10-10김상철

대한응급의학회지제 24 권제 1 호 Volume 24, Number 1, February, 2013 원 저 헬멧미착용자의이륜자동차사고에서사고기전에관한분석 건국대학교의학전문대학원응급의학교실, 교통안전공단자동차성능연구소 1, 건국대학교충주병원정형외과 2 김상철 이재완 1 고덕환 2 백광제 정호성 박상오 홍대영 이경룡 Analysis of Accident Mechanisms in Unhelmeted Motorcycle Accident Victims Sang Chul Kim, M.D., Jae Wan Lee, Ph.D. 1, Duk Hwan Ko, M.D. 2, Kwang Je Baek, M.D., Ho Sung Jung, M.D., Sang O Park, M.D., Dae Young Hong, M.D., Kyeong Ryong Lee, M.D. Purpose: Due to their vulnerability and relatively high driving speed, motorcycles have been associated with a high risk of sustaining multiple severe injuries after traffic accidents. We sought to investigate sustained injuries and the association of accident mechanisms with injury severity for unhelmeted motorcycle accident victims. Methods: This study was conducted as an observational retrospective study. Unhelmeted motorcycle accident victims who visited the study hospital from January 2010 to December 2011 were included. Data were obtained from medical records, ambulance run-sheets, and telephone interviews. Accident mechanisms were divided into collision with an obstacle, single vehicle accident, collision with another vehicle, collision by another vehicle, and falling accident from the viewpoint of energy. Glasgow coma scale (GCS), Revised trauma score (RTS), and Injury Severity Score (ISS) were analyzed for comparison of injury severity according to the accident mechanisms. Results: Of 404 patients who visited the study hospital, 165 patients were included; 87.3%(144/165) were male, and 78.8%(130/165) were drivers. The incidence of motor cycle accident showed the highest in the teenager and in time during 18:00~24:00 o clock. Lower extremity was the most 책임저자 : 백광제서울특별시광진구화양동 4-12 건국대학교의학전문대학원응급의학교실 Tel: 02) 2030-5551, Fax: 02) 2030-5789 E-mail: 20050694@kuh.ac.kr 접수일 : 2012년 11월 18일, 1차교정일 : 2012년 11월 30일게재승인일 : 2013년 1월 12일 70 common site of injury, followed by upper extremity, head, and face etc. Injury due to falling was the most severe injury mechanism, followed by collision with another vehicle, collision by another vehicle, and a single vehicle and an obstacle (p=0.013). Conclusion: Lower extremity injury was the most common injury site in unhelmeted motorcycle accidents, and motorcycle accidents by fall and collision with another vehicle should be considered as a severe mechanism of injury. Key Words: Motorcycles, Injuries, Injury Severity Score Department of Emergency Medicine, School of Medicine, Konkuk University Medical Center, Seoul, Korea, Advanced Vehicle Safety & Dynamics Research Office, Korea Automobile Testing & Research Institute, Korea Transportation Safety Authority, Hwaseong, Korea 1, Department of Orthopedic Medicine, School of Medicine, Konkuk University, Chungju, Korea 2 서 이륜자동차는다른자동차와유사한속도로주행하지만, 탑승자의신체가외부에노출되어있고차량자체구조에탑승자보호장치나기능이부족하여사고시다발성손상및중증사고로연결되기쉽다 1-4). 경찰청 2010년교통사고통계에의하면원동기장치자전거를포함한이륜자동차사고총 17,672건가운데사망자는총 747명 (4.23%) 으로자동차관리법에서분류하는자동차가운데치사율이가장높았다 5). 국내자동차관리법에서는총배기량또는정격출력의크기와관계없이 1인또는 2인의사람을운송하기에적합하게제작된이륜의자동차및그와유사한구조로되어있는자동차를이륜자동차로정의하며, 승용차, 승합차, 화물차, 특수자동차와별도로구분하고있다. 2011년 5 월 24일자동차관리법개정사항에의하면배기량이 50 cc 미만인것도경형이륜자동차로분류하여신고및보험가입을의무화하고있어, 향후등록될이륜자동차는 2010 론

김상철외 : 헬멧미착용자의이륜자동차사고에서사고기전에관한분석 / 71 년 182만 5,474대보다훨씬증가할것으로추정된다. 국내이륜자동차교통사고의현황에비해이륜자동차사고에대한연구가미진할뿐아니라, 이륜자동차사고에서원인규명을위한사고현장조사에서부터환자손상에관한병원자료까지세부적인자료수집체계가확립되어있지않은실정이다. 경찰청통계자료의분류에서는이륜자동차를포함한모든차량을차대사람, 차대차, 차량단독, 건널목사고로사고유형을분류하고있다. 그리고 119 구급일지에는오토바이교통사고를질병외환자발생유형으로구분하여응급, 준응급, 잠재응급으로분류하지만, 세부기전에관한기록사항은없으며중증도분류에대한명확한기준도없다. 이전의이륜자동차에관한연구에서사고기전을충돌방향및충돌대상등에따라분류하였는데, 김등 6) 의연구에서는정면충돌, 측면충돌, 추돌로분류하여중증도를비교하였고, Maimaris 등 7) 은주행중인차량과충돌, 자전거사고, 보행자사고, 추락사고로분류하였고, Jou 등 8) 은다중충돌, 단독충돌, 철도건널목충돌, 보행자와충돌로분류하여치사율을비교하였다. 하지만기존연구에서이용한사고기전에따른손상분석은헬멧의효과에대한연구가대부분이고, 헬멧과같은안전장치의효과때문에이륜차사고로인한손상의기초자료를얻는데한계가있다. 따라서이연구에서는헬멧을착용하지않은이륜자동차교통사고환자를대상으로교통사고시손상부위에대한분포를알아보고, 사고기전에따른손상부위및손상중증도에차이가있는지를알아보고자이연구를진행하였다. 대상과방법 2010년 1월에서 2011년 12월까지 2년간이륜자동차교통사고로건국대충주병원응급센터에내원한환자가운데헬멧을착용하지않은환자를대상으로후향적연구를시행하였다. 연구병원응급센터에서는 2009년부터응급센터에내원한손상환자에대한자료를자체적으로수집하고있으며, 오토바이손상환자에대해서는국가응급환자진료정보망 (NEDIS, National Emergency Department Information System) 의기본입력사항인환자내원정보 ( 발병일시, 내원일시, 내원수단, 손상기전, 교통사고보호장구착용여부와종류 ) 및초기평가정보 ( 내원시의식, 활력징후, 주증상 ), 응급진료결과외에탑승위치, 상세사고기전, Revised trauma score (RTS), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS) 를추가하여자료를정리하고있다. AIS 및 ISS는응급구조사인조사원이입력한자료에서응급의학전문의가환자퇴원자료를바탕으로최종점수를입력하고있고, 사고기전은 119구급대원의구급일지, 의무기록을바탕으로하였고, 기록사항에서사고기전이불명확한경우전화설문을통하 여사고기전과헬멧착용여부를확인하였다. 전화통화를하지못하거나, 전화설문에서협조를하지않아서사고기전을알수없는환자, 이륜자동차사고로응급센터에서초기진료후추적치료를위해다시내원한환자는제외하였다. 손상부위는환자의통증호소부위와진찰소견을바탕으로시행한방사선검사결과로두부, 안면부, 경부, 흉부, 복부, 요추, 상지, 하지로나누었고, 각부위의손상정도를 AIS 점수를이용하여비교하였다. 경추, 흉추손상은각각경부, 흉부손상에포함하였고, 타박상, 찰과상, 염좌, 일정범위내의열상등의 AIS 1점의손상과사고로인한화상은각신체부위에포함하였다. 사고기전은구급일지, 의무기록지, 전화설문내용을바탕으로에너지관점에서장애물과충돌, 단독사고로인한전복, 차량과충돌 (collision with motor vehicle), 차량에의한충돌 (collision by motor vehicle), 추락사고로나누었다. 장애물과충돌은주행중보행자, 자전거, 이륜자동차, 가드레일등과충돌한사고기전으로정의하였다. 단독사고는주행중차량및구조물과 1차충돌없이이륜자동차가넘어지거나, 측면및전면으로회전 (rollover) 하는사고기전으로정의하였다. 그리고차량과충돌은주행중인이륜자동차가이륜자동차외의차량을충돌한사고로, 차량에의한충돌은이륜자동차가이륜자동차외의차량에의해충돌당하는사고로정의하였고, 추락은사고전후에 1 m 이상의높이차가있는사고로정의하였다. 수집자료는 PASW Statistics 18(IBM, Chicago USA) 을이용하여통계처리하였는데연구대상의일반적인사항및손상부위, 진단명은빈도분석을이용하였고, 나이와손상계수는평균및표준편차를이용하여구하였다. 사고기전에따른손상부위및손상중증도의비교는 Kruskal Wallis-test를실시하였다. 전반적인통계적인유의성은 p값이 0.05보다작은경우로설정하였다. 결과 1. 일반적특징연구기간 2년동안이륜자동차사고로내원한 404명가운데헬멧을착용하지않은대상환자는 165명이었다. 이가운데남자는 144명 (87.3%), 운전자는 130명 (78.8%) 이었고, 연령대는 10대가 73명 (44.2%) 으로가장많았고, 사고발생은 18시에서 24시사이에 70건 (42.4%) 으로가장많이발생하였다. 손상부위는하지 (69.1%), 상지 (46.1%), 두부 (36.4%), 안면부 (33.9%) 순이었다 (Table 1).

72 / 대한응급의학회지 : 제 24 권제 1 호 2013 2. 사고기전에따른손상부위및중증도비교장애물충돌시에는안면부의손상중증도가가장높았고, 손상빈도또한하지손상과동일하게가장많았다. 단독사고일경우흉부, 복부에서손상중증도가높았고, 차량과충돌, 차량에의한충돌모두흉부, 두부, 복부순으로중증도가높았으며, 추락사고에서는두부의손상중증도가가장높았다. 사고기전에따른손상중증도는추락, 차량과충돌, 차량에의한충돌, 단독사고, 장애물과충돌순이었고 (p=0.013), 특히두부손상은추락, 차량과충돌, 차량에의한충돌, 단독사고, 장애물과충돌순으로중증도의차이가있었다 (p=0.012) (Table 2). 3. AIS 2점이상의하지및두부손상의진단명 AIS 2점이상의하지손상으로입원혹은전원이필요했 던환자의진단명을손상기전별로분석하였을때, 하지손상에서사고기전에따라서는차량에의한충돌, 차량과충돌순으로골절이많고, 대퇴골절, 경골골절순으로골절손상이발생하였다. 두부손상에서압궤손상 (crush injury) 으로인한사망이차량에의한충돌에서 3건, 차량과충돌및추락사고에서각각 1건발생하였다. 뇌출혈은경막외출혈, 경막하출혈, 지주막하출혈순이었고, 의식소실을동반한뇌진탕이 12건이었다 (Table 3). 고찰이륜자동차사고에서탑승자의손상은주행하는이륜자동차자체의보유에너지나상대방물체의에너지가탑승자신체에전달되어외상의형태로발생한다 9). 이륜자동차이외의차량의경우충돌사고에서주요충돌방향 (PDOF, Table 1. Demographic characteristics of study subjects Category Number of subjects (N=165, 100%) Gender Male 144 (87.3) Age (years) 10-20 073 (44.2) 20-30 024 (14.5) 30-40 008 (04.8) 40-50 009 (05.5) 50-60 017 (10.3) 60-70 015 (09.1) 70 019 (11.5) Position Driver 130 (78.8) Passenger 035 (21.2) Time (o clock) 00-6 022 (13.3) 06-12 024 (14.5) 12-18 049 (29.7) 18-24 070 (42.4) Injury site Head 060 (36.4) Face 056 (33.9) Neck 032 (19.4) Thorax 027 (16.4) Abdomen 011 (06.7) Lumbar spine 021 (12.7) Upper extremity 076 (46.1) Lower extremity 114 (69.1) Disposition Discharge 074 (44.8) Admission 070 (42.4) Transfer 014 (08.5) Death 007 (04.2) Neck and thorax include cervical spine and thoracic spine, respectively.

김상철외 : 헬멧미착용자의이륜자동차사고에서사고기전에관한분석 / 73 principal direction of force) 이나파손정도를통한유효충돌속도로사고의심각도를추정할수있다 10). 이륜자동차의경우에도충돌사고후앞바퀴와뒷바퀴의축간거리의변형량을통해사고시속도를추정하는방법이있지만, 이륜자동차사고는차량과의직각충돌외에다양한형태로사고가발생하기때문에사고후파손된이륜자동차를통해탑승자손상의중증도를예측하는것은한계가있다 11). 따라서이연구에서는손상에너지관점에서연구대상을사고기전에따라분류하였고, 사고기전에따라손상중증도에서차이가있음을알수있었다. 대부분의이륜자동차사고에서하지가가장흔한손상부위로알려져있다 12,13). Alicioglu 등 14) 의이륜자동차연구에서도사지가가장흔한손상부이고, 그다음으로두부, 안면, 흉부순으로손상이발생한다고보고하였다. 하지손상예방을위한장비가운데이륜자동차보호용의복이하지 의개방성창상및연부조직의손상감소로인한입원기간단축의효과는있지만, 골절손상을감소시키는데에는효과가없는것으로알려져있다 15,16). 연구결과에서하지손상환자 114명가운데골절이상의진단을받은환자가 29명이었고, 이중골반골절및대퇴절단으로인한사망자 2명외에는모두입원및전원치료를받았다. 하지손상의경우보행장애로인한입원시의료비용뿐만아니라노동력손실로인한경제비용까지고려해야한다. 미국의경우, 2005년도이륜자동차로인한사망을제외한, 3만여건의입원환자의의료비및생산손실비용은 40억달러이었고, 비입원및사망환자를포함하면 120억달러에이르는것으로보고되었다 17). 1981년도미국에서는이륜자동차사고원인요소를환경요소, 이륜자동차요소, 탑승자요소, 부상자요소로분류하여이륜자동차사고를분석하여그대책에관해보고 Table 2. Comparison of sustained injury and Injury severity by accident mechanism Injury sustained Obstacle Single vehicle MC* collide MV collide Fall with MV with MC (n=10) (%) (n=56) (%) (n=45) (%) (n=48) (%) (n=6) (%) Abbreviated injury scale (mean±standard deviation) p value Head 01.0 1.7±0.8 3.2±1.8 2.4±1.4 4.7±1.5 0.012 (1,10) (18,32.1) (16,35.6) (22,45.8) (3,50.0) Face 1.6±0.5 1.4±0.5 1.3±0.5 1.4±0.5 2.0 0.494 (7,70) (23,41.1) (8,17.8) (17,35.4) (1,16.7) Neck 01.0 1.0 1.0 1.0 2.0±2.0 0.136 (3,30) (9,16.1) (8,17.8) (8,16.7) (4,66.7) Thorax 1.3±0.6 3.2±1.8 3.4±1.9 2.8±1.3 4.0 0.342 (3,30) (5,8.9) (9,20) (9,18.8) (1,16.7) Abdomen 0 3.0 2.0 2.2±0.8 0 0.320 (0,0) (3,5.4) (2,4.4) (6,12.5) (0,0) Lumbar spine 01.0 2.0 1.0 1.1±0.4 1.5±0.7 0.132 (2,20) (5,8.9) (5,11.1) (7,14.6) (2,33.3) Upper extremity 1.2±0.4 1.1±0.3 1.2±0.4 1.2±0.4 0 0.616 (6,60) (32,57.1) (20,44.4) (18,37.5) (0.0) Lower extremity 1.1±0.4 1.2±0.7 1.6±1.1 1.6±0.9 1.0 0.107 (7,70) (34,60.7) (30,66.7) (39,81.3) (4,66.7) Injury score GCS 15.0 14.6±2.00 13.6±3.80 14.3±2.70 11.0±6.20 0.153 RTS 12.0 11.7±1.60 11.0±3.10 11.5±1.80 9.3±4.8 0.195 ISS 4.6±3.6 06.2±11.1 12.9±22.6 10.5±13.5 23.2±27.3 0.013 Obstacle: collision with bicycle, pedestrian, guard rail and stationary obstacle etc. Single vehicle: over quarter turning without collision with other vehicle due to loss of control. p value by Kruskal-Wallis test. * MC: motorcycle. MV: motor vehicle. GCS: Glasgow Coma scale. RTS: Revised Trauma Score. ISS: Injury Severity Score.

74 / 대한응급의학회지 : 제 24 권제 1 호 2013 하였다 18). 이 Hurt 보고서는이후이륜자동차사고에관한연구에서자료수집방법에대한기준이되었고, 2007년이륜자동차현장심층조사에관한 Organization for Economic Cooperation and Development (OECD) 방법에서는이륜자동차사고한건에서차체요소, 충돌현장및환경요소, 탑승자요소를고려한 1,657가지의자료를수집하도록하고있다 19). 이륜자동차사고에서사고기전을통한원인분석을고려할때사고전상황, 충돌시속도, 충돌대상, 충돌방향, 충돌후상황등여러요소가관련되기때문에사고기전의간단한분류가어려운것이사실이다. 이연구에서는에너지관점에서사고기전을분류하였는데, 탑승자의손상중증도는장애물과의충돌이가장낮았고, 단독사고, 차량에의한충돌, 차량과충돌, 추락으로갈수록높아지는것으로나타났다. 운동량및충돌량의개념에서보면, 주행중인이륜자동차보다질량이적거나속도가느린장애물과충돌시이륜자동차의운동량으로인해상대장애물에더큰변형및손상을유발한다. 이륜자동차의충돌시운동에너지가상대장애물의변형및파손으로 전달되면서감소되어, 단독사고및타차량과의충돌에비해이륜자동차의손상에너지가작아지게된다. 일반적인손상기전에서도추락은비의도적인손상에서차량사고다음으로사망률이높은손상기전이다 20). 이연구에서도추락시신체손상부위대부분에서중증도가높았는데, 이는이륜차의운동에너지와추락시위치에너지가더해져서충격량이더커지기때문이다. 이륜자동차의타차량과의충돌에서는충돌주체와충돌방향및각도, 속도등여러가지사항을고려할수있다. 이연구에서는이륜자동차와타차량과의충돌을이륜자동차가다른차량을충돌하는경우와다른차량에의해충돌당하는경우로분류하였다. Rome 등 15) 은 2001 OECD 이륜자동차조사방법에근거하여, 단독사고, 타차량과의충돌, 동물과충돌로나누었고, 단순히조정불능으로넘어졌는지타물체혹은타차량과충돌했는지두가지로도분류하였다. Gopalakrishna 등 21) 은이륜자동차단독사고, 이륜자동차가타차량을충돌했는지, 다른차량이이륜자동차를충돌했는지의 3가지분류방법을사용하였다. Chang 22) 도차 Table 3. Head and lower extremity injuries over 2 scores in abbreviated injury scale Obstacle Single vehicle MC* collide MV collide Fall Injury sustained with MV with MC Total (n=10) (%) (n=56) (%) (n=45) (%) (n=48) (%) (n=6) (%) Head injuries Crush injury 3 (60). 1 (20). 1 (20)0. 5 (12.5) SDH 1 (16.7) 01 (16.7) 3 (50). 1 (16.7) 6 (15)0. EDH 1 (12.5) 4 (50). 03 (37.5) 8 (20)0. SAH 2 (50)0. 2 (50). 4 (10)0. Contusional hemorrhage 1 (50)0. 1 (50). 2 (5)00. DAI.1 (100) 1 (2.5)0 Simple fracture 1 (50)0. 1 (50)0. 2 (5)00. Cerebral concussion 3 (25)0. 02 (16.7) 07 (58.3) 12 (30)00. Total 0 9 (16.1) 13 (28.9) 15 (31.3) 3 (50)0. 40 (100)0. Lower extremity injuries Pelvic fracture 1 (33.3) 01 (33.3) 01 (33.3) 3 (08.3) Femoral fracture 3 (16.7) 07 (38.9) 07 (38.9) 1 (05.6) 18 (50)0. Knee injury.2 (100) 2 (05.6) Tibia fracture 1 (12.5) 1 (12.5) 2 (25). 4 (50). 8 (22.2) Fibular fracture 1 (100). 1 (02.8) Tibiofibular fracture.1 (100) 1 (02.8) Ankle fracture 1 (50)0. 1 (50). 2 (05.6) Foot fracture.1 (100) 1 (02.8) Total 1 (10)0. 7 (12.5) 11 (24.4) 16 (33.3) 1 (16.7) 36 (100)0. * MC: motorcycle. MV: motor vehicle. SDH: sudural hematoma. EDH: epidural hematoma. SAH: subarachnoid hemorrhage. DAI: diffuse axonal injury. Knee injury includes ligament and meniscus tear.

김상철외 : 헬멧미착용자의이륜자동차사고에서사고기전에관한분석 / 75 량과의충돌을이륜자동차가충돌한것과타차량이이륜자동차를충돌한것으로구분하였다. 저자들의연구에서는이륜자동차가타차량과충돌했을때, 두부손상및흉부손상의중증도가타차량에의해충돌한경우보다높았다. 이륜자동차가타차량과의직각충돌인지비스듬한충돌인지에따라손상기전및부위가틀리게된다. 즉이륜자동차가차량의측면직각충돌인경우두부가상향으로튕기게되어두부손상가능성이높고, 비스듬한충돌에서는차량의옆평면에몸이던져지면서몸통에더심한충격을받게된다 23). 그리고에너지관점에서는속도가사고시승객의손상에가장큰영향을미치게된다 24). 이륜자동차단독사고에서운전자의사망에영향을미치는요인에서속도가 2/3를차지하며, 50 km/h 이상의이륜자동차사고시에는헬멧의두부손상으로인한사망예방의효과가감소한다 25). 그리고 2011년 Centers for Disease Control and Prevention (CDC) 의손상환자의현장분류지침에의하면이륜자동차사고당시 32 km/h 이상일경우외상센터이송의기준으로제시되었다 26). 이륜자동차의속도에관한분석연구에서는대부분사고후운전자의추정에근거하여사고당시속도를나타내는데, 사고직전에는보통브레이크를잡기때문에실제충격당시속도는추정속도보다낮은것이일반적이다 15,23). 저자들의연구가도농복합도시일개대학병원에내원한환자를대상으로한후향적인연구이기때문에이와관련된여러제한점을고려할수있다. 첫째, 연구대상자에대한선택바이어스가발생할수있다. 사고후보행이가능한경증환자는연구병원지역응급의료센터에방문을하지않은경우가대부분이므로상지및하지의경증손상환자가제외되었을것이다. 하지만저자들의연구자료가이륜자동차사고에서응급실기반의중증환자에관한자료로는효과적으로활용될수있을것이다. 둘째, 사고기전에대한보다세부적인분류방법을이용할수없었다. 에너지관점의사고기전분류에는속도와배기량에따른차체무게에대한정보가기본사항이지만, 이연구의조사항목에포함할수없었다. 또한사고당시차량과충돌시차량과의충돌방향, 각도, 속도, 차량의종류를알수없었기때문에이와관련된심층분석은할수없었다. 결론헬멧을착용하지않은이륜자동차탑승자는사고시하지, 상지및두부와안면부순으로손상을입을가능성이많고, 이륜자동차사고기전에서추락및차량과충돌사고의경우손상중증도가높으므로이러한기전에의한이륜자동차사고일경우현장분류및병원내평가에서신중을기해야한다. 연구결과의타당성을높이기위한국내이륜자동 차사고의전향적다기관연구도필요하겠지만, 보다적극적인대책수립을위해서는국가적차원의이륜자동차사고자료수집및분석체계의재정비가이루어져야할것이다. 참고문헌 01. Ankarath S, Giannoudis PV, Barlow I, Bellamy MC, Matthews SJ, Smith RM. Injury patterns associated with mortality following motorcycle crashes. Injury 2002; 33:473-7. 02. Tham KY, Seow E, Lau G. Pattern of injuries in helmeted motorcyclists in Singapore. Emerg Med J 2004;21:478-82. 03. Lin MR, Kraus JF. A review of risk factors and patterns of motorcycle injuries. Accid Anal Prev 2009;41:710-22. 04. Solagberu BA, Ofoegbu CK, Nasir AA, Ogundipe OK, Adekanye AO, Abdur-Rahman LO. Motorcycle injuries in a developing country and the vulnerability of riders, passengers, and pedestrians. Inj Prev 2006;12:266-8. 05. Available at http://taas.koroad.or.kr/blist.sv?board_idt _cd=01&category_cd=02/. Accessed October 15, 2012. 06. Kim HB, Lee KH, Kim H, Cha KC, Hwang SO, Hwang JY, et al. Risk Factors affecting severity of injury in patients of motor cycle accidents. J Korean Soc Emerg Med 2011;22:226-30. 07. Maimaris C, Summers CL, Browning C, Palmer CR. Injury patterns in cyclists attending an accident and emergency department: a comparison of helmet wearers and non-wearers. BMJ 1994;308:1537-40. 08. Jou RC, Yeh TH, Chen RS. Risk factors in motorcyclist fatalities in Taiwan. Traffic Inj Prev 2012;13:155-62. 09. Nzegwu MA, Aligbe JU, Banjo AA, Akhiwui W, Nzegwu CO. Patterns of morbidity and mortality amongst motorcycle riders and their passengers in Benin-City Nigeria: oneyear review. Ann Afr Med 2008;7:82-5. 10. Kang SM, Ahn BJ. A study on the effect of delta-v based on vehicle damages and injuries subjected by rear-end collisions. The Korean Society of Safety 2008;23:72-80. 11. Severy DM, Brink HM, Blaisdell DM. Motorcycle collision experiments. Society of Automotive Engineers 1970;SAE 700397:61-120. 12. Peek C, Braver ER, Shen H, Kraus JF. Lower extremity injuries from motorcycle crashes: a common cause of preventable injury. J Trauma 1994;37:358-64. 13. Wladis A, Boström L, Nilsson B. Injuries in 8927 patients admitted after motor-cycle crashes in Sweden 1987-1994 inclusive. Eur J Surg 2002;168:187-92. 14. Alicioğlu B, Yalniz E, Eşkin D, Yilmaz B. Injuries associated with motorcycle accidents. Acta Orthop Traumatol Turc 2008;42:106-11.

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