Temporal Instability of Factors Affecting Injury Severity in Helmet-Wearing and Non-Helmet-Wearing Motorcycle Crashes: A Random Parameter Approach with Heterogeneity in Means and Variances.

Not wearing a helmet, not properly strapping the helmet on, or wearing a substandard helmet increases the risk of fatalities and injuries in motorcycle crashes. This research examines the differences in motorcycle crash injury severity considering crashes involving the compliance with and defiance of helmet use by motorcycle riders and highlights the temporal variation in their impact. Three-year (2017-2019) motorcycle crash data were collected from RESCUE 1122, a provincial emergency response service for Rawalpindi, Pakistan. The available crash data include crash-specific information, vehicle, driver, spatial and temporal characteristics, roadway features, and traffic volume, which influence the motorcyclist's injury severity. A random parameters logit model with heterogeneity in means and variances was evaluated to predict critical contributory factors in helmet-wearing and non-helmet-wearing motorcyclist crashes. Model estimates suggest significant variations in the impact of explanatory variables on motorcyclists' injury severity in the case of compliance with and defiance of helmet use. For helmet-wearing motorcyclists, key factors significantly associated with increasingly severe injury and fatal injuries include young riders (below 20 years of age), female pillion riders, collisions with another motorcycle, large trucks, passenger car, drivers aged 50 years and above, and drivers being distracted while driving. In contrast, for non-helmet-wearing motorcyclists, the significant factors responsible for severe injuries and fatalities were distracted driving, the collision of two motorcycles, crashes at U-turns, weekday crashes, and drivers above 50 years of age. The impact of parameters that predict motorcyclist injury severity was found to vary dramatically over time, exhibiting statistically significant temporal instability. The results of this study can serve as potential motorcycle safety guidelines for all relevant stakeholders to improve the state of motorcycle safety in the country.

An Integrated Fuzzy Analytic Hierarchy Process (AHP) Model for Studying Significant Factors Associated with Frequent Lane Changing.

Frequent lane changes cause serious traffic safety concerns, which involve fatalities and serious injuries. This phenomenon is affected by several significant factors related to road safety. The detection and classification of significant factors affecting lane changing could help reduce frequent lane changing risk. The principal objective of this research is to estimate and prioritize the nominated crucial criteria and sub-criteria based on participants' answers on a designated questionnaire survey. In doing so, this paper constructs a hierarchical lane-change model based on the concept of the analytic hierarchy process (AHP) with two levels of the most concerning attributes. Accordingly, the fuzzy analytic hierarchy process (FAHP) procedure was applied utilizing fuzzy scale to evaluate precisely the most influential factors affecting lane changing, which will decrease uncertainty in the evaluation process. Based on the final measured weights for level 1, FAHP model estimation results revealed that the most influential variable affecting lane-changing is 'traffic characteristics'. In contrast, compared to other specified factors, 'light conditions' was found to be the least critical factor related to driver lane-change maneuvers. For level 2, the FAHP model results showed 'traffic volume' as the most critical factor influencing the lane changes operations, followed by 'speed'. The objectivity of the model was supported by sensitivity analyses that examined a range for weights' values and those corresponding to alternative values. Based on the evaluated results, stakeholders can determine strategic policy by considering and placing more emphasis on the highlighted risk factors associated with lane changing to improve road safety. In conclusion, the finding provides the usefulness of the fuzzy analytic hierarchy process to review lane-changing risks for road safety.

Assessment of Significant Factors Affecting Frequent Lane-Changing Related to Road Safety: An Integrated Approach of the AHP-BWM Model.

Frequent lane changes cause serious traffic safety concerns for road users. The detection and categorization of significant factors affecting frequent lane changing could help to reduce frequent lane-changing risk. The main objective of this research study is to assess and prioritize the significant factors and sub-factors affecting frequent lane changing designed in a three-level hierarchical structure. As a multi-criteria decision-making methodology (MCDM), this study utilizes the analytic hierarchy process (AHP) combined with the best-worst method (BWM) to compare and quantify the specified factors. To illustrate the applicability of the proposed model, a real-life decision-making problem is considered, prioritizing the most significant factors affecting lane changing based on the driver's responses on a designated questionnaire survey. The proposed model observed fewer pairwise comparisons (PCs) with more consistent and reliable results than the conventional AHP. For level 1 of the three-level hierarchical structure, the AHP-BWM model results show "traffic characteristics" (0.5148) as the most significant factor affecting frequent lane changing, followed by "human" (0.2134), as second-ranked factor. For level 2, "traffic volume" (0.1771) was observed as the most significant factor, followed by "speed" (0.1521). For level 3, the model results show "average speed" (0.0783) as first-rank factor, followed by the factor "rural" (0.0764), as compared to other specified factors. The proposed integrated approach could help decision-makers to focus on highlighted significant factors affecting frequent lane-changing to improve road safety.

Asymptomatic cecal perforation and ileocecal fistula after intrauterine device migration: a case report.

Implantation of an intrauterine device (IUD) is a common method for long-term contraception. However, IUDs can cause colon perforation and fistula formation. We report a case of cecal perforation and ileocecal fistula secondary to IUD migration. The present study investigated incidental identification of a missing IUD after 9 years of deployment in a 35-year-old female with a three-year history of infertility. Abdominal imaging revealed a missing IUD. Intracecal perforation and ileocecal fistula consequent of IUD migration were identified during surgical exploration. Limited ileocecal resection was performed as an appropriate and safe surgical option. IUD migration can present with serious complications. Patients considering IUDs should be educated about the importance of regular check-ups to monitor the position of the IUD. Thorough examination should be carried out if a missing IUD string is reported.

The incidence and predictors of pneumothorax among trauma patients in Saudi Arabia. Findings from a level-I trauma center.

OBJECTIVES: To investigate the incidence and predictors of traumatic pneumothorax using data from a Level-I trauma center in Riyadh, Saudi Arabia. METHODS: This is a retrospective chart-review study carried out in King Abdulaziz Medical City, Riyadh, Saudi Arabia. Data were extracted from the hospital's trauma registry (2016-2018). A total of 2,109 trauma patients were included. Inclusion criteria were patients ≥16 years  old admitted for a traumatic injury. Variables included patient demographics, transport mode, trauma team activation, mechanism of injury, mortality rate, Glasgow Coma Scale and Injury Severity Scores. A logistic regression analysis was constructed to evaluate potential predictors of pneumothorax. Results: Of 2,109 patients included from the trauma registry, 236 (11.2%) were diagnosed with pneumothorax. The majority of the study population was young (19-49 years) (60.7%) and male (79.4%.) Injury mechanism was significantly associated with the presence of pneumothorax (p greater than 0.001). Regression analysis indicated that the odds of having pneumothorax among intentional injury victims was 15 times higher than fall injury victims (OR=15.3, 95% CI= 7.2-32.9). Participants who sustained motor vehicle collision injuries had 3 times higher odds of developing pneumothorax than those who suffered fall injuries (OR=3.1, 95% CI= 1.5-6.1). Conclusion: The incidence of traumatic pneumothorax is sizable and highly associated with the mechanism of injury. Efforts to reduce motor vehicle collision burden should be directly associated with decreasing the burden of traumatic pneumothorax.

Effect of the Trauma Evaluation and Management module on the knowledge of senior medical students: a prospective cohort study

Background: Despite the high incidence of motor vehicle collisions and associated mortality rates in Saudi Arabia, formal trauma training and management for undergraduate medical students is not optimal. The aim of our study was to assess the effect of the Trauma Evaluation and Management (TEAM) module on trauma knowledge among senior medical students. Methods: Final-year medical students were recruited between September 2016 and May 2017 at King Abdulaziz University, Jeddah. They were allocated to 1 of 2 groups: 1 group was exposed to the TEAM module, and the other was not (control group). We employed a widely used 20-item multiple-choice standardized questionnaire to assess trauma-related knowledge of both groups. Results: Our study included 136 participants, 68 in the TEAM module group and 68 in the control group. The mean scores for trauma-related knowledge were 68.4% (standard deviation [SD] 15.63%) and 45.4% (SD 19.52%), respectively. Linear regression analysis showed that the TEAM module participants scored 23% higher on the test than the control participants (ß = 22.94%, 95% confidence interval 16.94%­28.94%). Conclusion: Mean test scores were significantly higher for those who completed the TEAM module than for those who did not. We highly recommend incorporating the TEAM module into the formal medical curriculum at all Saudi universities.

Contexte: Malgré la forte incidence des accidents de la route et la mortalité qui y est associée en Arabie saoudite, la formation formelle au traitement et à la prise en charge en traumatologie chez les étudiants en médecine de premier cycle laisse à désirer. Notre étude avait pour but d'évaluer l'effet du module TEAM (Trauma Evaluation and Management) sur les connaissances en matière de traumatologie acquises par les étudiants en médecine de niveau avancé. Méthodes: Durant leur dernière année de formation, des étudiants en médecine ont été recrutés entre septembre 2016 et mai 2017 à l'Université du roi Abdulaziz, à Djeddah. On les a assignés à 1 de 2 groupes : un groupe a été exposé au module TEAM, et l'autre non (groupe témoin). Nous avons utilisé un questionnaire à choix multiples standardisé en 20 points pour évaluer les connaissances des 2 groupes en matière de traumatologie. Résultats: Notre étude a regroupé 136 participants, 68 dans le groupe exposé au module TEAM et 68 dans le groupe témoin. Les scores moyens en ce qui concerne les connaissances en traumatologie ont été de 68,4 % (écart-type [É.-T.] 15,63 %) et de 45,4 % (É.-T. 19,52 %), respectivement. L'analyse de régression linéaire a révélé que les participants exposés au module TEAM ont obtenu des résultats de 23 % supérieurs aux participants du groupe témoin (ß = 22,94 %, intervalle de confiance à 95 % 16,94 %­28,94 %). Conclusion: Les scores moyens aux tests ont été significativement plus élevés chez les participants ayant complété le module TEAM que chez les autres. Nous recommandons fortement d'intégrer le module TEAM au programme de formation médicale dans toutes les universités de l'Arabie saoudite.

Substance abuse at early age as a potential risk factor for driving under the influence of substance in Jeddah, Saudi Arabia: A cross-sectional study.

OBJECTIVE: Worldwide, trauma is a major health problem, and road traffic accidents (RTAs) are the primary cause of death among young men in Saudi Arabia. The aim of our study was to estimate the extent of driving under the influence of an abused substance in Saudi Arabia and to explore the associated factors. METHODS: This is a cross-sectional survey conducted between May and September 2016 at Al-Amal Hospital in Jeddah, Saudi Arabia, a referral center for addiction. We included all patients who were admitted for additional education and rehabilitation and had no psychotic symptoms. We used a standardized and pretested questionnaire to collect data regarding sociodemographic and socioeconomic characteristics, history of and current substance abuse, driving under the influence of an abused substance, injuries, imprisonment, and fatalities under the influence of an abused substance. Whenever possible, we compared self-reported data with medical records and resolved any conflict by discussion with the patient. RESULTS: A total of 101 out of 112 invited patients participated in our study (90.2%). The mean age of the participants was 33.28 years (SD = 9.46 years). Of the total, 93.1% (n = 94) drove under the influence of an abused substance. Amphetamines and alcohol were the first substance abused (56.4% [n = 57] and 25.7% [n = 26] of patients, respectively). As currently abused substances, amphetamines and cannabis were reported in 38.6% (n = 39) and 24.8% (n = 25) of participants, respectively. The mean age at the time of the first substance abuse was 18.76 years (SD = 4.99 years). In the univariate regression (odds ratio [OR] = 0.86; 95% confidence interval [CI], 0.75-0.99; P = .046) but not the multivariate regression (OR =0.87; 95% CI, 0.75-1.00; P = .056), a younger age at the time of the first substance abuse was associated with a higher probability of driving under the influence of an abused substance. CONCLUSIONS: Our study showed that among individuals hospitalized due to substance abuse problems, driving under the influence of drugs and alcohol was common. Preventive measures to reduce driving under the influence should be introduced in addition to specialized hospitals. Further research is required to investigate the factors associated with driving under the influence of abused substances in Saudi Arabia.

No benefit to surgical fixation of flail chest injuries compared with modern comprehensive management: results of a retrospective cohort study.

BACKGROUND: Chest wall trauma is a common cause of morbidity and mortality. Recent technological advances and scientific publications have created a renewed interest in surgical fixation of flail chest. However, definitive data supporting surgical fixation are lacking, and its virtues have not been evaluated against modern, comprehensive management protocols. METHODS: Consecutive patients undergoing rib fracture fixation with rib-specific locking plates at 2 regional trauma centres between July 2010 and August 2012 were matched to historical controls with similar injury patterns and severity who were managed nonoperatively with modern, multidisciplinary protocols. We compared short- and long-term outcomes between these cohorts. RESULTS: Our patient cohorts were well matched for age, sex, injury severity scores and abbreviated injury scores. The nonoperatively managed group had significantly better outcomes than the surgical group in terms of ventilator days (3.1 v. 6.1, p = 0.012), length of stay in the intensive care unit (3.7 v. 7.4 d, p = 0.009), total hospital length of stay (16.0 v. 21.9 d, p = 0.044) and rates of pneumonia (22% v. 63%, p = 0.004). There were no significant differences in long-term outcomes, such as chest pain or dyspnea. CONCLUSION: Although considerable enthusiasm surrounds surgical fixation of flail chest injuries, our analysis does not immediately validate its universal implementation, but rather encourages the use of modern, multidisciplinary, nonoperative strategies. The role of rib fracture fixation in the modern era of chest wall trauma management should ultimately be defined by prospective, randomized trials.

CONTEXTE: Les traumatismes à la paroi thoracique sont une cause courante de morbidité et de mortalité. Dernièrement, des avancées technologiques et des articles scientifiques ont ravivé l'intérêt à l'égard du traitement chirurgical du volet costal. Les données fiables appuyant la fixation chirurgicale sont toutefois rares, et les avantages de cette technique n'ont pas été comparés à ceux de protocoles de prise en charge complets et modernes. MÉTHODES: Nous avons jumelé des patients consécutifs admis dans 2 centres régionaux de traumatologie entre juillet 2010 et août 2012 pour une fixation d'une fracture des côtes à l'aide de plaques verrouillées avec un groupe témoin rétrospectif présentant des blessures de type et de gravité semblables, toutefois pris en charge selon des protocoles multidisciplinaires modernes ne nécessitant aucune intervention chirurgicale. Nous avons ensuite comparé les issues à court et à long terme dans ces cohortes. RÉSULTATS: Les cohortes étaient bien appariées sur le plan de l'âge, du sexe et des indices de gravité des blessures. Les résultats des patients n'ayant pas subi d'intervention chirurgicale étaient significativement meilleurs que ceux de l'autre groupe en ce qui concerne le nombre de jours sous ventilation assistée (3,1 c. 6,1; p = 0,012), la durée du séjour aux soins intensifs (3,7 c. 7,4 jours; p = 0,009), la durée totale du séjour à l'hôpital (16,0 c. 21,9 jours; p = 0,044) et le taux de pneumonie (22 % c. 63 %; p = 0,004). Aucune différence significative n'a été observée en ce qui concerne les répercussions à long terme telles que les douleurs thoraciques ou la dyspnée. CONCLUSION: Si la fixation chirurgicale des blessures au volet costal suscite un grand enthousiasme, les résultats de notre analyse n'appuient pas le recours systématique à cette intervention, mais encouragent plutôt l'utilisation de stratégies modernes multidisciplinaires sans intervention chirurgicale. En conclusion, le rôle de la fixation des fractures des côtes dans la prise en charge moderne des traumatismes à la paroi thoracique devrait être défini dans le cadre d'études prospectives randomisées.

A short 4-cm oesophageal myotomy relieves the obstructive symptoms of achalasia.

OBJECTIVE: Controversy still persists regarding the ideal length of myotomy to treat oesophageal achalasia. This investigation reports the effects of a short myotomy with an added partial fundoplication for reflux prevention. METHODS: From 1997 to 2007, 22 patients (13 men, 9 women, median age: 41 years) with achalasia underwent a 6-cm short myotomy (four oesophagus and two stomach) with a Belsey partial fundoplication by left thoracotomy. Assessments include clinical and radiological evaluation, radionuclide transit studies, manometry, 24-h pH and endoscopy. RESULTS: No morbidity and no mortality occurred. Median follow-up is 54 months (range: 4-139 months). Dysphagia present in all 22 patients left an episodic slow emptying sensation in three patients after operation (p<0.001). Fresh food regurgitation decreased significantly after the myotomy (17 pre-, four post-regurgitation, p<0.001). Heartburn present in four patients before the operation was recorded in nine patients postoperatively (p=0.179). Radiologically, barium stasis decreased significantly from 85% to 30% (p=0.007). No diverticular formation was seen in the myotomy zone. On the oesophageal scintigram, stasis at 2 min decreased from a median of 60% before the operation to 16% (p<0.001). The lower oesophageal sphincter (LOS) gradient decreased from 30 to 9.7 mmHg (p<0.001). LOS relaxation improved from 40% pre- to 93% postoperatively (p=0.003). Endoscopies and biopsies documented increased mucosal damage after the operation (one preoperative, 13 postoperative; p<0.001). CONCLUSIONS: When treating achalasia, the myotomy, despite being shortened in length, reduces the LOS gradient, relieves obstructive symptoms and improves oesophageal emptying. The LOS relaxation is improved. Complete coverage of the myotomysed zone by the fundus prevents diverticular formation. Oesophageal mucosal damage from reflux is significant despite the partial fundoplication.

Thoracic actinomycosis presented with tracheoesophageal fistula and fatal pulmonary infection.

We report a case of a 60-year-old Saudi woman who developed tracheoesophageal fistula and fatal pulmonary infection secondary to thoracic actinomycosis. The cause, clinical presentation, radiological features and treatment of thoracic actinomycosis are discussed.