Jawood, Kedren Kent G.

BSN 4B/Sherwin G. Maputol, RN, MAN

Analysis of Transport and Vehicular Road Crash Cases
in Metro Manila from 2016 to 2020

Summary

Metro Manila, the metropolitan hub and seat of the national government, is made
up of 16 cities and 1 municipality and is the Philippines' second-most populous region.
Transportation is a critical industry for accessibility and economic success. However,
since road crashes continue to be reported, the topic of Manila's road safety continues.
The study's goal is to identify the trend of road crashes in Metro Manila, as well as the
factors that contribute to both fatality and injury among three groups of road users: drivers,
passengers, and pedestrians.

A review of 523,059 road crash data from 2016 to 2020 was conducted. The road
crash variables studied in the study were crash classification based on property damage,
fatal, and non-fatal crash, road user type based on driver, passenger, and pedestrian,
vehicle type, junction type, and risky road user behavior. To assess if these
characteristics were associated with road user death and injury, logistic and multinomial
regression models were used. The MMARAS database analysis revealed a rising trend
of road crashes that peaked in 2019, then reduced in 2020. Property damage was the
most common, followed by non-fatal or injurious instances and fatal outcomes. When
compared to passengers and pedestrians, drivers have the highest number of fatalities
and injuries.

Cars and motorbikes continue to be the most common types of vehicles involved
in traffic accidents. Pedicabs, motorbikes, buses, trucks, hit objects, self-accidents, and
bridge/flyover incidents were all strongly related with an increased chances ratio for driver
death. Motorcycle participation, angle impact, multiple collision, self-accident, and loss of
control were all strongly related with an increased chances ratio for passenger fatalities.
struck and run, struck pedestrian, and bridge/flyover crashes were all substantially
connected with pedestrian fatalities. Meanwhile, multinomial regression revealed that
collision classification and vehicle type were substantially related to both fatal and non-
fatal crashes. The study examined the trends in fatalities and injuries among drivers,
Jawood, Kedren Kent G.
BSN 4B/Sherwin G. Maputol, RN, MAN
passengers, and pedestrians from 2016 to 2020, as well as the factors that contribute to
road crashes in Metro Manila, such as vehicle type, driving behaviors, collision type, and
junction type.

Insights
The rise in worldwide traffic accidents and fatalities disproportionately impacts
developing countries. The MMARAS database was utilized in this study to investigate
road crashes and the factors influencing the severity of crashes in Metro Manila,
Philippines. Except for 2020 owing to pandemic lockdowns and community quarantine,
the trend of road crashes and the severity of crashes in Metro Manila is generally
increasing.

The survey also highlighted statistics on fatalities and injuries sustained by three
groups of road users: drivers, passengers, and pedestrians. These road crash outcomes
were also associated with known key categories of characteristics, including vehicle
kinds, road user behavior, collision type, and junction type. The prevalence of preventable
accident causes highlights the importance of greater enforcement and examination of
road traffic laws, policies, and regulations to address dangerous driving behaviors and
license requirements for road users and vehicles. There is also a need to educate road
users on safe road usage in order to reduce their engagement in unsafe driving practices.

More study and financing are required to collect data from Metro Manila cities to
evaluate the road crash variables, how existing road traffic rules, policies, and regulations
are being applied, and the availability and usage of enforcement equipment. There is a
need for thorough and accurate data on the key contributing variables to road crashes,
which can be used to develop safety initiatives and legislation.

Reference:
Lu, J. L., Herbosa, T. J., & Lu, S. F. (2022). Analysis of Transport and Vehicular Road
Crash Cases in Metro Manila from 2016 to 2020. Acta Medica Philippina, 56(19).
https://doi.org/10.47895/amp.v56i19.6262
Jawood, Kedren Kent G.
BSN 4B/Sherwin G. Maputol, RN, MAN
Surgical timing for open fractures Middle of the night or the light of day, which
fractures, what time?

Summary

As new clinical trials call open fracture management dogma into question, there is
debate over the best way to treat them. Open fractures are complicated injuries that
necessitate the orthopedic surgeon considering both the bone injury and the related soft
tissue injury. Infection prevention continues to rely on early IV antibiotics and tetanus
prophylaxis. The "six-hour rule" for initial open fracture debridement and
revascularization, on the other hand, has been called into question. New data
recommends immediate debridement with the proper surgical team within 24 hours.

Furthermore, orthopedic surgeons and vascular surgeons should collaborate on

the therapy sequence of open fractures with accompanying vascular damage. While
multicenter randomized controlled trials have provided answers to arguments about the
appropriate irrigation pressure and solution, more study is needed to discover the ideal
irrigation volume and timing of wound closure. With developments in open fracture
therapy, the efficacy of well-known classification systems such as the Gustilo-Anderson
classification and Mangled Extremity Severity Score must be reconsidered in favor of
more recent classification methods that better guide management and predict prognosis.

Insights
Open fracture management necessitates a thorough examination of the bone
injury, including fracture features and bone loss, as well as soft tissues such as
contamination, integument injury, muscle damage, and neurovascular injury. Despite
their shortcomings, the Gustilo-Anderson classification and Mangled Extremity Severity
Score remain the most often used open fracture classification systems. However, newer
classification systems, such as the Unified classification system, may define open fracture
characteristics more accurately and with greater interrater reliability.
Jawood, Kedren Kent G.
BSN 4B/Sherwin G. Maputol, RN, MAN
Open fracture care aims to reduce infection risk and promote fracture union. Early
IV antibiotics and tetanus prophylaxis are used in the initial therapy. In contrast to open
fracture dogma, initial debridement should be conducted with an adequate surgical team
within 24 hours rather than within 6 hours. Irrigation of open fractures should be done by
gravity flow with normal saline; however, the ideal irrigation amount has not been
determined clinically. To optimize patient outcomes in the case of an open fracture with
vascular injury, early communication between orthopaedic surgery and vascular surgery
is necessary. If wounds are clean and tension-free closure can be achieved, early primary
closure of open fractures should be considered.

Reference:
You, D. Z., & Schneider, P. S. (2020). Surgical timing for open fractures: Middle of the
night or the light of day, which fractures, what time?. OTA International 3(1):p e067 | DOI:
10.1097/OI9.0000000000000067