ALCOHOL-RELATED ROAD-TRAFFIC ACCIDENTS ON THE FEDERAL HIGHWAY M-8 "KHOLMOGORY" IN THE ARKHANGELSK REGION Baranov A.V.
Northern State Medical University, Arkhangelsk, Russia
Cherepovets State University, Cherepovets, Russia
The federal highway M-8 "Kholmogory" goes through the territory of Arkhangelsk region. It has all features of northern highways: black ice on roads in autumn and spring, short daylight hours, strong wind, as well as specific features of functioning of federal medical facilities (insufficient amount of physicians and nurses, low availability of equipment).
These features determine the development of multiple road traffic accidents (RTA) with medical consequences. From other side, they complicate timeliness and quality of medical care for patients. Road traffic injuries take one of the leading places in mortality from all causes. Fatal injuries encounter in young people of working age, and in older individuals [1-5]. The burdening factor of modern road traffic injuries in Russia and in the world is alcohol use when driving [6, 7]. Alcohol intoxication is one of the causes of RTA in 10-35 % of cases, depending on a studied region, both on township, regional and federal roads [8, 9]. Therefore, research of alcohol-determined road traffic accidents on federal roads is important direction, which has no uniform solution and requires for studies and improvement.
Objective – to analyze alcohol-related traffic accidents on the federal highway M-8 “Kholmogory” in the Arkhangelsk Region.
MATERIALS AND METHODS
The materials were the sample of 906 medical records by patients treated in hospitals (f.003/u). After RTA, the patients were urgently admitted to hospitals of Arkhangelsk region in the period from January 1, 2012, to December 31, 2018. The registered forms were selected according to the criteria of retrospective continuous documentary follow-up (all cases of patients with road traffic injury treated in hospitals within the studied period were included).
The inclusion criteria for the study:
1) any gender;
2) patients who suffered in RTA on the federal highway M-8 "Kholmogory" in Arkhangelsk region, treated in hospitals;
3) accident within 2012-2018.
The exclusion criteria:
1) age < 18;
2) absence of road traffic injuries in anamnesis.
Severity of concomitant injuries in trauma patients was determined with ISS (S. Baker, 1974). This score considers anatomical and topographic injuries and provides division of human body into 6 segments: 1) head and neck; 2) face; 3) chest; 4) abdominal cavity and internal pelvic organs; 5) extremities and pelvic girdle; 6) skin surface and soft tissues. Injury to each segment was carried out with 5-point score. Scores of 3 maximally injured segments were raised to the square and summed. The final digital value was the estimate.
Alcohol intoxication fact was stated with data from medical records of patients treated in hospitals (f.003/u).
Statistical analysis was performed with SPSS 22. It included creation of null and alternative hypotheses, and testing hypothesis of concordance between empirical distribution and normal distribution law with use of Kholmogorov-Smirnov test. Patterns of distribution differed from normal ones in all groups. Therefore, quantitative data is presented as the median, 25 % and 75 % quartiles. When comparing two groups, Mann-Whitney test was used for accept or declination of the null hypothesis. Kraskal-Wallis test was used for comparison of several groups. The intergroup differences were statistically significant when p value was less than 0.05. Bonferroni correction was used.
The study was conducted according to ethical standards of Helsinki Declare. The study protocol was approved by the expert biomedical ethical board of Northern State Medical University, Arkhangelsk (the protocol No. 08/11-17, 29 November 2017).
RESULTS AND DISCUSSION
153 (16.9 %) patients suffered on the federal highway M-8 "Kholmogory" of Arkhangelsk region were in alcohol intoxication of various degree. The main characteristics are in the table.
Table
Comparative characteristics of patients in alcohol intoxication and without it suffered in road traffic accidents on the federal road M-8 «Kholmogory»
|
Characteristics, % (abs.) |
alcohol intoxication |
no alcohol intoxication |
p level |
|
n |
153 |
753 |
|
|
Men |
85.6 % (131) |
65.1 % (490) |
< 0.001 |
|
Women |
14.4 % (22) |
34.9 % (263) |
< 0.001 |
|
Age |
32 [24; 45] |
36 [26; 53] |
0.013 |
|
Circumstances of injury: |
|
|
|
|
pedestrians |
30.7 % (47) |
29.5 % (222) |
0.761 |
|
passengers |
22.2 % (34) |
28.5 % (215) |
0.110 |
|
drivers |
30.1 %(46) |
30.3 % (228) |
0.959 |
|
motorcyclists |
17.0 % (26) |
11.7 % (88) |
0.072 |
|
Type of injury: |
|
|
|
|
single |
22.9 % (35) |
22.8 % (172) |
0.993 |
|
multiple |
17 % (26) |
13 % (98) |
0.192 |
|
concomitant: |
60.1 % (92) |
64.2 % (483) |
0.343 |
|
subgroup 1 (ISS = 0-10) |
25 % (23) |
37.5 % (181) |
0.022 |
|
subgroup 2 (ISS = 11-20) |
37 % (34) |
30.4 % (147) |
0.218 |
|
subgroup 3 (ISS > 20) |
38 % (35) |
32.1 % (155) |
0.266 |
There were more men (85.6 %) in alcohol intoxication than women.
The mean age of patients in alcohol intoxication was 32 [24; 45]. They were younger (p = 0.013) than sober patients. There were not any statistically significant differences after comparison of mean age of men and women suffered on M-8 "Kholmogory". There were more persons at the age of 18-39 (> 50 %) among all patients in alcohol intoxication (p < 0.001).
On the basis of circumstances of RTA on M-8 "Kholmogory", we did not find any significant differences between studied categories of patients. However, we noted that about 17 % of motorcyclists were in alcohol intoxication. Probably, it can be explained by the fact that motorcyclists are younger and, therefore, more sensitive to influence of subcultures, which promote alcohol consumption.
The federal highway M-8 "Kholmogory" passes through 3 medical districts of Arkhangelsk region: Severovdinsk, Arkhangelsk, Velsk. Analyzing the incidence of alcohol-determined RTA on the federal highway M-8 "Kholmogory", we found that the highest proportion was in Severodvinsk medical district (66.7 %; 102/153). The second place was taken by Arkhangelsk medical district (23.5 %; 36/153). The last place was taken by Velsk medical district (9.8 %; 15/153) as compared to Severodvinsk (p < 0.001) and Arkhangelsk (p = 0.002).
The analysis of a relationship between injury and alcohol intoxication state showed alcohol intoxication in patients with single injuries in 22.9 %, with multiple injuries – in 17 %, with concomitant injuries – in 60.1 %. We did not find any statistically significant differences after comparison with injured patients without alcohol intoxication.
For deeper review of alcohol-related RTA in category of patients with concomitant injuries, which are more difficult to treat and diagnose, we found that it would be more appropriate to divide patients into subgroups:
1) ISS = 1-10;
2) ISS = 11-20;
3) ISS ≥ 21.
On the basis of ISS, we found that increasing severity (according to ISS) raises the proportion of RTA victims in alcohol intoxication from 25 % in the subgroup 1 to 37-38 % in the groups 2 and 3 as compared to sober injured patients. It supposes development of more severe injuries at the background of alcohol consumption.
For the studied period, the very interesting time trends of proportion of patients in alcohol intoxication who suffered on M-8 "Kholmogory" was found (Fig. 1). For 7 years (2012-2018), it was found that proportion of patients in alcohol intoxication had decreased from 24.6 % in 2012 to 11.9 % in 2018.
Figure 1
Structure of victims in road traffic accidents on the federal road M-8 Kholmogory in dependence on presence of alcohol intoxication for 2012-2018, %
Note: *– p = 0.002 (comparison between incidence of patients in alcohol intoxication in 2012-2017). Comparison of incidence between years was conducted by pairs with χ2 test with Bonferroni correction. P < 0.0024 was statistically significant for paired comparisons.
One can suppose that this positive trend is associated with realization of more strict rules for driving in condition of alcohol intoxication in the Russian Federation: "zero" level of alcohol level in blood, several-fold increase in penalties for drunk driving, with possibility of criminal prosecution.
CONCLUSION
Therefore, after analysis of alcohol-related RTA on the federal highway M-8 "Kholmogory" in Arkhangelsk region, we have made the following conclusions:
- 15-20 % of all RTA are related to alcohol consumption; there were more men (p < 0.001); the mean age of patients in alcohol intoxication was 32 [24; 45] years, i.e. lower (p = 0.013) than in sober persons;
- among alcohol-associated RTA, the lowest proportion was found in Velsk medical district (9.8 %) as compared to Severodvinsk (66.7 %, p < 0.001) and Arkhangelsk (23.5 %, p = 0.002) districts;
- for 7 years, the proportion of trauma patients in alcohol intoxication decreased more than two times – from 24.6 % in 2012 to 11.9 % in 2018 (p = 0.002).
Information on financing and conflict of interests
The study was conducted without sponsorship.
The author declares the absence of any clear or potential conflicts of interests relating to publication of this article.