Introduction Recently, cases of clothing-related entanglement in motorcycles have been increasingly reported from India and Pakistan but no epidemiological studies are available for such crashes.

Objective To assess the injury burden and severity of clothing-related two-wheeler crashes in Pakistan.

Methods The study setting was Karachi, Pakistan. Cases were defined as riders and pillion riders of motorised two-wheelers involved in a crash as a result of entangling of clothing in parts of the vehicle. Cases were selected from an ongoing traffic injury surveillance study. For each case, Abbreviated Injury Scale (AIS) of involved body parts was recorded and used in computation of New Injury Severity Score (NISS).

Results A total of 986 injuries were reported from January 2007 to December 2009. Most were females (73.9%) and pillion riders (80.6%). These crashes were mostly single vehicle (98.5%) and involved head (41.5%), face (35.9%), limbs (51.0%), and external body that is, skin (60.3%). As per NISS, one-third of injuries were moderate (26.7%) to severe (10.2%). A total of 10 deaths were reported and head and face injuries were reported in nine of them. Female gender, age≥45 years (21.5%), pillion riders (80.6%) and crashes occurring at intersections (34.3%) were more likely to result in severe NISS than other users (p<0.001).

Significance Clothing-related motorised two-wheeler injuries are common in Karachi indicating the risks associated with wearing traditional clothing when riding motorcycles. Promotion of appropriate, conspicuous clothing by both riders and pillion riders might prevent such injuries.