Factors Associated with All-cause Mortality and Morbidity of Motorcycle Crash-Related Neurological and Musculoskeletal Injuries: The MOTOR Trial Ancillary Study

IntroductionThe objective of this study was to examine the factors linked to all-cause mortality and morbidity from neurological and musculoskeletal injuries in motorcycle accidents. MethodsThe study was part of a two-armed, parallel, multi-period, cluster-randomized controlled trial of 1003 motorcycle crash victims. Morbidity was assessed using various scoring systems, and mixed effects regression models were employed for analysis. Results90-day all-cause mortality was 9.2% (82/887). Factors associated with mortality included referral-to-discharge >1 hour [OR 4.215 (1.802-9.858), p=.001), Kampala Trauma Score (KTS) [&le;]6 [OR 7.696 (1.932-30.653), p=.004], GCS 9-12 [OR 3.432 (1.194-9.870), p=.022], GCS [&le;]8 [OR 6.919 (2.212-21.645), p=.001], intra-axial lesions [OR 78.647 (9.871-626.587), p<.001], extra-axial lesions [OR 11.933 (1.386-102.750), p=.024], skull fracture [OR 11.366, (1.197-107.977), p=.034], and decompressive craniotomy (DC) [OR 0.260 (.095-.706), p=.008). A proportion of 14.5% had unfavourable Glasgow Outcome Scale (1-3); associated factors included increasing age [OR 1.02, (1.013-1.045, p<.001], multiple injuries [OR 4.559 (1.185-17.531), p=.027], KTS 7-8 [OR 2.755 (1.285-5.906), p=.009], KTS [&le;]6 [OR 7.551 (2.815-20.255), p=.001], GCS 9-12 [OR 4.07 (1.901-8.719), p=.001], GCS [&le;]8 [OR 13.779 (5.643-33.645), p<.001], and DC [OR 0.149 (.075-.295), p<.001]. Factors associated with unfavourable patient-reported musculoskeletal outcomes included being married [OR 1.984 (1.322-2.976), p=.001], multiple injuries [OR 1.762, (1.001-3.100), p=.049], and enrolment after the onset of the COVID-19 pandemic [OR 2.095 (1.199-3.659), p=.009]. ConclusionsThe key determinants of mortality and adverse neurological and musculoskeletal injury outcomes observed in this study are essential for establishing core outcome sets in future research and predictive models. Summary of the Key MessagesO_LIExisting Knowledge: Motorcycle crashes in low- and middle-income countries represent significant public health issues, exacerbated by low helmet usage and insufficient trauma care resources. C_LIO_LIStudy Contributions: This MOTOR trial ancillary study investigated factors associated with all-cause mortality and morbidity from motorcycle crashes, emphasizing neurological and musculoskeletal injuries as critical targets for enhancing rural trauma care systems. C_LIO_LIImplications for Research, Practice, and Policy: Our findings indicate that the anatomical nature, multiplicity and severity of injuries, referral-dispatch intervals, operative interventions, and COVID-19-related social conditions significantly influence injury outcomes. These factors may serve as a foundational outcome set for benchmarking future clinical trials and trauma registries. C_LI