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YJOMS-D-19-01130 R1

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Journal of Oral and Maxillofacial Surgery
DO TYPE OF HELMET AND ALCOHOL USE INCREASE FACIAL TRAUMA
SEVERITY?
--Manuscript Draft-Manuscript Number:
YJOMS-D-19-01130R1
Article Type:
Full Length Article
Section/Category:
Craniomaxillofacial Trauma
Corresponding Author:
gabriela porto
Universidade de Pernambuco
Recife, PE BRAZIL
First Author:
Gabriela Granja Porto, PhD
Order of Authors:
Gabriela Granja Porto, PhD
Ladyanne Pavão de Menezes, DMD
Darlan Kelton Ferreira Cavalcante, DMD
Rosa Rayanne Lins de Souza, DMD
Suzana Célia De Aguiar Soares Carneiro, PhD
Antonio Azoubel Antunes, PhD
Abstract:
Purpose
Facial trauma caused by motorcycle accidents has become major issue due to its high
prevalence and morbidity, causing death, aesthetic and functional sequelae in many
victims. This work evaluated helmet and alcohol use and severity of facial fractures in
motorcyclists, treated at public hospitals in Pernambuco, Brazil.Patients and Methods
This was a prospecive study, conducted from December 2016 to December 2018, and
submitted to statistical-descriptive analysis. Variables such as gender, age, helmet use
and type, previous accidents and duration of hospitalization were collected. The Facial
Injury Severity Scale was used to classify the facial fractures. Alcohol Use Identification
Test Disturbance was used to verify alcohol dependence.Results
The sample was composed of 455 patients. The majority were males (90.8%), aged
18-29 years (54.5%). 36.5% of the patients reported no helmet use and 31.6%
reported wearing open helmet. Alcohol use was reported in 38.7% of the group. 79.8%
of the sample was classified as low-risk alcohol use. There was greater likelihood of
having severe facial trauma if the patients were between 30 and 39 years old, and had
a harmful or at-risk alcohol use. These patients also tended to remain hospitalized
more than 10 days. There was no statistically significant relationship with the type of
helmet.Conclusion
Those most affeted by facial trauma were young male patients (18 to 29 years).
Patients aged 30-39 yr with a high-risk use and dependence on alcohol are more likely
to have more complex facial trauma. The type of helmet used was not effective in
reducing the severity of facial fractures.
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Cover Letter
Cover Letter
Dr. Editor in Chief,
We state that the manuscript entitled DO TYPE OF HELMET AND ALCOHOL USE
INCREASE FACIAL TRAUMA SEVERITY? has not been submitted to another journal or
published elsewhere. It has been read and approved by all the authors, that the
requirements for authorship have been met and that each author believes that the
manuscript represents honest work.
In consideration of the Journal of Oral and Maxillofacial Surgery taking action in
reviewing and editing our submission, the authors undersigned hereby transfers,
assigns, or otherwise conveys all copyright ownership to the American Association of
Oral and Maxillofacial Surgeons in the event that such work is published in the JOURNAL
OF ORAL AND MAXILLOFACIAL SURGERY. The undersigned authors understands that if
the manuscript is accepted, the Editors reserve the right to determine whether it will be
published in the print edition or solely in the Internet edition of the Journal. Articles
accepted for publication are subject to editorial revision.
Gabriela Granja Porto - Email: [email protected]
Ladyanne Pavão de Menezes - Email: [email protected]
Darlan Kelton Ferreira Cavalcante - Email: [email protected]
Rosa Rayane Lins de Souza - Email: [email protected]
Suzana Célia De Aguiar Soares Carneiro - Email: [email protected]
Antonio Azoubel Antunes - Email: [email protected]
Revision Notes
Dear Mrs Hupp,
We have been asked to submit a revised title page that also includes all authors'
degrees (e.g. DMD, MD, PhD), which is attached in the submission file.
Please let us know if there is any other change you might like for us to do.
Thank you very much!
Gabriela Porto
Title Page
DO TYPE OF HELMET AND ALCOHOL USE INCREASE FACIAL TRAUMA
SEVERITY?
Gabriela Granja Porto1, Ladyanne Pavão de Menezes2, Darlan Kelton Ferreira
Cavalcante3, Rosa Rayanne Lins de Souza4, Suzana Célia de Aguiar Soares
Carneiro5, Antonio Azoubel Antunes1
1. PhD, Adjunct Professor of the Master in Forensic Sciences. University of Pernambuco
(UPE), Brazil.
2. Undergraduate student. Faculty of Dentistry. University of Pernambuco (UPE), Brazil.
3. DMD, Posgraduate student of the Master in Forensic Sciences. University of
Pernambuco (UPE), Brazil.
4. DMD, Resident at Restauração Hospital. University of Pernambuco (UPE), Brazil
5. PhD, Oral and Maxillofacial Surgeon at Restauração Hospital. University of Pernambuco
(UPE), Brazil.

Department address:
Master in Forensic Sciences. University of Pernambuco / Faculty of Dentistry
of Pernambuco.
Av. General Newton Cavalcanti, 1650; 54753-220, Camaragibe-PE-Brazil.

Address for correspondence:
Prof. Gabriela Granja Porto
University of Pernambuco/Faculty of Dentistry of Pernambuco
Av. General Newton Cavalcanti, 1650; 54753-220, Camaragibe-PE-Brazil.
Email: [email protected] Telephone: +55 81 99232-3241.
Revised Manuscript
Click here to access/download;Revised Manuscript;Manuscript
11.09.2019 (1).docx
DO TYPE OF HELMET AND ALCOHOL USE INCREASE FACIAL TRAUMA
SEVERITY?
Porto GG, Menezes LP, Cavalcante DKF, Souza RRL, Carneiro SCAS, Antunes AA.
ABSTRACT
Purpose
Facial trauma caused by motorcycle accidents has become major issue due to its high
prevalence and morbidity, causing death, aesthetic and functional sequelae in many
victims. This work evaluated helmet and alcohol use and severity of facial fractures in
motorcyclists, treated at public hospitals in Pernambuco, Brazil.
Patients and Methods
This was a prospecive study, conducted from December 2016 to December 2018, and
submitted to statistical-descriptive analysis. Variables such as gender, age, helmet use
and type, previous accidents and duration of hospitalization were collected. The Facial
Injury Severity Scale was used to classify the facial fractures. Alcohol Use Identification
Test Disturbance was used to verify alcohol dependence.
Results
The sample was composed of 455 patients. The majority were males (90.8%), aged
18-29 years (54.5%). 36.5% of the patients reported no helmet use and 31.6% reported
wearing open helmet. Alcohol use was reported in 38.7% of the group. 79.8% of the
sample was classified as low-risk alcohol use. There was greater likelihood of having
severe facial trauma if the patients were between 30 and 39 years old, and had a
harmful or at-risk alcohol use. These patients also tended to remain hospitalized more
than 10 days. There was no statistically significant relationship with the type of helmet.
Conclusion
Those most affeted by facial trauma were young male patients (18 to 29 years).
Patients aged 30-39 yr with a high-risk use and dependence on alcohol are more likely
to have more complex facial trauma. The type of helmet used was not effective in
reducing the severity of facial fractures.
INTRODUCTION
Traffic accidents have become an epidemic in modern-day society1. The data are
even more alarming when one observes motorcycle accident rates. Among the
damage caused to patients who survive these accidents, motor, psychological and
mutilation sequelae may be emphasized2. Lesions in the head and face region tend to
be more complex, due to the peculiarities of their anatomical structures, such as a
complex vascularization, nervous system, bones, muscles and cartilage 3.
They also play an important role in physical, aesthetic functional and mental
sequelae4.Thus, they definitively compromise the life of the individual and, when poorly
treated, may leave sequelae, marginalizing the individual from social interaction,
generating incapacity for work, and condemning the victim to economic segregation2.
The causes of trauma injuries may vary from country to country, due to different
local, cultural and social factors1. Worldwide, especially in developing countries, the
most frequent cause of fractures and serious facial injuries are traffic accidents,
especially those involving motorcycles. Such accidents may become more serious
when associated with alcohol use5. This substance has proven to be an aggravating
factor, and is cause of concern for road safety around the world, due to the role of
alcohol in reducing reflexes and concentration, directly interfering with individuals'
driving ability6.
It has been observed that in many countries motorcycles have been used as the
main means of transport. They can be purchased at low cost and are associated with
the increase in the speed of traffic, being important factors in their use in professional
activities7. Indeed, motorcycles play important role in transportation, especially for the
working class that uses them for various services8. For this reason accidents involving
motorcycles have increased in many countries with major repercussions on the public
health system.
Much work needs to be done in order to prevent these accidents involving
motorcyclists. Prevention is the most important way to reduce this public health
problem. In this respect, actions focused on primary prevention level may minimize
accidents initially, generating changes in this population´s behavior2. Therefore
obtaining recent epidemiological data on facial trauma may help in planning strategies
for the prevention of traffic acidents.
In many countries, there are laws that oblige the motorcyclists to wear helmets
and forbid them to drive after drinking alcohol. However they do not specify the most
appropriate type of helmet that could lead to fewer serious injuries9. Futhermore it is
still unknown whether the use of alcohol increase trauma severity, and there are no
studies in the literature correlating alcohol and helmet use with the severity of facial
injuries. Thus the main purpose of this study was to evaluate the helmets used and the
use or non use of alcohol in relation to the type of facial injuries in a Brazilian population
of motorcyclists.
MATERIALS AND METHODS
The study was approved by the University´s Ethics Committee (nº
57061115.9.0000.5207) and followed the Declaration of Helsinki on medical protocol
and ethics. It was conducted at the main emergency Hospitals in the state of
Pernambuco, Brazil: Restauração Hospital (HR) and Regional do Agreste Hospital
(HRA) from March 2016 to December 2018.
The study comprised all patients of both sexes at any age traumatized in the
oral and maxillofacial region due to motorcycle accidents who agreed to participate in
the study after reading the Informed Consent Form (ICF).
In order to collect data, an evaluation form was elaborated containing
information such as age, sex, address, type of motorcycle, use and helmet type (open
or closed), alcohol consumption prior to the accident, purpose of motorcycle use, type
and severity of trauma and length of hospitalization.
The FISS (Facial Injury Severity Scale), designed by Bagheri et al. (2006)10 was
used to calculate the severity of facial injury. The FISS is represented as a numerical
value according to the sum of all facial injuries, with a higher score indicating greater
severity. On this scale, the face is divided into horizontal thirds for bony injuries:
mandible, midface and upper face. In addition, the total length for all facial lacerations
is included in the scale.
The AUDIT (Alcohol Use Disturbance Identification Test) questionnaire was also
applied in order to verify the risk of alcohol dependence.This questionnaire, consisting
of ten questions, is widely used in several countries because it is easy and inexpensive
to apply11. The total score ranges from 0 to 40 points, making it possible to identify four
patterns of alcohol use or risk zones: I) low-risk use (0 - 7 points); II) at-risk use (8 - 15
points); III) harmful use (16 - 19 points); IV) probable dependence (20 or more points).
Data were analyzed descriptively using absolute and percentage distributions
for categorical variables and statistical measurements: mean, standard deviation and
median for the numerical variables age and FISS score. To evaluate the occurrence of
bivariate association between the FISS score (up to 5 versus 6 or more) and the other
variables in the study, Pearson's Chi-square test or Fisher's Exact test was used in
situations where the conditions for the Chi-test were not verified. The Mann-Whitney
test was used in the comparison of two categories. The Kruskal-Wallis test was used
to compare the categories of the variables (more than 2) in relation to the numerical
variable (FISS score). In the case of significant diferences, multiple comparison tests
were used.
It should be noted that the choice of the Mann-Whitney and Kruskal-Wallis tests
was due to the absence of data normality in at least one of the categories. The
verification of normality was performed by the Shapiro-Wilk test.
To estimate the probability of a patient having a FISS score of at least 6, a
multivariate logistic regression model was fitted with variables that showed a significant
association of up to 20% (p <0.20) in the bivariate study. In the bivariate study, the
values of significance of each variable, OR (Odds Ratio) and confidence intervals for
each category were obtained in relation to the FISS score (6 or more). In the
multivariate logistic regression model, the same parameters were obtained.
The margin of error used in the statistical test was 5% and intervals of confidance
of 95% were obtained. The data were entered on the EXCEL worksheet and the
program used to obtain the statistical calculations was the IBM SPSS version 23.
RESULTS
The sample comprised 455 patients who suffered motorcycle accidents as a pilot.
The mean age was 31.19 years ± 11.36 (minimum 15 years, maximum 72).
Most patients were male (90.8%). More than half (54.5%) were 15-29 years old.
The percentage who reported using alcohol was 38.7%. The purpose of motorcycle
use was 36.3% for work. Table 1 shows the evaluation of any previous accident and
hospitalization, location and fracture complexity and AUDIT classification.
Table 2 presents the FISS classification in relation to the use and type of helmet,
motor power, duration of hospitalization, alcohol use and AUDIT. There was a significant
association between FISS and age group, days of hospitalization and AUDIT. For these
variables it is emphasized that the percentage of patients with a FISS of at least 6 was
lower in the 18-29 year age group (7.3%) and higher in the 30-39 year one (16.4%); it
increased with the number of days hospitalized and was higher among those classified
as AUDIT with risk / harm use than in those with low-risk use (17.4% x 7.7%).
Table 3 shows significant differences between age, sex, helmet use, number of
days hospitalized, AUDIT and FISS. For these variables it is evident that the mean of
FISS score was higher in males than in females (p=0.029). It was also higher with
significant differences in those age a 30-39 yr (p < 0.001), in those who not were wearing
a helmet (p=0.026) and in patients classified by AUDIT with risk / harmful use of alcohol
(p=0.014). Patients who had a high FISS remained in the hospital for more than 10 days
(p<0.001).
Table 4 presents the results of the bivariate and multivariate logistic regression for
the patients classified with a FISS of at least 6 according to the independent variables
that presented p < 0.20 in the bivariate study. The following variables were included in
the multivariate logistic regression model: age, motor power, length of stay and AUDIT
classification; of these 4 variables, only motor power was not significant at 5%. Of the
OR values for the three significant variables, it is estimated that the likelihood of a patient
being classified as having a FISS of at least 6 increases if the patient is 30 to 39 years
old, hospitalized for more than 10 days and classified with AUDIT risk / use harmful.
The results of other model indicated acceptance of our model (p <0.001), an
adequate fit to the data (p = 0.353 using the Hosmer and Lemeshow test) and correct
classification of 86.4% of the data.
DISCUSSION
Motorcycle accidents are one of the leading causes of death in traffic all over the
world. Among road deaths worldwide, accidents involving motorcyclists accounted for
9% of deaths in Europe, 20% in the United States and 34% in the countries of the
Western Pacific and Southeast Asia12. Therefore, studies must be carried out so that
prevention and education campaigns in transit can be designed in such a way to
reduce these numbers. The present study evaluated whether the type of helmet and
alcohol comsuption increased facial trauma severity in motorcyclists.
When assessing the distribution of patients according to sex, a predominance of
males (90.8%) was observed, corroborating other studies in the literature13. This can
be explained by the greater involvement of men in outdoor activities and their greater
exposure to violent actions14. It should also be noted that male drivers outnumber
female ones15. Interestingly, however finding on the study of Zhou et al. (2015)16 in
China found that women in the 11-20 yr age group were more associated with facial
trauma than men. This indicates that females tend to take an early active role in society
and is associated with the greater participation of women in extra-community activities,
bringing them closer to men in risk groups in some countries16,17.
The most prevalent age group was 18 to 29 yr (54.5%), similar to the study of Yu
et al. (2011), in which 51.5% of the patients were young people between 18 and 35
years of age18. The prevalence of these traumas in this age group can be attributed to
the fact that this group engaged in dangerous sports, besides using means of
transportation in a high speed16. We expected that this age group would have a greater
severity of facial trauma. But this was not confirmed in this study, with all age group
having mild facial trauma (between 2 and 3, according to FISS). We found that there
is a greater likelihood of patients aged 30-39 years having more complex traumas.
In this study, approximately 1/3 (28%) of the interviewes reported involvement in
previous motorcycle accidents. In a study by Veronese et al. (2006), 51% of the sample
had already suffered more than one accident, while 8% had already had more than
1019. It maybe that the use of alcohol contribute to this behavior, because they either
lose fear or momentarily forget about their previous accidents following alcohol
intake20, which in this study had occurred in about 38.7% of the sample.
A recent study by Roccia et al. (2019) in Italy found a progressive reduction in the
incidence of maxillofacial fractures over 17 years. The authors attribute these results
precisely to the implementation, application and observance of road safety policies,
which was reflected in low percentages of patients reporting alcohol abuse while
driving and large percentages of helmet use21. Thus, in this regard it was to be
expected that people would not drink alcohol at all, because drinking and driving any
vehicle is forbidden by a Brazilian law, implemented in 2008 and reinforced in 2012
through a resolution, that prohibited driving under the influence of any amount of
alcohol6.
However, it is worth mentioning that the number of patients who used alcohol
before an accident may be underestimated. Fearing legal proceedings, patients may
claim that they did not use alcohol before driving, which would constitute a crime
according to the Brazilian Traffic Code6. This bias may be repeated regarding the nonuse of the helmet at the time of the accident, since a helmet constitutes mandatory
protection equipment by law. According to Soares-Carneiro et al. (2016), an objective
method of confirming wether the patient was actually drunk before the trauma would
be through an intoxication test at the time of the patient´s arrival at the hospital22.
Thus, alcohol use and a previous accident reported by a large number of the
motorcyclists may suggest that the possible ingestion of an alcoholic beverage may
interfere with a driver´s cognitive and motor responses, impairing control of
the motorcycle23. This data is relevant, since a considerable number of the patients in
this study reported being recidivists in traffic accidents, which increases the state´s
expenditure on emergency services and treatment of possible sequelae. Moreover, it
was demonstrated that drivers classified as harmful alcohol users were about twice as
likely to have more complex fractures (FISS score of at least 6) compared to low-risk
users.
The majority of the victims in this study reported driving a motorcycle with a
horsepower greater than 50 cubic centimeters (90.8%), which is in accordance with
the work of Hidalgo-Fuentes and Sospedra-Baeza (2018)17, in which the mortality rate
of motorcycle drivers who suffered an accident while driving at excessive speed, was
much higher than those involved in a traffic accident at a low speed. Thus, in this
connection, it was expected that patients who were driving more powerful motorcycles
had more severe facial injuries when compared to those who were not. But this was
not confirmed in the present study, maybe because the sample was not large enough
to make such comparisons.
Regarding the use of a helmet, 63.5% of patients stated they were wearing one
at the time of the trauma, a percentage lower than that of Kuo et al. (2017), who
reported a frequency of 86.3%24. This value should be close to 100%, when taking into
account mandatory helmet use since the current Brazilian Traffic Code came into
force in 19979.
The highest frequency of helmets used in this study was the closed type worn in
approximately 31.9%, being a piece of equipment that is expected to offer adequate
face protection. In addition, 31.6% of the patients of the 63.5 % who reported wearing
a helmet were using an open helmet, which is not expected to provide adequate
protection in case of facial trauma. Thus, it can be considered that a total of 68.1% of
the patients did not present adequate protection for the bones of the face at the time
of the motorcycle accident. But contrary to our expectations and the literature
consulted15, we did not find any significant differences when comparing facial severity
with type of helmets.
However, similar percentages of facial trauma with higher scores on the FISS
scale (characterizing more severe injuries) were found, both in individuals who used
open helmets and in those who did not wear a helmet at al. Thus, even though no
significant differences were found between type of helmet and trauma severity there is
a tendency for finding more complex traumas tend to be found in patients wearing
opened helmet or no wearing a helmet at all. These data are in agreement with the
systematic review developed by Liu et al. (2008), in which the evidence indicated that
the use of closed helmet affords greater protection against head injuries, when
compared to the absence of helmet use, but no evidence was found to support the
claim that the use of an open helmet offers less protection against facial injuries than
the use of a closed one. The authors concluded that, at present, no conclusive
evidence exists on the effect of motorcycle helmets on neck or facial injuries25. To
substantiate this suposition a greater sample should be taken in a multicenter studies,
considering other variables such as correct size of the helmet and whether it was
attached to the neck, as well as impact energy and direction of the accident.
According to the Brazilian Ministry of Health and the National Mortality
Information System26 in 2016, traffic accidents in Brazil caused 180,443
hospitalizations, generating a total cost of US$ 65.7 million. In our study, most patients
(36.9%) were in the hospital for more than 10 days, which generates direct and indirect
hospital costs (treatment sequelae, social security, interruption of production, among
others). Nevertheless, a statistically significant relationship was observed between
drivers who had an inpatient period of more than 10 days and a lesion severity degree
as high as 6 and above. This result may be directly related to the fact that patients with
more severe lesions may need care for edema regression, stabilization of vital signs
and other evaluations by other specialists, so they reach the ideal treatment, which
requires more days of hospitalization. Moreover, the FISS scale, as proposed by
Bagheri et al. (2006)10, was an indicator of duration of hospital stay of patients with
facial trauma27. This variable is worth studying to see whether there are any significant
differences in the expenses incurred by more complex fractures.
These results, confirmed by the bivariate and multivariate logistic regression,
indicate that the chances of a patient presenting a lesion with an elevated FISS
score (i.e., lesions of greater severity) increase if the patient is aged between 30 and
39 years, presents at-risk or harmful alcohol use according to the AUDIT, and is
hospitalized for more than 10 days. The results are, therefore, in agreement with the
literature that indicates alcohol use as an inducer of euphoria and self-confidence,
generating driver inattention and favoring the abuse of speed22. These factors,
associated with inadequate protection, may be paramount in determining of the
fractures suffered. The present data are even more relevant in that there are no studies
in the literature comparing the severity of facial trauma, alcohol abuse and use and
type of helmet, at the time of the motorcycle accident.
CONCLUSION
Those most affeted by facial trauma in this study were young patients (18 to 29
years), and particularly males. Patients aged 30-39 yr with a high-risk use and
dependence on alcohol are more likely to have more complex facial trauma. In addition,
these patients tend to stay hospitalizaed for more than 10 days. The type of helmet
used was not effective in reducing the severity of facial fractures.
ACKNOWLEDGMENTS
This research received financial support from PIBIC/CNPq/UPE 2016-2017 and
PIAEXT/UPE 2017-2018
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http://www.2datasus.gov.br/DATASUS/index.php?area=060701. Accessed August
13, 2019.
27. Aita TG, Pereira Stabile CL, Dezan Garbelini CC, Vitti Stabile GA: Can a Facial
Injury Severity Scale Be Used to Predict the Need for Surgical Intervention and Time
of Hospitalization? J Oral Maxillofac Surg 76(6):1280.e1-1280.e8, 2018.
TABLES
Table 1 - Evaluation of the occurrence of previous accident and hospitalization, location
and fracture complexity, AUDIT classification.
Variable
n
%
TOTAL
455
100.0
Number of days hospitalized
Up to 10
More than 10
321
134
70.5
29.5
AUDIT Classification I
Low risk use (0 to 7 points)
At-risk use (8 to 15 points)
Harmful use (16 to 19 points)
Probable dependency (20 points or more)
363
88
3
1
79.8
19.3
0.7
9.2
AUDIT Classification II
Low risk use
At-risk use/ harmful / Probable dependency
363
92
79.8
20.2
FISS Classification I
Up to 5
6 or more
411
44
90.3
9.7
FISS Classification II
0 to 1 (Slight)
2 to 5 (Moderate)
6 or more (Severe)
133
278
44
29.2
61.1
9.7
Table 2 – Evaluation of facial severity according to age, sex, use and type of helmet,
motor power, alcohol use and AUDIT classification.
Variable
Total Group
FISS
6 or more
n
%
0 to 5
TOTAL
P value
n
n
n
%
44
9.7
411
90.3
455
100.0
Age Group
18 to 29
30 to 39
40 to 72
18
18
8
7.3
16.4
8.2
230
92
89
92.7
83.6
91.8
248
110
97
100.0
100.0
100.0
Sex
Male
Female
43
1
10.4
2.4
370
41
89.6
97.6
413
42
100.0
100.0
Helmet Use
Yes
No
26
18
9.0
10.8
263
148
91.0
89.2
289
166
100.0
100.0
Helmet Type
No Helmet
Closed
Open
OR (CI 95%)
p(1) = 0.023*
1.00
2.50 (1.25 to 5.02)
1.15 (0.48 to 2.74)
p(2) = 0.105
**
p(1) = 0.521
1.00
1.23 (0.65 to 2.32)
1.00
p(1) = 0.236
18
17
9
10.8
11.7
6.3
148
128
135
89.2
88.3
93.8
166
145
144
100.0
100.0
100.0
1.82 (0.79 to 4.20)
1.99 (0.86 to 4.63)
1.00
p(2) = 0.105
Motorcycle Power
> 50 cylinder
< 50 cylinder
43
1
10.4
2.4
370
41
89.6
97.6
413
42
100.0
100.0
Days of Hospitalization
1 to 10
13
4.0
308
96.0
321
100.0
> 10
31
23.1
103
76.9
134
100.0
Alcohol Use
Yes
No
19
25
10.8
9.0
157
254
89.2
91.0
176
279
100.0
100.0
AUDIT
Low Risk Use
At-risk Use / Harmful Use
28
16
7.7
17.4
335
76
92.3
82.6
363
92
100.0
100.0
**
p(1) < 0.001*
1.00
7.13 (3.59 to
14.15)
p(1) = 0.519
1.23 (0.66 to 2.31)
1.00
p(1) = 0.005*
(*) Significant association at the 5.0% level.
(1) Using Pearson's Chi-square test.
(2) Using Fisher's exact test
1.00
2.52 (1.30 to 4.89)
Table 3 – FISS stathistics according to helmet use and type, motorcycle power, use of
alcohol and AUDIT.
Statistics
Median
Minimum
Variable
Mean ± SD
TOTAL
2.76 ± 1.97
2.00
0.00
12.00
2.81 ± 1.74 (A)
3.05 ± 2.23 (A)
2.31 ± 2.15 (B)
2.00
2.00
2.00
0.00
0.00
0.00
11.00
10.00
12.00
2.82 ± 1.99
2.19 ± 1.63
2.00
2.00
0.00
1.00
12.00
10.00
Age
18 to 29
30 to 39
40 or more
Sex
Male
Female
Maximum
P value
p(1) < 0.001*
p(2) = 0.029*
p(2) = 0.026*
Helmet Use
Yes
No
2.63 ± 1.89
3.00 ± 2.09
2.00
2.00
0.00
0.00
11.00
12.00
Helmet Type
No helmet
Closed
Open
3.00 ± 2.09
2.73 ± 2.11
2.52 ± 1.63
2.00
2.00
2.00
0.00
0.00
0.00
12.00
11.00
10.00
Motorcycle power
Over 50 cc
50 cc
2.81 ± 2.02
2.29 ± 1.33
2.00
2.00
0.00
0.00
12.00
6.00
Days of Hospitalization
1 to 10
> 10
2.38 ± 1.53
3.67 ± 2.53
2.00
3.00
0.00
1.00
10.00
12.00
p(1) = 0.083
p(2) = 0.209
p(2) < 0.001*
p(2) = 0.909
Alcohol Use
Yes
No
2.78 ± 2.01
2.75 ± 1.95
2.00
2.00
0.00
0.00
12.00
11.00
AUDIT
Low Risk Use
Risk Use / Harmful Use
2.64 ± 1.88
3.25 ± 2.23
2.00
3.00
0.00
0.00
12.00
11.00
p(2) = 0.014*
(*) Significant at 5.0%
(1) Using Mann-Whitney test
(2) Using Kruskal Wallis test
Obs. If the letters between parenthesis are different there is significant difference between groups.
Table 4 – Logistic regression results for the facial trauma prevalence for lesions
classified as at least 6 using the FISS score.
Variable
n
Bivariate analysis
% (1)
OR e IC 95.0%
Age
18 to 29 (n = 182)
30 to 39 (n = 77)
40 to 72 (n = 50)
17
17
8
9.3
22.1
16.0
1.00
2.75 (1.32 to 5.73)
1.85 (0.75 to 4.57)
Motorcycle Power
More than 50 cc (n = 281)
50 cc (n = 28)
41
1
14.6
3.6
4.61 (0.61 to 34.88)
1.00
0.147
5.49 (0.69 to 44.08)
1.00
0.109
Days of Hospitalization
1 to 10 (n = 195)
> 10 (n = 114)
12
30
6.2
26.3
1.00
5.45 (2.66 to 11.16)
< 0.001*
1.00
5.43 (2.59 to 11.42)
< 0.001*
26
11.2
1.00
0.034*
1.00
16
20.8
AUDIT
Low Risk Use
(n = 232)
Risk Use / Harmful Use
(n = 77)
P value
Ajusted Multivaried
OR and CI 95.0% (2)
P value
0.021*
2.08 (1.05 to 4.12)
(*): Significant at 5.0%.
(1) Percentage obtained from the total group in each cathegory.
0.012*
1.00
3.16 (1.43 to 6.98)
2.63 (0.98 to 7.05)
2.22 (1.05 to 4.72)
0.005*
0.055
0.038*
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