PATTERN AND DISTRIBUTION OF INJURIES IN FATAL ROAD TRAFFIC ACCIDENT CASES Dr. K.K. Aggarwal, Additional Professor, Forensic Medicine Department, GMC, Patiala. Dr. S.S. Oberoi, Associate Professor, Forensic Medicine Department, GMC, Patiala. Dr. Rakesh Kumar, M.O. Resident, Forensic Medicine Department, GMC, Patiala. Dr. Manisha Sharma, Assistant Professor, Anatomy Department, Gian Sagar Medical College, Patiala. Abstract The present study was conducted in the Department of Forensic Medicine, Government Medical College & Rajindra Hospital, Patiala. Total 602 dead bodies were brought for postmortem examination in year 2008, out of which, 334cases were road traffic accident deaths which accounted for 55.48%. This study included 100 cases. Most common were abrasions (86%) followed by lacerations (75%). and contusion (58%). Incised wounds were found in only 2% of cases. Most common site involved was head and face (85%) followed by lower limb (65%), upper limb (54%), chest (48%) and abdomen (36%). Head injury was the dominant cause of death (57%) followed by abdominal (19%) and thoracic (7%). Keywords: Road accidents; pattern of ; distribution of 2009 JPAFMAT. All rights reserved Introduction An accident has been defined as "an unexpected unplanned occurrence which may involve injury" A WHO advisory group in 1956 defined accidents as "an unpremeditated event resulting in recognizable damage. According to another definition an accident is that "occurrence in sequence of events which usually produces unintended injury, death or property damage. During 1990s road traffic accident ranked ninth among the leading causes of deaths in world. It is projected to become second leading cause by the year 2020 next to ischemic heart disease. About 3.5 million people die of unintentional. Road traffic accidents claim 1.2 million lives. In developed countries accidents are shown to be as numerous as in underdeveloped countries. It is increasing rapidly as a cause of (Corresponding author) Dr. K.K. Aggarwal Phone: 9814195527 Email:sinika.aggarwal06@gmail.com death in absolute numbers and in terms of proportions. Accidents represent a major epidemic of non-communicable disease in the present century. They are no longer considered accidental rather they are a part of the price we pay for technological progress. Accidents have their own natural history and follow the same epidemiological pattern as any other disease i.e. the agent, the host and the environment interacting together to produce injury or damage. They occur more frequently in certain age groups, at certain times of day and week and at certain localities. Some peoples are more prone to accidents than others and susceptibility is increased by the effect of alcohol and other drugs as well as physiological state such as fatigue. Lastly a majority of accidents are preventable. [8] The present study was conducted on 100 autopsy cases to ascertain incidence of fatal road traffic accidents and to find pattern and distribution of. 71
Material & Methods The present study was conducted in the department of Forensic Medicine and Toxicology at Govt. Medical College & Rajindra Hospital Patiala. The material for present study was dead bodies as a result of road traffic accidents brought by police in the mortuary for post mortem examination. Study included 100 autopsies for pattern and distribution of, of fatal road traffic accident cases were recorded after the autopsy examination of victims. All the data thus collected was analyzed statistically. Results In present study 100 autopsies of road traffic accident victims were conducted in the department of Forensic Medicine Government Medical College & Rajindra hospital Patiala. All the observation noted and result, are as below: Table 1 Sites of in road traffic accidents S. No. Site of No. of cases %age 1. Head & Face 85 85 2. Chest 48 48 3. Abdomen 36 36 4. Upper limbs 54 54 5. Lower limbs 65 65 6. Spine injury 1 1 Total 280 Table 1shows distribution of cases according to the on the body parts involved. Multiple body parts were involved in each case. Injuries to head and face were observed in 85 cases comprising 85 percent of all. Next common were observed in lower limb in 65cases (65 percent) victims and in upper limbs in 54cases (54 percent). Injuries to chest were seen in 48cases (48 percent), to abdomen in 36cases (36 percent) and to spine and neck in 1 case (1percent). Total number of all seen in 100 victims was 289. Table 2 Distribution of cases according to type of S. Type of Injury No. of %age No. cases 1. Abrasions 86 86 2. Contusions 58 58 3. Lacerations 75 75 4. Incised wounds 2 2 Total 219 Table 2 shows type of. All types of except incised wounds were common. Abrasions were the commonest seen in 86cases (86 percent), followed by lacerations seen in 75cases (75 percent) and contusions seen in 58 cases (58 percent) of all cases. Incised wounds were seen in 2 cases only. Table 3 Distribution of cases according to fatal S. No. Fatal No. of cases %age 1. Head injury 57 57 2. Abdominal 19 19 3. Thoracic Injuries 7 7 4. Spinal Injuries 1 1 5. Head & abdominal 5 5 Injuries 6. Head & chest 2 2 7. Multiple 6 6 /fracture 8. Chest & abdominal 3 3 Total 100 100 Table 3 shows fatal. Out of 100 autopsy cases, head injury was dominant in all deceased 57 cases (57 percent) followed by abdominal 19 cases (19 percent), thoracic 7cases (7percent), multiple fractures 6 cases (6 percent), spine and neck one case (1percent). The combination of head and abdominal 5cases (5 percent), 72
chest and abdominal 3 cases (3 percent) while head and chest were the least accounting for death only in 2 cases (2 percent). This study shows that 57 percent deaths in road traffic accidents were due to head alone. Discussion There is a steep rise in the vehicular accidents in the present era due to urbanization and tremendous growth in road transport sector. Population explosion is a catalyzing factor for increased number of accidents. Accidents just do not happen but are caused. The causes in given situations may vary. Since accidents are multi-factorial hence call for an inter-sectoral approach to both prevention of accident and care of the injured. Since accidents are multi-factorial, epidemiological techniques are especially useful for their study and control. The commonest were observed on head and face in 85 percent, lower limbs 65 percent upper limbs 54 percent, chest 48 percent followed by 36 percent on abdomen and only one percent having spinal. Chandra et al [1] observed on head & face in 77.99 percent. Tripude et al [2] observed 67.5 percent were on head and face and 47.5percent were on chest, 26.25 percent were on abdomen. Singh H et al [3] observed on Head and face 77.6 percent, chest 44 percent, abdomen 31.8percenf, upper limbs 35.6percent, lower limbs 44.2percent, spine 12.9percent which are almost similar with present studies Menon A et al [4] showed 88.88percent skull fractures as cause of deaths occurring in fatal accidents. Arvind K et al [5] observed on head and face as 68.79percent, chest 26.9percen and abdomen 47.31percent. Multiple and multiple body parts were found involved in all the cases in the present study. The sustained were abrasions, contusions, lacerations, incised wounds, fractures and involving internal organ. All types of were common in road accidents victims. Abrasions, lacerations and contusions were more common. Abrasions were seen in 86percent cases followed by lacerations in 75 percent cases and contusions in 58percent cases. The were as a result of heavy blunt forces seen in hit and run cases, crush due to impact of the vehicle and rough surface of roads. Singh H et al [3] observed that fracture dislocation and lacerations were seen in 89.1 percent and 88.8percent cases respectively followed by abrasions 84.4percent. Dos Santos AM et al [6] showed that 69.3percent of victims suffered lacerations, 51.4 percent got fractures, and 20.7percent suffered from head trauma. Abrasions constituted largest percentage (86 percent) of all amongst motor bikes as victim was dragged on the road in the roadside accidents. There were total of 289 in 100 cases ( per case being 2.9). Head were the dominant cause of death among all road users cases (57percent), followed by abdominal 19 percent cases, thoracic 7percent cases and multiple fractures were seen in 6percent cases. Least accounting for death 1 percent of cases was seen in spinal. The present study is in concurrence with Chandra et al [1] who observed 49.46percent of cases died of head, 22.52percent of abdominal, and 28 percent of multiple. Singh H et al [3] observed 50.4percent of cases died due to head injury followed by 19.3percent of multiple, 5.3 percent of abdominal and 4.2percent of chest Chaudhary et al [7] observed 56.25percent of cases died of head. Arvind K et al [5] observed that 31.51 percent of cases died of head and 37.21 percent had head injury along with chest injury or abdominal. Conclusion The present study was conducted in the Department of Forensic Medicine Government Medical College and Rajindera Hospital Patiala. This study included 100 cases of the fatal road traffic accidents brought for post-mortem examination, details of which had been 73
recorded. The whole data was analyzed with reference pattern and distribution f in fatal road traffic accidents. Road vehicles have no respect for anatomical boundaries or surgical specialties. Two, three or more body regions were injured in road traffic accidents. Multiple were observed in all the cases. On average per case were 2.9. All types of were common in road accidents victims. Abrasions, lacerations and contusions were more common. Abrasions were seen in 86percent cases followed by lacerations in 75percent cases and contusions in 58percent cases. Head and face was involved n 85 percent cases followed by lower limbs 65percent, upper Iambs 54percent, chest 48percent and abdomen36percent. The commonest single fatal injury in all types of road users was head injury accounting for 57percent of deaths followed by abdominal 19percent. Recommendations Keeping in view the results of study, the mortality in road traffic accident victims can be reduced with following recommendations: The roads should be properly planned and maintained with widening of narrow section of roads. Building of flyovers or underpasses at required sites and four-laning of highways should be done. As far as pedestrians and slow moving vehicles are concerned, complete segregation from the highway should be carried out. The vehicles should be well designed with newer technology and vehicles should be inspected regularly for mechanical faults and properly maintained. The driver of the vehicle should be educated, properly trained by an authorized centre. The driving licenses should be issued only after strict testing of his/her driving skills, medical fitness including strict vision checking and knowledge of traffic rules. The government should bring in the suitable legislations and strictly enforce them for the prevention of accident Advanced Trauma Care Centre with well equipped infrastructure supported by a team of trauma surgeons especially neurosurgeons & vascular surgeon at major Government Hospitals is the cornerstone for the management of road traffic accident cases. There is no panacea that will prevent all road traffic accidents, what is required is an organized team work by people in many disciplines such as education, engineers, medical practitioners, psychologists and enforcement officers for effective prevention of road accidents.. As it very rightly said that, "people are more important than the machines they make and use". Conflict of Interest None declared. References 1. Chandra J, Dogra TD and Dikshit PC. Pattern of cranio intracranial in fatal vehicular accidents in Delhi 1966-76. med Sci Law 1979; 19(3): 186-94. 2. Tirpude BH, Naik RS, Anjankar AJ and Khajuria BK. A study of pattern of craniocerebral in road traffic accidents. JIAFM 1998; 20(1):9-12. 3. Singh H and Dhatterwal SK. Pattern and distribution of in fatal road traffic accidents in Rohtak (Haryana). JIAFM 2004; 26(1): 20-23. 4. Menon A, Pai VK and Rajeev A. Pattern of fatal head due to vehicular accidents in Mangalore. J Forensic Leg Med. 2008 Feb; 15(2): 75-7. 74
5. Arvind K, Sanjeev L, Deepak A, Ravi R and Dogra TD. Fatal road traffic accidents and their relationship with head : An epidemiological survey of five years. Indian journal of neurotrauma 2008; 5(2): 63-67. 6. Dos Santos AM, Moura ME, Nunes BM, Leal CF and Teles JB. Profile of motorcycle accident victims treated at a public hospital emergency department. Cad Saude Publica. 2008 Aug; 24(8): 1927-38. 7. Choudhary BL, Singh D, Tirpude BH, Sharma RK and, Meel V. Profile of road traffic. accidents cases in Kesturba Hospital of MGIMS, Sevagram, Wardha, Maharashtra. Ind medica medico legal update 2005; 5(4): 1-12. 8. Park text book of Social & preventive medicine. 19th ed. 2007. p 340-345. 75