Effective interventions in road traffic accidents among the young and novice drivers of low and middle-income countries: A scoping review

Problem considered
Road traffic accident (RTA) is the ninth leading cause of global mortality and are also contributes mortality rates among young adults aged 15–29 years. This paper aims to conduct a comprehensive review to provide evidence of effective interventions of RTA prevention among young adults.

Methods
Three databases, MEDLINE, Embase, and PsychINFO, were searched. Eligible articles were practical behavioural and technological interventions directly affecting young drivers. The quality assessment used critical appraisal tools from the Joanna Briggs Institute (JBI). A narrative approach was used to analyze data of the 1107 articles identified, 17 articles met the inclusion criteria. Six studies used a driving simulator; five studies were educational training interventions; one used an incentive and in-car GPS, and one video-based training. One intervention used a vehicle warning system. A motorcycle simulator intervention and two-hybrid interventions, a pc-training and field training, and a driving simulator and vehicle training were also identified.

Result
The Green Light for Life, a training program, was emphasized as it was a simple intervention, using parent influences to improve injury crash rates by 12.7% p < 0.001. Furthermore, RAPT, a driving simulator, improved gaze in the range of 52.1–70% p < 0.001, and HRT, a motorcycle simulator, showed 0.92, p < 0.001 proportion of hazard avoidance. Conclusion These interventions can provide important leads to be adapted and replicated in various settings globally, to improve RTA outcomes among young adults. Future research can adopt a qualitative approach to determine the willingness of use for these interventions and adherence to current interventions.

Decompressive Craniectomy in Traumatic Brain Injury: An Institutional Experience of 131 Cases in Two Years

Decompressive craniectomy (DC) effectively reduces intracranial pressure (ICP), but is not considered to be a first-line procedure. We retrospectively analyzed sociodemographic, clinical, and surgical characteristics associated with the prognosis of patients who underwent DC to treat traumatic intracranial hypertension (ICH) at the Restauração Hospital (HR) in Recife, Brazil between 2015 and 2016, and compared the clinical features with surgical timing and functional outcome at discharge. The data were collected from 131 medical records in the hospital database. A significant majority of the patients were young adults (age 18-39 years old; 75/131; 57.3%) and male (118/131; 90.1%). Road traffic accidents, particularly those involving motorcycles (57/131; 44.5%), were the main cause of the traumatic event. At initial evaluation, 63 patients (48.8%) were classified with severe traumatic brain injury (TBI). Pupil examination showed no abnormalities for 91 patients (71.1%), and acute subdural hematoma was the most frequently observed lesion (83/212; 40%). Glasgow Outcome Scale (GOS) score was used to categorize surgical results and 51 patients (38.9%) had an unfavorable outcome. Only the Glasgow Coma Scale (GCS) score on admission (score of 3-8) was more likely to be associated with unfavorable outcome (p-value = 0.009), indicating that this variable may be a determinant of mortality and prognostic of poor outcome. Patients who underwent an operation sooner after injury, despite having a worse condition on admission, presented with clinical results that were similar to those of patients who underwent surgery 12 h after hospital admission. These results emphasize the importance of early DC for management of severe TBI. This study shows that DC is a common procedure used to manage TBI patients at HR.

The Epidemiology of Traumatic Brain Injury Due to Traffic Accidents in Latin America: A Narrative Review

Objective Traumatic brain injuries (TBIs) are devastating injuries and represent a major cause of morbidity and mortality worldwide. Traffic accidents are one of the main causes, especially in low- and middle-income countries. The epidemiology of TBI due to road traffic in Latin America is not clearly documented.

Methods A narrative review was conducted using PubMed, SCOPUS, and Google Scholar, looking for TBI studies in Latin America published between 2000 and 2018. Seventeen studies were found that met the inclusion and exclusion criteria.

Results  It was found that TBI due to road traffic accidents (RTAs) is more frequent in males between the ages of 15 and 35 years, and patients in motor vehicles accounted for most cases, followed by pedestrians, motorcyclists, and cyclists.

Conclusion Road traffic accidents is a common cause of TBI in Latin America. More studies and registries are needed to properly document the epidemiological profiles of TBI related to RTAs.