Road Traffic Accident Admissions in the United Arab Emirates

Introduction

M Sankaran-Kutty, A Bener, KP Muralikuttan, M Sebastian, Road Traffic Accident Admissions in the United Arab Emirates. 1998; 18(4): 349-351

Previous studies have shown that casualty and fatality rates in the United Arab Emirates (UAE) and in other Gulf countries are much higher than in the developing and developed countries with comparable vehicle ownership levels.^1–3 The discovery of oil about the middle of the century has changed many aspects of life in the UAE. There has been a dramatic rise in the national economy, expressed convincingly in terms of income per capita. Road construction programs have increased, parallel to other national developments, and with an increase in road traffic accidents (RTA) and casualties reaching serious public health proportions.²

The factors causing road traffic accidents and resulting casualties may be viewed in the light of those causing injury, which makes them suitable for the epidemiological approach. The problem has long been the focus of attention in developed countries and the fatality rates are generally improving there, but relatively little has been achieved in reducing the magnitude of the problem in developing countries.⁴

Most researchers agree that it is not appropriate to attempt to isolate a single main cause of an accident. Earlier RTA studies demonstrated that about 90% of all accidents could be attributed to road user characteristics. Hence, road user behavior is often examined for compliance with existing traffic rules and regulations.³

WHO statistics indicate that one million people die and between 15 and 20 million are injured annually in road traffic accidents.⁵ RTAs are the second major cause of deaths in the UAE.⁴ The death rate from RTA in the Arab Gulf countries^1–4,6–9 is reported to be much higher than that in the USA.⁶ Although there have been previous reports on the subject of RTA in the UAE,^2–4,7–8 none have dealt with admissions of the injured patients to the hospitals. All types of data are valuable in the planning of preventive measures from such accidents, as well as the management of the injured. In this paper we analyzed all RTA admissions to the major teaching hospital of the UAE University for a one-year period.

MATERIALS AND METHODS

This study was conducted over the twelve months of 1995. Those traffic accident victims who did not survive the accident, and those who did not survive the initial management in the emergency department, as well as those who were treated on outpatient basis, were excluded from this study. The current study was confined to inpatient admissions which followed RTA. Data gathered included age, sex, the time of injury, the nature of injury, the region of the body injured, and the severity of injury, graded according to the Abbreviated Injury Scale (AIS).¹⁰ Also recorded were whether the injured was the driver or the occupant of the vehicle, or a pedestrian, whether the occupant of the vehicle was wearing a seat belt or not at the time of the injury, whether one or two vehicles were involved in the collision or objects or pedestrians, the time interval between the accident and the arrival at the hospital, the length of stay in the hospital and the final outcome.

Additional data were obtained from various sources, including the UAE Health Statistics Annual Reports for the years 1991 and 1995, and from the Ministry of Health.¹¹ Data were also obtained from the Annual Report of the Ministry of the Interior, Directorate of Traffic, Road Traffic Accident Statistics for United Arab Emirates,¹² and from the World Health Statistics Annual Report (WHO).⁶

RESULTS

A total of 247 patients were admitted to the hospital as a result of injuries sustained in RTA during the period of this study. Of these, 213 (86%) were male and 34 (14%) were female, a ratio of 6:1. Thirty-three (13%) were children (14 years and under), and 201 (81%) were under the age of forty years. Two moving vehicles were involved in 108 cases (44%), one moving vehicle and a stationary object in 53 cases (21.5%), and overturning of the vehicle caused the injuries in 86 cases (34.5%). The driver was injured in 117 cases (47%), the passenger in 79 (32%), and pedestrian in 51 cases (21%). The present study showed that the rate of regular seat belt usage was about 6%. Head injuries, including facio-maxillary injuries, occurred in 185 cases (75%), lower extremity injuries in 102 (41%), upper extremity injuries in 67 (27%), spinal injuries in 44 (19%), chest injuries in 54 (22%) and abdominal and pelvic injuries in 31 cases (13%). Multi-system injuries were seen in 34% of patients. Most of the accidents (70%) occurred between 6 a.m. and 6 p.m., and 93.5% arrived at the hospital within one hour of the accident. Only 6% of the injured were wearing seat belts at the time of the accident. The number of patients ranked according to the severity of injury (AIS Grades 1, minor, to Grade 6, most severe) were as follows: grade 1, 6%; grade 2, 47%; grade 3, 26%; grade 4, 10%; grade 5, 6%; and grade 6, 5%. Forty-one percent of patients required a hospital stay of 10 days or under, while 18% (45) needed inpatient care for over 30 days. Follow-up of patients showed 197 (80%) recovered fully, while 22 were left with varying degrees of disability. Another 11 were totally disabled, either due to head (8) or spinal injuries (3). Seven percent of patients died directly as a result of severe injuries within 30 days of the accident. Table 1 depicts fatality rates in different countries, which allow comparisons to be made. The death rates per hundred million kilometers of travel, per 100,000 registered motor vehicles, and per 100,000 resident population of UAE in 1995 were, respectively, 2.90, 131.5 and 23.68, and all rates were higher than those of developed countries. Also, population per car in UAE (5.88) was higher than for the UK and USA.

Table 1. Statistical comparison of motor-vehicle traffic fatalities in the United Kingdom, USA, and the United Arab Emirates (UAE).

The major causes of death for all age groups in the UAE during the years 1991 and 1995 are shown in Table 2. The present study shows that road traffic fatalities were second only to cardiovascular disease in the list of major causes of death in both years.

Table 2. Leading causes of death for all age groups in UAE in the years 1991 and 1995.

DISCUSSION

This study is confined to those admitted as inpatients to the hospital as a result of RTA, thus also indicating the severity of the injuries. We concur with previous studies from this area that 80% of the victims were young and under 40 years. A disturbing fact is that 13% were children. This is probably due to the fact that many young children are also unrestrained front seat passengers. Such a practice in the Gulf countries^3,7,9,13 lead to the conclusion that children are more susceptible to injuries inside the moving vehicle than getting hit by one on the road.^1,4,6,9 An earlier study by Bener et al.⁸ showed that the rate of frequent seat belt usage among drivers was 5.8%. In the present study, the rate of regular seat belt usage was about 6%. Unfortunately, extensive safety seat belt wearing publicity in the UAE has remained rather unsuccessful, since the UAE does not have safety seat belt legislation and enforcement. There is no better effective measure than legislation to increase awareness of the necessity of wearing seat belts. Most of these RTAs occurred during the daytime, rather than during the night as one would expect.

Road traffic accidents generally cause more serious trauma than other accidents. This was reflected in the high number of fatal and serious injuries in the UAE, which was considerably higher than those in the USA or UK. Road traffic fatalities are the second most common cause of death in all age groups in the UAE, as was noted in earlier studies.^{1–4,15–17} Injuries to the head featured predominantly and were the cause of death in many patients. Only 6% of all patients wore seat belts at the time of the accident. It is noteworthy that there was no mortality in those who wore seat belts. Enforcing the wearing of seat belts, as suggested in earlier reports,^1,4,7,9,13 will certainly reduce the incidence of serious injuries.

Strict enforcement of speed limits will reduce the number of RTAs. Such measures have been found highly effective in the USA.¹⁴ Every effort should be made to reduce the mortality and the morbidity from these accidents, which divert billions of dollars of health care resources,¹ not to mention the impact of death on the family, the domestic disruption and psychological distress that accompany it.

In summary, RTA continue to be a major cause of death and morbidity in the UAE. Simple measures such as the strict imposition of speed limits, and the wearing of seat belts, will pay rapid and rich dividends in terms of life, disability and use of national resources.