Changing Presentation of Traumatic Brain Injuries in a Tertiary Hospital Lahore Following Enforcement of Motorcycle Helmet Laws - A Mixed-Method Study

Abstract

Objectives: To observe change in traumatic brain injury (TBI) presentation after enforcement of a motorcycle helmet law and to explore perspectives of stakeholders on road safety measures. Methods: A cross-sectional study was undertaken based on retrospective record review of traffic-related TBI patients, supplemented by a qualitative component. Patient data in periods before and after helmet-law enforcement were stratified by TBI grade. Stakeholders as doctors, motorcyclists, and policemen were interviewed to explore perceptions regarding the observed changes in neurotrauma, helmet-use behaviour and effectiveness of helmet-law enforcement. Setting: Neurosurgery department, public-sector tertiary hospital in Lahore. Results: After the law’s enforcement, significant improvement in mean Glasgow Coma Scale (GCS) scores were seen on patient-admission (from 11.15 ± 3.51 to 12.24 ± 3.30). The severity of TBI, proportion of intracranial haemorrhages and other associated head injuries all reduced significantly (p < 0.05). Patient-survival rate increased (74.7% to 82%) and the operative rate reduced from 13.3% to 10.8%. After interviewing stakeholders, the main theme identified was “Enforcement of road safety measures remains partial and inconsistent”. Changes in healthcare burden and challenges in implementing legislature were noted. Conclusion: An association between the enforcement of a motorcycle helmet law and a decrease in the severity of traffic-related TBI hospital admissions was observed. Nonetheless, sustained helmet law enforcement remains a challenge in a temperate climate, and children, females and pillion riders are poorly-protected by current road policies.