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PATTERN OF CHEST INJURIES IN FATAL ROAD TRAFFIC ACCIDENTS--AN AUTOPSY STUDY.

BACKGROUND

Road traffic accidents are a human tragedy. They involve high human sufferings and socio-economic loss in terms of premature deaths, injuries and loss of productivity. [1] Nearly, 1.3 million people die every year in the world due to road traffic accidents and 20-50 million people suffer non-fatal injuries leading to disability. [2] Road traffic accidents are the leading cause of death in young people aged 15-29 years and costs countries 1-3% of the country's GDP. [3] According to WHO, road traffic accidents are the sixth leading cause of death in India with a greater share of economic losses in the young and middle-aged population. [4] Seat belt injuries: in severe collisions if the person is wearing seat belt, injuries on the chest and abdomen may be caused. Compression on the chest wall will lead to contusions and injuries to mediastinal structures. These injuries are collectively known as 'seat belt' syndrome. [5] Falling from motor cycles in high speed produce injuries to extremities as well as chest and abdomen. [6] Mobile phones have become one of the serious threats leading to road traffic accidents. Studies have shown that 'Reaction Time' of drivers has increased when they are using mobile phones while driving from 0.5 sec to 1.5 secs. [7] The Relative Risks (RR) for injury collisions and also for all collisions is 38% higher for men and women cell phone users. These risks diminish to 1.1 for men and 1.2 for women, if other variables such as the kilometres driven and driving habits are incorporated into the models. [8] A study on traffic injury prevention by Johnson MB and others found that mobile phone usage was decreased towards weekends, when exceeding their speed limits and when other passengers are travelling along with them. [9] Hands free mobile phones or hands free speaker phones possess a significantly lower risk rate than who have hand-held phones. [10]

Objectives

1. To study the pattern of chest injuries in fatal road traffic accidents.

2. To analyse the survival period and cause of death in fatal road traffic accidents.

MATERIALS AND METHODS

An autopsy-based descriptive analysis was conducted.

Sample Size

A total of 161 cases of fatal road traffic accidents with chest injuries was studied during the period of 12 months from 04.02.2016 to 03.02.2017.

Source Population

All cases of fatal road traffic accidents with chest injuries brought for post mortem examination to the Department of Forensic Medicine, Govt. Medical College, Kottayam during the study period was included in the study.

Inclusion Criteria

All autopsies in which death was due to chest injuries in road traffic accidents were included in the study.

Exclusion Criteria

All unidentified bodies and cases in which proper history was not available.

Data collection: Baseline data like age, sex, height, weight and a brief history of the case were collected from the relatives and investigating officers. A detailed information regarding the nature, time of accident, type of vehicle involved, and category of victim were recorded from the investigating officer and hospital records in case of treated cases. Details of external injuries and chest injuries are recorded in the proforma.

Analysis

Data collected was entered in MS-Excel and analysed using IBM SPSS version 16.

RESULTS

The study was conducted in the Department of Forensic Medicine, Govt. Medical College, Kottayam during the period from 04.02.2016 to 03.02.2017. A total number of 161 fatal cases in Road Traffic Accidents with chest injuries were analysed on the basis of history and post-mortem findings.

Epidemiology of Fatal Road Traffic Accidents: Gender Wise Distribution

Out of the 161 cases in the present study, majority of the victims were males, 136 cases (84.5%) and 25 cases (15.5%) were females.

Age Distribution

Maximum number of victims (57 cases) belonged to age group of 45-60 years followed by age group of 60-70 years (35 cases). The following table depicts age group distribution and the corresponding gender distribution.

Time of Occurrence

In the present study, it was observed that maximum number of accidents were seen between 12 PM and 6 PM (41.6%) followed by 6 PM and 12 AM (28%) and least occurrence was between 12 AM and 6 AM (4.3%).

Month of Occurrence

Of the total number of cases, maximum cases occurred during the month of August and least occurred during the month of October.

Type of Vehicles Involved

Out of the 161 cases studied 86 cases were two wheelers, 51 cases were light motor vehicles and the remainder were heavy motor vehicles.

Type of Victims Involved

Most of the victims involved were pedestrians (62 cases) followed by riders of motor cycles (57 cases). Others were drivers 18, pillion rider (15), side seaters (3) and back seaters (6).

Distribution of Safety Precautions Adopted by the Victims

Of the 161 cases, 83 persons did not have any safety precautions. 17 cases wore helmets and only 3 cases wore seat belts.

Alcohol Consumption

Out of 161 cases, 69 have consumed alcohol. Among these, 22 cases were either drivers or riders and 47 were pedestrians or occupants of vehicles.

Period of Survival

Of the 161 cases 17 (10.2%) have died on the spot, 62 cases (38.5%) survived for less than 6 hours, while 67 cases (41.6%) survived more than 24 hours and were hospitalised.

Pattern of Chest Injuries

Fracture of sternum was present in 55 (34.2%) cases, while 106 (65.8%) cases of victims did not have fracture of sternum. Fracture of sternum seen in direct impact is the major cause for haemothorax and injuries to pericardium and heart.

Distribution of Fracture Sternum in different Categories of Victims

Of the 62 pedestrians who succumbed to death, 25 persons (21.8%) had fracture of sternum. Side seat occupants had only 1.8% of sternum fracture. The most common site of fracture sternum was between 1st and 2nd costal cartilages followed by 2nd and 3rd costal cartilages.

Fracture of Ribs

A rib fracture secondary to blunt thoracic trauma is an important indicator of the trauma. Of the 161 cases studied 88 (54.6%) cases had bilateral rib fractures and 73 (45.4%) cases showed unilateral rib fracture. Out of 161 cases, 149 had haemothorax and 12 cases had no haemothorax.

Fracture of Sternum

Fracture of sternum in direct impact is one of the causes of haemothorax and injuries to heart and pericardium. In the present study, sternum was fractured in 55 cases (34.2%).

Fracture of Thoracic Vertebra

Older individuals were found to be almost 5 times more likely to sustain spinal injury compared to younger individuals. Among the 161 cases, 33 cases had fracture of spinal column and 19 cases had fracture of thoracic vertebrae.

Fracture of Clavicle

Among the 161 cases, 78 (48.4%) cases had fracture of clavicle and in 6 cases there was bilateral clavicle fracture.

Fracture of Scapula

It is relatively uncommon. In the present study there were 5 cases (3.1%) of scapular fracture, of which 3 were bilateral.

Lung Injury

Contusion of lung was the most common injury found in blunt trauma to chest. It is usually caused by deceleration that results when the moving chest strikes a fixed object like the steering wheel. Right lung was contused in 62 cases (38.5%). Left lung was contused in 38 cases (23.6%).

Cardiac Contusions

Among the 161 cases, 34 (21.1%) cases showed evidence of cardiac contusion. The favoured sites of cardiac contusions were right ventricle 18 cases (52.9%) and right atrium 16 (47.1%) cases.

Injuries to Aorta

Among the 161 cases in the present study, aorta was injured in 26 (16.1%) cases, of which 16 (9.9%) cases showed involvement of ascending aorta, in 4 (2.5%) cases descending aorta was involved and in 6 (3.7%) cases the arch of aorta was involved.

DISCUSSION

Pedestrians, cyclists and motor cyclists are the most vulnerable road users accounting for around 46% of global traffic deaths. [11] The number of total accidents reported in India during the year 2010 was 499,628. [12] The total number of accidents reported in Kerala state during the period 2011 was 35,216. [13] Among these, death occurred in 4145 cases. Road traffic accident deaths are higher in men than in women in all regions regardless of income level and across all age groups. [14] In India this is partly due to low representation of women in Indian workforce and exposure on roads. [15]

Among the 161 cases of fatal road traffic accident victims with chest injuries, 136 (84.5%) were males and 25 (15.5%) were females. Maximum number of victims, 57 (35.4%) were in the age group of 45-60 years. Maximum number of accidents, 34 (21.1%) occurred in the month of August and least occurred in the month of October (3.1%). Maximum number of accidents (41.6%) occurred during the time 12 PM to 6 PM and least occurrence (4.3%) was between 12 AM to 6 AM. Two wheelers were the commonest vehicle involved (53.4%) followed by car (31.7%). In case of collisions, cars colliding with two wheelers was the commonest (14.3%) followed by two wheelers colliding with heavy vehicles (13%). Majority of victims involved were pedestrians (38.5%) followed by motor cyclists (35.4%). Among the motor cyclists, those wearing helmets were 17 (10.6%) and those occupants with seat belts were only 2 (1.2%). Among the drivers 22 (13.7%) were under the influence of alcohol and among the other victims 29.2% have consumed alcohol. Among the fatal cases 10.6% died on the spot, 38.5% died within 6 hours and 41.6% died within 24 hours. Sternum was fractured in 34.2%, bilateral rib fractures seen in 54.6% and unilateral fracture in 45.4%. Regarding fracture of thoracic vertebrae, the 4th thoracic vertebra was fractured in 11 (6.8%) followed by fracture of 1st and 12th thoracic vertebrae in 4 (2.5%) cases each. Both clavicles were fractured in 6 (3.7%). Right lung showed contusion in 58.4%, while left lung was involved in 65.9%. Laceration of right lung was seen in 40.4%, while left lung was involved in 37.9%. Laceration of aorta was seen in 26 (16.1%) cases. Contusion of heart was seen in 34 (21.1%) cases. Laceration of heart was seen in 6 (3.7%) cases. Associated injury to head was seen in 121 (75.2%) cases. Of which 25.5% had intracranial haemorrhages and 49.7% had fracture of skull. Fracture of cervical spine was seen in 19 (11.8%) cases, while 44.7% showed fracture of any of the limbs. Laceration of liver was seen in 54 (33.5%) and spleen was lacerated in 11 (6.8%) of cases.

CONCLUSION

The mechanism and circumstances of blunt chest injury due to road traffic accidents can be assessed in relation to the number and localisation of rib fractures as well as the presence of injuries to lung, heart and major blood vessels. The most common cause of death 82 (50.9%) was 'combined injuries to head and chest' followed by 'injuries to head, chest and abdomen' 38 (23.6%) and only 6.8% of cases died due to chest injuries alone.

REFERENCES

[1] Transport research wing, Ministry of Road Transport and Highways. Road accidents in India 2011. New Delhi: Ministry of Road transport and Highways, Govt. of India, 2012.

[2] United Nations decade of action for Road Safety, 201120. http://www.decadeofaction.org

[3] WHO. Road Traffic Injuries Fact Sheet N0 358, March 2013. http://who.int/mediacenter/factsheets/fs358/en.

[4] Ministry of Health and Family Welfare. Integrated Disease Surveillance Project-Project Implementation Plan 2004-2009. New Delhi: Govt. of India, 2004:1-18.

[5] Ignatius PC. Forensic Medicine and Toxicology. 1st edn. 2015;9:20.

[6] Krisnan V. Textbook of forensic medicine and toxicology. 6th edn. 2014;19:287.

[7] Sisiopiku VP. Implications of cellular telephony to Traffic safety. 14lh ICTCT Workshop, 12, 12, 2010.

[8] Laberge-Nadeau C, Magg U, Bellavance F, et al. Wireless telephones and the risk of road crashes. Accident Analysis and Prevention 2003;35(5):649-60.

[9] Johnson MB, Voas RB, Lacey JH, et al. Living dangerously: driver distraction at high speed. Traffic Injury Prevention 2004;5(1):1-7.

[10] Matthews R, Legg S, Charlton S. The effect of cell phone types on driver's subjective workload during concurrent driving and conversing. Accident Analysis and Prevention 2003;35(4):451-7.

[11] The global burden of disease: 2004 update. Geneva, World Health Organization 2008. http://www.who.int/LinkFiles/reports_GBD_report_2 004 update_fullpdf, 2012

[12] Road accidents in India Annual report. Transport Research Wing of the Ministry of Road Transport and Highways Publishers, 2010.

[13] Road Accident report for the year 2011, State Crime Records Bureau Thiruvananthapuram. http://www.keralapolice.org/newsite/pdfs/gazette/g az_2012/Jan_12/annual_road_%20accident_reports_ja n12.pdf, 2012.

[14] Peden M, Scurfield R, Sleet D, et al. The world report on Road Traffic Injury prevention. Geneva, World Health Organization, 2004.

[15] Mohan D. Road accidents in India. Transportation Research and Injury Prevention Programme, Indian Institute of Technology Delhi, New Delhi India. International Association of Traffic and Safety Sciences Research J 2009:33(1):75-9.

Ravi Kumar K (1), Rajeev V. M (2)

(1) Junior Resident, Department of Forensic Medicine, Government Medical College, Kottayam, Kerala, India.

(2) Associate Professor, Department of Forensic Medicine, Government Medical College, Kottayam, Kerala, India.

* Financial or Other Competing Interest': None.

Submission 11-09-2018, Peer Review 10-10-2018, Acceptance 17-10-2018, Published 29-10-2018.

Corresponding Author:

Dr. Rajeev V. M, Associate Professor, Department of Forensic Medicine, Kottayam-686008, Kerala.

E-mail: drrajeevvm3056@gmail.com

DOI: 10.14260/jemds/2018/1062

Caption: Figure 7. Distribution of Study Sample showing Fracture of Sternum among Different Categories of Victims
Table 1. Distribution of Victims based on their Age Group
and Gender

Age                         Gender                  Percentage
Group in          Male       Female (N=25)  Total
                  (N=136)                            (N=161)
Years
15-30        25      18.4%    01     04%     26        16.1
30-45        23      16.9%    01     04%     24        14.3
45-60        47      34.6%    10     40%     57        35.4
60-75        27      19.8%    08     32%     35        21.7
75-90        14      10.3%    05     20%     19        11.8
Total        136              25             161

Table 2. Distribution of Cases based on Time of Occurrence

Time          Distribution of Cases (%)

12 AM--6 AM             04.3
6 AM--12 PM             26.1
12 PM--6 PM             41.6
6 PM--12 AM             28.0

Table 3. Distribution of Vehicles Involved

Types of Vehicles   No. of Cases   Percentage

Two Wheelers             86           53.4
LMV                      51           31.7
HMV                      24           14.9
Total                   161          100.0

Table 4. Types of Victims Involved

Type of Victims   No. of Cases   Percentage

Pedestrian             62           38.5
Driver                 18           11.2
Motor cyclists         57           35.4
Pillion rider          15           9.3
Side seaters           3            1.9
Back seaters           6            3.7
Total                 161          100.0

Table 5. Table showing Period of Survival

Period of Survival   No. of Cases   Percentage

Died on the spot          17           10.2
Less than 6 hours         62           38.5
More than 24 hours        67           41.6

Table 6. Distribution of Study Sample showing Fracture of
Sternum among Different Categories of Victims

Type of         Fracture of   No. Fracture of    Total
Victim            Sternum         Sternum

Pedestrian          25              37            62
Driver              10               8            18
Motorcyclist        12              45            57
Pillion rider        5              10            15
Side seat            1               2             3
Back seat            2               4             6
Total               55              106           161

Table 7. Distribution of Fracture Sternum in
different types of Victims

Type of Victim   # Sternum Present   # Sternum Absent

Pedestrian              25                  37
Driver                  10                  8
Motor Cyclist           12                  45
Pillion Rider            5                  10
Side Seat                1                  2
Back Seat                2                  4
Total                   55                 106

Table 8. Laceration of Aorta Region Wise

Region of Aorta    No. of Cases   Percentage

Ascending aorta         16           61.5
Descending aorta        4            15.4
Arch of aorta           6            23.1
Total                   26           100

Table 9. Distribution of Chest Injuries in Fatal
Road Traffic Accidents

Site of Chest Injury          No. of Cases   Percentage

Fracture Ribs (Bilateral)          88           54.6
Fracture Ribs (Unilateral)         73           45.4
Fracture Sternum                   55           34.2
Fracture Thoracic Vertebrae        33           20.5
Fracture of Clavicle               78           48.4
Fracture of Scapula                5            3.1
Lung Contusion                    100           62.1
Heart Contusion                    34           21.1
Laceration of Aorta                26           16.1

Figure 1. Distribution of Victims based on their Age Group
and Gender

Age
Group   Males   Females

15-30    25        1

30-45    23        1

45-60    47       10

60-75    27        8

75-90    14        5

Note: Table made from bar graph.

Figure 2. Distribution of Cases based on the Time of
Occurrence

Distribution of cases (%)

12AM-6AM    4.3

6AM-12PM   26.1

12PM-6PM   41.6

6PM-12AM   28

Note: Table made from bar graph.

Figure 3. Distribution of Cases based on Month of
Occurrence (%)

Distribution of cases
based on month of
occurrence(%)

January     5.6
February    10.6
March       4.3
April       8.7
May         8.7
June        4.3
July        8.7
August      21.1
September   6.2
October     3.1
November    8.7
December    9.9

Note: Table made from bar graph.

Figure 4. Distribution of Type of Vehicles Involved

No. of Cases

Two wheeler   86
LMV           51
HMV           24

Note: Table made from bar graph.

Figure 5. Types of Victims Involved

No. of cases

Pedestrian       62
Driver           18
Motor cyclists   57
Pillion rider    15
Side seater       3
Back seater       6

Note: Table made from bar graph.

Figure 6. Period of Survival of Victims

No of cases

Died on the    17
spot

Less than 6    62
hours

More than 24   67
hours

Note: Table made from bar graph.

Figure 8. Distribution of Fracture Sternum in different
types of Victims

                 # sternum present   # sternum absent

Pedestrian               25                 37
Driver                   10                  8
Motor cyclists           12                 45
Pillion rider             5                 10
Side seater               1                  2
Back seater               2                  4

Note: Table made from bar graph.

Figure 9. Laceration of Aorta Region Wise

                  No of cases

Ascending aorta       16
Descending             4
  aorta
Arch of aorta          6

Note: Table made from bar graph.

Figure 10. Distribution of Chest Injuries in Road Traffic
Accidents

                              No of cases

Fracture ribs (Bilateral)         88
Fracture ribs (Universal)         73
Fracture Sternum                  55
Fracture Thoracic vertebrae       33
Fracture of clavicle              78
Fracture of scapula                5
Lung Contusion                    100
Heart Contusion                   34
Laceration of Aorta               26

Note: Table made from bar graph.
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Article Details
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Title Annotation:Original Research Article
Author:K., Ravi Kumar; M., Rajeev V.
Publication:Journal of Evolution of Medical and Dental Sciences
Article Type:Report
Geographic Code:9INDI
Date:Oct 29, 2018
Words:3069
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