thèse doctorat de l'université bordeaux 2 - ISPED-Enseignement à ...

person died at crash scene, during transport, or at ED; injured and transported, includinghospital taken to; injured and not transported) were extracted from these books.Hospital recordsThe Road Traffic Injury Research & Prevention Centre (RTIRP) at the Jinnah Post GraduateMedical Centre (JPMC) has been working since September 2006 [87]. This centresystematically collects, on standard Performa sheets, information on RTI patients presentingat the ED of the five largest teaching hospitals in Karachi: 1) JPMC, 2) Abbasi ShaheedHospital, 3) Civil Hospital Karachi, 4) Liaqat National Hospital, and 5) The Aga KhanUniversity Hospital.This dataset includes information on the crash date, time, and location as well as patient’sname, age, sex, road user group. Further information on whether the patient was wearinghelmet or seat belt was available. The New Injury Severity Score (NISS) [88] and outcome(discharged, admitted/referred, or died) of patients were recorded during their stay in the ED.Information on RTI patients involved in crashes on selected road section was extracted fromthis dataset.AnalysisAll information was recorded on Excel® spreadsheets. We computed percentages for crashand injury patient characteristics for three datasets and compared them with each other. Forthe ED dataset, the distribution of NISS according to the outcome was plotted. Records fromthe three datasets were then matched for crash date, name, age, and sex of RTI patientsinvolved. For matched records, we identified changes in outcome. Total deaths and injurieswere then assessed while removing the records appearing in two or more datasets.Ascertainment rates for police, ambulance, and ED records as compared to these totalfatalities and injuries were computed. Unique record and traffic counts from NationalHighway Authority (NHA) were used to compute overall traffic fatality and injury rates pervehicle-km for 2008 [83].ResultsCrash outcomeIn 2008, police reported 43 crashes, whereas 255 crashes were reported to EAS and 449 werereported to ED. One out of two police reported crashes (N=19, 44.4%) was fatal, whereas thisproportion was 14.5% (N=37) for those reported to EAS and 10.4% (N=47) for those reportedto ED. No information on crash outcome was available in 13.3% of EAS reported crashes and6.7% of those reported to ED.Injury outcomeA total of 143 RTIs were reported to police, 531 to EAS, and 661 to ED. Monthly trendsindicated higher proportions of RTIs in June and July 2008 (Figure 8). Over half of policereportedinjury patients received hospital care (N=80, 55.9%) (Table 6). Half of these patients(N=40), injured between km 16 and km 120 were treated in Karachi; RTIRP hospitals treated17 of them. Nearly one fifth of RTI patients reported in police records died (N=27, 18.8%),whereas this proportion was 10.4% for EAS and 9.1% for ED reported patients. One fourth ofpolice-reported injury patients (N=25.2%) were not transported to the hospital, whereas thiswas 9.0% for EAS-reported patients (N=48). Out of 661 patients presenting to ED, 47.7%(N=315) arrived by private means, whereas 43.0% (N=284) arrived in ambulances. Policetransported only four of these patients, and no information was available on the remaining 5831