The present study is part of the Persian Traffic Cohort (PTC) study and cases were selected from the Iranian Integrated Road Traffic Injury Registry (IRTIR) system used in it. IRTIR was designed by the Ministry of Health and Medical Education with the collaboration of WHO. The comprehensive IRTIR system has for the first time, with the support and cooperation of WHO, been established in the two referral specialized hospitals of Emam Reza and Shohada located in the Eastern Azarbaijan Province of Iran. The IRTIR gathers data at several sections as follows: Crash scene section; Emergency section; Hospital admission section; Forensic medicine section and post-discharge section.
In present study, 190 injured motorcyclists admitted at the two referral specialized hospitals of Emam Reza and Shohada in Tabriz City between June 2018 and January 2019 and agreed to participate in this study were included. Among them we could contact with 171 injured people (90) three months after the accident.
The inclusion criteria were:
1) being involved in traffic injury (according to the United Nations Economic Commission for Europe (UNECE) definition (13) "road traffic accidents are those accidents:
a) Which occurred or originated on a way or street open to public traffic
b) Which resulted in one or more persons being killed or injured and
c) In which at least one moving vehicle was involved"
2) being a rider or pillion passenger of motorcycle involved in traffic crash accordance with V20-V29 and V31 from International Classification of Diseases-10th revision (ICD-10).
3) being registered integrated road traffic injuries (hospitalization in trauma major centers),
4) having the participant’s consent to be included in the study.
5) being lucid, conscious and cooperative during the telephone follow up.
Those injured individuals who were either in a coma during the telephone follow up or could not talk due to their severe pain, were excluded.
2.1. Data collection
For each injured motorcyclist (both the cyclist and the passenger) who were admitted at the hospitals (Emam Reza and Shohada), baseline measurement was collected through face to face interview at hospital admission section of IRTIR through nursing station data collection tool.
The following information were gathered by using face to face interview in hospitals:
1. Information about the person (including the role of the injured person whether s/he was the cyclist or the passenger, whether the injured rider had a rider license, whether s/he had experience riding a motorcycle before, the average time of riding a motorcycle per day, the average number of days the injured motorcyclist rides the motor per week, whether cellphone was used during riding and if yes whether they were using headphones or they were holding their cellphone in their hand, the motorcyclist communication status with the passenger before the accident, whether the motorcyclists had used alcohol and/or drugs). All these were recorded in the comprehensive IRTIR system.
2. Information regarding the vehicle (including the number of vehicles involved in the accident, the type of vehicle involved in the accident and the mechanism of accident occurred).
- Information regarding the time and location of their accident (such as the day, month, and year of the accident, the exact day of the week, the time of the accident, whether it was light or dark, the weather condition, road condition at the time of the accident and whether it was slippery, whether the accident occurred inside a city or at the suburbs).
- Crash related variables including:
- Demographic characteristics (regarding the name of the hospital where they had been admitted, date of being admitted, case code, national ID number, age, sex, nationality, level of education, marital status, job, address, landline number, cellphone number, cellphone number of next of kin or anyone who could be contacted after the admitted individual was released from the hospital).
3. Information regarding the severity of accident injuries were extracted from the Health Information System (HIS) systems of the hospitals and the type of injuries were defined according to ICD-10 codes as follows: head injuries (S00-S09), neck injuries (S10-S19), thoracic injuries (S20-S29), injuries to the abdomen, lower back, lumbar spine and pelvis (S30-S39), shoulder and above elbow injuries (S40-S49), elbow and forearm injuries (S50-S59), wrist and hand injuries (S60-S69), leg and pelvis injuries (S70-S79), knee and lower knee injuries (S80-S89), foot and ankle injuries (S90-S99).
- Follow up assessment including QOL
One and three months after their accidents, injured hospitalized motorcyclists were contacted by telephone for a follow-up. Required information for performing the follow-up were collected from the IRTIR system. The call duration for each person lasted between 5 to 10 minutes.
The EQ-5D-3L questionnaire was developed in 1987 by a team of researchers from five European countries to assess the QOL. This standard questionnaire covers five aspects of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. For each of these aspects the following scale is considered: 1) I have no problem; 2) I have some difficulty; and 3) I have many problems. The overall score is calculated as the sum of the scores obtained from each aspect divided by 5. The average overall score is between 1 (high QOL) and 3 (low QOL) (14). The higher score showed a bad QOL.
2.3. Statistical analyses
Descriptive statistics for quantitative and qualitative variables have been reported as mean (standard deviation) and frequency (percent), respectively. Univariate and multivariate models of Generalized Estimating Equations (GEE) with unstructured variance-covariance matrix were used to determine the factors affecting the QOL of injured motorcyclists. Results lower than 0.05 were considered statistically significant. Stata SE software (Version 13) was used for data analysis.
This study has been approved by the Ethics Committee of Kerman University of Medical Sciences (reg. code IR.KMU.REC.1397.141) and carried out under the the national ethical codes for the main cohort and registry (IR.KMU.REC.1397.141). Also, verbal consent was received from all participants before including in the study.