Collision versus loss-of-control motorcycle accidents: Comparing injuries and outcomes

Objective: Motorcycles are a common mode of transport, especially in low-middle-income countries like Pakistan. The pattern and severity of injuries in motorcycle trauma depends on the mechanism of accident, which may be classified as collision accidents (CAs) or loss-of-control accidents (LOCAs). In this study, we aimed to investigate patterns of trauma due to motorcycle CAs and LOCAs, with a focus on injuries, management, complications, and outcomes. Methods: A retrospective cohort study was conducted at the Aga Khan University Hospital (AKUH), Pakistan (a level 1 trauma facility), enrolling all patients presenting with motorcycle trauma between January 2018 and March 2019. Results: The most common sites of major injury were the lower limb (40.9%), head and neck (38.1%), and upper limb (27.5%). A significantly higher percentage of CA victims had head and neck injuries (43.4% vs. 30.5%), abdominal injuries (5.5% vs. 1.1%), pelvic fracture (5.9% vs. 0%), and polytrauma (22.8% vs. 11.1%). Compared to LOCA victims, CA victims had a significantly higher incidence of acute kidney injury (AKI; 25.7% vs. 15.8%; P <.011), longer hospital lengths of stay (LOSs; 3 [2–6] days vs. 2.5 [2–4] days; P =.019), and long-term disability (P =.002). When adjusted for age and gender on multivariable logistic regression with mechanism of accident as the dependent variable, CA was significantly associated with male gender (odds ratio [OR] = 2.045, 95% confidence interval [CI] [1.038–4.026]), abdominal injury (OR = 5.748, 95% CI [1.285–25.702]), head and neck injury (OR = 1.492, 95% CI [1.007–2.211]), polytrauma (OR = 2.368, 95% CI [1.383–4.055]), AKI (OR = 1.937, 95% CI [1.183–3.171]), and LOS (OR = 1.041, 95% CI [1.004–1.079]). Conclusions: Though both motorcycle CAs and LOCAs stress trauma systems in developing countries, the dynamics of CAs mean that they result in worse injuries and outcomes. Specific measures to reduce CAs and LOCAs are urgently indicated in developing countries to reduce the burden of morbidity and mortality of motorcycle accidents.