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INTRODUCTION@#Metro Manila, the metropolitan center and seat of the national government, is composed of 16 cities and 1 municipality, and considered as the second-most populous region in the Philippines. Transport is a key sector that is needed for accessibility and economic progress. Yet, the question on safety of the roads of Manila remains as road crashes continue to be reported.@*OBJECTIVE@#The study aims to determine the trend of road crashes in Metro Manila, and the factors associated with both fatality and injury among three types of road users – the drivers, the passengers, and the pedestrians.@*METHODS@#A retrospective analysis of 523,059 road crash data between 2016 to 2020 was done. Using descriptive statistics, the road crash variables analyzed in the study were (1) crash classification according to damage to property, fatal, and non-fatal crash, (2) road user type according to driver, passenger, and pedestrian, (3) vehicle type, (4) junction type, and (5) risky road user behavior. Logistic and multinomial regression models were used to determine whether these variables were significant with road user fatality and injury.@*RESULTS@#The analysis of the MMARAS database (n=523,059) showed an increasing trend of road crashes occurred since 2016 and peaked in 2019, and declined in 2020. Majority (436,367, 83.426%) were damage to property, followed by non-fatal or injurious cases (84751, 16.203%) and fatal outcomes (1941, 0.371%). Drivers have the greatest number of fatalities and injuries compared to passengers and pedestrians. Cars (513482 52.322%) and motorcycles (136641, 13.923%) remain the major types of vehicles involved in road crashes. The factors that were significantly associated with increased odds ratio for driver death were involvement of pedicabs (OR=10.937, p=0.000), motorcycles (OR=55.061, p=0.000), bus (OR=5.835, p=0.000), truck (OR=7.073, p=0.000), hit object (OR=11.007, p=0.000), self-accident (OR=6.149, p=0.000), and collisions in bridges/flyovers (OR=2.713, p=0.010)). The factors that were significantly associated with increased odds ratio for passenger fatality were the involvement of motorcycle (OR=3.75, p=0.021), angle impact (OR=42.01, p=0.002), multiple collision (OR=18.42, p=0.040), self-accident (OR=32.66, p=0.010), and lost control (OR=82.98, p=0.001). The factors significantly associated with pedestrian fatality were hit and run (OR=56.04, p=0.000), hit pedestrian (OR=1085.17, p=0.000), and crashes in bridges/flyover (OR=4.20, p=0.025). Meanwhile, multinomial regression showed that classification of crash and vehicle type were significantly associated with fatal and non-fatal crashes.@*CONCLUSION@#The study showed the trend of fatality and injury among drivers, passengers, and pedestrians from 2016-2020, and factors of road crashes in Metro Manila including vehicle type, road behaviors, collision type and junction type.
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@#<p style="text-align: justify;"><strong>Introduction.</strong> The ever-increasing global road traffic accidents is caused by several risk factors: human factors, vehicle factors, and road environmental factors. In the Philippines, 12,000 road users die annually due to road crashes and almost one-third are alcohol-related crashes.<br /><br /><strong>Objectives.</strong> This study aims to investigate the effects of suspected alcohol intoxication on the severity of injuries among drivers and passengers in a major urban region in the Philippines using the Metro Manila Accident Recording and Analysis System (MMARAS) of the Metropolitan Manila Development Authority from 2005 to 2020.<br /><br /><strong>Methods.</strong> The Metro Manila Accident Recording and Analysis System (MMARAS) was used to determine the data on trends and association for alcohol-related road crashes, while descriptive and inferential statistics such as logistic and multinomial regression were used to determine trends and associations.<br /><br /><strong>Results.</strong> Suspected alcohol intoxication road crash cases in Metro Manila have decreased from 45 cases in 2005 to 31 cases in 2020. The year 2011 recorded the highest cases of alcohol-suspected road crashes. The years 2010, 2011, and 2012 recorded the highest number of driver's death while 2005, 2006, 2014, and 2019 recorded higher deaths for passengers. Cars and motorcycles are the most commonly involved vehicles in alcohol-suspected road crashes, while Quezon City (n=307) and Marikina City (n=267) are the common places of incidence for drunk-driving accidents. On the other hand, alcohol intoxication increases the risk of driver's death (OR=9.16; 95% CI [5.388-15.574]) and injury (OR=5.22; 95% CI [4.487-6.074]). While intoxicated, hitting an object (OR = 12.557; 95% CI [1.478-106.694]) and truck collisions (OR=7.176; 96% CI [1.261-40.817]) can increase the risk for driver's death. Meanwhile, side swipe (OR=2.330; 95% CI [1.029-5.277]) and angle impact (OR= 7.972; 95% CI [1.804-35.227]), increase the odds for driver injuries.<br /><br /><strong>Conclusion.</strong> Suspected alcohol intoxication road crashes can be prevented; however, a collaborative effort is needed. The government is responsible for road safety education as well as effectively enforcing road safety-related laws, while the road users shall use the roadways responsibly.</p>
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OBJECTIVE@#This study aimed to evaluate the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of a handheld Near Infrared Spectroscopy (NIRS) device (Infrascanner 2000®) in detecting intracranial hemorrhage in mild, closed traumatic brain injury patients in the emergency room setting.@*METHODS@#This prospective study evaluated the diagnostic validity of a NIRS device in hemodynamically stable patients with mild, closed traumatic brain injury. The authors included patients aged 15 to 65 years who were consecutively admitted to the Emergency Department of the Philippine General Hospital from June 2017 to September 2017. Patients were scanned by a trained research assistant with the NIRS device in the frontal, temporal, parietal, and occipital areas of the brain bilaterally. A cranial computed tomography scan was used as a reference standard for comparison.@*RESULTS@#A total of 83 participants with mild, closed traumatic brain injury were included in the final analysis. There were 68 (82%) males, and the mean age was 29.52 years old. Of the 83 participants, 41 had intracranial hemorrhages (23 subdural, 13 epidural, 5 intraprenchymal). The NIRS device exhibited a sensitivity, 85.37% [55-96.19%]; specificity, 92.86% [85.07-100.00%]; PPV, 92.12% [83.53-100.00%]; NPV, 86.67% [76.74-96.60%]; PLR, 11.96 [3.99- 35.82]; and NLR, 0.16 [0.07-0.33].@*CONCLUSION@#The NIRS device can reliably screen for hemorrhages in patients with mild, closed traumatic brain injury using CT scan results as the gold standard. These diagnostic values suggest the potential role of the NIRS device in the early evaluation of patients with traumatic brain injury requiring urgent care.
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Introduction@#Mobility in the Philippines has increasingly become a major issue especially with the growing economy of the country. Collisions on the road cannot be entirely avoided; thus, we focus our efforts to reducing road crashes that result in death and serious injuries. To do this, we analyzed road crash patients brought to the Philippine General Hospital (PGH). @*Objective@#The study aimed to quantify how crash factors affect length of hospital stay (LOS) of patients brought to PGH, as well as to look for associations between the LOS and demographic and clinical variables. @*Methods@#This is a retrospective study using database of patients admitted in PGH from 2008 to 2017. The study focused on LOS, which was used as the dependent variable for Poisson regression and Kruskal-Wallis H tests. The determinants considered in the study are socio-demographic variables such as age, sex, civil status, victim type, vehicle type, patient classification, and region of incidence, as well as clinical variables such as consult type, outcome of the patient, body parts injured, Glasgow coma score (GCS), among others. @*Results@#We analyzed data of 4979 road crash patients from the PGH database. We found that civil status, age, patient classification, vehicle type, and province were associated with LOS. For the clinical variables, consult type, primary service, outcome of patient, body injuries, GCS and systolic blood pressure were found significant. Poisson regression suggests longer hospital stay for patients with injuries sustained in the head and neck (RR = 1.102, p < 0.001), face (RR = 1.218, p < 0.001), and extremity (RR = 1.673, p < 0.001). @*Conclusion@#Results show that injury sustained in certain parts of the body such as head and neck, face, and extremity significantly affect LOS. Results also show that subgroups within demographic variables affect LOS. There is a need to address the ever-increasing number of road crash patients and implications to length of hospitalization.
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Tempo de InternaçãoRESUMO
Introduction@#Around 1.35 million people die due to road traffic accidents yearly. In the Philippines, there is an increasing trend of mortality and morbidity caused by road crashes. @*Objective@#The objective of the study is to show the epidemiology of transport and vehicular crash (TVC) cases in the Philippines using the Department of Health (DOH) Online National Electronic Injury Surveillance System (ONEISS) from 2010 to 2019. @*Methods@#We used data from ONEISS, a web-based system to electronically capture injury-related data from health facilities, store data in a centralized and secure location, process and consolidate data, and transform this data into meaningful information. For Transport and Vehicular Crash cases, risk factors such as drug use, alcohol use, mobile phone use, seatbelt, and helmet use are included. There are also data on vehicle type, place of crash, and activity. Descriptive and inferential statistics were computed to explore and analyze the ONEISS dataset, particularly the epidemiology of transport and vehicular crashes (TVC). @*Results@#There were a total of 296,760/894,989 (31%) patients admitted due to transport and vehicular crash (TVC) based on the 10-year data from ONEISS (2010–2019). There was an increasing trend in the number of transport/ vehicular crashes (TVC) during this period, with an average increase of 25.58% cases per year. Most victims were drivers (45.6%), males (72.5%), and from the younger age group (0-30 years old). Fatal crashes were observed to occur from 6:00 pm to 5:00 am while most accidents occurred during leisure activities (32.5%). The highest reported contributing factor was drunk driving (n = 25,537). There was observed low compliance on the use of vehicular safety equipment. The most common types of injuries for the TVC victims were abrasions, contusions, burns, and concussions while the vehicle most involved in TVC was the motorcycle. Motorcycle use was found to be associated with worse emergency room (ER) outcomes (p <.0001) and the highest injury types such as multiple injuries, abrasion, avulsion and burn. Alcohol use was also significantly associated with multiple injuries, abrasion, avulsion, burn, open fracture, open wound, and amputation (p < 0.05). @*Conclusion@#The trend of road traffic vehicular crashes affecting mainly the younger population has economic repercussions. Motorcycles are also most involved in crashes, hence, the need for motorcycle safety laws in the country. There is also a need to strengthen current laws and legislation governing road safety and to focus on structuring a systematic post-crash response for both the local government and hospitals throughout the Philippines.
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Acidentes de Trânsito , Intoxicação AlcoólicaRESUMO
Introduction@#Trauma scoring standardizes the severity of injuries of patients brought to trauma centers and is predictive of the outcome or prognosis among trauma victims. Hence, creating a trauma score allows for proper prioritization as well as proper management of patients in the emergency departments. @*Objectives@#The objective of the study is to come up with a trauma scoring system that correlates to the probability of survival of a patient using the patient databases in major hospitals in the Philippines representing the three major island groups, Luzon, Visayas, and Mindanao. The study will also compare this proposed trauma scoring system with the gold standard (Revised Trauma Score) developed by Champion in 1989. @*Methods@#The proposed Philippine Trauma Scoring System (PTSS) was based on data from the eight largest tertiary hospitals catering to trauma patients. A total of 40,286 patient charts were reviewed. The proposed trauma scoring system integrates concepts used in the Revised Trauma Score (RTS), with addition of age (from Kampala Trauma Scoring), as well as the Injury Score (based on the number of body parts injured). This proposed scoring system was weighted, using logistic regression to come up with coefficients for the components of the PTSS for a more accurate prediction of patient survival. The Receiver Operating Characteristic (ROC) was used to plot Sensitivity vs. 1-Specificity. In this analysis, ROC was used to evaluate and compare how good the models are in predicting patient recovery.@*Results@#The components of GCS, RR, SBP, age, and body parts injured were significant predictors of patient outcomes for patients with trauma, specifically the road crash patients in this Philippine study. This study showed that both the PTSS and RTS have a significantly greater area under the curve than the diagonal reference line, which means that both the scoring system have a significant predictive value. The best predictive value, however, comes from the proposed scoring system that is developed from this study in the Philippines. Compared to the gold standard, PTSS Model 1 is a better predictor of outcomes than the gold standard RTS (ROC-AUC = 0.659 vs. 0.633) using only 22,214 valid subject population that contained all the variables needed for the PTSS analysis. @*Conclusion@#In a developing country like the Philippines, there are limited resources especially in the healthcare setting. Therefore, it is important to lessen errors in triaging which may result in resource waste and a higher risk of adverse outcomes for the patients. Thus, the PTSS developed in this study can be used by Philippine hospitals as it is uniquely based on Filipino patients using a large database representative of the eight largest tertiary hospitals in the Philippines. The proposed PTSS is shown in this study as the best classifier for patient outcome compared to the gold standard – RTS of Champion.
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TriagemRESUMO
Introduction@#Globally, the number of people who die from road crashes continues to rise, reaching a high of 1.35 million in 2016. Due to this continued increase in fatalities and injuries within the road transport system, especially in low- and middle-income countries, 2011 to 2020 was declared by the United Nations General Assembly in 2010 as the Decade of Action for Road Safety. @*Objectives@#This study looked into the epidemiology of road crashes and injuries in Metro Manila over ten years, from 2008-2017, from data gathered at the Department of Surgery of the Philippine General Hospital (PGH). @*Method@#A retrospective review of patients’ clinical records was conducted to describe the epidemiology of road crash cases in the Trauma Division, Department of Surgery of the PGH. Clinical records of the road crash patients admitted to the division over the ten years, January 1, 2008, to December 31, 2017, were extracted from the Integrated Surgical Information System (ISIS). @*Results@#A total of 422 patients were admitted to the PGH Department of Surgery and recorded in the ISIS database, from 2008 to 2017, who suffered from road crashes in Metro Manila. Most of these patients (80.8%) were male. The mean age of patients was 32.4 years. The highest number of admissions (27.5%) and road crash deaths (6.9%) were in 2016; the highest number was from the city of Manila (26.7%), and most happened at nighttime (61.8%) between 6:00 PM and 5:59 AM. Throughout the years, motorcycle (52.8%) was the vehicle type involved. Among patients with helmet use information, 65.4% were not wearing helmets, 91.2% had a history of alcohol intake. The majority incurred multiple injuries (82.7%), with the external region (53.8%) as the most common. Patients who sustained injuries to their head and neck region were five times more likely to die and six times more likely to have an unchanged patient outcome than those who did not have these injuries. Patients who had a GCS of 8 and below or those who had severe brain injuries were eight times more likely to die and six times more likely to have an unchanged patient outcome. @*Conclusion@#This study looked into the epidemiology of road crash cases admitted to the Surgery Department of the PGH. Road crash injuries and deaths remain a growing concern among the citizens of Metro Manila. It is hoped that the results of this study will provide policymakers with an objective and data-driven perspective on road crashes.
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Acidentes , PacientesRESUMO
Introduction@#Road traffic injuries are among the leading causes of preventable death, claiming around 7000 lives every year. Furthermore, road traffic can injure or disable thousands more every year in the Philippines. @*Objectives@#This study determined the hospital length-of-stay patterns and risk factors for a prolonged length of stay in a tertiary hospital after road traffic injury. @*Methods@#A retrospective cohort study was conducted to determine the determinants of the length of stay in the Philippine General Hospital (PGH) among road traffic injury victims for the year 2016. Length of stay was recorded according to the median. The other variables were cross-tabulated against the length of stay, and each of their crude odds ratios along with corresponding p-values were presented. Continuous variables were analyzed using Wilcoxon Mann-Whitney U-test. The predictor model for the determinants of prolonged length of stay in the hospital was built using forward selection. Likelihood-ratio test was used to compare the model with and without the exposure variable. @*Results@#A total of 427 road traffic injury victims were admitted to the Philippine General Hospital in 2016. The mean age of the patients was 31.55 years (±14.97) with a median age of 29 years. The majority of patients were males (82.4%) and single (60.8%). Most patients were riding a motorcycle during the time of the accident (64.2%) while 20% were pedestrians. The majority of the victims were intoxicated (74.3%) and were not using helmets (57.1%) at the time of the accident. Most of the victims received first aid (69.2%) and the mean time of admission was 3.03 (±13.31) days while the median time to admission was 12 hours. Receiving first aid (p<0.01), availed services (p<0.01), and married civil status (p=0.04) were found to be strongly associated with length of hospital stay. Without controlling for any confounders, pay patients (OR = 3.46, 95% CI: 1.3, -9.87), elective patients (OR = 7.88, 95% CI: 2.64, 31.61), and those in non-trauma wards (OR=2.07, 95% CI: 1.29, 3.36) had higher odds for longer hospitalization stay. On the other hand, those who did not receive first aid (OR = 0.55, CI:0.35, 0.85) had lower odds for prolonged hospitalization. Those who suffered face injury and did not suffer external injuries had a higher mean rank, suggesting a longer length of hospital stay. On the other hand, upon controlling variables found to be associated with previous studies, those with low Glasgow coma scale (GCS) scores were 2.77 times (95% CI: 1.13, 6.91) more likely to stay longer in the hospital. @*Conclusion@#The type of victim, mortality status, age, and sex were found to be important determinants of prolonged hospitalization. To lessen the number of fatalities and road trauma injuries, laws on road safety should be strictly and properly implemented. Shared responsibility of all road users is also important in improving the safe usage of roads.