Office of Global Health, University of Texas Southwestern Medical School , Dallas , Texas.
Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana (UNIBE) , Santo Domingo , Dominican Republic.
Traffic Inj Prev. 2019;20(7):690-695. doi: 10.1080/15389588.2019.1643016. Epub 2019 Aug 5.
Road traffic accidents (RTAs) are the number one cause of traumatic brain injuries (TBIs) worldwide. This study examines RTA-related TBIs in the Dominican Republic, a country in the Caribbean with the highest RTA fatality rate in the Western Hemisphere. We interviewed 117 adult patients or medical guardians of patients admitted to Hospital Traumatológico Dr. Ney Arias Lora in Santo Domingo following an RTA. Information regarding the type of accident, patient demographics, and injuries sustained was collected for each patient. Most study participants were males (79.5%), and the most common method of transportation was motorized 2-wheeled vehicle (MTW; 74.4%). Of the 69 patients who suffered a TBI, 66.7% were classified as moderate-severe TBIs and 30.3% were classified as mild TBIs. The most common types of intracranial hemorrhage were subdural hemorrhage (12%) and subarachnoid hemorrhage (9.4%). Helmet use among admitted MTW riders was reported at 22.4%, and none of the 9 MTW riders who died in the hospital were wearing a helmet. Only 58.1% of patients lived in an area that offered 911 emergency response services at the time of the study. At 66.2%, the majority of people living within the 911 service area utilized emergency response services following an RTA. Multiple logistic regression determined that the utilization of 911 emergency response services was associated with a decrease in the likelihood of presenting with a moderate/severe TBI by a factor of 0.78 (adjusted odds ratio [OR]; < .008; 95% confidence interval [CI], 0.65, 0.93). Nonuse of a helmet was associated with a 1.22 times increased risk of presenting with a moderate/severe TBI (adjusted OR; < .04; 95% CI, 1.01, 1.61). Age and gender were not statistically significant in this model. The results of this study support 2 important avenues for reducing the burden of RTA-associated neurologic disease in the Dominican Republic. As with many other middle-income countries, MTWs represent an economical and efficient mode of transportation. Therefore, increasing helmet use may be the most effective way to reduce RTA-associated TBIs. In addition, continuing the expansion of postcrash emergency response services may mitigate the severity of RTA-associated neurologic disease.
道路交通事故（RTAs）是全球创伤性脑损伤（TBIs）的首要原因。本研究调查了多米尼加共和国与道路交通相关的 TBI，多米尼加共和国是西半球道路交通死亡率最高的加勒比国家。我们采访了 117 名在圣多明各创伤医生 Ney Arias Lora 医院因 RTA 住院的成年患者或患者的医疗监护人。为每位患者收集了有关事故类型、患者人口统计学和受伤情况的信息。大多数研究参与者为男性（79.5%），最常见的交通方式是机动两轮车（MTW；74.4%）。在 69 名患有 TBI 的患者中，66.7%被归类为中重度 TBI，30.3%被归类为轻度 TBI。最常见的颅内出血类型是硬膜下血肿（12%）和蛛网膜下腔出血（9.4%）。报告称，入院 MTW 骑手的头盔使用率为 22.4%，而在医院死亡的 9 名 MTW 骑手均未戴头盔。只有 58.1%的患者在研究时居住在提供 911 紧急响应服务的地区。在大多数情况下（66.2%），居住在 911 服务区域内的人在发生 RTA 后会利用紧急响应服务。多因素逻辑回归确定，使用 911 紧急响应服务与出现中重度 TBI 的可能性降低相关，降低幅度为 0.78（调整后的优势比[OR]；<.008；95%置信区间[CI]，0.65，0.93）。不使用头盔与出现中重度 TBI 的风险增加 1.22 倍相关（调整后的 OR；<.04；95%CI，1.01，1.61）。在该模型中，年龄和性别没有统计学意义。本研究结果支持减少多米尼加共和国道路交通相关神经疾病负担的 2 个重要途径。与许多其他中等收入国家一样，MTWs 是一种经济高效的交通方式。因此，增加头盔使用率可能是降低与 RTA 相关的 TBI 的最有效方法。此外，继续扩大事故后紧急响应服务可能会减轻与 RTA 相关的神经疾病的严重程度。
