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Op e n Ac c e ss
F u l l L e n g t h A r t i c l e
Motorcycle Accidents, A Real Burden & Challenge of Health
Care System in Tertiary Care Hospital
Ali Akhtar1, Muhammad Shoaib2, Ali Shami3
Associate Professor, Dept. of Orthopedics, Pakistan Institute of Medical Sciences, Islamabad
Postgraduate Resident, Dept. of Orthopedics, Pakistan Institute of Medical Sciences, Islamabad
Assistant Professor, Dept. of Orthopedics, Pakistan Institute of Medical Sciences, Islamabad
(Shaheed Zulifqar Ali Bhutto Medical University Islamabad)
A B S T R A C T
Objectives: To find out the incidence, modalities, reasons of injuries and existing burden of motorcycles trauma in the
Orthopedics department, of a tertiary care Hospital.
Patients and Methods: This study was performed among patients that presented to the department of orthopedic
surgery unit II, via accident and emergency from 1st September 2015 to 1st December 2015. Patients of both gender, age
above 11 years, presented in emergency calls of unit II were included in the study. All patients were initially managed as
per “Advance Trauma and Life Support” principles in Emergency department of PIMS and later either discharged or
admitted.
Results: Total 973 patients were categorized into four major groups, including 709 road traffic accidents, 186 incidental
traumas, 29 assaults and 49 miscellaneous injuries. Road traffic accidents which were 73% of a total number of cases
had a major share in the data. Among these 709 patients of road traffic accidents, 71% cases were the motorcycle
riders. Among all motorcycle accidents, 36% riders were between 16 years to 25 years of age and the most grievous
trauma was seen in this age group. Regarding license holding age, only 34% people had a driving license while
remaining all were without a license.
Conclusions: The motorcycle trauma ranges from minor abrasions to the long live disability. It is a huge percentage
among all types of trauma and casualties showing the burden on the health system and ultimately the families who
would be end sufferers. Younger population is more prone to the grievous injuries that ultimately pertain for a long time
or some of them would be living with the permanent disability.
Key Words: Disability, Fractures, Motorcycles, Trauma
Author`s Contribution
1,3Active participation in active methodology,
Review the Study,
2Synthesis and Planning of the research
1,2Conception-, Interpretation and discussion
Address of Correspondence
Dr. Muhammad Shoaib
drmshoaib@hotmail.com
Article info.
Received: Dec 29, 2016
Accepted: May 21, 2017
Cite this article: Akhtar A, Shoaib M, Shami A. Motorcycle Accidents, A Real Burden &
Challenge of Health Care System in Tertiary Care Hospital. JIMDC. 2017; 6(2):95-99.
Funding Source: Nil
Conflict of Interest: Nil
I n t r o d u c t i o n
Mankind has been progressing towards the prosperity and
financial stability since its beginning. Transport and roads
are the cardinal facts and truths of this development. As
the development has been progressing, the population
per unit area is increasing. Ultimately the frequent and
rapid mobility by two wheelers is increasing the risk of
trauma and accidents. The increase in population load per
unit area has been distorting the available resources,
exhausting the infrastructures, imbalance between rights
and obligations. Road side accidents and trauma have
been increasing enormously for past twenty years. It has
been observed that the resources of dealing with drastic
O R I G I N A L A R T I C L E
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trauma and major accidents are declining in trauma
centers and hospitals. A remarkable increase has been
observed in vehicles in last 15 years.
In economic terms, the cost of road crash injuries is
projected at roughly 1% of gross national product (GNP)
in low-income countries, 1.5% in middle-income countries
and 2% in high-income countries.1 The economic cost of
road crashes and injuries is estimated to be over Rs100
billion for Pakistan.2 Public transport usage has declined
and not preferred on personal vehicles irrespective to that
they are two or four-wheel vehicles. Two wheelers and
three wheelers are the priority of lower socioeconomic
groups as they are in the financial range.3 There are
many contributing factors in this reality, including the
decline in the profile of public transport, over filling of that,
more time consuming and no schedules. No supervision,
no check and balance on the public transport system is a
contributing factor in its down fall. According to the World
Health Organization (WHO) 2011 fact sheet, "over 90% of
the world's fatalities on the roads occur in low-income and
middle-income countries, even though these countries
have less than half of the world's vehicles.4 In a 2009
report, WHO estimated that in Pakistan road traffic
injuries result in 25.3 deaths per 100,000, which is high by
the international organization’s standards.5 Traditionally,
the data sources for epidemiological assessments of
RTAs in Pakistan have records from accident and
emergency departments, surgical and intensive care units
of specific hospitals and, more commonly, the police
stations but the hidden data which has not been
registered is an ice burg of unknown.6,7 It is estimated that
45% of road traffic fatalities in low-income countries are
among pedestrians, whereas an estimated 29% in middle-
income and 18% in high-income countries are among
pedestrians.8 In Hong Kong, pedestrians accounted for
70% of RTA fatalities. On the other hand, in China,
Malaysia, and Thailand, pedestrian deaths are between
10-15% but over 50% of deaths due to RTA involved
motorcyclists.9
High-velocity vehicles, carpeted and smooth roads, poor
legislation and weak implementation of penalties and fine
are leading causes of uprising road traffic accidents. In
past one and half decade, the number of vehicles has
been enormously raised in the cities and the inter city and
intra-city movements of public as well. Among all vehicles,
motorcycle trauma is most challenging and drastic for the
sufferers, families of the victims. Drastic traumas require
technical skillful professionals and gadgets which are not
widely available in our country health system.
Complicated surgeries, special implants, and prosthesis,
post-surgical ICU care, ventilators support in public
hospitals, all are not well advanced. Even the five big
cities of the country do not fulfill the technical
requirements of public sector health care system.
Specialties are not available in our DHQ and THQ
services of small towns. If some the consultants are
working there, they don’t have the backup support.
Ultimately the complicated trauma cases are referred to
main cities which are already exhausted and
overcrowded. Thus, our emphasis is prevention from
drastic trauma on motorcycles. Strict legislation and tough
implementation of rules with heavy fines on violation can
bring a decline in the major trauma and if this decline is
successful, the overall health care system will be more
efficacious for other deprives. All effort is made because
the massive bike injuries are preventable. In this study,
most important aspect of the preventable trauma of road
traffic accidents that is motorcycle trauma was aimed to
be studied in detail.
P a t i e n t s a n d M e t h o d s
In this cross-sectional study, a total number of cases of
trauma presenting to Orthopedics department, via
emergency were included. Duration of this study was 1st
September 2015 to 1st December 2015. These cases
were first categorized into four types of trauma: road
traffic accident, incidental trauma, assault injuries and
miscellaneous. The incidental trauma included all other
varieties of trauma including direct and indirect trauma,
sports injuries and trivial trauma. There was no gender
discrimination in the data. All geriatric fractures,
pathological fractures, and associated injuries were the
part of this group. Fresh trauma cases, old referred cases
from the periphery, infected trauma cases and neglected
trauma cases all were included in this study. However,
cases of soft tissue and bone infections like chronic
osteomyelitis, septic arthritis of joints, abscess or
empyema at the extremity and pediatric trauma were
excluded from this study. The assault injuries were kept
into a separate group because they were medico legal
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cases and needed other departmental involvement. The
assault category included fire arm injuries, stab injuries
and aimed injuries.
Regarding road traffic accidents, the data was subdivided
with respect to the nature of vehicles. There were four
groups designed; four-wheel vehicles, motorcycle,
bicycles and miscellaneous. Although motorbikes and
cycles both are of the same category but still they were
kept into two main groups. The reason is, use of cycle in
our society is limited now a day. Either it is used by a low
socioeconomic group or as a sports vehicle. In a
miscellaneous group, three wheels (Auto Rikshaws,
Ching chee, Carts) were included.
The number of patients received in accident and
emergency were grouped into three categories to see the
commonest age group presenting with trauma. First group
included patients below the age of 15 years. Remaining
two groups were from 16 years to 25 years and from 26
years to 60 years respectively. The patients were also
grouped on basis of holding the driving license or not.
R e s u l t s
The total number of reported cases in an emergency were
973. They were categorized into four groups. Out of
these, 709 (73 %) cases were road traffic accidents, 186
cases (19%) were of incidental trauma, 29 (3 %) were
assault injuries and 49 (5 %) were the miscellaneous
injuries. Regarding vehicle types, road trauma in 503
patients (71%) was due to motorcycles. In 188 (26%)
patients’ accident and trauma was due to four-wheel
vehicles. Only 11 (2%) cases were due to bicycle injuries
(Figure 1).
Figure 1: Types of vehicle responsible for road
trauma among patients presented in emergency
(n=709)
As regards the age group of motorcycle accidents cases
(503), 226 (45%) riders were in the age group between 26
to 50 years. Total 183(36 %) cases were in the age group
between 16 to 25 years (Figure 2). Regarding license
holding age, only 168(34%) people had a driving license
while 268(53%) riders had never a license. Total 67(13%)
individuals were below the age of holding a bike riding
license.
Figure 2: Age groups among victims of motorbike
accidents (n=503)
D i s c u s s i o n
Road traffic accidents are major series of trauma
presenting to the Orthopedic department via emergency.
The accidents range from minor abrasions to poly-trauma
cases and often the life-threatening situations. Among all
sorts of motor vehicle injuries, motorcycle trauma is most
debilitating and disastrous.10 It accounts almost three
fourth of the total emergency cases presenting to the
department of orthopedic. Their trauma is of high velocity,
leading to prolonged disability and financial burden on the
family.11 There is no social or government based
designed backup mechanism for the people support.12
Another study from a developing country showed 66% of
lower limb injuries in motorbike accidents where cases of
fracture of the tibia were in the highest proportion of cases
followed by femur injuries, though study had a limitation of
small sample size.13 A Swedish cohort study revealed
heavy burden of accidents involving young motorbike
riders (age 16 to 30 years).14 The same age group is
observed to be the most vulnerable to motorbike
accidents in our part of the world and this study has also
shown the highest number of motorbike injuries in the
same age group.15 Lower limb injuries would put a
behavioral and social impact on individuals. In this regard,
Lower Extremity Assessment Project (LEAP) in the United
States has elaborated on the demographic and social
98 J I M D C 2 0 1 7 98
effects of lower limb injuries.16 Rolison et al, reported that
fatality and injury rate among the motorcyclists and their
pillion riders is the highest in comparison to other road
users.17 Among the emerging economic countries,
Malaysia is among the Association of Southeast Asian
Nations (ASEAN) countries that have the highest rate of
fatality and more than 50 percent of road deaths are
among the motorcyclists.18,19
In this study, it was a trembling point that majority of
motorcycle riders had never applied for a license, they
never needed it. There was a significant population of
youngsters who were below 15 years of age, not capable
of getting a license, not allowed to ride bikes on main
roads but still, they were facing a significant trauma. It
was not surprising for us that majority of children facing
motorcycle accidents below the age of 15 were the owner
of motorbikes. Either they were gifted by their parents or
assigned by some authority where they were working.
Such youngsters usually encounter the fatal or disabling
trauma because they are unable to tackle the situations
rapidly during the trauma. We received many youngsters
in our emergency that either died or ended up with
amputation of a limb out of four. In addition, since
children, teenagers and active economic population are
highly involved in motorcycle crashes, much attention is
directed to this kind of accident due to the high rate of life
lost ratio and cost involved.20, 21
Youngers population is riding the unsafe and high-velocity
motorcycles which are emerging popular source of
traveling and are increasing the frequency of disabilities in
this age group.22 Penalties for violations are very low. Red
signal breaking for a motorcyclist charges him with 200
rupees only. Not wearing the safety helmet charges a
motorcyclist only 200 rupees. Similarly, rash riding,
drifting with ordinary bikes and mechanical modifications
for speed enhancement is not a punishable offense in our
country. Over speeding, one wheeling and drifting are
supposed a tiny violation of traffic rules in Pakistan. On
serious violations, motorbikes are fined with a small
amount of fine. There is no firm legislation or punishment
on all above-said objectives. We need the improvement in
law, increase in fines of violations and better designed
safe motorcycles with improved breaking and road grip
mechanics. By this number of massive traumas and
debilitating injuries that are the socioeconomic burden
and loss of lives can be declined.
C o n c l u s i o n
We concluded that the huge number of motorcycle trauma
is preventable if awareness programs at different levels
and law enforcement with heavy fines on violations of
rules are implemented.
R e f e r e n c e s
1. Nantulya VM, Reich MR. Equity dimensions of road traffic
injuries in low-and middle-income countries. Injury control
and safety promotion. 2003; 10(1-2):13-20.
2. Ahmad, B. Country Report on Road Network in Pakistan,
Ministry of Communications, Islambad. 2006
3. Ghaffar A, Hyder AA, Masud TI. The burden of road
traffic injuries in developing countries: the 1st national
injury survey of Pakistan. Public health. 2004; 118
(3):211-7.
4. World Health Organization. WHO: Road traffic injuries.
Fact sheet N°358. (Online). September 2011
5. World Health Organization. Global status report on road
safety: Time for action. (Online). 2010
6. Hassan Q, Bashir RM, Shah M. Physical trauma: A
leading cause of medico-legal cases at DHQ Hospital
Abbottabad. J Ayub Med Coll Abbottabad. 2010;
22(2):156-9.
7. Khan MH, Ahmed I, Zia NI, Babar TS, Babar KS. Road
traffic accidents, study of risk factors. Professional
Medical Journal. 2007; 14(2):323-7.
8. Naci H, Chisholm D, Baker TD. Distribution of road traffic
deaths by road user group: a global comparison. Injury
prevention. 2009; 15(1):55-9.
9. Jacobs GO, Aeron-Thomas A. A review of global road
accident fatalities. Paper commissioned by the
Department for International Development (United
Kingdom) for the Global Road Safety Partnership. 2000
Mar..
10. Box-Steffensmeier JM, Freeman JR, Hitt MP, Pevehouse
JC. Time series analysis for the social sciences. New
York: Cambridge University Press; 2014.
11. Box GE, Jenkins GM, Reinsel GC. Time series analysis:
forecasting and control. Vol 734. New York: Wiley; 2011.
12. Quddus MA. Time series count data models: an empirical
application to traffic accidents. Accident Analysis &
Prevention. 2008; 40(5):1732-41..
13. Oluwadiya K, Olassindi AA, Odu OO, Olakulehin OA,
Olatoke SA. Management of motorcycle limb trauma in a
teaching hospital in South-Western Nigeria. Niger J Med.
2008; 17(1):53-6.
14. Zambon F, Hasselberq M. Factors affecting the severity
of injuries among young motorcyclists: a Swedish
nationwide cohort study. Traffic Injury Prevention.2006;
7(2):143-9.
99 J I M D C 2 0 1 7 99
15. Aziz K, Khalil IU. Road traffic accidents in Peshawar. Ann
King Edward Med Coll Lahore. 2002; 8(2):103-4.
16. Cannada LK, Jones AL. Demographic, social and
economic variables that affect lower extremity injury
outcomes. Injury. 2006; 37(12):1109-16.
17. Rolison JJ, Hewson PJ, Hellier E, Hurst L. Risks of high-
powered motorcycles among younger adults. American
journal of public health. 2013; 103(3):568-71..
18. Manan MMA, Várhelyi A. Motorcycle fatalities in
Malaysia. IATSS research. 2012; 36(1):30–9.
19. Salehi S, Hamid H, Arintono S, Hua LT, Davoodi SR.
Effects of traffic and road factors on motorcycling safety
perception. Proceedings of the ICE-Transport. 2012;
166(5):289–93.
20. Zargar M, Sayyar Roudsari B, Shadman M, Kaviani A,
Tarighi P. Pediatric transport related injuries in Tehran:
the necessity of implementation of injury prevention
protocols. Injury. 2003; 34(11):820–4.
21. Forjuoh SN. Traffic-related injury prevention interventions
for low-income countries. Inj Control Saf Promot. 2003;
10(1-2):109–18.
22. Rolison JJ, Hewson PJ, Hellier E, Hurst L. Risks of high-
powered motorcycles among younger adults. Am J Public
Health. 2013; 103(3):568–71.