Rev. bras. ortop. vol.49 número6

w w w . r b o . o r g . b r

Original

Article

Accidents

involving

motorcyclists

and

cyclists

in

the

municipality

of

São

Paulo:

characterization

and

trends

夽

,

夽夽

Cintia

Leci

Rodrigues,

Jane

de

Eston

Armond,

Carlos

Gorios

_,

Patricia

Colombo

Souza

UniversityofSantoAmaro,SãoPaulo,SP,Brazil

a

r

t

i

c

l

e

i

n

f

o

Articlehistory:

Received18October2013

Accepted9January2014

Availableonline8November2014

Keywords:

Trafficaccidents

Epidemiology

Accidentprevention

a

b

s

t

r

a

c

t

Objective:Todescribethecharacteristicsofmotorcycleandbicycleaccidentvictims,

accord-ing to notifications of suspected and confirmed accidents that have occurred in the

municipalityofSãoPaulo.

Method:Thiswasadescriptiveepidemiologicalstudy.Itcoveredallaccidents(12,924)that

occurredinvolvingmotorcycles(11,366)andbicycles(1558)betweenJanuary2011and

Octo-ber2013.DataintheHealthDepartment’sinformationsystemforsurveillanceofviolence

andaccidents(SIVVA)wassurveyed.

Results:Motorcycleaccidentsaccountedfor52.1%ofthecasesnotifiedandbicycles,7.1%.

Malespredominatedinbothtypesofaccidents:81.6%and80.6%,respectively.Inthe

motor-cycleaccidents,thepredominantagegroupamongthevictimswasfrom20to24years.Both

typesofaccidentsoccurredduringthedaytime(7:00–18:00h):37.4%and27.0%respectively.

Amongthemotorcycleaccidents,thedriverhadbeenusingalcoholin3%anditwasnot

possibletoidentifywhetherthishadoccurredin67%.

Conclusions:Publicpoliciesprioritizingfinancialandhumanresourcesappliedtoward

reduc-ingthesetypesofaccidentsneedtobebroughtin.

©2014SociedadeBrasileiradeOrtopediaeTraumatologia.PublishedbyElsevierEditora

Ltda.Allrightsreserved.

Acidentes

que

envolvem

motociclistas

e

ciclistas

no

município

de

São

Paulo:

caracterizac¸ão

e

tendências

Palavras-chave:

Acidentesdetrânsito

Epidemiologia

Prevenc¸ãodeacidentes

r

e

s

u

m

o

Objetivo:Descreverascaracterísticasdevítimasde acidentesdemotocicletaebicicleta,

segundonotificac¸õesdeacidentes,suspeitoseconfirmados,ocorridosnomunicípiodeSão

Paulo.

夽

Pleasecitethisarticleas:RodriguesCL,deEstonArmondJ,GoriosC,SouzaPC.Acidentesqueenvolvemmotociclistaseciclistasno

municípiodeSãoPaulo:caracterizac¸ãoetendências.RevBrasOrtop.2014;49:602–606.

夽夽

WorkdevelopedattheUniversityofSantoAmaro,SãoPaulo,SP,Brazil.

∗ _{Correspondingauthor.}

E-mail:gorios@terra.com.br(C.Gorios).

http://dx.doi.org/10.1016/j.rboe.2014.11.002

Método:Estudoepidemiológicotransversal,descritivo.Abrangeutodososacidentes(12.924)

ocorridoscommotocicleta(11.366)ebicicleta(1.558)dejaneirode2011aoutubrode2013.

Fez-seumlevantamentodosdadosdoSistemadeInformac¸ãodeVigilânciaeViolênciae

Acidentes(SIVVA)daSecretariadeSaúde.

Resultados: Osacidentesdemotocicletacorresponderama52,1%doscasosnotificados;os

debicicleta,a7,1%.Osexomasculinofoipredominanteemambos:81,6%e80,6%,

respec-tivamente.Nosacidentesdemotocicleta,afaixapredominantedasvítimasfoientre20e

24anos.Ambososacidentesocorreramduranteodia(7às18horas):37,4%e27,0%

respec-tivamente.Entreosacidentesdemotocicleta,em3%ospilotosfizeramusodeálcooleem

67%nãofoipossívelidentificarseissoocorrera.

Conclusões: Faz-senecessáriaaadoc¸ãodepolíticaspúblicasquepriorizemaaplicac¸ãode

recursosfinanceirosehumanosnareduc¸ãodessestiposdeacidente.

©2014SociedadeBrasileiradeOrtopediaeTraumatologia.PublicadoporElsevier

EditoraLtda.Todososdireitosreservados.

Introduction

Terrestrial transport accidents, also known as traffic

acci-dents,areanimportantpublichealthproblembecauseoftheir

highimpactrelatingtomorbidityandmortality.1,2

AccordingtoMelioneandMello-Jorge,3_{fallsandtransport}

accidentshavebeenreportedtoberespectivelythefirstand

secondreasons forhospitalizationsduetoexternalcauses.

Increased rates of accident and violence (external causes)

havehadarepercussionontheorganizationofthe

health-caresystem,whichbecauseofitsresponsibilityforattending

totraumacaseshasbeenfacedwithhigherexpenditureon

medicalcare.Externalcausesaccountforhighermean

expen-ditureandcostperdayofhospitalizationthanthoseofcases

withnaturalcauses.

Amongtrafficaccidents,increasingnumbersofmotorcycle

accidentshavebeenobservedoverrecentyears.These

vehi-clesarebecomingevermoreacceptedandapprovedamong

thepopulationbecausetheyareagile,economicaland

inex-pensivetobuy.4

In the same way, bicycles are an efficient and popular

means of transport among many populations around the

world.Becauseoftheirlowpurchaseandmaintenancecosts,

theycanbeconsideredtobethecheapestformofurban

trans-port,accessibleto practicallyall sociallayers. Theydo not

pollutetheenvironment,theypreservepublicspacesandthey

donotcausethedisturbancethatcharacterizesmotorvehicles

inurbanareas.5

Forcharacterizingtheepidemiologicalprofileofaccidents,

hospitalmorbidityandmortalitydatapresentlimitations.6,7

In2008,inthemunicipalityofSãoPaulo,Brazil,an

infor-mationsystemformonitoringaccidentsandviolence(SIVVA)

wasimplementedwithinthe municipalhealthcaresystem.

Thishasenabled productionofinformationfordiagnosing,

planning,monitoringandevaluatingtheactionsundertaken

towardcopingwithaccidentsandviolence.7

Throughrecognizingaccidentsasamatterforsurveillance

and,atthesametime,comprehendingthecomplexityofthe

phenomenonbymeansofaninterdisciplinaryand

intersec-toralapproach,thesystemhasmadeitpossibletoformulate

integratedpublicpoliciesaimedatprevention.7

InthemunicipalityofSãoPaulo,in2013,5624transport

accidentswerenotified,amongwhich51.7%involved

motor-cyclesand8.8%,bicycles.8

Inviewoftheimportanceofmotorcycleandbicycle

acci-dents withinthe situation ofmorbidityand mortality, this

studydescribesthecharacteristicsofthevictims,according

tothenotificationsofsuspectedandconfirmedaccidentsthat

occurredinthemunicipalityofSãoPaulo.

Method

A descriptive cross-sectional epidemiological survey was

developedwithaviewtofindingoutaboutand

characteriz-ingaccidentsinvolvingmotorcyclesandbicyclesandoutlining

theprofileofthevictims.

This study covered all of the accidents (12,924) that

involvedmotorcycles(11,366)andbicycles(1558)inthe

munic-ipalityofSãoPaulobetweenJanuary2011andOctober2013.

ThedataweregatheredfromSIVVAduringSeptemberand

October 2013. This isa public-domain system that can be

accessedthroughtheportalofthemunicipalauthorityofthe

cityofSãoPaulo,viaitshealthdepartment.

SIVVA isaninstrument forall outpatientservices(both

primarycareandspecializedcare),hospitalsandemergency

services,bothwithintheNationalHealthSystem(SUS)and

withinprivate hospitalsinthe city ofSãoPaulo. The

noti-fication formforsuspectedorconfirmed casesisfilledout

by all healthcareprofessionals when the patient attended

presentssignsorsymptomsorreportssituationsofviolence

and/oraccidents.Somefieldsontheformareforphysicians

tofillout,suchasthediagnosisandcharacterizationofthe

injury.

SIVVA makes it possibleto gather dataon the location

wheretheviolenceoraccidentoccurredandanyassociation

withuse ofalcoholor drugs.Itreveals thegroupsthatare

morevulnerableandtheconsequencesthatfollowfromthese

events,sothatinterventioncriteriathattakeintoaccountthis

diversitycanbeestablished.Thesystemalsomakesitpossible

toconstructinformationonthenatureandtypesofviolence

andenablescharacterizationofaccidents.

The variables used were the type of vehicle,

pedes-trian/rider,age(in years),sex(maleorfemale),evolutionof

thecase,diagnosisoftheinjury,whethertheridersinvolved

intheaccidentshadanytypeofdeficiency(physical,visual,

auditoryormental)andanysuspicionofalcoholorillicitdrug

2011

Bicycle Motorcycle

0 2000 4000 6000 8000 10000 12000 14000

2012 2013 Total

Total

Fig.1–Notificationsperyearofattendance,accordingto thetypeofvehicle.

Afterthe datagathering,dataprocessingandtabulation

were performed and the absolute and relative frequencies

werecalculated.

Approvalbytheuniversity’sresearchethicscommitteewas

dispensedwithforthisproject,sinceitinvolveduseof

sec-ondarydatafromapublic-domaindatabase, asdeclaredin

Resolution196/96fromtheNationalHealthCouncil(CNS).9

Results

Overthe period studied (2011–2013), 21,795transport

acci-dentswere notifiedinthemunicipalityofSãoPaulo.Those

involvingmotorcyclesaccountedfor52.1%andthose

involv-ingbicycles,7.1%(Fig.1).

Therewere 1558notified bicycleaccidents: in21.4%the

victimswerepedestrians,andin76.8%,theridersthemselves.

Therewere11,366notifiedmotorcycleaccidents:in16.2%

thevictimswerepedestrians,andin79.1%,theriders

them-selves.

Malesexpredominatedinthemotorcycleorbicycle

acci-dents:81.6%and80.6%,respectively(Fig.2).

Amongthemotorcycleaccidents,thedominantagegroup

ofthevictimswasbetween20and29years(46.2%).Among

thebicycleaccidents,itwasbetween10and19years(39.3%)

(Fig.3).

Bothofthesetypesofaccidentsoccurredduringtheday,

between07:00and18:00h:37.4%and27%,respectively.

Amongthecyclistswhosufferedaccidentsandhadsome

typeofdeficiency(fivecasesnotified),20%hadphysical

defi-ciency,40%hadauditorydeficiencyand40%hadunspecified

deficiency.Amongthemotorcyclists(eightcases),62.5%had

physicaldeficiency,12.5%hadauditorydeficiencyand25%had

unspecifieddeficiency.

Amongthemotorcyclists,3%hadmadeuseofalcoholand

in67%ofthecases,itwasnotpossibletoidentifywhetherthis

hadoccurred.Overtheperiodevaluated,63casesofuseof

illicitdrugsbymotorcyclistsinvolvedinaccidentswere

noti-fied.

Female

Total 0

2000 4000 6000 8000 10000 12000 14000

Male Total

Bicycle Motorcycle

Fig.2–Notificationsaccordingtothesexofthevictimand thetypeofvehicle.

Amongthecyclists,fivecasesofuseofillicitdrugsand2.4%

withuseofalcoholicdrinkswerenotified.

AccordingtotheinstructionsfromtheMinistryofHealth

in2006,thenotificationshouldbefilledoutwhenthereisa

suspicionorevidencethatthepatienthadmadeuseofalcohol

orillicitdrugsbeforetheaccidentthatgaverisetotheinjury.

Thisshouldbedonebytheprofessionalwhoattendstothe

patient,atanyhealthcareestablishment.

Themaindiagnosisfortheinjuries,accordingtothe

Inter-nationalClassificationofDiseases,10thedition(ICD-10),was

traumatothekneeinmotorcycleaccidentsandtotheleg,in

bicycleaccidents.

In relationto theevolution ofcases, 14% ofthe bicycle

accidentcaseswere transferredtospecializedservices and

72.5%weredischargedfromhospitalimmediately.Amongthe

motorcycle cases,3.7%werekeptinhospitalatthe service

where they were attended, 1%were dead on arrival, 6.9%

weretransferredtospecializedservicesandtheotherswere

releasedfromhospitalimmediately(Fig.4).

Thebicycleaccidentsoccurredmainlyinthesouthernzone

ofthecity(15.2%)andtheeasternzone(6.1%).Themotorcycle

accidentsoccurredinthesamezones:11.2%and3.5%,

respec-tively.

Motorcycle Bicycle

2000 4000 6000 8000 10000

0 12000

Total 70 to 74 years 60 to 64 years 50 to 54 years 40 to 54 years 30 to 34 years 20 to 24 years 10 to 14 years 0 to 4 years

Bicycle Motorcycle

0 500 1000 1500 2000 2500 Hand and wrist injury

(S60-S69)

Arm and shoulder injury (S40-S49) Knee and leg injury

(S80-S89)

Neck injury (S10-S19)

Head injury (S00-S09)

Fig.4–Notificationsaccordingtothediagnosisofthe injuryandthetypeofvehicle.

Discussion

Preventionofaccidentsandviolenceisthemostimportant

meansforavoidingmorbidityandmortalityduetoexternal

causes.10

Thevictimsofmotorcycleandbicycleaccidentsobserved

hereweremostlyyoungmales,ashasalreadybeenindicated

inverymanystudiesconductedinotherBraziliancities.11

Inthepresentstudy,thebicycleaccidentsoccurred

pre-dominantly during adolescence (10–19 years) and among

males.Thegreatparticipationofbicyclesinaccidentsisdueto

avarietyoffactors,suchastheirrelativelylowcostandtheir

useamongchildrenandadolescents asrecreational

equip-ment(Figs.2and3).12

Today,bicyclesareconsideredinmanycountriestobea

viablesolutionfortrafficproblems,becauseofthehigh

num-bersofautomotivevehiclesinlargeandmedium-sizedcities.

Healthbenefitsforusersandnon-degradationofthe

environ-mentaresomeoftheadvantagesofthisvehicle.13_However,in

thisstudy,itwasnotpossibletoassesswhetherthoseinvolved

inaccidentswereusingbicyclesforrecreationorasameans

oftransport.Itwasalsonotpossibletoascertainwhetherthey

hadbeenusinghelmets,kneepadsandelbowpads.

AccordingtoMaltaetal.,14_{theimportanceofeventswithin}

trafficthatinvolvemotorcyclistsalsohastobehighlighted.

Motorcycleridersandpillionpassengersarenowinfirstplace

amongtrafficaccidentvictims.Thistrendhasnowbeen

regis-teredforsomeyearsinthemortalityinformationsystemand

thehospitalizationinformationsystem.Thepresentstudyhas

demonstrated,throughdatafromSIVVA,thatthenumberof

accidentscausedbymotorcyclesisgreaterthanthenumbers

causedbyothermeansoftransportandthatthevictimsof

theseaccidentsareyoungmales.

Inthepresentstudy,themajorityoftheaccidentsoccurred

duringthedaytime; someauthors havesuggestedthatthe

greatertrafficflowsduringthedayandtheexcessivelylong

workingdaysofupto15hwithoutbreaksamongprofessional

motorcyclistsmay befactorsassociatedwithgreater

occur-renceofaccidentsduringthisperiod.15

Althoughinthepresentstudynorelationshipwasshown

betweenthepresenceofdeficienciesandtheaccidentsthat

occurred,socialinclusionpracticesarenowunderdiscussion

atnationallevel,startingfromtheprinciplethatforall

indi-vidualstobeintegratedintosociety,itneedstobecapableof

meetingthedemandsofallitsmembers.

Inseveralcountries,studieshaveindicatedthat

consump-tion ofalcoholicdrinks andillicitdrugsisoneofthemain

factorsresponsibleforthehighincidenceofaccidentswith

victims.InBrazil,thisconsumptionhasalsobeenpointedout

asoneofthemaincausalfactorsofaccidents.Incomparing

the relevanceofthe impactofalcoholon trafficaccidents,

thereissignificantunderestimationandundernotificationof

alcoholconsumptionandillicitdrugabuseinrelationtotraffic

accidentsinBrazil.16,17

Transport accidents have been described in the

litera-tureasthesecond biggestcauseofhospitalization.Lignani

andVilella18_{observedthatinBrazil,hospitalizationsdueto}

injuriesresultingfromtransportaccidentsincreasedby8.7%

between2000and2010,whiletheriskofhospitalizationdue

tomotorcycleaccidentstripled.Inthepresentstudy,itwas

seenthatmostofthecasesofbicycleandmotorcycle

acci-dentswerereleasedfromhospitalimmediately.However,this

couldbealimitationofthepresentstudy,giventhatwewere

unabletoaffirmwhetherthenotificationformwasfilledout

atthetimeofreleaseorwhetherthecasesreallyevolvedto

hospitaldischarge.

AsshowninFig.4,itwasseenthatthemaininjury

diag-noses, according tothe ICD-10, were knee and leg trauma

and handand wristtrauma.For motorcyclistsand cyclists,

thelimbsarepreciselytheregionsthataremostunprotected,

giventhatthesafetyequipmentusedprovidesprotectiononly

for thehead. According to Oliveira and Sousa,4 _{authors in}

Japan concluded from a study conductedon the necropsy

recordsofmotorcycliststhateffectiveuseofahelmet

signifi-cantlyreducedtheseverityoftheirheadandneckinjuriesbut

didnothaveanyeffectontheoverallseverityofinjuriesin

otherpartsofthebody.4,19

Theeffectivenessofusinghelmetstoreduceheadinjuries

is incontestable. Most authors not only suggest that they

should beused butalsoaffirmthe importanceofmultiple,

synergicandcontextualizedstrategiesforinjuryprevention.

Suchstrategiesinvolve:useofbicyclelights;regulationand

legislationforthetransitofvehiclesandbicycles;educational

programs;andsupportandmodificationsoftheenvironment

inordertomakepracticessafer,whichincludescyclepaths

andexclusivelanesformotorcyclistsandcyclists.9,20

Oneimportantpointthatisworthtakingintoconsideration

is thedifficulty and limitations ofworkingwith secondary

data, because of deficiencies in filling out the notification

forms and delays indata entry into the databases and in

updatingtheinformationsystem.

Thealarminggrowth inthenumber ofmotorcycles and

bicycles,inrelationtoautomobiles,becausethesearecheaper

andmoreagilemeansoftransportand,moreover,less

pollut-ing,constitutesanewpublichealthproblembecauseofthe

accidentsthatoccur.

Conclusion

Actionstowardminimizingtrafficaccidentsshouldprioritize

adoptpublicpoliciesthatgiveprioritytoapplicationof

finan-cialresourcestostrategiesforreducingtheseaccidents.

Trafficeducationisessentialforaccidentprevention,forall

typesoftransportvehiclesusedbythepopulation.

Conflicts

of

interest

Theauthorsdeclarenoconflictsofinterest.

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1. Marín-LeónL,BelonAP,BarrosMB,AlmeidaSD,RestituttiMC. TendênciadosacidentesdetrânsitoemCampinas,SãoPaulo Brasil:importânciacrescentedosmotociclistas.CadSaúde Pública.2012;28(1):39–51.

2. RochaGS,SchorN.Acidentesdemotocicletanomunicípiode RioBranco:caracterizac¸ãoetendências.CiêncSaúde Coletiva.2013;18(3):721–31.

3. MelioneLPR,Mello-JorgeMHP.GastosdoSistemaÚnicode Saúdecominternac¸õesporcausasexternasemSãoJosédos Campos,SãoPaulo.BrasilCadSaúdePública.

2008;24(8):1814–24.

4. OliveiraNLB,SousaRMC.Diagnósticodelesõesequalidade devidademotociclistas,vítimasdeacidentesdetrânsito.Rev Latino-AmEnfermagem.2003;11(6):749–56.

5. BacchieriG,GiganteDP,Assunc¸ãoMC.Determinantese padrõesdeutilizac¸ãodabicicletaeacidentesdetrânsito sofridosporciclistastrabalhadoresdacidadedePelotas,Rio GrandedoSul.BrasilCadSaúdePública.2005;21(5):1499–508.

6. Brasil.MinistériodaSaúde.Viva:VigilânciadeViolênciase

Acidentes,2006e2007.Brasília;2009.Availableat:http://

tabnet.datasus.gov.br/cgi/viva/vivadescr.htm

7. PrefeituradaCidadedeSãoPaulo.SecretariaMunicipalda

Saúde.SistemadeInformac¸ãoparaaVigilânciadeViolênciae

Acidentes:manualdepreenchimentodafichadenotificac¸ão

decasossuspeitosouconfirmados;2007.Availableat:http://

www.prefeitura.sp.gov.br/cidade/secretarias/upload/080910 manualsivva1254424639.pdf

8. SistemadeVigilânciadeViolênciaeAcidentes:Acidentesde

Transporte;2013.Availableat:http://www.prefeitura.sp.gov.br

(accessedon01.10.13).

9.CaiffaWT,FricheAAL.Urbanizac¸ão,globalizac¸ãoeseguranc¸a viária:umdiálogopossívelembuscadaequidade?Ciênc SaúdeColetiva.2012;17(9):2238–41.

10.SantosAM,MouraME,NunesBM,LealCF,TelesJB.Perfildas vítimasdetraumaporacidentedemotoatendidasemum servic¸opúblicodeemergência.CadSaúdePública. 2008;24(8):1927–38.

11.LegayLF,SantosAS,LovisiGM,AguiarJS,BorgesJC,Mesquita RM,etal.Acidentesdetransporteenvolvendomotocicletas: perfilepidemiológicodasvítimasdetrêscapitaisdeestados brasileiros,2007.EpidemiolServSaúde.2012;21(2):283–92.

12.FeitasJPP,RibeiroLA,JorgeMT.Vítimasdeacidentesde trânsitonasfaixasetáriaspediátricasatendidasemum hospitaluniversitário:aspectosepidemiológicoseclínicos. CadSaúdePública.2007;23(12):3055–60.

13.BacchieriG,BarrosAJ,SantosJV,Gonc¸alvesH,GiganteDP. Intervenc¸ãocomunitáriaparaprevenc¸ãodeacidentesde trânsitoentretrabalhadoresciclistas.RevSaúdePública. 2010;44(5):867–75.

14.MaltaDC,MascarenhasMD,BernalRT,SilvaMM,PereiraCA, MinayoMC,etal.Análisedasocorrênciasdaslesõesno trânsitoefatoresrelacionadossegundoresultadosda PesquisaNacionalporAmostradeDomicílios(Pnad)Brasil, 2008.CiêncSaúdeColetiva.2011;16(9):3679–87.

15.MontenegroMM,DuarteEC,PradoRR,NascimentoAF. Mortalidadedemotociclistasemacidentesdetransporteno DistritoFederal,1996a2007.RevSaúdePública.

2011;45(3):529–38.

16.AbreuAMM,LimaJMB,MatosLN,PillonSC.Usodeálcoolem vítimasdeacidentesdetrânsito:estudodonívelde

alcoolemia.RevLatino-AmEnfermagem.2010;18(spe):513–20.

17.PechanskyF,DuartePC,DeBoniR,LeukefeldCG,vonDiemen L,BumaguinDB,etal.Predictorsofpositivealcohol

concentration(BAC)inasampleofBraziliandrivers.RevBras Psiquiatr.2012;34(3):277–85.

18.LignaniLO,VilellaLCM.Estudodescritivosobreamorbidade hospitalarporcausasexternasemBeloHorizonte,estadode MinasGerais,Brasil,2008–2010.EpidemiolServSaúde. 2013;22(2):225–34.

19.GawryszewskiVP,RodriguesEMS.Theburdenofinjuryin Brazil,2003.SãoPauloMedJ.2006;124(4):208–13.

20.CarvalhoML,FreitasCM.Pedalandoembuscadealternativas saudáveisesustentáveis.CiêncSaúdeColetiva.