, Colombia, 2009-2010. Colombia Medica. 2013;1:100–107. [PMC free article] [PubMed] [Google Scholar]
- 4.Alghnam S, Alkelya M, Alfraidy M, Al-bedah K, Albabtain IT, Alshenqeety O. Outcomes of road traffic injuries before and after the implementation of a camera ticketing system: a retrospective study from a large trauma center in Saudi Arabia. Ann Saudi Med. 2017;37(1):1–9. doi: 10.5144/0256-4947.2017.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Ashraf I, Hur S, Shafiq M, Park Y. Catastrophic factors involved in road accidents: underlying causes and descriptive analysis. PLoS one. 2019;14(10) doi: 10.1371/journal.pone.0223473. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Barrimah I, Midhet F, Sharaf F. Epidemiology of road traffic injuries in Qassim Region, Saudi Arabia: consistency of police and health data. IJHS. 2012;6(1):31–42. doi: 10.12816/0005971. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Vissoci JRN, Shogilev DJ, Krebs E, de Andrade L, Vieira IF, Toomey N, et al. Road traffic injury in sub-Saharan African countries: A systematic review and summary of observational studies. Traffic Injury Prevent. 2017;18(7):767–773. doi: 10.1080/15389588.2017.1314470. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Landes M, Venugopal R, Berman S, Heffernan S, Maskalyk J, Azazh A. Epidemiology, clinical characteristics and outcomes of head injured patients in an Ethiopian emergency Centre. African Journal of Emergency Medicine. 2017;7(3):130–134. doi: 10.1016/j.afjem.2017.04.001. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Hazen A, Ehiri JE. Road traffic injuries: hidden epidemic in less developed countries. J Natl Med Assoc. 2006;98(1):73–82. [PMC free article] [PubMed] [Google Scholar]
- 10.Azami-Aghdash S, Sadeghi-Bazargani H, Shabaninejad H, Gorji HA. Injury epidemiology in Iran: a systematic review. J Inj Violence Res. 2017:14. doi: 10.5249/jivr.v9i1.852. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Fite Robera Olana, Mesele Mamo, Wake Mathewos, Assefa Masresha, Tilahun Ayele. Severity of Injury and Associated Factors among Injured Patients Who Visited the Emergency Department at Wolaita Sodo Teaching and Referral Hospital. Ethiopia. Ethiop J Health Sci [Internet] 2020;30(2) doi: 10.4314/ejhs.v30i2.6. Mar 1 [cited 2021 Jun 4] [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.World Health Organization (WHO) WHO; Geneva, Switzerland: 2001. Injury Surveillance Guidelines. [Google Scholar]
- 13.Deresse E, Komicha MA, Lema T, Abdulkadir S, Roba KT. Road traffic accident and management outcome among in Adama Hospital Medical College, Central Ethiopia. Pan Afr Med J [Internet] 2021;38 doi: 10.11604/pamj.2021.38.190.11650. [cited 2021 Jun 4] [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Woldemichael K, Berhanu N. Vol. 21. South West Ethiopia; 2011. p. 11. (Magnitude and Pattern of Injury in Jimma University Specialized Hospital). [PMC free article] [PubMed] [Google Scholar]
- 15.Abolfotouh M, Hussein M, Abolfotouh S, Al-Marzoug A, Al-Teriqi S, Al-Suwailem A, et al. Patterns of injuries and predictors of inhospital mortality in trauma patients in Saudi Arabia. OAEM. 2018;10:89–99. doi: 10.2147/OAEM.S166026. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Yu W, Chen H, Lv Y, Deng Q, Kang P, Zhang L. Comparison of influencing factors on outcomes of single and multiple road traffic injuries: a regional study in Shanghai, China (2011-2014) PLoS ONE. 2017;12(5) doi: 10.1371/journal.pone.0176907. Xu J. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Lukumay GG, Ndile ML, Outwater AH, Mkoka DA, Padyab M, Saveman B-I, et al. Provision of post-crash first aid by traffic police in Dar es Salaam, Tanzania: a cross-sectional survey. BMC Emerg Med. 2018;18(1):45. doi: 10.1186/s12873-018-0199-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Delamou A, Kourouma K, Camara BS, Kolie D, Grovogui FM, El Ayadi AM, et al. Motorcycle accidents and their outcomes amongst victims admitted to health facilities in guinea: a cross-sectional study. Adv Prevent Med. 2020;2020:1–7. doi: 10.1155/2020/1506148. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Schlottmann F, Tyson AF, Cairns BA, Varela C, Charles AG. Road traffic collisions in Malawi: trends and patterns of mortality on scene. Malawi Med J. 2017;29(4):301–305. doi: 10.4314/mmj.v29i4.4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Deresse E, Komicha MA, Lema T, Abdulkadir S, Roba KT. Road traffic accident and management outcome among in Adama Hospital Medical College, Central Ethiopia. Pan Afr Med J. 2021;38:190. doi: 10.11604/pamj.2021.38.190.11650. PMID: 33995796; PMCID: PMC8106795. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Fite RO, Mesele M, Wake M, Assefa M, Tilahun A. Severity of injury and associated factors among injured patients who visited the Emergency Department at Wolaita Sodo Teaching and Referral Hospital. Ethiopia. Ethiop J Health Sci. 2020;30(2):189–198. doi: 10.4314/ejhs.v30i2.6. PMID: 32165808; PMCID: PMC7060375. [DOI] [PMC free article] [PubMed] [Google Scholar]