This cross-sectional study was conducted in casualty and neurosurgery ward of Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh from August 2010 to July 2011. Study subjects comprised of all the patients of Road Traffic Accidents (RTAs) with head injury, who used motorized two-wheeler vehicle at the time of accident, aged 15-45 years and those subsequently admitted to this hospital during the study period. The study was undertaken using purposive sampling technique. The presence of head injury following RTA was confirmed by residents of Neurosurgery unit of hospital who first came in contact with the patient. The patients excluded were those who did not give consent to be part of study, those immediately referred to higher centre and patients brought dead. Ethical clearance was obtained from Jawaharlal Nehru Medical College ethics committee.

A pre-tested and semi-structured proforma modified from WHO Injury surveillance guidelines was used for interview of patients. Informed consent (verbal) was taken from patient or concerned attendants or relatives after they were told the purpose of study and assured that confidentiality would be maintained.

Information regarding age and gender of the patient along with day and month of occurrence of RTA was put on record. Monday to Friday were grouped as weekdays and Saturday and Sunday as weekends. Further details about head injury were recorded. Injury was classified as scalp/vault injury or brain injury. Scalp injury was further subclassified as bruise/superficial injury, fracture of any skull bone and cut/open wounds. Similarly brain injury was divided into intracranial haemorrhage, concussion and diffuse axonal injury. Use of helmet was also assessed among both the road users.

Severity of head injury was assessed at the initial contact with the patient by the neurosurgery unit using Glasgow Coma Scale (GCS). Head injury was classified as mild, moderate, or severe as per GCS score. Before discharge GCS score was assessed again to classify patient into recovered completely and those who recovered with some deficit. Recovered completely was defined as having GCS score of 13-15 at the time of discharge while recovered with some deficit as having GCS score of 12 and below. Other outcome considered were died, referred to higher centre during the course of hospital treatment and left against medical advice. Association of type of road user with severity of injury and outcome of injury was analysed using chi-square test. Data was analysed using the SPSS 20.0.

Operational definition of RTA used in the study was: A collision involving at least one vehicle in motion on a public or private road that results in atleast one person being injured or killed [4,5].

A total of 340 cases of RTAs with head injury were included in the study. There was overall marked male preponderance. Males too outnumbered females among the drivers. However, the pillion riders comprised predominantly of females. The most vulnerable age group was 15-24 years both among the drivers and the pillion riders [Table/Fig-1,2].

Months of August and September accounted for highest number of RTAs with 38 (11.2%) and 39 (11.5%) cases respectively. This season also corresponds with the rainy season in India where numbers of RTAs are on the rise. Almost three-fourth of all accidents, 243 (71.5%), took place during weekdays but the difference with weekend was insignificant.

Scalp injury was noted in 337 (99.1%) of patients. Most frequent of all scalp injuries was bruise/superficial injury being present in 265 (77.9%), followed by fracture of skull bone noted in 182 (53.5%). Cut/open wounds were least common among those having scalp injury with 146 (42.9%). Distribution of different types of scalp injury was similar both among the drivers and pillion riders. Brain injury was present in 205 (60.3%) patients. Intracranial haemorrhage was most common of all types of brain injury, noted in 175 (51.5%) patients. Very few patients had other types of brain injury like concussion and diffuse axonal injury. The distribution of different types of brain injury too was similar both among the drivers and pillion riders.

Among the 261 drivers, 40 (15.3%) used helmet. However none of the pillion rider used helmet in the present study. Out of 340 patients included in the study, GCS could not be assessed in two patients because of overwhelming effect of alcohol. Therefore, severity of injury was assessed in 338 patients only. Most of the injuries were of mild grade in either type of road user, followed by moderate grade. Very few patients had RTIs of severe grade. Severity of injury did not differ significantly with the type of road user [Table/Fig-3] and with helmet use. Among the 40 drivers who used helmet, 2 (5%) had severe injuries as compared to 22 (7.4%) out of 298 non-helmet users.

Out of 340 patients, 17 left against medical advice during hospital stay while five others were referred to higher centre. Thereby, outcome was assessed in 318 patients. Among the remaining 318 patients, 253 (79.6%) of patients recovered completely with no deficit followed by those who recovered with some deficit. A total of 13(4.1%) of patients died during hospital stay. However, outcome of injury bore no significant relationship with type of road user [Table/Fig-4].

Age and gender distribution of present study were in corroboration with findings of Khan MK et al., Mishra B et al., Swarnkar M et al., and Suryanarayana S et al., [6-9]. RTAs peaked around the rainy season in the present study. Similar seasonal preponderance was also noted by Mishra B et al., and Rahman MZ et al., [7,10].

Three-fourth of all accidents took place during weekdays but the difference with weekend was insignificant. Kumar A et al., too did not find any significant difference between the RTAs, whether it took place during weekdays or weekends [11].

The distribution of different types of brain injury too was similar both among the drivers and pillion riders. Similar pattern of distribution of head injury was also noted by Khan M et al., and Kumar A et al., [6,11]. Most of the injuries were of mild grade in either type of road user and severity decreased proportionally in both groups. Similar observations with regard to severity were also noted by Agnihotri AK et al., [12].

A total 83 patients had moderate to severe grade of head injury and 13 among 318 patients (4.1%) died during hospital stay. Many of these head injuries could have been prevented or their severity could have been reduced through the use of simple and inexpensive helmets. It has been established that non-helmeted users of motorized two-wheelers are three times more likely to sustain head injuries in a crash compared to those wearing helmets [13]. Wearing a helmet correctly can cut the risk of death by almost 40%, and the risk of severe injury by 70% [14]. India has The Motor Vehicles Act which makes helmet use mandatory both for MTW drivers and pillion riders. However, the notification and enforcement of this law varies between individual states and is generally weak [15]. As per WHO, the enforcement of helmet law in India was rated 4 on a scale of 10 (where 0 was least and 10 was highly effective) [1]. Women too are not exempted from wearing helmet but again endorsement varies within the states. Now many states like Punjab, Haryana, Gujarat are coming up with strict enforcement of this law for women as well.

Some cases who might have had minor injuries, may have not visited the hospital. Hence these may have been missed.

Young males driving the MTWs are at significant risk of RTAs, but the risk among females is also distinguished as they often comprise the pillion riders. Injury profile along with the severity of the injury together with its outcome are similar in both types of road user irrespective of patient being driver or pillion rider. A multifaceted approach is required for the most effective and long-lasting changes to be made to national road safety. Strict implementation of traffic rules like mandatory helmet use is the need of hour. Further RTI prevention strategy needs to be incorporated into public health programmes if the burden of this non-communicable disease is to be decreased.