a Harvard Medical School , Boston , Massachusetts.
b Asia Injury Prevention Foundation , Chamka Mom District , Phnom Penh , Cambodia.
Traffic Inj Prev. 2018 Jan 2;19(1):66-70. doi: 10.1080/15389588.2017.1342821. Epub 2017 Jul 12.
Rapid urbanization and motorization without corresponding increases in helmet usage have made traumatic brain injury due to road traffic accidents a major public health crisis in Cambodia. This analysis was conducted to quantify the impact of helmets on severity of injury, neurosurgical indication, and functional outcomes at discharge for motorcycle operators who required hospitalization for a traumatic brain injury following a road traffic accident in Cambodia.
The medical records of 491 motorcycle operators who presented to a major tertiary care center in Cambodia with traumatic brain injury were retrospectively analyzed using multivariate logistic regression.
The most common injuries at presentation were contusions (47.0%), epidural hematomas (30.1%), subdural hematomas (27.9%), subarachnoid hemorrhages (12.4%), skull fractures (21.4%), and facial fractures (18.5%). Moderate-to-severe loss of consciousness was present in 36.3% of patients. Not wearing a helmet was associated with an odds ratio of 2.20 (95% confidence interval [CI], 1.15-4.22) for presenting with moderate to severe loss of consciousness compared to helmeted patients. Craniotomy or craniectomy was indicated for evacuation of hematoma in 20.0% of cases, and nonhelmeted patients had 3.21-fold higher odds of requiring neurosurgical intervention (95% CI, 1.25-8.27). Furthermore, lack of helmet usage was associated with 2.72-fold higher odds of discharge with functional deficits (95% CI, 1.14-6.49). In total, 30.1% of patients were discharged with severe functional deficits.
Helmets demonstrate a protective effect and may be an effective public health intervention to significantly reduce the burden of traumatic brain injury in Cambodia and other developing countries with increasing rates of motorization across the world.
城市化和机动化进程迅速发展，但头盔使用率并未相应提高，这使得道路交通伤害导致的创伤性脑损伤成为柬埔寨的一大公共卫生危机。本分析旨在定量评估头盔对因道路交通伤害而住院的摩托车驾驶员创伤性脑损伤严重程度、神经外科手术指征和出院时功能结局的影响。
使用多变量逻辑回归对 491 名在柬埔寨一家主要三级保健中心因创伤性脑损伤就诊的摩托车驾驶员的病历进行回顾性分析。
最常见的损伤是挫伤（47.0%）、硬膜外血肿（30.1%）、硬膜下血肿（27.9%）、蛛网膜下腔出血（12.4%）、颅骨骨折（21.4%）和面部骨折（18.5%）。36.3%的患者有中度至重度意识丧失。与戴头盔的患者相比，不戴头盔与中度至重度意识丧失的就诊比值比为 2.20（95%置信区间[CI]，1.15-4.22）。20.0%的病例需要开颅术或颅骨切除术以清除血肿，不戴头盔的患者需要神经外科干预的几率高 3.21 倍（95%CI，1.25-8.27）。此外，不使用头盔与出院时存在功能缺陷的几率增加 2.72 倍相关（95%CI，1.14-6.49）。总共有 30.1%的患者出院时存在严重的功能缺陷。
头盔具有保护作用，可能是一种有效的公共卫生干预措施，可显著减轻柬埔寨和其他全球机动化率不断上升的发展中国家的创伤性脑损伤负担。
