A Profile of the Autopsies of Road Traffic Accident Victims in Jammu.
Correspondence Address :
Dr Rashmi Sharma MD, DMCH. Asstt Surgeon , Accidental Hospital Vijaypur-
J&K Health Services-Jammu-India. 216-A Gandhi-Nagar Jammu- 180004. e.mail: firstname.lastname@example.org
BACKGROUND: RTA (road traffic accident) is the third major preventable cause of all deaths.
AIMS: To study the demographic and injury profile in autopsy cases with an alleged history of RTA.
DESIGN: The retrospective observational study.
SETTING: Forensic Medicine and Toxicology Department of a tertiary care hospital.
SUBJECTS AND METHODS: All autopsies of RTA victims which were performed between January 2000 to December 2005, were analysed for sex, age, time of RTA, type of vehicle, position of victim during RTA, nature of injury, and cause of death.
STATISTICAL ANALYSIS: All parameters were expressed in percentage.
RESULTS: A total of 249 RTA victims were referred for autopsy during the years 2000 to 2005. One hundred and thirty two (53.01%) victims were between 20-40 years of age, males constituted 85.14% of the total victims, and light vehicles were involved in 61.05% RTAs. 54.22% RTAs occurred during the daytime, between 9 AM to 8 PM. A total 609 type of injuries (organs involved) were reported in 249 victims. Limb injures constituted 189 (31.08%) of the total injuries, followed by injuries involving head, thorax, abdomen, pelvis and spine. Among head injuries, fractured skulls occurred in 68.85%, Subdural Haemorrhage in 79.31%, Subarachnoid Haemorrhage in 63.33%, Extradural Haemorrhage in 48.85%, Intra-cranial injuries in 21.26%, and Contusion in 35.63% of the victims. Head injury accounted for 173 (69.48%) of deaths, and haemorrhagic shock for 61 (24.49%) of deaths.
CONCLUSION: Various preventive measures like speed control, helmet use, no driving under alcohol influence etc., enforcing road safety regulations, and improving emergency medical services could be used to control the increasing toll of deaths due to RTA.
RTA, Autopsies, Injury profile.
Each year, road traffic injuries take the lives of 1.2 million people around the world and seriously injure millions more(1). The death rate is highest, and still growing in low and middle-income countries, where pedestrians, motorcyclists, cyclists and passengers are especially vulnerable(1). Moreover, estimated costs of road traffic injuries are between 1% and 2% of GNP per annum in these countries, and accounts for a loss of approximately US$ 65 billion every year; almost twice the total development assistance received worldwide by developing countries(1). India accounts for about 10 percent of road accident fatalities worldwide, 85% of all road accident deaths occur in developing countries, and nearly half in the Asia-Pacific region.(1) According to the World Health Report 2002, 30.3% morbidity and 28.7% mortality occurred in the South-East Asia Region due to injuries(2),(3). According to a report of the Ministry of Home Affairs, Government of India, one accident occurs every two minutes, and one suicide every five minutes in India, with the accident rate corresponding to 45 per 100 000 population.(3) However, there is underreporting of traffic injuries by the health sector in India(3). As there is no study available regarding injury profile in road accident deaths from our part of the country; the present study was conducted to study the demographic and injury profile in autopsy cases with alleged history of Road Traffic Accidents (RTAs).
The present retrospective study was conducted on 249 autopsy cases brought to the Forensic Department of a tertiary care institute during the period between years 2000 â€“ 2005, with an alleged history of RTA. For the purpose of the study, a RTA was defined as an accident which took place on the road between two or more objects, one of which must be any kind of a moving vehicle. Various study variables analyzed were sex, age, time of RTA, type of vehicle (light vehicle like two wheelers, three wheelers, car, jeep etc. and heavy vehicle like truck, bus, train, tractor) and position of the victim during RTA (occupant/ pedestrian/ driver), nature of injury, and cause of death. The data sources were statements of patient (dying declaration), history from relatives and friends, and police investigation reports. All the parameters were expressed in percentage and numbers. The international classification of diseases and related health problems (ICD-10) was used in coding morbidities and mortalities resulting from RTA.(4) In ICD-10, transport accidents (V01-V99) have been regrouped by the type of injured person (i.e. pedestrian, pedal cyclist, motorcycle rider, car or bus occupant) and mode of transport. All the parameters were presented in percentage.
(Table/Fig 1),(Table/Fig 2),(Table/Fig 3),(Table/Fig 4),
A total of 249 RTA victims were referred for autopsy during the years 2000 to 2005. One hundred and thirty two (53.01%) victims were between 20-40 years of age; but only 31 (12.45%) victims were below 20 years of age (Table/Fig 1). Males constituted 85.14% of the total victims, and light vehicles were involved in 61.05% RTAs (Table/Fig 1),(Table/Fig 4). Two wheelers were involved in 102 (42%) of RTA. One hundred and thirty five (54.22%) RTA occurred during the daytime, between 9 AM to 8 PM.
A total of 609 injuries (organs involved) were reported in 249 victims. Limb injures constituted 189 (31.08%) of the total injuries, followed by injuries involving head, thorax, abdomen, pelvis, and spine (Table/Fig 2). Among head injuries Subdural Haemorrhage was most common. (Table/Fig 3).
India has 1% of vehicles in the world; but it accounts for about 6% of the total cases of unintentional injuries(3). In the present study, males constituted 85.14% and females constituted only 14.86% of the total victims. Moreover, age between 20-40 years was found to be more vulnerable to RTA. Similarly, in a study from South India, there were 83% males and 17% female accident victims(2). Labourers were the highest (29.9%) among the victims(2). The occupants of various vehicles constituted the large (45%) group of the victims. Among the motorized vehicles, two wheeler drivers were more (31.1%) involved in accidents. Out of 254 drivers, 14.9% were found to have consumed alcohol. Being knocked down was the common mode of accidents(2). However, in our study, a majority of victims were pedestrians (55.32%). Previously a study from Delhi reported 69% injuries (out of total 680 traffic injuries) in the age group of 15 to 35, and males were four times more affected than females(3). The business group had a higher incidence, followed by the service group and the labour group(3). In a study from Maharahtra, maximum cases of RTA were among males (83.20%), and in the age group of 20 to 39 years (51.20%)(5). Banerjee K.K. from Delhi reported 81.80% victims of thoraco-abdominal injuries all of which were in males, and of all, 40% were in the age group of 21-30 years(6). A study from Nepal also reported 16-30 years as commonest age-group involved in RTA. Males sustained craniofacial injuries about 4 times more than females in this study(2).
A few studies reported pedestrians as the majority of victims involved in RTA, as reported in our study(5),(7). In our study, limb injures constituted 31.08% of the total injuries, followed by injuries involving head, thorax, abdomen, pelvis and spine. Among head injuries, fractured skulls occurred in 68.85%, Subdural Haemorrhage in 79.31%, Subarachnoid Haemorrhage in 63.33%, Extradural Haemorrhage in 48.85%, Intra-cranial injuries in 21.26%, and Contusion in 35.63% of the victims. In an earlier study from India, head was the commonest site to be injured in RTA, and Subdural Haemorrhage was the commonest haemorrhage. Laceration of brain tissue was highest among all brain tissue injuries, as reported in our study(5). In a study from Nepal, 39% of medico-legal cases that were brought to the emergency department, were of craniofacial trauma ( in 70% cases, cause is RTA)(2). Ganveer GB and Tiwari RR also reported in their study that out of total 423 subjects, 363 (85.8%) were males, while only 60 (14.2%) were female subjects, and a majority of the victims (75%) were in the age group 18- 37 years(8). Moreover, in the above study, two wheelers and LMV were the most common vehicles involved, and fracture of the bones was the common injury afflicted in accidents, as reported in our study.(8) In the present study, head injury was the major cause of death (69.48%), as reported earlier by Chaudhary B L, et al(5).
RTA is one of the major causes of disability and death all over the world. Every 4 minutes, a person killed or injured in India due to RTA(1). Behaviour of the road user, vehicle characteristics, and traffic environment, coupled with human errors, have been cited as the main causes. The All India road data shows that 83.5% of the accidents were due to the driverâ€™s fault. Other contributory factors were: mechanical defects in vehicles, pedestrian fault, fault of the passenger, bad roads, and bad weather(9). A study in Bangalore showed
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