Hit the road, jacked—road rash injuries

Road rash is an alliteration that is entrenched in American slang and heard with frequency on spring and summer trauma rounds. The term is distinct, descriptive, and diagnostic, but it refers to more than an allergic reaction to asphalt. It is unclear whether the term was born in the hospital or is rooted in the motorcycle, skate, or some other speed-loving subculture. Nevertheless, any activity that involves speed, skin, and asphalt has a potential for road rash.

Factors affecting degree of injury

The word “asphalt” derives from the Greek “asphaltos,” which is actually of Phoenician origin. Homer gave the name Asphaltites to a lake in Palestine, now known as the Dead Sea, which had been an ancient source of asphalt or bitumen.* Asphalt provides the maximum amount of traction between tires and other road-bound surfaces. Unfortunately, the same tractive forces used to generate motion between a body and a tangential surface can wreak havoc on exposed dermal areas.

The degree of injury ultimately depends on the bodies in motion, the speed of the skin when it hits the road, the texture and condition of the surface, and the sliding distance. In the spring and summer months, the frequency of kinematic activities prone to road rash tend to increase. The activity that comes to mind first would be motorcycling. Even with an entire industry based on apparel designed to protect motorcyclists, no federal laws or regulations mandate their use—and only 19 states and the District of Columbia require all motorcyclists to wear helmets.

Road rash injuries, as with thermal injuries, classify in terms of depth. These wounds can include a combination of deep abrasions, avulsions, and lacerations. Patients may require hospital admission for adequate pain control, assistance with wound care, and therapies if the injuries span joints. Deeper injuries that fail to heal may require excision and grafting. Healed injures also are prone to hypertrophic changes. Other considerations would be tattooing that occurs when bituminous particles become embedded in the dermis after re-epithelialization and produce discolorations of the skin. After Advanced Trauma Life Support® protocols are applied, principle tenets of wound care should be used to obtain the best functional and cosmetic outcomes.

Outcomes

Hospital Discharge Status

Figure 1. Hospital discharge status

To examine the occurrence of motorcycle-related road rash injuries in the National Trauma Data Bank® (NTDB®) research dataset for 2013, hospital admissions records were searched using the International Classification of Diseases, Ninth Revision, Clinical Modification diagnoses codes. Specifically searched were records for motorcycle-related injuries containing an external cause of injury code (E-code) E810–816 and E818 (motor vehicle traffic related) and either a post-decimal value of 0.2 for injured motorcyclist, or 0.3 for injured passenger on a motorcycle. These records were then searched for a diagnosis code 910.0–917.0 and 919.0 (abrasion or friction burn for varying parts of the body). A total of 20,407 records were found; 17,054 records contained a discharge status, including 13,554 patients discharged to home, 1,974 to acute care/rehab, and 1,126 to skilled nursing facilities; 400 died. These patients were 88.5 percent male, typically 40.1 years of age, had an average hospital length of stay of 5.8 days, an average intensive care unit length of stay of 5.8 days, an average injury severity score of 13.1, and were on the ventilator for an average of 7.1 days. Of those tested for alcohol (12,235) or drugs (7,466), 29.5 percent were positive for alcohol and more than half (52.1 percent) were positive for drugs. (See figures.)

Drug and alcohol testing percentages

Figure 2. Drug and alcohol testing percentages

Motorcycle rallies will be in abundance between Memorial Day and Labor Day, and bike enthusiasts have many options when it comes to scale and locale. The population of Sturgis, SD, for example, will soar from roughly 7,000 to potentially 600,000 during the first week of August as bikers from across the nation attend the annual rally commemorating the event’s 75th anniversary. Riding a two-wheeled, high-performance transportation device is challenging in and of itself; this summer, don’t hit the road jacked if you want to avoid spilling and sliding your way to road rash.

Throughout the year, we will be highlighting these data through brief reports in the Bulletin. The NTDB Annual Report 2014 is available on the ACS website.

In addition, information is available on the website about how to obtain NTDB data for more detailed study. If you are interested in submitting your trauma center’s data, contact Melanie L. Neal, Manager, NTDB, at mneal@facs.org.

Acknowledgement

Statistical support for this article has been provided by Chrystal Caden-Price, Data Analyst, NTDB.


*Transactions of the American Institute of Mining Engineers, Volume XVIII. New York, NY. American Institute of Mining Engineers; 1890.

Vrints I, Hondt M, Van Brussel M, Nanhekhan L. Immediate debridement of road rash injuries with Versajet® hydrosurgery: Traumatic tattoo prevention? Aesthetic Plast Surg. 2014;38(2):467-470.

Sturgis Motorcycle Rally. Available at: www.sturgismotorcyclerally.com. Accessed March 30, 2015.

 

 

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