The Prevalence, Severity And Pattern Of Head Injury Among Motorcycle Crash Victims At Kenyatta National Hospital

Abstract

Introduction. Motorcycles represent the most dangerous form of motorized transportation, and their increased use has been associated with a rise in motorcycle related crashes. In last decade, Kenya witnessed an explosion of motorcycle numbers and a concomitant increase in motorcycle crash-related deaths and injuries has been noted. Head injury is the main cause of death, severe morbidity and long-term disability among motorcyclists. However, few hospital based studies have been conducted to evaluate the prevalence and severity of motorcycle crash related-head injuries (MCR-HIs) and none has determined the pattern of head injuries in this patient population in Kenya. Objectives. This study aimed to determine the burden, evaluate severity and describe the pattern of MCR-HIs at Kenyatta National Hospital (KNH). The rate of helmet use among MCR-HI patients was also estimated. The desired outcome is prevention and reduction of motorcycle crash related head injuries, mortality and disability among motorcyclists in Kenya. Methodology. Sixty consecutive patients with motorcycle accident related head injury seen between 5th December, 2017 and 28th February, 2018 were prospectively studied using a predesigned questionnaire. Data analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0 software. Results. Head injury was present in 30.3% (n=60) of the patients with motorcycle crash injury (MCI) who presented to KNH during the study period. MCR-HI represented 25.0% of the total head injuries attended during the same period. Motorcycle operators (37, 61.7%) formed the largest proportion of patients with MCR-HI. Fifty-five (91.7%) subjects were male and the mean age was 29.4 years (SD 14.4 years, range 4 to 67 years), with majority (21, 35.0%) falling in the age group 20 – 29 years. More than two-thirds (44, 73.3%) of the patients were in the economically active age group (i.e. 20 - 49 years). There was a significant proportion of children younger than 10 years (8, 13.3%) and these made up 61.5% of the pedestrians. Motorcycle-vehicle collision (21, 35.0%) was the most common accident type. Thirty-nine (65.9%) of the patients had mild head injury, while seven (11.7%) and fourteen (23.3%) incurred moderate and severe head injury, respectively. Intracranial UNIVERSITY OF NAIROBI vi haemorrhage (42, 70.0%) was the most common craniocerebral injury type, with cerebral contusions (36, 63.2%) constituting the majority. Scalp injury (34, 56.4%), and skull fracture (31, 51.7%) were the other significant injuries. There was a notable low helmet use rate (11, 23.4%) among motorcyclists with MCR-HI, which was worse among passengers (1, 10.0%). Helmet use reduced the rate of severe head injury, scalp injury, skull fracture and extradural hematoma. However, helmets were not protective against cerebral contusions. Limb injuries represented the most common non-craniocerebral injury associated with MCR-HI. Conclusion. MCR-HI is an important public health problem in Kenya. Being a preventable injury, every effort is needed to eradicate it. Helmet use among motorcyclists with MCR-HI is low, especially amongst passengers. Though protective against head injury, the helmet’s efficacy has significant limitations. Therefore, measures to prevent MCR-HIs should not promote helmet use in isolation. Effective prevention efforts must, instead, be more holistic to include promotion of safe riding habits and behaviour, as well as enforcement of road traffic regulations. Limitations. This study has the following important limiting factors; small sample size, recall bias, single-site study, and pre-hospital deaths.